During an integumentary assessment the nurse observes multiple ...

[sarasara]

During an integumentary assessment the nurse observes multiple areas of ecchymosis over the patient's arms, legs, and upper back. What problems should the nurse consider as causes of these manifestations?
 
  Select all that apply.
 
  1. Septicemia
  2. Hemophilia
  3. Liver disease
  4. Vitamin C deficiency
  5. Vitamin K deficiency

Question 2

The nurse is preparing to assess a patient's integumentary status. What should the nurse do prior to beginning this examination?
 
  Select all that apply.
 
  1. Obtain a gown and drape for the patient
  2. Cleanse the blood pressure cuff with alcohol
  3. Obtain several pairs of disposable gloves
  4. Ensure the examination room is warm and private
  5. Place a ruler and flashlight near the examination table

[TINA]

Answer to Question 1

Correct Answer: 2, 3, 4, 5
Ecchymosis can be caused by hemophilia, liver disease, and vitamin C or K deficiency. Petechiae can be caused by septicemia.

Answer to Question 2

Correct Answer: 1, 3, 4, 5
For the examination the patient will remove all clothing and put on a gown or drape. Disposable gloves are worn when palpating lesions, skin surfaces with infections or infestations, or discharge from skin lesions and mucous membranes. The examination should be conducted in a warm, private room. A ruler is used to measure the size of lesions. A flashlight is used to better visualize lesions. A blood pressure cuff is not used for this examination.

[sarasara]

TYSM

[shailee]

Gracias!