When starting an intravenous (IV) catheter, the nurse must first prepare the potential site with alcohol and dress it using a gauze dressing. The nurse has done a literature review and believes that evidence-based practice dictates the use of a transparent dressing to prevent catheter dislodgment. In such a case, the nurse must undertake the following steps:-
-Inform the facility's charge nurse about the literature review findings and the best evidence for patient safety.
-Follow up with an evidence-based practice inquiry by communicating with the infection control department to determine if there is a new protocol or suggestion for dressings for IV catheters.
-If a new protocol is in place, the nurse may use it, but if it is not, the nurse should discuss the best available evidence with the healthcare team in order to develop an institution-specific protocol to improve patient safety.
-It is important to consider the hospital's policy when administering any medical procedure. This must be followed by an evidence-based practice inquiry to develop a more appropriate protocol, as illustrated in this example.
In summary, when starting an intravenous (IV) catheter, the nurse should first prepare the potential site with alcohol and dress it using a gauze dressing. The nurse can then discuss their literature review with the primary care provider or nursing supervisor, discuss the literature review with other members of the health care team, and if approved, implement the use of a transparent dressing to prevent catheter dislodgment.
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one day, hillary consumed a handful of peanuts, a bowl of chocolate pudding, a sugar-sweetened soft drink, and three hard-cooked eggs. which of these foods contains a lot of empty calories and is not a member of one of the usda's major food groups?
Peanuts are a dietary item that is high in empty calories and does not belong to a significant food group as defined by the USDA.
What advantages do eating peanuts offer?Charles M. Schulz is the author and illustrator of the syndicated daily and Sunday comic strip Peanuts in America. From 1950 to 2000, the comic strip ran regularly, and then it was reruns after that. Low cholesterol levels from peanuts help avoid heart disease. Along with lowering the risk of a heart attack or stroke, they can prevent the formation of tiny blood clots. You can feel satisfied while consuming less calories by eating foods that are high in protein. While growing in tropical and subtropical areas all over the world, the peanut is a native of the Western Hemisphere. Because of the peanut's adaptability, Spanish explorers believe it originated in South America and expanded throughout the New World.To learn more about Peanut, refer to:
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One day, Hillary consumed a handful of peanuts, a bowl of chocolate pudding, a sugar-sweetened soft drink, and three hard-cooked eggs. These food that contains a lot of empty calories and is not a member of one of the USDA's major food groups is Peanuts
Peanuts are high in calories but have many nutrients. Chocolate pudding contains a lot of empty calories and is not a member of one of the USDA's major food groups. A USDA food group is a category of foods that are similar in nutritional content. These groups are designed to help people make healthy choices. The major USDA food groups include vegetables, fruits, grains, protein foods, and dairy.
Chocolate pudding is high in sugar and fat and contains a lot of empty calories. It is not a member of one of the USDA's major food groups because it does not provide significant amounts of vitamins, minerals, or other nutrients. This is because it provides calories without significant nutrients and doesn't belong to any major food group.
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a nurse is administering digoxin to a 3-year-old child. what would be a reason to hold the dose of digoxin?
One reason to hold the dose of digoxin in a 3-year-old child is if the child's heart rate is below the recommended range.
Digoxin is a medication used to treat heart conditions, and it works by increasing the strength and efficiency of the heart's contractions. However, if the child's heart rate is too slow, giving digoxin can further decrease the heart rate and cause harm.
Therefore, the nurse should check the child's heart rate before administering the medication. If the heart rate is below the recommended range, the nurse should hold the dose and notify the healthcare provider.
It is important to closely monitor the child's heart rate and adjust the medication dosage as needed to ensure optimal therapeutic outcomes and avoid potential complications.
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1. what is your overall opinion of the discharge process by the hospital nurse? state three areas of priority concerns.
The discharge process by the hospital nurse is a very important part of ensuring the patient's safe and comfortable transition from the hospital to home. There are three key areas of priority that should be taken into consideration for the best patient experience and outcomes: communication, instructions, and follow-up care.
