The nurse is prioritizing care for two postoperative abdominal surgery clients; the first is 15 hours postoperative and the second is ready for discharge. Which of the interventions should be ac-complished first?
1. Discharge pain control
2. First day dangling and ambulation
3. First day post op coughing and deep breathing
4. Discharge teaching regarding the dressing change
ANS: 3
The first client's goals center on restoring physiological function impaired as a result of the stress of surgery. The second client's goals center on adequate preparation to assume self-care at home. Physiological interventions, particularly those affecting breathing, should receive priority. Dan-gling and ambulation may be addressed after the second client is readied for discharge.
You might also like to view...
When the nurse is assessing victims in an emergency situation, the first priority is to assess for:
a. hemorrhage. b. fractures. c. mobility. d. abnormal breathing.
A family member of a patient who is in adrenal crisis asks why the IV cortisone is continued after the initial IV push of Solu-Cortef, which seemed to stop the symptoms. What is the best explanation by the nurse?
a. Solu-Cortef has a very brief therapeutic period and needs a maintenance IV infu-sion to keep up the level. b. IV infusions guarantee that Solu-Cortef will be absorbed. c. Long-term IV infusions maintain adequate urine output. d. IV cortisone supports peripheral perfusion and elevates the blood pressure.
A serious highway accident on a foggy night involves 22 vehicles. Several of the victims are ambulatory. The emergency personnel determine that their injuries are minor and arrange for transportation home. Why are these victims triaged first?
1. To do the greatest good for the greatest number of people 2. To remove them so they do not see the critically injured victims 3. To secure the site in case the vehicles become overheated and ignite 4. To improve traffic conditions to clear the accident site quickly
The following statement: "There will be a change in nursing practice of nurses after completion of an EBP mentorship program as compared to before the mentorship program," is an example of a
a. problem statement. b. purpose statement. c. research hypothesis. d. correlation.