When teaching about wound care in the home environment, the nurse ...

[jake]

When teaching about wound care in the home environment, the nurse instructs the patient and caregiver to:
 
  a. make normal saline with 8 teaspoons of salt and .1 gallon of distilled water.
  b. use normal saline for 1 week and then discard it.
  c. not apply topical anesthetics before wound care.
  d. call the physician's office to have someone come to the home and complete the wound care.

Question 2

An appropriate method for assessing a client's respirations is for the nurse to:
 
  A. Place the bed flat
  B. Remove all supplemental oxygen sources
  C. Explain to the client that the respirations are being assessed
  D. Relax and gently place the client's hand over the upper abdomen

[bob]

Answer to Question 1

A
Teach the patient and caregiver how to make normal saline, especially if cost is an issue. They can make normal saline by using 8 teaspoons of salt in 1 gallon of distilled water and keeping it refrigerated for 1 month. The saline solution should be allowed to reach room temperature before use. Commonly used topical anesthetic solutions include 2 and 4 lidocaine jelly, which inactivates exposed wound pain receptors. Some patients need to receive wound care management in an outpatient wound care clinic. Be sure the patient has directions to the clinic and knows where to park and where to obtain dressing supplies.

Answer to Question 2

D
D. Place client's arm in relaxed position across the abdomen or lower chest, or place nurse's hand directly over client's upper abdomen
A. Be sure client is in comfortable position, preferably sitting or lying with the head of the bed elevated 45 to 60 degrees. Sitting erect promotes full ventilatory movement. Position of discomfort may cause client to breathe more rapidly.
B. Documentation should include any supplemental oxygen that the client is receiving.
C. Inconspicuous assessment of respirations immediately after pulse assessment prevents client from consciously or unintentionally altering rate and depth of breathing.

[jake]

Gracias!

[bulacsom]

TYSM