J.B. has several factors that make discharge planning especially problematic. Describe two
specific discharge problems and list possible solutions.
What will be an ideal response?
Homelessness: Because J.B. cannot be discharged to the street with his multiple medical needs,
involve the social services team early to register him for Medicaid and find placement for him until
the tracheostomy heals. If possible, he should be considered for either permanent extended care
facility placement or subsidized housing. If J.B. were to continue to be homeless, then you would
need to address the following:
Nutrition: J.B. has a PEG tube; this is his only source of nutrition. This raises a number of questions:
Is he on a pump or bolus? Where will his supplies be sent? Where will he store his cans of formula
for the month? Where does he obtain clean water for flushes and hydration?
Tracheostomy care: Who is going to do care for the tracheostomy? Where is he going to store his
supplies?
Communication: He will need to complete his alternate communication techniques training as an
outpatient.
High risk of developing pneumonia: J.B. will need to maintain his fluid intake at a level that will
prevent thickening of mucus. In addition, he will need to practice excellent oral care and
pharyngeal hygiene.
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The nurse is caring for a postoperative patient who has had abdominal surgery and whose wound has completely eviscerated when she walks into the room. In addition to notifying the physician, what should the nurse do?
a. Cover the wound with a sterile gauze pad. b. Cover the wound with a transparent dressing. c. Put pressure on the wound with a sterile gauze pad. d. Cover the wound with gauze soaked with normal saline.
A nurse sees the nursing theory of Dorothea Orem as providing a suitable framework for practice
This nurse would plan care to a. acknowledge the client's suffering related to illness. b. support client coping strategies to enhance adaptation. c. assist the client to discover and use stress reduction strategies. d. promote self-care activities of the seriously and persistently mentally ill client.
For Orem, the clear specification that the nurse uses in the nursing role is the power of nurses to
A. Initiate caring for others. B. Coordinate the work of all health providers. C. Design and produce nursing care for others. D. Maintain an objective stance toward others.
Which characteristic(s) of personality disorders should the nurse consider? (Select all that apply.)
a. Impaired cognition b. Maladaptive response to life's events c. Inability to maintain relationships d. Poor impulse control e. Inappropriate emotional responses