The clinic nurse should include in the instructions for a woman scheduling a pelvic examination is that you use a do.uc.he, avoid intercourse for 48 hours before the examination, and apply vaginal medication.
A do.uc.he is a tool, or the stream of water itself, that is used to inject water into the body for therapeutic or hygienic purposes. Do.uc.he typically refers to cleaning the vagina, commonly known as vaginal irrigation, although it can also apply to washing any body cavity.
In a pelvic examination, the doctor or nurse will press on the lower abdomen with one hand while inserting one or two of their gloves, lubricated fingers into the vagina. This is done to examine the uterus and ovaries' size, shape, and location.
The question is incomplete, find the complete question here
what should the clinic nurse include in the instructions for a woman scheduling a pelvic examination? select all that apply
use a do.uc.he
avoid intercourse for 48 hours before the examination
Wash vagina with soap and water
apply vaginal medication.
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in providing health promotion educaton to reduce the likelihood of transmission of sexually transmitted desease, which actions would still have a low increased risk? select all that apply
You can prevent STDs by using a conudom appropriately each time. All STDs have lower infection rates thanks to conduits. Certain STDs, such as herpes or HPV, are still contagious.
Which of the following is a strategy that professionals advise using to lower the risk of sexuually transmitted infections?Three fundamental strategies can be used to prevent and manage sexiually transmitted infections: lowering the risk of transmission during any sexuoal encounter (for example, by using conduoms); lowering the frequency of soexual partner switching; and lowering the duration of an individual's infectiousness.
Which of the following is thought to be the first action in stopping STIS?When having an oral, vagoinal, or nasal procedure, use a consent properly to lessen the chance of STI transmission.
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9. when recording their observations, evaluators should include all the following performance-related data except:
The IP takes the observations and recommendations from the draft AAR and resolves them through the development of concrete corrective actions.
What is evaluators?
In this model, the role of the evaluator is to provide information to the decision-maker at the context, input, process, and product stages of the evaluation.An evaluation is an appraisal of something to determine its worth or fitness. For example, before you start an exercise program, get a medical evaluation, to make sure you're able to handle the activity.The process of judging or calculating the quality, importance, amount, or value of something: Evaluation of this new treatment cannot take place until all the data has been collected.For example, an evaluator can be a judge during the phase of selecting criteria of merit, a methodologist when collecting data, a program facilitator during the program implementation, and an educator during the results dissemination.To learn more about evaluators refers to;
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your 94-year-old great-grandmother is having difficulty with bathing, dressing, food preparation and eating, housekeeping, and paying bills. your family is considering getting some professional nursing care for her. during the interview with the nursing care provider, the nurse asks what your great-grandmother's major concerns are. what would you tell the nurse?
The nurse describes the everyday activities (The difficulties center around the activities of daily living).
What nursing care means?Nursing includes providing independent and team-based care to people of all ages, couples, groups, and communities, whether they are ill or not and regardless of the location. Healthcare encompasses the support of good health, the avertance of disease, and also the care of the sick, the disabled, and the dying.
What is the role of nursing care?First from time from birth until the end of life, nurses are present in every community, big and small. Nurses do a variety of roles, from delivering direct patient care and handling cases to setting nursing practice standards, creating quality control procedures, and administering intricate nursing care systems.
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a nurse is searching for recent information concerning the most effective follow-up method for clients following bariatric surgery to maintain weight loss. which question is appropriate for the nurse to consider when appraising a study?
When evaluating a study, the nurse should take into account the following question: Were the subjects randomly assigned to a group?
Why should the nurse take the aforementioned question into account while evaluating a study?The three main inquiries of the quick critical appraisal method for analyzing a study are validity, reliability, and evaluation. To determine whether a study's subjects were randomly assigned to the treatment or control group, consider its validity.
What kind of research provide background knowledge but doesn't directly address a clinical question?Observational studies are those in which the researcher records a regular association between the exposure and the result under review. The exposure has already been determined naturally or by another cause, and the researcher does not actively intervene in any individual.
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The given question is incomplete. The complete question is:
A nurse is searching for recent information concerning the most effective follow-up method for clients following bariatric surgery to maintain weight loss. Which of the following questions is appropriate for the nurse to consider when appraising a study?
a. were there control groups from my area?
b. did the studies cover at least a year in follow-up
c. Were the subjects randomly assigned to a group?
d. will these methods be effective for everyone?
in response to a client's nausea, the nurse has mixed a dose of an antiemetic with 50 ml of sterile normal saline and will administer the dose by iv piggyback. what is the rationale for the use of iv piggyback?
