For which of the following practices should the nurse intervene? ATI Palliative Hospice Care Activity Gero Sim Lab 2 (CH) Business PLAN OF Pusong Lumpia; QSO 321 1-3: Triple Bottom Line Industry Comparison; Newest. Monitor I&O for clients with fluid or electrolyte imbalances Determine log1048=log10(8)(6)\log _{10} 48=\log _{10}(8)(6)log1048=log10(8)(6), and compare to log108+\log _{10} 8+log108+ log106\log _{10} 6log106. Naso tubes, like the nasogastric and nasoduodenal tubes, are the preferred tube because their placement is noninvasive, however, naso tubes are contraindicated when the client has a poor gag reflex and when they have a swallowing disorder because any reflux can lead to aspiration. What is the normal urine specimen gravity? Medications, including over the counter medications, interact with foods, herbs and supplements. hb```, eagGHm Which of the following precautions should the nurse plan for this client? A nurse is preparing to insert an IV catheter into a client's arm prior to initiating IV fluid therapy. What do you do if one or more patient's in the same room? Although more clients should reduce their weight, there are some clients that have to be encouraged to gain weight. B !$f%+1:H/ Which of the following findings should the nurse identify as a potential indication of abuse? A nurse is preparing to administer 750 mL of 0.9% sodium chloride IV to infuse over 7 hours. When the nurse performs the initial assessment, he notes that the client has received only 80 mL over the last 2 hrs. -Keep replacement batteries. A nurse is completing an admission assessment of an older adult client. Leave 1-2 inches of catheter at end of penis, Urinary Elimination: Maintaining an Indwelling Urinary Catheter (ATI pg. A nurse is caring for a client who has a respiratory infection. Measure with a graduated container. A nurse is reviewing the medical records of a client who has a pressure ulcer. Clients can be instructed to count calories by weighing the food that will be eaten and then multiply this weight in grams by the number of calories per gram. Determine the molecular formula of a compound that has the following composition: 48.648.648.6 percent C,8.2\mathrm{C}, 8.2C,8.2 percent H\mathrm{H}H, and 43.243.243.2 percent O\mathrm{O}O, and the molar mass is approximately 148g/mol148 \mathrm{~g} / \mathrm{mol}148g/mol. Which of the following pieces of information is the priority for the nurse to provide? Women, in contrast to male clients, are at greater risk for alterations in terms of bodily fluids because they tend to have more fat, which contains less fluid, than muscle which contains more bodily fluid. The client requests information about advance directives. Make sure the client wears a mask when outside her room if there is construction in the area. hbbd```b``z "s@$U0[D2'`LIv0yL $[9-gt&F7 !30}` $&w
Tube placement is determined by aspirating the residual and checking the pH of the aspirate and also with a radiography, and/or by auscultating the epigastric area with the stethoscope to hear air sounds when about 30 mLs of air are injected into the feeding tube. The doctor is notified when the residual volume is excessive and when the tube is not patent or properly placed. A pump, similar in terms to an intravenous infusion pump, controls the rate of the tube feeding infusion at the ordered rate. The clients urine color and amount can give us indications. Each must have urine receptacles labeled with The volume of bolus enteral feedings is usually about 200 to 400 mLs but not over 500 mLs per feeding. Which of the following actions should the nurse take? Y^+hh63&P1ZEA
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The signs and symptoms of mild to moderate dehydration include, among others, orthostatic hypotension, dizziness, constipation, headache, thirst, dry skin, dry mouth and oral membranes, and decreased urinary output. -Ankle pumps: point toes toward the head and then away from the head. Urinary output is monitored and measured in terms of mLs or ccs for toilet trained children and adults, and, in terms of diaper weights or diaper counts for neonates and infants. %PDF-1.7
