Final answer:
The nurse should first address the concept of fluid balance (option 1) in a bedbound nursing home resident with osteoarthritis who is refusing to drink fluids and has not urinated in 8 hours, as this could lead to dehydration and kidney issues.
Step-by-step explanation:
The nursing concept that the nurse should respond to first when a bedbound nursing home resident with osteoarthritis is refusing to drink fluids and has not urinated in 8 hours is fluid balance. Fluid balance is a critical concept because it pertains to the maintenance of the appropriate amount of fluid in each compartment of the body's cells, which is essential for physiological functioning. Without proper fluid intake, the risk for dehydration increases, which can lead to confusion, hypotension (low blood pressure), and in severe cases, kidney failure due to the inability of the kidneys to concentrate or dilute urine effectively as indicated by fluid intake.
This problem takes precedence because the patient's immediate physical well-being depends on the maintenance of fluid balance. Notably, while mobility and pain are important issues for this patient due to osteoarthritis, they become secondary to the potentially life-threatening issue of dehydration. The nurse should address the elimination concept as well, considering that not urinating for extended periods can indicate acute kidney injury or other serious conditions. However, ensuring the patient begins to consume fluids is paramount to addressing the urinary elimination issues and preventing further deterioration of their condition.