You are caring for a patient with a positive TB skin test (15 mm), productive cough for two months, and unintentional weight loss. Which of the following orders will assist with the diagnosis of active tuberculosis? (Select all that apply)

Choice A reason: Stage 2 pressure injuries involve partial thickness skin loss, affecting the epidermis and possibly the dermis. The wound bed appears red or pink due to exposed, viable tissue, often with serous exudate. This stage does not involve deeper structures like fat or bone, and the tissue remains intact enough for potential healing with proper care.

Choice B reason: Full thickness skin loss with visible bone is characteristic of a stage 4 pressure injury, not stage 2. Stage 4 involves damage to muscle, bone, or supporting structures, with significant tissue necrosis. Stage 2 is limited to superficial layers, primarily the epidermis and dermis, without exposure of deeper tissues like bone.

Choice C reason: Full thickness skin loss with visible adipose tissue indicates a stage 3 pressure injury. Stage 3 involves damage extending into subcutaneous fat but not to muscle or bone. Stage 2 pressure injuries are confined to partial thickness loss, affecting only the epidermis and dermis, without exposing adipose tissue.

Choice D reason: Intact skin with localized non-blanchable redness describes a stage 1 pressure injury. This stage shows no skin breakdown, only persistent erythema due to pressure-induced ischemia. Stage 2 progresses to partial thickness skin loss, with visible damage to the epidermis and possibly dermis, distinguishing it from stage 1’s intact skin.

Choice A reason: Administering insulin infusion is the priority in DKA to correct hyperglycemia and halt ketogenesis. Insulin lowers blood glucose by facilitating cellular uptake and inhibits lipolysis, reducing ketone production. This addresses the underlying metabolic derangement, preventing further acidosis and stabilizing the patient’s condition rapidly, critical for life-threatening DKA.

Choice B reason: Providing oral glucose is contraindicated in DKA, as the client already has severe hyperglycemia. Adding glucose would worsen the condition, increasing osmotic diuresis and acidosis. The focus is on lowering blood sugar with insulin and fluids, not adding more glucose, which could exacerbate dehydration and metabolic imbalance.

Choice C reason: Sodium bicarbonate may be used in severe DKA with profound acidosis (pH < 7.0), but it is not the priority. Insulin and fluid resuscitation correct the underlying cause of acidosis by stopping ketone production and restoring perfusion. Bicarbonate is an adjunct and may cause complications like hypokalemia if used prematurely.

Choice D reason: Deep breathing exercises do not address the metabolic cause of DKA. While compensatory hyperventilation (Kussmaul respirations) occurs to correct acidosis, encouraging breathing exercises does not treat hyperglycemia or ketosis. Insulin and fluids are critical to reverse the underlying pathology, making breathing exercises a low-priority intervention in this acute condition.