Firstly, communication is essential for a successful discharge. Nurses should ensure that they communicate effectively with the patient and their family, including providing clear explanations of the discharge process and instructions on how to properly care for the patient after they leave. Additionally, it is important that they are attentive to any questions or concerns the patient or family may have and make sure to answer them fully.
Secondly, nurses should provide comprehensive instructions on how to take medications and provide instructions for any follow-up care or tests the patient may need. They should also provide instructions for any changes to the patient’s diet and lifestyle, as well as contact information in case the patient or their family needs any additional assistance.
Finally, follow-up care is key to the patient’s recovery and long-term health. The nurse should provide contact information for a follow-up appointment and remind the patient to contact their primary care physician or any specialists if they are experiencing any complications or further issues.
In summary, the discharge process by the hospital nurse should involve effective communication, clear instructions, and follow-up care in order to ensure the patient's safety and comfort during the transition from the hospital to home.
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which activities would the nurse initiate for a client with alzheimer disease who is admitted to a long-term care facility? select all that apply. one, some, or all
Answer: Weighing the client once a week, having specialized rehabilitation equipment available, establishing a schedule with periods of rest after activities.
(Assuming these were ones that were on your multiple choice list)
Explanation: Monitoring weight is an objective way to assess the nutritional status. Having the rehab equipment facilitates in the client's participation of self-care. The rest periods prevents fatigue and energizes the client for the next activity.
Activities for a client with Alzheimer Disease who is admitted to a long-term care facility should include individualized interventions that are focused on maintaining the highest level of functioning for the individual. Examples of activities may include music therapy, cognitive-behavioral therapy, individual or group activities, or providing sensory stimuli such as aromatherapy.
How is the treatment for Alzheimer's patients?The nurse should focus on safety measures for the client to prevent wandering and self-injury. Music therapy can help to improve the quality of life for individuals with Alzheimer Disease by providing a non-threatening way to express emotions, reduce agitation, and provide an opportunity to enjoy the music. Cognitive-behavioral therapy can provide the client with strategies to manage symptoms such as anxiety, depression, and agitation. Group activities and one-on-one activities can be tailored to the individual’s interests and ability levels to keep them socially engaged and reduce boredom.
Finally, providing sensory stimuli such as aromatherapy can help reduce agitation and reduce stress for the individual. Overall, the nurse should create an individualized plan for the client that focuses on maintaining their highest level of functioning, safety, and well-being. Music therapy, cognitive-behavioral therapy, individual and group activities, and providing sensory stimuli can all be beneficial to a client with Alzheimer Disease.
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the nurse is assessing an older adult. the client states that she feels a constant, sharp pain only when walking. the nurse suspects the client is experiencing what?
The nurse suspects that the client is experiencing peripheral neuropathy, which is a condition caused by damage to the peripheral nerves. This can be caused by many different factors, such as diabetes, chemotherapy, trauma, and vitamin deficiencies.
Peripheral neuropathy often causes a constant, sharp pain that worsens with movement or exercise. In addition, it may cause other symptoms such as tingling or numbness, muscle weakness, balance problems, and abnormal sensations.
The nurse should conduct a thorough physical assessment of the patient to better understand the source of the pain.
Tests such as a complete blood count, nerve conduction studies, and electromyography may also be used to diagnose peripheral neuropathy. The goal of treatment is to reduce the pain and manage other symptoms. Treatments may include medications, physical therapy, and lifestyle modifications.
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which action would the nurse anticipate when admitting a client having a sickle cell crisis to the nursing unit? select all that apply
When admitting a client having a sickle cell crisis to the nursing unit, the nurse should anticipate the following actions:
Assessing the client's pain and initiating treatment Monitoring vital signs and oxygen saturation Administering oxygen Administering medicationsDuring a sickle cell crisis, a client's pain can be intense and need to be managed with medications and oxygen. Vital signs and oxygen saturation also need to be monitored regularly to assess the client's overall condition. Depending on the severity of the crisis, medications may need to be administered to control pain and prevent further complications.
