A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. Compromised circulation at the burn site 4.

• A nurse is planning care for a client who has extensive burn injuries and is immunocompromised Using the Rule of Nines, the nurse should estimate that the client has burned what percentage of body surface area? (Round the answer to the nearest tenth. High Fowler facilitates lung expansion and improves ventilation and gas exchange. B) Remove the dressing. Which instruction should the nurse provide to the LPN when assigning this client? a. Which parameter(s) would the nurse evaluate to determine if the client is receiving adequate fluid resuscitation? Select all that apply. Which of the following precautions should the nurse include in the plan of care to prevent pseudomonas aeruginosa infection? Mar 4, 2024 · The nurse should incorporate strict hand hygiene, the use of sterile dressings and equipment, regular monitoring for signs of infection, and limiting visitors in the care plan to prevent a Pseudomonas aeruginosa infection in an immunocompromised burn patient. Which of the following precautions should the nurse include in the plan of care to prevent a Pseudomonas aeruginosa infection? Nov 2, 2023 · When providing care for an immunocompromised client with extensive burn injuries, to prevent a Pseudomonas aeruginosa infection, the nurse should ensure to follow the appropriate precautions. d. Hemoglobin of 19 D. Increase protein intake D. serum potassium. It is edematous but not very painful. Which of the following findings is an adverse effect of this medication?, A nurse is caring for client who has emphysema and is receiving mechanical ventilation. Risk of infection C. Instruct client to consume 3,000 calories daily. Urine output D. The patient is confused, has difficulty breathing, and has nasal burns. Vesicles, A nurse is the nurse is developing a plan of care for a client who underwent extensive oral surgery for head and neck cancer. Advance the catheter 2 cm (0. Use standard precautions when performing wound care. 36-year-old who requires discharge teaching about nutrition and wound care after having skin grafts 3. infection d. A generalized body rash 3. Encourage fresh vegetables in the diet c. Nov 16, 2023 · A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. the client appears Study with Quizlet and memorize flashcards containing terms like A client is admitted to the hospital emergency department after receiving a burn injury in a house fire. After ensuring cardiopulmonary stability, what would be the nurse's immediate, priority concern when planning this client's care? 5 days ago · A nurse is planning care for a client who has deep partial thickness and full thickness thermal burns over 40% of his total body surface and is in the acute phase of burn injury. Two days later when removing the dressings the nurse finds that one of the dressings has adhered to tissue in serval places. A nurse is planning care for a client who has burn injuries. Study with Quizlet and memorize flashcards containing terms like A nurse in the emergency department is caring for a client who has extensive partial and full-thickness burns of the head, neck, and chest. Using the rule of nines, the nurse would calculate this client's burn as being: Study with Quizlet and memorize flashcards containing terms like A client with a severe electrical burn injury is treated in the burn unit. Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client whose wounds are covered with a heterograft dressing. Fluid imbalance A client who sustained a burn injury involving 36% of the body surface area is receiving hydrotherapy. Increase in subcutaneous tissue at the burn site The nurse is caring for a client with an acute burn injury. Teaching the client about risk factors for squamous cell carcinoma 2. Instruct the client to consume 2,000 calories Study with Quizlet and memorize flashcards containing terms like What is the cardiac function for a person with a burn?, A patient is brought to the emergency department after a house fire. Study with Quizlet and memorize flashcards containing terms like A client is admitted to the hospital emergency department after receiving a burn injury in a house fire. The keloid formation is indicative of which condition 1. maintaining the client A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. The client experiencing excessive stools. what instructions The nurse should plan to prepare the client for which of the following procedures? a) curettage b) external radiation therapy c) regional chemotherapy d) surgical excision, A nurse is caring for a client who has a lesion on the back of his right hand. the nurse should monitor for which electrolyte imbalance that is typically associated with the initial third-spacing fluid shift? a. a) Protect incision site. Study with Quizlet and memorize flashcards containing terms like In the role of client advocate, what does the nurse do first for a client who reports pain?, The nurse is preparing a client for home care pain management following discharge. Assess the clients wounds for signs of infection. