A nurse is caring for a client who is at the end of life. Which of the following interventions is most effective in reducing the client's social isolation?

Explanation:

A. A 6-year-old child with a spiral fracture of the tibia and fibula, reportedly occurring while riding a bicycle:

While a spiral fracture can be concerning, it is also a common injury seen in children due to falls or accidents during physical activities such as riding a bicycle. Without further evidence or suspicion, this may not immediately indicate physical abuse.

B. A 14-month-old toddler reportedly learning to walk and has several bruises on bony prominences of the lower legs and elbows:

Bruises on bony prominences can be common in toddlers who are learning to walk and explore their environment. These bruises are often seen on areas such as the lower legs and elbows. Without additional concerning signs or patterns, this may not indicate physical abuse.

C. A 9-month-old infant who sustained near drowning when he reportedly climbed into the tub and turned on the water:

Near drowning incidents can occur accidentally, especially in curious and mobile infants who may explore their surroundings. While this is a serious event, it does not necessarily suggest physical abuse unless there are other suspicious findings or a history of non-accidental injuries.

D. A 3-year-old toddler with scalding burns over the face and chest reportedly sustained when the child pulled on a tablecloth, spilling a cup of tea on himself:

Scalding burns, especially over sensitive areas like the face and chest, can raise concerns about physical abuse, especially when the reported mechanism of injury (spilling a cup of tea) seems inconsistent or disproportionate to the severity of the burns. The pattern and location of burns may not align with accidental spillage, leading to suspicion of abuse.

Explanation:

A. Increased bowel sounds:

In end-of-life care, clients often experience a decrease in bowel sounds rather than an increase. Bowel sounds may diminish or become absent as the body's systems slow down.

B. Hypertension:

Hypertension is less commonly observed in clients at the end of life. Instead, blood pressure may decrease as the body's overall function declines.

C. Mottled skin:

Mottled skin, characterized by a blotchy or marbled appearance, is a common finding in clients approaching the end of life. It occurs due to changes in peripheral circulation and may indicate decreased perfusion.

D. Moist mucous membranes:

In contrast to moist mucous membranes, clients at the end of life may experience dry mucous membranes. Reduced oral intake and hydration levels can lead to dryness of the mouth and mucous membranes.