A client has a reddened area on his right heel. What is the best intervention by the nurse to prevent further skin and tissue breakdown?
Document on the reddened area
Ask the client how the area became reddened
Assess the client’s diet
Relieve pressure from the right heel
The Correct Answer is D
Relieving pressure from the heel is essential to prevent further damage to the skin and underlying tissues. This can be achieved by using specialized cushions, repositioning the client regularly, or elevating the foot to reduce pressure.
While documenting the reddened area is important to monitor the progression of the wound, asking the client how the area became reddened and assessing their diet may not be the most relevant interventions in this situation.
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Related Questions
Correct Answer is D
Explanation
The most appropriate intervention for this client is to collaborate with the client and provider to develop a client-centered plan of care. As a healthcare provider, it is important to respect the client's cultural and religious beliefs while ensuring the client's safety and well-being. Fasting during Ramadan is an important religious practice for many Muslims, and it may not be appropriate to ask the client to abandon this practice.
However, it is also important to ensure that the client's diabetes is well-controlled and that the client is not at risk for complications such as hypoglycemia.
Correct Answer is ["A","B","C","E"]
Explanation
Eating a large meal close to bedtime can cause discomfort and indigestion, which can interfere with sleep. High levels of stress and anxiety can make it difficult to fall and stay asleep. Anxiety, in general, can interfere with sleep by causing racing thoughts and feelings of restlessness.Certain medications, such as stimulants or antidepressants, can interfere with sleep.
Having similar routines each night is actually a good sleep hygiene practice that can promote better sleep.
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