End of Life
True or false: the nurse should dispose of the patient's personal belongings after post-mortem care.
False
(the patient's belongings need to be returned to the family)
which device helps support the patient before transferring and helps the nurse hold the patient stable when ambulating?
gait belt
True or false: A blind patient cannot feed themselves.
False: they should be allowed to be as independent as possible. Describe what is on their plate, place it near them, and allow them to feed themselves if they can.
Normal urine output for a patient.
0.5mL/kg/hr
Describe how a normal colostomy stoma should look.
red, beefy, shiny, rosebud
6 months or less
on the strong side of the body.
Expressive aphasia
Measurement of blood pressure of a patient when lying, sitting, and standing.
orthostatic hypotension
A wound is considered unstageable when...?
There is eschar or slough covering the wound bed and you cannot gauge how deep the wound is.
On palliative care the patient can continue ___________ treatments.
Curative
proper body mechanics for transferring a patient
Too much visual, auditory, and equipment can cause the patient to go into sensory ______________.
Overload
Nursing assessment done before giving food/administering medications.
Gag reflex & swallowing ability
What is the purpose of CPT (chest physiotherapy)?
To enhance and loosen secretions for expectorating.
What is the primary goal for palliative care & hospice care?
Improving the patient's quality of life.
Signs and symptoms of deep vein thrombosis (DVT)
unilateral edema, redness, pain, and decreased pulses
Auditory hearing test used to determine bone conduction or air conduction loss using a tuning fork.
Weber or Rinne test
no more than 20 minutes.
Interventions to prevent skin breakdown
barrier cream, turning patient Q2, keeping skin clean and dry, elevating and offloading bony prominences, bowel and bladder training
What non-pharmacological interventions will help with patient comfort in the dying process?
Distraction/diversion, meditation, warm blankets, placing a fan blowing towards the patient.
Describe how two-point gait with crutches should work with a patient who is partial weight bearing on both legs.
Instruct the client to move the left crutch and the right foot forward 6 inches, following by moving the right crutch and left foot forward.
Emergency signs/symptoms in a patient with glaucoma.
severe headache, eye pain, blurred vision.
Purpose of administering albumin in a patient with low albumin levels?
to increase blood pressure and decrease generalized edema.
In an emergency, the nurse should place sterile soaked gauze on a wound that has become ____________.
Eviscerated.