hesi v3 :NURSING transition

An induration of greater than 15mm following an Intradermal Purified Protein Derivative (Mantoux Test) indicates what? Positive test for TB (assess raised area, not erythema) An induration of 10-15mm would be positive for: Birth in country with high TB African Americans, Hispanic, Asian American in poverty areas Injectable drug users LTC Patients Medical risk factors (malnutrition, DM, etc..) An induration of 5-9mm indicates what? People in close contact with infective TB pts Abnormal chest x-rays HIV infected patients Disaster Training - Safety/priority Nurses own safety first Red - first priority - immediate treatment Yellow - 2nd - systemic injury - treat within 30-6- minutes Green - minor injury - can wait several hours Black - NO HOPE Palliative Care-MS can't swallow, on palliative care, dehydrated, doesn't want IV Keep him comfortable Ten years after a female pt was diagnosed with multiple sclerosis (MS), she is admitted to the community palliative care unit. Which intervention is most important for the nurse to include in the pt's plan of care? Medication as needed for pain and anxiety Hair loss PEDIAlopecia Frictional hair loss, abnormal Usually on back of head from laying in crib on back