Virtual ATI Comprehensive Predictor Exam 2022 with complete solutions

Delegation for effective task management. - ANSWER A nurse is responsible for providing clear directions when a task is initially delegated and for periodic reassessment and evaluation of the outcome of the task. RNs must delegate tasks so that they can complete higher level tasks. RNs may delegate to other RNs, PNs or APs. PNs may delegate to other PNs or APs. Predictability of outcome: Is this routine, or is this new, is there potential for complications Potential for harm: Is the client stable? Risks? Aspiration, Bleeding Complexity of Care: Does the delegatee have the license to perform the task, and the training? Need for problem solving: Does this require the nursing process? Assessment skills or judgment Level of client interaction: Is there psychosocial support needed? TO PN - ANSWER Monitoring findings Reinforcing client teaching Tracheostomy Care Suctioning NG tube patency Enteral Feedings Insert Catheter Administering Meds TO AP - ANSWER ADLs Bathing, Grooming, Dressing, Toliet Ambulating Feeding Positioning Routine tasks Bed making Specimen Collection, I and Os Vitals For stable clients Concepts of management—Strategies to identify solutions to community health problems - ANSWER Planning Organizing: Controlling: Directing: Staffing: Planning: - ANSWER What needs to be done, and who is going to do it Organizing: - ANSWER Lines of authority, communications, and where decisions are made Directing: - ANSWER Influences and motivates people to perform Controlling: - ANSWER The evaluation of performance and unit goals to ensure outcomes are met Staffing: - ANSWER Adequate staffing, and staffing mix Characteristics of managers: - ANSWER Hold formal positions of authority and power, Possess clinical expertise, Network with members of the team, Coach subordinates, Make decisions for the organization: Resources, Budget, Hiring, and Firing Conflict Management between health care workers - ANSWER Autonomy: - ANSWER The ability of the client to make personal decisions, even when those decisions might not be in the client's own best interest Beneficence: - ANSWER Care that is in the best interest of the client Fidelity: - ANSWER Keeping one's promise to the client about care that was offered Justice: - ANSWER Fair treatment in matters related to physical and psychosocial care and use of resources Nonmaleficence: - ANSWER The nurse's obligation to avoid causing harm to the client Veracity: - ANSWER The nurse's duty to tell the truth Examples when an incident report should be filed: - ANSWER Medication errors, Procedure/treatment errors, Equipment related injuries/errors, Needlestick injuries, Client falls, Visitor/Volunteer injuries, Threat made to client or staff, Loss of property. Establishing Priorities---Facility Protocols: Triage evaluation of peds - ANSWER Emergent: Urgent Nonurgent: Expectant: Emergent: - ANSWER Highest priority, life threatening injuries but also have high survival rate once stable Urgent: - ANSWER Second highest priority can wait 40-60 mins for treatment Nonurgent: - ANSWER Minor injuries that are not life threatening and do not need immediate attention Expectant: - ANSWER Lowest priority, expected to die, Comfort care, but not restorative care Determining Priority Care for a group of clients - ANSWER Prioritizing Care for multiple home care clients - ANSWER Life before limb Acute before Chronic Actual problems before potential problems Listen carefully to clients and don't assume Trends vs Transient findings Complications vs expected findings Prioritizing Care for post op clients - ANSWER Airway, Breathing, Circulation, Disability, Examination/Exposure Maslow's Hierarchy - ANSWER Physiological, Safety and Security, Love and Belonging, Self-esteem, Self-Actualization Speaking to a client who has a hearing Impairment - ANSWER Learn the clients' preferred method of communications and make accommodations. Avoid covering your mouth Sit and face the client Speak slowly and clearly Encourage the use of hearing devices Try lowering vocal pitch before increasing volume Do not shout Use brief sentences with simple words Minimize background noise Ask for a sign language interpreter if necessary Write down what clients do not understand Fractures: Care for a new Cast - ANSWER Show the procedure on a doll Assist with crutches and use Assess for warmth Assess skin Apply ice for 24hrs Assess Neuro Status Elevate the cast for the first 48 hours to prevent swelling Cover area of cast with plastic Use mole skin over rough areas Provide skin and perineal care The cast will feel warm but will not burn client Report pain that is not