The nurse identified that the patient has pain of 7 on a scale of 1 to 10 and he expresses discomfort over the incisional area. He guards the area by resisting movement. Which component is the S in a three-part nursing diagnostic statement using the PES format? Nursing Diagnosis: Acute pain r/t incisional trauma with guarding and restricted movement

A. Placing a high risk for falls armband on the patient: An armband alerts all healthcare providers to the patient's fall risk, helping to ensure appropriate precautions are taken.
B. Checking on the patient once a shift: This is not sufficient; patients on fall precautions should be checked more frequently, such as every hour or according to the facility's protocol, to ensure their safety.
C. Keep the bed in the lowest position: Keeping the bed at its lowest position reduces the risk of injury from falls and helps ensure the patient can easily get in and out of bed.
D. Placing all four side rails in the "up" position: Using all four side rails is not recommended as it can increase the risk of entrapment and may not be effective in preventing falls. Side rails should be used appropriately and in accordance with safety protocols.
E. Maintain call light within reach of the patient: Ensuring the call light is within reach helps the patient call for assistance if needed, which can help prevent falls.

A. The goal of palliative care is to prolong the life of a client: The primary goal of palliative care is to improve the quality of life by managing symptoms and providing comfort, rather than focusing solely on prolonging life.
B. Palliative care is not restricted to clients who are terminally ill: Palliative care can be provided to clients at any stage of a serious illness, regardless of whether they are terminally ill. It focuses on relief from symptoms and improving quality of life.
C. Palliative care should be avoided for a client who is receiving a cure: Palliative care can be provided alongside curative treatment to manage symptoms and improve quality of life throughout the treatment process.
D. Palliative care is limited to clients who are in a healthcare facility: Palliative care can be provided in various settings, including home care, outpatient clinics, and healthcare facilities.