Cephalohematoma If cervical-ripening agents (Cytotec, Cervidil, and Prepidil) are used, baseline data on Monitor FHR and patterns in conjunction with A nurse is preparing to educate a client with diabetes who has a new prescription for metformin. HHS Vulnerability Disclosure, Help Blood loss is greater, and the repair is more difficult Wound infection Common side effects of oxytocin include: Slow heart rate Fast heart rate Premature ventricular complexes and other irregular heartbeats ( arrhythmias) Permanent central nervous system (CNS) or brain damage, and death secondary to suffocation Neonatal seizure Neonatal yellowing of skin or eyes ( jaundice) Fetal death Low Apgar score (5 minutes) Report excess bleeding, signs of infection, check site daily, apply ice to site to prevent bleeding, avoid aspirin, return in 7-10 days to remove sutures. Identify two (2) adverse effects related to this medication. Definitions Uterine tachysystole: 5 or more contractions in 10 minutes over a 30 minute period. The effects happen immediately because the half-life of oxytocin is approximately 3 minutes. -Severe abdominal pain Decreased gastric emptying (N/V), inhibition of bowel/bladder elimination sensations, bradycardia/tachycardia, respiratory depression, hypotension. Symptoms of mild to moderate OHSS include: Abdominal pain. (See Uterine Hyperactivity under General Precautions.) Symptoms Signs and symptoms of endometrial cancer may include: Vaginal bleeding after menopause Bleeding between periods Pelvic pain When to see a doctor Make an appointment with your doctor if you experience any persistent signs or symptoms that worry you. Grignaffini A, Soncini E, Ronzoni E, Piazza E, Anfuso S, Vadora E. J Gynecol Obstet Biol Reprod (Paris). Assist in positioning the client on the operating table. The beam weighs 7 lb. Turn the stockings inside to the heel, place on the foot, pull the remainder of the stocking over the heel and on the leg, smoothing any creases or wrinkles. and reapplied. Postmaturity of the fetus. Arrest of rotation. uterine overdistention. Performed at 10-13 wks gestation. Maternal lacerations to the cervix, vagina, or perineum, Maternal exhaustion and ineffective pushing efforts The .gov means its official. consists of using an instrument with two curved spoon-like blades to assist in the delivery of the fetal head. Identify three (3) priority teaching points to include when educating a client to use a cane. A nurse is caring for a client who has been admitted with renal calculi. All students were required to get some practicalpracticalpractical experience on the job before they could receive a diploma. Episiotomy location, stiches, edema, redness A client with peripheral vascular disease had a below the knee amputation three months ago. Put pt in side-lying position to increase uteroplacental perfusion. Although the vast majority of these patients had a decrease of the hyperstimulation while being given the magnesium, 31.8% in the group receiving oxytocin alone (P less than .05). Maternal medical complications Ruptured membranes, Shorten the second stage of labor Warm fluid using a blood warmer prior to infusion. ), therapeutic Procedures to assist with labor and delivery, Malpositioned fetus in breech or transverse position after 36 weeks, Nursing actions for ECV: Preperation for procedure, -Continous FHR pattern monitoring: to look for bradycardia and variable deceleration during procedure and 1 hr after it. Methylphenidate hydrochloride (ADHD med) - reduces symptoms of hyperactivity and impulsive behavior, increase attention and concentration span, by increasing dopamine levels in the brain. Follow recommendations by the manufacturer for product use to ensure safety. This med is approved only for female clients who have severe IBS-D that has lasted more than 6 months and has been resistant to conventional management. Animals (Basel). This includes: Diagnosis and Tests What categories should the nurse use and what do these mean? Meditation uses rhythmic breathing to calm the mind and the body. Thrombophlebitis Shorten the second stage of labor Late = Placental insufficiency, - Maternal postpartum assessment How should the nurse respond when the client requests information about meditation? sharing sensitive information, make sure youre on a federal the following sentences. -Prior to the administration of oxytocin, it is essential that the nurse confirm that the fetus is engaged in the birth canal at a minimum of station 0. A nurse is caring for a client following a bone marrow biopsy. S&S - eyes may appear crossed, eye may wander when opposite eye is covered, uncoordinated eye movements, asymmetrical corneal light reflex. No other uterine scars or hx of previous rupture Oxytocin is administered intravenously so that when there is hyperstimulation, then it could be quickly discontinued. However, an adverse reaction or incorrect dosage can lead to uterine tachysystole. 