relieved in one hour Turn client every 2 hrs to dry Monitor for drainage Teach the parent to perform neuro checks Preparing the body for viewing - ANSWER Maintain privacy Remove all tubes Remove all personal belongings to be given to the family Cleanse and align the body supine with a pillow under the head Place the arms outside of the blanket palms down, Keep dentures in place Close eyes Apply fresh linens with absorbent pads on bed and a gown Brush the client's hair, Place hair pieces Remove excess supplies, equipment, and soilded linens Dim the lights and minimize noise Necessary Loss: - ANSWER A loss related to a change that is part of the cycle of life Actual Loss - ANSWER : Any loss of a values person, item or status Perceived loss: - ANSWER Any loss that is not obvious to others Maturational or developmental loss: - ANSWER Any loss expected of life. (Child leaving for college) Situational loss: - ANSWER Any unanticipated loss caused by an external event (home loss by tornado) Anticipatory loss: - ANSWER Experienced before the loss happens Stages of grief - ANSWER Denial, Anger, Bargaining, Depression, Acceptance. Advance directives: - ANSWER Legal documents that direct end of life issues Living Will: - ANSWER Directive documents for medical treatment per the client's wishes Health Care Proxy/Durable Power attorney: - ANSWER A document that appoints someone to make medical decisions when the client is no longer able to do son on his own behalf. Rest and Sleep—Promoting Sleep Factors that interfere with sleep - ANSWER Illness: Can require more sleep or disrupt sleep Current life events: Traveling or work hours change Emotional stress: Anxiety, fear, grief Diet: Caffeine consumption, heavy meals before bedtime Exercise: Promotes sleep if at least 2 hours before bedtime Fatigue: Exhausting or stressful work makes falling asleep difficult Sleep environment: Too light, wrong temp or too noisy Medications: Some can induce sleep, some can interfere Bedtime routine, Limit waking clients, Promote quiet, Help with hygiene, CPAP, Sleep products Limit alcohol, caffeine and nicotine at least 4 hours before bedtime. Limit fluids 2-4 hours before bed time Engage in muscle relaxation if anxious or stressed Narcolepsy - ANSWER Exercise regularly, Eat small meals high in protein, Avoid sitting too long/warm environments /alcohol, Avoid accidents, driving or heights, Take naps when drowsy, Take stimulants Medication effecting urinary output Indications for use of diuretics - ANSWER Management of blood pressure Excretion of edematous fluid related to heart failure, Kidney and Liver disease Prevention of kidney failure Emergency Response Plan - ANSWER Facility Protocols: Appropriate client for discharge in event of community disaster First discharge or relocate ambulatory clients requiring minimal care. Next, make arrangements for continuation of care for clients who require some assistance which could be provided in the home or tertiary care facility Do not discharge or relocate clients who are unstable of require continuing nursing care and assessment unless they are in imminent danger. Discharge on the fact that some will likely be able to stay Handling Hazardous and Infectious materials Cancer treatment options: Implanted internal radiation device - ANSWER Follow protocol for proper removal of dressings and bed linens from the room Waste products should not be touched by anyone Place the client in a private room and keep the door closed as often as possible Place a radiation warning sign on the door Wear a dosimeter film badge that records personal amount of radiation expose Pregnant nurses or children should not come into contact with the client or radiation source Limit visitors to 30 min visits and maintain 6 feet from the source Wear a lead apron while providing care keeping the front of the apron facing the radiation source Keep a lead container in the client's room if the delivery method could allow spontaneous loss of radioactive material. Tongs should be available for placing material into this container Brachytherapy: - ANSWER This can be placed in vagina, abdomen or IV with radionuclide iodine which is absorbed by the thyroid. Standard Precautions---- - ANSWER 1. All body fluids, except sweat 2. Nonintact skin and mucous membranes 3. These apply to all clients regardless of condition 4. If hands are not viably soiled alcohol hand rub should be used 5. Antimicrobial soap should be used if hands are soiled or contaminated with spores 6. Remove gloves and complete hand hygiene between each client 7. Masks, eye protection, and face shields are required when care might cause splashing or spraying of body fluids 8. This