Vital signs, the results of a physical examination, and laboratory findings are examples of subjective data.
What nursing intervention occurs first throughout the admissions process?The assessment phase is the first step in the nursing process. At this point, the nurse compiles and arranges patient-related information. Information that is pertinent to a patient's health and wellbeing may include details about the patient, his or her family, carers, or the patient's community or environment.
What was the patient's initial evaluation?3 Initial Evaluation for Within an hour of admission, an assessment of the patient is to be made by the RMO, the treating physician, or a member of their team (as appropriate) to evaluate the patient's immediate care needs and to choose a plan of treatment.
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the patient becomes rigid with feet flexed and arms curled to the chest. which abnormal reflex does this represent?
Decorticate posing is sometimes referred to as "mummy baby," "decorticate response," "decorticate rigidity," and "flexor posturing."
Patients that exhibit decorticate posturing have their legs stretched and feet turned inside, their hands clenched into fists, and their arms flexed or bent inward on their chest.
What symptoms decerebrate rigidity exhibits?
Decerebrate posture is characterised by rigid arms and legs, toes pointing down, and an arched back. opisthotonic stance, characterised by a rigid, arched back and a thrown-back head
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Psychopathology includes illnesses or disorders that involve ______________ symptoms.
Diseases or conditions with psychological or psychiatric manifestations are considered psychopathologies.
Which four psychopathology models are there?The physiological, behavioural, cognitive, nor psychodynamic models are the four primary explanations for psychological disorder. They all make an effort to explain the causes et cures for all psychiatric diseases, but they all do so in a different way.
What contributes to psychopathology?Psychopathology has many causes, not just one. There are several elements that can raise the risk to mental disease, such as: DNA and the chemical makeup of the brain are biological factors. illnesses with a long course.
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nurse preparing to administer 40ml of 0.9% sodoim chloride to infuse over 20 mins. drop factor of the manual iv tubing is 15 gtt/ml. how many gtt/minnurse preparing to administer 40ml of 0.9% sodoim chloride to infuse over 20 mins. drop factor of the manual iv tubing is 15 gtt/ml. how many gtt/min
The answer is 30gtt/min to administer 40ml of 0.9% sodoim chloride to infuse over 20 mins.
What does gtt mean?
"gtt" is an abbreviation for "gutta", Latin meaning of which is "drop".
Since 1 ml consists of 15 gtt or drops, therefore 40 ml would consist 40x15=600 gtts or drops. These 600 drops need to be infused in 20 mins i.e. 600/20=30 ggts per min.
Therefore the answer is 30ggt/min.
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the nurse is assessing antibody levels for a client recovering from hepatitis b. which antibody does the nurse anticipate will be present at this time?
Hepatitis B is spread when blood, semen, or other body fluids from a person infected with the virus enters the body of someone who is not infected.
Is hepatitis B very serious?How serious is a chronic (long-term) hepatitis B? Chronic hepatitis B can develop into a serious disease resulting in long-term health problems, including liver damage, liver failure, liver cancer, and even death.
How does hepatitis B make you feel?Chronic hepatitis B infection may last a lifetime, possibly leading to serious illnesses such as cirrhosis and liver cancer. Some people with chronic hepatitis B may have no symptoms at all.
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assessment i suspect mr. luno is suffering from gastroesophageal reflux. other possibilities include gastritis, cholelithiasis, and pud. which is not part of the differential diagnosis?
The patient may have a stone in his pancreas. This is not a part of the differential diagnosis.
What is gastroesophageal reflux?
Gastroesophageal reflux disease (GERD) is a digestive disease wherein acid of the stomach or bile flows back repeatedly into the esophagus. It irritates the food pipe lining.
Gastroesophageal reflux disease or GERD is a chronic disease.
GERD is indicated when acid reflux and heartburn occur more than twice a week.
Symptoms include burning pain in chest that occurs usually after eating and often worsens after lying down.
If not treated, GERD can become a problem, because the tissue lining the esophagus gets damaged by the reflux of the stomach. This causes pain and inflammation.
