ATI/NCLEX Assessment 2 with Complete Solutions

ATI/NCLEX Assessment 2 with Complete Solutions Bronchodilators *** increased oxygen demand-myocardial Intermittent claudication *** think arterial vs venous-this is arterial-position leg dependently arterial *** skin shines arterial issues *** put your legs down-so blood flows down-like an A (artery) venous issues *** like a V-put them up-so blood can go up Heart Failure *** -pumping issue; give Lasix and Digoxin (help with pumping) V tach *** electrical conduction system issue INFILTRATION *** IV site painful and swollen blood reaction *** send blood and tubing to the lab New Trach *** DO NOT remove the ties before cleaning the tracheostomy-wrong-stoma is not formed yet-risk of stoma closing and airway impacted all tracheostomies *** dont cut the gauze; need a pre cut gauze C3 spinal fracture *** airway is your issue if you see a presenting part for a baby for a labor pt in ER *** prepare delivery room-priority pt found on the floor *** assess vital signs and LOC first, not injuries assessment first (if pt was conscious before the fall-vitals will tell us the most about the client; unconscious pt would not have been found on the floor-they cannot get up-most likely they rails are up) NCLEX wont test *** chemo drugs NCLEX will test *** Eriksson but not Piaget, high pressure alarms obese client that vomits after surgery-will increase pressure in the abdomen, at more risk for *** Adhehicence Disaster prioritization *** Priority pt-pt with burns on the face, with respiratory stridor; fixed pupil and agonal respirations-will not live, so not a priority LPN *** can give report during a transfer can take VS in a transfusion client, after RN has stayed with client for first 15 min or the necessary initial time pt after MVA on balanced suspension traction *** disorientation is a priority; not shallow respirations ECT *** before: withhold Dilantin; Atropine IS given- for its anticholinergic effects-will lower the secretions in the mouth; ECT causes seizures-we don't want them to have fluids in mouth-risk for aspiration; Methohexital- possible given for amesthesia; also Succinylcholine-possible given knee arthroplasty-1 week ago *** post op-for 4 to 6 weeks blood thinners are given throughout the recovery; also if pt was on blood thinners prior to arthroplasty, he won't be taken off these meds, because they are lying down (postop) so they are at risk for cloths; they won't be taking NSAIDs-they are on blood thinners; Motrin vs Lortab? pt that had a catheter in before, now catheter is out and pt cannot pee-intervention *** assessment FIRST-so do a bladder scan first; (full bladder-dull sounds when you percuss); anesthesia can cause decreases ability to urinate if chest tube is disconnected *** immerse the end of chest tube in a bottle of sterile water-this will prevent the air going into the chest-creates a water sill new dx of RA-Methotrexate order *** this drug is used in CA patients as well-but its not a chemo drug associated with this drug: WBC low- possible 1200, stomatitis-sores and difficulty in the mouth-hard to eat, fever above 101 can be caused (fever is only above 101 F), increased urine specific gravity-they are not eating or drinking-dehydration occurs; low platelets; also pts are advised to take Folic Acid with this drug-it causes a depletion of dolic acid three point crutches *** unaffected leg first, then crutches 6 inches forward 2 point leg *** R foot and the L crutch go first together; L foot and the R crutch after at same time-m0ve pass the other ones swing through gait *** crutches forward, lift both feet and swing forward Tetralogy of Fallot *** 4 issues here: ventricular septal defect, right ventricular hypertrophy, pulmonic stenosis, overriding aorta, there is a whole in the septum; this will impact blood getting around the body TPN pt- to prevent fluid volume deficit *** monitor glucose q 4-6 hrs-if the glucose is up-dehydration (osmotic diuresis) incident reports *** risk management investigates these, they are not shared with non involved staff, include description of incidents in the reports medication reconciliation *** contains documented meds taken by client, comparrison of current and past meds list; this list is done at any change in care..not only at admission and discharge; the purpose is to avoid errors of duplication, missing some meds etc; also the pharmacy has a role in this, not only the RN Autocratic manager *** "do this, don't ask any questions"; employees have little to say; these managers are good in critical situations Laissez Faire manager *** disorganized floor, chaotic environment, employees make the