The nurse would implement the following nursing actions during the primary survey of the emergency assessment process for a client: Assess airway, breathing, circulation, and vital signs. check for signs of trauma, physical assessment, level of consciousness, and head-to-toe physical examination.
The primary survey is an important step in the emergency assessment process for a client. During this step, the nurse assesses the ABCs (airway, breathing, circulation) and vital signs of the client to determine the best course of action. The nurse also checks for signs of trauma or injury. In addition, a brief physical assessment is performed, and a baseline for mental status and level of consciousness is established. The nurse then asks the client about their medical history and medications. Finally, a head-to-toe physical examination is performed, and the nurse monitors for changes in vital signs.
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true or false 2. the 8-inch pid is more effective than the 16-inch pid in reducing radiation exposure to the patient.
The 8-inch PID is not more effective than the 16-inch PID in reducing radiation exposure to the patient is false, because the 8-inch PID is designed to detect very low levels of hazardous gases and vapors, while the 16-inch PID is designed to detect higher levels.
The 8-inch PID (photo-ionization detector) has a more sensitive sensor, but it cannot detect higher levels of radiation, so the 16-inch PID is more effective in reducing radiation exposure. Furthermore, the 16-inch PID has a larger area of coverage and can detect radiation more quickly than the 8-inch PID. Additionally, the 16-inch PID is designed to detect larger amounts of hazardous gases and vapors that the 8-inch PID cannot. Therefore, the 16-inch PID is more effective in reducing radiation exposure to the patient than the 8-inch PID.
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while assessing a pediatric client, a nurse notices that the child is unable to focus on an object with both eyes simultaneously. which other finding in the client will suggest strabismus? select all that apply. one, some, or all responses may be correct.
The signs of strabismus are;
Crossed appearance of eyes
Impaired extraocular muscles
How do you know strabismus?Strabismus, also known as crossed eyes, is a condition in which the eyes are not properly aligned with each other. This causes one eye to look in a different direction than the other eye. Strabismus can occur in one or both eyes and may be constant or intermittent.
Some people with strabismus experience double vision, which occurs when the brain receives two different images from the misaligned eyes.
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Missing parts;
While assessing a pediatric client, an ophthalmologist notices that the child is unable to focus on an object with both eyes simultaneously. Which other findings in the client confirms the diagnosis as strabismus? Select all that apply.
1
Impaired near vision
2
Crossed appearance of eyes
3
Elevated intraocular pressure
4
Impaired extraocular muscles
5
Degeneration of central retina
The other findings in the client that suggest strabismus are:
Cross eye appearanceImpaired extraocular musclesWhat is strabismus?It is an eye disease that generates non-alignment of the eyes optimally. It can cause difficulty with depth perception, double vision and visual impairment if left untreated.
Therefore, strabismus can be detected through several factors such as crossed eyes and reduced vision in one eye, and should always be diagnosed as soon as possible by ophthalmologists.
The missing options for this question are:
Impaired near visionCrossed appearance of eyesElevated intraocular pressureImpaired extraocular musclesDegeneration of central retinaFind more about strabismus at:
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the nurse teaching the patient with allergic rhinitis that antihistamines are not effective in reducing which symptom?
The nurse is teaching the patient with allergic rhinitis that antihistamines are not effective in reducing nasal congestion. Nasal congestion is a symptom of allergic rhinitis and is caused by inflammation of the nasal passages.
Allergic rhinitis is an inflammation of the nasal passages that can cause a range of symptoms, including nasal congestion. Antihistamines are medications used to reduce the effects of histamine, a chemical released by the body's immune system in response to an allergen. While antihistamines can be effective in reducing itching, sneezing, and runny nose, they are not effective in reducing nasal congestion. This is because antihistamines work by blocking the effects of histamine and not by reducing the inflammation that causes the congestion.
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while obtaining a health history, a nurse learns that a client is allergic to bee stings. when obtaining this client's medication history, the nurse should determine if the client keeps which medication on hand?
When obtaining the medication history of a client who is allergic to bee stings, the nurse should determine if the client has an Epinephrine injection or EpiPen on hand.
The nurse should determine whether the client has an Epinephrine injection or EpiPen on hand when obtaining the medication history of a client who is allergic to bee stings.
What is an Epinephrine injection?
Epinephrine is a hormone that is naturally produced by the body. The hormone is used to treat a variety of life-threatening conditions. Epinephrine acts quickly to boost blood pressure, stimulate the heart and increase the amount of oxygen delivered to the body's tissues.
