You are caring for a child with a history of multiple admissions for recurrent systemic infections, and the child is not improving in the hospital, despite aggressive treatment. A doctor mentions "factitious disorder by proxy."
What nursing interventions would be appropriate when this disorder is suspected? Select all that apply. a. Provide more private visiting time for the parents to increase bonding.
b. Stop by the patient's room frequently during visiting hours.
c. Encourage family members to visit in groups of two or three.
d. Keep careful, detailed records of visitation and untoward events.
e. Educate visitors about the importance of strict hand washing.
f. Place mittens on the child to reduce access to ports and incisions.
B, C, D
Factitious disorder by proxy is a rare condition wherein a person intentionally causes or perpetuates the illness of a loved one (e.g., by periodically contaminating IV solutions with fecal material). When this disorder is suspected, the child's life could be at risk. Depending on the evidence supporting this suspicion, interventions could range from minimizing unsupervised visitation to blocking visitation altogether. Frequently checking on the child during visitation and minimizing unobserved access to the child (by encouraging small group visits) reduces the opportunity to take harmful action and increases the collection of data that can help determine whether this disorder is at the root of the child's illness. Detailed tracking of visitation and untoward events helps identify any patterns there might be between select visitors and the course of the child's illness. Increasing private visitation provides more opportunity for harm. Educating visitors about aseptic techniques would not be of help if the infections are intentional, and preventing inadvertent contamination by the child himself would also not affect factitious disorder by proxy.
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The nurse is caring for an older client who presents with dizziness and difficulty hearing. Which of the nurse's assessment findings will require collaboration with the client's primary health care provider? (Select all that apply.)
a. Tympanic membrane is retracted, with multiple air bubbles. b. The client reports inability to hear high-frequency voices and sounds. c. Clear watery drainage is present in the ear canal and is positive for glucose. d. Tympanic membrane is shiny and trans-lucent, with light reflex noted. e. Hearing test indicates positive Rinne test, with AC > BC noted bilaterally. f. The client reports dizziness after taking naproxen (Aleve) for arthritis pain.
The nurse manager from the oncology unit has had two callouts; the orthopedic unit has had multiple discharges and probably will have to cancel one or two of its nurses
The orthopedic unit has agreed to "float" two of its nurses to the oncology unit if oncology can "float" a nursing assistant to the orthopedic unit to help with obtaining vital signs. This is an example of (Select all that apply.) a. Autonomy. b. Accountability. c. Political activism. d. Politics.
Issues that need to be considered when using the Andragogic model include:
a. letting learners know why something is important b. showing learners how to direct themselves through information c. relating the topic to learners' experiences d. knowing that people will not learn until they are ready e. all of the above