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Solution Manual For Foundations and Adult Health Nursing, 8th Edition

  • Nursing
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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 0 7 : Asepsis and Infection Control Answer Keys - Critical Thinking Questions Nursing Care Plan 7 - 1 : The Patient with an Infection 1. Mr. R. has a peripheral IV infusing and reports discomfort at the site of insertion. What should the nurse do? The nurse should immediately assess the IV site for obvious dislodgment of the IV catheter, edema, erythema , or increased warmth or coolness. Coolness may indicate IV infi ltration; the other signs may indicate irritation (possibly from a previously administered medication or as an adverse effect of it) or infection. In general, if an IV site is obviously infi ltrated, nursing judgment is sufficient to determine whether to stop the IV infusion and/or remove the infi ltrated IV catheter. Warm compresses may generally be applied per nursing judgment as well. (F acility policies must be verified .) The health care provider must be notifi ed so that the determination can be made regarding the necessity to restart a new intravenous access site. 2. Mr. R. has a urinary catheter connected to continuous drainage. He reports burning at the site of insertion and the nurse note s dark, concentrated urine in the tubing. What should the nurse do next? The nurse should assess the site of the catheter insertion for any signs of edema, erythema, or exudate . The nurse should then take the patient’s vital signs, noting any change s in temperature and pulse. C ompare the data obtained with patient’s previous vital signs. ?? Following these nursing actions, the nurse should obtain urine samples for urinalysis and culture and sensitivity (using aseptic technique), in anticipation of the health care provider ’s orders to come . All of the above should then be reported to the patient’s health care provider as promptly as possible. The nurse should also encourage the patient to increase his fl uid intake. Make additional fl uids available to him, if not contraindicated. 3. The nurse note s on the sheet of lab oratory results for Mr. R. that his WBC count is 2800/mm 3 . Why is this a concern , and what is recommended as a precautionary measure? This indicates a severely compromised immune system, placing the patient at very high risk for infection. The patient is especially susceptible to microorganisms that normally do not pose a signifi cant threat to a healthy immune system. A healthy immune system will destroy or

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    Answer Keys - Critical Thinking Questions 7 - 2 deactivate most pathogens before they can multiply into greater numbers. If a patient is immunocompromised, even weaker or opportunistic pathogens (herpes varicella virus or CMV) can become established and cause infection or disease. O ften this is in a more severe form because the patient also cannot initiate an effective immune response to combat it. Mr. R. should be placed on neutropenic precautions (formerly known as reverse isolation or Protective Isolatio n ). The intent of neutropenic precautions is to minimize threats to the patient’s compromised immune status; for instance, protecting the patient from his or her environmen t. Most facilities have specifi c protocols for implementing neutropenic precautions. These generally involve a private room with the door to remain closed; limiting visitors; no obviously infected visitors; no fresh fruit, fl owers, or raw vegetables; and no open containers (juices, water, etc.) which can serve as reservoirs for environmental pathogens.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 0 8 : Body Mechanics and Patient Mobility Answer Keys - Critical Thinking Questions Nursing Care Plan 8 - 1 : The Patient with Activity Intolerance 1. The nurse is in the process of transferring Mr. D. from his bed to a chair using a mechanical lift. The nurse has prepared the chair and placed it near the bed. The nurse turns Mr. D. to his side, places the sling under Mr. D. to ensure adequate support of his head, returns Mr. D. to his back, and slowly begins to lift Mr. D. from his bed. What has the nurse forgotten to do, and why is it important? The nurse has forgotten to fold Mr. D. ’ s arms across his chest to prevent them from becoming injured during the lift. 2. The patient has a trapeze bar across the bed, trochanter rolls, and a footboard. Explain the rationale for each of these devices in maintaining proper body alignment. A trapeze bar allows the patient to use his upper body to move around in bed. T rochanter rolls stabilize the hip joint when placed firmly beside it, and prevent the hip from rolling outward. A footboard prevents permanent, abnormal plantar fl exion (footdrop) resulting from injury to the fl exor muscles.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 0 9 : Hygiene and Care of the Patient ’ s Environment Answer Keys - Critical Thinking Questions Nursing Care Plan 9 - 1 : The Patient Needing Skin Care 1. Mr. P. has a poor a ppetite and his chemistry profi le reveals low protein, low albumin, and a low anion gap ( A/G ) ratio. Explain why p oor nutrition predisposes the patient to impairment of skin integrity and poor tissue healing. Proteins, which are synthesized by the liver, are required for tissue repair and proper immune system function. The only source of proteins is through dietary intake. If a patient is undernourished, he will be unable to produce adequate protein for metabolic processes , such as tissue repair and healing, and fi ghting infection. 2. With Mr. P. ’s history of diarrhea, explain the possible complication that could evolve if dry, intact skin develops an open lesion. It is possible that an open lesion in this anatomic region may become contaminated and infected with bacteria normally found in the intestines, notably E scherichia coli . This type of situation is often diffi cult to treat with antibiotics. As a further consequence of Mr. P. ’s poor nutritional status, his immune system will be weakened and may not be able to effectively combat pathogens, making the infection even more diffi cult to manage.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 10 : Safety Answer Keys - Critical Thinking Questions Nursing Care Plan 10 - 1 : Patient Safety 1. The nurse walking down the hall hears a patient calling out for help. The nurse assesses the situation and realizes that the patient does not remember how to use the call light. What factors possibly contribute to the patient’s inability to remember, and how should the nurse teach the patient to use the call light? A patient’s memory and cognitive function can be affected by a variety of factors, such as medications, anxiety, pain, disorientation, and dementia. Sensory perceptions should be assessed by the nurse as thoroughly as possible, with information and education being provided to patients and family/visitors appropriate to level of comprehension. Reinforcement of information should be provided as necessary. Demonstrations of the use of equipment (in this case, the call light) by the nurse and return demonstrations by the patient may be appropriate in some situations, particularly if the patient is in new or unfamiliar surroundings. It is also often helpful in this type of situation if the nurse checks the patient frequently, both to assess the patient’s status and to reassure patients that they have not been left alone. Patients may need to be reoriented to surroundings frequently, especially if mental status changes are a concern. It is often helpful for a patient with sensory or cognitive impairment to be in a room close to the nurses’ station. 2. The nurse enters the patient’s room to answer the call bell and sees the patient frantically pointing to the trash can next to the bed. The nurse smells smoke and sees small flames. What should be done to help prevent fires, and what should the nurse do in this situation? The priority in this situation is to ensure patient safety. The nurse should call for assistance and implement the facility’s RACE protocol: R escue/ R emove the patient from the area; initiate the A larm process; C ontain the fi re (close fi re doors, patient room doors, etc.); E xtinguish the fi re, if realistic; and E vacuate the other patients, if necessary. Patients and visitors should be educated about facility safety policies: reinforce the no smoking policy ; and the use of equipment and personal items (hair dryers, electric shavers, lamps, etc.,) only if they meet appropriate facility codes. Safety reviews are generally conducted with facility personnel to ensure awareness of potential risks and proper safety procedures.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 16 : Care of Patients Experiencing Urgent Alterations in Health Answer Keys - Critical Thinking Questions Nursing Care Plan 16 - 1 : The Patient with a Laceration 1. Ms. T. ’s wound was superfi cial. In contrast, w hat would be the nurse’s actions if the wound appeared to be deep or was spurting blood? Firm, direct pressure must be applied to the area (the nurse should be wearing gloves) and the patient must be observed for signs and symptoms of shock. The health care provider should be notifi ed immediately by another nurse. 2. What safety measures are indicated to ensure Ms. T. is not injured again? Ms. T. may require more assis tan ce or supervision during mealtimes than she did previously . For example, she may need her food cut up , perhaps before the meal is served to her (to prevent embarrassment).