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The nurse obtains a history from a client suspected of having cirrhosis. Which statement, if made by the client to the nurse, should the nurse recognize as most directly related to a client's development of cirrhosis?
A. "For the past several weeks I have not slept for more than 5 hours a night."
B. "Since my spouse left me 5 years ago, I have been eating terribly."
C. "I have been drinking about a fifth of vodka a day for the last few months."
D. "My spouse was a heavy smoker, and I am concerned about second-hand smoke."
The nurse obtains a history from a client suspected of having cirrhosis. The statement made by the client to the nurse which the nurse should recognize as most directly related to a client's development of cirrhosis is C. "I have been drinking about a fifth of vodka a day for the last few months."
Cirrhosis is a chronic illness in which the liver becomes scarred, hardened, and damaged. The liver is unable to function properly due to this damage, and it can cause various health problems. Cirrhosis is a common and severe health problem that causes damage to the liver. There are several factors that can lead to the development of cirrhosis in a person. Some of the factors that can cause cirrhosis include chronic hepatitis, alcohol abuse, non-alcoholic fatty liver disease, and some genetic disorders.The client's statement that the nurse should recognize as most directly related to the client's development of cirrhosis is C. "I have been drinking about a fifth of vodka a day for the last few months." Excessive alcohol intake is one of the most frequent causes of cirrhosis. Therefore, the nurse should recognize that the client's excessive drinking can be the primary cause of the client's liver damage.Learn more about Cirrhosis: https://brainly.com/question/2266497
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2. during a surgical procedure, the rn observes a surgeon wearing sterile gloves brush his posterior hand surface on a tray. the tray had been cleaned with a liquid chemical agent. what is the most appropriate action by the rn?
The most appropriate action by the RN in this situation would be to remind the surgeon of the importance of maintaining sterility throughout the procedure. It is essential that sterile techniques are followed to prevent the spread of infection. The RN should also take steps to ensure that all necessary equipment is available and that it is sterile.
This can include wiping down any surfaces with a sterile solution prior to use and checking that any containers and instruments are properly labeled. In addition, the RN should monitor the area for potential contaminants and make sure all personnel are using appropriate PPE.
Sterile techniques are the cornerstone of surgical asepsis and must be strictly observed. They include wearing appropriate PPE, washing hands, and using antiseptic solution to clean any surfaces. Contamination can be spread in a number of ways, such as direct contact with contaminated materials, using contaminated instruments, and poor aseptic technique.
By reminding the surgeon of the importance of maintaining sterility and following appropriate protocols, the RN can help reduce the risk of infection and ensure a successful outcome for the patient.
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the nurse explains to a client that immunotherapy initially starts with injections at which interval?
Answer:
The interval for immunotherapy injections can vary depending on the specific treatment plan prescribed by the healthcare provider. However, it is common for immunotherapy to begin with a series of weekly or biweekly injections, with the frequency gradually decreasing over time as the body develops immunity to the allergen. It's important for the client to follow the specific instructions provided by their healthcare provider and attend all scheduled appointments to ensure the best possible outcome from the immunotherapy treatment.
when considering the moral decision-making model, what step is the nurse engaging in when devloping the plan of care?
When considering a model of moral decision-making, the nurse engages in a reflective evaluation step when developing a plan of care.
This step involves nurses assessing available information, considering available alternatives, and making decisions based on their professional judgment and experience. An explanation of the moral decision-making process and how it applies to the situation at hand should also be included in the treatment plan.
Nurses in making decisions to provide care must be ethical so that the decisions taken can provide satisfaction to all parties, both the giver and the recipient of assistance.
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the nurse is caring for a child who is receiving a skin test to determine the presence of allergies. a positive skin test for one particular allergen shows the mediation of which type of immune globulin?
The nurse is caring for a child who is receiving a skin test to determine the presence of allergies. A positive skin test for one particular allergen shows the mediation of Immunoglobulin E (IgE).
