Final answer:
The first action for a home health nurse when a client struggles more with mobility is to assess the cause. An impaired skeletal muscle pump can lead to symptoms like swollen feet and heart failure exacerbation. Immobility due to conditions like a hip fracture in the elderly can increase the risk of complications such as blood clots and infections.
Step-by-step explanation:
The question is inquiring about a home health nurse's first course of action when they observe a client with heart failure (HF) and osteoarthritis struggling more than before to get in and out of bed. The nurse should first assess the situation to understand the underlying cause of the increased difficulty. This could be an exacerbation of HF or osteoarthritis, or other factors such as medication side effects.
When evaluating an obese patient with symptoms like swollen feet and ankles, fatigue, shortness of breath, and feeling "spaced out," skeletal muscle pump dysfunction may be a contributing factor. The skeletal muscle pump contributes to venous blood return to the heart, and inadequate physical activity, such as in this patient's case, can impair this mechanism, leading to symptoms consistent with venous insufficiency and possibly exacerbating HF.
Regarding an elderly person with a hip fracture, immobility during the healing process can lead to numerous complications. These include the formation of blood clots, which can cause respiratory failure if they lodge in the lungs, and an increased risk of pneumonia, pressure sores, and urinary tract infections due to inadequate movement and catheterization.
Heart failure increases the risk of deep vein thrombosis (DVT) by possibly slowing down the circulation and contributing to venous stasis. A blood clot, or thrombus, can have serious health consequences like pulmonary embolism or stroke. Prolonged periods of sitting contribute to the risk of DVT, while walking and exercising help stimulate blood flow and reduce this risk.