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The nurse is caring for an older adult who has been placed in Buck's extension traction after a hip fracture. Upon assessment, the nurse notes that the client is disoriented. What is the best nursing action based on this information?

Answer :

The best nursing action based on the information provided would be to assess for potential causes of disorientation and initiate appropriate interventions to address the client's condition.

Disorientation in an older adult with a hip fracture who is in Buck's extension traction could be due to various factors, including pain, medication side effects, dehydration, sleep disturbances, or an underlying medical condition.

The nurse should first assess the client's vital signs, pain level, and hydration status. They should also review the client's medication list to identify any drugs that may cause confusion or disorientation.

If pain is identified as a potential cause, the nurse should provide appropriate pain management interventions. If medication side effects or interactions are suspected, the nurse should consult with the healthcare provider to review the medications and adjust the regimen if necessary.


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