[Kathyz]

I just started my nursing program 7 weeks ago. We use Maslow's Hierarcy to prioritize. I can't figure out this question; I'm stuck between 2 answers.

"The client w/ TB is to be discharged home w/ community health nursing follow-up. Of the following interventions, which would have the HIGHEST priority?

1. offering the client emotional support
2. teaching the client about the disease and its treatment
3. coordinating various agency services
4. assessing the client's enviornment for sanitation

I'm thinking #4 and my husband is leaning toward #2.

What do you guys think?

Thanks,
Kathy

[DAMomma]

I also say 4

[nurse2be09]

I would say # 4 as well.

[nurse4theplanet]

I would say #2. My reasoning for that is because the pt needs to understand what TB is...how its spread...and the importance of completing treatment. I know in some states, treatment is mandantory. In my state of residence, you must report to the health dept to take your medication in the presence of a nurse until your treatment is complete. Any failure to do so is a violation of the law and you can be reported to law enforcement authorities. Strict adherence to treatment regimens is necessary to prevent resistant strains of TB. The CDC has very specific guidelines for tracking and treating cases of TB.

Not sure if I'm right, but that would be my answer.

[Daytonite]

I give #4 a big, fat NO and I'll tell you why. The time for assessment is past. That's Step #1 of the nursing process. You are already in Step #4, Implementation of the Plan of Care, so the interventions should have already been put in place which means that all assessments should have been done. Also, from a practical standpoint, a hospital nurse just doesn't have the time or resources to be going to the patient's home to be making an assessment of the patient's environment. The home health nurse will, however. That will be their first order of business as part of their nursing care process and assessment.

Since the focus of the question seems to be that the patient is being discharged with community health nursing follow-up then the most logical choice to me would seem to be choice #3, coordinating various agency services. Nowhere in the stem of the question does it mention anything about having any disease or problems with sanitation. The answer choices sucked you into that. And, what emotional support? Most patients I know are thrilled to death to get out of the joint, er, the hospital. However, if somebody flubs up and forgets to call the home health agencies to follow-up--uh oh! The patient will be sitting at home waiting for a knock on her door and will then be in need of emotional support when no one shows up to help her out!

I believe your thinking is wrong and your husband is leaning the wrong way. Catch him before he falls over. Of course, I could be wrong. . .but I don't think so.

[november551]

It is one of those NCLEX style questions that I hate!!

#1 is correct, but not a priority in Maslow (It is higher up in basic needs than some of the others)
#2 is correct, but if the client is getting discharged then he has more than likely already been educated on this. I'd say the time for education is past in this case. Although it should be reinforced, I don't think it is a priority. Not only that, but education is up there in maslow's not at the basics.
#3 Is something we would do as managers of care, and is definitely a priority option. Add to that the fact that services provided would fulfill the basic needs of the client which is down low on maslow's ergo high priority.
#4 Assessing would be the first thing you'd do in the nursing process, so it would be a priority, but is it not an intervention (which the question specifically asks for).

I'm definitely going to have to go with 3 as well.

[nurse4theplanet]

The reason that I did not choose #3 is because it is not client centered...meaning that it directly involves the pt. It is an indirect way of managing and providing care to the client. In real life, it would be a very appropriate answer. However, on NCLEX and NCLEX style tests...we were told to never EVER pick an answer that is not client centered.

[moongirl]

Maslow
1. physiological needs. food. water. air
2. safety needs
3. love and belonging
4. self esteem

teaching about disease and tx is over, that came while hospitalized

Home health will assess the environment

the emotional support came while hospitalized, d/t being in isolation and having precautions

Priority now is setting up the resources so that the pt is safe and cared for at home
I choose 3. it is Maslows number 2. Safety.

[november551]

Originally Posted by asoldierswife05

on NCLEX and NCLEX style tests...we were told to never EVER pick an answer that is not client centered.

I could be wrong; one of my weak points on those types of questions is overanalyzing the ones that don't need analyzing. On the flipside, I also have a tendency to underanalyze the ones that need overanalyzing.

NCLEX

I wonder what the OP will find out.

[Sweetooth EMT-P, RN]

um I say four.. just a guess.

Swtooth