A nurse has just received change-of-shift report for four clients. Which of the following clients should the nurse assess first?

Choice A rationale:

Covering appliance cords with throw rugs is not an appropriate action to address the needs of a client with vision loss and medication management. While it promotes safety by reducing tripping hazards, it does not directly address the client's medication administration needs. Implementing measures that specifically assist the client in managing medications safely is essential in this scenario.

Choice B rationale:

Visiting the client once per month to assess medication usage is insufficient for an older adult with vision loss who takes medications throughout the day. Regular and more frequent assessments are necessary to ensure the client's safety and adherence to the medication regimen. The nurse should consider more proactive measures to support the client, such as providing medication organizers or arranging for a home healthcare aide to assist with medication administration daily.

Choice C rationale:

This is the correct answer. Using container lids of different shapes to indicate times of administration is an effective strategy for clients with vision loss. Associating specific shapes with different times of the day helps the client differentiate between medications, promoting accurate dosing. This method is tactile and easy for the client to understand, enhancing their ability to manage medications independently and safely.

Choice D rationale:

Rearranging furniture to clear walkways is a general safety measure but does not specifically address the client's medication administration needs. While it can prevent falls and accidents, it does not facilitate the client's ability to distinguish between different medications or their dosing schedules. The focus should be on implementing strategies that directly support the client in managing their medications effectively despite their visual impairment.

Serotonin syndrome: This is a potentially life-threatening condition caused by an excess of serotonin in the brain. It can occur when there is an increase in the dose of an SSRI or when a new SSRI is introduced, particularly if the client has recently been on another SSRI, as in this case where fluoxetine was switched to paroxetine.

Selective serotonin reuptake inhibitors (SSRIs): Both fluoxetine and paroxetine are SSRIs. The risk of serotonin syndrome increases with changes or increases in the dosage of SSRIs due to the potential for excessive serotonin levels.