If the client has an allergy to bee stings, it is crucial for the client to carry an Epinephrine injection or EpiPen at all times.
Why is an Epinephrine injection important?
Anaphylaxis can be caused by a severe allergic reaction, and the body can respond rapidly to the allergen. If anaphylaxis develops, the body releases large amounts of histamines, which causes a drop in blood pressure and constriction of the airways.
Epinephrine helps the airways to relax and prevents the blood pressure from dropping too low. An Epinephrine injection or EpiPen is critical for a person who is allergic to bee stings because the sting of a bee can cause anaphylaxis.
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the home health nurse arrives at a client's home and immediately notes the client is experiencing increased dyspnea. the client has a 7-year history of chronic obstructive pulmonary disease (copd). which assessment finding should the nurse prioritize?
When the client has a 7-year history of chronic obstructive pulmonary disease, the nurse should prioritize the client's oxygen saturation levels.
Oxygen saturation levels: The home health nurse should prioritize the client's oxygen saturation levels because increased dyspnea is a sign of hypoxemia, which is a decrease in oxygen levels in the blood. Clients with COPD often have low oxygen levels due to damage to the lungs, which can cause difficulty breathing, fatigue, and other symptoms. A low oxygen saturation level may require immediate intervention to improve the client's breathing and prevent further complications.
The nurse should assess the client's oxygen saturation levels using a pulse oximeter or other device and intervene as necessary to improve oxygenation, such as administering supplemental oxygen or adjusting the client's medications. The home health nurse should prioritize assessing the client's oxygen saturation level. This is because increased dyspnea in a client with a 7-year history of chronic obstructive pulmonary disease (COPD) may indicate worsening of the condition or possible complications, and oxygen saturation level is a critical parameter to evaluate respiratory function.
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9. the clinical instructor asks darla to explain to a postoperative client the importance of using an incentive spirometer to inhale deeply. what quality and safety education for nurses(qsen) competency is the instructor assessing?
The instructor is assessing the QSEN competency of patient-centered care when they ask Darla to explain the importance of using an incentive spirometer to inhale deeply.
Incentive spirometers are commonly used after surgery to help prevent respiratory complications. This is an example of patient-centered care because it emphasizes preventive health strategies that focus on the individual patient's needs and promotes patient autonomy.
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when using parallel independent testing as a testing strategy, which of the following criteria is used to determine dod (definition of done)?
In parallel independent testing, the criteria used to determine the Definition of Done (DoD) are typically the same as in other testing strategies. The DoD is a set of criteria or conditions that must be met before a particular test case, feature, or release can be considered complete.
The criteria for determining the DoD may vary depending on the specific project or organization, but some common criteria include:
Test cases have been executed and passed successfully.All identified defects have been resolved and retested successfully.All acceptance criteria have been met.The test results have been documented and reviewed.The feature or release has been approved by the stakeholders.By meeting these criteria, the testing team can ensure that the testing has been completed successfully, and the software is ready for release or further development.
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the nurse is caring for a client with right-sided weakness after having a cerebrovascular accident (cva). while conducting the head-to-toe assessment, the nurse notices the client has redness around the right elbow. when developing the client's care plan, which problem-focused nursing concern will the nurse include?
When the nurse is caring for a client with right-sided weakness after having a cerebrovascular accident (CVA) and during the head-to-toe assessment, the nurse notices redness around the right elbow, the nursing care plan will include the nursing concern of impaired mobility due to joint pain.
What is a Cerebrovascular accident (CVA)?
A cerebrovascular accident (CVA), also known as a stroke, happens when blood supply to the brain is interrupted, causing brain cells to die. It's a serious medical emergency that necessitates quick treatment. There are three different types of stroke: Ischemic, hemorrhagic, and transient ischemic attacks (TIA).
It is critical to note that the best care for a patient with a cerebrovascular accident (CVA) is prevention. Impaired mobility due to joint pain is a nursing concern that can be included in the nursing care plan. This nursing diagnosis is classified as a problem-focused nursing diagnosis because it is concerned with addressing the client's current issue.
It is also known as a present health problem, which is described as an undesirable response to an existing problem.
What is a Nursing care plan?
