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Shanerica Quin

Remediation A

Assignment, Delegation and Supervision

Ergonomic Principles: Evaluating Staff Performance

Ergonomics are the factors or qualities in an objects 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


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
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

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

Coordinating Client Care: Interdisciplinary Care Conference

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
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

Only health care team members directly responsible for the clients care
should be allowed access to the clients 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 password-protected, and care must be taken to
prevent public viewing of the information.

Informed Consent
Professional Responsibilities: Providing Translation for Informed Consent

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
Quality issues are identified by staff, management, or risk management
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

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 clients 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


No interventions required
Indicate reactive nonstress test

Normal Physiological Changes During Pregnancy: Nagele's Rule

Ngeles rule used to caluculate EDB

Take the first day of the womans 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 Joint 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

Family and Community Violence: Priority Interventions

Nursing interventions for child or vulnerable adult abuse must include the
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

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 clients thoughts, feelings, concerns, and
o Express empathy and genuine concern for the clients and familys
o Obtain information and give feedback about the clients condition.
o Intervene to promote functional behavior and effective interpersonal
o Evaluate the clients progress toward goals and outcomes.

Mental Health Concepts

Cognitive Disorders: Expected Findings of Delirium

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
Personality change is rapid.
Some perceptual disturbances may be present, such as hallucinations and

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 joint mobility (within
the capabilities of the client).
Monitor the client for indications of fatigue.
Teach the client measures to maximize functional activity

Medication Administration
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 Administration: Appropriate Technique for

Administering Eye Drops

Have client sit upright or lie supine with the head tilted slightly and looking
up at ceiling.
Rest dominant hand on clients 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

Assist with the clients 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
If a swallowing deficit is identified, the clients liquids may need to be
thickened with a commercial thickener to avoid aspiration

Parenteral/Intravenous Therapies

Intravenous Therapy: Administering 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

Apply a dressing over the puncture site, and assess dressing for bleeding or
Monitor the clients 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
Maintain a patent airway in the event of a seizure.
Administer antihypertensive medications as prescribed.

Meningitis and Reye Syndrome: Increased Intracranial Pressure

Increased ICP could lead to neurological dysfunction

Nursing Actions



Monitor for signs of increased ICP.

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 ICP (positioning; avoidance of
coughing, straining, and bright lights; minimizing environmental

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