The nurse is caring for a child on bed rest who has severe edema in a left lower extremity due to blocked lymphatic drainage. Which nursing diagnosis would take priority?
1. Risk for Impaired Skin Integrity
2. Risk for Altered Body Image
3. Risk for Imbalanced Nutrition: Less Than Body Requirements
4. Risk for Activity Intolerance
1
Explanation:
1. The highest priority problem is skin integrity.
2. Body image would not take priority over the integrity of the skin for this scenario.
3. Nutrition would not take priority over the integrity of the skin for this scenario.
4. Activity intolerance would not take priority over the integrity of the skin for this scenario.
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A client with lymphedema in the left arm has weeping from the skin and has a small 2-cm ulcer on the upper arm. What test does the nurse anticipate the client will be prepared for?
A) X-ray of the left arm B) Ultrasound of the left arm C) CT scan D) Lymphangiography
A client is complaining of pain in the lower left quadrant of the abdomen. The nurse prepares to percuss the abdomen and notes that the client has a great deal of hair on the lower abdomen. The nurse should:
1. Shave the client's abdomen. 2. Discontinue using percussion. 3. Moisten the abdominal hair. 4. Document that the client has hirsutism.
The nurse notifies the primary care provider that the patient is experiencing pain. The provider gives the nurse a telephone prescription for morphine 4 mg intravenously every hour as needed for pain
How should the nurse document this telephone order? a. 09/02/16 0845 morphine 4 mg intravenously q 1 hour prn pain. Kay Andrews, RN b. 09/02/16 0845 morphine 4 mg intravenously q 1 hour prn pain T.O.: Dr. D. Kelly/Kay Andrews, RN c. 09/02/16 0845 morphine 4 mg intravenously q 1 hour prn pain V.O.: Dr. D. Kelly/Kay Andrews, RN d. 09/02/16 0845 morphine 4 mg intravenously q 1 hour V.O. Kay Andrews, RN
Rate controllers rely on ________ to infuse IV solutions.
Fill in the blank(s) with the appropriate word(s).