The nurse is assisting with patient data collection in a clinic. The nurse is assigned to a young female patient who has an older male friend present at her bedside. The patient is nervous, timid, very thin, and with poor hygiene and lets the friend answer all of the nurse's questions. What actions should the nurse take?

Explanation:

A. Encourage the client to increase participation in community social activities:

While social activities can be beneficial for overall well-being, including mental and emotional aspects, at the end of life for a client with HIV, the focus shifts towards palliative care and symptom management. Encouraging social activities may not directly address the client's immediate end-of-life needs.

B. Prepare the client to begin highly active antiretroviral therapy (HAART):

Starting or continuing highly active antiretroviral therapy (HAART) may not be appropriate at the end of life. HAART is typically used to manage HIV infection and prolong life expectancy by controlling viral replication. However, at the end of life, the focus shifts towards comfort care rather than aggressive treatment aimed at extending life.

C. Provide routine analgesia to minimize episodes of breakthrough pain:

This intervention is more aligned with the principles of end-of-life care. Providing routine analgesia helps manage pain effectively, which is crucial for improving the client's comfort and quality of life during this stage.

D. Promote client weight gain of one to two pounds per week:

Weight gain may not be a priority at the end of life, especially if the client is experiencing advanced HIV disease or complications. Instead of focusing on weight gain, the emphasis should be on optimizing comfort, managing symptoms, and enhancing quality of life.

Explanation:

A. Evaluating the collected data:

This step in EBP involves assessing and analyzing the data that has been gathered through research or other sources. It includes examining the quality, relevance, and reliability of the data to determine its applicability to the clinical question or problem being addressed. Evaluation of data is crucial in EBP to ensure that decisions and interventions are based on sound evidence.

B. Implementing recommendations:

Implementing recommendations is a later step in EBP that comes after evaluating the evidence. Once credible sources have been identified, and the data has been analyzed, recommendations or interventions based on the best available evidence are put into practice. This step involves applying evidence-based guidelines, protocols, or interventions to patient care to improve outcomes and quality of care.

C. Identifying a problem:

This is the initial step in the EBP process where a specific clinical problem or question is identified. It involves recognizing gaps in knowledge, areas of uncertainty, or issues that require improvement in clinical practice. Identifying a problem is essential as it sets the stage for formulating focused research questions and seeking relevant evidence to address the problem effectively.

D. Searching for credible sources:

Searching for credible sources is a critical step in EBP where healthcare professionals gather evidence from reputable and reliable sources. This includes conducting literature searches, accessing databases, and reviewing published studies, clinical guidelines, systematic reviews, and other scholarly sources. The goal is to find the best available evidence to answer clinical questions, guide decision-making, and inform evidence-based practice.