Author Question: The nurse is completing an admission history on a new home health patient. The patient has been ... (Read 67 times)

09madisonrousseau09 · **on:** Jul 22, 2018

The nurse is completing an admission history on a new home health patient. The patient has been experiencing seizures as the result of a recent brain injury. Which interventions should the nurse utilize for this patient and family? (Select all that apply.

a. Demonstrate how to restrain the patient in the event of a seizure.
b. Instruct the family to move the patient to a bed during a seizure.
c. Teach the family how to insert a tongue depressor during the seizure.
d. Discuss with the family steps to take if the seizure does not discontinue.
e. Instruct the family to reorient and reassure the patient after consciousness is regained.

Question 2

The nurse is caring for an older adult who presents to the clinic after a fall. The nurse reviews fall prevention in the home. Which information will the nurse include in the teaching session? (Select all that apply.)

a. Water outdoor plants with a nozzle and hose.
b. Walk to the mailbox in the summer.
c. Encourage yearly eye examinations.
d. Use bathtubs without safety strips.
e. Keep pathways clutter free.

debra928 · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

ANS: D, E
Prolonged or repeated seizures indicate status epilepticus, a medical emergency that requires intensive monitoring and treatment. Family should know what to do. Family should reorient and reassure the patient after consciousness is regained. Never force apart a patient's clenched teeth. Do not place any objects into patient's mouth such as fingers, medicine, tongue depressor, or airway when teeth are clenched. Do not lift patient from floor to bed while seizure is in progress. Do not restrain patient; hold limbs loosely if they are flailing. Loosen clothing.

Answer to Question 2

ANS: B, C, E
Walking to the mailbox in summer provides exercise when pathways are not icy and slick. Encourage annual vision and hearing examinations. Pathways that are clutter free reduce fall risk. Using a hose to water plants and using tubs without safety strips are all items the patient should avoid to help in the prevention of falls in the home.