The smaller bag is connected to, or "piggybacks" on, the existing main IV line, hence the word "piggyback." Once the drug has been infused, the smaller bag is removed, but the main IV is left in place.
What does an IV piggyback serve?A little bag of solution used to provide medication over a certain time period is called an IV piggyback and is connected to a primary infusion line or intermittent venous access device.
What does IVPB have as a goal?Due to the fact that secondary IV therapy is attached to the main bag of intravenous fluids, it is frequently referred to as "IV piggyback" (IVPB) medication. In this instance, the main line keeps venous access open in between doses of the medication.
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the nurse observes that a client's nasogastric tube has suddenly stopped draining. the tube is connected to suction, the machine is on and functioning, and all connections are snug. after checking placement, the nurse gently flushes the tube with 30 ml of normal saline, but the tube still is not draining. the nurse would conclude which is the problem, and what action would be taken?
The nurse would either let the doctor know or ask for a radiological assessment of the tube's placement.
Why would a patient need a nasogastric tube?Nasogastric tubes can also be used to provide nourishment or medication to individuals that are unable to accept oral administration. Nasogastric tubes are often utilized for decompress of the stomachs in the setting of bowel obstruction during ileus.
Who needs nasogastric tube?If your struggle to swallow or eat, you might need to have a nasogastric tube put in. The process is known as "nasogastric (NG) intubation." In NG intubation, the physician or nurse will insert a little piece of plastic into your nostril, esophagus, and stomach.
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the nurse is caring for a hospitalized client with a suspected diagnosis of tuberculosis (tb). which finding does the nurse expect to note during data collection?
Chills and night sweats need to be noted down by the nurse on the client who is having Tuberculosis.
Tuberculosis (TB) is a potentially serious infection that primarily affects the lungs. The bacteria that cause tuberculosis are spread from person to person through tiny droplets released into the air by coughs and sneezes. Tuberculosis (TB) is caused by one of the bacteria which is called Mycobacterium tuberculosis. Mycobacterium tuberculosis usually attacks the lungs, but it can attack any part of the body, including the kidneys, spine, and brain. Not everyone who is infected with tuberculosis becomes sick. Tuberculosis has three stages - exposed, latent and active disease.
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which type of pharmacy literature provides the foundation for the development of other pharmacy literature?
The primary pharmacy literature provides the foundation for the development of other pharmacy literature.
Pharmacy is the field of science that deals with the study and practice of discovering, producing, preparing, dispensing, reviewing and monitoring drugs and medicines. The goal of pharmacy is to ensure that medicines should be safe as well as effective for consumption.
Pharmacy literature is the collection of books, scholarly articles, encyclopedia, and various other sources that provide the in-depth knowledge of several drugs and medicines. It provides the actual knowledge about the development of medications. These literary books are written after extensive research and experiments.
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which of the following best describes the medical condition of shock? question 4 options: a) a state of inadequate tissue perfusion b) an extreme emotional reaction to a stressful event c) delayed capillary refill d) hypotension
The health problem of shock is most accurately described as an excessive emotional response to a stressful incident.
What word(s) sums up shock as a medical condition?A lack of blood flow to the body can result in shock, a potentially fatal condition. The cells and organs need blood flow in order to receive sufficient oxygen and nutrients and function properly. As a result, many organs may sustain harm. Shock must be treated right away since it might quickly develop worse.
Which one of the following best sums up the ability of the cardiac muscle to produce its own electrochemical stimulation?Intrinsic rhythm is the term for the electrical activity that the heart can produce on its own. Contraction begins at the wall of the right atrium (SA) node of a healthy heart .
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a patient develops an infection after dental implant surgery. which condition is the client likely to develop if the infection is left untreated?
Answer:
Septicemia
Explanation:
a client is being discharged today from the hospital. the nurse delegates morning care to the unlicensed assistive personnel (uap). the assessment finds that the client is able to stand and ambulate independently without weakness or dizziness. the nurse will delegate what type of care to be provided based on the assessment findings?
Today, a patient is being released from the hospital. The nurse assigns the unlicensed assistance staff morning care (UAP), Findings of the assessment.
