The tissue that makes the skin swell has been lost in older people.
What is Normal Aging Process?
Beginning in early adulthood, aging is a progressive, ongoing process of natural transformation. Many body processes start to gradually deteriorate in the early middle years.
At no particular age do people become old or elderly. Old age has traditionally been defined as commencing at age 65. But history, not biology, was the cause. Germany, the first country to create a retirement scheme, chose 65 as the retirement age many years ago. The eligibility age for Medicare insurance in the United States was set at 65 in 1965. This age is close to when the majority of people in economically developed cultures actually retire.
People frequently question whether their aging-related experiences are normal or pathological. Despite the fact that everyone ages somewhat differently, ageing itself can cause various changes. These changes occur in everyone who lives long enough, and that universality is part of the concept of pure ageing. Therefore, these changes, although undesirable, are considered normal and are frequently dubbed "pure ageing." The modifications are normal and usually unavoidable. For instance, the eye's lens thickens, stiffens, and loses its ability to concentrate on close things like reading materials as people age (a disorder called presbyopia). Almost all older persons experience this transformation. Presbyopia is therefore seen to come with getting older.
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alexandra measured her waist before going shopping for clothes. it measured 36 inches. what is her level of obesity-related health risk based on her waist circumference?
Increased waist circumference is greater than 40 inches.
What is the waist size that increases a woman's risk of disease?Waist Circumference This risk increases for women with waist sizes greater than 35 inches and for males with waist sizes greater than 40 inches. Place a tape measure around your center, slightly above your hipbones, while standing to get an accurate waist measurement.
What is the measurement of my waist in inches?Locate the bottom of your ribs and the top of your hip bone. Breathe normally out. Wrap the measuring tape around your waist, putting it halfway between these two points. Look over your measurements.
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a patient with asthma is prescribed albuterol [proventil], 2 puffs 3 times a day. the nurse should teach the patient to do what?
The nurse should instruct the client on how to take Albuterol should be given first, followed by Fluticasone five minutes later.
Which do you take first, Ventolin or Flovent?The patient is given the asthma medication inhaled Fluticasone (Flovent HFA) and inhaled Albuterol (Ventolin HFA) by the doctor. How will you, the nurse, deliver these medications? A. Administer Fluticasone first, followed by Albuterol five minutes later.
What type of corticosteroid would a nurse directly inhale into a patient?Fluticasone oral inhalation is used to treat asthma symptoms in both adults and children, including breathing difficulties, chest discomfort, coughing, and wheezing. It belongs to the corticosteroid drug family.
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which response would the nurse make to a cocaine addict remanded for rehabilitation by the court who curses at his or her spouse and tells the spouse to go home, causing the spouse to leave in tears?
Let's discuss what just occurred. Reason: If the client's behavior goes unchecked, the court can view it as approval of the client's rehabilitation as a cocaine addict.
Why do you keep referring to "rehabilitation"?According to the dictionary, rehabilitation is a set of actions intended to enhance functioning or lessen handicap in people with health concerns in connection with their environment.
What three categories of rehabilitation exist?Physical therapy, occupational therapy, and speech therapy are the three basic categories of rehabilitation therapy. Even while each type of rehabilitation has a unique role to play in promoting a patient's full recovery, they all ultimately strive to enable the patient to resume a healthy, active lifestyle.
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a nurse is teaching parents strategies to encourage healthy eating behaviors in children. what points would be important to include
The most beneficial advice to give parents of a 7-month-old girl on good eating patterns is to introduce new foods gradually over time.
Why is healthy eating important?
For optimal nutrition and health, a nutritious diet is necessary. You are protected from many lengthy, noncommunicable illnesses like cancer, diabetes, and heart disease. A healthy diet must include a variety of foods and be low in salt, sugar, trans fats, and trans fats made in factories.
Why is altering one's eating habits important?
You can get all the energy you need to stay active all day long from a diet that is balanced. You need certain nutrients for growth and repair, which will keep you strong and healthy and assist you in avoiding diseases like its some cancers which are linked to diet.
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who is charged with the implementation of clia? a. the attorney general (ag) b. health and human services (hhs) c. the centers for medicare and medicaid services (cms) d. the office of the inspector general (oig)
The Centers for Medicare & Medicaid Services (CMS) is in charge of carrying out CLIA, which includes laboratory registration, fee collection, surveys, and surveyor instructions.
