Question

unit-7 clinical practice Activity and Excercise Preparing for Clinical Practice Mrs. Smith has experienced some success in losing weight. She states, “I feel like I should have lost more weight by now.” However, she expresses concern about how to incorporate exercise into her daily routine to maintain weight and assist with future weight loss. 1. Mrs. Smith states, “It is hard for me to determine exactly how much exercise I get doing my usual activities.” She also expresses feelings of overwhelming stress and excessive demands on her time. Which interventions do you suggest to Mrs. Smith to help assess her current level of exercise? 2. Recognizing the challenges Mrs. Smith has voiced in balancing the excessive demands on her time and incorporating an exercise program. Develop some strategies to help initiate and maintain daily exercise. 3. Develop a feedback method for Mrs. Smith, emphasizing her success in exercise and maintaining a healthy weight. Hygiene 1. During Mrs. White's stay in the hospital, a student nurse prepares to provide perineal care. Mrs. White has a urinary catheter in place. The patient asks the student nurse why chlorhexidine gluconate (CHG) wipes are being used instead of soap and water. What is the response the student nurse should give Mrs. White? 2. Because the student nurse plans to use chlorhexidine gluconate (CHG) to bathe Mrs. White, list two assessments the student should conduct that are pertinent to using the antiseptic. 3. Given Mrs. White's current condition and medical history, which of the following hygiene activities pose the greatest risk for the patient? Why? 1. Shampoo 2. Eye care 3. Mouth care 4. Foot care Fluid, Electrolyte, and Acid-Base Balance Mrs. Hilda Beck, age 72, fell at home because she became light-headed after vomiting and diarrhea that lasted over 24 hours. Even though she was nauseated, she drank some water because she knew she needed fluid. She was admitted for oral and intravenous (IV) fluid therapy. 1. What was problematic about Mrs. Beck's oral fluid replacement at home when she had vomiting and diarrhea? 2. Mrs. Beck's intravenous (IV) fluid order is 1000 mL 0.9% sodium chloride to run over 5 hours. Calculate the mL/hr that you should program into her infusion pump. 3. Mrs. Beck says, “When I get diarrhea, I should drink sodium-containing fluid when I'm thirsty.” She needs what additional teaching? Sleep Julie returns to the neighborhood health clinic for a follow-up visit. She tells you that, since she started her sleep-hygiene plan, she feels more rested. She tells you that she is concerned because her husband says that she has started snoring loudly when she's sleeping. 1. On the basis of Julie's husband's report of her snoring, which additional assessment data should you gather from her? 2. Julie tells you that her 76-year-old mother is having trouble sleep­ing after being in the hospital. Julie asks you about a prescription for a sleeping pill for her mother. What is your best response? 3. Julie and David tell you that they are concerned about their 14-year-old daughter. She just started high school and is having sleep problems. List at least three interventions for Julie and David to use to improve their teenage daughter's sleep patterns.

Answer 1

1. Exercise is the physical activity to keep body and mind fit and healthy. As she is expressing overwhelming stress , she may have not followed the correct exercise and also would have burnt more calories which may be draining her energy. So first of all Mrs. Smith height, weight and body mass index should be calculated . After calculating BMI we can determine at what stage she lies in , whether normal weight / overweight/obese and then the current level of exercise and her exercise regimen can be formulated. Her dietary plan should also be formulated to reduce her weight.

2.Teach her lifestyle changes such as diet management, necessary exercise, stress management techniques. Resistance training such as weight lifting, can increase the lean muscle mass thereby increasing the resting metabolic rate. Regular daily exercise should be encouraged.

• Plan fitness goal and record it .
• We can advice her to be regular in doing exercise.
• Advice her to start slowly and progress to next levels in exercising.
• Don't do vigorous exercises when she feels weak and drained.
• Consume food according to meal plan and if extra pre exercise snack is required she can consume it too and it should not be subtracted from meal plan.

3.She can measure her weight before she starts her exercise plan. Then daily she should track her weight. If she decides to do exercise for a month with a formulated meal plan , she could look her daily weight chart and can know about how much weight she had reduced. BMI can be calculated and through her weight chart she can understand the effectiveness of her exercises.  

HYGIENE:

1. Chlorhexidine gluconate is found to bind with the bacterial cell wall and destruct the equilibrium inside the bacterial cell leading to death of the cell. These solutions are found to decrease the incidence rate of hospital acquired infections . Evidence based researches suggest chlorhexidine gluconate solution as it prevents vaginal bacterial infections .

2.The student nurse should explain the procedure to Mrs.White and get her consent. She should also provide privacy for the patient . The student nurse should check for sensitivity for the chlorhexidine gluconate , as some patient may develop allergies. Skin color, texture should be assessed and documented prior to perineal care .  

3. Catheterization is an invasive procedure , through that patient may get infections easily. As she is diabetic , she is at high for infections . Her skin should be assessed at regular intervals, because any break in skin may lead to infections. Her skin should be kept soft and smooth .

Foot care is very essential for her.

Her feet should be inspected everyday for any cuts, abrasions , swelling and also nails should be trimmed carefully.