Case studies for Foundations and Adult Health Nursing 9th Edition by Kim Cooper

TEACH Answer Key Cooper: Foundations and Adult Health Nursing , 9th Edition Copyright © 2023 by Els evier Inc. All rights reserved. ANSWER KEY FOR CASE STUDIES CHAPTER 7 -56 ANSWER KEY Cooper : Foundations and Adult Health Nursing , 9th Edition CHAPTER 07 Nursing Care Plan 7 -1: The Patient with an Infection 1. Mr. R. has a peripheral IV infusing and reports discomfort at the site of insertion. What should the nurse do? The nurse should immediately assess the IV site for obvious dislodgment of the IV catheter, edema, erythema , or increased warmth or coolness. Coolness may indicate IV infiltration; the other signs may indicate irritation (possibly from a previously administere d medication or as an adverse effect of it) or infection . In general, if an IV site is obviously infi ltrated, nursing judgment is sufficient to determine whether to stop the IV infusion and/or remove the infi ltrated IV catheter. Warm compresses may generally be applied per nursing judgment as well. (F acility policies must be verified .) The health care provider must be notifi ed so that the determination can be made regarding the necessity to restart a new intravenous access site. 2. Mr. R. has a urinary catheter connected to continuous drainage. He reports burning at the site of insertion and the nurse notes dark, concentrated urine in the tubing. What should the nurse do next? The nurse should assess the site of the catheter ins ertion for any signs of edema, erythema, or exudate . The nurse should then take the patient’s vital signs, noting any change s in temperature and pulse. C ompare the data obtained with patient’s previous vital signs. Following these nursing actions, the nur se should obtain urine samples for urinalysis and culture and sensitivity (using aseptic technique), in anticipation of the health care provider ’s orders to come . All of the above should then be reported to the patient’s health care provider as promptly as possible. The nurse should also encourage the patient to increase his fl uid intake. Make additional fl uids available to him, if not contraindicated . 3. The nurse notes on the sheet of laboratory results for the patient that his WBC count is 2800/mm3. Why is this a concern, and what is recommended as a precautionary Cooper 9 e Answer Key 2 TEACH Answer Key Cooper: Foundations and Adult Health Nursing , 9th Edition Copyright © 2023 by Els evier Inc. All rights reserved. measure? This indicates a severely compromised immune system, placing the patient at very high risk for infection. The patient is especially susceptible to microorganisms that normally do not pose a signifi cant threat to a healthy immune system. A healthy immune system will destroy or deactivate most pathogens before they can multiply into greater numbers. If a patient is immunocompromised, even weaker or opportunistic pathogens (herpes varicella virus or CMV) can become established and cause infection or disease. O ften this is in a more severe form because the patient also cannot initiate an effective immune response to combat it. Mr. R. should be placed on neutropenic precautions (formerl y known as reverse isolation or Protective Isolation ). The intent of neutropenic precautions is to minimize threats to the patient’s compromised immune status; for instance, protecting the patient from his or her environmen t. Most facilities have specifi c protocols for implementing neutropenic precautions. These generally involve a private room with the door to remain closed; limiting visitors; no obviously infected visitors; no fresh fruit, flowers, or raw vegetables; and no open containers (juices, water, etc.) which can serve as reservoirs for environmental pathogens. ANSWER KEY Cooper : Foundations and Adult Health Nursing , 9th Edition CHAPTER 08 Nursing Care Plan 8-1: Patient W ith Activity Intolerance 4. The nurse is in the process of transferring Mr. D. from his bed to a chair using a mechanical lift. The nurse has prepared the chair and placed it near the bed. The nurse turns Mr. D. to his side, places the sling under Mr. D. to ensure adequate support of his head, returns Mr. D. to his back, and slowly begins to lift Mr. D. from his bed. What has the nurse forgotten to do, and why is it important? The nurse has forgotten to fold Mr. D.’s arms across his chest to prevent them from becoming injured during the lift. 5. The patient has a trapeze bar across the bed, trochanter rolls, and a footboard. Explain the rationale for each of these devices in maintaining proper body alignment. A trapeze bar allows the patient to use his upper body to move around in bed. T rochanter rolls stabilize the hip joint when placed firmly beside it, and prevent the hip from rolling outward. A footboard prevents permanent, abnormal plantar fl exion (footdrop) resulting from injury to the flexor muscles . ANSWER