Make an NCP, one actual and one potential from the nursing diagnoses given for high-risk infants: Ineffective airway clearance related to presence of mucus or amniotic fluid in airway
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- Make an NCP, one actual and one potential from the nursing diagnoses given for high-risk infants: 1. Ineffective airway clearance related to presence of mucus or amniotic fluid in airway. 2. Ineffective thermoregulation related to newborn status and stress from birth weight variation. 3. Risk for infection related to lowered immune response in newborn. 4.Risk for imbalanced nutrition, less than body require- ments related to lack of energy for sucking.A 60-year-old male with a known history of chronic obstructive pulmonary disease (COPD) presents to the ED with increased shortness of breath, productive cough, and wheezing. His vital signs are: BP 150/90 mmHg, HR 110 bpm, RR 26 breaths/min, SpO2 88% on room air. What is the first-line nursing management? The first-line nursing management for a COPD exacerbation is to administer ________.A nurse is caring for a preschooler on the pediatric unit. Exhibit 1 Provider Prescriptions Day 1, 2350: Admit for observation. Obtain vital signs every 4 hr and PRN. Administer oxygen 2 L/min via nasal cannula to maintain oxygen saturation above 95%. Initiate saline lock. Administer ceftriaxone 250 mg IV every 12 hr. Administer acetaminophen oral suspension 240 mg every 4 hr PRN for temperature greater than 38° C (100.4° F). Place on regular diet and encourage oral fluids of preschooler's choice. Monitor intake and output every 8 hr. Exhibit 2 Assessment Day 2, 0030: Preschooler lying on bed, awake and alert. Breath sounds with wheezing auscultated on expiration on the right side. Nonproductive cough with no retractions or nasal flaring observed. Abdomen soft and nondistended, bowel sounds active in all four quadrants. Preschooler reports headache and pain in abdomen. Rates pain in abdomen as a 2 on a 0 to 10 FACES pain scale. Exhibit 3 Vital Signs Day 2, 0030: Temperature 38.1°…
- Give a rationale for each nursing diagnosis listed below in regards to the scenario attached Jack Soo Park, a 78-year-old man receiving intravenous (IV) therapy with antibiotics, states, “I’m having trouble breathing. “ Vital signs include 156/88, Pulse 105, Respiratory Rate 30, Temperature 98.4F, and O2 Sat of 94% on 2LNC. It just started a little while ago. Physical examination reveals a bounding pulse; distended neck veins; shallow, rapid respirations; and crackles and wheezes in the lungs. Excess fluid volume is suspected. Further checking reveals an IV fluid-administration error that has resulted in overhydration. Nursing Diagnoses -Impaired gas exchange related to disease condition as evidenced by lung sounds. -Risk for excess fluid volume related to overhydration as evidenced by observation. -Risk for electrolyte imbalance related to excess fluid as evidenced by observation. -Risk for blood pressure instability related to reduced cardiac output as evidence for fluid volume…Concept Map which consists of: 1 nursing diagnosis 1 Goal 3 Nursing interventions with rationale evaluation Completed medication cards Mr. S.B. has been a smoker for 20 years. He has noticed increased shortness of breath (SOB) for the past week and is complaining of a productive cough with thick whitish phlegm. VSS 99.9F, 92HR, 32R, and 152/90. Pulse oximetry is 90% on room air. Medications: Prednisone 10mg orally dailyProventil MDI 180mcg. 2 puffs inhaled every 6 hoursFor each of the following Patient Profiles, determine the most appropriate triage category (red, yellow, green, or black), and why. patient profiles: 1. C/O severe abdominal pain/Arm Lac - conscious - respirations : 16/min - radial pulse : present 2. asthma attack: audible wheezing - tells you his having an asthma attack - respirations : 28/min - radial pulse : present 3. pinned by beam now removed, no feelings in legs - tells you she can't feel her legs - respirations : 18/min - radial pulse : present 4. no obvious injuries - does not respond to commands - respirations : 16/min - radial pulse : present 5. multiple lacerations from glass - tells you he is going to throw up - respirations : 26/min - radial pulse : rapid and thready
- Think about the priorities inherent in the basic care and comfort needs of clients. After meeting the need for oxygenation, identify and briefly discuss the following: Discuss what actions a nurse could take to assist you with this change.All of the following are the most common ways that patients with HF present in a primary care setting except_____________? Fluid retention Sleep apnea Dyspnea Decrease exercise toleranceDiscuss the nursing interventions for a patient with Meniere's disease.
- Discuss the nursing interventions for a patient with sleep apnea.The registered nurse is evaluating a patient with pneumonia who reports chest pain during inspiration and cough. What evaluation data would be associated with this symptom?Plan, implement, and evaluate nursing care relatedto select nursing diagnoses involving oxygenationproblems.