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 20 : Complementary and Alternative Therapies Answer Keys - Critical Thinking Questions Nursing Care Plan 20 - 1 : Using Complementary and Alternative Therapies in Treatment 1. Ms. L. complains of feeling fatigued and tense. List some nonpharmacologic methods of bring ing about a state of physical and mental tranquility that may be helpful. Why might each of these methods be helpful for Ms. L. ? Have Ms. L. try d rinking some nonstimulating herbal tea , accepting a thera peutic massage, or positioning for comfort and relaxation . D ecreas e the stimulation of the environment by lowe ring the intensity of the lighting and listening to soothing music or nature sounds (especially rhythmic ones, such as waves or gentle rain). 2. Ms. L. turns on her light and she is crying. She complains of feeling helpless and inadequate to assume responsibility for caring for her children and husband when she is discharged. What are some t herapeutic interventions t hat will promote her feelings of stability and validation of her anxiety ? A llow and encourage Ms. L. to express her concerns and feelings. This may result in Ms. L. verbalizing more specifi c concerns regarding her perceived inability to assume her role in the family. A nswering any questions she may have and offering information regarding the usual healing process may help to alleviate some of her anxiety.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 21 : Pain Management, Comfort, Rest, and Sleep Answer Keys - Critical Thinking Questions Nursing Care Plan 21 - 1 : The Patient with Chronic Pain 1. During the morning ADLs, Mr. J. states, “ I feel so useless. I can’t even place the urinal for myself.” What would be the nurse’s most therapeutic response? Mr. J. should be encouraged to verbalize his concerns and frustrations. “It sounds like this is very diffi cult for you,” “You sound frustrated. Is that how you are feeling?” or “Why don’t you tell me more about how you’re feeling?” may help him to feel he can safely express himself. As part of his ongoing care, Mr. J. should also be allowed as much choice and control over his nursing care and treatment regimen as possible , and should be given adequate time to perform those ADLs and self - care measures he can manage. 2. What would be the most useful nursing intervention t o achieve the goal of reduc ed pain during Mr. J. ’s assisted ambulation ? Mr. J. should receive analgesia adequate to allow him enough relief from his pain to enable him greater mobility (i.e., ambulation) without sedative effects or impaired judgment. The analgesic should be administered 30 minutes before the scheduled activity if the drug is given IV ; 45 minutes to 1 hour before if the drug is given oral ly . 3. Which comfort measures could the nurse perform to ensure that Mr. J. has several hours of restorative sleep? Position and reposition Mr. J. as comfortably and as frequently as possible . P rovid e pain - relief measures preferred by the patient, as appropriate (analgesia, relaxation therapy) before retiring for the night . M inimiz e environmental stimulation. 4. Mr. J. complains of his eyes burning and feeling dry and the lights annoying him. What measures are most likely to help relieve his symptoms? Keep the patient’s eyes free from irritants and crusting by providing warm or cool soaks (as patient prefers) to eyes . R educe corneal drying by administering artifi cial tears . D ecrease lighting while Mr. J. is in bed or in a chair, but be sure to perform appropriate nursing assessments frequently with regard to Mr. J. ’s safety.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 23 : Specimen Collection and Diagnostic Testing Answer Keys - Critical Thinking Questions Nursing Care Plan 23 - 1 : Specimen Collection or Diagnostic Examination 1. The patient has been very quiet during his morning care. When you attempt a conversation , he is obviously not interested. What is a way for you to initiate a conversation to encourage him to relate his concerns over his upcoming bronchoscopy? The nurse might say something such as, “You seem preoccupied this morning,” or “It looks like something is on your mind this morning.” A statement like or similar to this often opens channels of therapeutic communication with the nurse and results in patients expressing their concerns. If more encouragement is needed, the nurse might be more direct by asking, “What has your doctor told you about your test this morning?” or “What questions do you have about your test today?” 2. Your patient is scheduled for an intravenous pyelogram (IVP). During your preparation of this patient, he remarks he once had a reaction while eating shellfi sh. What will you probably do next? Shellfi sh, iodine, or contrast dye (as is used in many diagnostic procedures, such as CT scans and MRIs) “reactions” can indicate sensitivity or an allergy to iodine - based substances , and they should be followed up with the health care provider immediately. The nurse should obtain as much additional information from the patient and his documented medical his tory on fi le. Certain effects of the contrast dye medium used are considered responses to it (i.e., sensations of warmth, total body fl ushing, nausea) and not allergic reactions. The health care provider should be notifi ed and the patient’s direct statements should be noted. All of these actions should be documented in the patient’s medical record. In some cases an alternate contrast medium will be used during the diagno stic procedure . In some cases the original iodine - based dye will still be used; the patient will receive antihistamines as part of his preprocedure preparation to minimize the possibility of a severe adverse reaction to it. 3. The patient is obviously quite anxious about his upcoming magnetic resonance imaging (MRI) scan . He breaks out in a cold sweat, and is breathing rapidly, and when assessing his pulse , you note tachycardia. How will you respond to this patient?

