A nurse is caring for a client who has dementia and is experiencing anticipatory grief. Which of the following actions should the nurse take?

Neurologic:

• Fatigue after being awake a few hours: Fatigue can be a symptom of various conditions, including anemia, depression, sleep disorders, and others. It’s important to investigate further to determine the cause.
• Feels “restless”: Restlessness can be a symptom of mental health disorders like anxiety or physical conditions like restless leg syndrome. Further evaluation is needed.
• Difficulty concentrating on work and other activities: This could be a symptom of stress, anxiety, depression, or other mental health conditions. It could also be related to the client’s reported fatigue.
• Difficulty falling asleep and wakes up “after a few hours”: This could indicate a sleep disorder such as insomnia, which could also be contributing to the client’s fatigue and difficulty concentrating.
• Worried about work and family needs: This could indicate stress or anxiety, which may need to be addressed with stress management strategies or counseling.

Musculoskeletal:

• Reports muscles feel tight and achy: This could be due to overuse, stress, or a medical condition like fibromyalgia. Further investigation is needed.

Gastrointestinal:

• Bowel sounds distant: This could indicate a slow-down in the digestive process and may require further investigation.

Cardiovascular:

• Apical 92/min and regular: While this is within the normal range, it’s at the higher end. If the client isn’t physically active, it might be worth investigating further.

Respiratory:

• Occasional dry cough: While this could be due to something benign like allergies, it could also be a symptom of a respiratory condition. If it persists, it should be investigated further.

Choice A Reason:
Offering to contact the client's spiritual advisor is a compassionate and supportive action that acknowledges the client's spiritual needs during the grieving process. Spiritual advisors can provide comfort, guidance, and a sense of connection to the client's faith or belief system, which can be crucial for emotional healing. This intervention respects the client's spiritual beliefs and provides an additional layer of support.

Choice B Reason:
Changing the subject when the client expresses anger about their situation is not an appropriate response. Anger is a natural part of the grieving process, and it is important for the nurse to allow the client to express their emotions. Avoiding the topic can make the client feel unheard and unsupported. Instead, the nurse should listen empathetically and validate the client's feelings.

Choice C Reason:
Allowing the client to be alone during times of spiritual inadequacy may not be beneficial. While some clients may need time alone to process their emotions, it is important for the nurse to assess the client's needs and provide support as needed. Isolation can exacerbate feelings of inadequacy and loneliness. The nurse should offer presence and support, ensuring the client knows they are not alone.

Choice D Reason:
Encouraging the client to internalize their feelings related to the loss is not advisable. Internalizing emotions can lead to unresolved grief and potential mental health issues. It is important for the nurse to encourage the client to express their feelings and provide a safe space for them to do so. Open communication and emotional expression are key components of the grieving process.