A nurse in an acute care facility is caring for a toddler.

Exhibits

For each assessment finding below, click to specify if the assessment finding is consistent with Crohn's disease, appendicitis, or intussusception. Each finding may support more than 1 disease process.

Rationale:
A. Pain: Persistent or severe pain in a client at the end of life indicates the need for a palliative care consultation. Palliative care focuses on symptom relief, comfort, and quality of life through interdisciplinary management, particularly when standard treatments fail to control pain effectively.

B. Dysphagia: While it requires assessment and dietary modification, it does not independently warrant a palliative consultation unless associated with uncontrolled distress or nutritional compromise.

C. Fatigue: Fatigue is a frequent symptom at the end of life, typically managed through rest, activity pacing, and supportive care. Although it contributes to discomfort, it is not the primary trigger for initiating palliative care unless it severely affects the client’s comfort.

D. Mottling: Mottling is a physical sign of imminent death resulting from decreased circulation. At this stage, palliative or hospice care is often already in place, and new consultation would not alter the course of care.

Rationale:

• Encourage naps during the day when client is tired: Daytime napping can interfere with nighttime sleep quality and reduce trazodone’s effectiveness in reestablishing a normal sleep pattern.

• Advise client to rise slowly from sitting position: Trazodone can cause orthostatic hypotension, particularly when therapy is initiated. Educating the client to change positions slowly helps prevent dizziness and potential falls caused by sudden drops in blood pressure.

• Instruct client to avoid foods that have been fermented or aged: This instruction applies to MAOIs due to the risk of hypertensive crisis from tyramine, but trazodone is a serotonin antagonist and reuptake inhibitor, not an MAOI.

• Encourage client to sleep until later in the morning: Oversleeping disrupts the circadian rhythm and may worsen fatigue. The goal is to maintain a stable sleep-wake cycle to enhance mood and energy regulation.

• Encourage a regular sleep-wake schedule: Establishing consistent sleep routines supports trazodone’s sedative effects and helps regulate the client’s circadian rhythm, improving overall sleep quality without disrupting normal activity patterns.

• Advise client to notify provider if pregnant: Trazodone is classified as pregnancy category C, meaning potential fetal risks exist. The client should notify the provider to evaluate the safety of continuing or adjusting medication during pregnancy.

• Encourage high-calorie finger foods: The client’s BMI has decreased, and trazodone may cause appetite suppression. Offering convenient, calorie-dense snacks helps maintain adequate nutrition and prevents further weight loss.