An older adult client is recovering in the intensive care unit ...

[melly21297]

An older adult client is recovering in the intensive care unit (ICU) from septicemia. Which intervention will help prevent further infection for this client?
 
  A) Foley drainage on the bed at the client's feet
  B) Oral and skin care
  C) Turn, cough, and deep breathe q shift.
  D) Sterile wound care

Question 2

A nurse working in the intensive care unit (ICU) is receiving a client diagnosed with early septic shock from the emergency department (ED). The nurse will recognize which symptoms associated with this condition?
 
  Select all that apply.
  A) Normal blood pressure
  B) Rapid and deep respirations
  C) Shallow respirations
  D) Warm and flushed skin
  E) Lethargic mental status
  F) Decreased urine output

[Kjones0604]

Answer to Question 1

Answer: B

Good oral and skin care will prevent breakdown and prevent entry by bacteria. In order to prevent skin breakdown and promote respiratory function, the client is turned at least every 2 hours. The Foley drainage bag is always kept below the level of the client's bladder to prevent reflux. There is no evidence that this client has a wound.

Answer to Question 2

Answer: A, B, D

Septic shock has an early phase and a late phase. Early-phase manifestations include normal blood pressure, rapid and deep respirations, and warm or flushed skin. The other manifestations occur in the late phase of shock.

[melly21297]

Thank you

[Kjones0604]

Happy to help you