What is a Medicare-eligible service?Medicare is a type of government-sponsored health insurance that: those 65 and above. folks with impairments who are younger. End-stage renal disease sufferers (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
What often isn't a Medicare benefit?The majority of health insurance programs and Medicare do not cover long-term care. Non-skilled personal care includes assistance with activities of daily life including dressing, eating, getting into or out of a chair or bed, moving around, and using the restroom.
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the nurse is caring for a client in the compensation stage of shock. one of the body's mechanisms of compensation in this stage of shock is the action of the renin-angiotensin-aldosterone system. what does this system do?
Renin-angiotensin-aldosteron system (RAAS) make vasoconstriction and reabsorption of water and sodium in compensation stage of shock.
Renin-Angiotensin-Aldosteron System (RAAS)Shock is a condition where there is an imbalance between the supply and demand of oxygen in the body. In the initial phase, the state of shock can be compensated by the body (compensation stage) such as by increasing the pulse, redistributing blood to vital organs, and so on so that blood pressure can still be measured normally. One of the systems that play a role in maintaining blood pressure is the Renin-Angiotensin-Aldosterone System (RAAS).
When hypovolemia (decreased intravascular volume) or hypotension (low blood pressure) occurs, the baroreceptors detect it. It also occurs hypoperfusion to the renal tissue. This causes it to be detected in the baroreceptors on the afferent arterioles.
Signals from these baroreceptors will increase renin, so that angiotensinogen changes to angiotensin I. Then angiotensin I will change to angiotensin II by the angiotensin converting enzyme.
This will result in:
Vasoconstricts the afferent arterioles and causes reabsorption of water from the renal tubules into the vasaIncreased reabsorption of sodium ions from the renal tubules into the vasaVasoconstriction of systemic arteriesThese three mechanisms will cause an increase in blood pressure.
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the advanced practice nurse is caring for a patient with chronic low back pain. in the provision of care for this patient, the apn wants to determine the best evidence based practice regardign these guidelines. what is the best database for the nruse to access?
The best database for the nurse to access is The Agency for Healthcare Research and Quality (AHRQ).
Clinical guidelines and evidence summaries are available from the Agency for Healthcare Research and Quality (AHRQ). Studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health are included in MEDLINE. Biomedical and pharmacological studies are included in EMBASE. PsycINFO covers psychology and allied medical specialties.
The mission of the Agency for Healthcare Research and Quality (AHRQ) is to produce evidence to improve the safety, caliber, accessibility, equity, and affordability of health care and to collaborate with other partners and the U.S. Department of Health and Human Services to ensure that the evidence is utilized.
The Agency for Healthcare Research and Quality is operated by the United States Department of Health and Human Services.
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what are the four critical steps of food safety that, if practiced, can reduce the risk for foodborne illness?
Clean, Separate, Cook, and Chill are the four steps to food safety, which can lower the risk of foodborne illness.
What is the most crucial kitchen rule?Making ensuring food is cooked properly is one of the most crucial food hygiene principles. Food poisoning from dangerous germs could result from undercooking. You can avoid that by following these guidelines: Check the food's doneness by cutting into it.
What significance does kitchen safety have?Food dangers and accidents are reduced in clean, safe kitchens. You can lessen or completely avoid burns, fires, falls, wounds, electrical shocks, and poisonings in your kitchen by adopting the required measures. A danger is anything in food that has the potential to make someone sick or hurt them.
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a client presents to the clinic reporting symptoms that suggest diabetes. what criteria would support checking blood levels for the diagnosis of diabetes?
A client presents the criteria would support checking blood levels for the Fasting blood sugar test would support checking blood levels for the diagnosis of diabetes.
Doctor check your blood sugar levels after a night of fasting (not eating). Prediabetes is defined as having a fasting blood sugar level between 100 and 125 mg/dL, diabetes as above 126 mg/dL, and normal blood sugar as less than 99 mg/dL.
Before a fasting blood glucose test, you might need to go without food for eight to ten hours. Before a blood test for iron, you might need to fast for 12 hours.
You should refrain from eating or drinking anything other than water for eight to twelve hours before to the fasting glucose test.