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) A. observe client's A client has been admitted to a burn intensive care unit with extensive full-thickness burns over 25% of the body. Withdraw the catheter if the client begins coughing. catecholamine-induced Study with Quizlet and memorize flashcards containing terms like A nurse is assessing for compartment syndrome in a client who has a short leg cast. Instruct the client to actively cough to prevent a buildup of Which of the following burn descriptions should the nurse document? a. Use the closed method of burn wound management for all wound care. Which of the following classifications should the nurse use to document this burn? A. The client asks the nurse which type of skin cancer is the most serious. Partial-thickness burns require grafting before they can heal. hourly urine output. Glucose of 200 B. A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. A white color to the skin, which is Study with Quizlet and memorize flashcards containing terms like The registered nurse is teaching the student nurse about precautions to take when treating a client with open burn wounds. Which precautions should the nurse include in the plan of care to rpevent pseudomonas aeruginosa? A. Urine output 24 ml/hr D. hypovolemic shock b. A client has experienced an electrical burn and has developed thick eschaf over the burn site . Oily skin 2. The nurse notes a hoarse cough, and the client is expectorating sputum with black flecks. concern with body image due to extensive scarring b. Study with Quizlet and memorize flashcards containing terms like Using the Rule of Nines to assess a client with burn injuries to the entire back region and all of the left arm, how should the nurse document the percentage (TBSA) of the patient's body that sustained burns? 18% 36% 9% 27%, The nurse cares for a patient with burn injuries. Which client is best to assign to an RN who has floated from the oncology unit? 1. Clustered skin vesicles 2. Based on the information in the client's chart, which of the following findings should the nurse report to the provider? (Click on the "Exhibit" button for additional information about the client Study with Quizlet and memorize flashcards containing terms like name the classification of burns by extent of injury, a nurse is planning care for a client who has burn injuries. Study with Quizlet and memorize flashcards containing terms like 1. What barrier defenses may be compromised in this client? Select all that apply. Avoid placing plants or flowers in the client's room. While planning care, the nurse recalls that the client's burn is different than full-thickness burns. D) Slit the dressing with blunt scissors. Which of the following foods selected by the parent indicates an understanding of the teaching?, a nurse is planning 5 days ago · A nurse is reviewing the laboratory findings of a client who has diabetes mellitus and reports that she has been following her (unable to read) care. What would cause a reduced hematocrit in this client? A) Hemoconstriction B) Lack of erythropoietin factor C) Hemodilution D) Metabolic acidosis, A client receiving emergency treatment for severe burns has just been assessed to establish Study with Quizlet and memorize flashcards containing terms like A nurse is performing tracheostomy care for a client who is postoperative following a laryngectomy. Compromised circulation at the burn site 4. 2. Which of the following actions should the RN take when suctioning the client's airway? A. Live plants can harbor P. aeruginosa, and this bacterium can infect burn wounds and cause life-threatening complications. Avoid placing plants or flowers in the client’s room B. blood urea nitrogen. The nurse creates a postoperative plan of care for the client and should include which intervention in the plan? 1. Clear, thin nail beds 3. Ulcerative colitis, The nurse is planning the care of a patient with a major thermal burn. Mar 4, 2024 · A nurse planning care for an immunocompromised client with extensive burn injuries must prioritize infection control measures to prevent a Pseudomonas aeruginosa infection, a pathogen notorious for hospital-acquired infections, especially in vulnerable patients. The nurse should plan to prepare the client for which of Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who has hepatic encephalopathy that is being treated with lactulose. ) Heart rate 55/min 46. Fluid status B. Wheals D. , In patients with extensive burns, edema occurs in both burned and unburned areas because of: a. Which statement made by the student nurse indicates the need for further teaching?, A client arrives in the emergency department with multiple crushing wounds of the chest, abdomen, and legs. Autonomic hyperreflexia, A nurse is caring for a client who experienced serious burns in a Study with Quizlet and memorize flashcards containing terms like A nurse is providing discharge instructions to a client following an upper gastrointestinal series with barium contrast. What is the best nursing intervention when providing wound care? 1 Use a consistent approach to care and encourage participation. 0 g/dl, A nurse is assessing a client who has aortoiliac disease. Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who presents to a clinic for a 1-week follow-up visit after hospitalization for heart failure. Which information did the nurse recall? a. A nurse is teaching a client about using a continuous positive airway pressure ( CPAP ) device to treat obstructive sleep apnea . Black fingertips surrounded by an erythematous rash 4. Which interventions should the nurse include in the plan of care? (Select all that apply) (a) samit visitors in the client's room when immunosuppressed (b) Encourage raw foods to improve exposure to natural flora (c) Offer high-calorie, high protein A nurse is assisting with planning care for a client who has deep partial-thickness and full-thickness thermal burns over 40% of his total body surface. Mafenide acetate 10 % ( Sulfamylon Study with Quizlet and memorize flashcards containing terms like Which of the following is a common complication of an electrical burn injury?, The nurse cares for a client with extensive burn injuries. A. c) remove thick secretions. place the client in high-fowler's position. K+ of 6. Which of the following findings is an adverse effect of this medication?, A nurse is caring for a client who has emphysema and is receiving mechanical ventilation. Instruct the client to consume 2000 kcal/day Study with Quizlet and memorize flashcards containing terms like What would be the priority nursing intervention in a client with electric burns?, A client is severely injured with burns and sustained major trauma from a fire incident. Use a leading zero if Oct 29, 2024 · 16. observe color of wounds d. The nurse knows not to assign which staff member Study with Quizlet and memorize flashcards containing terms like Which condition is an example of wound healing by secondary intention? Abdominal wound with staples An infected burn of the arm Sacral skin tear closed with Steri-Strip Leg laceration with sutures, The client is receiving a vesicant antineoplastic for treatment of cancer. Which of the following interventions should the nurse include in the plan of care? ( Select all that apply. Which of the following precautions should the nurse include in the plan of care to prevent a Pseudomonas ceruginosa infection? Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who sustained a transection of the spinal cord with no other injuries. What is the most valuable blood test to use when monitoring a client's fluid loss? 1 Blood urea nitrogen (BUN) 2 Blood pH 3 Hematocrit 4 Sedimentation rate, A nurse in the postanesthesia care unit (PACU) is providing care to a client who had an abdominal Study with Quizlet and memorize flashcards containing terms like The nurse is caring for four clients admitted at once under mass casualty conditions. Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who has hepatic encephalopathy that is being treated with lactulose. Hypovolemic shock 3. Encourage the client to breathe deeply Nov 17, 2023 · A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. 23-year-old who has just been admitted with burns over 30% of the body after a warehouse fire 2. Superficial thickness B. Fiery red skin with edema in the nail beds 3. The nurse determines that this client's burn should be classified as which type? 1. Which of the following venous access devices should the nurse identify as appropriate for the client? A. Which assessment finding would require the nurse to take Study with Quizlet and memorize flashcards containing terms like The nurse cares for a client with extensive burn injuries. 0 mEq/L Na+: 145 mEq/L Ca: 9 mg/dL, The nurse provides care for a client with a full-thickness, circumferential burn of the left lower leg. "I will be on a special shower table. Limit visitors in the client's room B. Monitoring the surgical site for swelling Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who was a central line in place, which of the following actions is indicated for a client safely when flushing a central line, Assessing the client using bulge sign, would most likely check for which type of injury, A nurse is caring for a client who received preoperative atropine to dry up Study with Quizlet and memorize flashcards containing terms like A nurse is developing a care plan for a client recovering from a serious thermal burn. After maintaining respirations, the nurse knows that the most important immediate goal of therapy is: A. a nurse is planning care for a client who has extensive burn injuries and is immunocompromised. " b. Diverticulitis b. 3 Heat the water to 105º F to prevent loss of body temperature and prepare These cookies allow us to understand visits to Quizlet so we can measure and improve the performance of our site. , The nurse is caring for a client with burns over 55% of Which of the following activities should the nurse include in the plan of care for a client with burn injuries to be carried out about one-half hour before the daily whirlpool bath and dressing change? A) Soak the dressing. daily weight. Which client who sustained injuries in an accidental fire would be provided with immediate care based on priority? a) client with burns to the head b) client with burns in the chest area c) client with burns in the lower extremities d) client with burns in the upper extremities What serious gastrointestinal disturbance should the nurse monitor for that frequently occurs with a major burn? a. A nurse is providing discharge teaching to a client following a heart transplant . apply cool compresses for pain relief between dressing changes d. Which finding would the nurse note on assessment of the client's hand? 1. During the nurse's initial shift Study with Quizlet and memorize flashcards containing terms like A client arriving at the emergency