A nursing student is assessing a postoperative client who has developed bilateral pneumonia. The nursing plan of care includes positioning the client in the semi-Fowler’s position, elevating the head of the bed from 30 degrees to 45 degrees.
What is the rationale for this position?

Choice A rationale:
Reduced kidney ability to concentrate urine is a common physiological change associated with normal aging. This is due to several factors, including:

Decreased glomerular filtration rate (GFR): The kidneys filter waste products from the blood. As we age, the number of functioning nephrons (filtering units) in the kidneys decreases, leading to a decline in GFR. This means that the kidneys are less able to filter waste products and concentrate urine.
Decreased renal blood flow: Blood flow to the kidneys also decreases with age. This further reduces the kidneys' ability to filter waste products and concentrate urine.
Decreased tubular function: The tubules in the kidneys are responsible for reabsorbing water and electrolytes from the urine. As we age, the function of the tubules also declines, leading to a decrease in the ability to concentrate urine.
As a result of these changes, older adults often produce more urine, even at night. This can lead to nocturia, which is the need to wake up to urinate two or more times per night.
Choice B rationale:
Lower fluid intake during daytime hours can also contribute to nocturia, but it is not a direct physiological change associated with normal aging. Older adults may drink less fluids during the day for a variety of reasons, such as decreased thirst sensation, fear of incontinence, or limited access to fluids. However, even if they maintain adequate fluid intake during the day, they may still experience nocturia due to the reduced ability of their kidneys to concentrate urine.
Choice C rationale:
Enhanced bladder contractility leading to urinary stasis is not a typical physiological change associated with normal aging. In fact, bladder contractility often decreases with age, which can lead to difficulty emptying the bladder completely. This can contribute to urinary frequency and urgency, but it is not typically a cause of nocturia.
Choice D rationale:
Increased bladder muscle tone leading to frequent urination is also not a typical physiological change associated with normal aging. Bladder muscle tone may decrease with age, which can lead to difficulty emptying the bladder completely. However, it is not typically a cause of nocturia.

Choice A rationale:
Focuses on avoiding change rather than managing it effectively. Change is often necessary for improvement and growth. Seeking ways to avert it can hinder progress and prevent potential benefits.
Undermines the nurse's role as a change agent. Nurses are expected to play a proactive role in initiating and implementing change to enhance patient care and organizational effectiveness.
May lead to missed opportunities to address issues or challenges. By focusing on averting change, underlying problems may remain unaddressed, potentially compromising patient care or organizational efficiency.
Choice B rationale:
Addresses group cohesion, which is crucial for successful change implementation. Cohesive groups demonstrate better communication, collaboration, and support, facilitating acceptance and adaptation to change.
Recognizes that change can disrupt group dynamics and relationships. Assessing group cohesion allows for identification of potential challenges and development of strategies to strengthen relationships and foster teamwork during the change process.
Highlights the importance of considering the social and relational aspects of change. Change is not only a technical process; it involves individuals with emotions, beliefs, and social connections that need to be considered for successful implementation.
Choice C rationale:
Assesses the group's overall openness and willingness to accept change. Some groups may be more resistant to change due to past experiences, fear of the unknown, or attachment to existing practices.
Determines if the change aligns with the group's values and beliefs. Change that conflicts with deeply held values is likely to encounter stronger resistance and may require additional strategies to address concerns and build consensus.
Recognizes that not all groups are equally adaptable to change. Understanding the group's amenability to change helps in tailoring implementation strategies and managing potential resistance.
Choice D rationale:
Evaluates the group's preparedness for change in terms of knowledge, skills, and resources. Insufficient preparation can lead to confusion, frustration, and decreased effectiveness during the change process.
Considers the group's emotional readiness to accept and adapt to change. Even if a change is technically feasible, emotional resistance can hinder its success. Assessing readiness allows for addressing concerns and providing support to facilitate the transition.
Ensures that the group has the necessary support and resources to implement the change successfully. Change often requires training, guidance, and time for adjustment. Providing adequate support systems is essential for successful implementation.