Chapter 19 Implementing Nursing Care WGU C825 Intro to Nursing: Lab Prep Questions & Answers. 100% Accurate (2024/25 exam UPDATES. APPROVED)

Chapter 19 Implementing Nursing Care WGU C825 Intro to Nursing: Lab Prep Questions & Answers. 100% Accurate Tonya is preparing to change the dressing over Mr. Jacobs' wound, and Mrs. Jacobs is present to observe. Tonya determines Mr. Jacob's level of pain to be sure that he is comfortable. She decides to include discussion of wound and urinary catheter care during her time with the family. Before beginning instruction with the Jacobs, Tonya asks Mr. Jacobs if he is ready to learn about wound and catheter care. She observes Mr. and Mrs. Jacobs' behaviors to note their receptivity to instruction. She prepares all of her supplies before the dressing change. She also assesses the condition of the dressing before she starts. 1When Tonya asks Mr. Jacobs about his readiness for instruction, which aspect of the implementation process is she performing? - -1. Reassessing the patient. Reassessment occurs each time a nurse interacts with a patient. Tonya wants to reassess the patient's readiness for learning to be sure that the nursing diagnosis of deficient knowledge is relevant and that Mr. Jacobs will likely respond favorably to teaching. Her information determines if any modification of the care plan is needed. 2When changing Mr. Jacobs' dressing, Tonya cleans the wound following clinical practice guidelines for her nursing unit and checks the incision for signs of infection. Explain the benefit of cleansing the wound on the basis of practice guidelines. - -2. Using standardized interventions makes it quicker and easier for nurses to intervene. But more important, if the standards are evidence based, a nurse's actions are more likely to meet desired outcomes and ensure safe and effective nursing care. 3When Tonya begins instructing the Jacobs about wound care, what implementation skill most likely ensures good outcomes, specifically that the patient is able to learn how to change his dressing correctly at home? - -3. Interpersonal skills. Tonya must use good interpersonal skills to establish trust and show caring so she can clearly communicate instructions in a way that the patient will be receptive. 1 The nurse enters a patient's room and finds that the patient was incontinent of liquid stool. The patient has recurrent redness in the perineal area, and there is concern that he is developing a pressure ulcer. The nurse cleanses the patient, inspects the skin, and applies a skin barrier ointment to the perineal area. She calls the ostomy and wound care specialist and asks that he visit the patient to recommend skin care measures. Which of the following describe the nurse's actions? (Select all that apply.) 1The application of the skin barrier is a dependent care measure. 2The call to the ostomy and wound care specialist is an indirect care measure. 3The cleansing of the skin is a direct care measure. 4The application of the skin barrier is a direct care measure. - -1. Answer: 2, 3, 4.