Which instruction should the nurse include in the discharge teaching for a client who has gastroesophageal reflux?

Choice A reason: Increased oral fluid intake is a general recommendation for clients with an infection to prevent dehydration and help thin respiratory secretions. While staying hydrated is important, it is not a specific change in blood glucose management for a client with diabetes and an upper respiratory infection.

Choice B reason: Restriction of caloric intake is not appropriate advice for a client with diabetes and an infection. During illness, the body’s metabolic needs increase, and caloric intake should be adjusted to meet these needs. Restricting calories can lead to inadequate nutrition and further complications.

Choice C reason: Higher doses of insulin are often needed for clients with diabetes who are experiencing an infection. Infections can cause increased stress on the body, leading to elevated blood glucose levels. The body’s inflammatory response and the release of stress hormones can result in insulin resistance and higher blood sugar levels. Therefore, it is common for healthcare providers to adjust insulin doses upward to manage these changes and maintain glycemic control during periods of illness.

Choice D reason: Fewer fingerstick glucose checks are not recommended. In fact, during illness, it is crucial for clients with diabetes to monitor their blood glucose levels more frequently. Close monitoring helps to detect hyperglycemia or hypoglycemia and allows for timely adjustments in insulin or other diabetes medications. Frequent glucose checks are essential for managing blood sugar levels effectively during illness.

Choice A reason: Preparing the prescribed dose of rapid-acting insulin from the sliding scale instructions is not appropriate when the client's blood glucose level is low (56 mg/dL). Administering insulin at this point could further lower the blood glucose level, potentially leading to severe hypoglycemia. The priority is to raise the client's blood glucose level to a safe range.

Choice B reason: Giving the client six ounces of non-diet carbonated soda and instructing the client to drink it entirely is the correct first intervention. The client’s blood glucose level is significantly below the normal reference range (hypoglycemia). Administering a fast-acting carbohydrate, such as non-diet soda, helps to quickly increase the blood glucose level to a safer range. This intervention addresses the immediate need to correct the hypoglycemia and prevent potential complications such as confusion, seizures, or loss of consciousness.

Choice C reason: Collecting a blood specimen by venipuncture to send to the laboratory for serum glucose analysis is not the first intervention to implement. While laboratory confirmation of blood glucose levels can be important, the immediate priority is to treat the hypoglycemia. Delaying treatment to collect a laboratory specimen could result in worsening of the client's condition. Immediate administration of a fast-acting carbohydrate should be prioritized.

Choice D reason: Documenting the glucose reading in the electronic medical record (EMR) is important but not the first priority. While accurate documentation is necessary for ongoing care, the immediate intervention should focus on treating the hypoglycemia. Once the client's blood glucose level has been stabilized, the nurse can then document the reading and subsequent interventions in the EMR.