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NUR 2356 / NUR2356 Multidimensional Care I Final Exam / MDC 1 Final Exam Review | Rated A Guide | Latest 2020 / 2021 | Rasmussen College

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NUR 2356 / NUR2356 Multidimensional Care I Final Exam / MDC 1 Final Exam Review | Rated A Guide | Latest 2020 / 2021 | Rasmussen College 1. Vital signs that can indicate post-surgical pain? -... Elevated Heart Rate - Breathing rate can be elevated - Elevated BP 2. Complications of amputations - Body-image disturbances - Deep vein thrombosis (DVT) - Slow wound healing - Cardiac issues (eg. heart attack) - Pneumonia 3. Type of pain with amputations? - Possibility of phantom pain 4. Autonomy for a client requiring oral care - Brush the teeth twice a day. - Use a soft toothbrush. - Moisturize oral mucosa and lips every 2 to 4 hours. - Use chlorhexidine gluconate (0.12%) rinse twice a day during the perioperative period for patients who undergo cardiac surgery (adult patients). - Use mouthwash inside the mouth twice a day for adult patients who are on a ventilator. - Give the patients the oral supplies 5. Fires - Home fires are the major cause of death and injuries - Older adults & children < 5y/o have the highest risk. 6. Most common causes of fires - Cooking fires - Smoking - Heating Equipment - Home oxygen administration equipment: 75% of home fires involves oxygen, smoking materials are the ignition source 7. RACE - Rescue - remove patient from danger - Alarm - pull the alarm - Contain - close doors 8. 1st priority when a client falls when the nurse is not in the room? - check on patient for any injuries 9. What do you do when a client is about to about to fall while the nurse is there? - guide the patient to the floor. 10. Positioning to reduce injury for bony prominences - Place pillows under areas and elevate - Changes position for 2hrs - Elevate calves to protect heels 11. Reducing shear injury - Avoid pulling and sliding patient against bed - Keep head of bed at a slight elevation - Make sure sheets and blankets have ripples in them that rub against the patient's skin - Use others to assist to protect from shearing. 12. Reduce urinary tract infection - Proper cleaning of Perineum (front to back) 13. Preventing Pressure Injuries Positioning - Pad contact surfaces with foam, silicone gel, air pads, or other materials with pressure-redistribution properties. - Do not keep the head of the bed elevated above 30 degrees to prevent shearing. [Show More]

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