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1. Assessing the -search the client's belonging with the client present. Remove all glass, metal sil-
Care Environ- verware, electrical cords, vases, belts, shoelaces, metal nail files, tweezers, matches,
ment for a Client razors, perfume, shampoo, plastic bags, and other potentially harmful items from
Who is Expe- the client's room and vicinity
riencing Suicidal -allow the client to use only plastic eating utensils. Count utensils when brought
Ideations into and out of the client's room
-check the environment for possible hazards (windows that open, overhead pipes
that are easily accessible, non-breakaway shower rods, non-recessed shower noz-
zles)
-ensure that the client's hands are always visible, even when sleeping
2. Caring for a monitor skin and mucous membranes for infection (breakdown, fissures, and
Client Who abscess)
Has Immunosup-
pression
3. Developing an The Hospital Incident Command System (HICS) for disaster management offers a
Emergency Pre- clear structure for disaster management at the facility level
paredness Plan
4. Identifying Re- -Nurses are also mandated to report to the proper agency (local health depart-
portable Dis- ment, state health department) when a client is diagnosed with a communicable
eases disease
-a complete list of reportable diseases and a description of the reporting system
are available through the Centers for Disease Control and Prevent Web site. Each
state mandates which diseases must be reported in that state. There are more than
60 communicable diseases that must be reported to public health departments to
allow officials to do the following: ensure appropriate medical treatment of dis-
eases (tuberculosis), monitor for common-source outbreaks (foodborne: hepatitis
A), plan and evaluate control and prevention plans (immunizations for preventable
diseases), identify outbreaks and epidemics, determine public health priorities
based on trends, educate the community on prevention and treatment of these
, ATI Capstone Comprehensive Assessment A
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diseases
Nationally notifiable diseases: identified at the CDC website and include the fol-
lowing
-anthrax, botulism, cholera, congenital rubella syndrome (CRS), diphtheria, gia-
rdiasis, gonorrhea, hepatitis A, B, C, HIV, influenza-associated pediatric mortality,
legionellosis/legionnaires' disease, lyme disease, malaria, meningococcal disease,
mumps, pertussis (whooping cough), poliomyelitis, paralytic, poliovirus infection,
nonparalytic, rabies (human or animal), rubella (german measles), salmonellosis,
severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV),
shigellosis, smallpox, syphilis, tetanus/C. tetani, toxic shock syndrome (TSS) (other
than streptococcal), tuberculosis (TB), typhoid fever, vancomycin-intermediate and
vancomycin-resistant, viral hemorrhagic fever, staphylococcus aureus (VISA/VRSA)
5. Identifying a Pre- -caused by damage to sensory nerve fibers resulting in numbness and pain
scription to Clar- **peripheral neuropathy includes focal neuropathies, caused by acute ischemic
ify With the damage or diffuse neuropathies, which are more widespread and involve slow,
Provider progressive loss. This can lead to complications (foot deformities, ulcers).
**autonomic neuropathy can affect nerve conduction of the heart (exercise intol-
erance, painless myocardial infarction, altered left ventricular function, syncope),
gastrointestinal system (gastroparesis, reflux, early satiety), and urinary tract (de-
creased bladder sensation, urinary retention). It affects the autonomic nervous
system, which minimizes manifestations of hypoglycemia (diaphoresis, tremors,
palpitations), which can be dangerous for the client
-clients who have impaired sensory perception might not feel numbness, pain, or
burning
6. managing ad- orthostatic hypotension
verse effects of -nursing actions: monitor blood pressure and heart rate for orthostatic changes
risperidone -client education: change position slowly
7.