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Difficulty: MediumBasic Care and Comfort

A nurse is developing a plan of care for an 82-year-old client with advanced Parkinson's disease who requires assistance with activities of daily living due to generalized weakness, dysphagia, and muscle rigidity. Which basic care and comfort interventions should the nurse include? Select all that apply.

  1. Maintain the head of the bed at a 90-degree angle during meals and for at least 30 minutes afterward.Answer
  2. B
    Delegate the initial evaluation of the client's swallowing effectiveness during breakfast to the unlicensed assistive personnel (UAP).
  3. Schedule uninterrupted rest periods between hygiene tasks and physical therapy sessions.Answer
  4. D
    Place a pillow directly under the client's popliteal space while in bed to reduce lower back strain.
  5. E
    Document new-onset sudden confusion and urinary incontinence as expected physiological changes of advanced aging.
  6. Provide frequent oral care using a suction toothbrush to manage excess saliva and prevent aspiration.Answer

Answer

The correct interventions are maintaining the head of the bed at 90 degrees during and after meals, scheduling rest periods, and providing oral care with a suction toothbrush.
Clients with Parkinson's disease and dysphagia are at high risk for aspiration and severe fatigue. Elevating the head of the bed during and after meals uses gravity to prevent food and fluids from entering the airway. Scheduling regular rest periods conserves the client's energy and mitigates generalized weakness. Using a suction toothbrush for oral care safely removes excess secretions and pooled saliva, further reducing aspiration risk while maintaining mucosal integrity.

Step-by-Step Solution

1
Analyze the client's clinical presentation and risk factors.
The client has advanced Parkinson's disease, dysphagia, weakness, and rigidity, placing them at high risk for aspiration, fatigue, and immobility complications.
Identifying risk factors dictates the necessary basic care and comfort measures.
2
Evaluate the interventions for airway and aspiration safety.
Positioning the client upright for meals and using a suction toothbrush for oral hygiene effectively mitigate aspiration risks associated with dysphagia.
Aspiration pneumonia is a severe, preventable complication of dysphagia.
3
Evaluate the interventions for mobility and comfort.
Scheduling rest periods addresses the generalized weakness. However, placing a pillow under the popliteal space is contraindicated due to deep vein thrombosis risk.
Basic care must promote comfort without introducing new circulatory or mobility risks.
4
Evaluate the delegation and assessment interventions.
The RN must perform initial swallowing assessments, and sudden changes in cognition or continence must be investigated as pathology rather than normal aging.
UAPs cannot assess, and acute mental status changes in older adults often indicate infection or delirium.

Key Concept

Basic care, comfort, and safety interventions for clients with neuromuscular deficits and dysphagia.
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Topics

Basic Care and Comfort

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