client does not require a private room unless they are unable to maintain appropriate hygienic practices Isolation Guidelines: - ANSWER 1. Hand hygiene and the use of barrier precautions 2. These precautions apply to every client, regardless of the diagnosis 3. Change PPE after contact with each client and between procedures with the same client, if in contact with large amounts of blood or blood fluids (compromising the PPE) 4. Higher risk for loneliness explain the reason for isolation and provide sensory stimulation Airborne Precautions - ANSWER 1. Private room 2. Masks and respiratory protections (N95 for TB) 3. Negative pressure airflow exchange of at least 6-12 exchanges per hour 4. If splashing or spraying is possible wear full face protection 1. - ANSWER Private room Droplet Precautions - ANSWER 1. A private room or room with clients with the same disease a. Ensure that clients have their own equipment 2. Masks for providers and visitors Contact Precautions - ANSWER 1. A private room or room with the same illness 2. Gloves and gown worn by caregivers, and visitors 3. Disposal of infectious dressing material into a simple non porous bag without touching the outside of the bag. Vector based Transmission: - ANSWER Animals or insect's transmission: Ticks ---Lyme disease, Mosquitoes--- West Nile and Malaria Post-Partum Physiological Adaptations Pertussis booster recommendations - ANSWER This vaccine is recommended for women who have not previously received it. Administration prior to discharge or ASAP in the post-partum period is recommended Skin infections/infestations Expected findings of pediculosis capitits - ANSWER Intense itching, Small, red bumps on the scalp, Nits (White specks on the hair shaft) Use of restraints/ Safety Devices Client safety: Appropriate use of physical restraints - ANSWER 1. Shortest duration necessary and only if less restrictive measures are not sufficient. 2. They are for the physical protection of the client of the other clients and staff 3. A client may voluntarily request temporary seclusion if environment is too stimulating 4. Restraints can be either physical, vest, belt, mitts, or chemical such as sedatives 5. The prescription must include the reason for the restraints, the type of restraints, the location, and how long to use and the type of behavior that warrants using restraints 6. The prescription allows only 4hrs of restraints for an adult, 2 hrs for clients ages 9 to 17, and 1 hour for clients under the age of 9 7. These prescriptions can be renewed for a max of 24 consecutive hours. 8. Providers cannot write PRN prescriptions for restraints 9. Explain the need for the restraints to the client and family, emphasizing that the restraints keep the client safe and are temporary 10. Ask the client or guardian to sign a consent form 11. Assess skin integrity, provide skin care every 2 hours 12. Offer food and fluids, Provide hygiene and elimination 13. Monitor Vitals, and offer range of motion exercises 14. Pad bony prominences to prevent skin breakdown 15. Use a quick-release knot to tie the restraints to the bed frame where they will not tighten when raising and lower the bed. 16. Fit two fingers between the restraint and the client 17. Never leave the client alone without the restraints Pharmacological and Parenteral Therapies Expected actions/outcomes of Parkinson's: Effects of Levodopa Levodopa is a - ANSWER Dopaminergic Due to medication tolerance and metabolism the dosage, form and administration times must be adjusted to avoid periods of poor mobility NURSING ACTION: Monitor for the "wearing off" phenomenon and dyskinesias, which can indicate the need to adjust the dosage, time, or medication holiday Dopaminergics may be - ANSWER combined with carbidopa to decrease peripheral metabolism of levodopa requiring a smaller dose to make the same amount available to the brain Medication administration Cystic Fibrosis: Teaching about pancrelipase - ANSWER Monitor stools for adequate dosing (1/2 stools/day) Administer capsules WITH ALL MEALS AND SNACKS Client can swallow or sprinkle capsules on food Teach about diet and ways increase calorie intake With what type of foods should enzymes increase? - ANSWER Increase dosage of enzymes when eating high fat foods When should clients take pancrelipase - ANSWER WITH ALL MEALS AND SNACKS Can pancrelipase capsules be broken? - ANSWER Yes, they can be swallowed or sprinkled in food Medication administration Diabetes Mellitus management: Teaching self-administration for insulin - ANSWER Instruct the client to check the accuracy of the strips with the control solution provided Instruct the client to use the correct code number