A patient is admitted to the cardiac unit.


Everyone admitted to the cardiac unit will have an EKG done unless otherwise ordered. This is an example of which type of order?

Choice A rationale:

Debridement refers to the removal of dead, damaged, or infected tissue to promote healing. It is not a term used to describe skin breakdown caused by moisture.

Choice B rationale:

Evisceration is the protrusion of internal organs through a wound or surgical incision. It is not relevant to the condition of perineal skin breakdown due to wetness.

Choice D rationale:

Dehiscence is the separation of a surgical wound. It is not applicable in this case, as there is no mention of a surgical wound.

Choice C rationale:

Maceration is a term used to describe skin that has become softened and broken down due to prolonged exposure to moisture. This is the most accurate term to describe the condition of perineal skin breakdown after sitting in wet underclothes for many hours.

Key features of maceration:

Skin softening: The skin becomes white and wrinkled, resembling a prune.

Epidermal loss: The outer layer of skin (epidermis) may slough off, leaving the underlying tissue exposed. Redness: The affected area may become red and inflamed.

Pain or tenderness: The area may be painful or tender to the touch.

Increased risk of infection: Macerated skin is more susceptible to infection due to the breakdown of the skin barrier. Causes of maceration:

Prolonged exposure to moisture: This can include sweat, urine, feces, wound drainage, or excessive bathing. Friction: Rubbing or chafing of the skin can also contribute to maceration.

Impaired circulation: Poor blood flow to the area can make it more vulnerable to maceration. Prevention of maceration:

Keep skin clean and dry: This is the most important step in preventing maceration. Change wet or soiled clothing or dressings promptly.

Apply barrier creams or ointments: These can help to protect the skin from moisture.

Use incontinence products: These can help to keep the skin dry if the patient is incontinent. Reposition the patient frequently: This helps to reduce pressure and friction on the skin.

Choice A rationale:

STAT orders are urgent and require immediate action. They are typically used for life-threatening situations or when a rapid response is needed to prevent serious harm. In this case, an EKG is important for patients admitted to the cardiac unit, but it is not necessarily an urgent procedure that requires immediate action in all cases.

STAT orders are often given verbally or over the phone, and they are typically written in all capital letters with the word "STAT" prominently displayed.

Examples of STAT orders include medications for cardiac arrest, intubation for respiratory distress, or emergency surgery for a ruptured appendix.

Choice B rationale:

PRN orders are "as needed" orders, meaning they are only carried out when a specific condition or symptom arises. They are not routinely implemented for all patients in a particular unit or setting.

PRN orders allow for flexibility in treatment plans and can help to manage pain, nausea, anxiety, or other symptoms that may fluctuate over time.

Examples of PRN orders include pain medication, anti-nausea medication, or sedatives.

Choice C rationale:

One-time orders are administered only once and are not repeated. They are often used for procedures, diagnostic tests, or medications that are not required on an ongoing basis.

In this case, an EKG is typically a one-time order for patients outside of the cardiac unit, but it becomes a standing order for patients admitted to the cardiac unit due to the increased importance of cardiac monitoring in this setting.

Examples of one-time orders include a chest X-ray, a blood draw, or a dose of antibiotics.

Choice D rationale:

Standing orders are routine orders that are implemented for all patients in a particular unit or setting, unless otherwise specified. They are designed to provide consistent and standardized care, and they often reflect best practices or guidelines for a specific patient population.

Standing orders can help to streamline care processes, reduce the need for individual orders, and ensure that patients receive necessary treatments or interventions without delay.

In this case, the standing order for an EKG upon admission to the cardiac unit ensures that all patients receive this important cardiac assessment, even if the ordering provider does not specifically write an order for it.

Other examples of standing orders in a cardiac unit might include daily weights, regular vital sign checks, or administration of cardiac medications.