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    Answer Keys - Critical Thinking Questions 23 - 2 The nurse needs to ascertain exactly why this patient is so anxious, and then relieve his anxiety if possible . This situation is very similar to one discussed previously (please refer to Critical Thinking Question No. 1), and the same basic approach is indicated. Starting with statements such as, “You seem worried (nervous, etc.) this morning,” often allow a patient the opportunity to express his fears and concerns safely. In addition to the nurse’s therapeutic responses, the patient should be asked if he would fi nd it helpful to ask some questions , have the nurse offer information about his upcoming diagnostic test, or speak with his health care provider . Some patients may be claustrophobic and this can be ascertained when discussing the patient’s concerns. The nurse should use simple language and explanations, bec a u s e people exhibiting anxiety at this level will generally be unable to comprehend or process detailed or large amounts of information.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 2 5 : Loss, Grief, Dying, and Death Answer Keys - Critical Thinking Questions Nursing Care Plan 2 5 - 1 : The Patient Experiencing Complicated Grieving (Unresolved Grief) 1. Ms. S. is admitted to the medical unit for severe weakness, weight loss, and chronic depression. She is reluctant to get out of bed to dress and have meals. How could the nurse facilitate progression through the grieving process ? Encourage and assist Ms. S. with ADLs, allowing her as much control as is reasonable. The nurse needs to be aware that too many choices or too much detail can be overwhelming for a patient who is depressed. Choices should be kept as simple as possible; for example, “Would you like me to help you bathe now, or would you rather I come back in 10 minutes?” It is also important for the nurse to be especially consistent in this type of situation. If “10 minutes” is the time frame offered, the nurse should make every effort to adher e to it. Inconsistency can accentuate a depressed patient’s feeling that she is not “worth the trouble.” Ms. S. also needs to feel that she can safely express her emotions. She should be allowed ample time and opportunity to talk about her concerns, encouraged by accepting, nonjudgmental responses from the nurse; for example, “You seem sad, Ms. S . How can I help you?” 2. Ms. S. appears thin, with poor tissue turgor. How can the nurse and dietitian encourage improvement of her nutritional status ? Ascertain Ms. S. ’s food preferences and attempt to incorporate them into her diet as much as possible. Offering frequent, small meals and snacks may also be indicated. A larger meal may seem overwhelming and require too much energy for a depressed individual. Nutritional supplements may also be an option. Monitor the patient’s i ntake and output , and record periodic weights to determine whether nutritional status is improving. 3. The nursing assessment for Ms. S. revealed a flat affect, little verbalization, and poor personal hygiene. Which therapeutic nursing interventions would help achieve patient goals and expected outcomes ? Encourage and assist Ms. S. with ADLs, and offer acceptable choices to her (for example, “Would you like a tub bath or a shower today?”). Attempts to “cheer up” the patient should not be made. These may be perceived by Ms. S. as the nurse’s inability to understand her feelings and attempts to minimize the signifi cance of her emotional pain. This can result in further withdrawal and isolation of the patient.

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    Answer Keys - Critical Thinking Questions 2 5 - 2 Nursing Care Plan 2 5 - 2 : The Patient Facing Death 1. Ms. B. complains of severe bone pain and nausea. She appears cachexic and extremely weak. What are some nursing interventions t o decrease Ms. B. ’s symptoms ? Administ e r and a ssess the effect of analgesic and antinausea medications required for increased comfort; give supplemental oxygen as ordered. Administ e r sips or drops of oral fl uids (using a syringe without a needle) to decrease some of the dehydration symptoms that accompany cachexia, although this may not be desired by Ms. B . Mouth care and ice chips may help decrease dehydration as well, but Ms. B. ’s nausea must be managed fi rst. 2. Ms. B. says, “I want to go home to die. I don’t want to stay in the hospital. All I want to do is go home and be with my family.” How can the hospice team most beneficially assist Ms. B. ? Evaluat e Ms. B. ’s situation to determine if hospice home care services can be realistically delivered. This will include assessing her home and family/support system as well. 3. When the nurse enters Ms. B.’ s room to begin ADLs, she notes the patient’s extreme fatigue and lethargy. What are some nursing interventions to conserve Ms. B.’s strength? Minimiz e environmental stimulation , perform only necessary physical care and gentle repositioning for comfort , and assess Ms. B. ’s need for analgesia (which will decrease metabolic demands and can therefore provide relaxation, as well) . E xplain all nursing actions to Ms. B .

