The nurse is continuing to care for the client.

Exhibits

A nurse is evaluating the client's response to therapy. Which of the following recent findings indicate the client's condition has improved or not changed?
For each assessment finding, click to specify if the finding indicates that the client's condition has improved or has not changed.

Rationale:
A. Encourage cultural practices to be incorporated into their care: Respecting and incorporating a Muslim client’s cultural and religious practices promotes culturally competent and patient-centered care. This approach fosters trust, comfort, and cooperation between the client and healthcare team.

B. Incorporate hot and cold practices into the client's care: Hot and cold theory is typically associated with Hispanic, Asian, and Middle Eastern folk medicine traditions, but not all Muslim clients follow this practice. Care should be based on the client’s individual beliefs.

C. Acknowledge that the client may be cared for by a male provider: Many Muslim women prefer to be cared for by female providers due to religious and cultural values of modesty. The nurse should make reasonable efforts to accommodate this preference whenever possible.

D. Have the client remove any face coverings to obtain their history: Muslim women who wear a niqab or hijab may choose to keep their face covered for modesty. The nurse should not insist on removal unless necessary for identification or assessment, and even then, it should be done privately with sensitivity to religious beliefs.

Rationale:
A. Oxygen saturation 97% on room air: Adequate oxygenation is essential for wound healing because oxygen supports collagen synthesis and tissue repair. An oxygen saturation of 97% indicates sufficient oxygen delivery to tissues and does not place the client at risk for delayed healing.

B. Pain level of 1 on a scale of 0 to 10: Minimal pain suggests effective postoperative pain management and allows the client to move, breathe deeply, and participate in recovery activities. Pain at this level does not negatively impact the wound-healing process.

C. BMI 35: Obesity is associated with delayed wound healing due to poor vascularity in adipose tissue, which reduces oxygen and nutrient delivery to the wound. Increased tension on wound edges and a higher risk of infection also contribute to impaired healing in obese clients.

D. Capillary refill time 1 second: A capillary refill of 1 second reflects adequate peripheral perfusion, which supports effective oxygen and nutrient delivery to tissues. Normal circulation facilitates the healing process rather than delaying it.