A nurse is assisting with an admission interview for a client who has schizophrenia. He tells the nurse that he is receiving special audible messages from the Central Intelligence Agency that no one else is able to hear. The nurse should identify that the client is having which of the following alterations in perception?

b. Perform passive range-of-motion exercises.

During a vaso-occlusive crisis in sickle-cell disease, blood flow to certain areas of the body may be restricted, leading to pain and tissue damage. Passive range-of-motion exercises can help promote blood circulation and prevent joint stiffness and further complications. These exercises involve gently moving the child's joints through their full range of motion without active participation from the child.

Explanation for the other options:

a. Limit fluid intake during the evening: Fluid intake is important in sickle-cell disease to prevent dehydration and maintain adequate blood flow. Restricting fluid intake during a vaso-occlusive crisis can further contribute to dehydration and may worsen the crisis. It is important to encourage fluid intake unless otherwise instructed by the healthcare provider.

c. Apply cold compresses to painful areas: Cold compresses are not recommended during a vaso-occlusive crisis in sickle-cell disease. Cold temperatures can cause vasoconstriction and further worsen the blood flow to affected areas, leading to increased pain and tissue damage. Warm compresses or warm packs may be used to promote vasodilation and provide pain relief.

d. Provide a low-protein diet: A low-protein diet is not specifically indicated in the plan of care for a vaso- occlusive crisis in sickle-cell disease. Adequate protein intake is important for overall nutritional needs and tissue repair. The focus of nutritional management in sickle-cell disease is usually on a well-balanced diet that includes adequate hydration and appropriate nutrient intake.

In summary, performing passive range-of-motion exercises is an appropriate intervention to include in the

plan of care for a school-age child experiencing a vaso-occlusive crisis in sickle-cell disease.

c. Initiate a client referral to Reach to Recovery.

Explanation:

When caring for a female client who has a new diagnosis of breast cancer and expresses concerns about potential changes to her body image, the nurse should initiate a client referral to Reach to Recovery. Reach to Recovery is a program provided by the American Cancer Society that connects breast cancer patients with trained volunteers who have gone through a similar experience. These volunteers can provide emotional support, information, and resources to help the client cope with the physical and emotional changes that may occur due to breast cancer and its treatment.

Explanation for the other options:

a .Reassure the client that she will adjust to changes to her body:

While providing reassurance is important, it may not be sufficient to address the client's concerns about potential changes to her body image. Initiating a referral to Reach to Recovery can provide the client with additional support and resources tailored to her specific needs.

b. Contact an occupational therapist to talk with the client:

While an occupational therapist may have valuable input on certain aspects of the client's care, such as functional abilities and adaptations, initiating a referral to Reach to Recovery would be more appropriate for addressing the client's concerns related to body image.

d. Explain that surgery can restore the breast to its original appearance:

While surgery options such as breast reconstruction can restore the breast to a similar appearance, it is not appropriate for the nurse to make guarantees about the outcome or appearance of the breast after surgery. Every individual's situation is unique, and the decision to undergo surgery and the results of such procedures are dependent on various factors. Referring the client to Reach to Recovery would be more beneficial in addressing her concerns holistically.

In summary, when a client with a new diagnosis of breast cancer expresses concerns about potential changes to her body image, the nurse should initiate a client referral to Reach to Recovery. This program can provide the client with the necessary emotional support and resources to navigate the physical and emotional changes associated with breast cancer and its treatment.