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1.Maintaining standard precautions related to body fluids. Record intake when: What do you do if one or more patient's in the same room? learn more TEST YOUR A & P KNOWLEDGE This online practice exam for Anatomy and Physiology is designed to test your general knowledge. A nurse is teaching a client whose left leg is in a cast about using crutches. Consider client choices regarding meeting nutritional . 100 mL of ice chips = 50 mL of water, Step 10 b. For example, the elderly is at risk for alterations in terms of fluid imbalances because of some of the normal changes of the aging process and some of the medications that they take when they are affected with a chronic disorder such as heart failure. The client's respirations are noisy from secretions in her airway and she is short of breath. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. -Limit fluids 2 to 3 hr before bedtime. -Routine tasks- bed making, specimen collection, I&O, Vital signs (Stable Clients). The residual volume of these feedings is aspirated, measured and recorded at least every 6 hours and the tube is flushed every 4 hours to maintain its patency. Apply clean gloves. 27) CNA. Teach family members the rationale for the, importance of offering fluids regularly to, clients who are unable to meet their own needs, cognition, or other conditions such as impaired. Recorded as 50% of measured volume Which of the following statements should the nurse make? Which of the following assessment findings should the nurse expect to confirm correct tube placement? "We need to document the exact mediation you were taking because you might be allergic to it.". -Infertility gloves and dispose in proper receptacle and perform hand hygiene. 1.swallowing Greater than 7.5% in 3 months indicates a significant weight loss 6 The patient calculating a patient ' s daily intake will require you to record all fluids that go the! "It might help me to listen to music while I'm lying in bed.". Second intercostal space at the left sternal boarder. -remove stockings EVERY 8 hours -Periodontal disease due to poor oral hygiene This includes oral intake, tube feedings, intravenous fluids,medications, total parenteral nutrition, lipids, blood pro, ACTIVE LEARNING TEMPLATE Nursing Skill STUDENT NAME SKILL NAME REVIEW MODULE CHAPTER Description of Skill Indications CONSIDERATIONS Nursing Interventions (pre, intra, post) Outcomes/Evaluation Client Education Potential Complications Nursing Interventions. After securing a safe environment, which of the following actions should the nurse take next? All intake and output should . ***Relaxation- meditation, yoga, and pregressive muscle relaxation. The parents have refused the treatment due to religious beliefs. Basic Concept safe medication Administration error reduction, Medication Template Isophane Insulin NPH (Humulin N, Novolin N), RUA Medication Teaching Plan - Abolanle Salami, NR 324 Chapter 017 Med Surg electrolytes sheet-3, NR 324 Week 3 Lab Prep - NR 324 Week 3 Lab Prep, Med surg Altered Fluid and Electrolyte Balance, Nursing Skill Performing a Catheter irrigation, Medical/Surgical Nursing Concepts (NUR242), Organizational Theory and Behavior (BUS 5113), Managing Projects And Programs (BUS 5611), Elementary Physical Eucation and Health Methods (C367), Communication As Critical Inquiry (COM 110), Foundation in Application Development (IT145), Variations in Psychological Traits (PSCH 001), Fundamental Human Form and Function (ES 207), Foundational Concepts & Applications (NR-500), Accounting Information Systems (ACCTG 333), Professional Application in Service Learning I (LDR-461), Advanced Anatomy & Physiology for Health Professions (NUR 4904), Principles Of Environmental Science (ENV 100), Operating Systems 2 (proctored course) (CS 3307), Comparative Programming Languages (CS 4402), Business Core Capstone: An Integrated Application (D083), Lesson 12 Seismicity in North America The New Madrid Earthquakes of 1811-1812, Sociology ch 2 vocab - Summary You May Ask Yourself: An Introduction to Thinking like a Sociologist, Lesson 8 Faults, Plate Boundaries, and Earthquakes, How Do Bacteria Become Resistant Answer Key. All diets, including these special diets, must be modified according to the client's cultural preferences, religious beliefs and personal preferences to the greatest extent possible. Which of the following client statements indicates to the nurse that he understands the use of this assistive device? In addition to measuring the client's intake and output, the nurse monitors the client for any complications, checks the incisional site