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Difficulty: HardBasic Care and Comfort

A nurse is delegating care tasks to an unlicensed assistive personnel (UAP) for a client who is receiving continuous enteral tube feedings, wears bilateral sequential compression devices (SCDs), and is on contact precautions for a Clostridioides difficile infection. Which instruction provided by the nurse to the UAP is appropriate?

  1. Remove the sequential compression sleeves during the bed bath and ensure the legs are completely dry before reapplying them.Answer
  2. B
    Pause the enteral feeding pump temporarily before lowering the head of the bed to change the linens.
  3. C
    Keep the head of the bed flat while performing the bath to make turning the client from side to side easier.
  4. D
    Use an alcohol-based hand rub immediately after removing and bagging the client's soiled bed linens.

Answer

The correct instruction is to remove the sequential compression sleeves for the bed bath and ensure the client's legs are completely dry before reapplying them.
The UAP is permitted to remove and reapply sequential compression devices (SCDs) to perform basic hygiene tasks like a bed bath. Instructing the UAP to ensure the skin is completely dry before reapplication is a correct and necessary intervention to prevent moisture accumulation, which can lead to skin maceration and breakdown. This task safely falls within the UAP's scope of providing basic care and comfort.

Step-by-Step Solution

1
Analyze the client's risk factors and prescribed therapies.
Identified continuous tube feeding (aspiration risk), SCDs (skin integrity risk), and C. difficile (transmission risk).
Comprehensive care requires addressing mobility, nutrition, and infection control safely during basic care tasks.
2
Evaluate the UAP scope of practice for the suggested interventions.
Determined that operating feeding pumps is outside the UAP's scope, while assisting with hygiene and SCD removal/reapplication is within scope.
Safe delegation requires matching the task to the personnel's legal and educational boundaries.
3
Assess the physical positioning and safety implications of each instruction.
Identified that lowering the bed flat without RN intervention to pause the pump causes aspiration risk, and alcohol rub fails to eradicate C. difficile spores.
Nursing instructions must not inadvertently cause harm or violate standard safety protocols.
4
Select the appropriate basic care instruction.
Selected the instruction regarding SCD removal and skin drying.
This is a safe, delegable basic care task that promotes skin integrity and comfort.

Key Concept

Delegation of basic care tasks while maintaining safety protocols for enteral feeding, infection control, and skin integrity.
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Topics

Basic Care and Comfort

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