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 2 6 : Health Promotion and Pregnancy Answer Keys - Critical Thinking Questions Nursing Care Plan 2 6 - 1 : The Patient with a Normal Pregnancy 1. How should the nurse respond to Ms. P. if she expresses concern about her dietary practices and their effect on her baby? What suggestions can the nurse give her to ensure that her diet is adequate to support the pregnancy? There is a strong correlation between maternal diet and fetal health that can be explained to Ms. P . Her concern for her baby should be viewed as a positive occurrence. Determin e Ms. P. ’s food preferences and eating habits by ask ing her to keep a food diary for a few days and to bring it with her for review at her next visit. It is important that Ms. P. be assured that this will be for her and her baby’s benefi t only. The nurse must take special care not to appear judgmental regarding Ms. P. ’s eating habits and choices. The nurse can review Ms. P. ’s nutritional needs during pregnancy and suggest ways to meet them. She will need basic nutritional education (the USDA ’ s new My Plate plan) with modifi cations addressing her vegetarian choices. Since she does eat fi sh, she can be encouraged to have at least three servings of tuna, salmon, halibut, fl ounder, or mackerel (not fried ) a week . Advise her not skip any meals. Additionally, peas, beans, and lentils and green leafy vegetables all also contain nutrients vital to normal fetal development. Ms. P. should be encouraged to increase these foods, which are staples of the vegetarian diet. It may also be easier for her to tolerate small, frequent meals rather than the usual three meals per day. Ms. P. may fi nd it helpful to speak with a dietitian (a WIC referral is appropriate, if the eligibility criteria are met). 2. Ms. P. states that she is concerned about having to reduce her activity schedule, particularly tennis, which she enjoys. She is worried she will begin to resent her baby because of the need to alter her activities. How should the nurse respond to her concerns? What suggestions should the nurse give her? The goal of exercise during pregnancy is maintenance of fi tness, but strenuous exercise should be avoided. Ms. P. should be reassured that once medically cleared by her obstetrician or midwife after the birth , she will be able to gradually resume her activities to her former levels. Ms. P. is also processing through Rubin’s four maternal tasks. She should be reassured that feelings of ambivalence are normal. Ms. P. is expressing valid concerns and should be encouraged to continue to do so.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 2 7 : Labor and Delivery Answer Keys - Critical Thinking Questions Nursing Care Plan 2 7 - 1 : The Patient with Spontaneous Rupture of Membranes 1. Ms. G.’ s labor is progressing normally with continuous monitoring. Suddenly the fetal heart rate drops to 90 bpm with late decelerations with each contraction. What should the nurse do? Explain the reason for these actions. Reposition the mother to prevent supine hypotension . A dminister oxygen via mask to increase the amount of oxygen in the mother’s blood . I ncrease maintenance IV fl uid to expand blood volume and make more available to the placenta . S top oxytoci n infusion because it intensifi es contractions and reduces placental blood fl ow , and administer tocolytic drugs to decrease uterine contractions. The health care provider should be notifi ed after these initial steps are taken to correct the decelerations. 2. Ms. G. and her coach have been working well together to manage her labor, using a focal point, breathing techniques, and guided imagery. Suddenly she becomes irritable and tells her coach, “Don’t touch me!” Her coach is bewildered by this change in behavior. How should the nurse explain Ms. G.’s behavior to her coach? How can the nurse help the coach continue to be effective during this time? Ms. G. ’s behavior indicat es she is approaching transition. During this phase of labor, the cervix dilates from 7 to 10 cm (full dilation) and it becomes completely effaced. Ms. G. is fatigue d; she may request medication but fears losing control and is obviously demonstrating irritability, all expected during this phase. The nurse can best support the coach by explaining all of this and reassuring both Ms. G. and her coach that these signs indicat e that labor is progressing normally. The coach should be encouraged to accept any negative comments from Ms. G. to be part of this process and to try not to take them personally. The coach should continue to encourage breathing and relaxation techniques, praise and reassure Ms. G. , and maintain a positive approach. Even though coaches are usually reluctant to leave the laboring woman’s side, Ms. G. ’s coach should be encouraged to take rest or snack breaks periodically to best assist Ms. G .