A nursing care plan is a written guide that describes the goals, objectives, and nursing care activities to be performed to meet the client's health care requirements. Nursing care plans help the nursing staff to provide comprehensive and individualized care for their patients. A nursing care plan helps in prioritizing nursing care interventions, and the nursing team can easily identify and manage the client's health care needs.
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which infection does the nurse suspect in a patient receiving antibiotics who reports abdominal pain and cramps associated with frequent watery stols
It is likely that the nurse suspects a Clostridium infection due to the patient's symptoms. Clostridium is a type of bacteria that can cause abdominal pain, cramps, and diarrhea when treated with antibiotics.
Clostridium is a genus of Gram-positive, anaerobic, rod-shaped bacteria that are commonly found in soil, sediments, and the gut of animals and humans. Clostridium infections are caused by several species of bacteria, such as C. perfringens, C. tetani, and C. botulinum.
Symptoms of a Clostridium infection may include abdominal pain, nausea, vomiting, and diarrhea, as well as fever and muscle pain. In severe cases, symptoms can lead to tissue death and gangrene. Clostridium infections are often spread through contact with soil, contaminated food, or contact with an infected animal or person. Treatment typically involves antibiotics and may also include wound debridement and hyperbaric oxygen therapy.
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while performing an assessment, the nurse presses the tissue on the legs and there is increased pitting with a 4-mm depression. how would the nurse document this?
The nurse would document this as 4mm pitting edema on the legs.
Making documentation is proof of recording and reporting that nurses have in carrying out expertise records that are useful for the benefit of clients, nurses and the health team in providing health services.
Pitting edema is an accumulation of fluid in the tissue which causes an indentation that remains after the tissue is pressed for several seconds. Pitting edema is measured on a scale of 1+ (trace) to 4+ (gross) with 4+ being the deepest indentation. In this case, the nurse has assessed the pitting edema to be 4mm deep, indicating a 4+ on the scale. This would be documented in the patient's chart.
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ms. delgado brings in a new prescription for lovaza. which law sets guidance for providing information about her medication and condition to a family member?
(d) is the correct option. The patient's name, the patient's usage instructions, which must be written in full sentences, the drug name and strength, and the usage instructions must all appear on a prescription label.
A once daily pill called Truvada (emtricitabine/tenofovir disoproxil fumarate) is used to prevent HIV. Truvada must be given out by pharmacists in its original container, much like other HIV drugs. If it's not used correctly, it can be exposed to airborne moisture and lose some of its effectiveness. Under the guidance of a preceptor pharmacist, a pharmacy intern is permitted to carry out all tasks assigned to pharmacists by law, rule, or regulation.
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ms. Delgado brings in a new prescription for Lovaza. which law sets guidance for providing information about her medication and conditions to a family member
a. Hatch-Waxman Act
b. the controlled substance act
c. dietary supplement health and education act
d. health insurance portability and accountability act
The nurse is preparing a client for a total hip arthroplasty and is obtaining data preoperatively. Which statement made by the client is most important for the nurse to immediately report to the health care provider?
a. "I have not had anything to eat or drink for 8 hours."
b. "My hip pain has prevented me from doing the things I enjoy."
c. "I've been taking ibuprofen for my hip pain twice a day."
e. "My other hip will probably need to be done eventually."
The statement made by the client that is most important for the nurse to immediately report to the health care provider is c. "I've been taking ibuprofen for my hip pain twice a day.
"What is total hip arthroplasty?
Hip arthroplasty refers to a surgical procedure in which a damaged hip joint is replaced with an artificial prosthesis. The artificial prosthesis, which is typically constructed of metal, plastic, or ceramic, allows for a more fluid movement of the hip joint and the reduction of pain in the joint. Why is it necessary to report that the client is taking ibuprofen for hip pain twice a day? Ibuprofen is a nonsteroidal anti-inflammatory drug that is utilized for the treatment of pain and inflammation in the body. Ibuprofen has anticoagulant properties. Hence the option c. "I've been taking ibuprofen for my hip pain twice a day is correct.
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screen time contributes to obesity by: limiting access to fresh foods. increasing energy expenditure. increasing risk of depression. replacing time spent being active.
Screen time contributes to obesity by replacing time spent being active. When people spend more time sitting in front of screens, they are less likely to engage in physical activity, which is an important factor in maintaining a healthy weight.
This sedentary behavior can lead to weight gain and obesity, as well as other health problems like diabetes and heart disease. Additionally, screen time can increase the risk of obesity by promoting unhealthy eating habits. People who spend more time in front of screens are more likely to consume high-calorie, low-nutrient foods and drinks.