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a 40-week gestation primigravida client is being induced with an oxytocin (pitocin) secondary infusion and complains of pain in her lower back. which intervention should the nurse implement?
A 40-week pregnant primigravida patient who is having an oxytocin (Pitocin) secondary infusion is complaining of lower back pain.
During the fourth stage of labor, which nursing intervention is most important?Identification and prevention of hemorrhage during the fourth stage of childbirth are top nursing priorities. 24. The nurse will make an effort to encourage cervical effacement and increase contractions in a patient whose status is uncertain.
Which course of action should the nurse take for a client at 36 weeks?Which nursing intervention is most crucial to carry out for a patient who is admitted with vaginal bleeding at 36 weeks gestation? Observe the uterine contractions. Place a client's bottom on disposable pads.
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an adult client with low functioning down syndrom (trisomy 21) appears in the emergency department via ambulance after an accident. which assessment method would be the best instrument to use when determining the client's level of pain
The greatest tool to utilize in assessing a client's pain level is really the Wong-Baker Face images Pain Rating Scale evaluation method.
Why was emergency Cancelled?Despite receiving high ratings, the show was suspended in 1977 after the sixth season due to concerns about the actor Robert Fuller's health. The series returned in 1978 and 1979 with six movie specials, which are referred to as "Season Seven."
Why is emergency important?A calamity may be managed if you are prepared for it by having the necessary knowledge and attitude. Every year, hundreds of first responders suffer workplace injuries. Numerous deaths occur. If you are gravely hurt yourself, you cannot take care of your community.
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6. which primary interventions are most appropriate for the client who survived an earthquake and is presenting with sharp abdominal pain; decreased pulse pressure; decreased level of consciousness; cool, clammy skin; and decreased urine output? select all that apply. one, some, or all responses may be correct.
Ensuring patent airway
Utilizing a non-rebreather mask
Inserting an indwelling urinary catheter.
What is a urinary catheter?
In order to allow urine to drain from the bladder and be collected, a latex, polyurethane, or silicone tube known as a urinary catheter is placed into the bladder through the urethra. Additionally, it can be used to inject liquids for the diagnosis or therapy of bladder problems. Through the use of a flexible tube known as a catheter, urinary catheterization is a procedure used to empty the bladder and collect urine. In hospitals or the community, doctors or nurses typically insert urinary catheters. The catheter itself must be changed out at least every three months. Although a doctor or nurse typically performs this task, you or your caretaker may occasionally be able to learn how to do it.
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the nurse is monitoring a client who appears to be hallucinating. the client displays paranoid speech content, seems agitated, and gestures at a figure on the television. which nursing interventions are appropriate? select all that apply.
Reiterate that there is no danger to the client. Recognize the hallucinations presence. Use a soft voice and basic instructions. False perceptions of sensory events are hallucinations and pshycosis.
Some hallucinations, like those brought on by dozing off or waking up, are typical. Others, however, can be a symptom of a more severe condition like schizophrenia, dementia, or a disorder related to pshycosis. False perceptions of things or occasions involving your senses sight, hearing, smell, touch, and taste are known as hallucinations. Although hallucinations appear real, they are not.
Hallucinations are brought on by chemical interactions and/or abnormalities in the brain. Although hallucinations are frequently a sign of a psychosis related disorder, particularly schizophrenia, they can also be brought on by substance abuse, some transitory ailments, and neurological issues. Although hallucinations are frequently a sign of a psychosis related disorder, particularly schizophrenia, they can also be brought on by substance abuse, some transitory ailments, and neurological issues.
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the nurse suspects that a newborn infant who presents with bilateral flank masses, impaired lung development, and oliguria may be suffering from which disorder?
The nurse suspects that a newborn infant who presents with bilateral flank masses, impaired lung development, and oliguria may be suffering from Autosomal recessive polycystic kidney disease (ARPD).
What is Autosomal recessive polycystic kidney disease (ARPD)?One in 20,000 children have autosomal recessive polycystic kidney disease (ARPKD), an uncommon hereditary condition. 8. Kidney cysts that are fluid-filled in an infant or fetus with ARPKD might expand or make the kidneys overly big. Even when still in the pregnancy, ARPKD can lead to impaired kidney function in children.Hence, The nurse suspects that a newborn infant who presents with bilateral flank masses, impaired lung development, and oliguria may be suffering from Autosomal recessive polycystic kidney disease (ARPD).
