Answer Key to Chapter 13 Learning Activities

1. The nurse should perform a comprehensive pain assessment using a framework such as “PQRST” or “OLDCARTES” and treat Ms. Curtis’s pain according to assessment findings. The nurse should use therapeutic communication techniques to determine why the client is refusing to attend physical therapy. For example, the nurse could ask, “Can you help me understand the reasons you have not attended your previous physical therapy appointments?,” keeping in mind that pain and fear of falling are common causes. It is often helpful to premedicate the client with analgesics before attending physical therapy. If currently prescribed medications are not effective, the provider should be notified.
2. Ms. Curtis is at risk for complications of immobility, such as pneumonia, deep vein thrombosis, constipation, and skin breakdown. The nurse should assess for signs of these complications, as well as educate the client regarding signs to report.
3. A SMART outcome (established with Ms. Curtis) could be, “The client will attend the next scheduled physical therapy appointment and report effective pain management during and after the session.”
4. The nurse will monitor the client’s pain level using a pain intensity scale one hour prior to physical therapy and administer prescribed medications according to current pain level and anticipated pain level. The nurse will use therapeutic communication to determine the client’s causes for declining physical therapy appointments and plan interventions accordingly. The nurse will encourage rest before and after physical therapy appointments. The nurse will encourage coughing and deep breathing to prevent pneumonia and range-of-motion exercises while in bed or sitting to prevent deep vein thrombosis. The nurse will perform hourly rounding to encourage repositioning to prevent skin breakdown. The nurse will encourage fiber and fluids to prevent constipation.
5. The nurse will evaluate if interventions were successful by referring to the established SMART outcome and monitoring if the client attends the next scheduled physical therapy appointment and if pain was effectively managed during the session.

Answers to interactive elements are given within the interactive element.