When performing dressing changes in an older client, what should the nurse assess for?
Signs of infection
Skin color changes
Decreased pain levels
Changes in blood pressure
The Correct Answer is A
A. Signs of infection: Older adults may have compromised immune systems and are more susceptible to infections. During dressing changes, the nurse should assess for signs of infection such as increased redness, swelling, warmth, drainage, or foul odor, which could indicate an infection at the wound site.
B. Skin color changes: While changes in skin color can be indicative of various skin conditions or circulation problems, assessing for signs of infection is more pertinent during dressing changes to prevent and manage complications.
C. Decreased pain levels: Older adults may have altered pain perception due to age-related changes or comorbidities. However, assessing for signs of infection takes priority during dressing changes to ensure timely intervention if infection is present.
D. Changes in blood pressure: Changes in blood pressure may be relevant in certain clinical contexts but are not specifically related to performing dressing changes in older clients.
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Related Questions
Correct Answer is D
Explanation
A. When the patient will be resting for at least an hour: There is no specific requirement for the patient to rest after applying ointment to an inflamed skin rash.
B. In the evening before bed: While applying ointment before bed may be convenient for some patients, it may not be the best time for all patients, especially if the rash requires more frequent application.
C. In the morning before the patient dresses: Applying ointment in the morning may be appropriate, but it depends on the specific needs of the patient and the frequency of application recommended by the healthcare provider.
D. After the patient bathes: Applying ointment after the patient bathes can help ensure that the skin is clean and dry, maximizing the effectiveness of the ointment. Additionally, bathing can
help remove any debris or irritants from the skin, preparing it for the application of the ointment.
Correct Answer is C
Explanation
A. Incontinence: Incontinence can occur in older adults with UTIs, but it is not necessarily unique to this age group and can occur in individuals of all ages with UTIs.
B. Low back pain: Low back pain can be a symptom of a UTI in individuals of any age and is not specifically unique to older adults.
C. Confusion: Confusion, also known as acute delirium, is a common and often unique symptom of UTIs in older adults. It can manifest as disorientation, altered mental status, agitation, or
behavioral changes.
D. Urinary retention: Urinary retention, the inability to completely empty the bladder, is not typically associated with UTIs. It is more commonly seen in conditions such as urinary tract obstruction or neurological disorders.
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