in the meter to match the strip bottle number Instruct the client to store strips in the closed container in a dry location Instruct the client to obtain an adequate blood sample when performing the test Keep a record of the SMBG, Date time, glucose, dose, food and other events Rotate Injection sites, Inject at a 90 degree angle, 45 degrees if the client is thin, Advise the client to eat at regular intervals, avoid alcohol intake, and adjust insulin to exercise and diet to avoid hypoglycemia Medication Administration Self-medication administration: Error Reduction Eye Drop administration - ANSWER Wait 5-10 minutes between eye drops Avoid touching the tip of the application bottle to the eye Always wash hands before and after use Place pressure on the inner corner of the eye Medication Administration Bipolar: Teaching about mood stabilizers - ANSWER 1. Monitor plasma lithium levels during treatment, at least 5 days after starting and after any dosing changes until therapeutic level has been achieved then every 1 to 3 months 2. Blood for monitoring should be obtained in the morning usually 12hrs after the last dose 3. Maintenance level range is between 0.4 and 1.0, Greater than 1.5 can be toxicity 4. Hemodialysis may be indicated for toxic lithium levels 5. Monitor CBC, serum electrolytes, renal function tests, and thyroid function tests 6. Advise clients to take lithium as prescribed 7. Taking lithium with food can help decrease gastric distress 8. Advise clients that effects take 7 to 14 days 9. Encourage clients to adhere to lab appts 10. Emphasize the high risk of toxicity due to the narrow therapeutic range 11. Provide nutritional counseling, Stress the importance of adequate fluid and sodium intake 12. Instruct clients to monitor for manifestations of toxicity and when to contact the provider 13. Clients should withhold medication and seek medical attention if experiencing diarrhea, vomiting or excessive sweating 14. Conditions that cause dehydration such as exercising in hot weather, or diarrhea, put client at risk for lithium toxicity Intravenous Therapies Assessing the IV site - ANSWER Infiltration or extravasation Pallor, local swelling at the site, decreased skin temperature around the site, damp dressing, slowed rate of infusion Phlebitis or thrombophlebitis Edema, throbbing, burning or pain at the site, increased skin temperature, erythema, a red line up the arm with a palpable band at the vein site, slowed rate of infusion Hematoma Ecchymosis at the site Fluid overload Distended neck veins, increased blood pressure, tachycardia, SOB, crackles in the lungs, edema, additional finding varying with the IV solution Cellulitis Pain. Warmth edema, induration, red streaking, fever, chills, malaise Catheter embolus Missing catheter tip on removal, severe pain at the site with migration, absence of findings if no migration Hematoma - ANSWER Ecchymosis at the site Fluid overload - ANSWER Distended neck veins, increased blood pressure, tachycardia, SOB, crackles in the lungs, edema, additional finding varying with the IV solution - ANSWER Cellulitis - ANSWER Pain. Warmth edema, induration, red streaking, fever, chills, malaise - ANSWER Catheter embolus - ANSWER Missing catheter tip on removal, severe pain at the site with migration, absence of findings if no migration - ANSWER Pharmacological Pain Management Post-operative nursing care: Prevention of complications - ANSWER - ANSWER Some complications of surgery are - ANSWER 1. Hypovolemic shock 2. Paralytic ileus 3. Wound dehiscence or evisceration 4. Deep vein thrombosis 5. Airway obstruction 6. Hypoxia 1. - ANSWER Hypovolemic shock 2. - ANSWER Paralytic ileus 3. - ANSWER Wound dehiscence or evisceration 4. - ANSWER Deep vein thrombosis 5. - ANSWER Airway obstruction 6. - ANSWER Hypoxia Airway Obstruction - ANSWER Swelling or spasm of the larynx or trachea, mucus in the airway or relaxation of the tongue into the nasopharynx - ANSWER Nursing Considerations: for airway obstruction - ANSWER Monitor for choking, noisy irregular respirations, decreased ox stats, cyanosis Implement a head tilt, chin lift, to open the airway Keep emergency equipment at the bedside in the PACU Notify the anesthesiologist, elevate head of bed if not contraindicated, provide oxygen, and plan for reintubation with endotracheal tube - ANSWER - ANSWER Hypoxia - ANSWER Decrease in ox stats Nursing Considerations: Monitor ox stat and admin ox as prescribed Encourage coughing and deep breathing to prevent atelectasis Position client with head of bed elevated and turn every 2hr to facilitate chest expansion Decrease in ox stats - ANSWER Nursing Considerations: Monitor ox stat and admin ox