The home care nurse is making an initial visit to a client just discharged after admission for severe exacerbation of chronic obstructive pulmonary disease (COPD). The nurse observes wall-to-wall stacks of old newspapers and magazines in every room, with pathways that just allow passage from one room to another. What is the priority nursing action?

Question

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This client exhibits signs of hoarding disorder, an anxiety disorder defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (American Psychiatric Association) as persistent difficulty with discarding or parting with possessions, even those of little value. Clients with hoarding disorder will typically accumulate items such as clothing, food, boxes, bags, newspapers, and magazines. These items commonly fill up and clutter their living areas and can create environmental and fire hazards. The client will most likely experience severe anxiety if the items are removed. Clients with hoarding disorder may never seek mental health services or come to the attention of a mental health professional. Their own behavior usually does not concern them, although it may cause great distress in family members or friends. The treatment for the client with severe COPD will include home oxygen therapy. The priority nursing action is to ensure the safety of the client when using oxygen in an environment that is already at high risk for a hazardous event. (Option A) Referral to mental health services is an appropriate intervention but is not the priority nursing action. (Option B) The nurse cannot intervene in this manner without the consent of the client. Removing the newspapers and magazines could cause the client to experience severe anxiety. (Option C) Reconciling the client's discharge medications is appropriate but is not the priority nursing action. Educational objective: Teaching the safe use of home oxygen is the priority nursing intervention for a client with hoarding disorder who lives in an environment at high risk for fire due to the accumulation of newspapers and magazines. Hoarding disorder is the persistent difficulty with discarding possessions, no matter their value. Removal of the items will cause the client to experience severe anxiety.

The Home Care Nurse Is Making an Initial Visit to a Client