A nurse is delegating tasks for an assistive personnel (AP) to perform for a client who is 1-day postoperative following cardiac surgery. Which of the following tasks should the nurse perform herself?

A. A 14-month-old toddler with bruises on bony prominences:

Bruises on bony prominences are common in toddlers who are learning to walk and are prone to falls. While bruising can raise concerns, it is not necessarily indicative of physical abuse, especially in this age group.

B. A 9-month-old infant who sustained near drowning:

Near drowning in an infant who climbed into the tub and turned on the water suggests an accidental event rather than physical abuse. This scenario is consistent with lack of supervision or an unfortunate accident.

C. A 3-year-old toddler with scalding burns:

Scalding burns from spilling hot tea on oneself can occur accidentally, especially in young children who may not understand the dangers associated with hot liquids. While the circumstances may raise suspicion, it does not necessarily indicate physical abuse without further evidence.

D. A 6-year-old child with a spiral fracture:

A spiral fracture of the tibia and fibula is concerning for physical abuse, especially in a child who reportedly sustained the injury while riding a bicycle. Spiral fractures are often associated with twisting or pulling forces and are considered suspicious for non-accidental trauma, particularly when there is no plausible explanation for the injury.

(A) Increase the heat in the client’s room: Increasing the heat in the client’s room is not typically recommended for a client experiencing dyspnea. Heat can sometimes make breathing more difficult, and it does not address the underlying cause of the dyspnea.

(B) Perform nasotracheal suctioning for the client: Nasotracheal suctioning can be used to clear the airway in certain situations, but it is not typically the first-line treatment for dyspnea in a client at the end of life. It can be uncomfortable and distressing for the client.

(C) Place the head of the client’s bed flat: Placing the head of the bed flat can actually make breathing more difficult for a client experiencing dyspnea. It is generally more helpful to elevate the head of the bed to facilitate easier breathing.

(D) Administer an opioid narcotic to the client: This is the most appropriate answer. Opioid narcotics can help to relieve dyspnea in clients at the end of life by reducing anxiety, decreasing the sensation of breathlessness, and improving the client’s overall comfort level. The use of opioids in this context should be carefully monitored to manage potential side effects.