after change-of-shift report which patient should the nurse assess first

What is the correct nursing diagnosis for a 78-year-old with chronic heart failure?

During a visit to a 78-yr-old patient with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain over the past 2 days, and complains of "feeling too tired to get out of bed." Based on these data, a correct nursing diagnosis for the patient is a. activity intolerance related to fatigue.

Which physical findings are characteristic of acute decompensated heart failure (ADHF)?

A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. Several drugs have been ordered for the patient.

When is a physical exam indicated in the evaluation of respiratory distress?

When a patient has severe respiratory distress, only information pertinent to the current episode is obtained, and a more thorough assessment is deferred until later. Obtaining a comprehensive health history or full physical examination is unnecessary until the acute distress has resolved.

How does a nurse teach an older female patient with heart failure?

The nurse working on the heart failure unit knows that teaching an older female patient with newly diagnosed heart failure is effective when the patient states that a. she will take furosemide (Lasix) every day at bedtime. b. the nitroglycerin patch is to be used when chest pain develops.

Which client should the nurse assess first after receiving a change-of-shift report?

Which client should the nurse on the vascular unit assess first after receiving the shift report? The client with an above the knee amputation who needs a full body lift to get in the wheelchair. The charge nurse of a long-term care facility is making assignments.

Which patient should the nurse assess first?

Begin first with the patient who has the highest priority and progress to the patient who has the lowest priority. A nurse is performing a complete physical assessment of an adolescent.

What should be included in shift change nursing?

It should include the patient's medical history, current medication, allergies, pain levels and pain management plan, and discharge instructions. Providing these sorts of details about your patient in your end of shift report decreases the risk of an oncoming nurse putting the patient in danger.

Which of the following should be included in the change-of-shift report?

Change-of-Shift Report Should: Include significant objective information about the client's health problems. Proceed in a logical sequence. Include no gossip or personal opinion.

Which client does the nurse assess first after receiving Morning Report?

WHICH CLIENT SHOULD THE NURSE ASSESS FIRST AFTER MORNING REPORT? Expiratory wheezes should be seen first as may indicate allergic reaction to the contrast.

In what order should the nurse assess assigned clients following shift Report place in priority order?

Terms in this set (59) In what order should the nurse assess assigned clients following shift report? Place in priority order.

What happens during a change-of-shift report?

Change-of-shift report is the time when responsibility and accountability for the care of a patient is transferred from one nurse to another. The communication that ensues during this process is linked to both patient safety and continuity of care giving.

What happens during nurse shift change?

The shift change is a period of 30 minutes, during which a nurse can have 3-6 patients, which they spend an average of 3-7 minutes with. Nurses are able to complete each patient because some conversations are quick and easy, leaving time for more difficult cases.

What is end of shift report in nursing?

An end-of-shift report is a detailed report of a patient's current medical status while under your care as a nurse. When a nurse finishes their shift, they take a few minutes to record the patient's status so that the next nurse has all a patient's information when they take over their care.

Which of the following questions would be most important for the nurse to ask first when obtaining the health history?

Which of the following questions should the nurse ask first when obtaining the health history? "What is your major health concern at this time?" A nurse collects data about a client's family health history.

Why is change-of-shift report important?

The importance of a change-of-shift report can't be underestimated. Not only does the report provide nurses with an effective and meaningful way to transfer responsibility and accountability of patient care, it helps build team cohesion, enhances shared values, and supports ritualistic functions.

Why is shift report important in nursing?

Shift report, when completed at the patient bedside, allows the nurse to visualize and assess the patient and the environment, as well as communicate with and involve the patient in the plan of care.

What causes a drop in oxygen saturation in the blood?

Elevated temperature increases metabolic demands and oxygen use by tissues, resulting in a drop in oxygen saturation of central venous blood. Information about the patient's body mass index, urinary output, and lipase will not help in determining the cause of the patient's drop in ScvO2.

Should ICU visitation be individualized?

ICU visiting should be individualized to each patient and family rather than being dictated by rigid visitation policies. Inviting the family to participate in a multidisciplinary conference is appropriate but should not be the initial action by the nurse.

Can family members remain in the room during CPR?

Research indicates that family members want the option of remaining in the room during procedures such as cardiopulmonary resuscitation (CPR) and that this decreases anxiety and facilitates grieving. The other options may be appropriate if the family decides not to remain with the patient. Click again to see term 👆.