A hospice nurse is caring for a client who is approaching death and has fecal incontinence. Which of the following actions should the nurse take?

Request a prescription for lactulose from the provider.

Place an occlusive dressing over the client's buttocks every 8 hr.

Insert a lubricated rectal tube gently.

Keep disposable undergarments clean and dry.

Answer and Explanation

The Correct Answer is D

A. Request a prescription for lactulose from the provider: Lactulose is a laxative commonly used to treat constipation, but it is not appropriate for managing fecal incontinence in a hospice client approaching death. It focuses on promoting bowel movements rather than managing incontinence.

B. Place an occlusive dressing over the client's buttocks every 8 hr: Occlusive dressings are not typically used for managing fecal incontinence. They may trap moisture and exacerbate skin breakdown, especially in a hospice client who may be immobile or bedridden.

C. Insert a lubricated rectal tube gently: Inserting a rectal tube is invasive and may cause discomfort or injury, especially in a client who is approaching death. It is not recommended for managing fecal incontinence in this situation.

D. Keep disposable undergarments clean and dry: This is the most appropriate action for managing fecal incontinence in a hospice client. Keeping disposable undergarments clean and dry helps maintain skin integrity and prevents skin breakdown and discomfort. It also promotes comfort and dignity for the client during this sensitive time.

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Correct Answer is D

Explanation

A. "Don’t let him get away with this abuse. He doesn’t need to yell at you": This response is dismissive of the patient's emotions and fails to address the underlying issues causing the anger. It may escalate the situation and create conflict rather than fostering understanding and support.

B. "I'm afraid he is having a bad day and feels neglected": While this response acknowledges the patient's feelings, it does not provide a broader context for understanding the patient's behavior. It may also inadvertently minimize the patient's emotions and the impact of his terminal illness.

C. "This may be how he feels best in dealing with this illness. You'll just have to ignore it": This response dismisses the patient's behavior as acceptable without exploring its underlying causes. It does not promote therapeutic communication or help address the patient's needs and concerns.

D. "Anger is a reaction that dying people experience. You may be feeling some anger yourselves": This response acknowledges the patient's emotions as a common reaction to terminal illness, normalizing his experience. It also recognizes the emotions of the nurses and family, encouraging empathy and understanding. By validating the patient's feelings and providing context, the nurse can facilitate a supportive environment and promote effective communication and care.

A. IV fluids or tube feeding would likely make the patient more uncomfortable, and dehydration has been shown to decrease pain and discomfort. B. Once the patient is unconscious, his health care proxy can order IV fluids or tube feedings to prevent dehydration. C. IV fluids or a tube feeding would make the patient much more comfortable, and they should try to talk him into accepting them. D. dehydration is painful, and medication can be given to overcome any pain.

Correct Answer is A

Explanation

A. This response aligns with best practices in hospice care, which prioritize comfort and quality of life for terminally ill patients. Dehydration is a common occurrence at the end of life and is generally not associated with discomfort when managed appropriately. IV fluids or tube feedings may cause discomfort, contribute to fluid overload, or lead to complications such as aspiration pneumonia.

B. While the healthcare proxy may have the authority to make decisions on behalf of the patient, the focus should be on honoring the patient's wishes as expressed in advance directives. If the patient has clearly indicated a preference against IV fluids or tube feedings in their advance directives, this should be respected.

C. Encouraging the family to try to talk the patient into accepting IV fluids or tube feedings goes against the principles of patient autonomy and informed decision-making. The decision regarding medical interventions should be based on the patient's preferences and comfort.

D. While dehydration can be uncomfortable in some circumstances, providing adequate symptom management, including pain medication, is essential in hospice care. However, IV fluids or tube feedings are not typically used to manage dehydration in patients who are at the end of life, as they may not improve comfort and can lead to complications.

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A hospice nurse is caring for a client who is approaching death and has fecal incontinence. Which of the following actions should the nurse take?

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Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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