What comfort measures are important for A.G. while she has an NGT?
What will be an ideal response?
• Properly tape the tube to the nose so that it does not pull on the nares or cause ulceration.
• Pin the tube to her gown at such an angle that the tube does not apply pressure on the nares.
• Regularly observe and cleanse the nares.
• Provide good oral care.
• Obtain an order for benzocaine spray or lozenges (such as Chloraseptic, a topical anesthetic) if A.G.
complains of (C/O) a sore throat. (Use your communication chart to be sure you have a set of "pain"
words.)
• Help A.G. turn in bed to avoid traction on the tube. Sitting in semi-Fowler position helps reduce the
pressure of the distended abdomen on the chest.
You might also like to view...
The primiparous client has told the nurse that she is afraid she will develop hemorrhoids during pregnancy because her mother did. Which statement would be best for the nurse to make?
1. "It is not unusual for women to develop hemorrhoids during pregnancy." 2. "Most women don't have any problem until after they've delivered." 3. "If your mother had hemorrhoids, you will get them, too." 4. "If you get hemorrhoids, you probably will need surgery to get rid of them."
A nurse is reviewing a patient's medical record before administering a medication. Which factor(s) can alter the patient's physiologic response to the drug? (Select all that apply.)
a. Ability to swallow pills b. Age c. Genetic factors d. Gender e. Height
You have arrived on the scene outside a grocery store where an elderly woman is sitting on the sidewalk with several bystanders. She has a hematoma on her forehead, abrasions on her palms, an obvious deformity of her right forearm, and an avulsion on her right knee that is continuing to bleed. Your patient says she is 80 years old and lives alone. She takes no medications and states she is in good health. She tells you she tripped over the curb as she approached the store entrance. When assessing the patient, which of the following would be most appropiate?
A. a focused physical exam and rapid trauma assessment B. a detailed physical examination C. a rapid trauma assessment D. a focused physical exam
A client tells the nurse at the methadone clinic that he has a prescription for methadone 40 mg daily orally. The nurse recognizes that methadone maintenance can be used as an effective drug replacement for individuals addicted to:
1. Opiates 2. Amphetamines 3. Barbiturates 4. Hallucinogens