Comp Predictor A Remediation 1x6s3f

Shanerica Quin 04/14/2016 Remediation A

Assignment, Delegation and Supervision Ergonomic Principles: Evaluating Staff Performance    

Ergonomics are the factors or qualities in an object’s design and/or use that contribute to comfort, safety, efficiency, and ease of use. Using good body mechanics when positioning and moving clients promotes safety for the client as well as for health care providers. Before attempting to position or move a client, the nurse should perform a mobility assessment. Begin this assessment with the easiest movements (range of motion) and progress as long as the client tolerates it (balance, gait, and exercise)

Managing Client Care: Appropriate Delegation of Tasks   

Nurses can only delegate tasks appropriate for the skill and education level of the health care provider who is receiving the assignment. RNs cannot delegate the nursing process, client education, or tasks that require clinical judgment to LPNs or AP. Task factors – Prior to delegating client care, the nurse should consider: Predictability of outcome, Potential for harm, Complexity of care, Need for problem solving and innovation, and Level of interaction with the client

Managing Client Care: Evaluating Time Management Skills andTime Management Strategies   

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Time management involves organizing care according to client care needs and priorities What can be delegated Time initially spent developing a plan will save time later and help to avoid management by crisis. Set goals and plan care based on established priorities and thoughtful utilization of resources. Complete one client care task before beginning the next, starting with the highest priority task. Reprioritize remaining tasks based on continual reassessment of client care needs. At the end of the day, perform a time analysis and determine if time was used wisely

Collaboration with Interdisciplinary Team Coordinating Client Care: Addressing Family Concerns

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Initiate the necessary consults or notify the provider of the client’s needs so the consult can be initiated. Provide the consultant with all pertinent information about the problem (information from the client/family, the client’s medical records). Incorporate the consultant’s recommendations into the client’s plan of care.

Coordinating Client Care: Interdisciplinary Care Conference  

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Collaboration involves discussion of client care issues in making health care decisions, especially for clients who have multiple problems. The specialized knowledge and skills of each discipline are used in the development of an interprofessional plan of care that addresses multiple problems. Nurses should recognize that the collaborative efforts of the interprofessional team allow the achievement of results that a team member would be incapable of accomplishing alone.

Confidentiality/Information Security Professional Responsibilities: HIPAA Violation 

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Only health care team directly responsible for the client’s care should be allowed access to the client’s records. Nurses may not share information with other clients or staff not involved in the care of the client Clients have a right to read and obtain a copy of their medical record, and agency policy should be followed when the client requests to read or have a copy of the record. Client medical records must be kept in a secure area to prevent inappropriate access to the information. Using public display boards to list client names and diagnoses is restricted. Electronic records should be -protected, and care must be taken to prevent public viewing of the information.

Informed Consent Professional Responsibilities: Providing Translation for Informed Consent 

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The person who signs the form must be capable of understanding the information provided by the health care professional who will be providing the service, and the person must be able to fully communicate in return with the health care professional. When the person giving the informed consent is unable to communicate due to a language barrier or hearing impairment, a trained medical interpreter must be provided. Many health care agencies contract with professional interpreters who have additional skills in medical terminology to assist with providing information.

Performance Improvement (Quality Improvement) Managing Client Care: Quality Improvement

Steps in the Process:     

A standard is developed and approved by facility committee. Standards are made available to employees by way of policies and procedures. Quality issues are identified by staff, management, or risk management department. An interprofessional team is developed to review the issue. The current state of structure and process related to the issue is analyzed

Accident/Error/Injury Prevention: Client Safety: Impaired Vision  

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For clients who are sedated, unconscious, or otherwise compromised, the bed rails are kept up, and the bed is kept in the low position Older adult clients may be at an increased risk for falls due to decreased strength, impaired mobility and balance, and endurance limitations combined with decreased sensory perception. Other clients at increased risk include those with decreased visual acuity, generalized weakness, urinary frequency, gait and balance problems (cerebral palsy, injury, multiple sclerosis) and cognitive dysfunction. Side effects of medications (orthostatic hypotension, drowsiness) also can increase the client’s risk for falls.

Ante/Intra/Postpartum and Newborn Care Fetal Assessment During Labor: FHR with Variability and Accelerations    

Causes: Healthy fetal/placental exchange Intact fetal central nervous system (CNS) response to fetal movement Vaginal exam Fundal pressure

Interventions:   

Reassuring. No interventions required Indicate reactive nonstress test

Normal Physiological Changes During Pregnancy: Nagele's Rule   

Nägele’s rule used to caluculate EDB Take the first day of the woman’s last menstrual cycle, subtract 3 months, and then add 7 days and 1 year, adjusting for the year as necessary.

