The nurse is caring for a patient with a healing Stage III pressure ulcer. The wound is clean and granulating. Which health care provider's order will the nurse question?
a. Use a low-air-loss therapy unit.
b. Irrigate with Dakin's solution.
c. Apply a hydrogel dressing.
d. Consult a dietitian.
ANS: B
Clean pressure ulcers with noncytotoxic cleansers such as normal saline, which will not kill fibroblasts and healing tissue. Cytotoxic cleansers such as Dakin's solution, acetic acid, povidone-iodine, and hydrogen peroxide can hinder the healing process and should not be utilized on clean granulating wounds. Consulting a dietitian for the nutritional needs of the patient, utilizing a low-air-loss therapy unit to decrease pressure, and applying hydrogel dressings to provide a moist environment for healing are all orders that would be appropriate.
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Donna is a 34-year-old patient with a spinal cord injury. After two months in the hospital, Donna expresses concern to the nurse that she hasn't had a menstrual period since her accident. The nurse explains that
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Providing spiritual care to a client requires the nurse to have a comfort level with this type of care and:
a. the use of touch b. conscientious thought and personal reflection c. knowledge of religions d. prior spiritual experiences
A military veteran is being evaluated for traumatic brain injury (TBI). Which nursing assessment data supports such a diagnosis? (Select all that apply.)
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The nurse is teaching a client the importance of taking the medication as prescribed. Client teaching is guided by the nurse's knowledge of which principles of pharmacokinetics?
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