A skin test is a medical test in which a small amount of a test substance is put into or under your skin. This can show if you are allergic to something. The skin test helps determine whether you have allergies or not. A positive skin test for a particular allergen indicates that the individual has developed IgE antibodies to the allergen.
The body's immune system generates antibodies to fight foreign substances, such as bacteria and viruses. Immunoglobulins, also known as antibodies, are a type of protein that aids in this process.
IgE antibodies are the type of antibodies that are produced when an individual has an allergy. They connect to mast cells and basophils, two cell types involved in inflammation, causing them to discharge histamine and other substances that cause allergy symptoms. The immune system's IgE antibodies are activated in response to an allergen, resulting in the release of chemical mediators that cause allergic symptoms.
Hence, When an individual has a positive skin test, it indicates that they have developed an IgE response to the allergen. It indicates that the person is allergic to the substance.
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the nurse is caring for a client with right-sided weakness after having a cerebrovascular accident (cva). while conducting the head-to-toe assessment, the nurse notices the client has redness around the right elbow. when developing the client's care plan, which problem-focused nursing concern will the nurse include?
When the nurse is caring for a client with right-sided weakness after having a cerebrovascular accident (CVA) and during the head-to-toe assessment, the nurse notices redness around the right elbow, the nursing care plan will include the nursing concern of impaired mobility due to joint pain.
What is a Cerebrovascular accident (CVA)?
A cerebrovascular accident (CVA), also known as a stroke, happens when blood supply to the brain is interrupted, causing brain cells to die. It's a serious medical emergency that necessitates quick treatment. There are three different types of stroke: Ischemic, hemorrhagic, and transient ischemic attacks (TIA).
It is critical to note that the best care for a patient with a cerebrovascular accident (CVA) is prevention. Impaired mobility due to joint pain is a nursing concern that can be included in the nursing care plan. This nursing diagnosis is classified as a problem-focused nursing diagnosis because it is concerned with addressing the client's current issue.
It is also known as a present health problem, which is described as an undesirable response to an existing problem.
What is a Nursing care plan?
A nursing care plan is a written guide that describes the goals, objectives, and nursing care activities to be performed to meet the client's health care requirements. Nursing care plans help the nursing staff to provide comprehensive and individualized care for their patients. A nursing care plan helps in prioritizing nursing care interventions, and the nursing team can easily identify and manage the client's health care needs.
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a nurse is assessing a client who may be pregnant. the nurse reviews the client's history for presumptive signs. which signs would the nurse most likely note? select all that apply.
The signs the nurse most likely note are:
Skin Changes
Urinary Frequency
Amenorrhea
Fatigue
The presumptive signs that the nurse would most likely note when assessing a client who may be pregnant are the following:-
Amenorrhea:
This is the most common sign of pregnancy. The pregnant woman will stop having her regular menstrual cycle. Nausea and Vomiting: Also known as morning sickness. It occurs due to hormonal changes in the woman's body.
Fatigue:
Pregnant women often feel tired and sleepy due to the changes in their body and hormonal changes.- Breast Changes: The breast may become tender, sore, or swollen. The nipples may also become darker and more prominent. These changes are due to the hormonal changes in the woman's body.
Urinary Frequency:
Pregnant women may need to urinate more often due to the pressure on the bladder caused by the growing fetus.- Quickening: This is the first movement of the baby that the mother feels. It usually occurs between the 16th and 20th week of pregnancy.
Skin Changes:
Pregnant women may develop dark patches on their face, abdomen, or breasts. This is known as melasma, and it is due to hormonal changes in the woman's body.
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people who suffer from gastroesophageal reflux disease can reduce symptoms by avoiding foods that cause discomfort, including:
People suffering from gastroesophageal reflux disease (GERD) can reduce symptoms by avoiding foods that cause discomfort, such as: acidic foods, spicy foods, fatty foods and Alcohol.
People who suffer from gastroesophageal reflux disease can reduce symptoms by avoiding foods that cause discomfort, including acidic foods, spicy foods, and fatty foods.
