A nurse is caring for a client who has impaired speech. Which of the following actions should the nurse take?

Choice A reason : Administering an opioid narcotic can be an effective measure for managing dyspnea in end-of-life care. Opioids, such as morphine, can reduce the sensation of breathlessness and improve comfort without significantly affecting oxygen saturation levels. The use of opioids is a well-established practice in palliative care for the relief of dyspnea, particularly when other causes of dyspnea have been addressed and managed appropriately.

Choice B reason : Increasing the heat in the client's room is not a recommended action for managing dyspnea and may actually worsen the client's comfort. Patients experiencing dyspnea often feel better in a cooler environment, as warm temperatures can make breathing feel more labored⁴.

Choice C reason : Placing the head of the client's bed flat is not advisable for managing dyspnea. Elevating the head of the bed can help ease breathing by reducing pressure on the diaphragm and allowing for better lung expansion. A semi-upright position, such as Fowler's or semi-Fowler's position, is typically recommended for patients experiencing dyspnea.

Choice D reason : Nasotracheal suctioning is a procedure used to clear secretions from the airway. While it may be necessary in some cases, it is not a standard action for managing dyspnea in end-of-life care unless there is a specific indication, such as excessive secretions that the patient cannot clear on their own. It can be uncomfortable and distressing for the patient and should be used judiciously⁵.

Choice A reason : This response is patient-centered and collaborative. It acknowledges the client's concerns and preferences, which is crucial in managing diabetes effectively. By involving the client in the decision-making process, the nurse empowers the client to take an active role in their health care. This approach can lead to better adherence to dietary recommendations and improved glycemic control. It is also aligned with the principles of effective communication with patients living with diabetes, which emphasize understanding, empathy, and cultural competency.

Choice B reason : This statement is accusatory and could make the client feel guilty or blamed for their condition. It is not constructive and does not contribute to a positive therapeutic relationship. Diabetes mellitus is a complex disease with multiple risk factors, including genetics, lifestyle, and environmental factors. It is not helpful to oversimplify the cause of the disease to one factor, such as diet alone.

Choice C reason : While this statement may be true for some, it does not acknowledge the individual challenges the client may face in adjusting to a new diet. It is important to recognize that each person's experience with diabetes and dietary changes is unique. A more supportive approach would be to offer guidance and resources to help the client gradually adapt to the changes.

Choice D reason : This statement is presumptive and does not take into account the client's current feelings or potential difficulties they may encounter. While a healthier diet can lead to better health outcomes, it is essential to validate the client's feelings and provide support and education to help them understand the benefits of the dietary changes.