[Verified Answer]: Directions: Use the Braden Scale to assess…

Directions: Use the Braden Scale to assess the following patient’s level of risk for development of pressure ulcers. ACTIVITY Definition: degree of physical activity 1. Bedfast Confined to bed. 2. Chairfast Ability to walk severely limited or non-existent. Cannot bear own weight and/or must be assisted into chair or wheelchair. 3. Walks Occasionally Walks occasionally during day, but for very short distances, with or without assistance. Spends majority of each shift in bed or chair. 4. Walks Frequently Walks outside room at least twice a day and inside room at least once every two hours during waking hours. Prompt: • Your patient is 78-year-old female admitted from the long-term care facility for abdominal surgery. She is alert and oriented x 4. • Past medical history: Diabetes Mellitus, Heart Failure and Obesity. • She has a Jackson Pratt (JP) drain placed in the right upper quadrant (RUQ) of the abdomen to drain fluid from the surgical incision. The output is serosanguineous, ranging from 30-50cc every shift. It is sutured in place and has a dry gauze dressing over the insertion site. • She has some neuropathy (sensory impairment) in her feet due to Diabetes. • She has occasional urine leakage while in bed. Linens are changed daily and usually one extra time each day due to the moisture. • Her activity is limited and she cannot bear weight on her own. She is only able to transfer to chair with assistance. • She can make minor changes in body position while in bed but requires the assistance of one person when turning in bed. • She has had a decreased appetite and takes in only about 1⁄2 of her meals offered. She usually drinks a dietary supplement daily. • She occasionally slides down in bed and during movement and her skin tends to rub against the sheets.