While screen time may not directly limit access to fresh foods, it can indirectly contribute to unhealthy eating habits by encouraging the consumption of processed and fast foods that are often high in calories, sugar, and fat.
Overall, it is important to limit screen time and encourage physical activity to help prevent obesity and promote overall health.
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a patient who is about to begin chemotherapy asks the nurse when the risk of infection is highest. the nurse will tell the patient that infection risk is greatest at which point?\
The risk of infection is highest at the start of chemotherapy treatment and will continue to decrease as the treatment progresses.
Chemotherapy is a type of cancer treatment that works by killing cancer cells, but it can also harm healthy cells. This means that chemotherapy increases the risk of infection, as healthy cells in the body are weakened. The risk of infection is higher when your white blood cell count is low, as these cells are responsible for fighting off infection.
To reduce this risk, chemotherapy patients should take extra precautions such as washing their hands frequently, avoiding crowds, and avoiding contact with people who are sick. It's also important to take the prescribed medications that are given to prevent infection and to report any signs of infection to your doctor right away.
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a child is diagnosed with hypoparathyroidism. which electrolyte imbalance would the nurse most likely expect to address?
Answer:
Hypocalcemia
Explanation:
The low production of parathyroid hormone (PTH) in hypoparathyroidism leads to abnormally low calcium levels in the blood and an increase of phosphorus in the blood
according to dietary reference intakes (dris), pregnant women need to begin adding at least 250 calories during the first trimester. this statement is:
Answer: According to dietary reference intakes (DRIs), pregnant women need to begin adding at least 250 calories during the first trimester. This statement is true.
What are Dietary Reference Intakes (DRIs)?
Dietary Reference Intakes (DRIs) are a set of nutrient intake values established by the Food and Nutrition Board of the National Academies of Sciences, Engineering, and Medicine. These values are used to assess and plan diets for healthy individuals based on age, gender, and life stage.
According to DRIs, pregnant women need to add at least 250 calories per day during the first trimester. This is because the first trimester of pregnancy is when the baby's organs are being formed, and the mother's body is preparing for the baby's growth and development.
DRIs are updated frequently to reflect the latest research on nutrition and health. It is important to consult a healthcare provider or registered dietitian to determine an appropriate dietary plan during pregnancy.
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the nurse assesses the surgical dressing of a client who has just arrived from the post-anesthesia care unit (pacu) and observes the dressing has a moderate area of serous drainage on it. what is the best action by the nurse?
The nurse observes the dressing has a moderate area of serous drainage on it after the patient has arrived from PACU, the best action by the nurse is to evaluate the wound beneath the dressing.
The surgical dressing must be examined for any drainage or bleeding after surgery.
This is accomplished by checking the dressing for blood or fluid marks and the amount of fluid. The nurse should assess the wound beneath the dressing if there is a moderate area of serous drainage on the surgical dressing.
This requires identifying the form and color of the drainage, as well as its quantity. If the drainage is clean, the nurse should be careful not to contaminate the wound while replacing the dressing.
The nurse should seek assistance if the wound is draining a considerable amount of blood. The nurse should notify the doctor if the dressing is full of serous exudate or if the dressing is not securely attached.
To summarize, when the nurse assesses the surgical dressing of a client who has just arrived from the post-anaesthesia care unit (pacu) and observes the dressing has a moderate area of serous drainage on it, the best action by the nurse is to evaluate the wound beneath the dressing.
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the nurse is preparing the client to make the necessary dietary changes from pregnancy to lactation. what statement should the nurse include in client teaching?
The nurse should explain to the client that her calorie intake should be increased even if she has adequate fat stores, in order to keep up with the increased energy demands of lactation.
During pregnancy, the diet should be balanced with an adequate amount of proteins, carbohydrates, vitamins, and minerals. During lactation, the diet should be focused on increasing caloric intake, as well as increasing proteins, vitamins, and minerals. Calcium, iron, and vitamin D are especially important for the lactating mother. Additionally, the nurse should emphasize the importance of drinking enough water.
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the nurse is caring for a client who has had unrelieved back pain for 3 years. how will the nurse document this type of pain? select all that apply.
