A client experiencing withdrawal from the benzodiazepine alprazolam is demonstrating severe agitation and tremors. Which is the best initial nursing action?

A. Involve your mother in the decision-making process.

Involving the client in decision-making can help maintain her autonomy, reduce feelings of

helplessness, and potentially decrease the daughter's caregiver burden by sharing responsibility.

B. Moving your mother into a care facility will show her that you do not love her.

This statement is incorrect and could exacerbate feelings of guilt and stress in the caregiver. Decisions about care facilities should be based on the best interests of both the client and the caregiver, not on guilt or misconceptions about love.
C. It is okay not to love or like your mother when you are caring for her.

This statement might be misunderstood and could increase feelings of guilt and stress. It's more helpful to acknowledge that caregiving can be challenging and that it's normal to have mixed emotions.
D. You made a promise to your mother that you need to keep.

This statement could increase stress by suggesting that the caregiver has no options or flexibility, potentially exacerbating feelings of obligation and guilt.
E. Take time for yourself and the other relationships that you care about.

Taking time for self-care and maintaining other relationships is crucial for reducing caregiver stress and preventing burnout.
F. Saying "no" to things involving the care of your mother is a selfish action.

This statement is incorrect and could increase feelings of guilt and stress. It's important for caregivers to set boundaries and understand that it's okay to say "no" sometimes to maintain their well-being.
G. Helping your mother should be easier than raising a child.

This statement is misleading. Caregiving for an elderly parent can be as demanding, if not more so, than raising a child. It's important to recognize and validate the challenges of caregiving to provide appropriate support.
H. Avoid discussion of negative situations that may occur in the future.

This statement is not advisable. Open and honest communication about potential challenges is important for planning and reducing stress through preparedness.

Actions to Take:

A. Educate on disease process and management: Rheumatoid arthritis (RA) is a chronic

autoimmune disorder characterized by inflammation of the synovial membrane, leading to joint pain, swelling, and stiffness. Educating the client about RA helps them understand the disease, its

progression, treatment options, and the importance of adherence to prescribed medications and lifestyle modifications. This empowers the client to actively participate in managing their condition and improve outcomes.

B. Turn every two hours to offload bony prominences to prevent pressure injuries: Rheumatoid arthritis predisposes individuals to joint deformities and immobility due to joint inflammation and pain. Immobility increases the risk of pressure injuries, especially over bony prominences. Turning the client every two hours helps redistribute pressure, reduces the risk of pressure ulcers, and maintains skin integrity.

Potential Condition:

D. Rheumatoid arthritis: The client's clinical presentation, including bilateral joint pain and stiffness, positive rheumatoid factor, positive antinuclear antibody test, elevated erythrocyte sedimentation rate (ESR), and soft tissue swelling with marginal erosions on hand X-rays, is consistent with rheumatoid arthritis (RA). RA is a chronic autoimmune disease characterized by inflammation of the synovial joints, leading to joint damage, pain, and functional impairment.

Parameters to Monitor:

C. Pain: Monitoring pain is essential in rheumatoid arthritis management to assess the effectiveness of pain management interventions and adjust treatment accordingly. Pain assessment tools, such as numerical rating scales or visual analog scales, help quantify pain intensity and guide pain management strategies.

D. Skin breakdown: Rheumatoid arthritis can limit mobility and predispose individuals to prolonged immobility, increasing the risk of pressure injuries. Monitoring for signs of skin breakdown, such as erythema, blanchable or non-blanchable skin changes, and skin integrity over bony prominences, helps prevent pressure ulcers and facilitates early intervention if skin breakdown occurs. Regularly turning the client, maintaining proper positioning, and providing adequate support surfaces are essential to prevent pressure injuries.