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the nurse is teaching about prevention of hepatitis a. which group does the nurse suggest will benefit from this vaccine?
People in the following groups should receive the vaccine because they are at an increased risk of contracting HAV: individuals who are homeless. individuals who share a home with an infectious person in hepatitis A.
Which of the following is the best sign of a recent hepatitis A virus infection?Almost all acute hepatitis A patients show detectable IgM anti-HAV. The presence of IgM anti-HAV in serum during the acute or early convalescent phase of infection confirms an acute HAV infection.
Can drinking cause hepatitis A?Hepatitis refers to liver inflammation. The liver is a crucial organ that filters blood, processes nutrients, and fights infections. The liver's function can be affected by inflammation or injury.
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the nurse working with patients with cognitive disorders uses a specialized therapeutic and trust-building technique called reminiscence therapy. this intervention is characterized by which one?
Answer:
Encouraging residents to talk about pleasurable past events.
Explanation:
a 75-year-old man was admitted to the hospital for altered mental status. he had been in his usual state of good health until this morning when a nurse at the long-term care facility where he lives noticed that he was confused. shortly after being admitted to the hospital, he became combative and had to be restrained. his bed linens have to be changed frequently because of urinary incontinence. which nursing diagnosis best describes this client's condition?
The loss of total body sodium leads to volume depletion, also known as extracellular fluid (ECF) volume contraction. The use of diuretics, excessive perspiration, diarrhoea, burns, and renal failure are among the causes.
What transpires when the extracellular fluid level rises?Water will move from the cell into the extracellular space to balance the osmotic gradient if the ECF osmolarity rises due to a disruption; nonetheless, the total body osmolarity will stay higher than usual, and the cell will contract.
The creatinine urine test quantifies the creatinine content of the urine. A blood test can also be used to measure creatinine.
Inadequate ECF volume primarily impairs cardiovascular function by reducing plasma volume and, in certain circumstances, by resulting in circulatory shock.
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7) what is the difference between point sources of nutrient pollution and non-point sources? provide an example of each.
Point source pollution refers to the pollution that occurs from a single identifiable source while non-point source pollution refers to the pollution that occurs via many diffuse sources.
Point source examples include discharge outlets like a sewage pipe or a smokestack. In contrast, nonpoint source pollution originates over a broad area. A parking lot or farm field surface runoff.
Pollution is defined the addition of any substance (solid, liquid, or gas) or any form of energy (such as heat, sound, or radioactivity) to the environment at a rate faster than it can be dispersed, diluted, decomposed, recycled, or stored in some harmless form. The major kinds of pollution, usually classified by environment, are air pollution, water pollution, and land pollution. Modern society is also concerned about specific types of pollutants, such as noise pollution, light pollution, and plastic pollution. Pollution of all kinds can have negative effects on the environment and wildlife and often impacts human health and well-being.
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a client who has aids is being treated in the hospital and admits to having periods of extreme anxiety. what would be the most appropriate nursing intervention?
As long as the physician's diarrhea is not brought on by an infectious microorganism, regularly administering antidiarrheal medications may be more advantageous than using them just when necessary.
The term "microorganisms" is confusing.A microorganism, often known as a microorganism, is technically a tiny organism. This science of microorganism is referred to as "microbiology." Microorganisms include fungi, protists, bacterial, and archaea.. Prions and viruses are not considered microbes because they are considered non-living in general.
What exactly are microbes and how do you perform?Everywhere in the environment, microorganisms play a crucial part in a variety of natural processes. Among many other things, they run the fundamental drug cycles required for the plants to get the nutrients they need from the response of organic materials in the soil.
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the nurse assesses a client admitted to the labor and delivery unit and obtains the following data: dark red vaginal bleeding, uterus slightly tense between contractions, bp 110/68, fhr 110 beats/minute, cervix 1 cm dilated and uneffaced. based on these assessment findings, what intervention should the nurse implement?
Intervention should the nurse implement is to monitor IV site for bleeding
What is nursing intervention for labor and delivery ?Offering emotional support and promoting the expression of feelings verbally are the two most crucial nursing interventions for lowering anxiety. Encourage and facilitate frequent bed position changes for women. Respect the woman's wishes and give her family member access if they so desire.