2022 Nov 3;12(11):2675. doi: 10.3390/diagnostics12112675. Measure calf/thigh circumference and the length of the leg to select correct TEDS size. Meconium-stained amniotic fluid and fetal oxygen saturation measured by pulse oximetry during labour. deliberate initiation of uterine contractions to stimulate labor before spontaneous onset to bring about the birth by chemical or mechanical means, Mechanical or chemical approaches Reproductive system. is the stimulation of hypotonic contractions after labor has spontaneously started, with oxytocin Postterm pregnancy. -Monitor FHR and contraction pattern every 15 min and with every change in dose. contractions. IUPC-identified pressures higher than 90 mm Hg, resting tone of the uterine higher than 20 mm Hg between the . Uses for Oxytocin Elective induction of labor (i.e., no medical indication for induction) merely for clinician or patient convenience is not a valid indication for oxytocin use. Estimate the beam stiffness k. External cephalic version (ECV) is the attempt to manipulate the abdominal wall todirect a malpositioned fetus into a normal vertex cephalic presentation after 37 weeksof gestation. Ciprofloxacin SE: GI discomfort (Nausea, vomiting, diarrhea), Achilles tendon rupture, suprainfection (thrush, vaginal yeast infection), phototoxicity (severe sunburn). Measure calf/thigh circumference and the length of the leg to select correct TEDS size. doi: 10.1016/j.jgyn.2007.11.009. Hyperkalemia, hypercalcemia, hyponatremia, hypoglycemia, decreased cortisol levels, increased BUN/Creatinine. Mild to moderate OHSS With mild to moderate ovarian hyperstimulation syndrome, symptoms can include: Mild to moderate abdominal pain Abdominal bloating or increased waist size Nausea Vomiting Diarrhea Tenderness in the area of your ovaries forceps will cause a decrease in the FHR. Oxytocic; indirectly stimulates contraction of uterine smooth muscle; elicits all the responses of endogenous oxytocin. the birth canal at a minimum of station 0. Cesarean birth: Postprocedure actions and eductaion, Monitor for evidence of infection and excessive bleeding The yeast artificial chromosome behaves like a chromosome in a yeast cell. Traction is applied during contractions to assist in the descent and birth of the head, after which, the vacuum cup is released and removed preceding delivery of the fetal body. -BP, pulse, and respirations every 30 min and with every change in dose. Premature rupture of membranes. Am J Obstet Gynecol. Document the time of rupture. frequently change pads, [Fetal heart rate during labour: definitions and interpretation]. A nurse has provided education to a client who has a new prescription for brimonidine ophthalmic drops. One of the most critical aspects of safe nursing care during labor induction and augmentation is titration of intravenous (IV) oxytocin based on maternal and fetal response. Synthetic dilators contain magnesium sulfate, Chemical agents based on prostaglandins are used to soften and thin the cervix. Prior to the administration of oxytocin, it is essential dose if there is What information should be provided? Autistic people who received intranasal oxytocin paid greater attention to others' faces during a cooperative game, evidence that the hormone can address one of autism's core traits, according to a small 2010 study. - contraction intensity results with pressures greater than 90 mm Hg as shown by IUPC Insert an IV catheter, and initiate administration of IV They can be in the form of oral medication or vaginal suppositories/gels. Injuries to the bladder or bowel Administer oxygen to mother. Assess for evidence of uterine rupture. Dystocia Teaching: Take immediate-release tablets 2x/day with breakfast and dinner. Abruptio placentae is defined as the premature separation of the placenta from the uterus. Check the client for any possible injuries after birth. 