Therefore, the patient may have a stone in his pancreas. This is not a part of the differential diagnosis.
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the nurse will notify the health care provider immediately if the client taking amoxicillin for otitis media is also taking what medication?
The nurse will inform the healthcare physician about these tetracycline for acne medications.
A client is not a customer.Instead of a specific sort of customer who pays for professional assistance from a company, anybody who makes use of a company's products or services is referred to as a user. Clients often buy solutions and guidance, whereas consumers frequently buy things.
Who would you utilize as a representative client?A customer is a person who uses a business's products or services and pays for them. Companies might be among the clients. Clients, as opposed to customers, typically have a connection or agreement with the vendor. If you purchase a cup of coffee from a café kiosk in a train station, for instance, you are a client.
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when evaluating a chest pain patient's 12-lead ecg, you note that lead avr is positively deflected. this is indicative of:
Positively deflected lead avr is indicative of atrial tachyarrhythmias while when evaluating a chest pain patient's 12-lead ECG.
What is ECG?
ECG stands for Echocardiography. Its is done for the patient having issues with heart related problems such as High BP, Cardiac arrest, etc.
Also it is the process or technique of creating a ecocardiodiagram.In it heart's electrical signals are recorded by placing electrodes on the body.What is atrial tachyarrhythmias ?Atrial tachyarrhythmias is condition where heartbeat rate increases to more than 100 beats per minute. It is also known as the type of supraventricular tachycardia (SVT).
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the nurse caring for clients admitted for infectious diseases understands what information about emerging global
The nurse learning about infection discovers that which factor is the best and most important.
When caring for a hospitalized client with influenza, which intervention would the nurse carry out to stop illness transmission?Droplet safety measures: When a patient carrying a virus, such influenza, is three to six feet away from the patient, droplet precautions are required. When someone coughs, sneezes, talks, or comes in close contact with the breathing of an infected person, air droplets from those actions can spread the infection.
What causes infections to spread most frequently among individuals who are institutionalized?Transmission over contact. In the healthcare environment, this is the most significant and frequent mode of transmission. Direct contact between an infected or colonized patient and a susceptible individual results in the spread of organisms.
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the nurse is caring for a 2-year-old child who has been having frequent diarrhea. what actions are appropriate? select all that apply.
When a 2-year-old is being cared for by the nurse, she regularly monitors the client's electrolyte levels.
What causes electrolyte abnormalities in toddlers?
Electrolyte imbalances can occur for a variety of causes. Dehydration, fever, other ailments like liver or renal disorders, some medicines, vomiting, and diarrhea are just a few of the many factors that can lead to an electrolyte imbalance.
What is two-year-old can consume electrolytes?moderate dehydration brought on by sickness in toddlers older than 2 years old You might also try giving your child some water or ice cubes. You should give your child electrolyte beverages like Pedialyte or Gatorade to replenish lost electrolytes and fluids.
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which initial statement would the nurse use when a client with a history of alcoholism returns to a previously attended residential alcohol treatment program?
A individual with this disease used to be called a "alcoholic."However, this is becoming more and more disfavored as a label.Professionals in the medical field now describe someone as having an addiction to alcohol (AUD).
What is the initial course of alcoholism treatment?Naltrexone – We advise naltrexone as the first line of treatment for the majority of newly diagnosed individuals with mild to severe alcohol use disorders.
How is alcoholism treated?Acamprosate: The U.S. Food and Drug Administration (FDA) has given this medication approval to treat alcoholism.It aids in restoring the equilibrium of brain chemicals that may have been altered by excessive drinking.Disulfiram: The FDA has given this medication approval to treat alcoholism.
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during a blood transfusion, a client begins to have chills, back pain, and develops a fever. the nurse determines the client is experiencing a transfusion reaction. the nurse educates the client about transfusion reactions. which statement indicates the cause of the reaction?
If the immune system perceives the HLA types as foreign, a reaction occurs.
