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passive ROM exercises. Just before leaving the patient's room, the nurse decides to move the patient up in bed. Case Study Questions

passive ROM exercises. Just before leaving the patient's room, the nurse decides to move the patient up in bed. Case Study Questions

Anatomy & Physiology
Anatomy & Physiology
1st Edition
ISBN:9781938168130
Author:Kelly A. Young, James A. Wise, Peter DeSaix, Dean H. Kruse, Brandon Poe, Eddie Johnson, Jody E. Johnson, Oksana Korol, J. Gordon Betts, Mark Womble
Publisher:Kelly A. Young, James A. Wise, Peter DeSaix, Dean H. Kruse, Brandon Poe, Eddie Johnson, Jody E. Johnson, Oksana Korol, J. Gordon Betts, Mark Womble
Chapter16: The Neurological Exam
Section: Chapter Questions
Problem 1ILQ: Watch this video (http://openstaxcollege.org/l/neuroexam) that provides a demonstration of the...
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An older male patient is admitted to the hospital with a diagnosis of pneumonia and an 8-year history of Parkinson's disease. When transferring the patient from a wheelchair to the bed, a nurse identifies that the patient has stiff joints and is walking with small, shuffling steps with involuntary accelerations. The patient states, "I'm afraid to leave the house because I have difficulty maintaining my balance and I fell twice recently. I hold on to furniture and walls as I walk around my house. Occasionally, I get a little light-headed when I stand up. really just sit around the house all day because l get too tired and out of breath when I'm more active." When completing a skin check, the nurse identifies in the sacral area several small (1 cm) shallow, red, shiny breaks in the patient's skin that are surrounded by erythema. The nurse also notes rhonchi in the left and right lung fields; heavy, moist cough; occasional expectoration of thick yellow secretions; delayed capillary refill in the toes; respiratory rate of 28/minute and shallow respirations at rest; and dyspnea on exertion. The patient's oxygen saturation is 88 percent on room air and 95 percent with nasal oxygen at 2 L/minute. The primary healthcare provider orders passive ROM exercises. Just before leaving the patient's room, the nurse decides to move the patient up in bed. Case Study Questions 1. Place in order of priority the following concerns identified by the nurse and explain the reasoning behind the equence identified. Risk for injury: Impaired walking: Ineffective airway clearance: 2, What stage pressure ulcer is associated with several small (1 cm) shallow, red, and shiny breaks in the skin surrounded by erythema? 3. What wound care/ pressure reduction intervention should be implemented or care of this patient? Name at least four.
Transcribed Image Text:An older male patient is admitted to the hospital with a diagnosis of pneumonia and an 8-year history of Parkinson's disease. When transferring the patient from a wheelchair to the bed, a nurse identifies that the patient has stiff joints and is walking with small, shuffling steps with involuntary accelerations. The patient states, "I'm afraid to leave the house because I have difficulty maintaining my balance and I fell twice recently. I hold on to furniture and walls as I walk around my house. Occasionally, I get a little light-headed when I stand up. really just sit around the house all day because l get too tired and out of breath when I'm more active." When completing a skin check, the nurse identifies in the sacral area several small (1 cm) shallow, red, shiny breaks in the patient's skin that are surrounded by erythema. The nurse also notes rhonchi in the left and right lung fields; heavy, moist cough; occasional expectoration of thick yellow secretions; delayed capillary refill in the toes; respiratory rate of 28/minute and shallow respirations at rest; and dyspnea on exertion. The patient's oxygen saturation is 88 percent on room air and 95 percent with nasal oxygen at 2 L/minute. The primary healthcare provider orders passive ROM exercises. Just before leaving the patient's room, the nurse decides to move the patient up in bed. Case Study Questions 1. Place in order of priority the following concerns identified by the nurse and explain the reasoning behind the equence identified. Risk for injury: Impaired walking: Ineffective airway clearance: 2, What stage pressure ulcer is associated with several small (1 cm) shallow, red, and shiny breaks in the skin surrounded by erythema? 3. What wound care/ pressure reduction intervention should be implemented or care of this patient? Name at least four.
E. Identify six nursing interventions that the nurse should implement to reduce the risk of thrombus formation, 1. 2. 3. 4. 5. 6. F. Identify seven nursing interventions that the nurse should implement when assisting with or providing ROM exercises. 1. 2. 3. 4. 5. 6. 7. G. Identify ten principles of body mechanics that the nurse should follow when moving a patient up in bed and explain their purposes. 1. 2. 3. 4. 5. 6.
Transcribed Image Text:E. Identify six nursing interventions that the nurse should implement to reduce the risk of thrombus formation, 1. 2. 3. 4. 5. 6. F. Identify seven nursing interventions that the nurse should implement when assisting with or providing ROM exercises. 1. 2. 3. 4. 5. 6. 7. G. Identify ten principles of body mechanics that the nurse should follow when moving a patient up in bed and explain their purposes. 1. 2. 3. 4. 5. 6.
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