2000 Nov;183(5):1049-58. doi: 10.1067/mob.2000.110632. What are five (5) adverse effects noted with epidural analgesia administration during labor? -The nurse should document the time of the amniotomy and the findings. The overstimulation will result in no relaxation between contraction and cause the muscle to fatigue faster. Cesarean birth: Indications/Potential diagnoses, Malpresentation, particularly breech presentation Researchers conducted a retrospective study in 56 healthy nulliparous women admitted for elective labor induction to evaluate effects of oxytocin-induced uterine hyperstimulation in labor on fetal oxygen saturation (FSpO 2) and FHR patterns. Provide pain relief and antiemetics as RX'ed "Brimonidine decreases production and can also increase outflow of aqueous humor to lower IOP. that the nurse confirm that the fetus is engaged in resulting from blood vessel damage Breast size, shape, engorgement What are two (2) nursing interventions that can be initiated for this client? What questions should a nurse ask when obtaining a health history for a client with a history of chest pain and dyspnea? Clients taking salmeterol should be taught to take their pulse daily and report an increase in 20 bpm. Document responses to interventions. Then underline the two words or the two groups of words connected by the Unable to load your collection due to an error, Unable to load your delegates due to an error. The physician prescribes meperidine 25 mg IM now for a client's pain. before xoytocin administration confirm fetus is in the birth canal and at a min. Frequency or intensity of the pain and if it radiates to another area, any exacerbating events, if anything makes it better/worse, how long the pain/SOB lasts, and if anything helps to reduce the dyspnea. Purpose of the tool: The Uterine Tachysystole In Situ Simulation tool provides a sample scenario for labor and delivery (L&D) staff to practice teamwork, communication, and technical skills in the unit where they work.Upon completion of the Uterine Tachysystole In Situ Simulation, participants will be able to do the following: Demonstrate effective communication with the patient and support . FETAL Report to the postpartum nursing caregivers that Liquid water flows at a mass flow rate of 0.05 kg/sthrough the annulus with the inlet and outlet mean temperatures of 20C20^\circ C20C and 80C,80^\circ C,80C, respectively. The nurse is teaching a new parent appropriate finger foods to introduce around nine (9) months. Un gobierno democrtico y un gobierno autocrtico. Fetal demis. -Anesthesia associated complications, -premature birth of fetus if gestational age is inaccurate Clinical Experiences and Mechanism of Action with the Use of Oxytocin Injection at Parturition in Domestic Animals: Effect on the Myometrium and Fetuses. Monitor for uterine hyperstimulation (contractions lasting longer than 60 seconds, occurring more frequently than every 2 to 3 min, resting uterine pressure greater than 15 to 20 mm Hg). What instructions should the nurse include concerning use of these inhalers? Continue to monitor FHR. The nurse should proceed with caution in clients Fetal distress Compression of the cord between the fetal head and List three (3) interventions to address the pain associated with this condition. who have major injuries which are not yet life-threatening and can wait 45-60mins for treatment Fetal oxygen saturation and heart rate patterns during each period and the preceding 30 minutes of less than 5 contractions in 10 minutes were compared. This car is not only attractive but also very efficient. Administer via IV bolus, flushed with saline after administration. Chorioamnionitis. What should you prepare the pt for if vacuum birth is unsuccessful? A client's lab values indicate a serum sodium level of 150 mEq/L. Bloating. Wound dehiscence Elective inductions that do not meet recommended criteria can result in increased risk for infxn, premature delivery, The https:// ensures that you are connecting to the Consider tocolysis (for uterine tetany or hyperstimulation) Discontinue oxytocin if used: . Underline each adverb clause and adjective clause. -The nurse may initiate oxytocin (Pitocin) 6 to 12 hr after administration of the prostaglandin. delivery of the head Encourage splinting of the incision with pillows. Oligohydramnios (scant amount or absence of amniotic fluid) or cord compression due to postmaturity of the fetus Urine retention resulting from bladder or It gets its name from the two membranes that surround a fetus in your uterus: the chorion and the amnion. What behaviors are observed by the nurse in the client during the latent phase of the first stage of labor? What interventions should be completed for this client? What are symptoms ofuterine hyperstimulation that would cause the nurse to discontinue this medication? starting any labor induction protocol. a transcervical catheter introduced into the uterus to supplement the amount of amniotic fluid. Accessibility Third-degree laceration can occur. administration to 200 mL/hr unless C/I. "piggyback" to the main IV line and administered via Ripe bananas, graham crackers, noodles, pears, peaches. Subjective: feeling of heaviness in the testicles, lump in the testes, painless testes Use: Indicated for chronic pain syndromes (fibromyalgia, neuropathic pain, headache, lower back pain) duration (e.g., maternal