KEY Cooper 9 e Answer Key 3 TEACH Answer Key Cooper: Foundations and Adult Health Nursing , 9th Edition Copyright © 2023 by Els evier Inc. All rights reserved. Cooper : Foundations and Adult Health Nursing , 9th Edition CHAPTER 09 Nursing Care Plan 9-1: Skin Care 6. Mr. P. has a poor a ppetite, and his chemistry profi le reveals low protein, low albumin, and low anion gap ( A/G) ratio. Explain why poor nutrition predisposes to impairment of skin integrity and poor tissue healing . Proteins, which are synthesized by the liver, are required for tissue repair and proper immune system function. The only source of proteins is through dietary intake. If a patient is undernourished, he will be unable to produce adequate protein for metabolic processes , such as tissue repair and healing, and fi ghting infection . 7. With Mr. P.’s history of diarrhea, explain the possible complication that could evolve if the dry intact skin develops an open lesion . It is possible that an open lesion in this anatomic region may become contaminated and infected with bacteria normally found in the intestines, notably Escherichia coli. This type of situation is often diffi cult to treat with antibiotics . As a further consequence of Mr. P.’s poor nutritional status, his immune system will be weakened and may not be able to effectively combat pathogens, making the infection even more diffi cult to manage . ANSWER KEY Cooper : Foundations and Adult Health Nursing , 9th Edition CHAPTER 10 Nursing Care Plan 10 -1: Patient Safety 8. The nurse walking down the hall hears a patient calling out for help. The nurse assesses the situation and realizes that the patient does not remember how to use the call light. What factors possibly contribute to the patient’s inability to remember, and ho w should the nurse teach the patient to use the call light? A patient’s memory and cognitive function can be affected by a variety of factors, such as medications, anxiety, pain, disorientation, and dementia. Sensory perceptions should be assessed by the nurse as thoroughly as possible, with information and education being provided to patients and family/visitors appropriate to level of comprehension. Reinforcement of information should be provided as necessary . Demonstrations of the use of equipment (in this case, the call light) by the nurse and return demonstrations by the patient may be appropriate in some situations, particularly if the patient is in new or unfamiliar surroundings. It is also often helpful in this type of Cooper 9 e Answer Key 4 TEACH Answer Key Cooper: Foundations and Adult Health Nursing , 9th Edition Copyright © 2023 by Els evier Inc. All rights reserved. situation if the nurse checks the patient frequently, both to assess the patient’s status and to reassure patients that they have not been left alone . Patients may need to be reoriented to surroundings frequently, especially if mental status changes are a concern. It is often helpful for a patient with sensory or cognitive impairment to be in a room close to the nurses’ station . 9. The nurse enters the patient’s room to answer the call bell and sees the patient frantically pointing to the trash can next to the bed. The nurse smells s moke and sees small flames. What should be done to help prevent fires, and what should the nurse do in this situation ? The priority in this situation is to ensure patient safety. The nurse should call for assistance and implement the facility’s RACE protocol: Rescue/ Remove the patient from the area; initiate the Alarm process; Contain the fi re (close fire doors, patient room doors, etc.); Extinguish the fi re, if realistic; and Evacuate the other patients, if necessary . Patients and visitors should be educated about facility safety policies: reinforce the no smoking policy ; and the use of equipment and personal items (hair dryers, electric shavers, lamps, etc.) only if they meet appropriate facility codes. Safety reviews are generally conducted with fa cility personnel to ensure awareness of potential risks and proper safety procedures . ANSWER KEY Cooper : Foundations and Adult Health Nursing , 9th Edition CHAPTER 16 Nursing Care Plan 1 6-1: The Patient With a Laceration 10. Ms. T.’s wound was superficial. In contrast, what would be the nurse’ s actions if the wound appeared to be deep or was spurting blood ? Firm, direct pressure must be applied to the area (the nurse should be wearing gloves) and the patient must be observed for signs and symptoms of shock. The health care provider should be n otified immediately by another nurse . 11. What safety measures are indicated to ensure Ms. T. is not injured again ? Ms. T. may require more assis tance or supervision during mealtimes than she did previously . For example, she may need her food cut up, perh aps before the meal is served to her (to prevent embarrassment ). ANSWER KEY Cooper : Foundations and Adult Health Nursing , 9th Edition