Nursing interventions/priorities

Created by sdmurry 

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First-level priority problems

Airway problems; breathing problems; cardiac and circulation problems; Signs (vital signs concerns)

Second-level priority problems

Mental status change; Acute pain; acute urinary elimination problems; untreated medical problems requiring immediate attention (e.g. a diabetic who hasn't had insulin); abnormal lab values; risks of infection, safety, or security (for the patient or for others)

Third-level priority problems (later priorities)

health problems that don't fit into the above categories (e.g. problems with lack of knowledge, activity, rest, family coping)

The nursing process is:

Assessing, diagnosing, planning, implementing, and evaluting

Assessing includes

gathering data

diagnosing includes

identifying the problem and formulating a nursing diagnosis

planning includes

writing a care plan to meet the goals

implementing includes

carrying out your written care plan

evaluating includes

collecting objective data to determine the extent that goals were met or not met. Revise the plan, as needed.

Contraindications for NSAIDS (NSAIDS)

Nursing and pregnancy; Serious bleeding; Allergy/Asthma/Angioedema; Impaired renal function; Drug (anticoagulant)

syncope treatment

if the face is red, Raise the Head;
if the face is pale; Raise the Tail

healthy lifestyle modification (DRAINS)

Diet; Reduce weight; Alcohol reduced; Improve circulation (exercise); No other disease; Smoking stopped

Influenza clinical manifestations (Having Flu Symptoms Can Make Moaning Children A Nightmare)

Headache; Fever; Sore throat; Chills; Myalgias; Malaise; Cough; Anorexia; Nasal congestion

jaundice is best assessed in

sclera, nail beds, and mucous membranes

patients with Emphysema should have oxygen rates of

no more than 2 liters per minute because of longstanding hypercapnia--they are used to hypoxic drive

for patients on seizure precautions, what should be present/available?

an airway, O2, suction equipment available, rails padded, bed in low position, IV access in place

what is impetigo

a highly contagious bacterial infection of the skin.

how long are patients contagious with impetigo?

until 48 hours after initiation of antibiotic thera py

What should the nurse avoid in patients with a Wilms tumor?

excessive manipulation of the abdomen that can cause seeding of the tumor

what is the antidote to heparin?

Protamine sulfate

What is the antidote to Coumadin

Vitamin K

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