department has experienced frostbite to the right hand. which of the following precautions should the nurse include in the plan of care to prevent a Pseudomonas aeruginosa infection. Deep partial Study with Quizlet and memorize flashcards containing terms like A nurse in a provider's office is assessing a client who has a severe sunburn. Which of the following precautions should the nurse include in the plan of care to prevent a Pseudomonas aeruginosa infections? Provides routine client care and documentation. Which condition does the nurse suspect? Pulmonary edema Lower airway injury Upper airway injury Carbon monoxide poisoning, A nurse Study with Quizlet and memorize flashcards containing terms like The registered nurse assigns a client who has an open burn wound to a licensed practical nurse (LPN). The client becomes restless, and his color is becoming dusky. Which of the following precautions should the nurse include in the plan of care to prevent a Pseudomonas aeruginosa infection? ----- Correct Answer ----- A client should sign an informed consent before receiving a placebo during a research trial. The client states that they are very painful. Based on the information in the client's chart, which of the following findings should the nurse report to the provider? (Click on the "Exhibit" button for additional information about the client. The client is experiencing excessive stools. Superficial partial thickness C. Which of the following precautions should the nurse include in the plan of care to prevent a pseudomonas aeruginosa infection? A. Short peripheral catheter B. Stupor 2. Study with Quizlet and memorize flashcards containing terms like the nurse makes a home health visit 1 year after a patient was burned over 30% of his body. Psychosocial coping Study with Quizlet and memorize flashcards containing terms like A nurse in a provider's office is assessing a client who has a severe sunburn. Blood pressure B. pig skin c. 6 days ago · A nurse is caring for a client with extensive 2nd & 3rd degree burn injuries. Which of the following information should the nurse include in the teaching ?, 2. hypernatremia c. chronic pain due to contractures and nerve compartmentalization c. Which of the following precautions should the nurse include in the plan of care to prevent Pseudomonas aeruginosa infection? 1) Administering prophylactic antibiotics 2) Using sterile technique during dressing changes 3) Encouraging frequent handwashing A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. Study with Quizlet and memorize flashcards containing terms like The nurse participates in a health fair about fire safety. The nurse is explaining what to expect from the prescribed hydrotherapy Which of the following statements by the client indicates an understanding of the teaching? a. One, some, or all response may be correct. Red-purplish scaly lesions 4. His wounds have been debrided and covered with a silver-impregnated dressing. The patient states that the burn is not painful. c. Which pathophysiologic risk is increased in the client? 1. Which intervention does the nurse implement?, A client being discharged after hip replacement says, "I am going to use hypnosis instead of medication to Study with Quizlet and memorize flashcards containing terms like A client who sustained burn injuries due to a fire and explosion has a carbon monoxide level of 14%. The nurse determines that this client's burn should be classified as which type?, The nurse is developing a nursing care plan for a The nurse should include the following precautions in the plan of care to prevent a Pseudomonas aeruginosa infection for a client with extensive burn injuries and immunocompromised status: 1) Use strict hand hygiene: Proper handwashing is crucial in preventing the spread of infections, including Pseudomonas aeruginosa. Which of the following precautions should the nurse include in the plan of care to prevent Pseudomonas aeruginosa Study with Quizlet and memorize flashcards containing terms like The nurse cares for a client with extensive burn injuries. Papules B. The client has second- and third-degree burns to the right and left arms, back and both posterior legs. Explanation: A nurse planning care for an immunocompromised client with extensive burn a nurse is planning care for a client who has extensive burn injuries and is immunocompromised. Which of the following laboratory values should be reported immediately to the healthcare provider? A. The client will need to receive 12 weeks of antibiotic therapy. b) elevate head of the bed. A nurse cares for a client who has burn injuries. Silver sulfadiazine 1 % ( Silvadene ) water - soluble cream B. Study with Quizlet and memorize flashcards containing terms like When assessing a patient who spilled hot oil on the right leg and foot, the nurse notes that the skin is dry, pale, hard skin. Which activity can you delegate to an experienced LPN/LVN? 1. 2 Prepare equipment while doing the procedure and explain the treatment to the client. Which of the following precautions should the nurse include in the plan of care to prevent a Pseudomonas aeruginosa infection? 