The practical nurse (PN) is providing care for a client with a history of a stroke and who has aphasia. The client is exhibiting restlessness, shallow respirations and is clenching teeth. Which problem should the PN assess further?

• Protein deficiency: The client is post-operative (POD 4) and unable to tolerate solid foods, yet she is drinking full liquids without issue. This dietary limitation, especially after surgery, may not be providing sufficient protein, which is essential for wound healing and overall recovery. The client has a slow-healing surgical wound that is red around the edges with serosanguinous drainage. Protein deficiency can impair the body's ability to heal wounds properly and fight infections.
• Include protein supplement shakes in the client's diet: These shakes can provide the necessary protein without requiring the client to eat solid food, ensuring she gets adequate nutrition to support healing and immune function. Protein is critical in recovery, particularly for wound healing and tissue repair, which is why this intervention is essential.
• Advance diet to regular as tolerated: Once the client is able to tolerate liquids without issue, gradually introducing solid foods will ensure she receives a full spectrum of nutrients, including protein, from different food sources. This will support her overall nutritional needs and help improve the rate of wound healing. This should be done gradually, depending on how well the client tolerates solid food.
• Signs of infection: The client has a surgical wound that is red around the edges and has serosanguinous drainage, which could indicate a potential infection. Given the risk of infection, especially in a slow-healing wound, monitoring for other signs such as increased redness, warmth, or purulent drainage is important.
• Wound healing: Wound healing is a critical parameter to monitor in this patient. Given the client's slow-healing surgical wound and potential for protein deficiency, it’s important to track the progress of healing over time. Delayed healing could signal inadequate nutrition (like protein deficiency) or infection, so regular assessment of the wound will help guide further interventions.
• Iodine deficiency: Iodine deficiency typically affects thyroid function and does not directly contribute to the wound healing problems or the inability to tolerate solid foods seen in this client. There are no signs in the patient's data that suggest thyroid dysfunction or iodine deficiency, making this an unlikely condition.
• Glucose deficiency: While glucose is essential for energy, there is no indication from the client’s current condition or lab values that glucose deficiency is a concern. The client is awake and alert, and there are no signs of hypoglycemia or low blood sugar. The primary issue seems to be a lack of protein, not glucose.
• Sodium deficiency: Sodium deficiency is unlikely because there are no signs of hyponatremia (like confusion, dizziness, or muscle cramps) or fluid imbalance, which would be expected in sodium deficiency. The client does not exhibit signs of hypovolemia, and her laboratory results do not suggest significant sodium imbalances.
• Add table salt to any broth that the client takes: Adding salt is not necessary at this time because the client's sodium levels are not critically low. Sodium supplementation is typically used in cases of hyponatremia or fluid imbalances, which do not appear to be a concern here. The primary focus should be on addressing the protein deficiency.
• Place a feeding tube and start enteral feeds: A feeding tube and enteral feeding are typically reserved for clients who are unable to tolerate any oral intake at all. Since the client is drinking full liquids, it is not necessary to place a feeding tube at this stage. If the client continues to struggle with solid food intake over time, then enteral feeding might be considered, but this is not immediately required based on the information provided.

A. Provide a PRN hypnotic medication: Administering a hypnotic should not be the first response without first assessing the underlying cause of the sleep difficulty. Non-pharmacological approaches are safer, especially for older adults who are more sensitive to sedative side effects.
B. Reassure the client that it is still early: Simply reassuring the client does not address the immediate concern of why the client cannot sleep. Dismissing the complaint without assessment may lead to prolonged distress and unresolved sleep disturbances.
C. Evaluate the room environment: Assessing the room for factors like noise, lighting, temperature, and comfort is a priority because environmental factors often contribute significantly to insomnia. Addressing modifiable conditions can promote natural sleep without immediately resorting to medications.
D. Close the door to the client's room: While closing the door might reduce noise, it is a single action that may not fully address all potential environmental issues affecting sleep. A complete evaluation of the environment is necessary first to identify and correct all possible disruptions.