ATI Fundamentals for Nursing ATI Questions and Complete Solutions Graded AI+.

ATI Fundamentals for Nursing ATI Questions and Complete Solutions Graded AI+ Preventive health care - Answer: focuses on educating and equipping clients to reduce and control risk factors of disease. Examples include immunizations, stress management programs, and seat belt use Primary health care - Answer: emphasizes health promotion, and includes prenatal and well-baby care, nutrition counseling, and disease control. is based on a sustained partnership between client and provider. examples include office or clinic visits and scheduled school/work centered screenings (vision, hearing, obesity) Secondary health care - Answer: includes the diagnosis and treatment of emergency, acute illness, or injury. examples include care given in hospital settings (inpatient and EDs), diagnostic centers, or emergent care centers Tertiary health care - Answer: involves the provision of specialized highly technical care. examples include oncology centers and burn centers Restorative health care - Answer: involves intermediate follow-up care for restoring health. examples include home health care, rehab centers, and skilled nursing facilities Continuing health care - Answer: designed to address long-term or chronic health care needs. examples include hospice, adult day care, and in-home respite care Health care regulatory agencies include: - Answer: -US Dept of Health and Human Srvcs -US FDA -State and local public health agencies -State licensing boards (to ensure providers & agencies comply with state regulations) -the Joint Commission/JCAHO (set quality standards for accreditation of health care facilities) -Professional Standards Review Organizations (PSROs) -Utilization review committees (monitor for appropriate diagnosis and treatment of hospitalized clients) Morals are: - Answer: the values and beliefs held by people that guide their behaviors and decision making Ethical theory examines: - Answer: the different principles, ideas, systems, and philosophies used to make judgments about what is right/wrong and good/bad Ethical principles - Answer: standards of what is right/wrong with regard to important social values and norms Autonomy - Answer: ability of client to make personal decisions, even when those decisions may not be in the client's best interest Beneficence - Answer: agreement that the care given is in the best interest of the client; taking positive actions to help others Fidelity - Answer: agreement to keep one's promise to the client about care that was offered Justice - Answer: fair treatment in matters related to physical and psychosocial care and use of resources Nonmaleficence - Answer: avoidance of harm or pain as much as possible when giving treatments Ethical dilemmas are: - Answer: problems about which more than one choice can be made and the choice made is influenced by the values and beliefs of the decision makers A problem is an ethical dilemma if: - Answer: -it cannot be solved solely by a review of scientific data -it involves a conflict between two moral imperatives -the answer will have a profound effect on the situation/client Steps in ethical decision making - Answer: -identify whether or not the issue is indeed an ethical dilemma -state the ethical dilemma including all surrounding issues and individuals involved -list and analyze all possible options for resolving the dilemma and review implications of each option -select option that is in concert with the ethical principle applicable to this situation, the decision maker's values and beliefs, and the profession's values set forth for client care; justify why chosen over other options -apply this decision to the dilemma and evaluate the outcomes Advocacy - Answer: support of the cause of the client regarding health, safety, and personal rights Responsibility - Answer: willingness to respect obligations and follow through on promises Accountability - Answer: ability to answer for one's own actions Confidentiality - Answer: protection of privacy without diminishing access to quality care According to the UDDA, death is determined by one of two criteria: - Answer: -an irreversible cessation of circulatory and respiratory functions -irreversible cessation of all functions of the entire brain, including the brain stem A determination of death must be made: - Answer: in accordance with accordance with accepted medical standards Nurse's roles in ethical decision making include: - Answer: -agent for client facing an ethical decision: adolescent child debating on abortion; parent contemplating blood transfusion even when against religious beliefs -decision maker in regard to nursing practice: increasing staff load due to shift cuts; witnessing a surgeon discussion only surgical options without informing client of more conservative options Entities with codes of ethics that may be used to guide nursing practice include: - Answer: -the American Nurses Association (ANA) -the International Council of Nurses (ICN) -the National Association for Practical Nurse Education and Services, Inc. By practicing nursing within the confines of the law, nurses are able to: - Answer: -shield oneself from liability -advocate for client's rights -provide care that is within the nurse's scope of practice -discern the responsibilities of nursing in relationship to the responsibilities of other members of the health care team -provide safe, competent care that is consistent with standards of care Federal laws impacting nursing practice include: - Answer: -HIPAA -ADA -the Mental Health Parity Act (MHPA) -the Patient Self-Determination Act (PSDA) Types of unintentional torts - Answer: -Negligence -Malpractice (professional negligence) Types of quasi-intentional torts - Answer: -Breach of confidentiality -Defamation of character Types of intentional torts - Answer: -Assault -Battery -False imprisonment Negligence - Answer: example: a nurse who fails to implement safety measures for a client who has been identified as at risk for falls Malpractice (professional negligence) - Answer: example: a nurse administers a large dose of medication due to a calculation error; the client has a cardiac arrest and dies Breach of confidentiality - Answer: example: a nurse releases the medical diagnosis of a client to a member of the press Defamation of character - Answer: example: a nurse tells a coworker that she believes the client has been unfaithful to her spouse Assault - Answer: example: the conduct of one person makes another person fearful and apprehensive (threatening to place a nasogastric tube in a client who is refusing to eat). Battery - Answer: example: intentional and wrongful physical contact with a person that involves and injury or offensive contact (restraining a client and administering an injection against her wishes) False imprisonment - Answer: example: a person is confined or restrained against his will (using restraints on a competent client to prevent his leaving the health care facility) State laws - Answer: -regulate the core of nursing practice -each state has enacted statutes defining parameters of practice and gives authority to regulate to the state board of nursing Board of nursing - Answer: -has authority to adopt rules and regs for nursing practice in that state -has authority to both issue and revoke a nursing license -set standards for nursing programs -delineate scope of practice among RNs, LPNs, and APNs Professional negligence - Answer: -failure of person with professional training to act in a reasonable and prudent manner -issues that prompt malpractice suits include failure to: follow standards of care, use of equipment in responsible & knowledgeable manner, effectively & thoroughly communicate with the client, document care was provided 5 elements necessary to prove negligence - Answer: 1) duty to provide care as defined by a standard 