exhaustion) An official website of the United States government. Mechanical soft diet includes clear and full liquids plus diced and ground foods, indicated by trouble chewing/swallowing, difficulty moving or loss of feeling in areas of the mouth, or surgery in the mouth. Recognizing Correlative Conjunctions. During labor, when the fetus's body (usually head) pushes against your cervix, the nerve impulses from this stimulation travel to your brain and stimulate your pituitary gland to release oxytocin into your bloodstream. Lacerations of the vagina and perineum What is the indication of this medication and how is this medication administered? official website and that any information you provide is encrypted -The nurse should notify the primary care provider if uterine hyperstimulation or fetal distress is noted. Tonsillitis teaching - Tonsillitis is an infection of the tonsils which results in inflammation and pain. Local anesthetic is administered to the perineum Homan's sign - positive? Continually monitor FHR. Use the infusion port closest to the client for Fetal injuries during surgery. Cephalopelvic disproportion Stop the infusion and report hyperstimulation immediately. CLIENT EDUCATION Monitor FHR prior to and immediately following AROM to assess for cord prolapse as evidenced by variable or late decelerations. Frequent meals, avoiding coffee, alcohol, or foods causing GI irritation. Complications involve spontaneous abortion (higher than amniocentesis risk), fetal limb loss (greatest risk prior to 9wks gestation), miscarriage, chorioamnionitis, rupture of membranes. A median (midline) episiotomy A nurse is caring for a client with placenta previa. Uteroplacental insufficiency. Increase IV fluids. Hygroscopic dilators may be inserted to absorb fluid Am J Obstet Gynecol. contraction pattern is obtained and then maintain the notify the anesthesiologist. fluids as RX'ed. What should the nurse include in their teaching to the family about the pain control plan for this client? Assess skin, circulation, leg edema. List three (3) subjective and objective findings in the client with testicular cancer? In group 1, the mean FSpO 2 5 minutes prior to the 30 minutes of hyperstimulation was 52.14% and 41.46% in the last 5 minutes of hyperstimulation, representing an absolute decrease of 10.68 and a negative 20% change (P < .001). Approaches to Preventing Intrapartum Fetal Injury. -A Bishop score rating should be obtained prior to starting any labor induction protocol. But when ovarian cancer symptoms occur, they're usually attached to other, more common conditions.Signs and symptoms of ovarian cancer may include:Abdominal pain or tendernessFeeling bloatedUnexplained Weight lossDiscomfort in the pelvic areaEasily fatigueLower back painConstipationA frequent urge to urinate Risk Factors of Ovarian CancerRisk and with every change in dose. It is standardized to contain 10 units of oxytocic hormone/mL and contains 0.5% Chlorobutanol, a chloroform derivative as a preservative, with the pH adjusted . A client is diagnosed with Addisonian Crisis. -Thrombophlebitis If a client has a pheochromocytoma and is administered clonidine, what will the outcome be? Ovarian hyperstimulation syndrome ( OHSS) is a medical condition that can occur in some women who take fertility medication to stimulate egg growth, and in other women in very rare cases. ultrasound-guided hands on procedure to externally manipulate the fetus into a cephalic lie (done at 36 to 37 weeks in a hospital setting. Injury to the bladder obtain temp every 2 hours, An amnioinfusion of 0.9% sodium chloride or lactated Ringer's solution, as prescribed, is instilled into the amniotic cavity through oxytocin or rupture of membranes. Arrest of rotation, Forceps-assisted birth: preparing patient. Postdate gestation . For documentation of hyperstimulation of uterus that meets ACS 0002 Additional diagnosis criteria VICC considers O62.4 Hypertonic, incoordinate, and prolonged uterine contractions is the correct code to assign for documentation of hyperstimulation of the uterus . Monitor for potential side effects: N/V/D, fever, and Vigilance is required to avoid excessive uterine activity, because it can increase risk of fetal compromise and adverse maternal and fetal outcomes. conjunction. Identify three (3) complications associated with this medication the client can develop with administration of this medication. Dystocia (prolonged, difficult labor) due to inadequate Chorioamnionitis why would someone get an induction of labor. -Use the infusion port closest to the client for administration. Maternal hypotension and uterine hyperstimulation may decrease uterine blood flow. Abruptio placentae Hyperstimulation is associated with negative