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Difficulty: HardSelf-Care

A community health RN is establishing a home management plan for an 80-year-old client with late-stage Parkinson's disease. The client's spouse reports that the client has become increasingly fatigued, struggles to manipulate eating utensils, and recently developed sudden episodes of urinary incontinence. Which action by the nurse best addresses the client's health and self-care needs?

  1. A
    Request that the unlicensed assistive personnel (UAP) determine the client's risk for aspiration during meals.
  2. B
    Incorporate secondary disease prevention into the care plan by administering the annual influenza and pneumococcal immunizations.
  3. Introduce adaptive dining devices to maintain feeding autonomy and obtain an order for a urinalysis.Answer
  4. D
    Educate the spouse that the new onset of bladder incontinence is a normal age-related change and suggest utilizing absorbent pads.

Answer

The nurse should introduce adaptive dining devices to maintain feeding autonomy and obtain an order for a urinalysis.
The correct answer addresses two critical clinical priorities. First, introducing adaptive dining devices directly promotes the client's self-care and autonomy by compensating for the tremors and rigidity associated with Parkinson's disease. Second, the nurse correctly recognizes that sudden urinary incontinence in an older adult is an indicator of acute pathology (such as a urinary tract infection) rather than a normal part of aging, thus appropriately requiring a medical investigation via a urinalysis.

Step-by-Step Solution

1
Analyze the client's reported symptoms and identified self-care deficits.
The client exhibits feeding difficulties secondary to Parkinson's disease progression and has a new, sudden onset of urinary incontinence.
Accurate identification of functional deficits and acute physiological changes is necessary to formulate an effective and safe home care plan.
2
Select interventions that maximize the client's independence in daily activities.
Adaptive dining devices, such as weighted or built-up utensils, are identified to compensate for fine motor deficits and tremors.
Promoting autonomy in basic activities of daily living (ADLs) is a core component of self-care maintenance for clients with progressive neurological disorders.
3
Evaluate the clinical significance of the new-onset incontinence.
Sudden urinary incontinence is recognized as a red flag for acute pathology (e.g., urinary tract infection) rather than a normal age-related change.
Distinguishing normal aging from acute disease processes ensures that the client receives timely medical intervention and prevents severe complications.

Key Concept

Promoting Self-Care and Differentiating Acute Pathology from Normal Aging
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Self-Care

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