A nurse is caring for a client who is scheduled for surgery.

Exhibit 1

Medical History

0800:

Client has a history of malnutrition, hyperlipidemia, and diabetes mellitus.

Mini Nutritional Assessment screening tool score of 7 points (0 to 14 points)

The nurse is reviewing the client's medical record. Which of the following findings places the client at risk for delayed wound healing? Select all that apply

A. Place the client in high-Fowler's position: Placing the client in high-Fowler's position (sitting up at a 90-degree angle) can help improve oxygenation by optimizing lung expansion. This position facilitates better respiratory mechanics and can be beneficial for clients experiencing respiratory distress.

B. Administering epinephrine to the client: Epinephrine is not indicated for the management of fluid overload or transfusion reactions characterized by respiratory symptoms such as TRALI. Therefore, this action is not appropriate in this scenario.

C. Administer oxygen to the client: Hypoxia is a serious concern and requires immediate intervention. Administering oxygen will help improve oxygenation and alleviate respiratory distress.

D. Obtaining a prescription for a diuretic: While diuretics may be indicated in some cases of fluid overload, their use should be guided by the healthcare provider's assessment and prescription. Obtaining a prescription for a diuretic may be considered after the transfusion has been stopped and the healthcare provider has evaluated the client.

E. Stop the transfusion: The presence of lung crackles, hypoxia, and distended neck veins suggests fluid overload, which can be a sign of transfusion-related acute lung injury (TRALI) or circulatory overload. Stopping the transfusion is essential to prevent further fluid overload and worsening of respiratory symptoms.

A. Social worker:

While social workers play a vital role in addressing psychosocial needs and connecting clients with community resources, they typically do not have the specialized skills or training to address the physical limitations associated with feeding difficulties due to rheumatoid arthritis. Therefore, a referral to a social worker may not directly address the client's need for assistance with feeding.

B. Occupational therapist

Occupational therapists specialize in helping individuals regain or maintain independence in performing activities of daily living (ADLs), including feeding oneself. In the case of a client with severe rheumatoid arthritis in her hands who is unable to feed herself, an occupational therapist can assess the client's abilities, provide interventions such as adaptive equipment or techniques to facilitate feeding, and offer strategies to improve hand function and joint mobility. They can also collaborate with the client and other members of the healthcare team to develop a customized plan of care to address the client's specific needs and goals related to feeding and self-care.

C. Physician assistant:

Physician assistants work closely with physicians to provide medical care and may be involved in diagnosing and managing various health conditions. However, they do not typically provide specialized rehabilitation services or interventions related to activities of daily living such as feeding. Therefore, a referral to a physician assistant may not address the client's specific need for occupational therapy services.

D. Physical therapist:

Physical therapists specialize in restoring mobility, strength, and function, primarily focusing on gross motor skills and movement patterns. While physical therapists may address certain aspects of hand function and mobility, they do not specialize in activities of daily living such as feeding. Therefore, a referral to a physical therapist may not directly address the client's need for assistance with feeding due to severe rheumatoid arthritis in her hands.