Your second older adult female client has been experiencing some problems with urinary incontinence. You suggest that she document which of the following in a “bladder/voiding diary”? (Select all that apply.)

Choice A reason: Encouraging the client to use a cane when ambulating is not a cause of concern for the home health nurse, as it is a way of providing support and stability for the client, and preventing falls or injuries.

Choice B reason: Keeping several low wattage night lights on in the evening is not a cause of concern for the home health nurse, as it is a way of improving the visibility and orientation for the client, and reducing the risk of tripping or stumbling in the dark.

Choice C reason: Keeping the side rails up on the client’s bed at night is a cause of concern for the home health nurse, as it is a way of restricting the client’s mobility and increasing the likelihood of entrapment, injury, or death. Side rails can also create a false sense of security and encourage the client to climb over them, which can result in falls or fractures.

Choice D reason: Installing wooden railings on the stairway to the bathroom is not a cause of concern for the home health nurse, as it is a way of enhancing the safety and accessibility for the client, and preventing falls or slips on the stairs.

Choice A reason: Evaluating the medication list is a possible step that the nurse can take, as some medications can affect urine concentration or cause dehydration. However, it is not the first step that the nurse should implement, as it does not address the immediate problem of fluid balance.

Choice B reason: Reviewing laboratory reports is another possible step that the nurse can take, as some laboratory tests can indicate the level of hydration or kidney function of the patient. However, it is not the first step that the nurse should implement, as it does not provide a direct assessment of fluid status.

Choice C reason: Increasing oral fluid intake is a potential intervention that the nurse can suggest, as it can help to dilute the urine and prevent dehydration. However, it is not the first step that the nurse should implement, as it may not be appropriate for some patients who have fluid restrictions or other medical conditions.

Choice D reason: Determining fluid volume status is the first step that the nurse should implement, as it can help to identify the cause and severity of urine concentration and guide further actions. The nurse can assess the patient's fluid intake and output, weight, blood pressure, pulse, skin turgor, mucous membranes, and urine specific gravity to determine fluid volume status.