2) breach of duty by failure to meet standard 3) foreseeability of harm 4) breach of duty has potential to cause harm (combines 2&3) 5) harm occurs Nurses can avoid being liable for negligence by: - Answer: -following standards of care -giving competent care -communicating with other health team members -developing a caring rapport with clients -fully documenting assessments, interventions, and evaluations Client's rights - Answer: -legal guarantees that clients have with regard to their health care -situations where nurses have opportunity to protect client's rights include: informed consent, refusal of treatment, advanced directives, confidentiality, and information security Resident rights - Answer: further protection of rights for residents in nursing facilities that participate in Medicare programs; govern the operation of such facilities Nurse's role in client rights includes: - Answer: -client understands their rights -protecting rights of clients under their care The client has the right to: - Answer: -be informed about the aspects of care in order to be active in the decision making process -accept, refuse, or request modification to the plan of care -receive care that is delivered by competent individuals who treat the client with respect Informed consent - Answer: legal process by which the client has given written permission for a procedure or treatment to be performed Consent considered informed when the client has been provided and understands: - Answer: -the reason the treatment or procedure is needed -how the treatment or procedure will benefit the client -risk involved if treatment or procedure is chosen -other options to treat the problem (including no action) Nurse's role in the informed consent process is: - Answer: to witness the client's signature on the informed consent form and to ensure the informed consent has been appropriately obtained Implied consent - Answer: client adheres to instructions provided by the nurse; ex: the nurse is preparing to administer a TB test and the client holds out his arm for the nurse For an invasive procedure or surgery, the client is required to provide ____ consent. - Answer: written Individuals who are authorized to grant consent for another person include: - Answer: -parent of a minor -legal guardian -court-specified representative -individual who has durable power of attorney for health care -emancipated minors (for themselves) The provider's responsibility for informed consent: - Answer: -obtain informed consent -must give complete description of treatment/procedure, description of who will be involved in treatment, description of risks, options for other treatments, and the right to refuse -provide clarification if requested The client's responsibility for informed consent: - Answer: -giving informed consent -must give consent voluntarily (no coercion), be competent and of legal age (or authorized individual), and receive enough information to make a decision The nurse's responsibility for informed consent: - Answer: -witness informed consent -must ensure provider provided necessary information, ensure the client understood and is competent to give consent, have the client sign informed consent document, notify provider if more information or clarification needed/requested by client, and document client questions and that the provider was notified (also if interpreter was used) Refusal of treatment - Answer: -PSDA stipulates all clients have the right to accept and refuse care and must be advised of this right upon admission -if client refuses treatment, will be asked to sign an "Against Medical Advice" form and nurse must document information was provided and provider notified -if client refuses to sign form, nurse must document -if a client decided to leave the facility w/o discharge order, nurse must notify provider and discuss risks of leaving prior to discharge Advanced directives - Answer: -communicate client's end-of-life care wishes for them if they become unable to -PSDA requires all clients be asked if they have advanced directives upon admission -clients with out advanced directives must be provided with written information about their health care rights and how to formulate advanced directives -a health care rep should be available to help with the process Living will - Answer: legal document that expresses client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues Durable power of attorney for health care - Answer: document that designates a health care proxy, who is authorized make health care decisions for a client who is unable Provider's orders - Answer: "do not resuscitate" (DNR) or "allow natural death" (AND) are orders written by a provider and must be placed in the client's medical record; the provider consults the client and family prior to administering a DNR or AND Nursing role in advanced directives - Answer: -provide written information regarding advanced directives -document the client's advanced directives status -ensure that the advanced directives reflect the client's current decisions -inform all members of the health care team of the client's advance directives Mandatory reporting - Answer: -abuse: child or elder abuse, domestic violence -communicable diseases (according to CDC) such as hepatitis and TB Documentation must be: F___, A___ & C___, C___ & C___, and O___. - Answer: -Factual -Accurate & Concise -Complete & Current -Organized Subjective data can be documented as: - Answer: direct quote, within quotation marks, or summarized and identified as the client's statement Objective data should be documented: - Answer: -descriptive and should include what the nurse sees, hears, feels, and smells -w/o derogatory words, judgments, or opinions -accurately Problem-orientated medical records consist of: - Answer: a database, problem list, care plan, and progress notes; examples include SOAPIE, PIE, and DAR SOAPIE - Answer: S-ubjective O-bjective A-ssessment (inc nursing diagnosis) P-lan I-ntervention E-valuation PIE - Answer: P-roblem I-ntervention E-valuation DAR (focus charting) - Answer: D-ata A-ction R-esponse Incident reports (unusual occurrences) - Answer: -important part of a facility's quality improvement plan -examples of incidence include med errors, falls, and needle sticks -facts documented without judgment or opinion -should not be referred to in client's medical record Delegating - Answer: Process of transferring authority and responsibility to another member of the health care team to complete a task, while retaining accountability Supervising - Answer: Process of directing, monitoring, and evaluating the performance of tasks by another member of the health care team Prior to delegating client care, the nurse should consider: - Answer: -predictability of outcome -potential for harm -complexity of care -need for problem solving and innovation -level of interaction with the client Examples of questions to use to determine predictability of care: - Answer: -will the completion of the task have a predictable outcome? -is it a routine treatment? -is it a new treatment? Examples of questions to use to determine potential for harm: - Answer: -is there a chance something negative may happen to the client (risk for bleeding, risk for aspiration)? -is the client unstable? Examples of questions to use to determine complexity of care: - Answer: -are complex tasks required as part of the client's care? -is the delegatee legally able to perform the task and do they have the skills necessary? Examples of questions to use to determine need for problem solving and innovation: - Answer: -will a judgment need to be made while performing the task? -does it require nursing assessment skills? Examples of questions to use to determine level of interaction with the client: - Answer: -is there a need to provide psychosocial support or education during the performance of the task? Factors