VATI RN COMPREHENSIVE PREDICTOR FOCUSED REVIEWManagement of Care – (9) Advance Directives – (1) Legal Responsibilities: Purpose of a Living Will (RM FUND 9.0 Chp 4) A living will is a legal document that expresses the client’s wishes regarding medical treatment in the event the client becomes...
VATI RN COMPREHENSIVE
PREDICTOR FOCUSED
REVIEW
Management of Care – (9)
Advance Directives – (1)
Legal Responsibilities: Purpose of a Living Will (RM FUND 9.0 Chp 4)
A living will is a legal document that expresses the client’s wishes regarding
medical treatment in the event the client becomes incapacitated and is
facing endof-life issues. Most state laws include provisions that protect
health care providers who follow a living will from liability.
Assignment, Delegation and Supervision – (2)
Delegation and Supervision: Delegating Tasks to an Assistive Personnel (RM
FUND
9.0 Chp 6)
Examples of tasks nurses may delegate to Aps (provided the facility’s policy
and state’s practice guidelines permit)
Activities of daily living (ADLs) – bathing, grooming, dressing, toileting,
ambulating, feeding (without swallowing precautions), positioning
Routine tasks – bed making, specimen collection, intake and output,
vital signs (for stable clients)
Managing Client Care: Delegation Strategy for Effective Task Management
(RM
Leadership 7.0 Chp 1)
Consideration for selection of an appropriate delegate include the following:
education, training, and experience; knowledge and skill 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; the delegatee’s culture; agency policies and procedures and
licensing legislation (state nurse practice acts)
Case Management – (1)
Cardiovascular Disorders: Tetralogy of Fallot (RM NCC RN 10.0 Chp 20)
Tetralogy of Fallot – four defects that result in mixed blood flow: Pulmonary
stenosis, ventricular septal defect, overriding aorta, right ventricular
hypertrophy
Cyanosis at birth: progressive cyanosis over the first year of life.
Systolic murmur. Episodes of acute cyanosis and hypoxia (blue or “Tet”
spells)
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, Surgical procedures – shunt placement until able to undergo primary repair;
complete repair within the first year of life
Collaboration with Interdisciplinary Team – (1)
Communicable Diseases, Disasters, and Bioterrorism: CDC Reportable
Diagnoses
(RM CH RN 7.0 Chp 6)
Anthrax. Botulism. Cholera. Congenital rubella syndrome (CRS).
Diphtheria. Giardiasis. Gonorrhea. Hepatitis A, B, C. HIV infection.
Influenza-associated pediatric mortality. Legionellosis/Legionnaires’
disease. Lyme disease. Malaria. Meningococcal disease. Mumps.
Pertussis (whooping cough). Poliomyelitis, paralytic. Poliovirus infection,
nonparalytic. Rabies (human or animal). Rubella (German measles).
Salmonellosis. Severe acute respiratory syndrome-associated coronavirus
disease (SARS-CoV). Shigellosis. Smallpox. Syphilis. Tetanus/C. tetani.
Toxic shock syndrome (TSS) (other than Streptococcal). Tuberculosis
(TB). Typhoid fever. Vancomycin-intermediate and vancomycin-resistant.
Staphylococcus aureus (VISA/VRSA)
Continuity of Care – (1)
Information Technology: Change-of-Shift Report (RM FUND 9.0 Chp 5)
• Nurses give this report at the conclusion of each shift to the nurse
assuming responsibility for the clients.
Formats include face to face, audiotaping, or presentation during
walking rounds in each client’s room (unless the client has a roommate
or visitors are present)
An effective report should: include significant objective information
about the client’s health problems; proceed in a logical sequence;
include no gossip or personal opinion; relate recent changes in
medications, treatments, procedures, and the discharge plan
Establishing Priorities – (1)
Managing Client Care: Determining Priority Care for a Group of Clients (RM
Leadership 7.0 Chp 1)
• Prioritize systemic before local (“life before limb”)
Prioritizing interventions for a client in shock over interventions for a
client who has a localized limb injury
• Prioritize acute (less opportunity for physical adaptation) before chronic
(greater opportunity for physical adaptation)
Prioritizing the care of a client who has a new injury/illness (e.g. mental
confusion, chest pain) or an acute exacerbation of a previous illness
over the care of a client who has a long-term chronic illness
• Prioritize actual problems before potential future problems
Prioritizing administration of medication to a client experiencing of
medication to a client experiencing acute pain over ambulation of a
client at risk for thrombophlebitis
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, • Listen carefully to clients and don’t assume
Asking a client who has a new diagnosis of diabetes mellitus what he
feels is most important to learn about disease management
• Recognize and respond to trends vs. transient findings
Recognizing a gradual deterioration in a client’s level of consciousness
and/or Glasgow Coma Scale score
• Recognize indications of medical emergencies and complications vs.
expected findings
Recognizing indications of increasing intracranial pressure in a client
who has a new diagnosis of a stroke vs. the findings expected
following a stroke
• Apply clinical knowledge to procedural standards to determine the priority
action
Recognizing that the timing of administration of antidiabetic and
antimicrobial medications is more important than administration of
some other medications
Ethical Practice – (1)
Professional Responsibilities: Demonstration of Veracity (RM Leadership 7.0
Chp 3) Veracity: the nurse’s duty to tell the truth
Legal Rights and Responsibilities – (1)
Professional Responsibilities: Rights of Clients (RM Leadership 7.0 Chp 3)
Client rights are the legal guarantees that clients have with regard to their
health care
Clients using the services of a health care institution retain their rights
as individuals and citizens of the United States. The America Hospital
Association (AHA) identifies client rights in health care settings in the
Patient Care Partnership (www.aha.org)
Residents in nursing facilities that participate in Medicare programs
similarly retain resident rights under statutes that govern the operation
of these facilities
Nurse are accountable for protecting the rights of clients. Situations that
require particular attention include informed consent, refusal of treatment,
advance directives, confidentiality, and information security.
Safety and Infection Control – (5)
Accident/Error/Injury Prevention – (2)
Medications Affecting Urinary Output: Indications for the Use of a Diuretic
(RM
Pharm RN 7.0 Chp 19)
• High-ceiling loop diuretics work in the ascending limb of loop of Henle –
block reabsorption of sodium and chloride and prevent reabsorption of
water. Causes extensive diuresis even with severe renal impairment
• They are used when there is an emergent need for rapid mobilization of
fluid – pulmonary edema caused by heart failure; conditions not
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