ATI remediation RN Leadership 2019

Management of Care Advocacy 1. Professional Responsibilities: Caring for an Older Adult Client Who Might Be Abused (RM Leadership 8.0 Chp 3 Professional Responsibilities) ActiveLearningTemplate: Basic Concept Reasons for not reporting: - may be embarrassed or ashamed of abuse - worry about how their report may affect lives of loved ones - feel guilty and have come to believe they're cause of abuse - afraid no one will believe them - afraid of unknown future if they're removed from care of abuser - worst nightmare is to end in a nursing home Assessment for abuse: - examine client alone - don't rush during interview - don't be judgmental or allow personal feelings to interfere - don't diagnose prematurely Subjective data: - ask client to describe a typical day to determine degree if independence - ask client role and expectations for self and caregiver - inquire any recent family crisis - ask if there is any alcohol, drug use, mental illnesses in home Objective Data: - assess if patient senses being ignored or is made to feel like burden - assess degree of dependence of caregiver (financial, physical, and/or emotional support) - observe and document any new lesions Assignment, delegation and supervision 2. Managing Client Care: Assigning Client Care to a Licensed Practical Nurse (RM Leadership 8.0 Chp 1 Managing Client Care) ActiveLearningTemplate: Basic Concept  Monitoring client findings (as input to the RN’s ongoing assessment of the client) ›  Reinforcement of client teaching from a standard care plan ›  Tracheostomy care ›  Suctioning ›  Checking nasogastric tube patency  Administration of enteral feedings  Insertion of a urinary catheter  Medication administration (excluding intravenous medications in several states) 3. Managing Client Care: Feeding a Client Who Has Dysphagia (RM Leadership 8.0 Chp 1 Managing Client Care) ActiveLearningTemplate: Basic Concept  place client in an upright or high Fowler's position to facilitate swallowing  stay with client due to risk for aspiration  refer to speech therapist for evaluation  make diet alterations, avoid thin liquids and sticky foods 4. Managing Client Care: Nursing Assessment to Perform Prior to Delegation of Care (RM Leadership 8.0 Chp 1 Managing Client Care) ActiveLearningTemplate: Basic Concept Case Management 5. Coordinating Client Care: Addressing Priority Issues During Case Management (RM Leadership 8.0 Chp 2 Coordinating Client Care) ActiveLearningTemplate: Basic Concept  Open communication: Use “I” statements, and remember to focus on the problem, not on personal differences. Listen carefully to what the other people are saying. Move a conflict that is escalating to a private location or postpone the discussion  Share ground rules with participants. For example, everyone is to be treated with respect, only one person can speak at a time, and everyone should have a chance to speak.  Steps of the problem-solving process  identify the problem  Discuss possible solutions  Analyze identified solutions – The potential pros and cons of each possible solution should be discussed  Select a solution.  Evaluate the solution’s ability to resolve the original problem. The outcomes surrounding the new solution should be evaluated according to the predetermined time line. The solution should be given adequate time to become established as a new routine before it is evaluated. If the solution is deemed unsuccessful, the problem-solving process will need to be reinstituted and the problem discussed again.  negotiation Client Rights 6. Professional Responsibilities: Inappropriate Use of Restraints (RM Leadership 8.0 Chp 3 Professional Responsibilities) ActiveLearningTemplate: Basic Concept  Prevents harm of self or others  Never used for: - Convenience of the staff - Punishment for the client - Clients who are extremely physically or mentally unstable - Clients who cannot tolerate the decreased stimulation of a seclusion room 7. Professional Responsibilities: Treatment Decisions (RM Leadership 8.0 Chp 3 Professional Responsibilities) ActiveLearningTemplate: Basic Concept  Competent adults have the right to refuse treatment, including the right to leave a health care facility without a discharge order from the provider.  If the client refuses a treatment or procedure, the client is asked to sign a document indicating that he understands the risk involved with refusing the treatment or procedure, and that he has chosen to refuse it. Advance Directives/Self-determination/Life planning 8. Professional Responsibilities: Client Advocacy Regarding Advance Directives (RM Leadership 8.0 Chp 3 Professional Responsibilities) ActiveLearningTemplate: Basic Concept  Providing written information regarding advance directives  Documenting the client’s advance directives status  Ensuring that advance directives are current and reflective of the client’s current decisions  Recognizing that the client’s choice takes priority when there is a conflict between the client and family, or between the client and the provider  Informing all members of the health care team of the client’s advance directives Collaboration with interdisciplinary team 9. Assessment of Fetal Well-Being: Interdisciplinary Care Conference (RM MN RN 11.0 Chp 6 Assessment of Fetal Well- Being) ActiveLearningTemplate: Basic Concept  The nonstress test (NST) is a noninvasive antepartum evaluation of fetal wellbeing.  Fetal movement and fetal heart rate accelerations correlate with adequate oxygenation.  Normal function of the autonomic nervous system and adequate oxygenation is observed in a fetus through reactivity of the fetal heart rate.