Skin/Infection
Non-blanchable redness to a boney prominence
What is stage 1 pressure ulcer?
nurse would expect these findings in psoriasis
What is silvery, white thick scales? (can have itching burning, dry)
during a tube feeding, patient should avoid this postition
What is supine?
If I am using a blood pressure cuff that is too small for my patient's arm, how would I expect it to affect the reading
What is higher than normal?
What color would describe a pressure ulcer with slough?
What is yellow?
Nurse is assigned to 4 clients. Which client should the nurse see FIRST?
What is ABC?
GERD interventions. Name 3
What is elevate HOB, Avoid laying down for 2-3 hours after eating, sleep on left side, medication related interventions, stop smoking, dietary modifications?
Part 1 symptoms of hypoglycemia. Part 2 what about older adults?
Part 1: What is tremors, pallor, diaphoresis, anxiety, hunger?
Part 2: What is confusion?
manifestations of a wound infection
What is swelling, warmth and tenderness around the wound, fever, foul odor, chills, fatigue, purulent drainage
Continuous high pitch squeaking is used to describe what adventitious breath sound
What is wheezing?
"guiac" stool sample will show what?
What is blood in stool?
client who had hypertension that resulted in TIA should maintain SBP in this range
SBP between 120-129 mmHg
Name 3 interventions for older, at risk adults to help prevent skin breakdown?
What is reposition every 2 hours, high protein diet, hydration, moisture management, skin assessment, minimize friction and shear
Symptoms of peripheral edema will be evidenced in what heart failure?
What is right sided heart failure?
Name 3 diagnoses we discussed that should significantly increase their fluid intake?
What is gout, kidney stones, dehydration (diarrhea, vomiting, gastroenteritis, UTI, constipation, sickle cell disease, anyone with thick respiratory secretions)
in what order should the nurse assess the abdomen
what is inspection, auscultation, palpation?
This virus is transmitted through contact with bodily fluids, not by hugging.
What is HIV?
nursing intervention if patient develops wheezing, swollen tongue and hives
What is administer epinephrine?
Describe how a stoma should look less than 24 hours after having a colostomy placed
What is bright red to dark pink, moist, swollen (swelling expected for 24-48 hours), small amt bleeding, little output?
The first action after a client has a fall
What is check the client for injuries?