A nurse is assisting with the care of a client on a medical surgical unit who was admitted from the emergency department.

Exhibits

For each assessment finding on Day 2 click to specify if the finding is due to lisinopril, carvedilol, or furosemide. Each finding may be related to more than 1 medication.

A. "Request that the nurses show their nursing license prior to removing your newborn from the room." While it's important to ensure that only authorized personnel handle the newborn, asking for nursing licenses is not practical and may not be feasible in a busy clinical environment. Instead, parents should be encouraged to verify the identity of staff based on hospital protocols.
B. "Leave your newborn in the bassinet in your room while you use the bathroom." Leaving the newborn unattended, even in the bassinet, is not advisable. Parents should take their newborn with them if possible or ask for help from staff to ensure the baby's safety while they are away.
C. "Alert the staff if any of your newborn's identification bands are missing." Alerting staff about missing identification bands is crucial for the safety of the newborn. Identification bands help prevent abductions and ensure that the correct infant is returned to the right mother. Parents should be vigilant and report any issues immediately.
D. "Carry your newborn back to the nursery in your arms when you need to rest." Carrying the newborn back to the nursery is not recommended for safety reasons. If the parent needs to rest, they should ask the staff to take the baby to the nursery instead, allowing for proper handling and minimizing the risk of falls or accidents.

A. Offer the client several choices at mealtimes. Clients with delirium often experience confusion and difficulty processing information. Providing too many choices can increase anxiety and agitation. Instead, offering simple and limited options helps reduce cognitive overload.
B. Alternate daily caregivers. Consistency in caregivers is important for clients with delirium to minimize confusion and distress. Frequent changes in caregivers can contribute to disorientation and make it more difficult for the client to feel secure.
C. Remind the client of the day and time often. Delirium is characterized by fluctuating levels of consciousness and confusion. Frequent orientation to time, place, and situation helps reduce anxiety and supports cognitive function. Using clocks, calendars, and familiar objects in the environment can reinforce orientation.
D. Avoid discussing the client's fears. Clients with delirium may have distressing thoughts or fears that should be acknowledged and addressed. Providing reassurance and a calm, supportive environment can help alleviate anxiety and improve the client's well-being.