Examkin

Question

Difficulty: Very hardBasic Care and Comfort

An 82-year-old client with advanced Parkinson's disease is admitted for severe dehydration and profound weight loss. Assessment reveals pronounced bradykinesia, freezing of gait episodes, and prominent dysphagia with coughing during meals. When prioritizing the daily basic care, mobility, and comfort needs for this client, which of the following evidence-based interventions should be incorporated? Select all that apply.

  1. Schedule energy-intensive activities such as bathing and hallway ambulation precisely during the peak action of the client's dopaminergic medications.Answer
  2. B
    Delegate the initial bedside swallow screening to the unlicensed assistive personnel (UAP) before offering the first oral fluid trial.
  3. Teach the client to consciously lift the toes and visualize stepping over a target on the floor to overcome episodes of gait freezing.Answer
  4. D
    Place the client in a high-Fowler's position with the neck slightly hyperextended to facilitate gravity-assisted esophageal emptying during meals.
  5. E
    Apply soft bilateral wrist restraints at night to prevent the dislodgment of the prescribed continuous intravenous fluid infusion.
  6. F
    Document the sudden onset of nighttime disorientation and new urinary incontinence as expected physiological age-related progression of the neurological disease.

Answer

The correct interventions are scheduling activities during peak medication times and teaching the client to visualize stepping over a target to overcome freezing of gait.
For clients with Parkinson's disease, coordinating energy-intensive activities like hygiene and ambulation with the peak effect of dopaminergic medications ensures optimal muscle function and reduces injury risk. Furthermore, teaching the client to visualize and step over an imaginary target effectively utilizes intact neural pathways in the frontal cortex to overcome the freezing of gait caused by basal ganglia dysfunction.

Step-by-Step Solution

1
Analyze the client's clinical presentation.
The client has advanced Parkinson's disease, bradykinesia, freezing of gait, dysphagia, and dehydration.
Understanding the complex physiological deficits dictates the priority safety and comfort interventions.
2
Evaluate each intervention for safety and efficacy regarding mobility and basic care.
Timing care with medication peaks and utilizing conscious motor strategies directly address the complications of Parkinson's disease safely.
These interventions promote independence, reduce fatigue, and decrease fall risk.
3
Identify contraindicated or unsafe actions in the remaining options.
Delegating assessments, hyperextending the neck during meals, using immediate restraints, and dismissing sudden confusion as 'normal' are all significant safety violations.
Standard nursing guidelines require RN-level assessment for dysphagia, a chin-tuck position for feeding, restraint alternatives, and immediate evaluation of acute delirium.

Key Concept

Basic Care and Comfort: Complex Mobility, Nutrition, and Safety in Neurological Degeneration
Rate this question

Topics

Basic Care and Comfort

More questions from this topic