The nurse is preparing a discharge teaching plan for a client who had a liver transplant. Which instruction is most important to include in this plan?

Rationale:
A. Encourage activity as tolerated: Gradual mobilization supports respiratory function, circulation, and muscle strength after prolonged intubation. Activity also helps reduce the risk of complications like atelectasis and deep vein thrombosis.

B. Assess ability to swallow solids and liquids: After extended intubation, clients are at risk for dysphagia, which can lead to aspiration pneumonia. A swallowing assessment is necessary to ensure safety before resuming a regular oral diet.

C. Assist client with active range of motion: Prolonged immobility in the ICU often leads to deconditioning and muscle weakness. Assisting with range of motion exercises promotes circulation, prevents contractures, and maintains joint flexibility.

D. Reinforce deep breathing exercises: Deep breathing promotes alveolar expansion, improves oxygenation, and prevents postoperative complications such as pneumonia or atelectasis, which are particularly concerning after extubation and in clients with COPD.

E. Obtain dietary consult for meal supplements: Poor appetite post-extubation can contribute to malnutrition and delayed recovery. A dietary consult ensures the client receives adequate caloric and protein intake through appropriate supplements.

Rationale:

A. Respiratory Therapist: Although respiratory therapists are involved when respiratory compromise occurs, the client has normal oxygen saturation and stable respiratory function, so this role isn’t prioritized in current care.

B. Pharmacy Technician: Pharmacy technicians focus on medication dispensing and inventory, but do not participate in direct patient care or individualized therapy planning for stroke recovery.

C. Speech Therapist: A speech therapist is essential for evaluating and managing post-stroke speech and swallowing difficulties, such as dysarthria and dysphagia, which this client is exhibiting.

D. Medical Assistant: Medical assistants support clinic operations and perform basic administrative or procedural tasks, not advanced rehabilitative or discharge planning roles in acute stroke recovery.

E. Case Manager: The case manager facilitates discharge planning, ensures access to follow-up care and services, and coordinates rehabilitation or home care as needed for stroke recovery.

F. Physical Therapist: A physical therapist aids in improving mobility and strength, especially with the client’s observed diminished left-sided motor function, helping restore independence and prevent complications.

G. Chief Nursing Officer: The CNO is a high-level administrative leader not involved in direct bedside care or individual rehabilitation planning, making them unnecessary for the client’s interdisciplinary recovery team.

H. Occupational Therapist: Occupational therapists help the client regain skills needed for daily living, such as dressing or feeding, which may be impaired due to hemiparesis from the stroke.