During care for Paget disease, which action by the LPN/LVN requires the charge nurse's intervention?

• A. Administering 600 mg of ibuprofen
• B. Applying ice and gentle massage
• C. Reminding the patient to drink milk and eat cottage cheese
• D. Encouraging the patient to perform PT-recommended exercises

Answer: (B)

Paget disease causes abnormal bone remodeling, so bones can become enlarged, deformed, and more fragile. Because of this fragility, moving or manipulating the affected area with massage can increase the risk of causing a fracture or pain flare. Ice and gentle massage to the involved sites may seem harmless, but in this condition such manipulation requires higher-level assessment and guidance from the RN to ensure safety and to adjust the care plan. The LPN/LVN should not initiate this intervention without the charge nurse’s oversight. Other actions described—providing analgesic as ordered, encouraging prescribed PT exercises, and supporting nutrition as appropriate—align with typical care within the LPN/LVN role when ordered.