Gastroesophageal reflux disease (GERD) is a digestive condition in which stomach acid flows back into the esophagus. People who suffer from GERD should avoid acidic, spicy, and fatty foods because they can cause discomfort and increase acid production in the stomach.
Additionally, some foods can weaken the lower esophageal sphincter (LES), which is a muscular ring that controls the opening between the esophagus and stomach. When the LES is weak, stomach acid can flow back up into the esophagus.
Here are some foods to avoid if you suffer from GERD:
Acidic foods and drinks: oranges, grapefruit, lemons, limes, tomatoes, cranberries, and citrus juices.
Spicy foods: chili peppers, black pepper, curry, hot sauce, and salsa.
Fatty foods: fried foods, fast food, bacon, sausage, cream sauce, butter, and high-fat meats.
Chocolate and mint: chocolate contains caffeine, which can relax the LES and trigger GERD symptoms. Mint can also relax the LES.Caffeine and carbonated drinks: coffee, tea, soda, and energy drinks can increase acid production in the stomach and weaken the LES.
These foods can exacerbate GERD symptoms, so it is recommended to avoid them to reduce discomfort.
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which techniques would the nurse use in a relaxation group? select all that apply. one, some, or all responses may be correct.
The techniques that a nurse may use in a relaxation group include:
Deep breathing exercisesProgressive muscle relaxationGuided imageryMeditationMindfulness techniques. Options 1, 3, 5, 7 and 8 are correct.Relaxation groups are designed to help individuals learn how to manage stress, anxiety, and other emotional or psychological concerns through the use of relaxation techniques. These groups are often led by a nurse or other mental health professional, and may include a variety of different techniques.
Deep breathing exercises, also known as diaphragmatic breathing, involve taking slow, deep breaths in through the nose and out through the mouth. This technique can help reduce feelings of anxiety and promote relaxation. Progressive muscle relaxation involves tensing and relaxing different muscle groups in the body in a systematic way. This technique can help reduce feelings of tension and promote relaxation.
Guided imagery involves using mental images to promote relaxation and reduce stress. The nurse may guide group members through a visualization exercise, such as imagining a peaceful scene or a place where they feel safe and relaxed. Meditation involves focusing the mind on a specific object, sound, or phrase, with the goal of reducing distracting thoughts and promoting relaxation. Mindfulness involves being fully present in the moment, without judgment or distraction. The nurse may lead the group in mindfulness exercises, such as body scans or mindful breathing. Options 1, 3, 5, 7 and 8 are correct.
The complete question is
Which techniques would the nurse use in a relaxation group? Select all that apply. One, some, or all responses may be correct.
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a patient at a long-term care facility suffered a spinal cord injury at level t 7 several months ago, developed a flushed face, diaphoresis and blurred vision. the nurse notes that the patient's blood pressure is 194/105 mm hg. which of the following interventions should the nurse perform first? a. palpating the area over the bladder for distention b. placing the patient in a semi fowler's position c. give prescribed stool softeners for constipation d. prepare to administer prescribed apresoline ivp
The nurse should first prepare to administer the prescribed Apresoline IVP. This is due to the fact that the patient's blood pressure is 194/105 mm Hg, which is indicative of hypertension and a medical emergency. Administering the IVP can help quickly bring the patient's blood pressure back to a safe range.
To administer the Apresoline IVP, the nurse should first collect the medication, any equipment needed (e.g. needles, IV bag), and any supplies needed for the procedure (e.g. antiseptic).
The nurse should then explain the procedure to the patient and gain their consent before continuing. The nurse should also check the patient’s vital signs to ensure that the medication can be safely administered. Finally, the nurse should administer the medication as prescribed and monitor the patient’s vital signs for any adverse reactions.
In conclusion, the nurse should prepare to administer the prescribed Apresoline IVP first in this case due to the high blood pressure, with other interventions such as palpating the area over the bladder for distention, placing the patient in a semi-Fowler's position, or giving prescribed stool softeners for constipation being done afterwards.