relating to any signs and symptoms of irritation or infection for internally placed tubes, secures the tube to prevent inadvertent dislodgement or malpositioning, cleans the nostril and tube using a benzoin swab stick, applies a water soluble jelly just inside the nostril to prevent dryness and soreness, provides frequent mouth care, and replaces the securing tape as often as necessary. Continuous tube feedings are typically given throughout the course of the 24 hour day. In which of the following situations does the nurse demonstrate the ethical principle of veracity? Measure CT drainage by marking and recording A urinary output of less than 30 mLs or ccs per hour is considered abnormal. Assessing the Client for Actual/Potential Specific Food and Medication Interactions, Considering Client Choices Regarding Meeting Nutritional Requirements and/or Maintaining Dietary Restrictions, Applying a Knowledge of Mathematics to the Client's Nutrition, Promoting the Client's Independence in Eating, Providing and Maintaining Special Diets Based on the Client's Diagnosis/Nutritional Needs and Cultural Considerations, Providing Nutritional Supplements as Needed, Providing Client Nutrition Through Continuous or Intermittent Tube Feedings, Evaluating the Side Effects of Client Tube Feedings and Intervening, as Needed, Evaluating the Client's Intake and Output and Intervening As Needed, Evaluating the Impact of Diseases and Illnesses on the Nutritional Status of a Client, Adult Gerontology Nurse Practitioner Programs (AGNP), Womens Health Nurse Practitioner Programs, Advanced Practice Registered Nurse (APRN), Providing Information to the Client on Common Side Effects/Adverse Effects/Potential Interactions of Medications and Informing the Client When to Notify the Primary Health Care Provider, Non Pharmacological Comfort Interventions, Basic Care & Comfort Practice Test Questions, Assess client ability to eat (e.g., chew, swallow), Assess client for actual/potential specific food and medication interactions, Consider client choices regarding meeting nutritional requirements and/or maintaining dietary restrictions, including mention of specific food items, Monitor client hydration status (e.g., edema, signs and symptoms of dehydration), Apply knowledge of mathematics to client nutrition (e.g., body mass index [BMI]), Manage the client's nutritional intake (e.g., adjust diet, monitor height and weight), Promote the client's independence in eating, Provide/maintain special diets based on the client diagnosis/nutritional needs and cultural considerations (e.g., low sodium, high protein, calorie restrictions), Provide nutritional supplements as needed (e.g., high protein drinks), Provide client nutrition through continuous or intermittent tube feedings, Evaluate side effects of client tube feedings and intervene, as needed (e.g., diarrhea, dehydration), Evaluate client intake and output and intervene as needed, Evaluate the impact of disease/illness on nutritional status of a client, Personal beliefs about food and food intake, A client with poor dentition and misfitting dentures, A client who does not have the ability to swallow as the result of dysphagia which is a swallowing disorder that sometimes occurs among clients who are adversely affected from a cerebrovascular accident, A client with an anatomical stricture that can be present at birth, The client with side effects to cancer therapeutic radiation therapy, A client with a neurological deficit that affects the client's vagus nerve and/or the hypoglossal cranial nerve which are essential for swallowing and the prevention of dangerous and life threatening aspiration, 18.5 to 24.9 is considered a normal body weight. Ethical Responsibilities: Responding to a Client's Need for Information About Treatment, Grief, Loss, and Palliative Care: Responding to a Client Who Has a Terminal Illness and Wants to Discontinue Care, Information Technology: Action to Take When Receiving a Telephone Prescription, Information Technology: Commonly Used Abbreviations, Information Technology: Documenting in a Client's Medical Record, Information Technology: Identifying Proper Documentation, Information Technology: Information to Include in a Change-of-Shift Report, Information Technology: Maintaining Confidentiality, Information Technology: Receiving a Telephone Prescription, Legal Responsibilities: Identifying an