5 days ago · A client has been admitted to a burn intensive care unit with extensive full-thickness burns over 25% of the body. inhalation injury, which assessment technique should the nurse use to assess the percentage of burn injury? a. The nurse shades in a diagram indicating the burned surface areas. a. Study with Quizlet and memorize flashcards containing terms like (NGN) A nurse is caring for a client who presents to a clinic for a 1-week follow-up visit after hospitalization for heart failure. Random serum glucose . ) Eating liver several times a week will help build up Study with Quizlet and memorize flashcards containing terms like 4. Which of following statements should the nurse include?, a nurse is teaching the parent of a school-age child who has celiac disease. The client is in the acute phase of burn injury. The nurse should interpret this data as indicating which? Study with Quizlet and memorize flashcards containing terms like A nurse is planning care for a client who has a terminal cancer and has a prescription for morphine. Fluid resuscitation with crystalloid and colloid solutions is calculated from the time the burn injury occurred to restore the intravascular volume and prevent hypovolemic shock and renal failure. A client has a diagnosis of partial-thickness burns. The nurse understands that which characteristic is associated with this skin disorder? 1. wash the wound Study with Quizlet and memorise flashcards containing terms like The nurse is assessing a client who spilled hot oil on the right leg and foot and notes that the skin is red, swollen, and covered with large blisters. Deep partial thickness D. Which action should the nurse take to prevent infection by autocontamination? a. cadaver skin b. The client appears There are three tabs that contain separate categories of data. Advocate for proper and consistent Science; Nursing; Nursing questions and answers; A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. what problem may the patient be experiencing at this time? select all that apply a. See full list on nurseslabs. C. Which are the Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who has a state III pressure ulcer. Paralytic ileus d. Slight breathlessness, The nurse is examining four different clients who present with thermal burns. Heart rate C. Limit visitors to those who have received the influenza 5 days ago · Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a client with a severe burn who is scheduled for an autograft to be placed on the lower extremity. 3 The nurse is caring for a client who has just been admitted to the nursing unit after receiving flame burns to the face and chest. The client is experiencing excessive stools Study with Quizlet and memorize flashcards containing terms like which wound care would be given by a nurse managing severe burn injuries during the acute phase?, Which mechanism would a nurse describe to a client newly diagnosed with scleroderma as a factor in the development of the disease?, Which response would be given by a nurse caring for a client who is receiving radiation for cancer Study with Quizlet and memorize flashcards containing terms like which complication is common for victims of electrical burns? a. reapply a new dressing without disturbing the wound bed b. Nutritional status D. The nurse should identify which of the following findings indicates a need to revise the client's plan of care. Hematemesis c. What term would the nurse use to document the burn depth?, On admission to the burn unit, a patient with an approximate 25% total body surface area (TBSA A nurse is planning care for a client who has burns and is immunocompromised. Study with Quizlet and memorize flashcards containing terms like A nurse provides care for a client with deep partial-thickness burns 48 hours after the burn. (Unable to read) C. continued risk for infection due to Study with Quizlet and memorize flashcards containing terms like A nurse is evaluating a client's fluid loss resulting from extensive burns. Hematocrit of 55% The spouse of a client who was struck by lightning asks the nurse why the areas involved seems so small but the damage is extensive. Which assessment should the RN accomplish first? A) determine total body surface area burned B) Breath sounds C) Pain level D) Blood pressure, Clients with which dietary deficiency are at Fluid resuscitation Explanation: Fluid resuscitation requirements are paramount in the management of clients having burns that exceed 20% of TBSA. Superficial partial-thickness skin destruction, The nurse is admitting a client to the burn unit who has burns to the upper body and head after a garage fire. "The water temperature will be very cool to ease my pain. Which of the following Study with Quizlet and memorize flashcards containing terms like When assessing a patient who spilled hot oil on the right leg and foot, the nurse notes that the skin is dry, pale, hard skin. The client’s wife asks, “When will his high risk for infection decrease?” Study with Quizlet and memorize flashcards containing terms like 1. 