Asked by Jenna Carlee on Apr 27, 2024
Verified
The nurse is caring for a patient who is immobile. The nurse wants to decrease the formation of pressure ulcers. Which action will the nurse take first\bold{first}first ?
A) Offer favorite fluids.
B) Turn the patient every 2 hours.
C) Determine the patient's risk factors.
D) Encourage increased quantities of carbohydrates and fats.
Pressure Ulcers
Localized damage to the skin and underlying tissue, usually over a bony prominence, caused by pressure or friction.
Turn Patient
The act of repositioning a patient who is unable to move themselves, to prevent bedsores and promote circulation.
Risk Factors
Attributes, characteristics or exposures that increase the likelihood of a person developing a disease or injury.
- Examine the factors contributing to the development of pressure sores.
- Apply and appraise measures to decrease risks tied to immobilization and dermal impairments.
Verified Answer
OO
oluwatobiloba OlayemiApr 28, 2024
Final Answer :
C
Explanation :
The first step in prevention is to assess the patient's risk factors for pressure ulcer development. When a patient is immobile, the major risk to the skin is the formation of pressure ulcers. Nursing interventions focus on prevention. Offering favorite fluids, turning, and increasing carbohydrates and fats are not the first steps. Determining risk factors is first so interventions can be implemented to reduce or eliminate those risk factors.
Learning Objectives
- Examine the factors contributing to the development of pressure sores.
- Apply and appraise measures to decrease risks tied to immobilization and dermal impairments.