Which part of denture care can the nurse properly assign to unlicensed assistance people (UAP)?Which part of denture care can the nurse properly entrust to unlicensed assistance staff (UAP)? It is acceptable to delegate this part of denture care because brushing falls under the UAP's purview of practice.
In a hospital setting, the nurse is giving clients perineal care. What nurse intervention is suitable for this kind of care Apply a emollient as directed after drying the areas you've cleaned.
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an 80-year-old woman tells the nurse that she just itches all the time and her skin seems very dry. how do these symptoms relate to aging skin?
These symptoms are related to ageing skin when the activity of the skin's glands decreases.
Skin that has aged seems thinner, paler, and clearer (translucent). In sun-exposed regions, pigmented patches such as age spots and "liver spots" may form. Lentigos is just the medical word for these regions. Changes in connective tissue weaken and sag the skin's suppleness. Dry skin can also be caused by conditions such as diabetes or renal disease.
Using quite so much soap, antiperspirant, and perfume, as well as taking hot showers, can aggravate dry skin. Some medications might irritate the skin. Scratching can cause bleeding and infection in elderly adults because their skin is thinner. See a physician if ones skin is really dry and irritated.
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in the next sets, you are given the magnitude and one component. there is an ambiguity in determining the vector, because you can only determine the absolute value of the other component and not its sign; therefore, there are two possibilities. in these tables, you must enter the absolute value of the component and provide two angles for the vector, the first one assuming the other component is positive and the other assuming the component is negative. you must also provide two angles for the antiparallel vector in the same order.
A scalar is a value whose magnitude, or the number of components measured on an appropriate scale, determines it. A force is a vector quantity whose magnitude and direction are independent.
A scalar is what?
scalar, a mathematical quantity whose magnitude serves as its sole description. Volume, density, mobility, energy, mass, & time are a few examples of scalars. Other quantities, like as potential and kinetic energy, are referred to as vectors since they have both direction and magnitude.
What are scalar and vector terms?
In physics and mathematics, two different types of quantities are called scalars and vectors. While vectors have had both magnitude and direction, scalars simply have magnitude (or size). Learn about several scalar and vector examples, such as distance, motion, speed, and velocity.
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a nurse is reading a journal article about the evolution of nursing informatics. the nurse demonstrates understanding of the article by identifying which time frame as being associated with the shift in definition from a technology orientation to more of an information orientation?
Nurse is reading a magazine article about development of nursing informatics. Nurse demonstrates understanding of article by identifying mid-1980s timeframe associated with shift in definitions from technology-oriented to more information-oriented.
What Role Does Nursing Informatics Play?Nursing informatics refers to the practice and science of integrating nursing information and knowledge with technology to manage and integrate health information. The goal of nursing informatics is to improve the health of people and communities while reducing costs.Nursing informatics combines nursing, computer science, and informatics to develop and maintain data systems designed to manage medical records, improve patient outcomes, and improve the overall performance of healthcare organizations. It covers all areas of science. What are elements of nursing informatics?Components of nursing informatics: data, iNforMatioN, KNowledge, aNd wisdoM:
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the nurse is assisting in caring for a client who is receiving morphine sulfate by continuous intravenous infusion. the nurse ensures that which medication is readily available if a morphine overdose occurs?
If a client is getting morphine sulfate via continuous intravenous infusion and a morphine overdose develops, nalmefene (Revex) medicine is easily accessible.
What types of pain does morphine work best on?For the treatment of moderate to severe cancer pain, morphine is regarded as the gold standard opiate and the medication of choice (Schug et al 1990; Wilson et al 1997; Benedetti et al 2000). Before switching to another opiate like fentanyl, hydromorphone, or oxycodone, it should be titrated to the point of maximal tolerance.
What is morphine now used for?The non-synthetic narcotic morphine is produced from opium and has a significant potential for misuse. It is employed to manage pain.
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after a total knee replacement, a client will be using a continuous passive motion device. which therapy goal identified by the client would indicate to the nurse that teaching was effective?
therapy at a 45o angle with your legs apart and one foot front of the other, face on head of the bed. Place yourself at the patient's waist. As well as offering support proper alignment helps prevent back problems.
