Npu1202 Osce Part B |84 Questions| With Correct Answers.

FLUID BALANCE DEFICIT: 1 goal, 4 interventions, 4 rationales, 1 way to evaluate if your care has been effective care. {Ans: Goal: fluid volume will return to within normal limits I: weigh pt daily R: 1L fluid = 1kg weight gain. I: monitor intake and output on FBC. R: decreased kidney function, cardiac insufficiency and fluid shifts may cause decreased urinary output and oedema formation - oedema fluid is not available for general circulation I: monitor vital signs including temp, pulse, rr, bp, O2 sats and cap refill R: changes in vital signs can indicate hypovolaemia. Increased temp, tachycardia, tachypnoea, hypotension, low O2 and slow cap refill due to poor blood flow r/t decreased blood volume I: evaluate pt's ability to care for their own hydration R: cognitive deficits, impaired swallow, oral discomfort, medication use may impact pt's ability to consume fluid orally Evaluation: monitor fluid balance, daily weight, vital signs and O2 saturation for changes}What is the normal SG and pH of urine {Ans: SG: 1.016 - 1.022 pH: 4.5 - 8.0 (average 5.0-6.0)}Pts care plan identifies ongoing GCS assessment. How does the nurse complete the following r/t GCS? RATE {Ans: RATE assign according to highest