decisions Democratic manager *** decisions are made as a group , employees ARE asked their opinions UAP *** CANNOT encourage to share feelings-this requires therapeutic communications-RN has the skills to do this CANNOT get a urine specimen from a indwelling catheter-this is sterile CAN assist with ambulating the client; CAN empty the suction container, but RN has to assess the fluid collected LPN *** CANNOT administer Rogham-its a blood product; they CAN hang the second bag for TPN, not the first one-RN they CANNOT do anything with titration they CANNOT stick the pt-no IV's start CAN hang a piggy pag as long as its not a titration and as long as its a second bag; always RN has to hang the first bag; LPN CAN give IM injections, they CAN hang the bag of fluid; when LPN hangs the second bag, she does not need the RN there CAN do wound care-dressing changes, irrigations, sterile techniques CAN listen for the lung sounds-for data collection only-not as an assessment-RN will go in there and listen to those heart sounds UAP *** new admission or post of fresh pt-RN has to do the vitals, not the UAP CAN do specimen collection but not something that require sterile specimens IV antibiotics *** 30 min window antidiarrheals *** always PRN acute glomerulonephritis *** can lead to acute kidney failure-watch for decreased urine output these CAN be disclosed/reported to DMV *** uncontrolled seizure disorder of a school bus driver, if it is not controlled dx of TB or HIV someone with a gun in the hospital can be called to the cups right away nonmaleficence *** do not insert a contaminated catheter in after not sterile anymore implied consent *** unless you have a DNR, you do everything for them living will WITHOUT a DNR order *** you have resuccitate in a code in an outbreak for STD's *** tell sexually active students to trace outbreaks-in a high school (when addressing the community outbreak) phone triage for a client exposed to EBOLA-client has no symptoms *** tell client: "we will have to notify the health dept, HIPPA does not apply in this case" Fire disaster *** evacuate the ones can ambulate first-smoke kills before fire NCLEX *** increased number of questions about religions and cultures practices when you need a translator *** call a certified one; no family member should translate-HIPPA Ebola *** report immediately-fever, epistaxis, vomiting AMA client *** no need to call security but DO inform about possible complications if they leave Amiodarone *** should be given through a central line, not peripherally- because ph < 5 Vacomyocin *** ph is <5-not given peripherally but PICC line ok TPN *** not given peripherally narcotics (eg. Morphine) *** can be taken out without a witness signature BUT needs second nurse when wasting it never take out a narcotic if drower count is incorrect LPN CAN sign a waste for narcotics SEIZURES (precautions before a seizure, after an aura) *** roll them on their side only if they lost consciousness; if not they CAN maintain their airway time it during a seizure-needs to be documented after: report it, document, determine LOC postdictal state: drowsy; ok for them to sleep on their side chemo treatment *** if it spills you call the biohazard, not the housekeeping-you put them at danger (not the housekeeping, not the laundry department) incident report done as well smoking client on non smoking campus *** give hime a patch cane use left side weakness *** cane opposite affected leg (COLL)-move cane and the bad leg forward first crutches *** arms flexed; 2-3 inches to underarmed cannot rest on crutches (underarm) Parkinson client *** walker with wheels-not ok for this client-safety problem should use the walker with tennis balls-he is shuffling he needs smooth sole shoes- not the non skid ones-he will fall Shingles and TB *** cannot share room neutropenic pt *** needs private room DONT isolate *** an HIV pt UNLESS he is neutropenic or he has an opportunistic infections private room *** productive cough and possible TB rash with possible varicella only airborne needs private room C-dif is contact-does not need private room but its recommended (its only in the stool-only way to get it-if you touch the stool) Laryngectomy client with fresh trach, Hep C and HIV *** need gloves, gown, mask, googles-all of these needed because the new tracheostomy client with MRSA + client who's post op total knee replacement *** you dont want them in the same room-knee rejection risk-MRSA might get in the knee mammogram *** after 40 annually colorectal exam *** should start at age of 50 prostate *** discuss with pcp at 50 pap test *** every 3 years starting at 21 if there is an abnormal