Granny Smith
Granny responds to verbal commands but cannot always communicate discomfort. There is an inability to feel pain in one or two extremities. What is her Braden score for sensory perception?
What is Sensory Perception #3: Slightly Limited
Name the risk factors of the Braden Scale
What is sensory perception, moisture, activity, nutrition, mobility, shear/friction
Seymour never eats a complete meal and rarely eats more than 1/2 of any food offered. This patient has poor fluid intake and refuses liquid dietary supplements. What is the Braden score for Nutrition?
What is Nutrition level #1: Very Poor
Mrs. A is completely unresponsive to painful stimuli due to diminished level of consciousness or sedation. What Braden Score do you give this patient for Sensory Perception?
What is Sensory Perception #1 Completely limited
Elvis is full strength TPN and is scheduled for a PEG, he is NPO. What is the Braden Score for Nutrition?
What is Nutrition # 3: Adequate
Granny is damp every time you move or turn her. What is the Braden Score for Moisture for this patient?
What is Moisture #1: Constantly Moist
What is the frequency of documentation of the Braden Score and skin reassessments?
What is every shift.
Seymour is not able to walk, cannot bear own weight and must be assisted to the chair. What Braden Score do you award this patient for Activity?
What is Braden Activity Level # 2: Chairfast
Mrs. A is NPO but is has been maintained on IV fluids x 5 days. She does not have TPN or tube feedings yet. What is her braden score for nutrition?
What is Nutrition #1: Very Poor
Your patient is moist constantly,by perspiration, urine, etc. Dampness is detected every time patient is moved or turned. What Braden score for moisture would you give Elvis?
What is Moisture #1: Constantly Moist.
Granny eats most of her meals and never refuses meals. She occasionally eats between meals & doesn't require supplements. What is the Nutrition Score for sweet ole Granny?
What is Nutrition #4. Excellent Nutrition
Sue responds to verbal commands with no limitations to feel or voice pain or discomfort. What is this Patient's Braden score for Sensory Perception?
What is Sensory Perception#4: No Impairment
Seymour skin is usually dry; linen only requires routine changes. What is the Braden Score for Moisture for this patient?
What is Moisture Level #4: rarely moist.
Mrs. A makes occasional or slight changes in body or extremity position but cannot make frequent or significant changes independently. What is the Braden Score for mobility?
What is Braden Mobility Score #2: Very Limited mobility
You have a patient who is rather feeble and requires minimal assistance. During repositioning, this patient slides against the sheets. The patient maintains a good position in the chair or bed but occasionally slides down. What Braden score would you give this patient?
What is Friction & Shear #2: Potential Problem
Granny is able to take short walks occasionally during the day, with or without assistance. Most of the time, Granny likes to sit in bed or her wheelchair. What Braden Score would you give Granny for activity?
What is Activity #3: Walks occasionally.
Your patient's skin requires a linen change approximately once per day. What Braden Scale score do you award Sue?
What is moisture level #3: occasionally moist
Seymour moves in bed and in the chair independently and has sufficient muscle strength to lift up completely during moving. What is the Braden Score for Friction and Shear?
What is Braden Friction & Shear #3: No apparent problem
Mrs. A skin is usually but not always moist. You change the bed linens for this patient about once per shift. What score do you give this patient for moisture?
What is Moisture #2: Often moist
Elvis makes frequent though slight changes in body or extremity position independently. What Braden Scale Score would you give to this patient?
What is Mobility #3: Slightly Limited
Granny requires moderate to max assistance in moving, and frequently slides down in the bed or chair. Spasticity, contractures or agitation leads to almost constant friction. What is the Braden Score for Friction and Shear?
What is Friction and Shear #1: Problem
Sue makes major and frequent changes in position without assistance. What is the Braden Score for mobility?
What is Mobility Score #4: No Limitations
Seymour is confined to bed post angiogram. What is the Braden Scale Score for this patient for Activity?
What is Activity #1 Bedfast
It is important to document the Braden Score and Skin Reassessment findings when?
What is: "during the same shift of discovery."
Elvis responds only to painful stimuli. He is sensory impaired which limits the ability to feel pain over 1/2 of his body. What Braden score would you give to this patient?
What is Sensory Perception #2: Very Limited