to consider when selecting a delegated - Answer: -education, training, and experience -knowledge and skill required to perform the task -level of critical thinking required to complete the task -ability to communicate with others as it pertains to the task -demonstrated competence -agency policies and procedures -licensing legislation (state nurse practice acts) Examples of tasks that can be delegated to LPNs - Answer: -monitoring client findings -reinforcing client teaching from a standard care plan -trach care -suctioning -checking NG tube patency -admin enteral feedings -inserting urinary cath -admin meds (exc IV in most states) Examples of tasks that can be delegated to AP - Answer: -ADLS -bathing, grooming, dressing, toileting -ambulating -feeding (w/o swallowing precautions) -positioning -bedmaking -specimen collection and I&Os -VS for stable clients 5 rights of delegation help decide: - Answer: -what task should be delegated (right task) -under what circumstances (right circumstance) -to whom (right person) -what info should be communicated (right direction/communication) -how to supervise/evaluate (right supervision /evaluation) Critical thinking incorporates: R___, L___, and I___. - Answer: R-eflection L-anguage I-ntuition Intuition - Answer: an inner sensing that something is not currently supported with fact. Intuition should spark the nurse to search the data to confirm or disprove the "feeling." The nurse should ponder the following: -"Did the vital signs reflect any changes that would account for the client's present status?" -"When the client's status changed in this way last month, there was a specific reason for it. Is that what is happening here?" Levels of critical thinking - Answer: -basic critical thinking -complex critical thinking -commitment Knowledge - Answer: information specific to nursing and acquired through: basic nursing ed; continuing ed courses; advanced degrees and certifications Experience - Answer: decision-making ability derived from opportunities to observe, sense, and interact with clients followed by active reflection. The nurse: demonstrates an understanding of clinical situations; recognizes and analyzes cues for relevance; incorporates experience into intuition. Competence - Answer: cognitive processes a nurse uses to make nursing judgments, such as: -general critical thinking: scientific method; problem-solving; decision-making; diagnostic reasoning and inference; clinical decision-making - collaboration -specific critical thinking in nursing: the nursing process Standards - Answer: model to which care is compared to determine acceptability, excellence, and appropriateness -intellectual standards ensure the through application of critical thinking. -professional standards include: nursing judgment based on ethical criteria; evaluation that relies on evidence-based practice; demonstration of professional responsibility baseline data - Answer: -provided by the admissions assessment -compared with future assessments to monitor client status and response to treatment asepsis - Answer: -the absence of illness-producing micro-organisms -maintained through the use of aseptic technique with hand hygiene as the primary associated behavior medical asepsis - Answer: -aka "clean technique" -the use of precise practices to reduce the number, growth, and spread of micro-organisms from an object, person, or area -used for administering oral meds, managing NG tubes, providing personal hygiene, and many other common nursing tasks surgical asepsis - Answer: -aka "sterile technique" -the use of precise practices to eliminate all micro-organisms from an object or area -used for parenteral med administration, insertion of urinary catheters, surgical procedures, sterile dressing changes, and many other common nursing procedures before beginning any task or procedure that requires aseptic technique, health care team members must check for: - Answer: -latex allergies (client and team members) -if there is a known allergy, latex-free gloves, equipment, and supplies must be used the number one measure to reduce the growth and transmission of infectious agents is: - Answer: -hand hygiene -hand hygiene refers to both handwashing with an antimicrobial or plain soap and water as well as the use of alcohol-based gels, foams, and rinses the three essential components of hand washing include: - Answer: -soap -water -friction time requirements for handwashing - Answer: -at least 15 seconds to remove transient flora from the hands -up to 2 minutes when hands are more soiled risks of infection - Answer: -inadequate hand hygiene (client and caregivers) -compromised health or defenses against infection -use of poor medical/surgical asepsis by caregivers -clients who have poor personal hygiene, poor nutrition, and those who are stressed -clients who live in a very crowded environment -older adult clients -clients who used IV drugs and share needles -clients who engage in unprotected sex -clients who have recently been exposed to poor sanitation, mosquito-born/parasitic diseases, or diseases endemic to area visited but not in client's home country individuals with compromised health or defenses against infection include: - Answer: -those who are immunocompromised -those who have had surgery -those with indwelling devices -a break in the skin -those with poor oxygenation -those with impaired circulation -those who have chronic or acute disease health-care associated infections (HAIs) - Answer: -an infection acquired while the client is receiving care in a health-care setting -formally called nosocomial infections -can come from exogenous source or endogenous source -most common setting for HAIs is the ICU -best way to prevent HAIs is through frequent and effective hand hygiene -most common site of HAIs is the urinary tract -most common causative agents are Escherichia coli, Staphylococcus aureus, and enterococci -an iatrogenic infection results from a diagnostic or therapeutic procedure -HAIs are not always preventable and not always iatrogenic s/s of generalized or systemic infection - Answer: -fever -increased pulse and resp rate (in response to high fever) -malaise -anorexia, nausea, and/or vomiting -enlarged lymph nodes s/s during 1st stage of the inflammatory response (local infection): - Answer: -redness (from dilation of arterioles bringing blood to the area) -warmth of the area on palpation -edema -pain or tenderness -loss of use of the affected part the types of exudate appearing at the site of infection during the 2nd stage: - Answer: -serous (clear) -sanguineous (contains RBCs) -purulent (contains leukocytes and bacteria) during the 3rd stage of infection, ___ ___ is replaced by ___ ___. - Answer: damaged tissue is replaced by scar tissue lab results indicating infection include: - Answer: -leukocytosis (WBCs > 10,000/uL -increases in the specific types of WBCs on differential (left shift = increase in neutrophils) -elevated erythrocyte sedimentation rate (ESR) -presence of micro-organisms on culture of the specific fluid/area components of the chain of infection include: - Answer: -an infectious agent (bacteria, virus, fungi, protozoa) -a reservoir where the infectious agent grows (wound drainage, food, oxygen tubing) -an exit portal of the infectious agent (skin, resp or GI tracts) -a means of transmission (droplet, person-to-person contact, touching contaminated items) -an entry portal to a susceptible host (same as exit) -a host that must be susceptible to the infectious agent adequate fluid intake/hydration prevents: - Answer: -the stasis of urine by flushing the urinary tract and decreasing the growth of micro-organisms -the skin from breaking down which will help prevent micro-organisms from entering the body pulmonary hygiene for immobile clients - Answer: -includes turning, coughing, deep breathing, incentive spirometry -done every 2 hrs or as