A patient is taking a medication that has the potential to cause orthostatic hypotension. Which of the following nursing interventions is appropriate for this patient?
a. Have the patient sit slowly and dangle.
b. Refer the patient to physical therapy.
c. Keep the side rails up at all times.
d. Obtain a walker or a cane for patient use.
A
Dangling allows adjustment to orthostatic hypotension, permitting blood pressure to stabilize before ambulating. Have the patient dangle his or her feet for a few minutes before standing, walk slowly, and ask for help if dizzy or weak. The nurse would confer with physical therapy on the feasibility of gait training and muscle-strengthening exercise. Check agency policies regarding side rail use. Side rails are a restraint device if they immobilize or reduce the ability of a patient to move his or her arms, legs, body, or head freely. Keep one side rail up in a two-rail system, and keep three of four rails up (one lower rail down) in a four-rail system, with the bed in low position and wheels locked, when you are not administering patient care. This allows the patient to maneuver and get out of bed safely. Do not assume that the patient requires a walker or a cane. Evaluate the need for assistive devices such as walker, cane, or bedside commode. Assistive devices may provide greater stability and may help the patient to assume a more active role.
You might also like to view...
Which area is not critical to an older adult's ability to be successful in his or her plan of care?
a. Physical status b. Psychological status c. Family status d. Functional status
A researcher must select a sample that is representative of the population. Which of the following venues would be most practical for recruitment of patients with primary hypertension?
A) Prenatal clinic B) High school clinic C) Primary care clinic D) Acute care hospital
The nurse plans to teach a safety class to parents of toddlers about household exposure to medications. What will the best plan of the nurse include?
1. Keep the toddler awake and observe for side effects of the medication. 2. Keep all medications locked up and stored out of reach of the toddler. 3. Use syrup of ipecac immediately if the toddler has ingested medication. 4. Call the Poison Control Center for guidance with any medication ingested. 5. Teach the toddler that medications are for adult use only.
When administering aspirin to a patient with a history of peptic ulcer disease, the nurse may anticipate administering which drug(s) for prophylaxis against aspirin-induced ulcers? (Select all that apply.)
a. Misoprostol (Cytotec) b. Ranitidine (Zantac) c. Omeprazole (Prilosec) d. Lansoprazole (Prevacid) e. Antacids