A school nurse is teaching a group of guardians about measures to prevent firearm injuries in the home. Which of the following instructions should the nurse include in the teaching?

A. Move the client using a slider board: A slider board can assist with lateral transfers, but for a client weighing 136 kg (300 lb), it may not provide the safest method due to the increased risk of strain and injury to staff. A more advanced device is preferred.

B. Use an air-assisted transfer device to move the client: An air-assisted transfer device is the safest choice for bariatric clients because it significantly reduces friction, making movement easier and safer for both the client and healthcare workers. It minimizes musculoskeletal injury risk during transfer.

C. Raise the bed to 5 cm (2 in) above the level of the stretcher: The bed should be adjusted to the same height as the stretcher to allow a smooth transfer. Raising it higher can make the transfer unsafe and increase the risk of injury or difficulty sliding the client across.

D. Position the head of the bed at 25° prior to the transfer: The head of the bed should be flat during lateral transfers to maintain spinal alignment and ease movement. Elevating the head complicates the process and increases the chance of shear or strain.

Rationale for Correct Choices:
• Client reports abdominal pain as a 9 on a pain scale of 0 to 10: Severe abdominal pain indicates significant underlying pathology. In the presence of vomiting, distention, and altered bowel sounds, it could reflect obstruction, ischemia, or peritonitis, requiring urgent intervention.

• Abdomen is distended and firm: Distention and firmness suggest accumulation of gas or fluid within the abdomen. This is concerning for bowel obstruction or peritonitis, which can compromise circulation and lead to sepsis if untreated.

• Bowel sounds are distant and hypoactive: Diminished bowel sounds point to decreased peristalsis. In a client with abdominal pain and distention, this strongly suggests obstruction or ileus, requiring prompt diagnostic and therapeutic measures.

• Perianal skin is excoriated, and small ulceration is noted: Frequent diarrhea has led to skin breakdown and ulceration. This not only causes pain and discomfort but also increases the risk of secondary infection, requiring local wound care and protection.

• Tenting of skin for 4 seconds is noted: Delayed skin turgor indicates poor hydration status. Given this client’s vomiting, diarrhea, and low oral intake, this is a strong indicator of fluid volume deficit needing IV replacement.

• Temperature 38.7 °C (101.7 °F): Fever signals the presence of infection. With gastrointestinal complaints, this may be due to bacterial gastroenteritis, abscess formation, or other intra-abdominal infection that warrants further evaluation.

• Mucous membranes are dry: Dry mucous membranes reflect fluid volume depletion. This is consistent with the client’s history of poor intake, vomiting, and diarrhea, and further confirms dehydration.

Rationale for Incorrect Choices:

• Skin is warm and dry: Warm, dry skin suggests adequate peripheral perfusion and does not require follow-up compared to more urgent findings like dehydration and abdominal changes.

• Capillary refill is 2 seconds: A refill time under 3 seconds indicates sufficient peripheral circulation. This finding is within normal limits and does not require additional intervention.

• Respiratory rate 20/min: A respiratory rate within the range of 12–20 breaths/min is considered normal for adults. This shows stable respiratory function and does not require follow-up.