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 2 8 : Care of the Mother and Newborn Answer Keys - Critical Thinking Questions Nursing Care Plan 2 8 - 1 : The Mother with a Newborn 1. Even though Caleb is nursing well at each feeding, Ms. P. is anxious about her ability to successfully breast - feed. She asks how she will know whether Caleb is getting enough breast milk and whether she should supplement with formula, juice, or cereal. How should the nurse answer her? Signs that Ms. P. is successfully breastfeeding are that her breasts feel full before feedings and soften afterward; the “letd own” refl ex occurs; Baby C. nurses at each breast for 10 to 15 minutes, 8 to 10 times per day; Ms. P. hears an audible swallow as Baby C. sucks; Baby C. demands his feeding and appears relaxed after feeding; Baby C. has 6 to 8 wet diapers per day and passes stools several times per day; and Baby C. steadily gains weight and grows in length according to standardized growth charts. Supplementation with formula is not necessary if these are regular occurrences, but additional water can be offered, if Ms. P. desires. Adding juices or cereals is generally not recommended for several months, but Ms. P. should check with her pediatric health care provider for specifi c recommendations. 2. A Gomco circumcision is performed on Caleb. After the procedure is completed, Caleb is returned to his mother’s room. What should the nurse tell Ms. P. in response to her questions regarding diaper changes and care of the circumcision? How should the nurse describe the expected appearance of the circumcised penis? Petrolatum jelly or petrolatum jelly – impregnated gauze may be applied to the end of Baby C. ’s penis to prevent sticking to the diaper; the area should be checked for signs or symptoms of bleeding, irritation, or infection ( exudate , with or without odor). Baby C. ’s ability to urinate should be monitored (checking diapers and noting saturation and odor). Since during circumcision , the foreskin of the penis is removed, the head of Baby C. ’s penis will be visible and should appear pink. It may also appear slightly swollen from the recent circumcision.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 3 2 : Care of the Child with a Physical and Mental or Cognitive Disorder Answer Keys - Critical Thinking Questions Nursing Care Plan 3 2 - 1 : The Child with a Congenital Heart Disease 1. You enter D.’ s room and notice her mother sitting at her bedside crying. She states, “I don’t know how I will deal with her having heart surgery.” What would be an appropriate initial response to D.’s mother? “You sound worried. Why don’t we talk about your daughter’s surgery and any concerns you have ?” This statement and question allow Ms. B . an opportunity to express her feelings and concerns. 2. The mother states that D. has a very poor appetite. What two helpful suggestions may help educate the mother? Offering Baby D. smaller, more frequent feedings, using a soft nipple with holes large enough to prevent the baby from tiring (sucking requires a great deal of energy expenditure in this situation); and holding and comforting Baby D. during her feedings whenever possible. Offer small, nutritious snacks several times a day. 3. The mother mentions that she is concerned that D. will get an infection and become acutely ill. What are two therapeutic nursing interventions for patient teaching? Avoid crowds and people (including family members) who are ill, even with something as seemingly minor as a mild upper respiratory infection . These can be dangerous to Baby D. , whose immune system is already compromised. Immunizations should also be reviewed and updated as age - appropriate . Baby D. ’s pediatric health care provider should b e consulted for recommendations . Proper handwashing should be reviewed with Ms. B . and encouraged as well. Nursing Care Plan 3 2 - 2 : The Child Who Attempts Suicide 1. Upon entering S.’s room, the nurse notices that she is crying. She states, “I can’t live without my mother; I want to be with her.” What is an appropriate initial response? “You’ve been going through such tough times. You sound very sad right now.” This may give patient S . an opportunity to express safely her feelings further. It is important not to contradict patient S . by saying things such as, “Oh, no, you’re so young. Your mother wouldn’t want that.” Statements such as th is may be perceived as minimizing the emotional pain being experienced and emphasizing feelings of low self - worth.

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    Answer Keys - Critical Thinking Questions 3 2 - 2 2. S.’s father is concerned about taking her home after discharge. What are two therapeutic nursing interventions for patient and family teaching? Patient S . should return home with specifi c counseling appointments, and her father need s to ensure that she keeps them. (He may also be expected to attend family sessions with her.) Patient S. will also benefi t from her father displaying reassurance and a nonjudgmental manner towards her. Patient S. ’s father also needs education regarding early warning signs of suicidal ideation or gestures, such as isolation, disinterest in the future or activities with friends, and insomnia. He should also be given information regarding maintaining a safe environment for his daughter , a s well as health care provider and crisis hotline phone numbers. It should be remembered that p atient S. ’s father has also suffered a signifi cant loss (his wife), and may need help in coping with his own grief as well as caring for his daughter. 3. S. begins to express interest in others and in activities in her hospital unit. What nursing interventions would be appropriate to encourage her? It is important for the nurse to interact with patient S. in a nonjudgmental manner. Positive feedback should be given whenever she displays interest in age - appropriate activities , and the nurse should discuss patient S. ’s feeling with her after attending activities . She should be encouraged to become involved in activities that seem to interest her, but she should be reassured if interactions do not initially proceed as well as she had hoped.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 3 5 : Care of the Patient with a Psychiatric Disorder Answer Keys - Critical Thinking Questions Nursing Care Plan 3 5 - 1 : T he Patient with Depression 1. Mr. W. is admitted to the psychiatric unit and placed on suicide precautions. He sits stoically staring out the window and does not respond to the nurse’s greeting. What safety interventions should the team incorporate into Mr. W.’s care to prevent his self - destruction? Mr. W. ’s environment should be continuously monitored for safety. He may require constant (1:1 or with remote access ) visual supervision, or close supervision (visual check every 15 minutes). Potential safety hazards ( e.g. , in this case, the window) should be evaluated for possibly providing Mr. W. an opportunity for a suicide attempt. Assessing Mr. W. for increasing suicide risk should be ongoing, because his mental status may fluctuate . Many patients give some clue before exhibiting self - destructive behavior. The nurse should be especially aware of Mr. W. appearing to be deep in thought or suddenly happy. A no - suicide contract may be appropriate at some point, but should be implemented cautiously. 2. Mr. W. sleeps poorly, approximately 2 to 3 hours a night. What therapeutic interventions should be used to correct his sleep pattern disturbance? Engaging Mr. W. in activities of interest to him during the day, especially those involving some physical activity (short walks, running) or concentration (card games, sanding or pounding wood, if appropriate). These activities can also enhance Mr. W. ’s feelings of self - worth when he completes these tasks. Other nonpharmacologic nursing interventions include avoiding daytime naps, eliminating stimulants such as caffeine in the evening , and keeping a journal of daily activities and a sleep log. Pharmacologic interventions should only be implemented after considering Mr. W. ’s total treatment regimen (i.e., antidepressant medications). 3. Mr. W. has lost 32 lb. What are some options for the staff to help him meet adequate nutritional requirements? Snacks, fi nger foods, or nutritional supplements may be necessary. The nurse or dietitian should ascertain Mr. W. ’s food preferences and try to incorporate them into a dietary plan for him. Intake and output should be monitored daily until Mr. W. is able to assume responsibility for meeting his nutritional needs.

