A nurse at a long-term care facility is reviewing the plan of care for client who has a prescription for mitten restraints. Which of the following tasks should the nurse assign to an assistive personnel?
Explanation & Rationale
A) Assist the client with range-of-motion exercises of the hands: This task is appropriate for the assistive personnel (AP) as it is a routine, non-invasive intervention that can help maintain mobility and prevent contractures in the hands. The AP can assist with range-of-motion exercises, following proper technique, and reporting any abnormalities to the nurse. This falls within the AP's scope of practice and can be delegated to them effectively. B) Determine the circulation status of the affected extremities every hr: Assessing circulation is a nursing responsibility and requires clinical judgment to identify signs of impaired circulation, such as color changes, pulse, or temperature of the skin. This task cannot be delegated to an AP, as it requires a nurse’s skill to interpret findings and take appropriate action. C) Instruct the client's family about the purpose of mitten restraints: Educating the client's family about the use of mitten restraints is a responsibility of the nurse, not the AP. This involves assessing the family’s understanding, providing relevant information, and answering any questions they may have. Only licensed healthcare professionals are responsible for providing education about the purpose and use of restraints. D) Evaluate the need for the client to remain in mitten restraints: Evaluating the necessity of restraints involves assessing the client's condition, safety, and overall care needs. This requires critical thinking and professional judgment and should be performed by the nurse, not the AP. The nurse must determine if the restraints continue to be necessary or if they can be removed, ensuring the client’s safety and dignity.