Health Screening

Musculoskeletal and Neurosensory Systems: Assessing Range of Motion 

Expected Range of Motion of t Movement o Flexion – a movement that decreases the angle o Extension – a movement that increases the angle and Hyperextension – an extreme extension o Adduction – the movement of an extremity toward the midline o Dorsiflexion – flexing the foot and toes upward o pLantar flexion – bending the foot and toes downward

Abuse/Neglect Family and Community Violence: Priority Interventions 

Nursing interventions for child or vulnerable adult abuse must include the following: o Mandatory reporting of suspected or actual cases of child or vulnerable adult abuse. o Complete and accurate documentation of subjective and objective data obtained during assessment. o A forensic nurse has advanced training in the collection of evidence for suspected or actual cases of sexual assault or other forms of physical abuse

Grief and Loss Effective Communication: Responding to Client who is Grieving 

The nurse uses interactive, purposeful communication skills to o Elicit and attend to the client’s thoughts, feelings, concerns, and needs. o Express empathy and genuine concern for the client’s and family’s issues. o Obtain information and give about the client’s condition. o Intervene to promote functional behavior and effective interpersonal relationships. o Evaluate the client’s progress toward goals and outcomes.

Mental Health Concepts Cognitive Disorders: Expected Findings of Delirium  

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Level of consciousness is usually altered and may rapidly fluctuate. Restlessness, agitation, and fluctuating mood are common; sundowning (confusion during the night) may occur; behaviors may increase or decrease daily. Personality change is rapid. Some perceptual disturbances may be present, such as hallucinations and illusions.

Assistive Devices

Mobility and Immobility: Proper Use of Quad Cane   

Cane instructions: always maintain a two point gait on the ground the cane should be on the stronger side of the body the cane should move first when walking followed by the weak side then the stronger side last

Non-Pharmacological Comfort Interventions Rheumatoid Arthritis: Managing Symptoms    

Apply heat or cold to the affected areas as indicated based on client response Assist with and encourage physical activity to maintain t mobility (within the capabilities of the client). Monitor the client for indications of fatigue. Teach the client measures to maximize functional activity

Medication istration Medications for Depressive Disorders: Amitriptyline   

These medications block reuptake of norepinephrine and serotonin in the synaptic space, thereby intensifying the effects of these neurotransmitters. Amitriptyline is a pregnancy risk category C medication. This medication is contraindicated for clients who have seizure disorders

Pharmacokinetics and Routes of istration: Appropriate Technique for istering Eye Drops  

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Have client sit upright or lie supine with the head tilted slightly and looking up at ceiling. Rest dominant hand on client’s forehead, hold dropper above conjunctival sac approximately 1 to 2 cm, drop medication into center of sac, and have client close eye gently. Apply gentle pressure with finger and a clean tissue on nasolacrimal duct for 30 to 60 seconds to prevent systemic absorption of medication

Stroke: Nursing Interventions Based on Assessment Findings  

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Assist with the client’s communication skills if his speech is impaired Assist with safe feeding. Assess swallowing and gag reflexes before feeding. Speech therapy may request a swallowing study that can involve swallowing a barium substrate and radiography of the peristaltic activity of the esophagus. If a swallowing deficit is identified, the client’s liquids may need to be thickened with a commercial thickener to avoid aspiration

Parenteral/Intravenous Therapies

Intravenous Therapy: istering Cefazolin

Diagnostic Tests Assessment of Fetal Well-Being: Clients in Need of Fetal Monitoring    

Premature rupture of membranes Maternal infection Decreased fetal movement Intrauterine growth restriction

Potential for Alterations in Body Systems Peripheral Vascular Diseases: Client Education about Foot Care 

Instruct the client about foot care o keep feet clean and dry o wear good-fitting shoes never go barefoot o cut toenails straight across or have the podiatrist cut nails

Therapeutic Procedures Respiratory Diagnostic Procedures: Nursing Interventions for a Thoracentesis  

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Apply a dressing over the puncture site, and assess dressing for bleeding or drainage. Monitor the client’s vital signs and respiratory status (respiratory rate and rhythm, breath sounds, oxygenation status) hourly for the first several hours after the thoracentesis. Auscultate lungs for reduced breath sounds on side of thoracentesis. encourage the client to deep breathe to assist with lung expansion

Alterations in Body Systems Medical Conditions: Client Teaching about Preeclampsia for Home Care        

Maintain the client on bed rest, and encourage side-lying position. Promote diversional activities. Have the client avoid foods that are high in sodium. Have the client avoid alcohol and limit caffeine. Instruct the client to increase her fluid intake to 8 glasses/day. Maintain a dark quiet environment to avoid stimuli that may precipitate a seizure. Maintain a patent airway in the event of a seizure. ister antihypertensive medications as prescribed.

Meningitis and Reye Syndrome: Increased Intracranial Pressure  

Increased I could lead to neurological dysfunction Nursing Actions

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Monitor for signs of increased I. Infants – bulging or tense fontanels, increased head circumference, high-pitched cry, distended scalp veins, irritability, bradycardia, and respiratory changes Children – increased irritability, headache, nausea, vomiting, diplopia, seizures, bradycardia, and respiratory changes Provide interventions to reduce I (positioning; avoidance of coughing, straining, and bright lights; minimizing environmental stimuli).

Medical Emergencies Gastrointestinal, Structural, and Inflammatory Disorders: Reportable Findings    

Recurrent pneumonia, weight loss, and failure to thrive Repeated reflux of stomach contents can lead to erosion of the esophagus or pneumonia if stomach contents are aspirated Esophageal damage can lead to the inability to eat. Nursing Actions o Evaluate the prescribed treatment plan. o Monitor for clinical manifestations of pneumonia and failure to thrive