Nurses Books

Determine cause of activity intolerance (see Related Factors) and determine whether cause is physical, psychological, or motivational. Determining the cause of a disease can help direct appropriate interventions. Assess client daily for appropriateness of activity and bed rest orders. Inappropriate prolonged bed rest orders may contribute to activity intolerance. A review of 39 studies on bed rest resulting from 15 disorders demonstrated that bed rest for treatment of medical conditions is associated with worse outcomes than early mobilization (Allen, Glasziou, Del Mar, 1999). Minimize cardiovascular deconditioning by positioning clients as close to the upright position as possible several times daily. The hazards of bed rest in the elderly are multiple, serious, quick to develop, and slow to reverse. Deconditioning of the cardiovascular system occurs within days and involves fluid shifts, fluid loss, decreased cardiac output, decreased peak oxygen uptake, and increased re...

Assess client’s behavior and cognition systematically and continually throughout the day and night as appropriate. Rapid onset and fluctuating course are hallmarks of delirium (Murphy, 2000). The Confusion Assessment Method is sensitive, specific, reliable, and easy to use (Inouye et al, 1990). Nurses play a vital role in assessing acute confusion because they provide 24- hours-a-day care and see the client in a variety of circumstances (Marr, 1992). Delirium always involves acute change in mental status; therefore knowledge of the client’s baseline mental status is key in assessing delirium (Flacker, Marcantonio, 1998). Perform an accurate mental status exam that includes the following: Overall appearance, manner, and attitude Behavior observations and level of psychomotor behavior Mood and affect (presence of suicidal or homicidal ideation as observed by others and reported by client) Insight and judgment Cognition as evidenced by level of consciousness, orientation (to ti...