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A nurse is assisting in the care of a client. Exhibit 1 Exhibit 2 Nurses' Notes 4 days ago: Client admitted to skilled nursing facility. Client has decreased mobility and is confined to their bed, client only able to communicate with moans. Client is incontinent of urine and stool. Client receiving tube feeding for nutrition. Braden score 7. Data Collection 4 days ago: Client only responds to painful stimuli. Heart rate and rhythm regular. Lungs clear to auscultation bilaterally. Full passive range of motion of all extremities. Client has darkly pigmented skin tone. Skin intact and free of lesions, good turgor, warm and moist. Today: Client only responds to painful stimuli. Heart rate and rhythm regular. Lungs clear to auscultation bilaterally. Client has darkly pigmented skin tone. Skin intact, good turgor, warm and moist. Non-blanchable area of hyperpigmentation present on sacrum.rag words from the choices below to fill in each blank in the following sentence. When prioritizing care for the client, the nurse should first Target 1 , Target 2 , and Target 3 . Options for Targets Evaluate the client's response to the plan of care. Plan a turning and positioning schedule. Apply hydrocolloid dressing to the client's sacrum. Request a prescription for pressure redistribution bed. Perform passive range of motion exercises.
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