as prescribed - ANSWER Encourage coughing and deep breathing to prevent atelectasis - ANSWER Position client with head of bed elevated and turn every 2hr to facilitate chest expansion - ANSWER Hypovolemic shock - ANSWER Post op shock can result from a massive loss of circulating blood volume Nursing Considerations: Monitor for decreased blood pressure and urinary output, increased heart and respiratory rates, narrowing of pulse pressure, and slow cap refill Administer oxygen Place the client in a supine position with legs elevated Administer IV Fluids and vasopressors as prescribed Post op shock can result from a massive loss of circulating blood volume - ANSWER Nursing Considerations: - ANSWER Monitor for decreased blood pressure and urinary output, increased heart and respiratory rates, narrowing of pulse pressure, and slow cap refill - ANSWER Administer oxygen - ANSWER Place the client in a supine position with legs elevated - ANSWER Administer IV Fluids and vasopressors as prescribed - ANSWER Paralytic ileus - ANSWER Can occur due to the absence of GI peristaltic activity caused by abdominal surgery or other physical trauma Nursing Considerations: for Paralytic Ileus - ANSWER Monitor bowel sounds Encourage ambulation Advance the diet as tolerated when bowel sounds, or flatus are present The client can have an NG tube inserted to empty stomach contents Administer prokinetic agents such as metoclopramide as prescribed Wound dehiscence or evisceration Caused by spontaneous opening of the incisional wound Can progress to the protrusion of the internal organs through the incision Monitor for risk factors (Obesity, coughing, moving without splinting, poor nutritional status, diabetes mellitus, infection, hematoma, steroid use) If wound dehiscence or evisceration occurs, call for help, stay with the client, cover the wound with a sterile towel or dressing, do not attempt to reinsert organs, place in a low fowlers position with hips and knees bent monitor for shock, and notify the provider immediately Causes for Deep vein thrombosis - ANSWER Caused by dehydration, stress response that leads to hypercoagulability of the blood, immobility, obesity, trauma, malignancy, history of thrombosis, hormones, and use of indwelling venous catheter Nursing considerations: for DVT - ANSWER Prophylactic measures include administration of low molecular weight heparin, low dose heparin or low dose warfarin, antiembolism stocking, pneumatic compression devices, range of motion, exercises, and early ambulation Avoid any form of pressure behind the knee with a pillow or blanket, which can cause constriction of blood vessels and decreased venous return Avoid dangling the client's legs for long periods of time Provide adequate hydration by administering IV fluids or encouraging increased oral fluid intake Health Promotion and Maintenance Priority Assessment: Membrane Rupture Ante/Intra/Post-Partum and newborn care Early Onset of Labor - ANSWER Premature rupture of membranes (PROM): Spontaneous rupture of the amniotic membranes 1hr or more prior to the onset of true labor. Temperature elevation Increased maternal heart rate or FHR Foul smelling fluid or vaginal discharge Abdominal tenderness Assess for a prolapsed umbilical cord Abrupt FHR variable or prolonged deceleration Visible or palpable cord at the introitus A positive nitrating paper test (blue, pH6.5 to 7.5) or Positive ferning test is conducted on amniotic fluid to verify rupture of membranes Nursing Care: for early rupture of membranes - ANSWER Prepare for birth if indicated: Evidence of infection or fetal or maternal compromise Obtain vaginal and rectal cultures for strep B Obtain vaginal culture for chlamydia and Neisseria gonorrhoeae Avoid vaginal exams Provide reassurance to reduce anxiety Assess vital signs every 2hrs, Notify the provider of a temperature greater than 100 Assess FHR and uterine contractions Advise the client to adhere to bed rest with bathroom privileges Encourage hydration Obtain a CBC Instruct the client to perform daily fetal kick counts and notify the nurse of uterine contractions Health Promotion and Maintenance Ante/Intra/Post-Partum and Newborn Care Newborn Nutrition: Effective breastfeeding - ANSWER Gain of 100 to 200 g/week for the first 3 months Fluid intake of 100 to 140mL/kg/24hrs 110kcal/kg/day the first 3 months 100kcal/kg/day for 3-6 months Breast milk and formula provide 20kcal/oz Carbos should make up 40-50% of the newborn's total caloric intake. Lactose is the most abundant carb in breast milk and formula At least 15% of calories must come from fat Protein: 2.25 to 4 g/kg/day Solids should not be introduced until 6 months of age Newborns