Nur 2050: Final Exam Study Guide!!

What are nursing interventions/teaching for someone with thrombocytopenia? {Ans: -Protect from injury, monitor for bleeding/bruising/red patches (petechiae and ecchymosis) -Avoid IM injections, strenuous activities, aspirin/NSAIDs/anticoagulants, or sharp foods -Put prolonged pressure over injection/venipuncture sites -Use electric razors, and eat cooked food (mushy/soft) -No enemas or rectal temp., use stool softeners to avoid hemorrhoids from straining}what should nurse teach patient about a clean catch urine sample/nursing considerations? {Ans: How to obtain a clean catch: 1) Patient should first clean the tip of penis or labia 2) Patient should hold labia apart or hold penis steady 3) Then patient should urinate a small amount into the toilet 4) Then patient should urinate urine into the specimen cup 5) Then patient should urinate the rest of urine into toilet}For NG and PEG- how can you prevent aspiration, what value is a high residual? What does it mean to have a high residual? {Ans: -Do tube checks -Keep HOB no lower than 30* during continuous feeding and 1 hour after bolus feeding -Hold feeding when turning pt or during hygiene care high post residual value= non-absorption/slow absorption of tube feeds (200-250=high PVR)}what is a time-out in surgery? {Ans: before procedure