Each person has two HLA haplotypes that allow human cells to be identified. Blood typing entails identifying these haplotypes (ABO compatibility). The closer the HLA types match, the greater the likelihood of identical antigens and the lower the chance of rejection.
What are Antigens?
Any substance that causes your immune system to produce antibodies against it is referred to as an antigen. This indicates that your immune system does not recognise the substance and is attempting to combat it. An antigen can be a natural substance such as chemicals, bacteria, viruses, or pollen.
Your body contains three types of antigen-presenting cells: macrophages, dendritic cells, and B cells. One of their jobs is to act as a detective, showing other immune system cells suspects they believe are invading your body.
When an antigen enters the body, it activates the adaptive immune system, which includes specialised immune cells such as B and T lymphocytes (B cells and T cells).
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the nurse is teaching a client about contact dermatitis. what type of contact dermatitis requires light exposure in addition to allergen contact?
The kind of contact dermatitis known as photoallergic contact dermatitis necessitates exposure to light in addition to allergen interaction.
What kind of contact dermatitis necessitates light exposure in addition to allergen contact?Sometimes people get photoallergic contact dermatitis. UV light may exacerbate allergic contact dermatitis, or patients may only experience an allergic reaction if a chemical is present on their skin and when their skin has had enough UV exposure (UV-A; 320-400 nm).
Which immunoglobulin subtype is most likely to be implicated in allergic reactions?Antibodies called immunoglobulin E (IgE) are created by the immune system. Your immune system produces antibodies called Immunoglobulin E when you have an allergy because it overreacts to an allergen.
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a college student reports the onset of skin burning and hives when walking outdoors in cold weather. which suggestions will the nurse make to limit this reaction from occurring? select all that apply.
When swimming in chilly weather, wear a wetsuit, stay away from cold-temperature meals and drinks, and take an over-the-counter antihistamine before venturing outside.
What do you mean reaction?Resistant or resistance to a source, influence, or movement is a reactionary act, process, or occurrence. especially: a reaction to just a particular treatment, circumstance, or stimulus; leaning toward a past and typically antiquated political or social system or policies.
What is the meaning of reaction and example?The reaction is an activity that is taken as a result of anything. You can tell if your parents are upset if you tell them you would really like to move out by their response. A reaction frequently has a physical component.
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What is a contraindication for breastfeeding in the less developed parts of the world?.
the nurse is caring for an infant born to a mother with cocaine use disorder during her pregnancy. the nurse would likely notice that this infant:
The nurse would likely notice that this infant: cries when touched.
What happens to the baby whose mother is a cocaine consumer?Cocaine usage during pregnancy has been linked to the mother's headaches and seizures, early membrane rupture, and placental lining separation before delivery.
Cocaine usage exacerbates the natural cardiovascular changes that occur during pregnancy, which can occasionally result in major hypertensive crises, spontaneous miscarriage, premature labor, and challenging deliveries. To lessen these dangers, pregnant women who use cocaine must undergo the proper medical, psychiatric, and addiction treatment.
It is challenging to gauge the complete impact of maternal drug usage and to identify the precise risks that each medication poses to the developing fetus.
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the nurse is caring for a newborn whose mother is suspected of having a drug addiction. which would the nurse do to most accurately confirm that the newborn may be at risk for withdrawal?
Shaking that is regular and involuntary is a symptom of the neurological illness known as essential tremor. The most common cause of handshaking is executing simple tasks.
What exactly do you mean by drug abuse?
Drug addiction, also known as substance use disorder, is a condition that impairs a person's capacity to control their use of drugs and medications, whether they are legal or not. Drugs include substances like nicotine, alcohol, and marijuana.
What negative repercussions might drug addiction have?
People who struggle with addiction frequently experience one or more coexisting medical disorders, such as lung or heart disease, stroke, cancer, or mental health issues. The harmful effects of long-term drug usage can be shown by imaging scans, chest X-rays, and blood testing..