pap->annual exam recommended vaginal exam *** has to be done annual in all patients analgesia *** cold and hot hot *** relaxes emergency numbers *** should be next to the phone, not the exit door progressive macular degeneration *** room free of clutter call light within rich fall history *** have bed alarm for client purulent exudate drainage from wound *** clean site first with sterile saline and water place specimen in biohazard bag who is at risk for falls *** over 65 yrs old bifocal glasses pt on Lasix hypotonic pulls fluid INTO the cell *** hypertonic pulls it OUT of the cell to check for JVD *** place in semi fowler if you see JVD when client is standing *** CHF R side Calculate output *** Assume-0.5 ml per kg output per hour if we dont know the weight then is 30 ml per hr the lower the Na it goes *** the higher the risk for seizures it is kidney function decreased *** creatinine increased hyperventilation *** blowing out CO2-give rebreather bag-client is in respiratory alkalosis Atropine *** metabolic acidosis Narcan *** risk for respiratory acidosis-they are not breathing pt on Zofran *** risk for metabolic alkalosis-they are vomiting Insulin *** metabolic acidosis-K is high Dilaudid *** respiratory acidosis or alkalosis sputum specimen *** collect in the morning- also provide oral care for this pt bronchoscopy *** they are looking for lung cancer assess gag reflex asks client if he has night sweats-lung CA pts has this particular symptom Quantiferon Gold-TB *** blood test definitive for TB results within 24 hrs ask for night sweats Thoracentesis *** place a chest tube in the room- pt at risk for pneumothorax during procedure check lung sounds on that side pulmonary hygiene *** CPT turn and cough bronchodilators steroids use bronchodilator first suctioning *** 3 rounds before you hyper oxygenate again, max 15 secs rounds suction on exiting TB *** mucopurulent sputum, low grade fever, chest tightness, decreased appetite chronic bronchitis *** copious sputum cough for few months emphysema *** pursed lip breathing asthma *** bronchospasms careful with beta blockers lung cancer *** non specific s/s pneumonia *** pleuritic chest pain-that does not go down when you sit/lay down, movement hurts anginal pain *** pain goes away when you lay down pneumothorax *** O2 decreases, put pt on O2, semi high fowler position; give anxiolytics- if anxious they won't be breathing ok; give analgesics- because it hurts chest tube placed as well Chest tubes components *** right container-this is the drainage water seal-middle-red suction bubbles on the left if no bubbling- possible kick in the tube if drainage becomes purulent-check for fever, check when CBC was done last time, look at the insertion side for infection in case of crackles-these are in the pleural space-crackles mean fluid; check to see if a chest xray was done this morning intubated client *** nurse should do frequent hand wash provide oral decontamination clean oral suction device turn client q 2 hrs high fowler preop clients *** might take half of insulin post op *** respiratory, circulation, neuro, GU, GI, pain-these are all impaired by the surgery dehisscence *** put some stitches on high fowler evisceration *** lay pt down, bend knees, call for help, cover with sterile dressing acute cholecystitis *** low fat diet have rich in HDL food sources NG tube *** verify with x-ray first, gastric ph later empty when 1.5 to 3/4 full check residual in continuous feeding-check in q 4 hrs; if less than 100 ml-put it back; if more than 200-call provider; if more than 200 is taken out-metabolic alkalosis risk meds through NG tube are given liquid, if crushed you give the meds 1 at a time-you don't know how they interact when crushed and mixed in all together-also flush in between you don't give extended release meds through ng tube-they need liquid or non extended released GERD *** prokinetic agents- Reglan Peptic ulcer *** ... IBS *** diarrhea and constipation LLQ pain cramps Inflammatory bowel disorders (UC and Crohn's) *** give immune modulators with the Ulcerative colitis-stool gets into the tissues? Diverticulitis *** they always have diverticulosis, but if something gets in a diverticula-then it becomes diverticulitis fluids only, rest the bowel later-low fiber and after, transition to high fiber Dumping syndrome *** dizziness, sweating, tachicardia post bariatric surgery-avoid lactose and high concentrated sugar, high fat and protein foods, turn to the L side not supine Bariatric clients *** they are obese- so high risk clients Colostomy care teaching *** include cranberry juice and yogurt to the diet-this will help with the odor empty