A client on a medical-surgical unit experiences a code blue ...

[swpotter12]

A client on a medical-surgical unit experiences a code blue situation unexpectedly. The emergency situation has ended and the client survived.
 
  The nurses are breaking for lunch and plan to process their feelings about the emergency. Which action by the nurses will facilitate this?
  A) Discussing the event outside the hospital.
  B) Asking management for the use of a private room to debrief.
  C) Talking while riding in the staff elevator.
  D) Debriefing about the situation at home.

Question 2

The nurse is preparing discharge instructions for a client with an open surgical wound. Which instructions are important for the nurse to include for this client?
 
  Select all that apply.
  A) Apply lubricating lotion to the edges of the wound.
  B) Notify your doctor if you notice edema, heat, or tenderness at the wound site.
  C) Thoroughly irrigate the wound with hydrogen peroxide.
  D) Wash hands before and after changing the surgical dressing.
  E) Adjust your diet to increase the amount of protein.

[robbielu01]

Answer to Question 1

Answer: B

To comply with HIPAA, nurses cannot discuss events involving client in any setting where the conversation can be heard by others, so a private room would be the best solution to debrief. The nurses must also guard against other health professionals not directly involved with the client overhearing their discussion; consequently, a staff elevator is not acceptable. Discussing the event outside the hospital is inappropriate because anyone could overhear the conversation. This would also preclude nurses from discussing client care in the home.

Answer to Question 2

Answer: B, D, E

A client being discharged with an open surgical wound has to be instructed on the detection of infection because the skin is the first line of defense. Signs such as edema, heat, and tenderness would indicate a local infection and should be reported to the healthcare provider. Increasing protein in the diet will help to enhance wound healing. Hand hygiene before and after dressing changes is essential to decrease the risk of a wound infection. Applying lubricating lotion to the edges of a wound would impede the healing process. Irrigating with hydrogen peroxide would break down good granulating tissue, so this also would not increase healing.

[swpotter12]

Excellent

[tranoy]

TYSM