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    Answer Keys - Critical Thinking Questions 3 5 - 2 Any attempts Mr. W. makes to improve his nutritional status should be acknowledged and positively reinforced. Since patients with depression are often unable to make decisions as simple as what foods to choose, positive reinforcement has the added benefit of increasing Mr. W. ’s self - esteem , as well as improving his nutritional status.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 3 6 : Care of the Patient with an Addictive Personality Answer Keys - Critical Thinking Questions Nursing Care Plan 3 6 - 1 : T he Patient Who Abuses Alcohol 1. During Mr. J.’ s assessment, the nurse notes that he has tremors, is agitated, and verbalizes visual hallucinations. What therapeutic interventions are appropriate to perform to prevent injury to the patient? Mr. J. ’s personal safety is a priority. It will be diffi cult for nurses to anticipate fully the patient ’s perceptions, and he must be protected from harm while he is experiencing these symptoms. He should be admitted to a room as close to the nurse’s station as possible for close monitoring . Stimuli should be reduced, including decreasing the lighting in his room. He should be assessed for impending seizure activity and placed on facility seizure precautions. Medications not considered toxic to the liver, or those necessary to decrease Mr. J. ’s anxiety and increasingly irritable neurologic status ( e .g. , lorazepam [ Ativan ] or IV barbiturates ) may be indicated in certain circumstances. 2. As Mr. J.’s physical condition improves, he discloses his hopelessness and lack of desire to continue living. What is an appropriate response by the nurse? Patient safety is the priority in this situation; a safe physical environment needs to be provided and maintained at all times. Substance abusers often have low self - esteem and depression. As Mr. J. ’s physical and mental status improve, he is becoming aware of the poor choices he has previously made and their consequences. This can serve as the basis of overwhelming emotional and psychological pain, and can lead to suicidal ideation. Treatment fa cilities generally have specifi c protocols for staff to implement and follow in this potentially high - risk situation. The nurse must be aware of the patient’s increased need for acceptance and support during this time, and should reassure Mr. J. that the staff is available to him. Mr. J. should also be given opportunities and encouragement to express his concerns further . 3. During group therapy, Mr. J. states, “Now that I am physically better, I know I will be able to stop drinking. I don’t need any help. There really isn’t anything wrong with me.” What is the appropriate staff intervention at this time? Mr. J. is exhibiting denial, which must be addressed and overcome for treatment to be effective. Staff can identify and relate problems and difficulties the patient has experienced in his life that are directly related to his alcohol use. Mr. J. should also not be allowed to rationalize the circumstances of their occurrence; blaming others and not accepting responsibility for one’s actions serves as an excuse to continue both his denial and his drinking.

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    Answer Keys - Critical Thinking Questions 36 - 2 It is important that the staff interactions with Mr. J. occur in an accepting, nonjudgmental manner. Mr. J. should also be assisted and encouraged to identify his own behaviors that have caused some of these problems in his life. He needs to receive more education about alcoh olism as a disease; the signifi cant role denial plays in the disease process; and assistance with exploring alt ernate, effective ways of dealing with stressful situations.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 3 9 : Rehabilitation Nursing Answer Keys - Critical Thinking Questions Nursing Care Plan 3 9 - 1 : The Patient with Spinal Cord Injury 1. Describe the stimuli or precipitating factors associated with bowel functioning or management that have potential to cause autonomic dysreflexia. What are the appropriate interventions if it does occur? Autonomic dysrefl exia typically occurs in patients with injuries above the T - 6 level. It is usually caused by some type of noxious stimulus below the spinal cord injury activating the sympathetic nervous system. This response remains unchecked because the parasympathetic nervous system cannot descend past the level of injury. The goal of intervention is to identify and relieve the cause without further increasing the sympathetic nervous system response. The most co mmon cause of autonomic dysrefl exia is bladder distention, but it can also be caused by bowel impaction, among other stimuli. Multiple factors contribute to the risk for development of this potentially life - threatening complication in the patient with a spinal cord injury : immobility, slowed bowel motility, and loss of rectal sphincter tone. Insertion of a rectal suppository (for bowel regulation and cont inence) may precipitate dysrefl exia, as this may cause increased stimulation of the rectal area and cause exacerbation of symptoms. It is recommended that anesthetic ointment be applied to the rectum before manual disimpaction or suppository insertion to prevent this from occurring. If autonomic dysrefl exia does occur, the patient’s blood pressure should be taken immediately and then monitored every 5 minutes. (Since spinal cord injury patients are generally hypotensive, even mildly hypertensive readings may indicate a signifi cant rise from the baseline.) The patient should be placed in the Fowler position to use the effect of orthostasis to control blood pressure (i.e., induce hypotension). Once the acute episode is past, a plan to prevent reoccurrence should be devised with the patient and caregivers. 2. The patient has C5 quadriplegia. How is it possible to lessen the patient’s potential for developing orthostatic hypotension? The patient’s quadri plegia greatly increases his risk for development of orthostatic hypotension, but the prevention of it is similar to that of other patients. Patients should be taught to change position gradually, especially when raising their heads or going from the supine or horizontal position to the vertical (lying fl at to sitting to standing) position .

