The nurse is caring for an older adult client with a pulmonary infection. Which nursing action is a priority with this client?
a. Encouraging the client to increase fluid intake
b. Assessing the client's level of conscious-ness
c. Raising the head of the bed to at least 45 degrees
d. Providing the client with humidified oxy-gen
B
Assessing the client's level of consciousness will be most important because it will show how the client is responding to the presence of the infection. Although it will be important for the nurse to encourage the client to turn, cough, and breathe deeply frequently; to raise the head of the bed; and to humidify the oxygen administered, none of these actions will be as important as assessing the level of consciousness. Also, the client who has a pulmonary infection may not be able to cough effectively if an area of abscess is present.
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