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a client has been diagnosed with hypothyroidism. how will the nurse explain this condition in relationship to basal energy expenditure (bee)?
Hypothyroidism is a condition in which the body does not produce enough of the hormone thyroxine, which is essential for maintaining basal energy expenditure (BEE). This can lead to decreased metabolism and energy production, resulting in fatigue and weight gain.
Hypothyroidism is a condition in which the thyroid gland, which is located in the neck, fails to produce enough of certain important hormones. Symptoms can include fatigue, weight gain, depression, constipation, dry skin, and a low heart rate. Treatment is generally with the replacement of the hormones that the thyroid is not producing, either orally or through injections. Long-term management includes periodic monitoring of hormone levels and other tests to assess thyroid status.
The most common cause of hypothyroidism is an autoimmune disorder known as Hashimoto's thyroiditis, where the body's own immune system attacks the thyroid. Other causes of hypothyroidism include surgical removal of the thyroid, radiation therapy, medications, and other rare medical conditions.
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an adolescent with asthma has controlled her asthma using a drug regimen that includes theophylline. which new behavior would be of greatest priority to report to the prescriber?
The new behavior of smoking or any tobacco use should be of greatest priority to report to the prescriber.
Smoking or any tobacco use can decrease the effectiveness of theophylline and increase the risk of adverse effects. Smoking can also worsen asthma symptoms, making it more difficult to control the condition. Therefore, it is essential to inform the prescriber if the adolescent starts smoking or using tobacco products.
The prescriber may need to adjust the medication regimen or recommend smoking cessation resources to help manage the asthma effectively. Reporting any changes in behavior to the prescriber is crucial to ensure the best possible treatment outcomes and prevent any potential harm.
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List two updates provided for QPU April-June 2020
The two updates provided for QPU April-June 2020 are
layout of the page and incorporated the links to the documents in a table formatWhat do these QPUs do?The Quarterly Provider Update lists Agency regulations as well as meeting notices. This list also includes non-regulatory changes to the Medicare and Medicaid programs, such as manual instructions.
The QPU is available in two formats: an Adobe Acrobat file that is sorted by Provider Type for each category—Regulations and/or Issuances, and a zipped Word file. When unzipped, the zipped Word file will allow you to sort by File Code for Regulations or Transmittal, Change Request (CR), and Publication Numbers for Issuances.
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after noting meconium-stained amniotic fluid and fetal heart rate decelerations, the physician diagnoses a depressed fetus. the appropriate nursing action at this time would be to do what?
Answer: To infuse cefoxitin over 30 minutes, which drip rate that should be used by the nurse is 33 drops/minute.
What is recommended infusion time?
The recommended infusion time is defined as the time that is being prescribed by the physicofor the administration of the client's intravenous drugs and fluids.
From the question, the quantity of cefoxitin given = 1 g in 100 ml of 5% dextrose in water.
The available infusion set has a calibration = 10 drops/ml.
The prescribed infusion time given = 30 mins
That is;
10 drops = 1 mL
X drops = 100 ml
Make X drops the subject of formula;
X drops = 10 × 100 = 1000 drops
From the infusion time given, calculate the drive rate as follows;
1000 drops = 30 minutes
X drops = 1 Minute
Make X drops the subject of formula;
X drops = 1000/30
X drops = 33 drops / minute.
Explanation:
in the emergency care of a client with a pelvic fracture, the nurse must be especially alert for indications of the complication of a. deep vein thrombosis. b. hyperthermia. c. hypovolemic shock. d. infection.
A nurse must be particularly watchful for signs of hypovolemic shock when providing emergency treatment to a client who has a pelvic fracture. A major injury like a pelvic fracture might result in considerable bleeding and hypovolemic shock. This happens when the body significantly loses blood or other fluids,
Even so, they are not as frequent or as dangerous as hypovolemic shock. Deep vein thrombosis (DVT), hyperthermia, and infection are possible consequences linked to pelvic fractures. When a patient stays immobile for an extended amount of time, DVT, a blood clot that develops in a deep vein, usually in the legs, can be risky. Although it is not directly connected to the pelvic fracture, hyperthermia can develop in reaction to infection. Another possible risk is infection, especially if the pelvic fracture has an open incision. Yet, in the emergency management of a client with a pelvic fracture, this is often not a matter of urgent concern.
