An older woman tells the nurse practitioner that she fears her family will place her in a nursing home because she developed stress incontinence. Which recommendation should the nurse implement?

Rationale for Correct Choices:

• Have ABGs drawn: Obtaining ABGs is the priority because this client has pneumonia with worsening respiratory status, oxygen saturation dropping to 90% on room air, and signs of hypoxia. ABGs provide immediate information about oxygenation, ventilation, and acid-base balance, which are critical for respiratory distress and guiding oxygen therapy.

• Administer antibiotics: Administering antibiotics is the next priority after collecting labs, as timely treatment of pneumonia and potential sepsis is critical. The client shows signs of worsening infection with elevated WBC and vital sign changes, and early antibiotic administration improves outcomes and prevents further deterioration.

Rationale for Incorrect Options:

• Collect blood for BMP: While a BMP is important to assess electrolyte imbalances and kidney function, it is secondary to evaluating respiratory function and oxygenation in this acutely ill client. BMP can be collected after addressing urgent respiratory needs.
• Encourage PO fluids: While encouraging oral fluids supports hydration and recovery, it may not be feasible or safe initially if the client is confused, agitated, or has respiratory distress. Prioritizing assessment through lab tests before interventions ensures a targeted approach.
• Implement fall precautions: While fall precautions are important due to the client’s confusion and restlessness, they are a safety measure rather than an immediate clinical intervention. These should be implemented concurrently but do not take precedence over diagnosing and treating the infection.
• Discontinue oxygen therapy: Discontinuing oxygen therapy is inappropriate given the client’s oxygen saturation drops to 90% without supplemental oxygen. Maintaining adequate oxygenation is essential, especially in pneumonia, and should not be stopped.

A. Keeping several low wattage night lights on in the evening: Adequate lighting reduces disorientation and prevents tripping hazards in dim environments. Night lights are a safe and effective fall-prevention strategy for older adults.

B. Keeping the side rails up on the client's bed at night: Side rails can increase the risk of injury, as frail older adults may attempt to climb over them and fall from a greater height. This intervention is considered a restraint and raises safety concerns in fall prevention.

C. Installing wooden railings on the stairway to the bathroom: Secure railings provide needed support and stability for frail adults navigating stairs, reducing the risk of falls. This is an appropriate home modification for safety.

D. Encouraging the client to use a cane when ambulating: A cane improves balance and reduces fall risk when fitted and used properly. Encouraging its use supports safe mobility and independence in older adults.