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a group has asked the nurse to discuss how lifestyle factors affect heart health. which statements by members of the group would indicate that the teaching was effective? select all that apply.
Answer:
• "Gradually increasing my exercise levels will help enhance circulation through the heart."
• "As a borderline diabetic, if I lose weight and lessen my intake of simple carbohydrates, this should benefit my heart."
• "Walking is excellent exercise to strengthen my heart."
• "If I change my diet and lessen my intake of saturated fats and trans fatty acids, this may decrease my cholesterol levels."
Explanation:
a 66-year-old man who originally sought care because of increasing pain in his great toe has subsequently been diagnosed with gout. in addition to pharmacological interventions, what dietary regimen should the nurse recommend to this patient?
The nurse should advise this patient to follow a diet high in fluids and low in protein.
How do proteins work?Almost all of the body's organs, tissues, and parts, including muscle, bone, clothing, and hair, include protein. It is a component of either the hemoglobin, which transports oxygen in the blood, and the enzymes, which power numerous chemical processes. You are constructed from at least 10,000 different proteins, all of which work together to create and preserve who you are.
How much protein is too much protein?Because many elevated foods you consume are heavy in both total and saturated fat, consuming too much protein can also cause blood lipid levels to rise and increase your risk of heart disease. For those who are prone to kidney illness, consuming more protein puts additional strain on the kidneys.
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which expected outcome about nutrition would be appropriate for a client who has had a total gastrectomy for gastric cancer? the client will:
The majority of dumping syndrome patients suffer signs and symptoms 10 to 30 minutes after eating, including abdominal cramping and diarrhea.
How long can someone live after having a gastectomy?
Overall five-year survival and disease-free survival rates for group A were 61% and 60%, compared to 50% and 43% for group B. Patients over the age of 70 should carefully consider having a gastrectomy if the procedure may be justified by a low mortality rate and favorable long-term results.
How does life change following a gastrectomy?
After undergoing a gastrectomy, you'll probably need to consume several small meals throughout the day rather than three large ones. Nevertheless, as time passes, your residual stomach and small intestine will expand, allowing you to progressively eat larger, less frequent meals.
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a client with venous insufficiency reports swelling in the feet and ankles. what is the most appropriate intervention for the nurse to recommend?
A nurse inspecting a client's IV site notices redness and swelling at the site so she should discontinue the IV and relocate it to another site.
What would be the most appropriate nursing intervention for this situation?Untreated venous insufficiency outcomes no longer handiest in a sluggish loss of cosmoses however also in variety of complications such as persistent ache The nurse ought to examine the IV site for the presence of redness (inflammation), infection, or infiltration and discontinue and relocate the IV if any of those signs is noted.The most common site for IV tubing is that the forearm, the rear of the hand or the hi.nge joint fossa. The catheters are for peripheral use and may be placed wherever veins are straightforward to access and have sensible blood flow, though the simplest accessible website isn't forever the foremost appropriate.A client with venous insufficiency asks the nurse what they can do to decrease their risk of complications. what advice should the nurse provide to clients with venous insufficiency Stabilizing heart rate and blood pressure and easing anxiety.Continual venous insufficiency occurs while your leg veins do not permit blood to glide back up to your heart. commonly, the valves in your veins make certain that blood flows in the direction of your heart. but while these valves don't work well, blood can also waft backwards. this can motive blood to acquire (pool) for your legs.To learn more about venous insufficiency refer to:
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the nurse is admitting a 10-month-old infant who is being hospitalized for a respiratory infection. the nurse develops a plan of care for the infant and includes which most appropriate intervention?
The nurse develops a plan of care for the infant and includes : Providing a consistent routine with touching, rocking, and cuddling throughout hospitalization.
What are the plans of care for a patient with respiratory infection ?The next set of nurse assessments and actions for pneumonia work to maintain the patency of the airways, boost fluid intake, and instruct and support deep breathing and an efficient cough.