1 C. hypercalcemia b. Partial-thickness burns are often painful, reddened, and have blisters. hyperkalemia A nurse is planning care for an adult client who sustained severe burn injuries. Which nursing diagnosis would be most appropriate? Knowledge deficit related to daily care procedures in the acute care setting Risk for fluid volume overload related to thermal injuries Acute A client with a burn injury is applying mafenide acetate to the wound. The nurse notes that the lesions are 0. Which of the following precautions should the nurse include in the plan of care to prevent a Pseudomonas aeruginosa infection? Aug 30, 2022 · The client's greatest risk is airway obstruction. Which of the following precautio… A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. While planning the client's care, the nurse should identify which of the following risks as the priority for assessment and intervention? a. The patient has extensive trunk and lower extremity burns, and is diagnosed with a deep partial thickness burn. Study with Quizlet and memorize flashcards containing terms like A nurse in the ED is caring for a client who has a snakebite on her arm. First-degree skin destruction b. Prior to treatment, the nurse documents the appearance of the wound as: Reddened; blanches with pressure. Macules C. The nurse determines that this client's burn should be classified as which type? partial, The nurse is developing a nursing care plan A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. check VS c. com While planning the client's care, the nurse should identify which of the following risks as the priority for assessment and intervention? Choice A Reason: Infection is a serious complication of burn injuries, but not the priority risk for assessment and intervention. A pink, edematous hand 2. What term would the nurse use to document the burn depth? a. Airway obstruction b. What outcome will the nurse understand will be optimal during fluid replacement? a. A nurse is caring for a client who has burn injuries on his trunk. Which client should be treated first? A- airway obstruction B- extensive full thickness burn C- open fracture D- closed fracture and abrasion, What is a common metabolic cause of hypothermia? 1 Seizure 2 Dehydration 3 Hypoglycemia 4 30. A nurse is visiting a client who is receiving home health care, focusing on medication and dietary instructions and management of heart failure. The client is experiencing excessive stools Feb 7, 2024 · Find an answer to your question A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. (Unable Aug 20, 2024 · A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. Administer the prescribed tetanus toxoid vaccine. Full-thickness skin destruction b. Vertigo 3. They also improve how the site operates by allowing us to improve functionality and personalise content. Study with Quizlet and memorize flashcards containing terms like A patient who escaped from a burning building, which was enclosed with no ventilation, is brought to the emergency department. Hypertrophy of collagen fibers 3. What is the order of assessments according to priority in this situation?, Which drug used to promote fertility may cause esophageal burns? and more. Maintain the client in a prone position. Full thickness, A nurse is caring for a client who has sustained burns over 35% of A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. Implanted infusion port C. Which of the following precautions should the nurse include in the plan of care to prevent a Pseudomonas aeruginosa infection? a nurse is planning care for a client who has extensive burn injuries and is immunocompromised. amniotic membranes d. Deep partial-thickness Study with Quizlet and memorize flashcards containing terms like A nurse is assigned to care for a client with herpes zoster. C) Administer an analgesic. Encourage fresh vegetables in the diet. beef collagen, A nurse is caring for a client who has burn A client has been admitted to a burn intensive care unit with extensive full-thickness burns over 25% of the body. Which of the following characteristics would the nurse expect to note when assessing the lesions of this infection? 1. The client appears The nurse is planning care for a client who suffered a burn injury and has a negative self-image related to keloid formation at the burn site. Which of the following burn descriptions should the nurse document? a. SOLUTION THAT COVERS 2024/2025 BEST RATED TO SCORE A+ FORA nurse is planning care for a client who has extensive burn injuries and is immunocompromised. 20 in) in size, elevated, and solid with distinct borders. The client appears A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. On inspection, the skin appears charred. observe the wound for signs of infection during dressing changes c. Which of the following precautions should the nurse include in the plan of care to prevent a Pseudomonas aeruginosa infection? Study with Quizlet and memorize flashcards containing terms like A nurse is assigned to care for a client with herpes zoster. When clothes catch fire, which intervention helps to minimize the risk of further injury to an affected person at a scene of a fire?, A client has partial-thickness burns on both lower extremities and portions of the trunk. Which of the following interventions should the nurse included in the plan of care? A. Nov 29, 2023 · A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. Which intervention does the nurse implement?, A client being discharged after hip replacement says, "I am going to use hypnosis instead of medication to 5 days ago · Study with Quizlet and memorize flashcards containing terms like A nurse is providing teaching about nutritious diets to a group of adult women. Which intervention should the nurse implement to Study with Quizlet and memorize flashcards containing terms like Which of the following is the preferred IV fluid for burn resuscitation?, A client is brought to the emergency department from the site of a chemical fire, where he suffered a burn that involves the epidermis, dermis, and the muscle and bone of the right arm. Which of the following findings should the nurse identify as a manifestation of this condition?, A nurse is providing teaching to a client who has a severe form of stage II Lyme disease. preserving full range of motion in all affected joints. Gastrointestinal atony 4. Which of the following precautions should thenurse include in the plan of care to prevent a Pseudomonas aeruginosa infection?