NSG 300 Exam 2
A 22-year-old new mother is breastfeeding. I am making eating choices according to the recommended dietary allowances
You ask her if she is taking the correct
quantities of nutrients. what reflects that she
understands the dietary guidelines?
abrasions scrapes
-small intestine
absorption -done by passive diffusion, osmosis, active transport, and pinocytosis
-Without absorption a client becomes malnourished
according to the WOCN what is the normal saline
preferred cleaning agent
-examine results of care according to clinical data collected
actions that show a nurse is competent to -compare achieved effects/outcomes with goals/expected outcomes
perform evaluation -recognize errors/omissions
-understand pt situation, reflect on situation, and correct errors
suggested intake based on observed or experimentally determined estimates f
adequate intake
nutrition intakes when not enough evidence to set RDA
after cardiac surgery, a patient is prescribed 300mg/day
a diet to reduce cholesterol. what amount
would be the recommended cholesterol
intake in this diet
, NSG 300 Exam 2
-blanching is not distinctly visible
assessing development of pressure injuries
-differentiate skin color changes to baseline skin color
in darker skinned individuals
-use GNASC tool
location, staging (depth), type and % of tissue in wound bed, wound dimensions
assessment for pressure ulcers includes (including tunneling), exudate description (if odor is present), and condition of
surrounding skin
-data collection
assessment process -interpretation
-validation
uses synthetic dressings over a wound to allow the eschar to be self-digested b
autolytic debridement
action of enzymes that are present in wound fluids.
Energy needed at rest to maintain life-sustaining activities for a specific amount
basic metabolic rate
time
keeps everything secure, especially after a procedure. gives extra support and s
benefits of bandages and binders
of security. helps to prevent dehiscence
body's defenses against infection normal flora, inflammatory response, immune response
elimination pattern, stool characteristics, routines, bowel diversions, appetite
bowel elimination factors changes, diet history, daily fluid intake, surgery/illness, meds, emotional state,
exercise, pain/discomfort, social history, mobility
, NSG 300 Exam 2
-Acute care: environment, cathartics and laxatives (cathartics are faster), antidia
agents (use opiates with caution), insert/maintain NG tube
-Restorative care: care of ostomies, irrigating a colostomy, pouching ostomy,
bowel problems nursing care
nutritional considerations, psychological considerations, bowel training, mainten
of fluid/food intake, exercise promotion (stimulates peristalsis), managing fecal
incontinence, maintenance of skin integrity
assesses risk for developing pressure ulcers; includes patient's sensory percept
moisture, activity, mobility, nutrition, friction and shear; the lower the number the
higher the risk
>9= very high risk
Braden Scale
10-12= high risk
13-14= moderate risk
15-18= mild risk
19-23= generally not at risk
BUN levels 10-20 mg/dL
BWAT tool is used for assessing wound status
dairy products, green leafy vegetables, soy, nuts, fish (canned sardines and salm
calcium products
with bones), fortified grains
characteristics of body fluids that influence fluid amount (volume), concentration (osmolality), composition (electrolyte
body system function concentration), degree of acidity (pH)
, NSG 300 Exam 2
may use topical enzymes to induce changes in the substrate resulting in the
chemical debridement
breakdown of necrotic tissue. (Dakin's solution)
chronic pressure ulcers use ______________ clean
technique
clinical dehydration ECV deficit and hypernatremia combined
created policy for hospitals to no longer receive additional reimbursement for c
CMS
related to eight conditions to improve quality of health care
cold (on an injury) initially decreases the pain and inflammation (long exposure=reflex vasodilation)
vasoconstriction
local anethesia
cold therapy physiological response reduced cell metabolism
increased blood viscosity
decreased muscle tension
complications of wound healing hemorrhage, infection, dehiscence, evisceration
comprehensive assessment specific information (problem oriented)
-ongoing assessment from time of injury, wound care, any condition changes, an
scheduled basis
comprehensive wound assessment -Important to include cause of injury, history of wound, treatment, description,
response to therapy
-Braden scale: assesses risk for pressure/skin injury every shift
A 22-year-old new mother is breastfeeding. I am making eating choices according to the recommended dietary allowances
You ask her if she is taking the correct
quantities of nutrients. what reflects that she
understands the dietary guidelines?
