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Difficulty: MediumEthical Practice

During a routine home visit, a palliative care registered nurse assesses an 84-year-old client diagnosed with severe dementia. The nurse notes several distinct, blistered circular lesions on the client's posterior thorax. The family caregiver explains, "We applied heated glass cups to draw out the toxins causing their back pain." The client winces when the area is touched but cannot verbally communicate. Which of the following represents the most appropriate ethical and legal nursing action?

  1. Contact the state vulnerable adult protection agency regarding the assessment findings.Answer
  2. B
    Schedule a follow-up visit for the following week to monitor the healing of the lesions before intervening.
  3. C
    Record the lesions in the medical record as an expected finding related to a traditional healing practice.
  4. D
    Direct the home health aide to monitor the characteristics of the lesions during future bed baths.

Answer

Contact the state vulnerable adult protection agency regarding the assessment findings.
The correct answer demonstrates the nurse's ethical obligation to act as an advocate and the legal obligation as a mandatory reporter. A client with severe dementia cannot consent to or refuse therapies. When a complementary or cultural therapy results in actual tissue damage (blistered burns), the nurse must prioritize the ethical principle of nonmaleficence by reporting the incident to adult protective services to ensure the vulnerable client's safety is evaluated.

Step-by-Step Solution

1
Analyze the client's vulnerability and the nature of the injury.
The client is 84 with severe dementia (highly vulnerable) and has sustained blistered lesions (second-degree burns), which is an abnormal and harmful outcome.
Establishing the severity of harm and the client's inability to advocate for themselves dictates the urgency of the intervention.
2
Evaluate the caregiver's explanation against ethical principles of nonmaleficence and advocacy.
Although the caregiver claims a cultural intent (cupping), the practice resulted in actual physical injury (burns).
Cultural competence does not override the fundamental nursing duty to protect clients from physical harm and report suspected abuse or neglect.
3
Determine the mandatory legal obligation for the registered nurse.
The nurse must immediately report the findings to the appropriate adult protective services.
Nurses are legally mandated reporters for suspected elder abuse, neglect, or harmful circumstances, regardless of the caregiver's stated intent.

Key Concept

Ethical Practice: Mandatory Reporting and Client Advocacy
Estimated Time:1m 15s
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Topics

Ethical Practice

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