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    Answer Keys - Critical Thinking Questions 3 9 - 2 Use of elastic or antiembolism stockings will help promote venous return to the heart and prevent pooling of blood in the legs. A reclining wheelchair can also help lessen this response. 3. When explaining orthostatic hypotension to a new nursing assistant, what commonly occurring signs and symptoms should the nurse describe, and what instructions should be given to the nursing assistant? Common signs and symptoms of orthostatic hypotension are light - headedness , sweating ( sometimes with cool or pale skin ), and the patient may also complain of nausea or headache. The patient should immediately sit or be returned to bed and placed in the supine position. If this is not realistic ( e.g., the patient is ambulating out of her room) she should be supported by the unlicensed assistive personnel and both should gently slide down to th e fl oor, if necessary.

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    Answer Keys - Critical Thinking Questions 3 9 - 3 Nursing Care Plan 3 9 - 2 : The Patient with Traumatic Brain Injury 1. Deficits with socialization, motivation, and sexual behaviors that occur after brain injury result from damage to which portion of the brain? Discuss appropriate nursing interventions for a patient with this type of injury. These types of neurologic defi cits may be the result of damage to the cerebral cortex (which interprets stimuli) , the temporal and limbic areas (which modify responses to stimuli) , or the hypothalamus and pituitary (which coordinate the motor cortex and language areas). The brain can be seen as an inhibitor of emotions . W hen it is not fully functional, emotional responses lack this inhibition. For this reason, nurses need to ensure provision of a safe, consistent environment for patients recovering from brain injury. Reinforcement of appropriate behaviors should be provided , and redirection of the patient demonstrating inappropriate behaviors may also be necessary. Emotional support should be provided for the patient and caregivers. Additionally, the patient’s family should be involved in the plan of care. These types of outbursts and behaviors can be highly distressing to caregivers. Educating everyone involved in the patient’s care that these outbursts are the result of the patient’s disease process will assist them in developing effective coping strategies for dealing with their loved one. This information will also assist them with management of their own stress levels. Social service and rehabilitation referrals are also indicated to develop the most comprehens ive plans of patient care. 2. A patient recovering from a traumatic brain injury has problems telling the difference between objects that have a similar shape. What is this type of deficit, and what nursing interventions are appropriate for a patient with this deficit? The patient has most likely developed a form of agnosia, which is the disturbance and resultant diffi culty in interpretation of sensory information. A patient with agnosia may be unable to recognize or attach meaning to familiar faces, objects, or symbols. This can pose significant self - care defi cits and safety risks for affected patients. Appropriate nursing interventions in this case include frequent patient assessment and monitoring for safety and potential risks for injury, and adapting the patient’s environment accordingly. Additionally, using frequent cues with repetition and demonstration m ay assist the patient with defi cits (e .g. , holding up a toothbrush and imitating actions for oral care while saying to the patient, “It’s time to brush your teeth now.”). This can help to reinforce the differences between similar objects ( e.g., a toothbrush and a pencil).

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    Answer Keys - Critical Thinking Questions 3 9 - 4 3. What interventions are most appropriate to begin establishing communication with a patient who is just emerging from coma after a brain injury? Nurses should initiate communication with the patient by speaking slowly and calmly while assessing the patient’s neurologic baseline function. The nurse should also assist with helping the patient as much as possible with memory function , and orient the patient to place and time . Sensory overload (including potentially noxious stimuli) should be avoided. Anxiety and fear are to be expected from a patient in this situation; all nursing actions should be explained to the patient as simply as possible before proceeding. The nursing focus should be on providing structure at this stage of the patient ’s recovery. After interaction with the patient , the nurse will be better able to determine if alternate methods of communication will need to be used .

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 40 : Hospice Care Answer Keys - Critical Thinking Questions Nursing Care Plan 40 - 1 : The Hospice Patient with Metastatic Prostate Cancer 1. Mr. B.’ s wife complains to the hospice nurse that her husband has not had a bowel movement in 3 days. What will be included in an appropriate nursing intervention that would provide relief for Mr. B.? Mr. B. should be receiving frequent sips of liquids to increase his fluid intake , as well as foods high in fi ber as tolerated. The nurse should also obtain medical orders for a regularly (generally three times daily ) administered stool softener and a gentle laxative if he has not had a bowel movement after 2 days. 2. The nurse notes that Mr. B. is restless and demonstrates dyspnea. She performs an oximetry check on Mr. B. and notes that oxygen saturation is 83%. List three nursing interventions to improve his respiratory distress. Raise Mr. B. ’s HOB to a high Fowler’s position as tolerated; encourage deep breaths (in through his nose, out through his mouth); and administer oxygen via nasal cannula. Additionally, Mr. B. m ay be experiencing increased pain. Position changes and nonpharmacologic pain management should be implemented. If these pain control methods are not effective, opioid analgesia should be administered promptly; this will decrease his oxygen demands and ease his dyspnea.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 4 2: Care of the Surgical Patient Answer Keys - Critical Thinking Questions Nursing Care Plan 4 2 - 1 : The Postoperative Patient 1. On the second postoperative day, Mr. S. is taking shallow breaths and having difficulty complying with coughing and deep breathing. His temperature is 101.8°F (38.8°C), and he has adventitious breath sounds bilaterally in the bases. List several nursing interventions to assist Mr. S. The nurse should perform a full assessment of Mr. S. The assessment will need to include vital signs, oxygen saturation/pulse oximetry, and respiratory status. The respiratory assessment will include shortness of breath, retractions, use of accessory muscles, rate, rhythm, and cyanosis . The completed assessment will need to be completed to the charge nurse and physician. A low dose of morphine sulfate may be obtained to ease Mr. S .’s anxiety and decrease his oxygen demand. This will result in a reduction of his labored respirations. The health care provider may also order respiratory and antibiotic therapy after sputum cultures and chest x - ray films are obtained. Raising the HOB to semi - Fowler or Fowler position if possible, and ensure oxygen administration at 2 L via nasal cannula. The nurse should also encourage deeper breathing by instructing Mr. S . to breathe in through his nose and out through his mouth, or use his incentive spirometer if he is able (unlikely at this point). 2. In his third postoperative day Mr. S . has an erythematous incision with moderate amounts of purulent exudate from the Penrose drain site. List the correct nursing interventions. The incision site and vital signs will be assessed by the nurse. The findings will be reported to the health care provider. Culture of the wound exudate is indicated. The incision site should be cleansed with normal saline (or per health care provider orders) several times a day. The site and dressing should be maintained as clean, dry, and intact, which may require dressing changes several times a day using an aseptic technique. Drainage should be marked on the patient’s dressing and monitored for amount, appearance, odor, and consistency. Vital signs should be monitored every 4 hours. WBC count should also be monitored. Changes in the wound status , vital signs, signs/symptoms, or WBC count should be reported to the health care provider. 3. What signs and symptoms would the nurse note when assessing Mr. S . for dehydration secondary to elevated temperature and decreased fluid intake?