prescribed -decreases growth of micro-organisms and development of pneumonia by preventing stasis of pulmonary excretions, stimulating ciliary movement and clearance which expands the lungs components of hygiene/cough etiquette that applies to anyone entering a health care setting includes: - Answer: -covering the mouth and nose when coughing and sneezing -using facial tissues to contain respiratory secretions, and disposing of them promptly into a hands-free receptacle -wear surgical mask when coughing to minimize contamination of the surrounding environment -turning head when coughing and staying a min of 3' away from others, especially in common waiting areas -performing hand hygiene after contact with respiratory secretions isolation guidelines - Answer: -group of actions that include hand hygiene and use of barrier precautions, which are intended to reduce the transmission of infectious organisms -apply to everyone regardless of diagnosis, and must be implemented whenever contact with a potentially infectious material is anticipated -PPE is changed after contact with each client and between procedures with the same client if in contact with large amounts of blood and body fluids standard precautions (tier 1) - Answer: -applies to all body fluids (excluding sweat), non-intact skin, and mucous membranes -hand hygiene recommended after all contact and alcohol-based waterless product is preferred unless hands are visibly dirty; also required after removal of gown -clean gloves are worn when touching all body fluids, non-intact skin, mucous membranes, and contaminated equipment/articles -gloves removed and hand hygiene completed between each client -masks, eye protection, and shields required when splashing or spraying of body fluid may occur -gloves worn whenever touching anything that has potential to contaminate hands of the nurse -sturdy, moisture resistant bag used for soiled items; contaminated laundry to be bagged and handled to prevent leaking; equipment for client care properly cleaned and one time use items disposed of -safety devices on all equipment/supplies enabled after use and sharps disposed of properly -private room not needed unless client is unable to maintain appropriate hygienic practices transmission precautions (tier 2) include: - Answer: -airborne precautions -droplet precautions -contact precautions airborne precautions - Answer: -used to protect against droplet infections smaller than 5mcg (measles, varicella, pulmonary or laryngeal TB) -require a private room, masks/respiratory devices for caregivers and visitors (N95 or HEPA respirator for known/suspected TB), and negative pressure airflow exchange room of at least 6 exchanges per hr droplet precautions - Answer: -protect against droplets larger than 5 mcg (streptococcal phryngitis or pnemonia, scarlet fever, rubella, pertussis, mumps, mycoplasma, pneumonia, meningococcal pneumonia/sepsis, pneumonic plague) -require a private room or room with clients with the same infectious disease and masks for providers and visitors contact precautions - Answer: -protect visitors and caregivers against direct client/environmental contact infections (respiratory syncytial virus, shigella, enteric diseases caused by micro-organisms, wound infections, herpes simplex, scabies, multidrug-resistant organisms) -require a private room or a room with other clients with the same infection, gloves and gowns worn by caregivers and visitors, and disposal of infectious dressing material into a single, nonporous bag without touching the outside of the bag it is the ___'s ___ to assess, report, and document client allergies and to provide client care that avoids exposure to allergens - Answer: provider's responsibility falls - Answer: -older adults at increased risk 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, and cognitive dysfunction; also side effects of some medications -clients are at greater risk when >1 of the risk factors are present -fall prevention is a major nursing priority complete a fall-risk assessment ___ ___ & at ___ ___ to limit risk of falls - Answer: upon admission & at regular intervals general measures to prevent falls includes: - Answer: -be sure client knows how to use call light, it is within reach, and encourage its use -respond to call lights in a timely manner -orient client to setting and assistive devices -place clients at risk for falls near nursing station -ensure bedside table and frequently used items are within client's reach -maintain bed in low position -for clients who are sedated, unconscious, or otherwise compromised, bed rails are kept up and bed kept in low position -avoid use of full side bedrails for clients who get out of bed or attempt to get out of bed without assistance -provide nonskid footwear -keep floor free of clutter with a clear path to the bathroom -keep assistive devices nearby after validation of safe use by client and family -educate client and family/caregivers on identified risks and plan of care -lock wheels on beds, wheelchairs, and carts -use chair or bed sensors for clients at risk for getting up unattended seizure precautions include: - Answer: -ensure rescue equipment is at bedside -inspect client's environment for items that may cause injury in event of seizure -assist client at risk for seizure with ambulation and transferring -advise all caregivers and family not to put anything in client's mouth in event of seizure (with exception of status epilepticus) -advise caregivers and family not to restrain in event of seizure but to lower to bed/floor, protect head, move nearby furniture, provide privacy, put on side with head flexed slightly forward, and loosen clothing to prevent injury -in event of seizure, stay with client and call for help -admin meds as ordered -note duration of seizure and sequence and type of movement -after seizure, explain what happened to client and provide comfort and quiet -document the seizure along with precipitating factors along with description of event and report it to provider seclusion and restraints - Answer: -must be ordered -should be ordered for the shortest duration necessary and only if less restrictive measures are not sufficient -a client may voluntarily request temp seclusion -restraints can be physical or chemical -if used, frequency of client assessments in regards to food, fluid, comfort, and safety should be performed and documented every 15-30 min seclusion and/or restraint must never be used for: - Answer: -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 restraints should: - Answer: -never interfere with treatment -restrict movement as little as is necessary to ensure safety -fit properly -be easily changed to decrease the chance of injury and to provide for the greatest level of dignity the following must occur in order for seclusion or restraint to be used: - Answer: -all other less restrictive means have to be exhausted -the treatment must be prescribed by provider in writing based on a face-to-face assessment of the client (exception is in emergency situation where client is a danger to himself or others and providers order must be written asap) -rx must include reason, type, location, how long it may be used, and type of behavior that warranted the restraint -provider must rewrite the rx every 24hrs or as specified by the facility -PRN rx is not allowed nursing responsibilities in regards to isolation/restraints: - Answer: -must be identified in the protocol -include how often the client should be: assessed; offered food/fluid; provided for means of hygiene/elimination; monitored for vital signs; offered ROM of extremities other responsibilities of health care providers when dealing with isolation/restraints include: - Answer: -always explain need to client and family -obtain signed consent from client or guardian, if required -review manuf. instructions for correct application -remove or