RN Comprehensive Predictor 2024 Remediation

RN Comprehensive Predictor 2024 Remediation Professional Responsibilities: Identifying Client Advocacy • Support of clients’ health, wellness, safety, and personal rights, including privacy • Autonomy: the right to make one’s own personal decisions, even when those decisions might not be in that person’s best interest • Beneficence: action that promotes good for others, without an self interest • Fidelity: fulfillment of promises • Justice: fairness in care delivery and use of resources • Nonmaleficence: a commitment to do no harm • Veracity: a commitment to tell the truth 1) Ensures the client has the information they need to make decisions about healthcare 2) Advocate even when they disagree with the client’s decision 3) Advocate when clients are unable to speak or act for themselves Managing Client Care: Action Requiring Intervention during Tracheostomy Suctioning • Provide tracheostomy care every 8 hours to reduce risk of infection • Use sterile suctioning supplies • Remove soiled dressings and excess secretions • Apply the oxygen source loosely if the client’s SpO2 decreases during procedure • Use cotton tip[ed applicators and gauze pads to clean exposed outer cannula surfaces. Clean in a circular motion from the stoma site outward • Use surgical asepsis to remove and clean the inner canula . Use a new inner cannula if it is disposable. • Clean the stoma site and then the tracheostomy plate • Place a fresh split gauze tracheostomy dressing of nonraveling material under and around the tracheostomy holder and plate 1) An open airway is necessary for breathing so it is the highest priority 2) Breathing is necessary for oxygenation of the blood to occur 3) Circulation is necessary for oxygenated blood to reach the body’s tissues Managing Client Care: Effective Time Management 1) Taking time to plan care and taking priorities into consideration 2) Making repeated trips to the supply room 3) Completing one task before beginning another task for equipment Coordinating Client Care: Planning Care for a Client Following a Stroke • Assess swallow and gag reflex before feeding • Can have thin (water, juice), nectar like (cream soups, nectars), honey like (honey, yogurt), spoon thick ( pudding, cooked cereals) • Pureed, mechanically soft, regular 1) Initiation revision and evaluations of the plan of care 2) Facilitating referrals and the use of community resources 3) Facility to another, such as from an acute care facility to a skilled facility Coordinating Client Care: Information to Report to Occupational Therapist • Assess and plans for clients to regain activities of daily living skills, especially motor skills of the upper extremities • Ex. A client has difficulties with using an eating utensil with her dominant hand following a stoke. 1) Client medical diagnosis and care providers 2) Overview of health status, plan of care, and recent progress 3) Most recent vital signs and medications Multiple Sclerosis: Priority Referral for a Client who has Amyotrophic Lateral Sclerosis • Degenerative neurological disorder of upper and lower motor neurons, resulting in progressive paralysis • Eventually causes respiratory paralysis within 3-5 years. Cognitive function is not impacted. No cure. • Palliative care is top priority 1) Plan for disease progression 2) Consider referral to occupational and physical therapy for home environment assessment to determine safety and ease of mobility. 3) Refer to speech language therapist for dysarthria and dysphagia. Information Technology: Using Correct Documentation 1) Begin each entry with the date and time 2) Record entries legibly, in nonerasable black ink, and do not leave blank spaces in the nurses’ notes 3) Sign all documentation as the facility requires, generally with name and title Professional Responsibilities: Priority Action When Obtaining a Signature on an Informed Consent Form • The reason the client needs the treatment or procedure • How the treatment or procedure will benefit the client • The risks involved • Other options to treat the problem • The nurse’s role is to witness the client’s signature on the informed consent form to ensure that the provider has obtained the informed consent responsibly 1) For an invasive procedure or surgery, the client is required to provide written consent 2) State laws regulate who is able to give informed consent 3) The nurse must verify that consent is informed and witness the client sign the consent form Communicable Diseases, Disasters, and Bioterrorism: Reportable Infectious Diseases • TB, Hep A/B/C, anthrax, diptheria, gonorrhea, HIV, influenza- associated pediatric mortality, pertussis, mumps, lyme disease, rubella, smallpox, syphilis, toxic shock syndrome Cultural and Spiritual Nursing Care: Communicating with a client who speaks a language different from the nurse • Always have a professional interpreter when translating 1) Nurses should accommodate each client’s cultural beliefs and values whenever possible, unless they are in direct conflict with essential health practices 2) Study the client and their environment for examples of cultural relevance 3) Use only a facility-approved medical interpreter Professional Responsibilities: Understanding Regulations for Nursing Scope of Practice 1) Nurses should refuse to practice beyond the legal scope of practice and/or outside of their areas of competence regardless of reason 2) Nurses should use the formal chain of command to verbalize concerns related to assignment in light of current legal scope of practice, job description, and area of competence 3) Standards of care guide, define, and direct the level of care that should be given by practicing nurses Medications Affecting Urinary Output: Teaching About Furosemide • Indications: pulmonary edema, edema, hypertension • Mode of action: blocks reabsorption of Na, Cl, and water in the ascending loop of Henle, causing rapid diuresis • Side effects: dehydration, electrolyte imbalances (hyponatremia, hypokalemia), hypotension, ototoxicity, hyperglycemia