Intentional Tort, Legal Responsibilities: Identifying Negligence, Legal Responsibilities: Identifying Resources for Information About a Procedure, Legal Responsibilities: Identifying Torts, Legal Responsibilities: Nursing Role While Observing Client Care, Legal Responsibilities: Responding to a Client's Inquiry About Surgery, Legal Responsibilities: Teaching About Advance Directives, Legal Responsibilities: Teaching About Informed Consent, The Interprofessional Team: Coordinating Client Care Among the Health Care Team, The Interprofessional Team: Obtaining a Consult From an Interprofessional Team Member, Therapeutic Communication: Providing Written Materials in a Client's Primary Language, Adverse effects, Interactions, and Contraindications: Priority Assessment Findings, Diabetes Mellitus: Mixing Two Insulins in the Same Syringe, Dosage Calculation: Calculating a Dose of Gentamicin IV, Dosage Calculation: Correct Dose of Diphenhydramine Solution, Intravenous Therapy: Inserting an IV Catheter, Intravenous Therapy: Medication Administration, Intravenous Therapy: Priority Intervention for an IV Infusion Error, Intravenous Therapy: Promoting Vein Dilation Prior to Inserting a Peripheral IV Catheter, Intravenous Therapy: Recognizing Phlebitis, intravenous Therapy: Selection of an Intravenous Site, Pharmacokinetics and Routes of Administration: Enteral Administration of Medications, Pharmacokinetics and Routes of Administration: Preparing an Injectable Medication From a Vial, Pharmacokinetics and Routes of Administration: Self-Administration of Ophthalmic Solutions, Pharmacokinetics and Routes of Administration: Teaching About Self-Administrationof Clotrimazole Suppositories, Safe Medication Administration and Error Reduction: Administering a Controlled Substance, Safe Medication Administration and Error Reduction: Con rming a Client's Identity, Airway Management: Performing Chest Physiotherapy, Airway Management: Suctioning a Tracheostomy Tube, Client Safety: Priority Action When Caring for a Client Who Is Experiencing a Seizure, Fluid Imbalances: Indications of Fluid Overload, Grief, Loss, and Palliative Care: Manifestations of Cheyne-Stokes Respirations, Pressure Injury, Wounds, and Wound Management: Performing a Dressing Change, Safe Medication Administration and Error Reduction: Priority Action When Responding to a Medication Error, Vital Signs: Caring for a Client Who Has a High Fever, Coping: Manifestations of the Alarm Stage of General Adaptation Syndrome, Coping: Priority Intervention for a Client Who Has a Terminal Illness, Data Collection and General Survey: Assessing a Client's Psychosocial History, Grief, Loss, and Palliative Care: Identifying Anticipatory Grief, Grief, Loss, and Palliative Care: Identifying the Stages of Grief, Grief, Loss, and Palliative Care: Providing End-of-Life Care, Grief, Loss, and Palliative Care: Therapeutic Communication With the Partner of a Client Who Has a Do-Not-Resuscitate Order, Self-Concept and Sexuality: Providing Client Support Following a Mastectomy, Therapeutic Communication: Communicating With a Client Following a Diagnosis of Cancer, Therapeutic Communication: Providing Psychosocial Support, Therapeutic Communication: Responding to Client Concerns Prior to Surgery, Airway Management: Collecting a Sputum Specimen, Bowel Elimination: Discharge Teaching About Ostomy Care, Complementary and Alternative Therapies: Evaluating Appropriate Use of Herbal Supplements, Diabetes Mellitus Management: Identifying a Manifestation of Hyperglycemia, Electrolyte Imbalances: Laboratory Values to Report, Gastrointestinal Diagnostic Procedures: Education Regarding Alanine Aminotransferase (ALT) Testing, Hygiene: Providing Oral Care for a Client Who Is Unconscious, Hygiene: Teaching a Client Who Has Type 2 Diabetes Mellitus About Foot Care, Intravenous Therapy: Actions to Take for Fluid Overload, Nasogastric Intubation and Enteral Feedings: Administering an Enteral Feeding Through a Gastrostomy Tube, Nasogastric Intubation and Enteral Feedings: Preparing to Administer Feedings, Nasogastric Intubation and Enteral Feedings: Verifying Tube Placement, Older Adults (65 Years and Older): Expected Findings of Skin Assessment, Preoperative Nursing Care: Providing Preoperative Teaching to a Client, Thorax, Heart, and Abdomen: Priority Action for Abdominal Assessment, Urinary Elimination: Selecting a Coud Catheter, Vital