Choice A rationale:
While PICCs are typically intended for shorter-term use (up to 12 weeks), the fact that a PICC has been in place for 4 weeks is not, in itself, an immediate cause for concern. Regular assessment of the catheter and site is crucial, but the duration of placement alone does not warrant immediate attention.
Choice B rationale:
While it's generally recommended to change PICC dressings every 7 days, a dressing that is 3 days old is not an immediate emergency. The nurse should prioritize changing the dressing as soon as possible, but it does not require the same level of urgency as other potential complications.
Choice C rationale:
A missing securement device is a concern because it can increase the risk of catheter dislodgement or migration. However, it does not necessarily indicate an immediate threat to the patient's well-being. The nurse should promptly address the missing securement device, but it would not be the most pressing issue compared to swelling in the extremity.
Choice D rationale:
Swelling in the upper extremity where the PICC is located is a significant finding that demands immediate attention. It can be a sign of several serious complications, including:
Thrombosis: A blood clot within the vein, which can obstruct blood flow and lead to pain, swelling, and potentially more severe consequences like deep vein thrombosis (DVT) or pulmonary embolism (PE).
Infection: Inflammation and infection at the insertion site or within the bloodstream, which can cause swelling, redness, warmth, and pain. If left untreated, infection can progress to sepsis, a life-threatening condition.
Phlebitis: Inflammation of the vein, which can cause pain, redness, and swelling along the vein.
Infiltration: Leakage of fluids or medications into the surrounding tissue, leading to swelling and discomfort.
Prompt action is crucial in these cases to prevent further complications and ensure patient safety. The nurse should immediately notify the appropriate healthcare provider, initiate necessary interventions, and closely monitor the patient's condition.

Rationale for Choice A:

Arranging for a bedside commode can be helpful for patients who have difficulty ambulating to the bathroom. However, it is not the most effective intervention for preventing falls in an ambulatory and independent patient. In fact, it could potentially increase the risk of falls if the patient attempts to use the commode without assistance or if they become disoriented in the dark.

Research has shown that bedside commodes are associated with an increased risk of falls in hospitalized patients. This is because patients may try to get out of bed to use the commode without assistance, or they may become disoriented in the dark and fall.

Additionally, bedside commodes can be a tripping hazard, especially for patients with impaired mobility.

Rationale for Choice B:

Ensuring the bathroom light is kept on during the night can help to reduce the risk of falls by making it easier for the patient to see. However, it is not the most effective intervention for preventing falls.

Patients may still fall even if the bathroom light is on, especially if they are weak, unsteady, or have impaired vision. Additionally, keeping the bathroom light on all night can disrupt the patient's sleep, which can also increase the risk of falls.

Rationale for Choice C:

Using side rails to keep the patient in bed is not an effective intervention for preventing falls. In fact, it can actually increase the risk of falls by making it more difficult for the patient to get out of bed safely.

Patients may try to climb over the side rails, which can lead to falls.

Additionally, side rails can restrict the patient's movement and make them feel trapped, which can lead to agitation and an increased risk of falls.

Rationale for Choice D:

Implementing a toileting schedule is the most effective intervention for preventing falls in an ambulatory and independent patient. This is because it helps to reduce the patient's need to get out of bed at night to use the bathroom.

When a patient has a scheduled time to toilet, they are less likely to try to get out of bed on their own and risk a fall. Additionally, a toileting schedule can help to prevent incontinence, which can also lead to falls.