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Difficulty: MediumCollaboration with Interdisciplinary Team

An older adult client with a history of severe rheumatoid arthritis is preparing for discharge to an assisted living facility. The client has intact swallowing reflexes but has been steadily losing weight over the past week. During meals, the nurse observes that severe joint deformities in the client's hands prevent them from holding standard forks and spoons. Which action should the nurse take to most appropriately address this clinical issue?

  1. A
    Consult a registered dietitian immediately to calculate an increased daily caloric requirement.
  2. B
    Delegate the evaluation of the client's baseline self-feeding abilities to the unlicensed assistive personnel (UAP).
  3. Arrange for an occupational therapy evaluation to obtain adaptive feeding devices.Answer
  4. D
    Assure the client that they do not need to worry because the facility staff will gladly feed them every day.

Answer

The most appropriate action is to arrange for an occupational therapy evaluation so the client can receive adaptive feeding devices.
The correct action directly addresses the root cause of the client's weight loss. Occupational therapists specialize in maximizing independence in activities of daily living (ADLs). By evaluating the client for adaptive feeding devices, such as built-up or weighted utensils, the therapist can help bypass the severe joint deformities caused by rheumatoid arthritis, allowing the client to feed themselves safely and effectively.

Step-by-Step Solution

1
Analyze the client's clinical presentation and identify the root cause of the weight loss.
The root cause is a mechanical inability to hold utensils due to rheumatoid arthritis, not a lack of available calories or a swallowing deficit.
Identifying the exact barrier to nutrition is required to select the appropriate interdisciplinary intervention.
2
Determine which interdisciplinary team member possesses the scope of practice to address the specific mechanical barrier.
An occupational therapist is identified as the correct professional.
Occupational therapists are experts in fine motor skills and adapting activities of daily living (ADLs) through environmental modifications and adaptive equipment.
3
Evaluate the other options for safety, delegation rules, and therapeutic communication standards.
Delegating evaluation to a UAP violates scope of practice, assuring the client the staff will feed them uses false reassurance, and a dietitian consult misses the mechanical priority.
Ruling out distractors confirms that the occupational therapy referral is the only safe, effective, and collaborative choice.

Key Concept

Occupational Therapy Scope of Practice for ADLs
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Topics

Collaboration with Interdisciplinary Team

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