bag when one third full clip hair surrounding the peristomal site post up stoma care *** pink and red is good the further in the colon the stoma is, the more solid the stool is emotional support, lots of teaching required they will have an NG tube initially in for feeding stoma care and assessment-priorities pancreatitis *** need for intervention: 1.042 Urine specific gravity-severe dehydration (osmotic diuresis-started on TPN, sugar elevates) amylase, lipase, related to the exocrine function of the endocrine system acute pancreatitis *** possible hypocalcemia (Tressou sign)-hand spasms occurs during blood pressure monitoring with the auto digestion-Ca ends up in the bloodstream Cirrhosis *** low protein diet bleeding-esophageal varices they are breaking down protein-so they have high ammonia-this is toxic to neuro system Hepatitis *** liver impairment Pancreatitis-malnutrition *** put them far away from nurses station-so when food comes the smell wont create pancreatic enzymes pancreatic cancer *** immunosuppression present treatment: Whipple procedure and chemo many times its mehtastazied OA *** weather changes-barometric pressure chronic unilateral pain pain worsen after activity Rheumatoid A *** bilateral joint inflammation morning stiffness and pain Gout *** men usually get it cannot put pressure on foot during acute episode multiple tophi excruciating pain with acute episode bed rest, avoid touch, increase fluids Allopurinol SIADH *** low sodium level seizure precautions Arterial line *** ... Clonidine *** change position slowly, this is a BP drug take at night in case of a cough->don't stop the med, just call the dr VTac *** obtain VS don't defibrillate but cardiovert (if hemodynamically stable don't cardiovert) check carotid pulse give Amiodarone Progressive MS *** get rest and avoid stress major personality changes need speech therapist might lose ability to empty bladder eye patch given Palliative care *** improve quality of life meet physical and emotional needs mental health pts-remember to *** treat based on developmental age, not chronologic age amputation *** first reaction-many times denial Olanzepine/Zyprexa for Anxiety *** antipsychotic-causes hyperglycemia and weight gain they can't eat whatever they want for the first two months-risk for agranulocytosis Agoraphobia *** intervention-desensitation-this is a slow process OCD *** intervention-allow the ritual-we are not allow to stop it without a physician order-we will send them into a panic attack PTSD *** intervention-support groups Hypochondriasis *** intervention-limit rumination-will help them not thinking of it Social Phobia *** Intervention-GAD? intervention-reinforce coping Schizophrenia *** Paranoid-auditory hallucinations-know what the voices are telling them Disorganized-flat affect, disorganized behavior and speech Catatonic-stupor or extreme agitation, bizarre body posture-they can be in same position for a long time-alteration of skin break down can happen Prolixin *** targets dyskenisia-repetitive involuntary facial and tongue motion Aripiprazole *** reduce daily delusional thoughts Aricept *** increase mental cognition Haloperidol/Haldol *** highest risk of EPS Clozapine *** agranulocytosis Seroquel (for depression) *** slipineess Congentin *** manages EPS Risperdal *** lowest risks gynecomastia is a major risk in young boys Olanzapine/Zyprexa *** hyperglicemia Autism-alterations in *** social skills-interventions-structured routines language-might talk late-interventions-foster independence behaviors-anger, frustration; intervention-safety cognition-depends where they fall-intervention-family support health-frequent GI disorders-advised to be on gluten free diet-intervention-offer community resources Niacin *** flushing-normal Rifampin (TB drug) *** orange body fluids Adenosine *** flushing and chest pain, iv push Protonix (PPI class) *** antiulcer med Pitocin *** decreases bleeding uterine stimulant Fentanyl (narcotic) *** reversible agent is Nalaxone Metothrexate *** ... Palivizunab *** prevents RSV Methylprednisolone sodium succinate *** given orally or IV IV push Selective Estrogen Receptor Modulator (Evista) *** given for postmenapausal osteoporosis Lipitor *** no grapefruit Prostaglandin-Xalatan-Lantanoprost *** ... Geodon *** ... Indocin *** administer with food, milk Singulair, montelukast *** bronchodilator anti inflamatory-Nasonex *** dont administer in clients with milk allergy Flagyl-no alcohol first 3 days *** ... Viagra-dont give with nitrates *** ... slows osteoporosis-Premarin *** ... avoid foods with tyramine-antibiotic-ZyvoxNeurontin-partial seizure and neuralgia given for these *** ... -Methadone-monitor respiratory *** ... -adminster sq with evening meal or HS-Levemir; dont mix with other insulins (long acting insulin); doses must be 12 hrs apart *** ... -antimicrobial-Zocyn-check allergy for penicillin *** ... -for ADHD-available in po form only, taken once daily-Vyvanse-Lisdexamfetamine dimesylate *** ... Coumadin *** anticoagulant, intake of greens important for vitamin K Ariprippazole *** avoid grapefruit, alcohol, overheating, dehydration Nemanda/Nemantine *** avoid diet in fruits and vegetables antibiotic *** caution in colitis Hydrochloride *** administer po-moderate to severe dementia such as Alzheimer fresh fruits will cause alkalinity-low excretion of drug Actonel *** CI with esophageal disorder remain uprights for 30 min take with a full glass of water Cardizem *** ... Avodart *** BPH drug females of age that might have kids should not handle this Chantix- *** nicotinic blocker Paxil *** antidepressant don't take St John Worth take at night time Depression *** Anhedonia-maintain ADLs sleep alteration-bedtime routine anergia-encourage exercise worthlessness-monitor safety poor concentration-clear directions suicidal ideation-giving away things Severe Mania *** Anorexia-provide finger foods Accelerated speech-calm demeanor Fragmented thoughts-redirect no impulse control-monitor safety SSRI *** weight gain therapeutic effect after 1 week Lithium *** AE with diuretics therapeutic effect after 1 week MAOI- *** therapeutic effect after 1 week TCA *** therapeutic effect after 1 week monitor for dysrhythmias detoxification of cocaine *** s/s several hrs later-poor concentrations hypertention crisis *** hrs after opiods alcohol withdrawal *** dont leave them alone Diaphoresis—fluid replacement hallucinations-decrease stimuli Wernicke-Korsakoff-Infuse IV Thiamine Oxazepam (Serax) *** Delirium Tremens Tachycardia-monitor VS stages of Alzeimer *** 4 only, not 6 stage 2 is moderate-cannot balance checkbook, decline in daily basic hygiene needs,; leave the stove after cooking; stage 1 (mild)-discuss meaning of client's framed photo: integrity vs dispair stage; you want them to have personal things around Dementia *** decrease in cognition-safety is major problem they need their routine provide education to the whole team taking care of this pt dont rationalize with them Anorexia *** we don't focus on their weight, they do prepare fluid therapy and enteral feeding for them Clozapine *** ... mental health miscellaneous *** pt can leave facility if at will involuntary admission occurs if people are deemed a threat to themselves or others clients can communicate with their attorney nurse cannot open postal packages prior to giving to client Hcg test-why is important before surgery *** a positive pregnancy test may require canceling surgery Hcg *** rises during pregnancy and maintains the pregnancy raises until about 12 weeks of pregnancy, then body recognizes it and then it drops again prenatal examination *** report if pt is on a vegetarian diet; usually they are pseudo anemic until 32 weeks, then the iron should become normal again first semester *** nausea, vomiting, nutrition 2nd semester *** dyspnea, heartburn 3rd trimester *** make sure she know how to recognize false vs true labor signs prenatal care *** assess at each exam-VS, weight, fundal height... Mag Sufate IV *** resp 10-priority Chronic HTN *** mom had HTN prior to pregnancy this pt may develop preeclampsia Gestational HTN *** mom gets HTN after 20th week of gestation NO protenuria STI *** higher risk for ectopic pregnancy Placenta previa *** no vaginal exam painless, bright red bleeding abruption placenta *** painful dark red bleeding hyperemesis *** whatch the weight and electrolytes hydatidiform mole *** avoid pregnancy until hCG returns to normal she can pass a grape like structure... ideally avoid pregnancy for 4 years ? she is at risk for cancer as well usually this only happens once Cerclage *** cervical insufficiency ectopic pregnancy *** unilateral, stabbing, abdominal pain ectopic pregnancy is never a livable pregnancy danger signs during pregnancy *** fever and chills (infection) decreased or absent fetal movement sudden weight gain (preeclampsia) severe HA ROM prior to 37 weeks gestation vaginal bleeding Isotonic IV fluids *** ... If contractions frequency is 90 secs *** stop Pitocin check FHR assess pain and fatigue severe back pain labor *** give back massage place on all fours (legs and nands) If baby has a longitudinal lie, with FHR above the umbilicus *** prepare for US need to evaluate for breech pain *** associated with labor stage 1 of labor *** keep her active after 3-7 cm-help