1. Evaluate the depth, rhythm, and rate of breathing as well as chest movement and auxiliary muscle use.
2. Evaluate the productivity and efficiency of coughing
3. Listen for crackles and wheezes as you auscultate the lung fields, looking for any locations where the airflow is diminished or nonexistent.
4. Pay attention to the sputum's color, viscosity, and smell. Provide updates.
Sputum changes could be a sign of an infection. Sputum that is discolored, persistent, or offensive may increase airway resistance and call for additional treatment.
5. Evaluate the patient's level of hydration.
Inadequate hydration and dehydration compromise airway clearance.
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question 15 of 20a client has a foot ulcer that has not shown signs of improvement over the past several months. which medical condition is most likely causing the delay in wound healing? select all that ap
Peripheral vascular disease is most likely causing the wound healing delay.
The emergent phase starts when a burn wound occurs through disease and lasts for approximately the first 24 hours, or until fluid resuscitation is finished. The focus of client care during the emergency period is to keep the client's airway open and manage their wound shock. The stratum basale, which is the epidermis' innermost layer, as well as the stratum spinosum, stratum granulosum, stratum lucidum, & stratum corneum are among the epidermis' layers (the most superficial portion of the epidermis. Keep a close eye on the patient's hourly fluid intake, urine output, blood pressure, and heart rate; any disease abnormalities should be communicated to the burn surgeon.
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a patient asks what medication would be most effective in the treatment of seasonal hay fever (aka allergic rhinitis). the nurse will teach the patient about the use of which drug?
The nurse will teach the patient about the use of Fluticasone. The most effective agents used to treat allergic rhinitis are Glucocorticoids (fluticasone [Flonase]).
Rhinitis: when a reaction that causes runny nose, nasal congestion, sneezing, and itching occurs. Most rhinitis are caused due to an inflammation and are associated with symptoms in the ears, eyes, or throat.
Allergens are a usually harmless substance that can cause an allergic reaction. Hay fever or allergic rhinitis, is an allergic reaction to certain allergens, most commonly pollen. These allergens trigger the release of histamine in a person’s body, which leads to swelling, itching, and build up of fluid in the fragile linings of nasal passages, eyelids and sinuses.
Common symptoms of allergic rhinitis are:
SneezingItchy noseRunny noseCoughingFrequent headachesDry, itchy skinAllergic rhinitis can be treated in several ways. Medications and/or home remedies are effective as well.
Therefore, the nurse will teach the patient about the use of Fluticasone. The most effective agents used to treat allergic rhinitis are Glucocorticoids (fluticasone [Flonase]).
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the parents of a 3-year-old boy have just been informed that allergy testing suggests their son has multiple food allergies. when providing health education for this family, what subject should the nurse prioritize?
The nurse should highlight the Potential sources of food allergens and techniques for avoiding irritating foods after informing the parents of a 3-year-old boy's various food allergies based on allergy testing.
What are the food allergies?A bad or harmful immunological response brought on by eating a certain meal. Food allergies have no recognized cause. Allergies that were present as a child sometimes go away as adults. An allergic response may cause hives, stomach issues, or enlarged airways. A severe reaction may endanger life. Mild responses are treated with antihistamines. A severe reaction necessitates the medication epinephrine injection and emergency hospital treatment.
What are the major food allergens and what's the most popular allergy?Celery, gluten-containing grains (like wheat, barley, and oats), crustaceans (like prawns, crabs, and lobsters), eggs, fish, lupin, milk, mollusks (like mussels and oysters), mustard, peanuts, sesame, soybeans, sulfites, and sulfur dioxide are the allergens.
One of the most prevalent allergies in the world is a reaction to pollen. Pollen allergies affect tens of millions of people in the United States. In order to help plants reproduce, pollen—a fine, yellow powder—is dispersed from plant to plant by the wind, birds, insects, and other animals.
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a patient was placed in restraints for 2 hours in order to help manage impulsive, destructive, unsafe behavior. which statement made by the charge nurse during a meeting to discuss the incident shows an understanding of the need to use restraints only as a last resort?
