Share This Link

While it is important to instruct the AP to seek assistance when unsure, this does not immediately address the safety of the client during the current incorrect transfer.

Demonstrating the proper technique is an important step, but it should come after ensuring the immediate safety of the client. This can be done once the client is safely transferred.

Referring the AP to the procedure manual is important for future reference, but it does not address the immediate risk to the client. This action can be taken after ensuring the client's safety and demonstrating the correct technique.

Educate the client about the risks of refusing the procedure:This option suggests providing information about the potential consequences of not undergoing the gastroscopy. While educating the client about risks is essential, the immediate concern is the client's lack of understanding about the procedure itself.

Complete the incident report:Filling out an incident report is typically reserved for situations where there has been an actual incident, such as a medical error or adverse event. In this case, the client's lack of understanding does not constitute an incident but rather a need for clarification.

Answer the client’s questions concerning the procedure:While answering the client's questions is important, it's not solely the nurse's responsibility to ensure the client understands the procedure. The provider, who will perform the gastroscopy, should be informed of the client's confusion so they can address it effectively.

Occupational therapists focus on helping clients develop, recover, or maintain daily living and work skills. They can assist with adapting the home environment for safety and independence but do not typically arrange for durable medical equipment like wheelchairs.

Home health: Home health services can provide ongoing medical care and assistance at home, but they do not typically handle the logistics of securing durable medical equipment like wheelchairs. They might recommend or facilitate a referral to social services for this need.

Physical therapy: Physical therapists help clients regain strength and mobility and may train clients on how to use a wheelchair effectively, but they do not typically arrange for the provision of the wheelchair itself.

Involve the client’s partner to assist with the teaching session: While involving the client's partner can be helpful, it may not ensure effective communication if the partner also does not speak the same language as the client.

Incorporate gestures and hand signals when presenting information: This is an effective strategy to enhance communication with a client who speaks a different language. Non-verbal cues such as gestures and hand signals can help convey meaning and facilitate understanding.

Validate understanding by interpreting the client’s body language: Interpreting the client's body language can be helpful in assessing their level of understanding and engagement. However, it may not be sufficient for effective communication, especially if the client has questions or needs clarification.

Wears clean gloves to remove the soiled dressing: This action is appropriate. Wearing clean gloves helps maintain aseptic technique and prevents contamination of the wound during dressing removal.

Uses slow, continuous pressure to flush the wound: This action is appropriate. Using slow, continuous pressure helps ensure effective irrigation of the wound without causing trauma to the tissue.

Places the syringe tip with angiocatheter 2.5 cm (1 in) above the open wound bed: This action is appropriate. Maintaining the appropriate distance ensures that the irrigation solution reaches the wound bed effectively without causing unnecessary trauma.

Request another family member assist the client’s partner with care: This may be a helpful action if there is another family member who can provide support. However, it's important to consider the availability and willingness of other family members to take on caregiving responsibilities.

Recommend the partner place the client in a long-term care facility: This option may be considered if the partner is unable to continue providing care and there are no other feasible options available. However, it should be discussed with the client and their partner and explored as one of several potential solutions.

Ask the provider to delay the client’s discharge home for a few more days: This may be appropriate if there are concerns about the client's safety or if additional time is needed to arrange for alternative care options. However, it's important to address the underlying issues contributing to the partner's inability to provide care and to explore long-term solutions.

A client who reports night sweats and fever for the last week:Night sweats and fever can be indicative of various underlying conditions, including infections. While these symptoms may require medical attention, they do not necessarily indicate an immediately life-threatening condition compared to other options.

A client who has compound fractures of the tibia and humerus:Compound fractures involve broken bones that penetrate through the skin, leading to a risk of severe bleeding, infection, and other complications. This client's injuries are significant and require immediate attention to prevent further complications and provide pain management and stabilization.

A client who reports severe vomiting and diarrhea:
Severe vomiting and diarrhea can lead to dehydration, electrolyte imbalances, and other complications, especially if prolonged or accompanied by other symptoms such as fever. While this client requires prompt assessment and treatment, the urgency may not be as high as for other conditions.

Compromising:Compromising involves finding a middle ground or mutually acceptable solution where both parties give up something to reach an agreement. It requires each party to make concessions to meet halfway and resolve the conflict. This approach aims to achieve a quick resolution by accommodating the needs and concerns of both sides to some extent.

Collaborating:Collaborating involves working together cooperatively to find a solution that satisfies the interests and concerns of all parties involved. It requires open communication, active listening, and joint problem-solving to achieve a consensus and reach a win-win outcome. This approach values mutual respect, trust, and cooperation among team members, emphasizing shared decision-making and collective ownership of the resolution.

Cooperating:
Cooperating involves willingly assisting or supporting others to achieve a common goal or resolve a conflict. It emphasizes teamwork, mutual support, and shared efforts to address challenges or differences constructively. This approach promotes harmony, unity, and a supportive environment where individuals work together toward shared objectives.

Delay the surgery until the nurse can obtain informed consent:This option advocates for ensuring that the patient's autonomy and rights are respected by obtaining informed consent before proceeding with surgery. While obtaining consent is essential, delaying surgery may not always be feasible or advisable in emergency situations where prompt intervention is necessary to prevent deterioration of the patient's condition. However, if circumstances allow, making efforts to obtain informed consent is ethically and legally preferable.

Obtain telephone consent from the facility administrator before the surgery:
This option proposes seeking consent from a designated authority within the healthcare facility, such as a facility administrator, via telephone. While this approach may be practical in some cases, it may not always be sufficient to ensure that the patient's rights are fully respected, particularly if the administrator does not have the legal authority to provide consent on behalf of the patient. In emergency situations, obtaining consent from a legally authorized representative of the patient, if available, is generally preferred.

Ask the anesthesiologist to sign the consent:This option involves delegating the responsibility of signing the consent form to another member of the healthcare team, in this case, the anesthesiologist. However, consent for surgery should ideally be obtained directly from the patient or their legally authorized representative, as they are the ones who have the right to make decisions about their medical care. Relying on another healthcare provider to sign the consent form may not adequately protect the patient's autonomy and legal rights.