What position is ideal for a patient following surgery?For the most parts, sleeping on flat back with both arms on your side your toes pointing upward may be the most comfortable place, while specific instructions in where your legs, shoulders, and feet should be put differ. When in doubt, consider sleeping on your back because it helps keep your entire body neutrally positioned.
Which posture would the nurse utilize to place the injured extremity of a recovering client?Legs can be stretched or slightly bent in the supine position, and arms can be raised or lowered. It offers general comfort to people recovering from surgery of any kind. most typical usage position The positions utilized for a general examination or patient exam are supine or dorsal recumbent.
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which calrification technique would the nurse use to learn more about the ideas and experiences of the patients?
Observing and examining the patient will be the clarification technique used by the nurse to examine the patient.
The main data collection methods are observations, questions, and surveys. Observations are made when the nurse is in contact with the client or assistant. Questionnaires are primarily used when collecting nursing medical histories. Tests are the primary method/technique used to assess physical health. Active Listening - Pay attention to what the client is saying verbally and non-verbally. Sit facing the customer, open up, lean toward the customer, make eye contact, and relax. Sharing Observations - Make observations by commenting on how others look, sound, or act. Repetition encourages patients to provide more information is one of the most effective therapeutic communication methods.
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the licensed practical nurse (lpn) is caring for a client with a wound culture positive for methicillin-resistant staphylococcus aureus (mrsa). which client data would be the priority to immediately report to the registered nurse (rn)?
put on gloves and a gown If a wound culture revealed methicillin-resistant staphylococcus aureus, the licensed practical nurse (lpn) would be required to notify this as soon as possible (mrsa).
How can one get MRSA?MRSA often spreads throughout a community through contact with infected individuals or objects. This includes coming into contact with an infected wound or sharing private things like towels or razors that have come into contact with diseased skin.
Is MRSA a harmful illness?Although staph bacteria are often not harmful, they can nonetheless result in life-threatening infections including sepsis. Due to its resistance to various drugs, Methicillin-resistant Staphylococcus aureus (MRSA) is a staph infection cause.
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what determines if a male patient should stand or sit to urinate?
in order to be certified in texas, a candidate must pass the following exam: a. national registry exam b. texas department of state health services (dshs) exam c. both the national registry and dshs exams d. none of the above
(a) national registry exam. in order to be certified in texas, a candidate must pass the national registry exam.
The National Registry test is it difficult?If 33% of EMTs and 23% of paramedics fail the exam, then 67% and 73% of those two groups, respectively, passed the exam. If you understand how the test is structured and how to prepare for it, you can be among those passing percentages. The key to passing the exam is effective and extensive EMT or Paramedic preparation.
How long is the validity of an EMS provider license?A candidate who satisfies the criteria in this section will be certified for a period of four years, starting on the day that a certificate and wallet-size certificate are issued. (6) providing a current and/or valid mailing address to the department within 30 days of any changes.
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the nurse is assessing fall risk in a community. what information would be included in the fall efficacy scale? (select all that apply.)
The nurse is evaluating the community's fall risk. The following details are contained in the fall efficacy scale: descending the stairs, attending church, shopping, and dressing. The correct answer is options(b),(c),(d), and (f).
Fall prevention involves any operation captured to help humble the number of accidental falls endured by naive things, to a degree the elderly and population accompanying affecting animate nerve organs or orthopedic indications. A fall grant permission influences fractures, lacerations, or within bleeding, superior to raised health management exercise.
Research shows that close to individual-tertiary falls may be prevented. Fall stop includes directing a patient's underlying fall risk determinants and optimizing the clinic's tangible design and atmosphere. Created by organizational psychologist Gilad Chen and crew (2001), the New General Self-Efficacy Scale is an 8-article measure that assesses by virtue of how much public trust they can achieve their aims, regardless of troubles.
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The complete question is:
The nurse is conducting an assessment of fall risk in a community. What information would be included in the fall efficacy scale? (select all that apply)
a. Walking the dog
b. Going downstairs
c. Going to church
d. Shopping
e. Toileting
f. Getting dressed
the nurse is preparing the client for the administration of an enema. the nurse will place the client into which position?
For the administration of an enema, the nurse will put the patient in a left lateral or knee-chest posture.
This position makes it simpler to insert the enema tube while also aiding in the relaxation of the rectal muscles.