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which statements made by the nursing student demonstrate adequate knowledge about the etiology of hypothermia and administration of different treatments?
To avoid "after-drop," core rewarming techniques should be started before exterior ones during moderate hypothermia.
Which patient should the nurse regard as requiring the highest level of care?There are frequently issues about patient prioritising on nursing exams. Which patient is a priority is a common question in these inquiries. Patients who have problems with their airways, breathing, or circulation should always be given priority, in that order.
Which of the following would be the nurse's top priority when caring for a hypothermic client?Get the victim to a warm, dry place if at all possible. If you are unable to rescue the person from the cold, do your best to keep them as warm and wind-free as you can.
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which individual will receive priority care within the special supplemental nutrition program for women, infants, and children (wic) program?
Within the WIC program, priority for care is given to pregnant women, postpartum women up to six months after delivery, and infants and young children who are at nutritional risk.
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federally funded program that provides nutrition education, healthy food, and support to low-income pregnant women, new mothers, and young children up to age five. The program is designed to improve the health outcomes of these vulnerable populations and reduce the risk of poor nutrition and health problems. Among these groups, priority is given to those with the greatest need, which may be determined based on factors such as income, nutritional status, and medical history.
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which client would the nurse categorize as urgent level according to the 3-tiered triage system based on condition?
According to the 3-tiered triage system, a client with an urgent level condition would be one who requires rapid assessment and intervention.
Urgent-level conditions include severe chest pain, severe respiratory distress, severe bleeding, or any life-threatening conditions.
The 3-tiered triage system is used to quickly assess a client’s condition in order to determine the appropriate course of action. The three levels of severity are urgent, semi-urgent, and non-urgent. A client with an urgent level condition would require rapid assessment and intervention and may have a life-threatening condition. Conditions requiring urgent care include severe chest pain, severe respiratory distress, severe bleeding, or any other life-threatening diseases.
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what instruction will the nurse provide the assistive personnel (ap) when a client is admitted to the emergency department (ed) with a pustular rash related to secondary syphilis
The nurse should instruct the assistive personnel (AP) on how to provide care to a client who has been admitted to the Emergency Department (ED) with a pustular rash related to secondary syphilis.
Instructions such as Providing the client with a private room, and implementing isolation procedures based on the suspected mode of transmission, if indicated. Use standard precautions at all times, regardless of the mode of transmission suspected or confirmed.
Wear gloves and a gown when providing direct patient care, as well as a mask and eye protection if splashing or spraying of blood or body fluids is expected. Follow hand hygiene procedures to ensure that hands are clean before and after contact with the client and their environment.
Notify the registered nurse (RN) of any changes in the client's condition, such as increased fever, pulse, or respiratory rate, or a decrease in urine output. Report any adverse reactions to medications that the client may have, as well as any problems with eating or drinking.
Perform client care, such as skin care, toileting, and feeding, according to the nursing care plan. To reduce the spread of infection, ensure that client care items are cleaned and disinfected before and after use.
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a client has just been diagnosed with psoriasis and frequently has lesions around his right eye. what should the nurse teach the client about topical corticosteroid use on these lesions?
The nurse should taught to the client regarding the use of topical corticosteroids: Wash your hands before and after using the cream or ointment.
Do not use on broken or infected skin or in the eye. Apply sparingly to the affected area using a gentle, rubbing motion. Overuse of topical corticosteroids can cause thinning of the skin or other adverse effects. If you experience side effects such as itching, burning, or rash, stop using the cream or ointment and consult your doctor or nurse. Avoid long-term use of corticosteroids, as this can lead to more severe psoriasis symptoms or other health problems.
