1
Hondros Nursing- Nur 150: Exam 2,
g g g g g
STUDY GUIDE 2023-
g g
2024 GUARANTEED PASS
g g
, 2
HondrosgNursing-gNurg150:gExamg2,gSTUDYgGUIDE
Stageg1gpressuregulcer
Intactgskingwithgnonblanchablegrednessg
Stageg2gpressuregulcer
Partialglossgofgdermis.gShallowgopeng
ulcer,gusuallygshiny,gorgdry.gRed-
pinkgwoundgbedgwithoutgsloughinggo
rgbruis-
Stageg3gpressuregulcer
ing.
Fullgthicknessgtissuegloss,gsubcutaneousgfa
tgmaygbegvisible.gPossiblegundermining
Stageg4gpressuregulcer
andgtunneling.
Fullgthicknessgtissueglossgwithgexposedg
bone,gtendon,orgmuscle.gSloughgorgesc
hargmaygbegpresentgasgwellgasgunder-
mininggandgtunneling.
Fullgthicknessgtissuegloss,gwoundgbase
Unstageablegpressuregulcer coveredgbygsloughgandgeschargtherefor
dullgdepthgcannotgbegdetermined.
FibrousgtissuegingwoundgbedgthatgcangbegS
oughgyellow,gtan,ggray,ggreen,gorgbrown.
Nursing interventions to DRI
preventgpressuregunlcers
Cognition
ExternalgnutritiongParenter
algnutrition
, 3
Repositiongbedgboundgptgeverygtwog
hours,ginstructgptgingwheelchairgtogsh
iftgtheirgweightgeveryghour.gUsegofgcu
shions
timizegnutritiongandghydration.
Allgthegprocessesginvolvedginghuma
n
thog
ugh
gt
Nutritiongsupportgviagtube
gfeedings
Nutritiongsuppliedgintravenously
Refersgtogagsetgofgnutritionalgbasedg
val-
uesgthatgservegforgbothgassessingg
and
, 4
andgbarriergcream.gManagegmoisture,g
op-
Three ways to confirm proper Chestgx-
NGgplacement ray,gPHgtestggastricgcontents,gairgbolus.
planninggdiets
With tube feeding what must
begmonitoredgdaily
I/O,gdailygweight,gdailyglabsgFatalg
riskgofgdysphagia
Aspirationgpne
umonia
Nectargthickened
Aglittlegslowergofgthegspoongthangwaterg
Verygmuchgslowergoffgthegspoongthangwa-
Honeygthickened
ter
Spoongthickened Willgnotgdropgoffgspoon
Puddinggconsistencygsuchgasgmashedgpo
PuréedgMe atoes,gvegetables,gpastagingpuddinggcons
tency
chanicalgsoft Allgfoodsgexceptghard,gcrunchy,gorgstickygIn
ludesgmoistgandgsoftgfoodsgsuchgas
Dysphagiagadvanced cookedgcereal,gcannedgfruit,gnoodlesgingsauce.
Recommended for first 24-48
hoursgafterginjury.gDogn
otgapplygtogredgorgbluegareas.gColdgtherapygNC
Checkgconditiongofgskingeveryg5gminutesgw
engusinggelectricalgcoolinggdevice.
Whatgcolorgshouldgthegcontentsgbegwhen
Green, brown, or
aspiratinggangNGgtube
Cautiongwithgdigitalgimpactiongremoval tangCardiacgpatient
Hondros Nursing- Nur 150: Exam 2,
g g g g g
STUDY GUIDE 2023-
g g
2024 GUARANTEED PASS
g g
, 2
HondrosgNursing-gNurg150:gExamg2,gSTUDYgGUIDE
Stageg1gpressuregulcer
Intactgskingwithgnonblanchablegrednessg
Stageg2gpressuregulcer
Partialglossgofgdermis.gShallowgopeng
ulcer,gusuallygshiny,gorgdry.gRed-
pinkgwoundgbedgwithoutgsloughinggo
rgbruis-
Stageg3gpressuregulcer
ing.
Fullgthicknessgtissuegloss,gsubcutaneousgfa
tgmaygbegvisible.gPossiblegundermining
Stageg4gpressuregulcer
andgtunneling.
Fullgthicknessgtissueglossgwithgexposedg
bone,gtendon,orgmuscle.gSloughgorgesc
hargmaygbegpresentgasgwellgasgunder-
mininggandgtunneling.
Fullgthicknessgtissuegloss,gwoundgbase
Unstageablegpressuregulcer coveredgbygsloughgandgeschargtherefor
dullgdepthgcannotgbegdetermined.
FibrousgtissuegingwoundgbedgthatgcangbegS
oughgyellow,gtan,ggray,ggreen,gorgbrown.
Nursing interventions to DRI
preventgpressuregunlcers
Cognition
ExternalgnutritiongParenter
algnutrition
, 3
Repositiongbedgboundgptgeverygtwog
hours,ginstructgptgingwheelchairgtogsh
iftgtheirgweightgeveryghour.gUsegofgcu
shions
timizegnutritiongandghydration.
Allgthegprocessesginvolvedginghuma
n
thog
ugh
gt
Nutritiongsupportgviagtube
gfeedings
Nutritiongsuppliedgintravenously
Refersgtogagsetgofgnutritionalgbasedg
val-
uesgthatgservegforgbothgassessingg
and
, 4
andgbarriergcream.gManagegmoisture,g
op-
Three ways to confirm proper Chestgx-
NGgplacement ray,gPHgtestggastricgcontents,gairgbolus.
planninggdiets
With tube feeding what must
begmonitoredgdaily
I/O,gdailygweight,gdailyglabsgFatalg
riskgofgdysphagia
Aspirationgpne
umonia
Nectargthickened
Aglittlegslowergofgthegspoongthangwaterg
Verygmuchgslowergoffgthegspoongthangwa-
Honeygthickened
ter
Spoongthickened Willgnotgdropgoffgspoon
Puddinggconsistencygsuchgasgmashedgpo
PuréedgMe atoes,gvegetables,gpastagingpuddinggcons
tency
chanicalgsoft Allgfoodsgexceptghard,gcrunchy,gorgstickygIn
ludesgmoistgandgsoftgfoodsgsuchgas
Dysphagiagadvanced cookedgcereal,gcannedgfruit,gnoodlesgingsauce.
Recommended for first 24-48
hoursgafterginjury.gDogn
otgapplygtogredgorgbluegareas.gColdgtherapygNC
Checkgconditiongofgskingeveryg5gminutesgw
engusinggelectricalgcoolinggdevice.
Whatgcolorgshouldgthegcontentsgbegwhen
Green, brown, or
aspiratinggangNGgtube
Cautiongwithgdigitalgimpactiongremoval tangCardiacgpatient