effects on fetal status. establish effective labor with the aggressive use of Induction of labor is the deliberate initiation of uterine contractions to stimulate labor before spontaneous onset to bring about the birth either by chemical or mechanical means. with life-threatening injuries, high possibility of survival once stabilized Prolonged 2nd stage of labor and need to shorten Garite TJ, Dildy GA, McNamara H, Nageotte MP, Boehm FH, Dellinger EH, Knuppel RA, Porreco RP, Miller HS, Sunderji S, Varner MW, Swedlow DB. Do not use iodine-containing contrast medias. National Library of Medicine Identify potential complications associated with CVS. What are symptoms of uterine hyperstimulation that would cause the nurse to discontinue this medication? Bekele H, Tamiru D, Debella A, Getachew A, Yohannes E, Lami M, Negash A, Asfaw H, Ketema I, Eyeberu A, Habte S, Eshetu B, Getachew T, Mesfin S, Birhanu B, Heluf H, Kibret H, Negash B, Alemu A, Dessie Y, Balis B. urethral injuries Provide emotional support. No effect, clonidine will not decrease BP, A mass casualty event has occurred and a nurse is responsible for client triage. (A tender uterus and foul-smelling lochia can indicate endometritis.) Obtain informed consent from the client. The provider must make sure that the patient understands the reason for the treatment or procedure, how the treatment or procedure will benefit the patient, and the risks involved if the patient chooses not to receive the treatment or procedure. If there are signs of fetal distress, such as an abnormally slow or fast heart rate, this is usually an indication that the fetus is deprived of oxygen and medical intervention is necessary. uterine tachysystole hyperstimulation oxytocin labor induction perinatal safety fetal monitoring ABSTRACT Objective: To determine the incidence of uterine tachysystole (UT) using nomenclature dened by the American College of Obstetricians and Gynecologists (ACOG) and Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). Mastitis - an infection of the breast, typically unilateral, starting about 2-4wks postpartum; painful/tender breasts with localized hard mass and reddened area usually on one breast; provide breast hygiene and proper hand hygiene to prevent mastitis; ensure a good latch by the baby. A client is at risk for a deep vein thrombosis. Promote relaxation and breathing techniques Encourage alternate labor positions to Remove every 8H to assess for redness, warmth, tenderness. Nausea Vomiting Facial flushing Retention of urine Ileus Depression Lethargy Muscle weakness Difficulty breathing Hypotension Irregular heart beat End of preview. A Bishop score is used to determine the maternal readiness for labor by evaluating if the cervix is favorable. When should montelukast sodium be taken? Oxytocin should be connected "piggyback" to the main IV line and administered via an infusion pump. Chorioamnionitis (intra-amniotic infection) is a serious infection that affects a person during pregnancy. How should the nurse position this client in the immediate post-operative period? DM (Review the Nursing Leadership Review Module), Emergent category (class 1) - highest priority given to pt. Assume the baby may be Rh positive regardless. A nurse is providing instructions to a client who has a prescription for methotrexate. Malpresentation CLIENT EDUCATION: Explain the procedure to the client If a FHR decrease occurs, the forceps are removed Lacerations of the cervix used to monitor frequency, duration, and intensity Front Glob Womens Health. catheterize if necessary. uterine tachysystole. 30 to 60 min and with every change in dose. Premature rupture of membranes Monitor for potential side effects: N/V/D, fever, and uterine tachysystole. FOIA Facilitate birth of a macrosomic (large) infant, Malpresentation, particularly breech presentation How could this affect the client's vital signs? 2. augmentation or induction of labor is indicated A critical care client is in need of adenosine. -The nurse should monitor FHR and uterine activity after administration of cervical-ripening agents. Forceps assisted birth is used if client presents: Fetal distress during labor -Wound infection 2008 Feb;37 Suppl 1:S56-64. Symptoms of uterine hyperstimulation include single contractions that last 2 minutes of more, or five or more contractions that are in a 10 minute period. May see FHR deceleration (variable/bradycardia). Hyperstimulation was associated with significant oxygen desaturation: (group 1 = 10.68 [20%] decrease from 52.14 to 41.46; P < .001); group 2 = 15.34 [29%] decrease from 52.02 to 36.68: P < .001) and significantly more nonreassuring fetal heart rate characteristics, compared with normal uterine activity. Discontinue oxytocin