Monitoring bleeding from peripheral sites (C) is the priority intervention. This client is presenting with signs of placentalabruption. Disseminated intravascular coagulation (DIC) is a complication of placental abruptio, characterized by abnormalbleeding. Invasive vaginal procedures (A and B) or (D) can increase the abruption and bleeding, so these interventions arecontraindicated.
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a home care nurse is caring for a client with complaints of epigastric discomfort who is scheduled for a barium swallow. which statement by the client indicates an understanding of the test?
I won't eat or drink anything for six to eight hours before the exam. Epigastric discomfort is the term used to describe pain that is felt in the upper abdomen, just behind the ribs.
How does abdominal discomfort feel?
Epigastric pain is a type of discomfort that only affects the upper abdomen in the area directly behind the ribs. People who have this kind of pain frequently have it during or immediately after eating, or if they lie down too soon after eating. It is a typical sign of heartburn or gastroesophageal reflux disease (GERD).
When is abdominal pain severe?
Antacids, either over-the-counter or prescribed, may be effective in easing chronic acid reflux and epigastric pain brought on by stomach acid. The occasional epigastric pain is typically nothing to worry about, however
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a nurse asks a coworker about the condition of the nurse's next-door neighbor, who has been admitted to the unit. if the coworker shares the neighbor's client information with the nurse, the coworker could be held liable for committing which act?
If the coworker shares the neighbor's client information with the nurse, the coworker could be held liable for committing unauthorized disclosure of confidential information.
Explain the act of unauthorized disclosure of confidential information.
Unauthorized disclosure of confidential medical information is a serious violation of patient privacy and can lead to serious legal and financial consequences. Depending on the circumstances, such a violation can result in civil or criminal penalties, including fines, imprisonment, or both. In addition to potential legal repercussions, unauthorized disclosure of confidential medical information can also have a negative impact on a person's reputation and cause emotional distress.
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the obstetrical nurse is caring for a client who has been treated for gestational diabetes. when teaching the client about the causes of gestational diabetes, the nurse should include which risk factor in the teaching?
Nurses who teach clients about the causes of gestational diabetes, also nurses, must include risk factors in teaching about excessive weight gain that can occur during pregnancy, increased risk of cesarean sections, and the risk of developing type 2 diabetes in the future.
What is gestational diabetes?Gestational diabetes is diabetes that occurs during pregnancy, in women who previously did not have diabetes only experienced by pregnant women. Generally, this disorder occurs at gestational age in the second trimester, between weeks 24 to 28.
The cause of gestational diabetes is because the placenta produces more hormones, such as the hormone estrogen, and HPL (human placental lactogen), including a hormone that makes the body immune to insulin, a hormone that lowers blood sugar levels. As a result, blood sugar levels increase and cause gestational diabetes.
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a patient with a spinal cord injury is complaining of pleuritic chest pain, shortness of breath, and is very anxious. these manifestations would most likely correlate with which complication?
These symptoms would very certainly be related to pulmonary embolism (PE) (p. 1205).
What is spinal cord injury?Damage to the spinal cord or the nerves at the cauda equina, the end of the spinal canal, can result in a spinal cord injury, which frequently results in permanent alterations to strength, sensation, and other bodily functions below the location of the lesion. It could seem as though every part of your life has been impacted if your spinal cord was suddenly harmed. Your injury may have psychological, emotional, and social repercussions. Many scientists are confident that future research developments will make it possible to repair spinal cord injuries. There are active research projects all throughout the world. Many people with spinal cord injuries may live active, independent lives in the interim because to medical interventions and therapy.
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the nurse is performing an admission assessment on a child with a seizure disorder. the nurse is interviewing the child's parents to determine their adjustment to caring for their child who has a chronic illness. which statement, if made by the parents, would indicate a need for further teaching?
The parents should ask "Our child sleeps in our bedroom at night."
What is seizure disorder ?An uncontrolled, sudden electrical disturbance of the brain is known as a seizure. It can alter your emotions, movements, behavior, and level of consciousness. Epilepsy is typically defined as having two or more seizures that are unprovoked and occur at least 24 hours apart.
In older adults, epilepsy is occasionally identified as the result of another neurological condition, such as a brain tumour or stroke. Other factors may include developmental disorders, prenatal injuries, prior brain infections, genetic abnormalities, or genetic abnormalities. However, there is no known cause for epilepsy in about 50% of cases.
