A nurse is caring for a group of clients who have chronic pain. Which of the following clients should the nurse identify as a candidate for occupational therapy?

A. Updating a family member on a client's condition following surgery: Communicating clinical information and updates to family members requires professional nursing judgment and understanding of the client’s status. This task cannot be delegated to assistive personnel because it involves interpretation of medical information and legal responsibility.

B. Observing a client's abdominal laceration for indications of infection: Assessment of wounds for signs of infection requires professional knowledge and clinical judgment to identify subtle changes and make appropriate care decisions. This task must be performed by a licensed nurse and cannot be delegated to assistive personnel.

C. Instructing a client about the use of an incentive spirometer: Teaching a client involves providing information, evaluating understanding, and demonstrating correct technique. This requires nursing knowledge and judgment, making it inappropriate to delegate to assistive personnel.

D. Documenting the amount of drainage from a client's NG tube: Measuring and recording output from an NG tube is a routine, non-invasive task that does not require clinical judgment. This task can be safely delegated to assistive personnel as long as they follow proper procedures and report abnormal findings to the nurse.

Rationale for correct choices

• Sudden onset of dyspnea and chest discomfort: These symptoms may indicate acute cardiopulmonary compromise such as pulmonary embolism, acute heart failure, or infection. Sudden dyspnea in a post-op orthopedic client requires immediate assessment and intervention to prevent deterioration.

• Tachypnea and appearance of distress: Rapid, labored breathing indicates the client is struggling to maintain adequate oxygenation and may signal hypoxemia or respiratory failure. Immediate follow-up is necessary to prevent further compromise.

• Crackles heard in bilateral lungs: Bilateral crackles suggest fluid accumulation in the alveoli, possibly from pulmonary edema or early pneumonia. This finding correlates with respiratory distress and requires prompt evaluation.

• S3 and S4 heart sounds noted: Extra heart sounds can indicate left ventricular dysfunction or volume overload, suggesting acute heart failure. Timely assessment is critical to prevent worsening cardiac output and pulmonary congestion.

• Temperature 38.9° C (102° F): Fever indicates possible infection, which in a post-operative patient could suggest pneumonia, surgical site infection, or sepsis. Early recognition and treatment are essential.

• Heart rate 112/min: Tachycardia may be a compensatory response to hypoxia, fever, or fluid overload. Persistent elevation increases cardiac workload and risk of decompensation.

• Respiratory rate 34/min: A significantly elevated respiratory rate confirms respiratory distress and inadequate oxygenation, warranting immediate intervention such as supplemental oxygen adjustment or further diagnostics.

Rationale for incorrect choices

• Client is awake and oriented x4: The client’s alertness and orientation indicate that cerebral perfusion and cognitive function are intact at this time. While this is important to note, it does not indicate acute cardiopulmonary compromise or a life-threatening event, so it does not require immediate follow-up.

• Surgical site is dressed, dry, and intact: The dressing being clean, dry, and intact indicates there is currently no active bleeding or wound complication. While ongoing monitoring is important post-operatively, this finding does not necessitate urgent intervention compared with the client’s acute respiratory and cardiovascular symptoms.