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ATI: RN Adult Medical Surgical Kidney Disease WITH 100% CORRECT ANSWERS

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Using the SBAR format, identify the info. Nurse Allyson received from report that will enable her to provide safe care to Mr. Jones. - CORRECT ANSWER S- Situation The ED admitted Mr. Jones at 4:30 AM for SOB and weakness. After treatment, he is transferring to the telemetry unit. B - Background 60 year old African-American male with a history of peripheral vascular disease, type 2 diabetes, chronic kidney disease, coronary artery disease, and atrial fibrillation. A provider recently discharged him from the facility after he treated Mr. Jones for atrial fibrillation and a type 2 diabetic ulcer of the right foot. Mr. Jones did not complete prescribed antibiotics after his discharge. He is non compliant in managing his diabetes. He smokes one pack of cigarettes a day and uses alcohol 3 to 5 times a week. A - Assessment Mr. Jones is awake, alert, and orientated x3. Current vitals are: BP 112/70, P: 158, R: 34, T: 99.1, and O2 sat 91% on 2 L via nasal cannula. ECG indicates atrial fibrillation; placed on telemetry. Chest x-ray: opacities greater in the right lung than left lung. Altered lab values include: sodium 128, potassium 5.1, BUN 44, creatinine 3.0, and glomerular filtration rate 25. His total bilirubin was 2.8, calcium 8.7, WBCs 16.1, hemoglobin 9.3, hematocrit 28.2, and blood glucose 71. We did a digoxin level, which was 0.6. He has a soiled dressing on his right foot and is a stage III ulcer. A #20 gauge IV catheter was inserted peripherally in his left forearm and a nurse gave him 1,000 mL of 0.9% sodium chloride. Intake: 1,000 mL Output: None. No family present. Nurse Allyson is preparing to perform a sterile dressing change to Mr. Jones's foot. After removing the exam gloves, performing hand hygiene, and gathering the needed supplies, what are the next steps Nurse Allyson should take for the dressing change? - CORRECT ANSWER 1. Apply clean gloves. 2. Remove dressing and place in moisture-proof bag. 3. Remove clean gloves. 4. Wash hands. 5. Apply sterile gloves. 6. Cover with sterile gauze. 7. Secure dressing.

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