/*! This file is auto-generated */ .wp-block-button__link{color:#fff;background-color:#32373c;border-radius:9999px;box-shadow:none;text-decoration:none;padding:calc(.667em + 2px) calc(1.333em + 2px);font-size:1.125em}.wp-block-file__button{background:#32373c;color:#fff;text-decoration:none} Problem 610 An 84-year-old female is brought... [FREE SOLUTION] | 91影视

91影视

Log out

Learning Materials

Features

Discover

Chapter 34: Problem 610

An 84-year-old female is brought to the E.R. presenting with confusion, restlessness and altered mental status. Which nursing action is appropriate? A. Ask the client about the medications she is currently taking. B. Give electrolyte replacing fluids. C. Refer the client for a psychiatric evaluation. D. Prepare for a physical exam including a chest \(x\)-ray; \(E K G, U A\), and \(C B C\).

Short Answer

Expert verified
D. Prepare for a physical exam including a chest x-ray; EKG, UA, and CBC.

Step by step solution

01

- Identifying Symptoms

The patient is presenting with confusion, restlessness, and altered mental status. These are critical symptoms that need immediate and thorough assessment.
02

- Considering Immediate Actions

Consider what immediate steps will help in assessing the patient's condition comprehensively. Gathering information and diagnostic testing can provide valuable insights.
03

- Evaluating Options

Review each option for appropriateness: A. Asking about medications can provide insights but may not be comprehensive enough for immediate assessment. B. Giving electrolytes can be crucial but should be informed by diagnostic results. C. Psychiatric evaluation might not address potential physical causes. D. Preparing for physical exams and tests addresses a broad range of potential issues.
04

- Selecting the Best Action

Option D prepares for a comprehensive physical exam, including necessary tests (chest x-ray, EKG, UA, CBC) which can provide a well-rounded understanding of the patient's condition.

Unlock Step-by-Step Solutions & Ace Your Exams!

  • Full Textbook Solutions

    Get detailed explanations and key concepts

  • Unlimited Al creation

    Al flashcards, explanations, exams and more...

  • Ads-free access

    To over 500 millions flashcards

  • Money-back guarantee

    We refund you if you fail your exam.

Over 30 million students worldwide already upgrade their learning with 91影视!

Key Concepts

These are the key concepts you need to understand to accurately answer the question.

Nursing Intervention
Nursing interventions are immediate actions taken by nurses to address patient needs. They鈥檙e essential in responding to symptoms like confusion and altered mental status. Effective interventions involve:
  • monitoring vital signs,
  • administering medications,
  • ensuring patient safety,
  • providing psychosocial support.
In the given exercise, preparing the patient for a comprehensive physical exam is a crucial nursing intervention. It helps diagnose underlying issues leading to altered mental status. Paying attention to the patient鈥檚 immediate needs and being ready for rapid action can significantly impact patient outcomes.
Patient Evaluation
Patient evaluation involves collecting detailed information to understand the patient's health status. In the case of altered mental status, comprehensive evaluation is key. Nurses often assess the following areas:
  • medical history,
  • current medications,
  • neurological status,
  • environmental factors.
For an 84-year-old presenting with confusion, gathering information about her medications is vital but not enough. Multiple factors, such as infections or electrolyte imbalances, could cause altered mental status. A structured evaluation helps in developing a targeted care plan.
Emergency Care Protocols
Emergency care protocols guide nurses in providing timely and effective care during critical situations. For altered mental status, protocols may include:
  • initial assessment and stabilization,
  • administering necessary fluids or medications,
  • initiating diagnostic tests,
  • ensuring patient safety and comfort.
In this scenario, option D follows emergency care protocols. Preparing for tests like chest x-ray, EKG, UA, and CBC can rapidly identify potential causes of confusion. Implementing protocols ensures systematic and efficient care, leading to quicker diagnosis and treatment.
Diagnostic Testing
Diagnostic testing is crucial for identifying the root cause of symptoms such as confusion and restlessness. Tests that can be particularly informative include:
  • Chest x-ray 鈥� checks for respiratory issues or infections.
  • EKG 鈥� assesses heart function.
  • Urinalysis (UA) 鈥� detects urinary tract infections or other abnormalities.
  • Complete Blood Count (CBC) 鈥� identifies infections, anemia, or other blood disorders.
In the example, preparing for these tests is the most appropriate action. Combined results can offer a comprehensive view of the patient's health, guiding the medical team in providing targeted treatment.

One App. One Place for Learning.

All the tools & learning materials you need for study success - in one app.

Get started for free

Most popular questions from this chapter

A child has a tonsillectomy. On return to the floor, the child is positioned prone until fully awake. Instructions given to the parents should include: (Select all that apply.) A. Avoid red liquids B. Use a straw to make drinking easier C. Cold liquids like popsicles will feel good. D. Give milk and non-acidic liquids to soothe the throat E. As soon as the child wakes up, start the child drinking

After a difficult delivery, a newborn develops a large cephalohematoma. The nurse will monitor this infant for: A. infection B. brain damage C. hyperbilirubinemia D. congestive heart failure

A child has been diagnosed with scabies. In addition to washing the child with the prescribed medication, the nurse would instruct the mother to: A. wash all bed linens in hot soapy water. B. wash all fruits and vegetables before use. C. have the family's dog checked for evidence of infestation. D. discard all of the child's clothing and replace with new clothing.

A nurse is preparing to teach a newly diagnosed diabetic about the disease. Which is the initial step the nurse should take? A. Identify the client's willingness to learn. B. Find out what the client knows about the disease. C. Determine the client's level of formal education. D. Select written material available for the client's use.

A client has had spinal surgery and the physician has ordered the client to be "log-rolled." To be log rolled, the nurse will: A. have the client turn slowly and stiffly. B. use a draw sheet to maintain body alignment. C. only position the client prone or supine to prevent spinal trauma. D. ask for assistance from another nurse to maintain the body alignment.
See all solutions

Recommended explanations on Biology Textbooks

Biological Organisms

Read Explanation

Bioenergetics

Read Explanation

Reproduction

Read Explanation

Ecological Levels

Read Explanation

Control of Gene Expression

Read Explanation

Organ Systems

Read Explanation
View all explanations

What do you think about this solution?

We value your feedback to improve our textbook solutions.

Study anywhere. Anytime. Across all devices.