abrasions scrapes
-small intestine
absorption -done by passive diffusion, osmosis, active transport, and pinocytosis
-Without absorption a client becomes malnourished
according to the WOCN what is the normal saline
preferred cleaning agent
-examine results of care according to clinical data collected
actions that show a nurse is competent to -compare achieved effects/outcomes with goals/expected outcomes
perform evaluation -recognize errors/omissions
-understand pt situation, reflect on situation, and correct errors
suggested intake based on observed or experimentally determined estimates f
adequate intake
nutrition intakes when not enough evidence to set RDA
after cardiac surgery, a patient is prescribed 300mg/day
a diet to reduce cholesterol. what amount
would be the recommended cholesterol
intake in this diet
, NSG 300 Exam 2
-blanching is not distinctly visible
assessing development of pressure injuries
-differentiate skin color changes to baseline skin color
in darker skinned individuals
-use GNASC tool
location, staging (depth), type and % of tissue in wound bed, wound dimensions
assessment for pressure ulcers includes (including tunneling), exudate description (if odor is present), and condition of
surrounding skin
-data collection
assessment process -interpretation
-validation
uses synthetic dressings over a wound to allow the eschar to be self-digested b
autolytic debridement
action of enzymes that are present in wound fluids.
Energy needed at rest to maintain life-sustaining activities for a specific amount
basic metabolic rate
time
keeps everything secure, especially after a procedure. gives extra support and s
benefits of bandages and binders
of security. helps to prevent dehiscence
body's defenses against infection normal flora, inflammatory response, immune response
elimination pattern, stool characteristics, routines, bowel diversions, appetite
bowel elimination factors changes, diet history, daily fluid intake, surgery/illness, meds, emotional state,
exercise, pain/discomfort, social history, mobility
, NSG 300 Exam 2
-Acute care: environment, cathartics and laxatives (cathartics are faster), antidia
agents (use opiates with caution), insert/maintain NG tube
-Restorative care: care of ostomies, irrigating a colostomy, pouching ostomy,
bowel problems nursing care
nutritional considerations, psychological considerations, bowel training, mainten
of fluid/food intake, exercise promotion (stimulates peristalsis), managing fecal
incontinence, maintenance of skin integrity
assesses risk for developing pressure ulcers; includes patient's sensory percept
moisture, activity, mobility, nutrition, friction and shear; the lower the number the
higher the risk
>9= very high risk
Braden Scale
10-12= high risk
13-14= moderate risk
15-18= mild risk
19-23= generally not at risk
BUN levels 10-20 mg/dL
BWAT tool is used for assessing wound status
dairy products, green leafy vegetables, soy, nuts, fish (canned sardines and salm
calcium products
with bones), fortified grains
characteristics of body fluids that influence fluid amount (volume), concentration (osmolality), composition (electrolyte
body system function concentration), degree of acidity (pH)
, NSG 300 Exam 2
may use topical enzymes to induce changes in the substrate resulting in the
chemical debridement
breakdown of necrotic tissue. (Dakin's solution)
chronic pressure ulcers use ______________ clean
technique
clinical dehydration ECV deficit and hypernatremia combined
created policy for hospitals to no longer receive additional reimbursement for c
CMS
related to eight conditions to improve quality of health care
cold (on an injury) initially decreases the pain and inflammation (long exposure=reflex vasodilation)
vasoconstriction
local anethesia
cold therapy physiological response reduced cell metabolism
increased blood viscosity
decreased muscle tension
complications of wound healing hemorrhage, infection, dehiscence, evisceration
comprehensive assessment specific information (problem oriented)
-ongoing assessment from time of injury, wound care, any condition changes, an
scheduled basis
comprehensive wound assessment -Important to include cause of injury, history of wound, treatment, description,
response to therapy
-Braden scale: assesses risk for pressure/skin injury every shift
