A nurse is caring for a client who has hearing loss. While communicating with the client, which of the following actions should the nurse take?

Rationale:

A. Nurses notes are used to create the critical pathway: Critical pathways are developed from evidence-based clinical guidelines and best practices, not directly from nurses’ notes. While documentation may help track progress, it is not the foundation for pathway creation.

B. Critical pathways should reduce health care costs: Critical pathways standardize care for specific diagnoses, promoting timely interventions and reducing unnecessary treatments or delays. This efficiency helps lower healthcare costs while improving patient outcomes.

C. Critical pathways have an unlimited timeframe for completion: Each critical pathway includes a defined timeline with expected outcomes for each phase of care. This structure ensures care is efficient and progress is monitored closely to prevent delays or complications.

D. Nurses should discontinue the critical pathway if variances occur: Variances are deviations from the expected outcomes and are used to evaluate and adjust care. They do not justify discontinuing the entire pathway but rather indicate a need for reassessment or individualized modifications.

Rationale for Correct Choices:

• Antibiotic prescription: The client is showing signs of a possible postoperative wound infection (fever, elevated WBC count, purulent discharge, tenderness), all of which warrant initiation of antibiotics to control local and systemic infection.
• WBC count: The WBC has increased significantly from 8,000/mm³ on day 1 to 14,800/mm³ by day 3, indicating a developing infectious or inflammatory process likely related to the surgical site.
• Temperature: The temperature has risen to 38.8°C (101.8°F) by day 3, suggesting a febrile response to infection, which aligns with the findings of purulent wound drainage and local tenderness.

Rationale for Incorrect Choices:

• Laxative: Although the client hasn’t had a bowel movement, this is expected early in the postoperative period, especially with hypoactive bowel sounds. Laxatives are contraindicated until full bowel function returns.
• IV fluids: There is no evidence of fluid volume deficit skin turgor is normal, and vital signs are stable making IV fluids unnecessary at this time.
• Prescription for IV iron: While hemoglobin is low, there is no evidence of acute blood loss, and infection is the more urgent concern. Iron supplementation would be a longer-term consideration.
• Bowel sounds: Hypoactive bowel sounds are common after abdominal surgery and not in themselves a reason to start antibiotics.
• Blood pressure: Client's BP is stable and within acceptable range; it does not indicate infection or require antibiotic treatment.
• Skin turgor: Normal skin turgor suggests hydration is adequate, not an indication for antibiotic use.
• Transferrin level: While slightly decreased, this is a nonspecific finding and not indicative of acute infection or requiring antibiotics.
• Bowel movements: Absence of bowel movement alone post-surgery does not justify antibiotics; infection indicators are more critical.