A nurse is planning care for a client who has a prescription for a bowel-training program following a spinal cord injury.

Which of the following actions should the nurse include in the plan of care?

The correct answer is Choice D, "We can provide a copy of your records, but the therapist's notes are not included."

Rationale for Choice A:

• Puts the client on the defensive:Asking "Why are you interested in seeing your therapist's notes?" can make the client feel like they need to justify their request,potentially leading to defensiveness or withdrawal.
• May not uncover true motivation:The client may not feel comfortable revealing their true reasons for wanting to see the notes,and this approach could hinder open communication.
• Undermines client autonomy:It's important to respect the client's right to access their own information,even if it's not always beneficial.Questioning their motives could make them feel less empowered in their treatment.

Rationale for Choice B:

• Paternalistic and dismissive:Saying "I don't think you will benefit from reviewing your therapist's notes right now" assumes that the nurse knows what's best for the client without exploring their perspective.
• Discourages open communication:It shuts down conversation and may prevent the client from expressing their concerns or needs.
• Could damage therapeutic relationship:By dismissing the client's request,the nurse risks eroding trust and rapport,which are essential for effective therapy.

Rationale for Choice C:

• Assumes dissatisfaction with treatment:Asking "Are you not happy with your treatment?" immediately focuses on potential problems rather than understanding the client's motivations.
• May not be accurate:The client's request may not stem from dissatisfaction with treatment but rather from curiosity,a desire for control,or other reasons.
• Could create unnecessary anxiety:Raising concerns about treatment satisfaction without proper exploration could create anxiety or doubts in the client's mind.

Rationale for Choice D:

• Clear and informative:It directly addresses the client's request while providing accurate information about the availability of records.
• Protects therapist's notes:It upholds the therapist's right to maintain confidentiality of their thought processes and clinical impressions.
• Offers alternative solutions:It suggests that the client can access other parts of their record,potentially addressing their underlying need for information.
• Professional and respectful:It maintains professional boundaries and respects the client's right to information without disclosing protected notes.

This means that the client knows who they are, where they are, and what time it is. This indicates a high level of consciousness and a normal Glasgow coma scale (GCS) rating of 15.

Choice A is wrong because the client withdraws from pain.

This means that the client reacts to a painful stimulus by pulling away from it. This indicates a lower level of consciousness and a GCS rating of 4 for motor response.

Choice B is wrong because the client is unable to obey commands.

This means that the client does not follow simple instructions such as moving a limb or opening their eyes. This indicates a lower level of consciousness and a GCS rating of 1 or 2 for motor response.

Choice C is wrong because the client opens eyes to sound.

This means that the client does not open their eyes spontaneously, but only when they hear a loud noise. This indicates a lower level of consciousness and a GCS rating of 3 for eye opening.

The Glasgow coma scale is a clinical tool used to assess the level of consciousness of a person after a brain injury.

It consists of three tests: eye opening, verbal response, and motor response.

Each test has a score range from 1 to 6, with higher scores indicating higher levels of consciousness. The total score ranges from 3 to 15, with lower scores indicating higher risk of death.