A nurse is providing end-of-life care to an older female client who practices Judaism. Which intervention would the nurse identify as potentially problematic for this client and her family?
The client requires transfusions of packed red blood cells during care.
Assessment by a male health care provider was required.
A do-not-resuscitate (DNR) order was recommended by the care team.
An autopsy was ordered due to the client's unique disease etiology.
The Correct Answer is D
A. The client requires transfusions of packed red blood cells during care.
In Judaism, blood transfusions are generally accepted as a medical intervention to save a life or improve health. However, opinions may vary among individuals and communities. It's essential to respect the client's wishes regarding medical interventions, including blood transfusions, and to involve the family in decision-making if necessary. While this intervention may not inherently conflict with Jewish beliefs, individual preferences and religious interpretations should be respected.
B. Assessment by a male health care provider was required.
In Orthodox Judaism, there are rules regarding modesty and gender separation, particularly concerning physical contact with members of the opposite sex. Some Orthodox Jewish women may prefer female healthcare providers, especially for intimate examinations or procedures. It's crucial to respect the client's religious beliefs and preferences regarding modesty and gender-related care.
C. A do-not-resuscitate (DNR) order was recommended by the care team.
End-of-life decisions, including DNR orders, can be complex and sensitive topics in Judaism. While some Jewish individuals may choose to have a DNR order based on their beliefs about the sanctity of life and quality of life, others may prefer all possible measures to be taken to prolong life. It's essential to involve the client, their family, and potentially a spiritual advisor or rabbi in discussions about end-of-life care preferences and decisions.
D. An autopsy was ordered due to the client's unique disease etiology.
Autopsies are generally discouraged in Judaism because they are viewed as desecrating the body and delaying burial, which is an important aspect of Jewish tradition. However, there may be exceptions in certain circumstances, such as when required by law or when necessary for medical research or legal reasons. Nevertheless, sensitivity to the religious beliefs and practices of the client and their family is crucial when considering autopsy requests.
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Correct Answer is C
Explanation
A. Spending the day at adult day care:
While adult day care programs can offer socialization, supervision, and activities for older adults during the day, they may not directly address the safety concerns associated with the client's recent falls, especially if the falls are occurring at home. Additionally, spending the day at adult day care may not address the need for immediate assistance in case of falls or emergencies when the client is at home alone.
B. A live-in home health care provider:
Having a live-in home health care provider can provide continuous assistance and supervision for the client, which may address safety concerns and reduce the risk of falls, particularly if the falls are related to mobility issues or other health conditions. However, this option may be more intrusive and costly compared to other solutions, and it may not be necessary if the client's needs can be addressed with less intensive interventions.
C. Use of a home monitoring system:
A home monitoring system, such as a medical alert system or a fall detection device, can provide immediate assistance in the event of a fall or emergency. This option allows the client to maintain independence and continue living alone while ensuring that help is readily available when needed. It addresses the immediate safety concerns raised by the client's recent falls and provides peace of mind for both the client and their family members.
D. Relocation to an assisted living facility:
Relocating to an assisted living facility may be considered as a last resort if other options are not feasible or if the client's needs cannot be adequately addressed at home. However, this option may be overly intrusive and disruptive to the client's lifestyle, especially if they prefer to remain in their own home. It is typically reserved for situations where the client requires a higher level of care and supervision that cannot be provided in a home setting.
Correct Answer is C
Explanation
A. "Fortunately, most people over 65 have a sufficient level of income."
This statement might not accurately reflect the reality for many older adults. While some older adults may indeed have sufficient income, there is significant variability in financial resources among older populations. Many older adults face financial challenges due to factors such as retirement savings, pensions, social security benefits, healthcare costs, and economic disparities. Therefore, this statement may not be reflective of the broader population of older adults.
B. "It is reassuring older adults are receiving more concern than in decades past."
While it is positive to recognize increased concern and attention towards the well-being of older adults, this statement does not directly address the trend of increasing admissions of older adults to subacute medical units. Moreover, without specific data or context, it is difficult to assess the accuracy of this statement in relation to current trends in healthcare utilization among older adults.
C. "Most of the older clients on the unit will have come to us from nursing homes."
This statement acknowledges a common trend observed in healthcare, where older adults are increasingly transitioning from nursing homes or long-term care facilities to subacute medical units. This reflects the evolving landscape of healthcare delivery and the need for specialized care for older adults with complex medical needs. Therefore, this statement is most reflective of current thinking about the increasing admissions of older adults to subacute medical units.
D. "It helps that older people do not have to incur any costs for their medical care.”
This statement is inaccurate. While older adults may have access to Medicare, which covers certain medical expenses, it does not cover all costs, and there may still be out-of-pocket expenses, such as copayments, deductibles, and services not covered by Medicare. Additionally, financial barriers can still exist for older adults, especially those with limited income or inadequate insurance coverage. Therefore, this statement does not accurately reflect the financial realities of older adults' healthcare costs.
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