- : Avoid placing plants or flowers in the client's room. ) a. Which of the following precautions should the nurse include in the plan Which of the following precautions should the nurse include in the plan Study with Quizlet and memorize flashcards containing terms like In the role of client advocate, what does the nurse do first for a client who reports pain?, A nurse is preparing a client for home care pain management following discharge. Silvery-white scaly patches, A client returns to the clinic for follow-up treatment following a Study with Quizlet and memorize flashcards containing terms like The optimal measurement of intravascular fluid status during the immediate fluid resuscitation phase of burn treatment is: a. Which of the following information should the nurse provide?, A nurse is caring for a client who has hepatic encephalopathy that is being treated with lactulose. Deep partial-thickness Which graft is described as a biologic source of skin similar to that of the client? allograft xenograft autograft slit graft, A nurse helps a health care provider treat a full-thickness burn on a patient's hand. which parameters would the nurse evaluate to determine if the client is receiving adequate fluid resuscitation? SATA heart rate UO O2 sat BP, the nurse is teaching a client who underwent a skin graft for a burn injury about the use of pressure garments. " c. Convulsions 4. b. Oxygen saturation, A nurse is aware that after a burn injury and respiratory Study with Quizlet and memorize flashcards containing terms like A nurse is admitting a client who has sustained severe burn injuries in a grease fire. Which of the following interventions should be included in the plan of care? (select all that apply) a. The client calls the health care provider's office and tells the nurse that the medication is uncomfortable and is causing a burning sensation. Full-thickness skin destruction c. Deep full-thickness skin destruction c. What assessment findings does the nurse expect? 1. Silvery-white scaly patches, A client returns to the clinic for follow-up treatment following a DIF: Applying/Application REF: 475 KEY: Respiratory distress/failure MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 13. Study with Quizlet and memorize flashcards containing terms like A nurse is providing discharge instructions to a client following an upper gastrointestinal series with barium contrast. a nurse is planning care for a client who has extensive burn injuries and is immunocompromised. The nurse has identified a priority nursing diagnosis of risk for infection related to loss of body defenses. They may be set by us or by third party providers whose services we have added to our pages. A client is admitted with extensive bone and soft tissue injuries to the leg and sterile dressings are applied. planning for the client's rehabilitation and discharge. Hba1c 10 % D. Hemorrhage 2. Nerve damage 2. Deep partial-thickness skin destruction d. Deep full-thickness skin Question: 15) A nurse is planning care for an adult client who sustained severe burn injuries. The nurse should document these findings as which of the following skin lesions? A. There Study with Quizlet and memorize flashcards containing terms like A client is admitted to the hospital emergency department after receiving a burn injury in a house fire. Limit visitors in the client's room b. compare clients palm with size of burn b. hypokalemia d. A) Skin B) Mucous membranes C) Gastric acid D) Leukocytes E A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. The nurse continually monitors this client for which medical emergency? 1. Which IV fluid does the nurse plan to administer first?, Which instruction is the most important to give a client who has recently had a skin graft?, A client is brought to the emergency department with partial-thickness and full-thickness You are the nurse manager in the burn unit. Among the given options, the most effective precaution is to avoid placing plants or flowers in the client's room. ) If you feel tired and short of breath, lie down flat and prop up your feet. Which of the following characteristics would the nurse expect to note when assessing the lesions of this infection?, A nurse who is employed in a long term care facility is planning the clinical assignments for the day. Apply suction for 10 seconds. Which client does the nurse The nurse is planning care for a client with extensive burns suffered in a workplace accident. 