The process of how the nurse will document this type of pain is as seen in the section below
Documentation of unrelieved back painThe following steps should be taken to documentation of unrelieved back pain
Document the intensity and characteristics of the pain, such as aching, burning, or stabbing. Document the location of the pain.Document the duration of the pain.Document any factors that increase or decrease the pain. Document any treatments tried and the effectiveness of the treatments.What is unrelieved back pain?
Unrelieved back pain is a type of chronic pain that is ongoing and does not respond to treatment or medications. It is a common condition that affects millions of people worldwide and can have a significant impact on a person's quality of life.
Symptoms of unrelieved back pain include a dull or sharp ache in the lower, middle, or upper back area.
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in the following table, describe the types of cells and the extracellular matrix of each type of loose connective tissue.type of loose connective tissue cells extracelullar matrixareolar tissue _______ ___________adipose tissue _______ ___________reticular tissue _______ ___________
The following table will describe the types of cells and the extracellular matrix of each type of loose connective tissue:
1. Areolar tissue
Cells: fibroblasts, macrophages, mast cells, and some white blood cells.
Extracellular matrix: Consists of collagen and elastic fibers and ground substances.
2. Adipose tissue
Cells: adipocytes (fat cells).
Extracellular matrix: Contains a minimal amount of collagen fibers and ground substance, primarily to support and hold the adipocytes in place.
3. Reticular tissue
Cells: Reticular cells (modified fibroblasts) and various immune cells such as lymphocytes and macrophages
Extracellular matrix: composed of reticular fibers (thin, branching collagen fibers) and ground substance.
Areolar tissue, also known as loose connective tissue, is a type of tissue that is found throughout the body. It is a type of connective tissue that is made up of cells and extracellular matrix, including collagen, elastin, and reticular fibers.
Areolar tissue is found between the skin and muscles, surrounding blood vessels and nerves, and in the mucous membranes that line organs like the respiratory and digestive tracts.
It provides support and flexibility, allowing organs and tissues to move and stretch without being damaged. It also plays a role in immune defense, as it contains immune cells and can act as a barrier against infection.
Adipose tissue, also known as fat tissue, is a type of connective tissue that is specialized for the storage of energy in the form of fat. It is composed of adipocytes, or fat cells, which contain a large droplet of lipid (fat) surrounded by a thin layer of cytoplasm. Adipose tissue is found throughout the body, but is most abundant in subcutaneous (under the skin) and visceral (around organs) regions.
Adipose tissue serves several functions in the body. Its primary role is to store energy in the form of triglycerides, which can be broken down and used by the body when energy is needed. It also acts as an insulator, helping to regulate body temperature, and provides cushioning and protection for organs and tissues.
Adipose tissue also secretes a variety of hormones and cytokines, which can influence metabolism, inflammation, and other physiological processes.
Reticular tissue is a type of connective tissue that is made up of reticular fibers and reticular cells. Reticular fibers are thin, branching fibers that form a mesh-like network that supports and holds together other types of cells and tissues.
Reticular tissue is found in many organs throughout the body, including the liver, spleen, lymph nodes, bone marrow, and kidneys. It provides structural support and helps to form the stroma, or framework, of these organs. Reticular cells produce and maintain the reticular fibers, and also play a role in immune defense by producing and presenting antigens to immune cells.
Overall, reticular tissue is an important component of many organs and plays a crucial role in maintaining their structure and function.
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which factor would the nurse consider when planning care for a client diagnosed with conversion disorder?
When planning care for a client diagnosed with conversion disorder, the nurse should consider the psychological, physical, social, and cultural factors of the client.
Psychological factors to consider include the client's prior mental health history, current stressors, and family dynamics. Physical factors to consider include the client's medical history, current medications, and any side effects. Social factors to consider include the client's relationships with family and friends, school/work life, and involvement in the community. Cultural factors to consider include the client's religion, spiritual beliefs, ethnicity, and language.
In summary, when planning care for a client diagnosed with conversion disorder, the nurse should consider the psychological, physical, social, and cultural factors of the client to ensure the best possible care.
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a 69-year-old man is admitted to the hospital following a popliteal embolectomy. he asks the nurse why he had to have surgery on his leg. what is the best response by the nurse?
The patient had to have surgery on his leg due to a popliteal embolectomy. The nurse should explain to the patient that this procedure is necessary to ensure the lower leg and foot are not damaged or put at risk by a lack of blood supply.
A popliteal embolectomy is a type of vascular surgery that removes a blood clot from the popliteal artery, which is the artery behind the knee. This surgery is necessary to restore adequate blood flow to the lower leg and foot, and to prevent further complications, such as tissue death and gangrene.