replace restraints frequently to ensure good circulation and full ROM of restricted limb -pad bony prominences -use quick-release knot to tie restraints to bed frame -ensure restraint is loose enough for ROM and 2 fingers can fit between device and the client -regularly assess need for continued need -never leave client unattended w/o the restraint complete documentation of isolation/restraint use includes a description of: - Answer: -precipitating events and behavior prior to seclusion/restraints -alternative actions taken to avoid seclusion/restraint -time restraints applied and removed (if discontinued) -type of restraint and location -client's behavior while restrained -type and frequency of care -client's response when restraint removed -meds administered The 3 classes of fire extinguishers: - Answer: -Class A: for paper, wood, upholstery, rags, or other types of trash fires -Class B: for flammable liquids and gas fires -Class C: for electrical fires home safety risks for preschoolers and school-age children include: - Answer: -drowning -motor vehicle/injury -burns -poison home safety risks for adolescents include: - Answer: -motor vehicle/injury -burns home safety risks for young and middle age adults include: - Answer: -motor vehicle crashes -occupational injury -high alcohol consumption -suicide home safety risks for older adults include: - Answer: -physical, cognitive and sensory changes -changes in musculoskeletal and logical systems -impaired vision and/or hearing -nocturia and incontinence prevention education for risk of aspiration in infants and toddlers: - Answer: -keep small objects out of reach -check toys for loose parts -do not feed infant hard candy, peanuts, popcorn, or whole/sliced pieces of hot dog -do not place infant in supine position while feeding or prop the bottle -pacifiers should be constructed of one piece -provide information on prevention of lead poisoning prevention education for risk of suffocation in infants and toddlers: - Answer: -keep plastic bags out of reach -ensure crib mattress fits snugly and no more than 2 2/3 inches between crib slats -never leave alone in bathtub -remove crib toys, including mobiles, as soon as infant begins to push up -keep latex balloons out of reach -fence swimming pools and use locked gate -begin swimming lessons as soon as developmental status allows -keep toilet lids down and bathroom doors shut prevention education for risk of motor vehicle/injury in infants and toddlers: - Answer: -use backward facing car seat until yr old and weighs at least 20 lbs -all car seats should be federally approved and be placed in the back seat prevention education for risk of motor vehicle/injury in preschoolers and school-age children: - Answer: -use booster seats for children < 4'9" and <40 lbs -use seat belts properly after booster seats no longer necessary -use protective equipment when participating in sports or riding/passenger on a bike -supervise and teach safe use of equipment -teach to play in safe areas, rules of the road, and what to do if approached by a stranger -begin sex education for school-ages children prevention education for risk of burns in preschoolers and school-age children: - Answer: -reduce setting on water heater to no higher than 120 deg F -teach dangers of playing with matches, fireworks, fire arms, etc -teach school-aged children how to use microwave and other cooking instruments prevention education for risk of poison in preschoolers and school-age children: - Answer: -teach about hazards of alcohol, prescription, non-prescription, and illegal drugs -keep potentially dangerous substances out of reach prevention education for risk of motor vehicle/injury in adolescents - Answer: ensure teen has completed driver's ed -set rules on # of people in car, seat belt use, and to call for ride home if driver is impaired -reinforce teaching on proper use of protective equipment used in sports -be alert to signs of depression -teach about hazards and safety precautions of firearms -teach to check water depth before diving prevention education for risk of burns in adolescents - Answer: -teach to use sunblock and protective clothing -teach dangers of sun bathing and tanning beds -educate on hazards of smoking safety prevention education for young and middle age adults includes: - Answer: -remind clients to drive defensively and not to drive after drinking -reinforce teaching about long term effects of high alcohol consumption -monitor for s/s of depression/suicide and refer as appropriate -encourage clients to be proactive about safety in workplace -ensure understanding of hazards of excessive sun exposure and the need to use sun block and protective clothing safety prevention education/modifications for older adults includes: - Answer: -home hazard evaluation conducted by nurse, physical therapist, occupational therapist if deemed necessary -remove items that could cause client to trip, such as throw rugs and loose carpets -place electrical cords against wall and behind furniture -ensure steps and sidewalks in good repair -place grab bars near toilet and in tub/shower and installing a stool riser -non-skid mat in tub or shower -place shower chair in shower -ensure lighting is adequate inside and outside home oxygen safety measures: - Answer: -use/store according to manufacture's recommendations -place a NO SMOKING sign near front door of home and on door of client's bedroom -inform client and family of smoking in presence of oxygen and that smokers should smoke outdoors -ensure electrical equipment is in good repair and well grounded -replace bedding that can generate static electricity (wool, nylon, synthetics) with cotton -keep flammable items (such as heating oil and nail polish remover) away from client when O2 in use -follow general safety measures for fire safety additional safety risks in home/community include: - Answer: -passive smoking -carbon monoxide poisoning -food poisoning -bioterrorism passive smoking - Answer: -unintentional inhalation of tobacco smoke -exposure can put one at risk for numerous diseases including: cancer, heart disease, and lung infections -low-birth weight, prematurity, stillbirths, and SIDS have been associated with maternal smoking -smoking in presence of children is associated with development of bronchitis, pneumonia, middle ear infections, and an increase in frequency/severity of asthma attacks carbon monoxide poisoning - Answer: -carbon monoxide binds with hemoglobin and reduces oxygen supply to tissues -cannot be seen. smelled, or tasted -s/s include: nausea, vomiting, headache, weakness, and unconsciousness -death may occur with prolonged exposure -prevention by ensuring proper ventilation when using fuel-burning devices -gas-burning devices should be inspected annually -flues and chimneys should be unobstructed -carbon monoxide detectors should be installed and inspected regularly food poisoning - Answer: -most cases caused by bacteria such as E. coli, Listeria monocytogenes, and Salmonella -healthy individuals usually recover in a few days -very young, very old, pregnant, or immunocompromised clients at highest risk for complications -clients who are especially at risk are instructed to follow a low-microbial diet -most cases due to unsanitary food practice -can be prevented by proper hand hygiene, cooking meats/fish to correct temp, handling raw and fresh foods separately to avoid cross-contamination, and proper refrigeration bioterrorism - Answer: -the dissemination of harmful toxins, bacteria, viruses, and pathogens for the purpose of causing illness or death -examples include anthrax, variola, Clostridium botulism, and Yersinia pestis steps of mobility assessment - Answer: -range of motion -moving from supine to sitting on side of bed -gait -exercise tolerance transfers and use of assistive devices - Answer: -assess client's ability to help with transfers (balance, muscle strength, endurance) -determine need for additional help or assistive devices (transfer belt, hydraulic lift, sliding board) -assist and monitor the client's proper use of mobility aids (canes, walkers, crutches) -include assistance or mobility aids needed for safe transfers and ambulation in the care plan semi-fowler's position - Answer: -client lies supine with head of bed elevated approx 30 degrees and knees may be slightly elevated (about 15 degrees) -position frequently used to prevent regurgitation of tube feedings and aspiration in clients with difficulty swallowing fowler's position - Answer: -client lies supine with head of bed elevated approx 45 degrees and knees may be slightly elevated (about 15 degrees) -position frequently used during procedures such as NG tube insertion and suctioning; also allows for better chest expansion & ventilation, as well as better dependent drainage, after abdominal surgeries high-fowler's position - Answer: -client lies supine with head of bed elevated approx 90 degrees, and knees may or may not be elevated -position promotes lung expansion by lowering the diaphragm and used for clients experiencing severe dyspnea supine or dorsal recumbent position - Answer: -client lies on his back with head and shoulders elevated on a pillow; client's forearms may be placed on pillows or placed at side; foot support prevents footdrop and maintains proper alignmentl prone position - Answer: -client lies flat on abdomen with head to one side -position promotes drainage from the mouth of clients following throat or oral surgery, but inhibits chest expansion lateral or side-laying position - Answer: -client lies on side with most of weight on the dependent hip and shoulder; arms should be flexed in front of the body; pillow placed under head & neck, the upper arm, and under the leg & thigh to maintain body alignment -this is a good sleeping position but the client must be turned regularly to prevent development of pressure ulcers on dependent areas; 30 degree lateral position is recommended for clients at risk for pressure ulcers sims' or semi-prone position - Answer: -client lies on side halfway between lateral and prone positions; weight is on anterior ileum, humerus, and clavicle; lower arm behind client while upper arm is in front; both legs flexed but upper at greater anger than lower at hip and knee -this is a comfortable sleeping position for many clients and promotes oral drainage orthpneic position - Answer: -client sits in the bed or at bedside; pillow placed on over-bed table, which is placed over client's lap; client rests arms on the over-bed table -position allows for chest expansion and is especially beneficial to clients with COPD trendelenburg position - Answer: -entire bed is tilted with head of bed lower than the foot of the bed -position used during postural drainage, and facilitates venous return reverse trendelenburg - Answer: -entire bed is tilted with the foot of the bed lower than the head -position promotes gastric emptying and prevents esophageal reflux a disaster is a ___ ___ or ___-___ event that overwhelms or interrupts, at least temporarily, the normal flow of services of a hospital and include ___ & ___ emergencies - Answer: - mass casualty -intra-facility -internal -external internal emergencies include: - Answer: -loss of electric power or potable water and -severe damage or casualties w/in the facility related to fire, weather, an explosion, or terrorist act internal emergency readiness includes: - Answer: -safety and hazardous materials protocols and infection control policies and practices external emergencies include: - Answer: -hurricanes -floods -volcano eruptions -earthquakes -pandemic flu -industrial accidents -chemical plant explosions -major transportation accidents -building collapse -terrorist acts (including biological and chemical warfare) external emergency readiness includes: - Answer: a plan for participation in community-wide emergencies and disasters categories of triage during mass casualty events - Answer: -emergent category (class I): highest priority given to clients who have life-threatening injuries but also have a high possibility of survival once they are stabilized -urgent category (class II): 2nd highest priority is given to clients who have major injuries that are not yet life threatening and can usually wait 45-60 mins for treatment -nonurgent category (class III): the next highest priority is given to clients who have minor injuries that are not life threatening and do not need immediate attention -expectant category (class IV): the lowest priority is given to clients who are not expected to live and will be allowed to die naturally; comfort measures may be provided, but restorative care will not criteria to follow when identifying clients who can be safely discharged in an emergency situation - Answer: -ambulatory clients requiring minimal care should be discharged or relocated first -clients requiring assistance should be next and arrangements made for continuation of their care -clients who are unstable and/or require nursing care should not be discharged or relocated unless they are in imminent danger during a severe thunderstorm or tornado - Answer: -draw shades and close drapes to protect against shattering glass -lower beds to lowest position and move away from windows -place blankets over clients confined to bed -close all doors -move as many ambulatory clients as possible into the hallways (away from windows) -do not use elevators -monitor for severe weather warnings using tv, radio, or internet biological incidents - Answer: -take measures to protect self and others -recognize s/s of infection/poisoning and appropriate treatments -incidents include: inhalational anthrax, botulism, smallpox, and ebola inhalational anthrax - Answer: -S/S: sore throat, fever, muscle aches, severe dyspnea, meningitis, shock -treatment/prevention: IV ciprofloxacin botulism - Answer: -S/S: difficulty swallowing, progressive weakness, nausea, vomiting, abdominal cramps, difficulty breathing -treatment/prevention: airway management, antitoxin, elimination of toxin smallpox - Answer: -S/S: high fever, fatigue, severe headache, rash (starts centrally and spreads outward) that turns to pus-filled lesions, vomiting, delirium, excessive bleeding -treatment: no cure -supportive care: hydration, pain medication, antipyretics -prevention: vaccine Ebola - Answer: -S/S: sore throat, headache, high temprature, nausea, vomiting, diarrhea, internal and external bleeding, shock -treatment: no cure -supportive care: minimize invasive procedures -prevention: vaccine chemical incidents - Answer: -take measures to protect yourself and to avoid contact -assess and intervene to maintain the client's ABCs and admin first aid as needed -effectively remove the offending chemical/decontaminate -gather specific history of the injury, if possible -in the event of chemical warfare, have knowledge of which facilities are open to exposed clients and which are open to unexposed clients only -follow facility's emergency ops plans hazardous material incidents - Answer: -take measures to protect self and avoid contact -approach scene cautiously -try to identify the material and have knowledge of where MSDS manual is located -try to contain material to one area as much as possible until haz-mat team arrives -if individuals are contaminated, decontaminate as much as possible at the scene or as close to the scene as possible radiological incidents - Answer: -amount of exposure is related to time exposed, distance from source, and amount of shielding -facility treating victims should activate interventions to prevent exposure to treatment areas -staff should wear water-resistant gowns, double glove, and fully cover bodies with caps/shoe covers/masks/goggles -staff should wear radiation or dosimetry badges to monitor