Author Question: The nurse is changing a dry, woven gauze dressing when she notices that the gauze has inadvertently ... (Read 31 times)

Pineappleeh · **on:** Jul 24, 2018

The nurse is changing a dry, woven gauze dressing when she notices that the gauze has inadvertently stuck to the wound. What should the nurse do?

a. Pull the dressing off to aid in debridement.
b. Recover the dressing and leave in place.
c. Moisten the gauze to minimize trauma.
d. Ensure that the shiny side of the dry gauze dressing does not stick.

Question 2

When applying a hypothermia or hyperthermia blanket, the nurse should:

A. Wrap the client's hands and feet
B. Apply an axillary temperature probe or skin sensor
C. Put the client directly onto the heating or cooling blanket
D. Place the client onto the blanket and then start the heating or cooling process

TheDev123 · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

C
When a dry dressing inadvertently adheres to the wound, moisten the dressing with sterile normal saline or sterile water before removing the gauze to minimize wound trauma. Moistening the gauze applies only to dry dressings and is not applicable for moist-to-dry dressings. A dry dressing is not used for debriding wounds. Telfa gauze dressings (not dry woven gauze dressings) contain a shiny, nonadherent surface on one side that does not stick to the wound.

Answer to Question 2

A
A. Wrap client's hands and feet in gauze. This reduces risk of thermal injury to body's distal areas.
B. Monitor client's temperature and vital signs every 15 minutes during first hour, and every 30 minutes of therapy thereafter.
C. Cover the hypothermia or hyperthermia blanket with a thin sheet or bath blanket.
D. Precool or prewarm blanket, setting pad temperature to desired level.