The nurse should explain to the patient that this procedure was necessary to ensure that his lower leg and foot do not become further damaged or put at risk due to an inadequate blood supply. Additionally, the nurse should provide the patient with information on the risks and benefits associated with the procedure and any potential post-operative complications.
The nurse should also provide emotional support to the patient by listening to their concerns and answering any questions that they may have. This will help to ensure that the patient has an understanding of their condition and that they are comfortable with the treatment they are receiving.
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a client attached to mechanical ventilation suddenly becomes restless and pulls out the tracheostomy tube. which is the nurse's priority intervention?
The nurse's priority intervention when someone suddenly pulls out their tracheostomy tube would be to check the client for spontaneous breathing
A tracheostomy tube is a medical device inserted into the trachea (windpipe) to help patients breathe. It provides an alternate airway when the normal route of breathing is obstructed or compromised. The tube provides access to the trachea for medical interventions, including the removal of secretions, suctioning, and oxygen therapy. It also helps to reduce the risk of aspiration by preventing fluids from entering the trachea. The tracheostomy tube is connected to a ventilator, which supplies air to the lungs.
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lauren is a 9 year old who comes to clinic with a 4-day history of cough, low grade fever (under 100 degrees), and rhinorrhea. when she blows her nose or coughs the mucous is greenish-yellow. the appropriate antibiotic to prescribe would be:
The appropriate antibiotic to prescribe for a 9-year-old patient with a 4-day history of cough, low-grade fever, and rhinorrhoea, and whose mucous is greenish-yellow is amoxicillin-clavulanate.
This is because amoxicillin-clavulanate is the recommended first-line antibiotic for uncomplicated acute bacterial sinusitis (ABRS) in children aged 6 months to 18 years with mild-to-moderate disease.
Augmentin (amoxicillin / clavulanate) is an antibiotic that contains both amoxicillin and potassium clavulanate. It is used to treat several bacterial illnesses. Amoxil (amoxicillin) is a penicillin antibiotic that is used to treat a wide range of bacterial infections.
Augmentin can cure the same germs as amoxicillin, but it is also effective against other more difficult-to-treat diseases, such as: Infections of the sinuses. Infections of the ears. Bacterial infections linked to COPD.
Broad-spectrum antibiotics, such as doxycycline, azithromycin, amoxicillin and clavulanic acid, mupirocin, and fluoroquinolones, target a broad range of gram-positive and gram-negative bacteria, whereas narrow-spectrum antibiotics, such as vancomycin, fidaxomicin, and sarecycline, target a narrow range of clinically important bacteria.
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a client with severe combined immunodeficiency disease is receiving immunosuppression therapy to ensure engraftment of depleted bone marrow during transplantation procedures. what is the priority nursing care for this client?
The priority nursing care for a client with severe combined immunodeficiency disease receiving immunosuppression therapy to ensure engraftment of depleted bone marrow during transplantation procedures is to:
1. Monitor for signs of infection and promptly treat any infections that arise.
2. Monitor the client's vital signs and laboratory values.
3. Monitor for signs of graft-versus-host disease and take appropriate action if signs appear.
4. Administer medications and treatments as prescribed.
5. Provide adequate nutrition, hydration, and rest.
6. Educate the client and family about the risks and benefits of immunosuppressive therapy.
7. Provide emotional support to the client and family.
8. Refer the client and family to relevant resources as needed.
Severe combined immunodeficiency disease (SCID) is a group of inherited disorders that cause the immune system to function improperly.
SCID patients, as a result, have very weak immunity against infections and are more susceptible to developing infections. The priority of nursing care for this client is to prevent the development of infections because of weak immunity.
Nurses must teach the patient about hand hygiene, respiratory hygiene, and infection prevention, as well as perform thorough skin assessments on a daily basis.
Preventative measures such as following sterile protocol for dressing changes, maintaining a clean environment, avoiding indwelling catheters or other invasive devices, and wearing protective equipment when appropriate must be taken to avoid infection.
Additionally, administering immunoglobulin or antibiotics prophylactically may also help prevent infections.
"a client with severe combined immunodeficiency disease is receiving immunosuppression therapy to ensure engraftment of depleted bone marrow during transplantation procedures. what is the priority nursing care for this client?"
