A nurse is caring for a client who has rheumatoid arthritis and is having difficulty with ADLs, such as cooking and eating. The nurse should ensure that the client has a referral to which of the following members of the interprofessional team?

Rationale:

• Write the full date on the client's whiteboard: Writing the date helps reinforce orientation to time, which the client is lacking. Visual cues are essential for reorienting clients with delirium. This simple step can reduce confusion and distress.

• Acknowledge the client's feelings: Acknowledging the client’s fear builds trust and therapeutic rapport. It reduces agitation and reassures the client when they experience hallucinations. Validation helps calm the client without reinforcing delusions.

• Request that the client's family bring the client's eyeglasses from home: Requesting the glasses improves the client’s ability to recognize surroundings. Visual impairment worsens confusion in older adults. Familiar visual aids reduce cognitive strain.

• Request that the client have the same caregivers with every shift: Consistent caregivers help the client form familiar relationships. Continuity reduces confusion, especially in clients with dementia or delirium. Routine and predictability lower anxiety.

• Reorient the client often: Frequent reorientation is key in delirium management. It helps the client regain understanding of time, place, and situation. Repetition promotes memory and reduces disorganized thoughts.

• Ask the client's partner to stay with the client as much as possible: The partner provides emotional comfort and familiarity. Their presence helps maintain the client’s orientation and decreases agitation. Family members often support communication and reorientation.

• Provide the client with information about what to expect during their care: Detailed information may overwhelm or confuse a delirious client. Cognitive overload can worsen disorientation. Simpler, brief explanations are more effective.

• Maintain a well-lit environment: Bright lighting may worsen hallucinations or cause overstimulation. Soft, ambient lighting is better suited for reducing visual misperceptions. Delirious patients benefit from calm, low-stimulation environments.

Rationale:
• Urinary stasis: Immobility slows bladder emptying and ureteral flow, increasing residual urine. This promotes bacterial growth and risk of urinary tract infection. MS clients with decreased mobility are especially vulnerable.

• Calcium resorption: Bone demineralization occurs during prolonged immobility. Without weight-bearing, calcium is released from bone into the bloodstream, raising serum calcium and weakening bones.

• Contractures: Lack of movement leads to shortening and stiffening of muscles and joints. Over time, joints lose flexibility, especially if the client remains curled in one position.

• Hypocalcemia: The client is more likely to develop hypercalcemia due to calcium resorption from bones. There's no evidence of low calcium symptoms like tetany or numbness.

• Hypertension: The client's vital signs are within normal range. Immobility may reduce cardiac output over time, but it does not typically cause high blood pressure.

• Diarrhea: Immobility usually causes constipation due to slowed peristalsis. There's no report of active GI symptoms or triggers for diarrhea in this case.

• Pressure ulcer: Continuous pressure on one area reduces capillary blood flow. This leads to tissue ischemia and skin breakdown, especially over bony prominences like the hip and shoulder.

• Atelectasis: Lying on one side restricts lung expansion, and refusal to change positions impairs ventilation. This can cause alveolar collapse and decreased oxygen exchange.