The nurse is working for a medical unit in a hospital. The nurse ...

[future617RT]

The nurse is working for a medical unit in a hospital. The nurse is responsible for obtaining intake and output measurements for patients. What items should be considered intake? (Select all that apply.)
 
  a. Gelatin eaten as a snack or for lunch or dinner
  b. Water used to flush tubing between jejunostomy feedings
  c. Amount of fluid contained in the gastric suction container
  d. Volume of the blood components that were given IV
  e. Volume of the postsurgical wound drainage

Question 2

The home care nurse is admitting a patient with COPD. The primary healthcare provider has ordered O2 /nasal cannula at 3 L/min.
 
  To promote safety, the nurse would instruct the patient on which of the following safety measures? (Select all that apply.)
  a. Place No smoking signs in all areas where oxygen will be used.
  b. Instruct family and visitors who smoke that they must smoke a minimum of 10 feet from the patient.
  c. Store tanks in a small closet, trunk of a car, or near the hot water heater.
  d. Oxygen tanks should stay a minimum of 6 feet from space heaters, fireplaces, and appliances with an electric motor.
  e. Know the exit routes and where the fire extinguisher are located in the home.

[ynlevi]

Answer to Question 1

A, B, D
Fluid intake includes all liquids that a person eats (e.g., gelatin, ice cream, broth), drinks (e.g., juice, coffee, tea, water), or receives through nasogastric or jejunostomy feeding tubes. Intravenous fluids (continuous and intermittent) and blood components also count as intake. A patient receiving tube feedings may receive numerous liquid medications; water will be used to flush the tube before and/or after the medications. Liquid output includes urine, diarrhea, vomitus, gastric suction, and blood and drainage from postsurgical wounds, burns, or other tubes.

Answer to Question 2

A, D, E
Promote safety by using the following measures:
 Place No smoking signs on the patient's room door, over the bed, and in every room of the home where oxygen is used. Inform the patient, visitors, roommates, and all personnel that smoking is not permitted in areas where oxygen is in use.
 Determine that all electrical equipment in a health facility room or patient's home is functioning correctly and is properly grounded.
 Know the fire procedures and the location of the closest fire extinguisher.
 Check the oxygen level of portable tanks before transporting to ensure that there is enough oxygen in the tank.
 Store oxygen tanks in secure holders to prevent them from being knocked over.
 Store oxygen tanks 6 feet away from toys with electric motors, electric space heaters, fireplaces, electric blankets, hair dryers, or other appliances. Do not store in a trunk box or small closet.