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- https://med.libretexts.org/Courses/University_of_South_Carolina_Upstate/Nursing_Fundamentals_(OpenRN)/05%3A_Safety/5.06%3A_Preventing_FallsCommonly used fall assessment tools used to identify patients at high risk for falls are the Morse Fall Scale and the Hendrich II Fall Risk Model. Assess patient pain levels using a pain-assessment sc...Commonly used fall assessment tools used to identify patients at high risk for falls are the Morse Fall Scale and the Hendrich II Fall Risk Model. Assess patient pain levels using a pain-assessment scale. (If staff other than a nurse is doing the rounding and the patient is in pain, contact the nurse immediately so the patient does not have to use the call light for pain medication.)
- https://med.libretexts.org/Courses/University_of_South_Carolina_Upstate/Nursing_Fundamentals_(OpenRN)/06%3A_Sensory_Impairments/6.04%3A_Putting_It_All_TogetherThe nurse performs a whisper test and discovers he is unable to report any of the six words whispered behind him. Assessment: The nurse performs a whisper test and discovers he is unable to report any...The nurse performs a whisper test and discovers he is unable to report any of the six words whispered behind him. Assessment: The nurse performs a whisper test and discovers he is unable to report any of the six words whispered behind him. She shares her assessment findings with the provider and requests a referral to an audiologist and then assists the patient in making the appointment. Appointment made with the audiologist and communicated place, date, and time to the patient and his daughter.
- https://med.libretexts.org/Courses/University_of_South_Carolina_Upstate/Nursing_Fundamentals_(OpenRN)/07%3A_Oxygenation/7.02%3A_Oxygenation_Basic_ConceptsIn order for oxygenated blood to move from the alveoli in the lungs to the various organs and tissues of the body, the heart must adequately pump blood through the systemic arteries. In a state of hyp...In order for oxygenated blood to move from the alveoli in the lungs to the various organs and tissues of the body, the heart must adequately pump blood through the systemic arteries. In a state of hypercapnia, the accumulation of carbon dioxide in the blood causes the pH of the blood to drop, leading to a state of respiratory acidosis.
- https://med.libretexts.org/Courses/University_of_South_Carolina_Upstate/Nursing_Fundamentals_(OpenRN)/16%3A_Grief_and_Loss/16.05%3A_Nursing_Care_During_the_Final_Hours_of_LifeThe American Nurses Association and the Palliative Care Nurses Association support the nurse in this dilemma that is often referred to as the Rule of Double Effect. After the family has said their goo...The American Nurses Association and the Palliative Care Nurses Association support the nurse in this dilemma that is often referred to as the Rule of Double Effect. After the family has said their goodbyes and left the room, it is the nurses responsibility to ensure identification tags are applied to the body and the patient is moved to the morgue.
- https://med.libretexts.org/Courses/University_of_South_Carolina_Upstate/Nursing_Fundamentals_(OpenRN)/09%3A_Integumentary/9.06%3A_Applying_the_Nursing_ProcessIf a patient has a chronic wound or is experiencing delayed wound healing, it is important for the nurse to assess the impact of the wound on their quality of life. In addition to the interventions ou...If a patient has a chronic wound or is experiencing delayed wound healing, it is important for the nurse to assess the impact of the wound on their quality of life. In addition to the interventions outlined under the “Braden Scale” section to prevent and treat pressure injury, see the following box for a list interventions to prevent and treat impaired skin integrity.
- https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/05%3A_Safety/5.04%3A_Culture_of_SafetyThe nurse mistakenly interprets the error to be a technology problem and proceeds to administer the medication instead of stopping the process and further investigating the error message, resulting in...The nurse mistakenly interprets the error to be a technology problem and proceeds to administer the medication instead of stopping the process and further investigating the error message, resulting in the wrong dosage of a medication being administered to the patient.
- https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/13%3A_Mobility/13.03%3A_Applying_the_Nursing_ProcessAssess muscle strength and coordination, and then assess mobility skills in the following order: mobility in bed, dangling on the bed with supported and unsupported sitting, weight-bearing while trans...Assess muscle strength and coordination, and then assess mobility skills in the following order: mobility in bed, dangling on the bed with supported and unsupported sitting, weight-bearing while transferring from sitting to standing or to a chair, standing and walking with assistance, and walking independently.
- https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/12%3A_Sleep_and_Rest
- https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/14%3A_Nutrition
- https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/14%3A_Nutrition/14.04%3A_Putting_It_All_TogetherAssessment: The nurse identifies that the patient is experiencing signs of imbalanced nutrition with the signs of increased weakness, fatigue, and signs of dehydration such as skin tenting and dryness...Assessment: The nurse identifies that the patient is experiencing signs of imbalanced nutrition with the signs of increased weakness, fatigue, and signs of dehydration such as skin tenting and dryness. The nurse will also encourage the use of plastic utensils and encourage the patient to eat mints or chew gum to minimize the metallic taste in the mouth.
- https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/20%3A_Answer_Key/20.06%3A_Chapter_6_(Cognitive_Impairments)Additional assessments would include assessing for signs of physical discomfort, changes in the environment that may be contributing to the increased anxiety or confusion, and communication pattern. M...Additional assessments would include assessing for signs of physical discomfort, changes in the environment that may be contributing to the increased anxiety or confusion, and communication pattern. Memantine (Namenda) and a combination of memantine and donepezil (Namzaric) are by approved the FDA for treatment of moderate to severe Alzheimer’s.
