An elderly client with end-stage renal disease who has refused dialysis is admitted to a long-term care facility for rehabilitation following hospitalization. The next day, the client becomes agitated and says to the nurse, "I've got to get back home to my things. I have so much to do." Which is the most likely interpretation of this client's behavior? A)The client has been admitted to the facility without the client's consent B)The client is becoming delirious and should be assessed for infection C)The client is concerned that someone might steal possessions D)The client wants to take care of business before imminent death

Question

Quizplus · Accepted Answer

This client with advanced renal failure who decides not to start dialysis treatments may have only a few weeks to live. Toxins will build up in the body and soon lead to increased weakness and cognitive decline. This client knows there is a limited time left to live and wants to ensure that possessions will be taken care of appropriately after the client's death (Option D). (Option A) The client has probably been admitted to the facility due to concerns about safe management at home. However, the statement does not indicate that the client has been admitted against the client's will. (Option B) Clients with end-stage renal disease are at risk for delirium due to a buildup of toxins, which may manifest as agitation and statements about needing to go somewhere. However, the nurse should not automatically assume that the client is delirious. Instead, it is important to assess the client's concern with an open mind so that appropriate interventions can be planned. (Option C) The client's statement about having "so much to do" suggests that this is not the concern prompting the behavior. Educational objective: The client with a limited life expectancy will have concerns about completing personal business, such as ensuring that possessions go to the appropriate people. The nurse should assess the client's needs and ensure that the plan of care will facilitate the client's life closure activities (eg, legacy building).

An Elderly Client with End-Stage Renal Disease Who Has Refused