Which actions would the nurse take to prevent skin tears on an older patient with friable skin? Select all that apply
1. Avoid harsh soaps.
2. Apply silk tape over dressings.
3. Ensure an adequate fluid intake.
4. Use a lift sheet to reposition in bed.
5. Apply skin-moisturizing cream to arms and legs twice a day.
1. Avoid harsh soaps.
3. Ensure an adequate fluid intake.
4. Use a lift sheet to reposition in bed.
5. Apply skin-moisturizing cream to arms and legs twice a day.
Explanation: 1. An intervention to prevent skin tears is to avoid harsh soaps.
2. An intervention to prevent skin tears is to use paper tape and not silk tape to affix dressings.
3. An intervention to prevent skin tears is to ensure an adequate fluid intake.
4. An intervention to prevent skin tears is to use a lift sheet to reposition the patient in bed.
5. An intervention to prevent skin tears is to apply skin-moisturizing cream to the arms and legs twice a day.
You might also like to view...
The major source of nutrients in the diet of a pregnant woman should be composed of
a. Simple sugars b. Fats c. Fiber d. Complex carbohydrates
The nurse administers bethanechol (Urecholine) to a patient to treat urinary retention. After 30 minutes, the patient voids 800 mL of urine and reports having a loose stool but no cramping or gastrointestinal pain
The patient's blood pressure is 110/70 mm Hg. The nurse will perform which action? a. Notify the provider of bethanechol adverse effects. b. Record the urine output and the blood pressure and continue to monitor. c. Request an order for intravenous atropine sulfate. d. Suggest another dose of bethanechol to the provider.
What information would be appropriate for a nurse to share when educating IV drug users about sharing equipment?
a. Tell the clients to throw away their equipment after one use. b. Educate the clients on using full-strength bleach on their drug paraphernalia for 30 seconds. c. Report illegal activities to the authorities and confiscate the needles and syringes. d. Give out needles and syringes to whoever wants them.
The nurse is caring for a patient who underwent a transfemoral cardiac catheterization with coronary angiography earlier in the day. The patient denies pain and no longer requires bed rest. The groin is soft with no palpable hematoma
Which postprocedure care is most important for the patient at this time? a. Encourage increased fluid intake. b. Administer pain medications as ordered. c. Obtain vital signs every 15 minutes. d. Assist the patient with ambulation.