A client has neurologic deficits that are causing tremors, unsteadiness, and weakness. An appropriate diagnosis of Risk for Falls related to unsteady gait, secondary to neurologic dysfunction has been formulated
A goal for this client is not to sustain any injuries for the next month. The client however, has fallen several times. In this situation, the nurse should do which of the following?
1. Review the data and make sure that the diagnosis is relevant.
2. Investigate whether the best nursing interventions were selected.
3. Modify the whole nursing plan.
4. Discard the nursing plan and start over from the assessment phase.
Correct Answer: 2
Rationale 1: The data presented are relevant for the diagnosis selected in this case.
Rationale 2: Even if all sections of the care plan appear to be satisfactory, the manner in which the plan was implemented may have interfered with goal achievement. The nurse needs to check and see if the interventions were appropriate for the client. If the interventions selected did not help the client achieve the goal, then rearranging or implementing new ones may be necessary.
Rationale 3: The data presented are relevant for the diagnosis selected in this case, and it is not necessary to modify the whole plan.
Rationale 4: The data presented are relevant for the diagnosis selected in this case, and it is not necessary to discard the whole plan and start over. Modifications may be the key to a successful outcome for the client.
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A) Engage in critical thinking B) Choose a value C) Identify isolated values D) Clarify one's values
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An older adult patient with depression is being treated with sertraline (Zoloft). This medication is often chosen for older adult patients because it:
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