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Episode Notes: Prioritizing Critical Nursing Care & Assessment**

Less subcutaneous fat

Presbycusis (age-related high-frequency hearing loss)

Reduced vital capacity → gets breathless more easily

Slower gait, unsteady movement

Slower cognitive processing

Mild recent-memory decline

Key nursing actions:

Monitor intake and output

Be cautious with medications cleared by kidneys

Give simple, step-by-step instructions

Assess social support and isolation risk

EN-klex trap:

“Increased gait speed” = NOT normal aging

“Intact recent memory” in older adults = distractor

Scenario: Older adult climbing over raised bed rails
First action: Lower the entire bed

Why:

Fastest way to prevent injury

Environmental change beats calling for help or meds

Restraints require an order and take time

Scenario: Client is sad and lonely but blood pressure is extremely high
First priority: Address the physical threat → recheck BP for accuracy

Reason: Physical instability always beats emotional distress.

Check the fundus — must be firm, midline

Assess lochia — evaluate bleeding

Pain medication

Ambulation

Why: Hemorrhage is the most preventable cause of postpartum death.
Bleeding always comes before pain.

Fundus expectations immediately after birth:

Firm (grapefruit-like)

Midline

At the level of the umbilicus

Drops one finger-width per day

Erikson Examples:

Toddler: Autonomy vs. shame → “NO” stage

Middle adult: Generativity vs. stagnation

Language milestones:

12 months: 1–3 specific words (“mama,” “dada”)

15 months: Same range still acceptable

Preschool thinking:

Imaginary friends = normal

Centration = focuses on one aspect only

Square copying and fully clear speech → later stages

Moro reflex:

Should disappear by 3–4 months

Persistence → neurological red flag

Primary: Prevents disease (vaccines)

Secondary: Early detection (mammograms, colonoscopy, screening CT)

Tertiary: Manage complications (rehab, chronic care)

TDap pregnancy timing:

Give between 27–36 weeks for passive newborn protection

Lung cancer screening:

Ages 50–80

Twenty pack-year history

Current smoker OR quit within last 15 years

Annual low-dose CT

Inspect

Listen

Percuss

Palpate

Reason: Touching stimulates bowels → false readings.

Vesicular = heard best in lung periphery

Bladder should cover 80% of upper arm circumference

Too small → falsely high

Too large → falsely low

Slow if:

Cold

Dehydrated

Poor circulation
Not usually slowed by high blood pressure.

UAP CAN:

Basic hygiene

Meals

Ambulation assistance

Newborn bath

UAP CANNOT:

Fundal assessment

Lochia assessment

Any evaluation

Any teaching

Anything requiring clinical judgment

RN always keeps assessment, evaluation, and teaching.

Scenario: Client has the skills + knowledge to change a colostomy bag but refuses to look at the stoma.
Deficit: Motivation deficit → needs emotional support, not more teaching.

Safety before comfort

Environment adjustments before interventions

Physical danger beats psychosocial needs

Bleeding beats pain

Assessment before action

Rationale behind every step

Think like a nurse, not a task robot

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