The nurse would consider incorporating which nursing diagnoses into the plan of care for a patient with acute adrenal insufficiency? Note: Credit will be given only if all correct choices and no incorrect choices are selected
Select all that apply. 1. Risk of Ineffective Therapeutic Regimen Management
2. Hyponatremia
3. Fluid Volume Excess
4. Risk for Injury
5. Imbalanced Nutrition: Less than Body Requirements
1,2,4,5
Rationale 1: The medication regimen for adrenal insufficiency can be complex and includes knowing how and when to alter the dosage relative to increased stress.
Rationale 2: A patient with adrenal insufficiency may have a sodium deficit.
Rationale 3: Acute adrenal insufficiency results in fluid volume deficit.
Rationale 4: The patient with acute adrenal insufficiency is at risk for injury even after the acute phase of the imbalance is corrected. The patient should wear medical alert jewelry so the condition will be recognized by first responders and medical personnel.
Rationale 5: Acute adrenal insufficiency may result in anorexia and weight loss.
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A patient who is a recovering alcoholic says, "I haven't had a drink in 10 days. I think I am over the hardest part and will be okay now.". The nurse formulates a response based on which information?
1. Symptoms of postacute withdrawal syndrome begin about a month after the last drink. 2. Symptoms of postacute withdrawal syndrome peak from 3 to 6 months after the last drink. 3. The recovering alcoholic is never "okay" again. 4. It is easier to recover from cocaine abuse than from alcohol abuse.
The nurse is teaching a parenting class for pregnant couples who will deliver soon. Which statement by a mother-to-be indicates that additional information is needed?
1. "Baby girls sometimes have a little bloody mucus in their diapers as a reaction to the high estrogen level in the mother." 2. "Genitals of babies look swollen and enlarged at birth as a result of the hormones in the mother's circulation." 3. "We can call the nurse help line any time of day or night if we have questions about our baby after we get home." 4. "Car seats are installed the same way in different models of cars. Our friends can show us how to install it."
Always use standard precautions when the patient is in isolation.
Answer the following statement true (T) or false (F)
What criteria would you use to suggest a change from enteral to parenteral nutrition?