As a nurse caring for a cognitively impaired older adult client, you need to observe for which of the following? (Select all that apply.)

A. Constipation.

Explanation: Constipation is a common side effect of opioid medications like morphine. Older adults, particularly those on bed rest or with reduced mobility, are already at an increased risk of constipation. Morphine further contributes to this risk by slowing down bowel motility. Preventive measures such as promoting adequate hydration, encouraging fiber intake, and considering stool softeners can help prevent constipation in this scenario.

B. Poor solid food intake.

Explanation: While monitoring and addressing poor solid food intake are important for overall nutritional status, it may not be the immediate priority related to morphine use and postoperative care.

C. Poor liquid intake.

Explanation: Ensuring adequate fluid intake is important for overall hydration, but constipation is a more specific and immediate concern associated with opioid use.

D. Diarrhea.

Explanation: Diarrhea is not a common side effect of morphine and is less likely to be the priority for preventive care in this situation. Constipation is a more anticipated concern when opioids are prescribed.

B. Provide nutritious food according to the residents' expressed food preferences.

Explanation: Offering nutritious food based on residents' preferences can enhance their satisfaction with meals, making them more likely to eat and maintain adequate nutritional intake. Taking individual preferences into account helps create a more person-centered approach to nutrition.

D. Distribute "med-pass" nutritional supplements.

Explanation: Nutritional supplements may be beneficial for residents who have difficulty meeting their nutritional needs through regular meals. "Med-pass" supplements can be distributed with medications or as a separate supplement to enhance calorie and nutrient intake, especially for those with specific dietary requirements.

The other options are not recommended:

A. Develop a seating chart for the main dining room based on the unit to facilitate a more organized and efficient meal delivery.

Explanation: While organization and efficiency are important, creating a seating chart based on the unit might not directly address the nutritional status of residents. Instead, focus should be on providing appetizing, nutritious meals and accommodating residents' preferences.

C. Replace the fluorescent lighting with candles at every table to create a cozy, restaurant-like atmosphere.

Explanation: While creating a pleasant dining environment is important, replacing fluorescent lighting with candles may not be practical or safe in a healthcare setting. Moreover, the emphasis should be on the nutritional content of the meals rather than the ambiance.