Question

A nurse is planning care for a morbidly obese 75-year-old adult patient with a Stage I pressure ulcer on the sacral area and a mid-line abdominal incision that requires a wet to dry dressing change. The patient has a history of diabetes mellitus (DM), anemia, and arterial insufficiency. The patient has an indwelling catheter due to frequent incontinence and has limited mobility. The doctor has ordered a sterile urine specimen to be collected. (20 points each)

·        Identify the steps the nurse should take to collect the urine specimen from the indwelling catheter.

·        Describe the nursing interventions the nurse should take to prevent further skin breakdown?

·        Discuss what specific components of the patient’s past medical history and current presentation may lead to poor wound healing.

·        While the nurse prepares for the abdominal dressing change, he finds that the previous dressing is adhered to the wound bed. Prioritize the appropriate next steps for the nurse to take with rationale.

·        Describe the principles of maintaining a sterile field when performing a sterile dressing change.

Answer 1

1, ensure patient has a fullbladder, clean the catheter valve port with alcohol swab and allow to dry.open the valve again and allow some urine to go out. open the valve again and empty the remaining urne into sterile container. avoid valve does not come into contact with sterile container.close the lid tightly.close the valve and wipe the port with an alcohol swab.
2, Keep the skin clean and dry, do not massage or rub the patient skin vigorously, use skin cleanser with correct PH and dry thoroughly. keep the pillows under the pressure area.encourage ambulation if the patient can. change the patient position every 2 hours. make sure patient nutritional status is adequate to improve wound healing.
3, patient chronic conditions like diabetes, material insufficiency impact body natural ability to recover. patient diabetes causes a metabolic disorder that narrows the blood vessels and decrease the blood flow to the affected area. due to poor circulations, it interferes the wound healing process. urinary incontinence alters the skin integrity that causes poor wound healing.
4, dressing is a painful experience for the patient. take time to soak the old dressing until it easily removed without damage, use soft silicone, alginate, and Hydrofiber dressing that is less adherent and easy to remove.select the product that is gentle to the skin and prevent adherence.