21 hours ago 36. After receiving change-of-shift report, which patient should the nurse assess first? a. Patient who is scheduled for the drain phase of a peritoneal dialysis exchange. b. Patient with stage 4 chronic kidney disease who has an elevated phosphate level. c. Patient with stage 5 chronic kidney disease who has a potassium level of 3.4 mEq/L. d. >> Go To The Portal
The response beginning, "It is important that you be realistic" discourages the patient from feeling hopeful, which is important to patients with any life-threatening diagnosis. Which information will the nurse provide for a patient with newly diagnosed gastroesophageal reflux disease (GERD)? a.
Check the medical record for the most recent potassium level. ANS: D The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider.
d. "I sleep with the head of the bed elevated on 4-inch blocks." ANS: B GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD. A 68-yr-old male patient with a stroke is unconscious and unresponsive to stimuli.
During an examination of facial features, the nurse observes that the patient exhibits asymmetry of the mouth. What problem may asymmetric facial features indicate? 2 answers QUESTION
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 of the following clients should the nurse assess first? *When using the acute versus chronic approach to client care, the nurse should place the priority on the client who has a chest tube and has asymmetrical chest movement because this can indicate a tension pneumothorax.
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.
Written by nurses who are wrapping up their shifts and provided to those nurses beginning the next shift, these details should include a patient's current medical status, along with his or her medical history, individual medication needs, allergies, a record of the patient's pain levels and a pain management plan, as ...
WHICH CLIENT SHOULD THE NURSE ASSESS FIRST AFTER MORNING REPORT? Expiratory wheezes should be seen first as may indicate allergic reaction to the contrast.
Terms in this set (59) In what order should the nurse assess assigned clients following shift report? Place in priority order.
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.
The LPN/LVN is responsible for giving end-of-shift reports. There are several types of reporting systems.
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.
Ensure patient's privacy and dignity. Assess ABCCS/suction/oxygen/safety. Ensure tubes and attachments are properly placed prior to the procedure to prevent accidental removal. A gait belt and wheelchair are required.
Questions to Ask During Nursing Report:Does that patient have any family?Who is the patient's primary contact if something was to happen?Does the patient have any type of testing that they must be NPO for?Does the patient need assistance eating, showering, or using the bathroom?More items...
18:5620:45How to Give a Nursing Shift Report - YouTubeYouTubeStart of suggested clipEnd of suggested clipSo you always just want to know who the family is and if you don't always look through the chart ifMoreSo you always just want to know who the family is and if you don't always look through the chart if the nurse doesn't know look through the chart. Because believe it or not to the patient.
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 👆.
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.