The nurse is caring for a patient who is recovering after hip surgery. The patient requires assistance to use the bathroom because no weight bearing is allowed on the right leg
Which goal is most important for the nurse to include for the diagnosis of toileting self-care deficit?
a.
The patient will demonstrate safe transfer technique between wheelchair and toilet.
b.
The call light will be answered promptly when the patient needs to use the toilet.
c.
Toileting will be scheduled for the early morning when the patient needs to defecate.
d.
Toilet paper and hand-washing items will be kept within easy reach of the patient.
ANS: A
The highest priority goal for this patient is the demonstration of safe transfer technique between the chair and the toilet. The other statements are interventions performed by staff rather than goals that will be accomplished by the patient.
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