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Question

Difficulty: MediumBasic Care and Comfort

An older adult client with severe osteoarthritis and mild dementia resides in a long-term care facility. During early morning rounds, the client becomes verbally agitated and physically resists when staff attempt to change the bed linens and assist with dressing. Recognizing that joint stiffness is a primary contributing factor, which action should the nurse take?

  1. Apply warm, moist heat packs to the client's major joints prior to continuing the morning routine.Answer
  2. B
    Assign the nursing assistant to evaluate which specific range-of-motion movements trigger the client's discomfort.
  3. C
    Elevate the client's lower extremities by placing a rolled blanket directly beneath the popliteal spaces.
  4. D
    Document the behavioral changes as an expected age-related progression of the cognitive impairment.

Answer

Apply warm, moist heat packs to the client's major joints prior to continuing the morning routine.
The correct answer addresses the root cause of the client's resistance. In clients with osteoarthritis, joint stiffness is typically most severe in the morning. Applying warm, moist heat is a standard, effective non-pharmacological comfort measure that increases blood flow, reduces muscle tension, and alleviates joint stiffness. By managing the physical discomfort first, the nurse can safely proceed with necessary basic care activities while reducing the client's agitation.

Step-by-Step Solution

1
Analyze the client's behavioral presentation in the context of their medical history.
The agitation and resistance to care are identified as behavioral expressions of physical pain caused by morning osteoarthritis stiffness.
Clients with dementia often express physical discomfort through resistance rather than verbally articulating their pain.
2
Determine the most appropriate basic care and comfort intervention.
Applying warm, moist heat is selected to directly address the physiological source of the discomfort.
Heat therapy promotes muscle relaxation, increases local tissue circulation, and effectively relieves osteoarthritic joint stiffness, which facilitates safer and more comfortable hygiene care.

Key Concept

Non-pharmacological pain management and comfort measures for older adults with cognitive impairment.
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Topics

Basic Care and Comfort

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