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    Answer Keys - Critical Thinking Questions 4 2 - 2 The diminished intake and elevated temperature will promote dehydration. Decreased urine output will be noted. Changes in urine characteristics may include dark color, strong odor , and elevations in specific gravity. Urine output below 30 mL/hr must be reported. Accompanying complaints may include thirst or dry mouth , dry oral mucosa. Lips may appear dry and chapped, and Mr. S . will most likely also exhibit poor skin turgor. Laboratory values most helpful in this case would be elevated BUN; unless he is developing renal problems, the hematocrit level may be elevated. Creatinine values will be within normal limits.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition Chapter 4 3: Care of the Patient with an Integumentary Disorder Answer Keys - Critical Thinking Questions Nursing Care Plan 4 3 - 1 : The Patient with Herpes Zoster 1. Ms. L. turns on her call light. She is crying and states she is in severe pain. She describes the pain as a burning, stabbing pain over her left forehead and eye. She rates her pain as a 7 on a pain scale of 0 to 10. She also complains of pruritus. What would be the most appropriate nursing interventions to provide comfort and pain control for Ms. L.? Liberal application of calamine lotion may help alleviate pruritus. Be careful not to get lotion into the eye. Ensuring administration of antiviral medication (acyclovir) on schedule is the mainstay of treatment; acetaminophen, possibly with codeine or a stronger analgesic, should also be administered on schedule for pain management. Do not exceed 400 mg of acetaminophen in 24 hours. Cold compresses may also be applied to ruptured lesions. 2. Ms. L. tells the nurse that a friend told her she could not visit because she has not had chickenpox. Her friend is afraid she might “catch chickenpox” from Ms. L.’s shingles. Describe the accurate patient teaching to give in response to Ms. L.’s statements. Herpes zoster infection is the result of the reactivation of a previous varicella (chickenpox) infection, usually in adults over age 50. Although much less communicable than varicella, it is possible for others who have not had varicella to develop it after exposure to someone experiencing an outbreak of herpes zoster. Visitors should be especially careful to avoid contact with any drainage from the patient’s lesions. Meticulous handwashing should be emphasized.

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    Answer Keys - Critical Thinking Questions 4 3 - 2 Nursing Care Plan 4 3 - 2 : The Patient with Systemic Lupus Erythematosus 1. Ms. T. has painful, edematous joints that greatly decrease her mobility. She has 4 + pitting edema to the lower extremities secondary to the loss of protein through her kidneys. What are the most appropriate nursing interventions to decrease Ms. T.’s pain level and to increase her mobility? Heat packs can be applied to relieve joint pain and stiffness. Regular exercise and movement as tolerated should be encouraged to ensure maintenance of full range of motion and to prevent contractures ; good body alignment should be maintained at all times. Physical and occupational therapy referrals should be made. Steroid therapy is often prescribed for management of inflammatory symptoms during disease exacerbations. Ms. T . will need to be observed for her response to the corticosteroids, including any adverse reactions to the medications. Because of her renal problems, Ms. T . will probably also require a low - protein, low - sodium diet. 2. On entering the room, the nurse notes Ms. T. crying. She says that her lifestyle is severely altered because she is unable to be in the sun to work in her beloved garden. What nursing interventions would be most beneficial? SLE often produces photosensitivity in patients. Ms. T . should be advised to minimize her direct sun exposure and to use a sunscreen with a minimum SPF of 15 when outdoors. She should also wear protective clothing such as a hat, long sleeves, and long pants when outdoors. Strategies to incorporate her new activity restrictions s hould be provided to Ms. T. These may include gardening at times that are not as “sunny” as well as shade gardening or possibly houseplants. In addition to avoiding excessive sun exposure, Ms. T should be advised to avoid tanning beds or salons. Occupational counseling would be helpful, also. The nurse should explore other potential areas of interest with Ms. T. 3. Ms. T. confides that she fears that this severe increase in her symptoms will lead to an early death. What initial response to this statement would be of greatest assistance? Development of a therapeutic relationship is crucial in this situation. Interpersonal communication skills will need to be used to encourage Ms. T . to verbalize her fears and concerns. Examples of appropriate nursing responses to this patient’s stated fears would include, “You sound very frightened about the effects of your illness. Would you like to talk about this?” and, “Would it help if we talked about treatment options?” Nursing responses such as these allow the patient to express concerns.

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