A patient with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the patient's plan of care?
A) Impaired physical mobility related to presence of an indwelling urinary catheter
B) Risk for infection related to presence of an indwelling urinary catheter
C) Toileting self-care deficit related to urinary catheterization
D) Disturbed body image related to urinary catheterization
Ans: B
Feedback:
Catheters create a high risk for UTIs. Because of this acute physiologic threat, the patient's risk for infection is usually prioritized over functional and psychosocial diagnoses.
You might also like to view...
The nurse working in an ambulatory clinic recognizes which of the following patients as possessing a greater risk for the development of hypothyroidism?
A) A 25-year-old male B) A 45-year-old female C) A 50-year-old male D) A 75-year-old female
A nurse needs to perform the Heimlich maneuver on an 8-month-old infant with a partial airway obstruction. Which of the following actions should the nurse perform?
A) Support the client with a safety belt on a table. B) Use the heel of one hand to administer back slaps. C) Use finger sweeps to locate the obstruction. D) Give a series of subdiaphragmatic thrusts.
The nurse would use hydrogen peroxide in wound care:
a. because it is an effective antiseptic. b. to loosen debris and facilitate cleansing. c. to protect the wound. d. to treat localized infection.
To communicate well with patients, show an interest in what they are saying by talking with the patient, NOT just to or at him/her
True False