A hospice nurse is concerned that the partner of a client is experiencing caregiver burden. Which of the following actions should the nurse take first?

The correct answer is Choice A because, "Offer to face the client's bed toward the east." This is the correct answer because traditional American Indian practices include spiritual and cultural beliefs that may require facing the client's bed towards the east.

Choice B is wrong because, "Provide direct eye contact when communicating with the client's family," is not the correct answer because direct eye contact may be seen as disrespectful in some American Indian cultures.

Choice C is wrong because, "Develop a list of appropriate hot and cold food choices," is not the correct answer because it is not specific to traditional American Indian practices.

Choice D is wrong because, "Discuss safe use of herbal medications," is not the correct answer because it is not specific to traditional American Indian practices and may be considered invasive or disrespectful in some cultures.

Interventions for Chemotherapy-Induced Nausea: Analyzing the Choices

The prompt describes a home health nurse caring for a client experiencing chemotherapy-induced nausea resistant to pharmacological interventions. We need to analyze the effectiveness of each offered intervention based on evidence and rationale:

a. Maintain the head of the client's bed in an elevated position after eating.

Rationale:

• Supportive:Some studies suggest elevating the head of the bed by 30-45 degrees might reduce gastroesophageal reflux and nausea after meals.

b. Provide sips of room-temperature ginger ale between meals.

Rationale:

• Supportive:Ginger has demonstrated antiemetic properties in several studies,potentially reducing nausea and vomiting.Room-temperature liquids are generally better tolerated than cold or hot ones for nausea.
• Considerations:The effectiveness of ginger may vary between individuals,and potential interactions with other medications should be checked.

c. Offer 120 mL (4 oz) of cold milk as a meal replacement.

Rationale:

• Unsupportive:Replacing meals with small volumes of milk is inadequate for nutritional needs and can worsen nausea due to an empty stomach.Chemotherapy can already impact appetite and nutrient intake,and offering small,frequent meals is generally recommended.
• Potential harm:Skipping meals can lead to electrolyte imbalances,dehydration,and further weaken the client.

d. Use seasonings to enhance the flavor of foods.

Rationale:

• Mixed evidence:While strong odors or unfamiliar flavors can trigger nausea in some clients,using bland or mild seasonings might not be universally effective.Some studies suggest offering preferred or familiar flavors based on individual preferences could improve appetite and tolerance.
• Individualization:Experimenting with different spices and flavors based on the client's preferences and observing their response is crucial.

e. Assist the client in using guided imagery.

Rationale:

• Supportive:Guided imagery is a relaxation technique that can help manage nausea by distracting the client from the unpleasant sensation and promoting feelings of calmness.Studies have shown its effectiveness in reducing nausea and vomiting in various contexts,including chemotherapy.
• Considerations:Not all clients may be receptive to guided imagery,and its success depends on individual preferences and practice.

In conclusion, the most appropriate interventions for the client include:

• Providing sips of room-temperature ginger ale between meals (choice b).
• Assisting the client in using guided imagery (choice e).

Choices a, c, and d require further evaluation or are not generally recommended based on current evidence.