A. Today: Client presents for evaluation of wound vac therapy that was applied to surgical wound on their left knee 1 week ago. Client rates pain as 8 on a scale of 0 to 10 in their left knee. Client reports no relief with pain medications. Respirations even and nonlabored. Heart rate regular and fast. Abdomen soft and nondistended. Left knee wound vac dressing removed. Left knee wound is 3 cm by 2 cm with 1 cm depth. Wound bed vascular with some approximation of the edges. Mild1 week ago: Temperature 37.1°C (98.9°F) Heart rate 94/min Respiratory rate 22/min Blood pressure 110/70 mm Hg Oxygen saturation 98% on room air Today. Temperature 38.6°C (101.4°F) Heart rate 104/min Respiratory rate 24/min Blood pressure 134/88 mm Hg Oxygen saturation 95% on room air purulent drainage noted.

A. Reposition the client every 3 hr.

B. Place the client on a donut-shaped cushion.

C. Elevate the head of the bed to 450.

D. Request a consult with a registered dietitian.

E. Provide a support pressure-redistribution surface.

F. Perform a skin risk assessment weekly.

G. Use a moisture barrier ointment after cleaning the client's skin.

A. Hold the dose of levothyroxine.

B. Request a prescription for an antiemetic medication.

C. Place the client on contact precautions.

D. Ensure the client wears a surgical mask when they are outside of their room.

E. Clarify the prescription for amoxicillin with the provider.

F. Recommend increasing the dose of metoprolol.

A. Administer acetaminophen.

B. Administer supplemental oxygen.

C. Ambulate the client 30 min after administering analgesia.

D. Instruct the client to use the incentive spirometer five times per hour.

E. Administer ondansetron.

F. Encourage the client to cough and breathe deeply.

G. Encourage the client to splint the abdomen.