infusion immediately if uterine hyperactivity or fetal distress occurs. High-risk pregnancy. Lacerations of the cervix The nurse should notify the provider if uterine Determine the length of the concentric annulus tube. Students also viewed Ensure that preoperative diagnostic tests are complete, is the artificial rupture of the amniotic membranes by the provider using an amnihook or other sharp object Traction is applied during Bowel movement The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Watch for GI bleeding (coffee ground, emesis, black tarry stools). reduce pressure on the perineum and promote perineal Hyperstimulation of uterus is also known as hypertonic uterine dysfunction. emergency cesarean birth if necessary Confusion, cyanosis, bradypnea, bradycardia, hypotension, cardiac dysrhythmias. -Wound dehiscence Common maternal adverse effects, i.e., affecting 1 in 100 women, reported during the drug testing trials include . Schifrin BS, Koos BJ, Cohen WR, Soliman M. Front Pediatr. or subdural hematomas after delivery. What are three (3) risk factors for testicular cancer? Contraction frequency of 2 to 3 min Encourage ambulation to prevent thrombus formation. administration. greater than 20 mm Hg between contractions showing no relaxation of uterus between in spite of contracted uterus What generally happens to the temperature of sinking air? uterine contractions. Pt. Explain the signs of magnesium toxicity for which the nurse should monitor. Provide three (3) dietary recommendations the nurse should include in client education? and fetus to risk of infxn. What client education should the nurse provide prior to the procedure? Obtain baseline data on fetal and maternal well-being. What statements by the client would indicate they understand the instructions? The instillation reduces the severity of variable decelerations caused by cord compression. Mg(OH)X2\ce{Mg(OH)2}Mg(OH)X2 will precipitate at the limiting pH equal to: A certain cantilever beam vibrates at a frequency of 5 Hz when a 30 lb motor is placed on the beam. Prolonged rupture of membranes predisposes the client 2023 Mar 2;23(1):137. doi: 10.1186/s12884-022-05221-w. Marcet-Rius M, Bienboire-Frosini C, Lezama-Garca K, Domnguez-Oliva A, Olmos-Hernndez A, Mora-Medina P, Hernndez-valos I, Casas-Alvarado A, Gazzano A. -Amniotic fluid pulmonary embolism Monitor fetal heart rate and rhythm, and report signs of fetal distress. before xoytocin administration confirm fetus is in the birth canal and at a min. What education should the nurse provide to the postpartum client regarding mastitis? -Assess fluid intake and urinary output. which could be suggestive of a UTI, MATERNAL since midnight before the procedure. Three students are pushing on a box. What instructions should the nurse include in thus education? Titration 5 (b) to determine the amount of ir, Complications in pregnancy - Infections ATI C, Chapter 10 Concepts of Emergency and Trauma N, Julie S Snyder, Linda Lilley, Shelly Collins. Hyperstimulation was identified and analyzed in 41 of the 56 patients, with 15 patients having no 30-minute periods of hyperstimulation. A client has a new prescription for an albuterol inhaler and a beclomethasone inhaler. Assist with the amniotomy if membranes have not already ruptured. Aspiration Unauthorized use of these marks is strictly prohibited. longer labor, and need for cesarean birth. Uterine activity of 56 women was evaluated retrospectively for hyperstimulation lasting 30 minutes using 2 definitions: group 1: 5 or more but less than 6 contractions in 10 minutes (n = 102, 30-minute periods); group 2: 6 or more contractions in 10 minutes (n = 56, 30-minute periods). limit activity What are the potential Rh issues in pregnancy? List three (3) teaching points to discuss with the client prior to the first administration. spontaneously begun, but progress is inadequate Nurses who care for pregnant and laboring women are faced with an increasingly frequent use of pharmaceutical agents that facilitate initiation of labor (uterotropins), augment labor (uterotonics), or potentially stop labor (tocolytics). often than every 2 min Identify five (5) teaching points to discuss with the new mother regarding storage of breast milk. to more easily facilitate delivery and minimize soft tissue damage, is the delivery of the fetus through a transabdominal incision of the Large for gestational age newborn on S&S bleeding, ATI Capstone Maternal Newborn Pre-Assignment. admin of cervical-ripening agents. Gemfibrozil SE - abdominal discomfort, myopathy. -Injuries to the bladder or bowel A nurse is conducting an admission assessment for an older adult client with a hearing impairment.
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