A home health nurse is caring for a group of older adult clients. The nurse should initiate a referral to the Program of All-Inclusive Care for the Elderly (PACE) for which of the following clients?

The correct answer is Choice A.

Choice A rationale:

Forming a committee of staff members to investigate current staffing issues is the first step the nurse manager should take. This is because it is important to understand the root cause of the problem before implementing any changes. The committee can gather data, identify patterns, and provide insights into why staffing for weekend shifts is a challenge. This could involve surveying staff members, reviewing shift patterns, and analyzing workload and patient acuity data. By involving staff members in the process, the nurse manager can ensure that the perspectives and experiences of those directly affected by the staffing issues are taken into account. This approach aligns with the principles of shared governance and participatory management, which have been shown to improve staff satisfaction and retention.

Choice B rationale:

While providing support to staff members who are resistant to staffing changes is an important part of change management, it is not the first step that should be taken. Resistance to change is often a symptom of deeper issues, such as lack of trust, poor communication, or perceived lack of fairness or respect. By first forming a committee to investigate the staffing issues (Choice A), the nurse manager can gain a better understanding of these underlying issues and address them directly. This can help to reduce resistance when changes are implemented.

Choice C rationale:

Scheduling a staff meeting to present different options to staff members is a key part of the change process, but it should not be the first step. Before presenting options, it is important to fully understand the problem and consider various possible solutions. This involves investigating the current staffing issues (Choice A) and potentially developing and evaluating different scheduling options. Once this has been done, the options can be presented to staff members for feedback and discussion.

Choice D rationale:

Giving staff members advance written notice of staffing changes is a crucial part of transparent and respectful communication. However, it is not the first step in addressing staffing issues. Before any changes can be announced, the nurse manager needs to understand the problem (Choice A), consider possible solutions, and involve staff members in the decision-making process (Choice C). Once a decision has been made, it should be communicated clearly and promptly to all staff members.

Choice A rationale:

Repositioning the NG tube is not the appropriate action for hyperosmolar dehydration. This condition occurs due to an excessive concentration of solutes in the body, leading to a decrease in intracellular water. Repositioning the tube would not address the hyperosmolarity issue.

Choice B rationale:

Increasing the rate of formula delivery may exacerbate the problem by introducing more concentrated formula into the client's system, worsening hyperosmolarity. This choice can lead to further dehydration and electrolyte imbalances.

Choice C rationale:

Adding water to the formula is the correct action in this scenario. Hyperosmolar dehydration requires dilution of the concentrated formula to reduce the osmolarity. By adding water to the formula, the nurse can decrease the concentration of solutes, helping to rehydrate the client effectively.

Choice D rationale:

Switching to a lactose-free formula is not the appropriate intervention for hyperosmolar dehydration. The issue lies in the concentration of the formula, not in its lactose content. Adding water is the more suitable and direct approach to address the problem.