wounds
Factors Effecting Immobility
O2 & Circulation
Delegation/ Stress & coping
Sensory
100

Applying this device helps prevent strain on abdominal incisions, supports weak abdominal muscles, and can assist with mobility after surgery.

abdominal binder

100

When instructing a patient on proper cane use, the nurse should emphasize that the cane should be held on the side opposite to this part of the body.

What is the weak or affected side?

100

Which oxygen delivery device gives exact/precise amounts of oxygen?

Venturi Mask

100

S/S of stress?

What is pupil dilation, tachycardia, tachypnea

100

This acute, reversible condition is characterized by confusion, altered consciousness, and fluctuating mental status, often triggered by an underlying medical condition or medication.

delirium

200

This complication occurs when the edges of a wound separate, often due to stress on the incision site, poor nutrition, or infection.

wound dehiscence

200

When ascending stairs with crutches, the patient should first step up with this leg, followed by the crutches and the other leg.

What is the strong (unaffected) leg?

200

Ways to know perfusion is adequate?

What is pulses, skin color and temp, hair distribution,  and urinary output

200

80-year-old Mr. Stevens is accompanied to the clinic by his son, who tells the nurse that the client’s constant confusion, incontinence, and tendency to wander are intolerable. The son is most likely experiencing what condition?

What is caregiver role strain

200

For a patient with impaired hearing, this nursing intervention helps enhance communication and ensure understanding of instructions and important information.

What is using a hearing aid, speaking clearly at a normal volume, and facing the patient while speaking?

300

This phase of wound healing involves filling the wound bed with granulation tissue and resurfacing the wound with new skin. Its duration varies depending on the wound size and closure method.

What is the proliferative phase?

300

These exercises, designed to strengthen the pelvic floor muscles, involve contracting the muscles without visible movement, making them a classic example of isometric exercise.

What are Kegel exercises?

300

What vital sign is MOST important to monitor with COPD pts. receiving oxygenation therapy?

RR

300

This emotional response is often a reaction to a specific, identifiable threat, while this response is more generalized and can occur without a clear or present cause.

What is fear (for a specific threat) and anxiety (for a generalized, unclear cause)?

300

For a patient with a decreased sense of taste, this nursing intervention can help improve the enjoyment of food and encourage adequate nutrition.

What is offering a variety of flavorful foods, adjusting seasoning, and ensuring proper oral hygiene?

400

This type of partial-thickness wound involves the epidermis and/or dermis but does not extend below the dermis and is classified as this stage of pressure injury.

What is a stage 2 pressure injury?

400

When a patient has hand contractures, placing this item in the palm can prevent the nails from irritating the skin.

What is a rolled washcloth?

400

This device is used postoperatively to help prevent pneumonia and improve lung expansion by encouraging deep breathing and increasing inspiratory volume.

What is an incentive spirometer?

400

This level of anxiety can cause the patient to become overwhelmed, may impair judgment, and can lead to difficulty focusing on anything other than the perceived threat, possibly resulting in physical symptoms like dizziness or hyperventilation.

What is severe anxiety?

400

This condition occurs when a person is exposed to excessive stimuli, leading to feelings of anxiety, confusion, and difficulty concentrating.

What is sensory overload?

500

This vitamin plays a key role in tissue repair, immune function, and collagen production, and its deficiency can impair wound healing.

What is vitamin A?

500

When fitting a patient for crutches, the top of the crutch should be positioned approximately this distance below the armpit to prevent nerve damage.

approximately 2 inches or three finger-widths of space between the top of the crutch and the axilla when the crutch is placed slightly in front of and 6 inches to the side of the foot.

500

When a patient is using oxygen, it is important to recommend this type of lubricant for nasal dryness or irritation to avoid the risk of combustion.

What is a water-based lubricant?

500

To help an anxious patient manage physical symptoms such as increased heart rate or shallow breathing, this technique involves teaching the patient to focus on their breath and engage in slow, deep breathing exercises.

What is teaching deep breathing exercises?

500

This type of visual impairment, often seen in older adults, results in gradual loss of central vision and can make tasks such as reading or recognizing faces difficult.

What is macular degeneration?