should be breastfed every 2-3hrs Awaken the newborn at least every 3hrs, during the day and every 4hrs at night Breastfeeding should occur 8 to 12 times within a 24hrs window Monitor lochia for color, amount. Consistency and odor, - ANSWER Monitor Vital signs, Encourage Breastfeeding, Early and frequent ambulation, Frequent Voiding - ANSWER D&C can be necessary to remove retained placental fragments - ANSWER Inversion of the uterus - ANSWER Assess for an inverted uterus - ANSWER - ANSWER Visualize the introitus - ANSWER Perform a pelvic exam - ANSWER Maintain IV Fluids - ANSWER Administer Oxygen Stop oxytocin if it is being administered at the time uterine inversion occurred - ANSWER Avoid excessive traction on the umbilical cord - ANSWER Anticipate surgery if nonsurgical interventions and management are unsuccessful - ANSWER Retained Placenta - ANSWER Nursing Care: Monitor the uterus for fundal height, consistency, and position - ANSWER Monitor lochia for color, amount, consistency, and odor. - ANSWER Monitor vital signs - ANSWER Maintain or initiate IV fluids - ANSWER Provide oxygen at 2-3L/min per nasal cannula - ANSWER Anticipate surgical interventions, such as a D&C or hysterectomy, if post-partum bleeding is present and continues - ANSWER Lacerations and hematomas - ANSWER Assess Pain - ANSWER Visually or manually inspect the vulva, perineum and rectum for lacerations and or hematomas - ANSWER Assess an episiotomy for extension into a third- or fourth-degree laceration - ANSWER Evaluate lochia - ANSWER Continue to assess vital signs and hemodynamic status - ANSWER Attempt to identify the source of the bleeding - ANSWER Assess the provider with repair procedures - ANSWER Use ice packs to treat small hematomas - ANSWER Administer pain medication - ANSWER Encourage sitz baths and frequent perineal hygiene - ANSWER Health Promotion and Maintenance - ANSWER - ANSWER Development Stages + Transitions Burns: Dressing Change on a school age kid Minor Burns - ANSWER Stop the burning process - ANSWER Cover the burn with a clean cloth to prevent contamination - ANSWER Cleanse with mild soap and tepid water - ANSWER Do not remove blisters - ANSWER Use antimicrobial ointment - ANSWER Apply dressing - ANSWER - ANSWER Nonadherent:Fine-mesh gauze - ANSWER Hydrocolloid: Occlusive dressing Provide Warmth - ANSWER Treat additional medical care - ANSWER Provide analgesia - ANSWER Check immunization status: Administer tetanus cassine if it has been more than 5 years - ANSWER Educate the family to avoid using greasy lostions on burns - ANSWER Educate to monitor for manifestations of infections - ANSWER Major Burns - ANSWER Maintain airway and ventilation - ANSWER Provide humidified 100% supplemental oxygen - ANSWER Monitor vitals - ANSWER Maintain cardiac output - ANSWER Initiate IV access with large-bore catheter Multiple access points may be necessary - ANSWER Fluid replacement is important during the first 24 hours - ANSWER - ANSWER Isotonic crystalloid solutions during early stages - ANSWER Colloid solutions, used after the first 24-48 - ANSWER Be prepared to administer blood products Urine output of 0.5/1ml/kg/hr below 30kg - ANSWER Urine output of 30ml/hr for more than 30kg - ANSWER Monitor for manifestations of septic shock and notify the provider - ANSWER - ANSWER Alterations in sensorium (Confusion) - ANSWER Increased cap refill - ANSWER Spiking fever - ANSWER Mottled or cool extremities - ANSWER Decreased bowel sounds - ANSWER Tachycardia - ANSWER Tachypnea - ANSWER Decreased urine output Manage pain - ANSWER Monitor for respiratory depression when opioids are being used - ANSWER Prevent infection - ANSWER - ANSWER Follow standard precautions when performing wound care - ANSWER Change positions frequently - ANSWER Use client designated equipment - ANSWER Restrict visitors and plants Provide nutritional support - ANSWER - ANSWER Increase caloric and protein intake - ANSWER Administer vitamins A and C to facilitate cell growth and zinc for wound healing Restore mobility - ANSWER - ANSWER Maintain correct body alignment, splint extremities and facilitate position changes to prevent contractures - ANSWER Maintain active and passive range of motion - ANSWER Assist with ambulation as soon as the child is stable - ANSWER Apply pressure dressings to prevent contractures and scarring - ANSWER Closely monitor areas at high risk for pressure sores Provide psychological support - ANSWER - ANSWER Provide developmentally appropriate support for the child Assist with coping - ANSWER Use family centered approach - ANSWER Make referrals as needed - ANSWER Wound Care - ANSWER Premediate - ANSWER Remove previous dressings - ANSWER