The following statement made by the charge nurse shows an understanding of the need to use restraints only as a last resort:
“Let’s review what exactly happened that led to the use of restraints.”
What are Restraints?
Restraints are physical or chemical means of limiting or restricting a person’s movement or actions. Physical restraints are objects or materials used to immobilize or limit a person’s freedom of movement, while chemical restraints are drugs used to restrain a person’s behavior. Restraints are often used in healthcare settings, such as hospitals and nursing homes, to help keep patients safe from harm.
The charge nurse must not put the staff on the defensive in order to encourage an open, honest examination of the situation that will allow learning to take place. Reviewing the events before the patient's restraint in an unaccusatory manner demonstrates an awareness of proper restraint use. The other selections indicate that the nurse manager does not believe the matter was handled appropriately.
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the nurse is admitting a 28-week neonate to the nicu. which assessment would indicate an intraventricular hemorrhage (ivh)?
For the nurse who is admitting a 28-week neonate to the nicu, Hypotonia is assessment would indicate an intraventricular hemorrhage.
Hypotonia is the medical word for a lack of muscle tone. Normal muscular contractions continue to occur even when the muscle is completely relaxed, giving it a springy feel and some resistance to passive movement. Muscular weakness is not the same as the two disorders, despite the fact that they can coexist.
Treatment can help with hypotonia, a lifelong condition. After being given a hypotonia diagnosis, a baby's muscle tone typically improves markedly over time. If a genetic disorder is the underlying cause of your child's hypotonia, the problem may get worse with time.
Hypotonia, or low muscle tone, is typically found at birth or in the first few years of life. The illness is additionally known as floppy muscle syndrome.
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the nurse is providing education to a client with high triglyceride and cholesterol levels. which food should the client be cautioned to avoid?
These highly saturated fats include coconut oil, palm oil, and palm kernel oil.
What foods should you stay away from?Avoid eating frozen dinners that are high in salt and processed meats such lunch meats, sausages, hot dogs, and ham (sodium). Many packaged snacks and toddler foods sold in stores include a lot of salt. Check the nutrition information label to identify foods that have less salt.
What four foods should you avoid?Beverages with added sugar are just empty calories. Preservatives and too much salt are present in salty snacks like potato chips and cheese doodles. Candy, packaged cookies, and other packaged sweets: empty calories, preservatives, and additives. Processed meats (Bacon, sausage, and cold cuts) are associated with heart disease and cancer.
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a renal length discrepancy of more than 10 mm may indicate kidney disease. which type of section might allow a doctor to see both of a patient's kidneys simultaneously?
Your kidneys are harmed and unable to properly filter blood if you have renal disease. If you have diabetes or high blood pressure, you are more likely to develop renal disease.
How can I tell if my kidneys are unhealthy?Blood and urine testing can be used to determine CKD. These exams check for elevated levels of specific compounds in your blood and urine, which are symptoms of a functioning kidney.
How long may kidney illness go undiagnosed?About 90% of those who have this illness are completely ignorant of it. One in five persons with CKD is unaware that they have severe chronic renal disease.
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a nurse is preparing to administer a sulfonamide to a client. the nurse is aware sulfonamides are commonly used to treat which types of infections? select all that apply.
Acute otitis media, urinary tract infection, and ulcerative colitis Sulfonamides are frequently used to treat acute otitis media, urinary tract infection, and ulcerative colitis.
What does "infection" mean to you?Infection is the spread and development of microorganisms such as bacteria, viruses, etc parasites that are not typically found in the body. Either a subclinical infection, which has no symptoms, or a clinically obvious illness, which does.
what is a body an infection?Bacteria can proliferate so swiftly that they crowd out host tissues and disrupt normal function in some cases. Tissues and cells can occasionally sustain lethal injury. There are occasions when they release toxins that can paralyze, harm cells' metabolic activities, or cause a strong immune response that is harmful in and of itself.
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an older client who requires frequent monitoring fell and fractured a hip. which nurse is at greatest risk for a malpractice judgment?