The nurse is caring for a client diagnosed with pneumonia. Which interventions should the nurse include in the plan of care? (Select All that Apply.)
Plan for periods of rest during activities, Monitoring the client's oxygen saturation
Place the client on strict fluid restriction
Placing the client on oxygen
Restrict the client's smoking to 5 cigarettes per day
Correct Answer : A,C
A. Planning for periods of rest during activities and monitoring the client's oxygen saturation are essential interventions for a client with pneumonia. Rest helps conserve energy and reduces the workload on the respiratory system, while monitoring oxygen saturation ensures that the client is maintaining adequate oxygen levels, which is crucial in pneumonia.
B. Placing the client on strict fluid restriction is not appropriate for pneumonia. In fact, adequate hydration is important to help thin respiratory secretions and facilitate expectoration.
C. Placing the client on oxygen is often necessary for clients with pneumonia, especially if they are hypoxic or have difficulty maintaining adequate oxygen levels. Supplemental oxygen supports the respiratory system and improves oxygenation.
D. Restricting the client's smoking to 5 cigarettes per day is not an appropriate intervention. Smoking should be completely stopped to help reduce the risk of further respiratory complications. Smoking cessation is a priority in managing respiratory conditions like pneumonia
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Related Questions
Correct Answer is D
Explanation
A. Sleeping on the stomach is not recommended for patients with GERD because it can increase pressure on the stomach, promoting acid reflux.
B. Lying on the right side can actually worsen GERD symptoms because it allows acid to flow more easily into the esophagus from the stomach, due to the positioning of the stomach and esophagus.
C. Sleeping on the back with the head flat does not provide sufficient elevation to prevent acid reflux, which can lead to symptoms worsening during the night.
D. Sleeping on the left side helps reduce the likelihood of acid reflux. This position prevents the stomach's contents from moving up into the esophagus, making it the most effective sleeping position for GERD.
Correct Answer is A
Explanation
A. Reviewing electrolyte values is the first action to take, as clients with acute exacerbations of ulcerative colitis are at risk for electrolyte imbalances due to diarrhea and fluid loss. It is essential to correct any imbalances promptly to avoid complications like cardiac arrhythmias.
B. While obtaining a dietary history is important to understand the client's eating habits and trigger foods, it is not the priority when the client is experiencing an acute exacerbation. Addressing immediate physiological needs comes first.
C. Checking perianal skin integrity is important, as diarrhea and frequent bowel movements can lead to irritation or breakdown of the skin, but this is not the first priority in the acute phase of exacerbation. Managing electrolyte levels and hydration takes precedence.
D. Investigating emotional concerns is important in the holistic care of the patient, but it is not the first priority in managing an acute exacerbation of ulcerative colitis. Ensuring the client is physically stable through electrolyte management is more urgent.
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