amount of exposure -clients should be initially surveyed with radiation meter to determine amount of contamination -decontamination should occur prior to entering the hospital with soap, water, and disposable towels -after decontamination, client should be resurveyed and washed until free of all contamination bomb threat - Answer: -when a phone call is received: >lengthen conversation as much as possible >listen for distinctive background noise >be alert for distinguishing voice characteristics >ask where the bomb will explode and at what time >note if the caller indicates knowledge of the facility by his description of the location -if what appears to be a bomb is found, don't touch, clear the area, isolate it, and obtain professional assistance -notify authorities and key personnel -cooperate with police and others -keep elevators available for authorities -remain calm and alert and try not to alarm clients the International Association for Healthcare Security & Safety (IAHSS) provides: - Answer: recommendations for the development of security plans Nurses should be aware that security measures include: - Answer: -an identification system that identifies authorized personnel -electronic security systems in high-risk areas Nurses should be aware that all health care institutions have color-codes designated for emergencies: some examples include: - Answer: -code red (fire) -code pink (newborn abduction) -code orange (chemical spill) -code blue (mass casualty incident) -code gray (tornado) **may vary by institution** risk factor assessment should assess the following: - Answer: -genetics: a predisposition to various illnesses can be attributed to heredity (heart disease, cancer) -gender: some specific diseases are more common in one gender than the other (autoimmune disorders, suicide rates) -physiologic factors: various physiologic states place a client at greater risk for health problems (BMI, pregnancy) -environmental factors: presence of toxic substances and chemicals can affect health where clients work and live; water quality, pesticide exposure, and air pollution should be commonly assessed -lifestyle-risk behaviors: stress, substance abuse, diet deficiencies, lack of exercise, and sun exposure age- early disease detection and intervention is facilitates by following screening guidelines screenings and exams for clients who are asymptomatic - Answer: -routine physical: (f) every 1-3 years beginning at 20/annually beginning at 40; 9m) every 5 years starting at 20/annually beginning at 40 -dental assessment: (f&m) every 6 months -blood pressure: (f&m) starting at 20, each routing health care visit, min of every 2 yrs -BMI: (f&m) starting at 20, each routing health care visit -blood cholesterol: (f&m) starting at 20, a min of every 5 yrs -blood glucose: (f&m) starting at 45, min of every 3 yrs -colorectal screening: (f&m) fecal occult blood test annually at 50 AND flexible sigmoidoscopy every 5 yrs or colonoscopy every 10 yrs or double contrast barium enema every 5 yrs -colonoscopy: (f&m) starting at 50, every 1-10 yrs depending on test used -pap test: (f) starting at 21 (or earlier if sexually active) every 1-2 yrs; after 30 every 1-3 yrs depending on provider/test used -clinical breast exam: (f) starting at 20, every 3 yrs; at 40, annually -mammogram: (f) starting at 40, annually -clinical testicular exam: (m) starting at 20, annually -prostate-specific antigen test & digital rectal exam: (m) starting at 50, as indicated by provider primary prevention - Answer: -addresses the needs of healthy clients to promote health and prevent disease with specific precautions -examples: immunizations programs; child car seat education; nutrition and fitness activities; health education in schools secondary prevention - Answer: -focuses on early identification of individuals or communities experiencing illness, providing treatment, and conducting activities that are geared to prevent worsening health status -examples: communicable disease screening and case finding; early detection and treatment of diabetes; exercise programs for older adult clients who are frail tertiary prevention - Answer: -aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning -examples: prevention of pressure ulcers as complication of a spinal cord injury; promoting independence for the client who has traumatic brain injury behavior-change strategies nurses can use in health promotion/disease prevention - Answer: -identify client's readiness to receive and act upon health info -identify interventions acceptable to the client -help motivate the client to change by setting realistic timelines -reinforce steps the client makes toward change -encourage the client to maintain the change ___ is an interactive process driven by specific client goals - Answer: teaching ___ is an intentional gain of new information and represents a change in behavior - Answer: learning ___ influences how much and how quickly a person learns - Answer: motivation purposes of client teaching include: - Answer: -providing clients with info and skills to maintain and promote health, and prevent illness (immunizations, lifestyle change, prenatal care) -providing clients with info about how to restore health (teaching how to admin insulin) -providing clients with info about how to adapt to permanent illness or injury (ostomy care, learning swallowing techniques, speech therapy) the 3 domains of learning are: - Answer: cognitive, affective, and psychomotor cognitive learning - Answer: -obtaining new info, being able to apply the info, and being able to evaluate the info -example: client is taught s/s of hypoglycemia and then can verbalize when to notify provider affective learning - Answer: -involves feelings, beliefs, and ideals -example: a client listens to the nurse explain life changes necessary to manage diabetes and then discusses feelings regarding the diagnosis psychomotor learning - Answer: -learning how to complete a physical activity or motor skill -example: client practices preparing insulin injections assessment/data collection related to client education includes: - Answer: -assess/monitor the client's learning needs -assess the learning environment -assess/monitor the client's learning style (auditory, visual, kinesthetic) -identify areas of concern -assess/monitor available resources (financial, social, community) -identify the client's developmental stage -determine the client's physical and cognitive ability -identify special needs (visual impairment, decreased manual dexterity) -determine the client's motivation and readiness to learn planning related to client education includes: - Answer: -identify mutually agreed upon client outcomes -prioritize the learning objectives with the client's needs in mind -use methods that emphasize the client's learning style -select age-appropriate teaching methods/material -provide electronic educational resources as appropriate -demonstrate use of the internet as in regard to accessing info and support services and how to recognize reliable sources -organize learning activities to move from simple to more complex tasks, and known to unknown concepts -incorporate active participation in the learning process - schedule teaching sessions to coincide with the client's daily activities implementation related to client education includes: - Answer: -create an environment conducive to learning (reduce distractions and interruptions, provide privacy) -use therapeutic communication to develop a trusting relationship that allows client to express concern -review previous knowledge and experiences -explain the therapeutic regimen or procedure -present steps building to more complex tasks -demonstrate psychomotor skills -allow time for return demonstration -provide positive reinforcement evaluation related to client education includes: - Answer: -ask client to explain info in his own words -observe the client demonstrating the learned activity -use written tools to measure accuracy of info -request client's self-evaluation of progress -observe verbal and nonverbal communication -determine client's ability to use info over time but re-evaluate learning during follow-ups -revise care plan as needed factors that enhance learning: - Answer: -perceived benefit -cognitive and physical ability -health and cultural beliefs -active participation -age/educational level-appropriate methods barriers to learning: - Answer: -fear, anxiety, depression -physical discomfort, pain, fatigue -environmental distractions -health and cultural beliefs -sensory and perceptual deficits -psychomotor deficits expected physical development (size): infant (birth-1 yr) - Answer: -posterior fontanel closes by 2-3 months -anterior fontanel closes by 12-18 months -weight: gains 150-210 g (5-7 oz) per month for 1st 6 months; birth weight should double by 4-6 months and triple by the end of the 1st year -height: grows about 2.5 cm (1 in) per month for 1st 6 months; then about 1.25 (0.5 in) per month til the end of 1st yr -head circumference: increases about 1.25 cm (0.5 in) per month for 1st 6 months; then about 0.5 cm (0.2 in)between 6-12 months) expected physical development (dentition): infant (birth-1 yr) - Answer: -6 to 8 teeth erupt in the infant's mouth by end of 1st yr -teething pain can be eased using cold teething rings, OTC teething gels, acetaminophen and/or ibuprofen; ibuprofen given only to children over 6 months -clean teeth using cool, wet washcloth -bottles should not be given when they are falling asleep; prolonged exposure to milk/juice can cause dental caries expected physical development (fine and gross motor development): infant (birth-1 yr) - Answer: -1 month: (g) demonstrates head lag; (f) has a present grasp reflex -2 month: (g) lifts head off mattress; (f) holds hands in an open position -3 month: (g) raises head and shoulders off mattress: (f) no longer has grasp reflex, keeps hands loosely open -4 month: (g) rolls from back to side; (f) places objects in mouth -5 month: (g) rolls from front to back; (f) uses palmer grasp dominantly -6 month: (g) rolls from back to front; (f) holds bottle -7 month: (g) bears full weight on feet; (f) moves objects from hand to hand -8 month: (g) sits unsupported; (f) begins using pincer grasp -9 month: (g) pulls to standing position; (f) has crude pincer grasp -10 month: (g) changes from prone to sitting position; (f) grasps rattle by its handle -11 month: (g) walks while holding on to something; (f) can place objects into container -12 month: (g) sits down from standing position w/o assistance; (f) tries to build two-block tower w/o success expected cognitive development (Piaget: sensorimotor stage from birth to 24 month): infant (birth-1 yr) - Answer: -separation: when infants learn to separate themselves from other objects in the environment -object permanence: occurs at about 9 months; the process by which an infant knows the object still exists when it is hidden from view -mental representation: recognition of symbols expected cognitive development (language development): infant (birth-1 yr) - Answer: -responds to noises -vocalizes with "ooos" and "aahs" -laughs and squeals -turns head to sound of a rattle -pronounces single-syllable words -begins speaking two and then three-word phrases expected psychosocial development (Erikson: trust vs mistrust): infant (birth-1 yr) - Answer: -infants trust that their feeding, comfort, stimulation, and caring needs will be met -social development initially influenced by infant's reflexive behavior and includes attachment, separation recognition/anxiety, and stranger fear -attachment seen when infant begins to bond with parents; this development occurs w/in 1st month; process is enhanced when the infant and parents are in good health, have positive feeding experiences, and receive adequate rest -separation recognition occurs during the 1st year as learning physical boundaries from that of other people; learning how to respond to people is next phase in development; positive interactions with parents, siblings, and other caregivers help est. trust -separation anxiety develops between 4-8 months; will protest loudly when separated from parents -stranger fear becomes evident between 6-8 months when children are less likely to accept strangers expected psychosocial development (self-concept development): infant (birth-1 yr) - Answer: -by end of 1st year will be able to distinguish themselves as being separate from their parents expected psychosocial development (body-image problems): infant (birth-1 yr) - Answer: -infant discovers mouth is a pleasure producer -hands and feet are seen as objects of play -discovers smiling causes others to react expected age-appropriate activities: infant (birth-1 yr) - Answer: -infants have short attention spans and participate in solitary play -appropriate toys and activities: rattles, mobiles, teething toys, nesting toys, pat-a-cake, playing with balls, reading books health promotion (immunizations): infant (birth-1 yr) - Answer: -birth: Hep B -2 month: DTaP, rotavirus vaccine (RV), inactive poliovirus (IPV), Haemophilus influenzae type B (Hib), pneumococcal vaccine (PCV), and Hep B -4 month: DTaP, RV, IPV, Hib, PVC -6 month: DTaP, IPV (6-18 months), PVC, Hep B (6-12 months), RotaTeq (alt to RV which required 3 doses completed by 32 weeks) -6-12 month: seasonal flu yearly, trivalent inactivated influenza vaccine (TIV) is available as IM injection health promotion (nutrition-feeding alternatives): infant (birth-1 yr) - Answer: -breastfeeding provides complete diet during 1st 6 months and is recommended -iron-fortified formula is an acceptable alternative; cow's milk is not recommended health promotion (nutrition-solids): infant (birth-1 yr) - Answer: -can be introduced between 4-6 months -indicators for readiness include voluntary control of head and trunk, hunger less than 4 hrs after vigorous nursing or intake of 8 oz of formula, interest of the infant -iron-fortified rice offered 1st -new foods introduced 1 at a time over a 5-7 day period to assess for allergies or intolerance; veggies or fruits introduced between 6-8 months and after both have been introduced, then meats -milk, eggs, wheat, citrus fruits, peanuts, peanut butter, and honey delayed till after 1st year -chopped, cooked, and unseasoned table foods by 9 months -appropriate finger foods include: ripe bananas, toast strips, graham crackers, cheese cubes, noodles, peeled chunks of apples/pears/peaches -breast milk/formula decreased as solid food intake increases -parents encouraged to use iron-enriched foods after 6 months of age health promotion (nutrition-weaning): infant (birth-1 yr) - Answer: -can be accomplished when infant is able to drink from a cup (sometime after 6 months) -replace 1 feeding with breast milk/formula in a cup -bedtime feeding is last to be replaced health promotion (injury prevention-aspiration of foreign objects): infant (birth-1 yr) - Answer: -avoid small objects (such as grapes, coins and candy) that can become lodged in throat -provide age-appropriate toys -check clothing for safety hazards (loose buttons) health promotion (injury prevention-bodily harm): infant (birth-1 yr) - Answer: -keep sharp objects out of reach -keep infant away from heavy objects that can be pulled down onto her -do not leave alone with animals -monitor for shaken baby syndrome health promotion (injury prevention-burns): infant (birth-1 yr) - Answer: -check temp of bath water -turn down thermostat on hot water heater -have working smoke detectors in the home -turn handles of pots/pans to back of stove -apply sunscreen when outdoors during daylight hours -cover electrical outlets health promotion (injury prevention-drowning): infant (birth-1 yr) - 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