The nurse would increase surveillance and prevention for pressure ulcer development in which at-risk patients? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply
1. A 70-year-old patient who has been living at home and has limited ability to obtain groceries
2. A 68-year-old patient whose assessment reveals a low body mass index
3. A 50-year-old patient who has developed urinary incontinence after hospitalization for cholecystectomy.
4. A 35-year-old patient who has diabetic neuropathy
5. A 29-year-old patient hospitalized for treatment of pregnancy-induced hypertension
1,2,3,4
Rationale 1: Patients with poor nutrition are more susceptible to pressure ulcer development. Good nutrition supports skin health.
Rationale 2: Being very thin reduces the amount of subcutaneous "padding" and increases pressure on bony prominences.
Rationale 3: Patients who have urinary or fecal incontinence or are exposed to other types of moisture such as perspiration, wound drainage, or emesis are more prone to ulcers.
Rationale 4: Reduced sensation prevents the patient from feeling the pain associated with the development of a pressure ulcer, which increases the risk of development and progression.
Rationale 5: A young patient with pregnancy-induced hypertension is probably well hydrated. There is no indication of any other standard risk factors.
You might also like to view...
A postpartum woman is Rho(D)-negative and needs an injection of Rho(D) immune globulin. Which of the following doses would the perinatal nurse expect to be ordered?
A. 120 µg B. 250 µg C. 300 µg D. 350 µg
A patient has arrived at the emergency department via ambulance. The EMT states, "She is barely responsive. She took all of the Ativan in this bottle." What medication should the nurse prepare to administer to the patient?
A) Naloxone (Narcan) B) Physostigmine (Antilirium) C) Methylene blue D) Flumazenil (Romazicon)
When using the DMAIC acronym of the Six Sigma quality process improvement model, the nurse understands that the I (improve) refers to:
a. Identification of the start and stop dates. b. Comparison of data to customer surveys. c. Use of technology to design improvements. d. Staff training.
The nurse is caring for a patient who has a heart rate of 98 beats per minute and a blood pressure of 82/58 mm Hg. The patient is lethargic, is complaining of muscle weakness, and has had gastroenteritis for several days
Based on this patient's vital signs, which sodium value would the nurse expect? a. 126 mEq/L b. 140 mEq/L c. 145 mEq/L d. 158 mEq/L