Signs: Palpating Systolic Blood Pressure, Client Safety: Care for a Client Who Requires Restraints, Client Safety: Implementing Seizure Precautions, Client Safety: Planning Care for a Client Who Has a Prescription for Restraints, Client Safety: Priority Action for Handling Defective Equipment, Client Safety: Priority Action When Responding to a Fire, Client Safety: Proper Use of Wrist Restraints, Ergonomic Principles: Teaching a Caregiver How to Avoid Injury When Repositioning a Client, Head and Neck: Performing the Weber's Test, Home Safety: Client Teaching About Electrical Equipment Safety, Home Safety: Evaluating Client Understanding of Home Safety Teaching, Home Safety: Teaching About Home Care of Oxygen Equipment, Infection Control: Caring for a Client Who Is Immunocompromised, Infection Control: Identifying the Source of an Infection, Infection Control: Implementing Isolation Precautions, Infection Control: Isolation Precautions While Caring for a Client Who Has Influenza, Infection Control: Planning Transmission-Based Precautions for a Client Who Has Tuberculosis, Infection Control: Protocols for Multidrug-Resistant Infections, Infection Control: Teaching for a Client Who is Scheduled for an Allogeneic Stem Cell Transplant, Information Technology: Action to Take When a Visitor Reports a Fall, Information Technology: Situation Requiring an Incident Report, Intravenous Therapy: Action to Take After Administering an Injection, Medical and Surgical Asepsis: Disposing of Biohazardous Waste, Medical and Surgical Asepsis: Performing Hand Hygiene, Medical and Surgical Asepsis: Planning Care for a Client Who Has a Latex Allergy, Medical and Surgical Asepsis: Preparing a Sterile Field, Nursing Process: Priority Action Following a Missed Provider Prescription, Safe Medication Administration and Error Reduction: Client Identifiers, Chapter 6. pg.162-164 Monitoring Intake and O, Virtual Challenge: Timothy Lee (head-to-toe), Nursing 110 Exam 1 - Diagnostic testing/Lab v, Julie S Snyder, Linda Lilley, Shelly Collins. : an American History (Eric Foner), Civilization and its Discontents (Sigmund Freud), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Psychology (David G. Myers; C. Nathan DeWall), The Methodology of the Social Sciences (Max Weber), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham). Serial bodyweights are an accurate method of monitoring fluid status One of the most sensitive indicators of patient volume status changes is their bodyweight. Exercise (promotes sleep as long as it's TWO HOURS BEFORE bed) -Violent death and injury. Administer the medication with the needle at a 45 degree angle. -Unplanned pregnancies Similarly, a client who will be eating 100 grams of a carbohydrate could calculate the number of calories by multiplying 100 by 4 which is 400 calories. The assessment of the client's nutritional status is done with a number of subjective and objective data that is collected and analyzed. What are we responsible for when monitoring I&O. Observe what in the foley cath: color and characteristics of urine in tubing and drainage bag. University: Chamberlain University. endstream
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1. time on collection chamber at specified intervals. KO2\mathrm{KO}_2KO2, and Cl4\mathrm{Cl}_4Cl4 ? Which of the following types of transmission precautions should the nurse initiate? calculating a clients net fluid intake ati nursing skill. These drinks come in a variety of flavors including chocolate, vanilla and strawberry. Clinical decision point: A nurse in a provider's office is obtaining the health and medication history of a client who has a respiratory infection. Edema is most often identified in the dependent extremities such as the feet and the legs; however, it can also become obvious with unusual abdominal distention and swelling. Some facilities include pureed vegetables in a full liquid diet Diet (caffeine consumption before bed) Clients with poor dentition and missing teeth can be assisted by a dental professional, the nurse and the dietitian in terms of properly fitting dentures and, perhaps, a special diet that includes pureed foods and liquids that are thickened to the consistency of honey so that they can be swallowed safely and without aspiration when the client is adversely affected with a swallowing disorder.
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