Author Question: The client has rheumatoid arthritis, is prone to skin breakdown, and is also somewhat immobile ... (Read 39 times)

michelleunicorn · **on:** Jul 22, 2018

The client has rheumatoid arthritis, is prone to skin breakdown, and is also somewhat immobile because of arthritic discomfort. Which of the following interventions is the best one for this cli-ent's skin integrity?

a. Having the client sit up in a chair for four-hour intervals
b. Keeping the head of the bed in a high-Fowler's position to increase circulation
c. Keeping a written schedule of turning and positioning
d. Encouraging the client to perform pelvic muscle training exercises several times a day

Question 2

A nurse is ambivalent about performing vigorous suctioning in a terminally ill client in a comatose state. Which of the following is the appropriate statement by the nurse in regard to processing this ethical dilemma?

a. I need to know the legalities of the living will of this client.
b. My spiritual beliefs mandate that I continue to provide all the interventions within my scope of practice.
c. I cannot figure out what's right in this situation. I need to collect more data.
d. I just feel that I should not suction this client.

bblaney · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

C
The frequency of repositioning should be individualized for the client; however, clients should be repositioned at least every two hours. The Registered Nurses Associated of Ontario (RNAO) recommends that a written turning and positioning schedule be used.
Clients able to sit in a chair should be limited to sitting for two hours or less.
Elevating the head of the bed to 30 degrees or less will decrease the chance of pressure ulcer de-velopment from shearing forces.
Pelvic muscle training may help prevent incontinence, but it is not the best intervention for maintaining the client's skin integrity.

Answer to Question 2

C
The first step in processing an ethical dilemma is determining whether the problem is an ethical one. The nurse who cannot figure out what is right is stating a characteristic of an ethical dilem-ma, which is that the problem is perplexing. The next step is to gather as much relevant infor-mation as possible.
The nurse who wants to know the legalities of the living will of a client is collecting some, but not all, data pertaining to the problem.
The statement My spiritual beliefs mandate that I continue to provide all the interventions within my scope of practice. describes the nurse's own beliefs.
The nurse is describing the problem in terms of her feelings.