In order to stimulate bowel movements, clean the colon, or deliver medication, a liquid solution is introduced into the rectum and colon through the anus .A person in the knee-chest position is on their hands and knees, with their head down and their chest near to their knees.
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while a client is holding and talking to her newborn immediately following delivery, she begins to cry. how does the nurse interpret the client's behavior
The client is experiencing a normal response to birth hence, there is nothing to worry about the client's behavior while a client is holding and talking to her newborn immediately following delivery, she begins to cry.
What does the term newborn refers in context of pregnancy?Term newborns are those born between 37 and 42 completed weeks, according to the American College of Obstetrics and Gynecology (ACOG) and the National Institutes of Health (NIH).
A baby who has recently entered the world is referred to as a newborn. The World Health Organization defines a newborn as being younger than 28 days old, but medical professionals often refer to infants as newborns up to 2 months old.
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which competencies did the american nurses association (ana) identify as essential for evaluating outcomes?
The competencies identified as essential for evaluating outcomes by the American nurses association (ANA) are: (2) Document evaluation information; (3) Incorporate ongoing assessment data; (5) Establish a priority order for nursing actions.
ANA is a professional organization that focuses towards the advancement and safeguarding the nursing profession. The organization began in the year 1896 under the name Nurses Associated Alumnae. It got renamed in the year 1911.
Assessment refers to the complex analysis of the patient's condition like physiological, psychological, sociological, as well as spiritual status. This is done in order to decide the best and appropriate treatment for the patient.
The given question is incomplete, the complete question is:
Which competencies did the American nurses association (ANA) identify as essential for evaluating outcomes? Select all that apply.
Include the patient’s perspective.Document evaluation information.Incorporate ongoing assessment data.Collaborate to develop the plan of care.Establish a priority order for nursing actions.To know more about ANA, here
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which intervention would the nurse implement to prevent precipitating a painful attack in a client with tic douloureux?
The nurse should implement the application of cold or heat to the affected area to prevent the onset of a painful attack in a client with tic douloureux.
The nurse should implement the application of cold or heat to the affected area to prevent the onset of a painful attack in a client with tic douloureux. This can be done through the use of a heat pack, cold pack, or alternating hot and cold compresses. The nurse should ensure the temperature of the pack or compress is comfortable for the client and monitor the effectiveness of the intervention. The nurse should also monitor the client for any adverse reactions, such as worsening of the pain, and adjust the intervention accordingly. Other interventions that can help in this situation include providing distraction techniques and relaxation techniques, as well as providing emotional support. It is important for the nurse to assess the client's response to the interventions in order to provide effective care.
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To stop a client with tic douloureux from having a painful attack, the nurse should apply cold or heat to the affected area.
To stop a client with tic douloureux from having a painful attack, the nurse should apply cold or heat to the affected area. A heat pack, a cold pack, or alternately applying hot and cold compresses can be used to achieve this. The nurse should monitor the client's comfort with the compress or pack's temperature as well as the intervention's efficacy.
Additionally, the nurse should keep an eye out for any negative reactions in the client, including a worsening of the pain, and change the intervention as necessary. Other solutions that can be helpful in this circumstance include teaching relaxation and distraction methods as well as offering emotional support. In order to deliver successful care, it is critical for the nurse to gauge the client's reaction to the interventions.
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a woman gave birth to a small infant with a malformed skull. the infant grows slowly and shows signs of substantial cognitive and intellectual deficits. the child also has facial abnormalities that become more striking as it develops. what might the nurse expect to find in the mother's pregnancy history?
The nurse would anticipate learning about chronic alcohol consumption from the mother's past pregnancies.
What are examples of abnormalities?Depression is really a excellent demonstration of an abnormal behavior that can be evaluated using a multi-criteria approach considering that it is frequently viewed as a departure from ideal sanity, it frequently prevents the person from "functioning" in normal life, and even though it is a statistically uncommon mental disorder, it remains relatively common.
What causes abnormality?Genetics, a disease, exposure with radiation or medicines, or an unknown cause, could be to blame for the issue. Congenital abnormalities include conditions including phenylketonuria, sickle cell disease as well as Down syndrome.
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describing and assigning nomenclature to a previously unrecognized or nameless concept based on a review of related empirical and conceptual contributions to nursing practice is termed ; taking a concept from another discipline and moving it to nursing to explain a phenomenon is termed .
