Voluntary control of bowel and bladder

Inability to control bowel or bladder function

Excessive sweating due to heat

Reduced urine output from dehydration

Muscles that are tight and rigid

Muscles with normal tone and strength

Muscles that are weak with little or no tone

Muscles that are spasming intermittently

$$8$$ – $$12$$ breaths per minute is normal

$$12$$ – $$20$$ breaths per minute is normal

$$20$$ – $$28$$ breaths per minute is normal

$$28$$ – $$36$$ breaths per minute is normal

Restricting movement to prevent injury

Moving a joint through its full range to maintain mobility and prevent contractures

Strength training with weights to increase muscle mass

Walking long distances to improve endurance

Blue

Yellow

Red

Pale white

No, decorations are never permitted

Yes, with personal items as long as it is safe and follows facility policy

Only during holidays

Yes, but only with staff-selected items

Leave the body untouched until family arrives

Provide respectful postmortem care and follow facility policy and cultural practices

Immediately remove all medical devices without documentation

Move the body to a chair for ventilation

Temporary muscle soreness after exercise

Permanent shortening of muscle or joint leading to limited movement

A sprain that heals in two weeks

A voluntary muscle spasm

On the patient’s weak side, far from the bed

On the patient’s strong side, close to the bed

Directly in front of the patient with brakes off

Behind the patient to encourage turning

Walk in silently and begin care

Knock, identify yourself, and speak before touching the patient

Turn on bright lights without warning

Move furniture to clear space without notice

At bedtime after the patient has been up all day

In the morning before the patient gets out of bed, when legs are least swollen

Only after a bath when the skin is moist

Only if the patient complains of leg pain

Assist from the left (weak) side and pivot toward the weak leg

Place the wheelchair and assist from the right (strong) side, pivoting toward the strong leg

Stand the patient without support and walk to the toilet

Pull the patient by the arms to the toilet

Turn the head first, then the shoulders, then the hips

Move the patient as one unit with the spine aligned, using a draw sheet and assistance

Twist the torso while keeping the legs straight

Lift the patient under the arms and rotate quickly

Yes, it is routine nursing care

No, toenail care should be performed by a podiatrist or per facility policy

Only if the patient requests it

Yes, but only with electric clippers

Cellulitis

Pressure ulcers

Eczema

Dermatitis

Massage directly on the reddened or ulcerated area

Do not massage the ulcer; protect the area and relieve pressure

Apply deep tissue massage for circulation

Massage only with ice

To decorate the bed

To prevent injury and skin breakdown from contact with the rail

To keep the patient from seeing outside the bed

To make the rail heavier

Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis D

$$55\%$$

$$75\%$$

$$80\%$$

$$90\%$$