Psoriasis is an autoimmune disorder that affects the skin, scalp, and nails. The condition causes the body to produce excess skin cells, which then accumulate on the surface of the skin, resulting in scaly, itchy, and painful patches. Although psoriasis cannot be cured, there are treatments available to manage the symptoms. Topical corticosteroids are commonly used to treat mild to moderate psoriasis symptoms.
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a client with a partial-thickness burn injury had a xenograft applied 2 weeks ago. the nurse notices that the xenograft is separating from the burn wound. what is the nurse's most appropriate intervention?
Answer: The nurse's most appropriate intervention if the xenograft is separating from the burn wound for a client with a partial-thickness burn injury is to observe the graft for further separation.
What is a xenograft?
A xenograft is a skin graft taken from an animal of another species, such as a pig or a baboon, and applied to a human. The grafting of skin from animals to humans is referred to as xenotransplantation, and it is only used in extremely rare circumstances when no human skin is available for transplantation.
The nurse's most appropriate intervention if the xenograft is separating from the burn wound for a client with a partial-thickness burn injury is to observe the graft for further separation. The nurse should consult with the physician and report the observations to plan and implement appropriate treatment measures if necessary.
The nurse should follow the doctor's orders and assist with wound care and dressing changes. When assessing the wound, the nurse should monitor the xenograft and the graft sites for signs of rejection, infection, or other complications.
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a nurse experiences difficulty with palpation of the dorsalis pedis pulse in a client with arterial insufficiency. what is an appropriate action by the nurse based on this finding?
The nurse should immediately assess the client's signs and symptoms and consider other interventions to improve the circulation in the client's lower extremities.
This can include raising the client's legs above the level of the heart, using elastic bandages or compression socks to increase the blood pressure in the lower extremities, and avoiding extreme temperatures in the lower extremities.
Additionally, the nurse should use a Doppler to measure the pulse and check for other potential causes of arterial insufficiency. If the findings are still not clear, then the nurse should consult a physician for further evaluation. Finally, the nurse should provide lifestyle modifications to the client, such as increasing physical activity, limiting salt intake, and avoiding smoking and alcohol.
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a nurse administers incorrect medication to a client. after assessing the client, and completing an incident report, which is the priority action by the nurse?
The priority action by the nurse after administering incorrect medication to a client is to assess the client and report the incident. This must be done immediately to prevent any potential harm to the client.
The nurse must assess the client for any signs or symptoms of an adverse reaction to the medication. This may include monitoring vital signs, lab tests, and any other procedures necessary to assess the client's condition. The nurse must then complete an incident report documenting the event, detailing the circumstances, any treatments that were provided, and any patient responses to the medication.
Once the incident is reported, the nurse must also inform their supervisor and/or the medical facility's risk management department. Additionally, the nurse must take any other steps necessary to ensure the client's safety and well-being.
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in which order would the nurse take steps to incorporate music therapy into a patient's care ?
Answer:
The nurse would take the following steps in order to incorporate music therapy into a patient's care:
Step 1: Assessment of patient's need for music therapy. The nurse would first assess the patient's need for music therapy by evaluating the patient's current condition, medical history, and symptoms.
Step 2: Determine the type of music therapy that would be appropriate for the patient. After assessing the patient's needs, the nurse would determine the type of music therapy that would be appropriate for the patient. The nurse would consider the patient's preferences, interests, and goals.
Step 3: Develop a music therapy plan. After determining the type of music therapy that would be appropriate for the patient, the nurse would develop a music therapy plan. This would involve identifying goals for the therapy, selecting appropriate music, and planning for the delivery of the therapy.
Step 4: Implement the music therapy plan. After developing the music therapy plan, the nurse would implement the plan. This would involve delivering the therapy to the patient and monitoring the patient's response.
Step 5: Evaluate the effectiveness of the music therapy. After the therapy has been delivered, the nurse would evaluate its effectiveness. This would involve assessing the patient's response to the therapy and making any necessary adjustments to the plan.
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