A nurse is receiving report on a group of clients. Using the ABCDE priority framework which f the following clients should the nurse see first?

A) Keep the head of the client’s bed elevated to 45 degrees:
Elevating the head of the bed to 45 degrees can actually increase the risk of pressure injuries, particularly in clients who are already at risk. This position can cause shearing forces and increase pressure on areas such as the sacrum, heels, and hips, making it more likely for pressure ulcers to develop.

B) Provide the client with a high-calorie diet:
A high-calorie diet is important for clients at risk of pressure injuries because adequate nutrition supports skin integrity and wound healing. Clients at risk for pressure injuries often have compromised nutritional status, and providing sufficient calories, protein, and other nutrients helps improve tissue regeneration and resilience. A high-calorie, high-protein diet helps prevent further breakdown of the skin and supports the healing process for any existing wounds.

C) Massage the client’s bony prominences:
Massaging bony prominences, such as the heels, elbows, and sacrum, is not recommended because it can cause tissue damage and increase the risk of pressure injury. Instead, the focus should be on minimizing pressure on these areas and using appropriate methods to redistribute pressure, such as repositioning the client or using pressure-relieving devices.

D) Reposition the client every 4 hours:
Repositioning the client every 4 hours may not be frequent enough for those at high risk for pressure injuries. For individuals who are immobile or at high risk, repositioning should typically occur at least every 2 hours to alleviate pressure on vulnerable areas of the body.

A) Denial:
Denial is the first stage in Kubler-Ross's model of grief. It typically involves a person having difficulty accepting the reality of their diagnosis or the reality of death. Clients in the denial stage may refuse to acknowledge the seriousness of their condition or may act as if everything is fine despite the obvious signs of illness. The statement “I am ready to update my will” suggests that the client has already accepted the reality of their terminal diagnosis and is preparing for what is to come, which is not characteristic of denial.

B) Acceptance:
Acceptance is the final stage in the Kubler-Ross model of grief. It is marked by coming to terms with the reality of death or a terminal diagnosis. Clients who are in the acceptance stage have typically processed their grief and are ready to make practical decisions, such as updating a will or making arrangements for the end of life. The client’s statement about updating their will reflects an acceptance of their condition and a focus on finalizing matters, which aligns with the stage of acceptance.

C) Anger:
Anger is a stage in the Kubler-Ross model of grief where individuals may feel frustrated, resentful, or upset about their situation. Clients in the anger stage may express feelings of injustice or frustration, often lashing out at others. Since the client is talking about practical matters such as updating their will, this does not indicate the emotional response of anger, which would be more likely to involve blaming others or feeling bitter.

D) Bargaining:
Bargaining is the stage where a person may make deals or promises in an attempt to delay or avoid the reality of their situation. Clients in the bargaining stage may attempt to negotiate with a higher power, themselves, or others, asking for more time or for changes in their circumstances. Since the client’s statement is about accepting the terminal diagnosis and preparing for the future, it is not indicative of bargaining, which often involves a desire for a change or a different outcome.