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Difficulty: HardClient Rights and Advocacy

An older adult client with moderate dementia is receiving continuous intravenous (IV) antibiotics for pneumonia. The client is highly restless and repeatedly attempts to pull out the IV catheter. The client's spouse tells the practical nurse (PN), "Just tie his hands down so he stops pulling at it. That is what we have to do at home sometimes." Which action best demonstrates the PN's role in client advocacy and safety?

  1. Assess the client's current oxygenation status, conceal the IV site with a rolled stockinette, and explain to the spouse that less restrictive measures must be attempted first.Answer
  2. B
    Apply soft bilateral wrist restraints to protect the life-sustaining IV infusion, then immediately contact the provider to obtain an emergency restraint prescription.
  3. C
    Contact the provider to request a prescription for a rapid-acting intravenous push (IVP) sedative and administer it to chemically restrain the client's agitation.
  4. D
    Tell the spouse, "Why do you tie him down at home? That is a violation of his basic rights and we absolutely will not do that here."

Answer

The correct action is to assess the client's current oxygenation status, conceal the IV site with a rolled stockinette, and explain to the spouse that less restrictive measures must be attempted first.
The correct action prioritizes the client's right to a restraint-free environment by utilizing least restrictive alternatives (concealing the IV site). It appropriately incorporates a physiological assessment for hypoxia—a common cause of restlessness in clients with pneumonia—and provides professional, therapeutic education to the spouse regarding the legal parameters of restraint use.

Step-by-Step Solution

1
Identify the conflict between safety and client rights
The client needs IV therapy for pneumonia, but has a fundamental right to the least restrictive care environment.
Recognizing competing priorities is the first step in ethical clinical decision-making.
2
Evaluate the spouse's request for physical restraints
The request must be denied initially because alternative, less restrictive measures have not yet been attempted or documented.
Federal guidelines and client advocacy principles mandate that physical or chemical restraints are a last resort.
3
Determine appropriate independent PN interventions
The PN must assess for physiological causes of agitation (such as hypoxia from pneumonia) and implement non-pharmacological deterrents (like a stockinette).
Agitation is often a symptom of an underlying unmet need; addressing the root cause and hiding the medical device are standard restraint alternatives.
4
Formulate a therapeutic response to the spouse
The PN educates the spouse on hospital policy and legal rights without using judgmental or confrontational language.
Therapeutic communication maintains the nurse-client-family relationship while clearly establishing boundaries regarding client rights.

Key Concept

Client right to the least restrictive environment and appropriate restraint alternatives.
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Topics

Client Rights and Advocacy

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