The nurse is providing client teaching on the correct administration of ophthalmic ointment with an older adult client. Which response by the client indicates further education is needed?

A. Avoiding acetylsalicylic acid (aspirin) and medications that contain it is a crucial component of discharge teaching for a client with an acute gout attack. Aspirin can interfere with renal excretion of uric acid, either increasing or decreasing serum uric acid levels depending on the dose, which may trigger or worsen an acute flare. Clients should be educated to read over-the-counter medication labels carefully, avoid aspirin-containing combination products (such as some cold or pain medications), and consult their healthcare provider before taking any new medication. This instruction helps prevent recurrent attacks and protects joint health.

B. Supporting joints in an extended position is not recommended during an acute gout flare. Forcing the affected joint into full extension can increase pain and inflammation. Instead, the joint should be positioned in a comfortable, slightly flexed position, sometimes elevated on a pillow, to reduce swelling and promote comfort. Teaching the client proper positioning helps manage pain effectively without aggravating the joint.

C. Using a heating pad during an acute gout attack is not advised because heat can increase blood flow to the inflamed area, potentially worsening swelling and pain. Cold therapy, such as applying an ice pack for 15–20 minutes at a time, is the preferred method for managing acute joint inflammation. Cold therapy helps reduce local tissue swelling, numbs pain, and provides temporary relief during severe attacks.

D. Limiting the use of mobility equipment to avoid muscle atrophy is inappropriate in the context of a gout flare. While rest of the affected joint is important initially, gentle movement of the unaffected joints and using mobility aids as needed for safe ambulation is encouraged to prevent deconditioning, maintain circulation, and promote overall function. Teaching clients to balance rest with gentle activity supports recovery without causing further joint trauma.

A. Identifying the client’s healthcare power of attorney (POA) is important for legal and consent purposes, especially when the client cannot make decisions independently. However, in the context of an SBAR (Situation, Background, Assessment, Recommendation) communication, this information is not the most urgent. It falls under background or additional information but does not directly address the client’s acute clinical change.

B. Reporting that the client fell at home provides relevant background information for the healthcare provider. It helps contextualize the admission and may guide the evaluation of injuries, but it does not communicate the immediate concern. In SBAR, this would be included under the “Background” section, after the urgent situation is stated.

C. Providing the client’s current medication list is also part of the background information and may help the provider identify potential contributors to the acute change in mental status, such as sedatives, anticholinergics, or polypharmacy. While important, it does not represent the urgent situation requiring immediate attention.

D. Reporting the client’s increasing confusion is the most critical information and should be provided first, under the “Situation” portion of SBAR. Acute confusion in an older adult, especially following a fall, can signal serious complications such as head injury, intracranial bleeding, delirium due to infection, medication-related adverse effects, or metabolic or electrolyte imbalances. Promptly communicating this change allows the healthcare provider to prioritize assessment, order necessary tests, and implement interventions quickly to ensure patient safety. In SBAR, starting with the urgent change in status helps focus the provider’s attention on immediate risks before reviewing the background or assessment details.