The conceptual-theoretical-empirical (CTE) structure is a framework for nursing knowledge that calls for careful consideration of both process and content elements.
What is the contribution of empirical in nursing?
EMPIRICISM'S CONTRIBUTION TO CLINICAL PRACTICE IN NURSING EPISTEMOLOGY. Additionally, clinical practice has evolved to be more technologically dependent and scientific in order to identify complex patient situations, which frequently necessitate extended observation and assessment due to the complexity. Empiricism allows for the objective identification and observation of human phenomena associated with both typical and pathological physiological or psychological processes. Conclusions: Based on an explanation of related phenomena, the nursing knowledge obtained through an empirical approach is deemed appropriate for generalization.Philosophy in nursing. The significance of nursing phenomena is explained through analysis, justification, and logical presentation in this most abstract type.To learn more about Nursing Process refer to:
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Dr. Mathews performed surgery on Nathan Weston to remove his gallbladder, after he was diagnosed with cholelithiasis with cholecystitis. Report this condition with:
A. K80.61Calculus of gallbladder and bile duct with cholecystitis, unspecified, with obstruction
B. K80.65Calculus of gallbladder and bile duct with chronic cholecystitis with obstruction
C. K80.10Calculus of gallbladder with chronic cholecystitis without obstruction
D. K80.70Calculus of gallbladder and bile duct without cholecystitis without obstruction
Report this condition with A. K80.61 Calculus of gallbladder and bile duct with cholecystitis, unspecified, without obstruction.
Cholelithiasis may not require treatment in asymptomatic persons. Cholelithiasis can be treated with drugs that dissolve gallstones, by specific diagnostic examinations, or through gallbladder removal surgery, also known as a cholecystectomy, in people who have symptoms. Gallstones can be caused by an excess of cholesterol, bile salts, or bilirubin (bile pigment). Cholelithiasis occurs when gallstones form in the gallbladder itself. Choledocholithiasis occurs when gallstones form in the bile ducts.
Cholecystitis is gallbladder inflammation. Symptoms include right upper abdomen discomfort, right shoulder ache, nausea, vomiting, and, on rare occasions, fever. Gallbladder episodes (biliary colic) frequently precede acute cholecystitis. Cholecystitis causes more discomfort than a regular gallbladder attack. Recurrent bouts of cholecystitis are prevalent in the absence of proper therapy. Acute cholecystitis complications include gallstone pancreatitis, common bile duct stones, and common bile duct inflammation.
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the nurse is administering a subcutaneous injection and notices that there is blood in the syringe prior to injecting the medication. what is the nurse's best action?
While giving a subcutaneous injection, the nurse detects blood in the syringe before injecting the medicine. The nurse's best move was to remove the syringe and prepare a fresh injection.
Subcutaneous means under the skin. In this type of injection, a short tease is used to introduce a drug into the fabric layer between the skin and the muscle. Medication likely this habit is consistently consumed more moderately than if introduced into a tone, sometimes over an ending of 24 hours.
As subcutaneous tissue has few ancestry ships, the introduced drug is spread very moderately at a maintained rate of absorption. Therefore, it is well-active in executing vaccines, tumor hormones, and insulin, that demand constant transfer at a depressed dose rate. A syringe is a natural alternating injection incorporating a bettor that fits fixedly inside a cylindrical tube called a barrel.
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which of the following statements about national health disparities initiatives is true? although multiple federal agencies have set goals for reducing health disparities, accountability and funding have been inadequate and little progress has been made. as a direct result of the establishment of the u.s. department of health and human services task force on black and minority health, health disparities have been significantly reduced throughout the united states. the national institutes of health has primary responsibility for reducing health disparities in the united states. the healthy people initiative was launched by the institute of medicine in 1999.
Although many government agencies have set targets for addressing healthcare disparities, little has been achieved cos of poor responsibility and funding.
What instances of health inequities are there?Although differences in health and healthcare are frequently seen through the lens of ethnicity and race they exist across a wide variety of characteristics. For instance, discrepancies exist in terms of financial position, age, region, language, gender, status as a person with a disability, nationality, and sexual orientation.
Why do health inequities exist?There is strong evidence that a person's health is significantly influenced by social characteristics such as education, work position, income level, gender, and ethnicity. There are significant differences in the health condition of various social groups in all nations, regardless of if they are low-, middle-, or elevated.
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