her breath assess FHR and UC comfort stage 2 of labor *** check FHR q 15 min assist pushing stage 3 stage of labor *** placenta delivered do newborn care stage 4 of labor *** priority-prevent bleeding fetal monitoring late deceleration *** reposition first on L side fetal monitoring *** VEAL CHOP (what causes it) MINE (what you do about it)-make sure you know where they are in the process Late decels *** uteroplacental insufficiency Lenght of contractions *** maximum length of contraction should be 90 secs if 90 secs or longer or FHR is lower than 11-stop Pitocin if a mom is on it L&D meds tocolytics-Indomethacin and Terbutaline *** stops labor Pitocin *** used to augment labor/assist labor Beamethasone *** 2 doses 24 hrs apart help to mature fetal lungs breastfeeding *** don't feed if discomfort is present schedule feeding for breastfeeding q 2-3 hrs meds might transfer to milk if mom is breastfeeding Rhogham administration *** monitor labs: Indirect Coomb's for baby Direct Coomb's for mom PP hemorrhage *** priority mom breastfeeding on heparin therapy *** breast milk will not be affected, after breast feeding is over she can go back to Coumadin Initial Newborn Care *** at 1 and 5 min check Apgar after drying him off put him skin to skin with mom for thermoregulation evaporation when baby is wet when baby is dry-heat is loss through.. baby assessment *** reflexes check-premie will not demonstrate all the reflexes fetal alcohol syndrome *** high pitch cry hard to console cognitive disabilities tobacco/nicotine *** vasoconstricor decreased O2 for baby-increased SIDS risk, asthma hypoglycemia in babies *** check glucose w/o an order; it takes some time for the baby to get used with the insulin production phototerapy *** cover eye with mask reposition newborn q 2 hrs cover scrotum take them off light only for feeding Kernisterus *** yellow baby, we only take the baby out of the light for feeding Womens Health *** ... cancers *** ... menopause *** hot flashes night sweats palpitations vaginal atrophy osteoporosis over 35 *** increased risk of DVT with oral contraception all these matter when choosing oral contraception *** history of hypertension severe PMS hist of DVT Diflucan *** ... Rocephin *** ... Flagyl *** ... postmenaupausal- 57 yrs old- (on Climara)monitor BP, yearly mammogram, take with food, call provider if bleeding occurs *** ... Methergine *** CI in HTN and cardiac disease promotes uterine contractions lyrics (Pregabalin) *** dont stop abruptly, monitor for edema Plavix *** Prilosec and Nexium will decrease the effects of this Synthroid *** give in the morning increases HR complicated UTI *** give antibiotics CI with sensitivity to cephalosporins-Maxipime Gentamicin *** antibiotic for bacterial infections monitor UO and renal function Antipshychotic-Risperdal *** dont mix oral solution with cola or tea Aricept *** monitor for bradicardia, dont interupt abrutptly Lidocaine *** not effective against SVT, given IV Bystolic *** don't stop abrupt, weight daily, can impair thinking and reaction time Oxycontin *** highly abused-should not be taken within 2 weeks of administration of an MAOI Dilaudid *** causes spasms of sphincter of odi Levaquin *** can alter glucose level in diabetic client Vancomycin *** antibiotic for MRSA risk for Red man syndrome Digoxin *** assess AP for one min hypokalemia can lead to toxicity Inderal *** check BP and pulse before administration PPI-Nexium (GERD) *** don't crush or chew Effexor *** can increase ptinr, don't discontinue abruptly Lithium *** mantain Na levels normal Lovenox *** hold if platelets are less than 100,000 administer sq Pradaxa *** avoid use with drugs that prolong bleeding keep dry and in a dark bottle Varivax vaccine *** prevents chicken pox Lasix *** Diuretic monitor HR, BP monitor weight Amiodarone *** first line drug for... Dilantin *** therapeutic level 10-20 Novolog *** ... Advair (Fluticasone) *** long term for asthma Concerta *** contra with MAOI Simvastatin and Zetia-Vytorin *** its a combination drug Gardasil *** prevents HPV administered to both male and female- Nitro *** onset 1-3 min sublingual regular Insulin *** the only one administered IV Haldol *** monitor for EPS causes dry mouth Ambien *** rapid onset given for short term insomnia PEDS-know *** infants and children-common causes of death incorrect car seat placement or not being in the seat Ritalin *** side effects-Tics, nervousness, increased BP; can cause insomnia, don't give in the evening pt that is on radiation *** no lotion on the side, no scrubbing, just warm water know back/spine safety for nurse *** upper bod mechanics, position client in the correct way