Which patients will the nurse determine are in most need of regular perineal care? (Select all that apply.)
A patient who has an indwelling catheter
A patient with urinary and fecal incontinence
A patient with rectal and genital surgical dressings
A bariatric patient
A circumcised male who is ambulatory
Correct Answer : A,B,C,D
A. A patient with an indwelling catheter requires regular perineal care to prevent infection due to increased risk from the catheter.
B. Urinary and fecal incontinence increase the risk of skin breakdown and infection, necessitating frequent perineal care.
C. Surgical dressings in the rectal and genital areas require perineal care to maintain hygiene and prevent wound contamination.
D. Bariatric patients often need regular perineal care due to skin folds and increased risk of moisture-related skin breakdown.
E. A circumcised, ambulatory male typically has a lower risk of infection and may not require as frequent perineal care unless other factors are present.
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Correct Answer is A
Explanation
A. After a nurse is exposed to blood from a cut by a used scalpel, it is crucial to test the patient for bloodborne pathogens (e.g., HIV, hepatitis B, hepatitis C) and to offer post-exposure prophylaxis or treatment to the nurse if indicated.
B. While removing gloves and disposing of them properly is part of standard infection control practices, it is not the primary process required after an exposure incident.
C. Although the nurse should report the incident, providing a medical evaluation should follow the protocols established by the facility, not just the manager's assessment.
D. Properly disposing of the scalpel in a sharps container is necessary for safety but does not directly address the required process for managing exposure to blood.
Correct Answer is C
Explanation
A. While metabolic acidosis is a potential concern for some diabetic conditions, avoiding acidic foods is not a common dietary guideline for managing diabetes.
B. Including dairy can contribute to calcium intake but does not directly impact diabetes management.
C. Staying hydrated is essential for overall health and helps regulate blood sugar levels, making it an appropriate dietary recommendation for this patient.
D. Since the patient does not require insulin, strict carbohydrate reduction may not be necessary, making this option less relevant.