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which are important points for the nurse to consider when working with clients with disruptive behavior disorders and their families? select all that apply.
Points for the nurse to consider when working with clients with disruptive behavior disorders and their families are: remember to focus on the client's strength and assets and their problems, avoid "blaming" attitude toward clients or families and focus on positive actions to improve behaviors.
What is a disruptive behavior disorder?It is believed that there is not one single root cause for disruptive behavior disorders but are thought to be the result of genetic, physical, and environmental risk factors working simultaneously.
Common types of disruptive behavior disorder are oppositional defiant disorder and conduct disorder.
To fix disruptive behavior: acknowledge the feelings of the individual, address the disruption individually and immediately.
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the nurse is taking care of a client who had a laryngectomy yesterday. to assure client safety, the nurse should give hand-off of care reports at which times? select all that apply.
When handing out care reports, the nurse should ensure client safety. Change of nurses and shift when nurse leaves for lunch.
How should the airway be managed in a patient who has had a laryngectomy?A pediatric facemask can be worn over the laryngeal stoma to perform preoxygenation and ventilation, respectively. Other options include covering the stoma with the end of a catheter mount or an inflated laryngeal mask airway.
Where should a laryngectomy patient be ventilated?Naturally, the stoma is the only way to get oxygen to the lungs if the patient had a laryngectomy. Try face-mask oxygenation or ventilation through the upper airways if these approaches don't work.
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a client from a correctional facility is admitted to the hospital wearing handcuffs. the nurse caring for the client needs to provide morning care and notices the two correctional officers socializing with the nursing staff at the desk. what is the best action by the nurse in this situation?
The nurse needs to discuss safety issues, policies, and regulations. Her worries would be justified because there have been numerous instances of inmates in hospitals escaping or causing harm. Since they are on duty, the correctional officers are entitled to take care of their duties while keeping an eye on the prisoner.
What is health and safety policy in healthcare?According to the law, every company needs to have a health and safety management plan.
A health and safety policy outlines your overarching strategy for health and safety. It describes how you, as an employer, will oversee health and safety practices at your company. Who does what, when, and how should be made crystal clear.
How is safety for nurses in healthcare is important?Both the patients they care for and the nurses themselves value their protection from illnesses and injuries brought on by their jobs. Work schedule characteristics have an impact on the complex relationship between work schedules and health and safety. Patient and family assaults on healthcare workers have been linked to environmental and organizational factors, such as understaffing, lax workplace security, public access to the facility without restriction, and patient transportation. The rate of assaults is decreased by the presence of security personnel, whereas the perception among administrators that assaults are expected as part of the job, receiving assault prevention training, working primarily with patients in need of mental health treatment, and working with patients who have lengthy hospital stays are all associated with increased risk.
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the nurse is instructing a hospitalized patient with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. which position should the nurse instruct the patient to assume?
Emphysema patient should be taught by the nurse how to improve breathing during dyspneic times while sitting on the side of the bed and leaning on an overbed table.
Emphysema, an ailment of the lungs, causes difficulty breathing. Alveoli, the lungs' air sacs, dyspneic suffer damage in those with emphysema. The air sacs' inner walls deteriorate and tear with time, resulting in the creation of fewer, dyspneic bigger air gaps as opposed to more, smaller ones. Emphysema has a bad prognosis and an average life expectancy of roughly five years because most patients aren't identified dyspneic periods until stage 2 or 3.
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the nurse is assessing a 3-day-postoperative client and the incision site. the nurse notes a moderate pinkish exudate on the dressing. this drainage is called .
Serosanguineous drainage is a somewhat pinkish exudate that appears on the dressing.
Which dressing would you apply to a wound with mild exudates?Use foam dressings, alginate dressings, or hydroactive dressings. Add a non-adherent, highly absorbent dressing on top. A foam dressing can also be combined with an alternate alginate dressing. AIM: Eliminate infection, lessen odor, absorb exudate, and safeguard.
What kind of exudates are signs of an infection?Exudate that turns thick and milky or that turns yellow, tan, gray, green, or brown is usually always an indication of infection. White blood cells, dead bacteria, wound debris, and inflammatory cells are all present in this discharge.
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