A nurse is providing teaching to a client who has a new colostomy. Which of the following actions should the nurse take when demonstrating how to change the ostomy appliance?

Choice A rationale:

The neighbor is not authorized to provide consent for the client's procedure. The durable power of attorney for health care typically designates someone to make medical decisions when the client is unable to do so, but the neighbor's role may not extend to medical procedure consent.

Choice B rationale:

The client's spouse might have a legal standing to make decisions for the client, but the durable power of attorney for health care typically takes precedence over the spouse's decision-making authority in situations where it has been established.

Choice C rationale:

The provider, in this case, the medical doctor or healthcare professional performing the endoscopy, has the authority to obtain consent for the procedure. Informed consent is a crucial ethical and legal requirement, and the provider must ensure that the client or their designated decision-maker understands the procedure, its risks, and benefits before proceeding.

Choice D rationale:

A member of the facility's ethics committee does not typically have the authority to provide consent for a specific medical procedure on behalf of an incapacitated client. The ethics committee's role is to provide guidance on ethical dilemmas and issues but not to provide individual procedural consent.

Choosing the best intervention for a client with fever due to infection:

The most appropriate intervention for a client with fever due to infection depends on various factors, including the severity of the fever, the client's age and overall health, and their individual preferences. Let's analyze each option and explain its rationale:

a. Encourage fluid intake of 2,500 mL/day.

Rationale:

• Pros:Fever often leads to increased sweating and fluid loss through respiration. Maintaining adequate hydration is crucial to prevent dehydration, which can worsen discomfort and potentially lead to complications like organ dysfunction. Encouraging a fluid intake of 2,500 mL/day is generally recommended for adults with fever, although individual needs may vary based on factors like body size and activity level.
• Cons:While hydration is essential, forcing fluids on a client who experiences nausea or vomiting can be counterproductive. Additionally, some clients with certain medical conditions, like heart failure, may require fluid restriction, making this option inappropriate.

b. Maintain the environmental temperature at 16°C to 18°C (60°F to 65°F).

Rationale:

• Cons:Excessively cool environments can trigger shivering, which actually increases body heat production and can worsen the fever. Additionally, maintaining such a low room temperature can be uncomfortable for the client and may increase their risk of chills.

c. Immerse the client in cold water.

Rationale:

• Cons:Immersing a client in cold water, like a bath, can be a dangerous and counterproductive intervention. The sudden chill can trigger violent shivering, significantly increasing body heat production and potentially causing shock. Moreover, rapid cooling can be uncomfortable and even risky for people with certain health conditions like heart disease.

d. Assist the client to ambulate.

Rationale:

• Cons:While ambulation is generally encouraged for healthy clients, it may not be suitable for everyone with a fever. Depending on the severity of the fever and the client's overall condition, ambulation could be tiring and even unsafe. In some cases, rest may be more appropriate to promote comfort and recovery.

Therefore, the most appropriate intervention for a client with fever due to infection is:

a. Encourage fluid intake of 2,500 mL/day.

Remember:

• Individualize care based on the client's specific needs and preferences.
• Monitor the client's response to interventions and adjust as needed.
• Consult with the healthcare provider for guidance on managing the fever and addressing any underlying infection.