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A client who is dying cannot swallow and is accumulating audible mucus in the upper airway (death rattles). These noises are upsetting to family members. What nursing action is appropriate?

A. Place the client in a side-lying position so secretions can drain.
B. Use a Yankauer suction tip to remove secretions from the client's upper airway.
C. Position the client in a high-Fowler position to minimize secretions.
D. Assist the family in leaving the room so that they can compose themselves.

Answer :

Final answer:

The most appropriate action for a nurse in taking care of a dying patient with death rattles is to place the patient in a side-lying position to allow the secretions to drain(option A).

Explanation:

The most appropriate nursing action to manage a client who is dying, cannot swallow, and is accumulating audible mucus or death rattles in the upper airway is to place the client in a side-lying position so that secretions can drain. Using a Yankauer suction tip to remove secretions from the patient's upper airway can be an invasive procedure and might cause discomfort. Positioning the client in a high-Fowler position could potentially decrease the comfort and may not be sufficient in allowing the secretions to drain naturally. Assist the family in leaving the room is not a nursing action directed towards the patient's comfort and care.

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