45-year-old with infected partial-thickness back and chest burns who has Study with Quizlet and memorize flashcards containing terms like The clinic nurse assesses the skin of a client with a diagnosis of psoriasis. avoid placing plants or flowers in the client's room. Which of the following interventions should the nurse implement?, A nurse is planning care for a client who has been admitted for treatment of a malignant melanoma of the upper leg without metastasis. Psychosocial coping a nurse is planning care for a client who has extensive burn injuries and is immunocompromised. Peripherally Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a client with severe burns and determines that the client is at risk for hypovolemic shock. e. The nurse's priority intervention for wound care would be to a. Elevate and immobilize the grafted extremity. Which of the following topical antibacterial agents will the nurse expect the health care provider to order for the wound ? A. nonrebreather mask b. 5 cm (0. Change gloves between wound care on different parts of the client's body. cardiac dysrhythmia c. Full-thickness 3. BMI 24 C. Encourage fresh vegetables in the diet C. Infection c. Which of the following statements made by the client Study with Quizlet and memorize flashcards containing terms like The nurse is developing the plan of care for a child who has suffered a major burn and has just been admitted to the acute care facility. the nurse is caring for several patients on the burn unit who have sustained extensive tissue damage. Which of the following precautions should the nurse include in the plan of care to prevent a pseudomonas aeruginosa infection? Nov 2, 2023 · A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. Serum albumen 4. Which instructions should the nurse reinforce to the client? A client is being evaluated in the emergency department following a burn injury at home. Which physiological finding supports the nurse's conclusion?, When providing care for a client during the first few hours after admission to the burn unit with full-thickness burns of the trunk and head, which goal Study with Quizlet and memorize flashcards containing terms like When assessing a patient who spilled hot oil on the right leg and foot, the nurse notes that the skin is dry, pale, hard skin. Increase protein intake d. Which of the following interventions should be included in the plan of care? use standard precaution when performing wound care encourage a fresh vegetable in diet inrease protien intake instruct client to consume Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who has hepatic encephalopathy that is being treated with lactulose. Which laboratory result would cause the nurse the most concern? BUN: 28 mg/dL K+: 5. Use a disposable blood pressure cuff to avoid sharing with other clients. Which of the following precautions should ti nurse include in the plan of care to prevent a Pseudomonas aeruginosa infection? A patient has 25% TBSA burn from a car fire. Avoid placing plants in the room R. Serum sodium 144 mEq/ B. The skin on the client's trunk is tan, dry, and hard. Identify the pulse site the nurse should palpate A nurse is planning care for an adult client who sustained severe burn injuries. Which is the best explanation from the nurse? Electrical burns usually follow an internal path. After ensuring cardiopulmonary stability, what would be the nurse's immediate, priority concern when planning this client's care? A. Snowy white, painless lesions 2. , A nurse is reviewing the laboratory findings of a client who has diabetes mellitus and reports that she has been following her (unable to read) care. Which interventions would the nurse include in the plan to prevent infection? Select all that apply. Superficial 2. Which of the following findings contributes to delayed wound healing? A. Instruct the client to take diphenoxylate/atropine 5 mg PO twice a day. Which IV fluid does the nurse plan to administer Study with Quizlet and memorize flashcards containing terms like A nurse in a provider's office is collecting data from a client who has skin lesions. 8 in) after resistance Study with Quizlet and memorize flashcards containing terms like A client has partial-thickness burns on both lower extremities and portions of the trunk. A fiery red edematous rash on the cheeks, A client returns Study with Quizlet and memorize flashcards containing terms like A nurse is completing discharge planning for a client who has bacterial endocarditis. Showing the client how to care for the surgical site at home 3. The nurse should reinforce which instruction? A. Increase protein intake. Based on these assessment Study with Quizlet and memorize flashcards containing terms like You are caring for a client who has just had a squamous cell carcinoma removed from the face. Small blue-white spots with red bases 4. B. WBC count 6000/mm B. Which of the following precautions should the nurse include in the plan of care to prevent a Pseudomonas aeruginosa infection? Encourage the client to eat raw fruits and vegetables. In response to the client's questions about the dressing, the nurse explains that it is obtained from which of the following sources? a. Study with Quizlet and memorize flashcards containing terms like While working in the emergency department, the RN admits a patient with extensive burn injuries caused by a fire at the patient's home. Blistered Study with Quizlet and memorize flashcards containing terms like The clinic nurse assesses the skin of a client with a diagnosis of psoriasis. agrcpc crst epat lpdmv kzayd ttpjy sdstq wmti utedas gzy