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the client is experiencing autonomic dysreflexia. what is the first action by the nurse? 1. place in high fowler's position 2. find and remove the trigger source 3. notify the primary healthcare provider 4. check for fecal impaction
The first action by the nurse when the client is experiencing autonomic dysreflexia is to find and remove the trigger source. Autonomic dysreflexia is a medical emergency that occurs due to the overactivity of the autonomic nervous system. This overactivity can be caused by a noxious stimulus below the level of the spinal cord injury or above the level of the spinal cord injury.
The symptoms of autonomic dysreflexia include high blood pressure, bradycardia, pounding headache, flushing, sweating above the level of the injury, piloerection, and goosebumps. It is essential to find and remove the trigger source as the first action by the nurse. The trigger source can be anything that irritates the body below the level of the spinal cord injury.
Some common triggers include: Bladder distension Bowel impaction Skin breakdownIn grown toenails Other painful stimuliIt is important to assess the client's medical history, medications, and level of injury to identify the trigger source. Once identified, the trigger source should be removed immediately to prevent further complications such as seizures, stroke, or myocardial infarction. The other options such as placing the client in high Fowler's position, checking for fecal impaction, and notifying the primary healthcare provider should also be done but after removing the trigger source. The priority is to find and remove the trigger source.
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a child with addison disease has been admitted with a history of nausea and vomiting for the past 3 days. the client is receiving iv glucocorticoids. which intervention would the nurse implement?
As a nurse, if a child with Addison disease has been admitted with a history of nausea and vomiting for the past three days, and the client is receiving IV glucocorticoids, the appropriate intervention would be to check the child's vital signs every hour, including blood pressure, temperature, pulse, and respirations.
Addison's disease is a rare endocrine disease that affects the adrenal glands' capacity to produce hormones such as cortisol and aldosterone. The disease can develop at any age and affects both males and females. Addison's disease can be life-threatening if left untreated.
Cortisol and aldosterone are hormones that help control blood sugar, metabolism, blood pressure, and electrolyte balance in the body.
Glucocorticoids are steroids that regulate metabolism and immune system response. They are used to treat a variety of conditions, including Addison's disease, rheumatoid arthritis, and other autoimmune disorders. They can also be used to suppress inflammation in the body by inhibiting the body's immune response.
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you are assessing a female patient as the extrication team gets ready to roll up the dashboard to remove her. the patient has multiple fractures in her left arm. what should you do?
When treating a female patient with multiple fractures in her left arm that is ready to get extracted, you should apply an air splint before she is removed.
An air splint is a medical device used to immobilize a bone or joint with a suspected fracture or injury. It consists of an inflatable sleeve and/or cuffs that are attached to a plastic, foam, or vinyl backing. It applies gentle and even pressure, which helps reduce pain and swelling. It can be used to treat a wide range of bone and joint injuries, including ankle sprains, wrist sprains, and knee injuries.
Air splints can also be used to provide comfort during the healing process of a fracture. The pressure provided by the air splint helps immobilize the injured area and reduce pain and swelling while promoting healing and reducing the chances of further injury.
Additionally, the air splint allows some range of motion, which can help to prevent stiffness. Air splints are a safe, comfortable, and effective way to immobilize an injured area.
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the nurse administers carbidopa levodopa to a client with parkinsons deiaes. which activity describes the emchanism of action of this emd
The mechanism of action of carbidopa levodopa is to increase the amount of dopamine available in the brain, which helps to reduce the symptoms of Parkinson's disease.
Parkinson's disease is a disease of the nervous system that interferes with the body's ability to control movement and balance. This condition causes various complaints, such as tremors, muscle stiffness, and impaired coordination.
Carbidopa inhibits the breakdown of levodopa in the bloodstream, which increases the effectiveness of the levodopa. This, in turn, increases the amount of dopamine available in the brain, helping to reduce the symptoms of Parkinson's disease.
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ou are talking with the family of a client who is in the irreversible stage of shock. they ask you why the physician has told the family that the client is going to die. what would you explain to this family?
I would explain to the family that the physician has likely made the determination that their loved one is in an irreversible stage of shock based on a variety of factors.
These factors may include vital signs, lab results, and the patient's overall clinical picture. It is the physician's responsibility to provide the family with an accurate assessment of the patient's condition so that they can make informed decisions about their care and treatment options.
While it is difficult to hear that a loved one may not survive, it is important to focus on making the patient as comfortable as possible and providing support to the family during this difficult time.
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