A multigravida patient is admitted to the labor and delivery unit in active labor
Nursing diagnoses that might apply to the patient with suspected abruptio placentae include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fluid Volume, risk for deficit related to hypovolemia.
2. Tissue Perfusion, risk for altered related to blood loss.
3. Anxiety related to concern for own safety.
4. Knowledge Deficit related to lack of information about inherited genetic defects.
5. Alteration in Respiratory Function related to blood loss.
1,2,3
Rationale 1: Maternal and perinatal fetal mortality are concerns due to hypoxia.
Rationale 2: Maternal and perinatal fetal mortality are concerns due to blood loss.
Rationale 3: This mother would be anxious for herself and her baby.
Rationale 4: Abruptio placentae is a premature separation of the placenta, not a genetic abnormality.
Rationale 5: Respiratory function is not related to the blood loss.
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Parents confide to the nurse that they are concerned about their preschooler because she demands to pick out her own clothes in the morning
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A child with cerebral palsy has undergone surgery for placement of a baclofen pump. Which instruction would the nurse include when teaching the parents about caring for their child?
A) Waiting 48 hours before allowing the child to take a tub bath B) Not allowing the child to sleep on his side for about 4 weeks C) Calling the physician if the child's temperature is over 100.5°F D) Discouraging the child from stretching or bending forward for 4 weeks
The nurse is engaged in establishing goals. Which statements would be classified as long-term goals? (Select all that apply.)
a. Become proficient in medication administration. b. Attain a grade of B in the Mathematics for Medication Administration examination. c. Develop skill in efficient, effective collection of patient data. d. Achieve successful initial completion of admission data collection forms.