name: Establish reasonable expectations for patient behavior based on the situation and the patient


name: Communicate the established consequences and behavioral expectations to the patient in a language that is easily understood and nonpunitive


name: Communicate the established consequences and behavioral expectations with the treatment team for consistency and continuity in care


name: Monitor patient for occurrence or nonoccurrence of the desired behaviors


name: Initiate the established consequences for the occurrence or nonoccurrence of the desired behaviors


name: Screen for depression to establish baseline


name: Establish the purpose and proposed number of visits


name: Establish an agreeable place and time for the visits


name: Maintain patient confidentiality and privacy


name: Use personal strengths to establish relationship with patient


name: Use open-ended questions to encourage expression of thoughts, feelings, and concerns


name: Use silence to encourage the expression of thoughts, feelings, and concerns


name: Avoid barriers to active listening (i.e., minimizing feelings, offering easy solutions, interrupting, talking about self, and premature closure)


name: Use nonverbal behavior to facilitate communication (i.e., be aware of physical stance conveying nonverbal messages)


name: Explore patient's behavior, feelings, and cognition about a situation


name: Assist patient to name feelings and emotion, associated with situation


name: Assist patient to generate a comprehensive list of current problems


name: Assist patient to identify most important problem


name: Assist patient to generate a list of solutions


name: Assist patient to evaluate the disadvantages and advantages of the list generated


name: Encourage patient to select desired solutions


name: Assist patient to develop a plan to carry out the solution


name: Explore progress toward resolution of the problem at subsequent visit


name: Evaluate depression symptoms at appropriate intervals


name: Inspect toenails for changes (e.g., thickening, fungal infection, ingrownness, and evidence of improper trimming)


name: Inquire about changes in feet and current or past history of foot ulcers or amputation


name: Determine mobility status (i.e., walks without assistance, walks with assistance of an assistive device, or does not walk, uses a wheelchair)


name: Elicit deep tendon reflexes (i.e., ankle and knee), as indicated


name: Monitor appropriateness of shoes (i.e., low-heeled with a shoe shape that matches foot shape; adequate depth of toe box; soles made of material that will absorb shock; adjustable fit by lace or straps; uppers made of breathable, soft, and flexible materials; changes made for gait and limb length disorders; and potential for modification, if necessary)


name: Identify patient, family, or significant others' preference for referral health professional or agency, as appropriate


name: Refer patient with family history of malignant hyperthermia for further testing to determine risk (e.g., muscle contracture test, molecular genetic test)


name: Notify surgical team of patient history or risk status


name: Maintain emergency equipment for malignant hyperthermia, per protocol


name: Monitor vital signs, including core body temperature


name: Provide anesthesia machine free of precipitating anesthetic agents for patient at-risk for malignant hyperthermia or discontinue use of anesthesia machine for patient experiencing malignant hyperthermia


name: Place cooling water mattress under patient at-risk for malignant hyperthermia at start of procedure


name: Use nontriggering anesthetic agents for patient at-risk for or experiencing malignant hyperthermia (e.g., opioids, benzodiazepines, local anesthetics, nitrous oxide, and barbiturates)


name: Avoid or discontinue use of triggering agents (e.g., succinylcholine used alone or in conjunction with volatile inhalation agents such as halothane, enflurane, isoflurane, sevoflurane, or desflurane)


name: Monitor for signs of malignant hyperthermia (e.g., hypercarbia, hyperthermia, tachycardia, tachypnea, metabolic acidosis, arrhythmias, cyanosis, mottled skin, muscle rigidity, profuse sweating, and unstable blood pressure)


name: Monitor for abnormalities in laboratory values (e.g., increased end-tidal carbon dioxide level with decreased oxygen saturation, increased serum calcium, increased potassium, unexplained metabolic acidosis, hematuria, and myoglobinuria)


name: Intubate or assist with intubation if endotracheal tube is not already in place


name: Hyperventilate with 100% oxygen using highest flow rate possible


name: Prepare and administer medications (e.g., dantrolene sodium, sodium bicarbonate, insulin, antidysrhythmic agents other than calcium channel blockers, and osmotic or loop diuretics)


name: Apply cooling blanket or commercial cooling device over torso


name: Rub or wrap extremities with cold, wet, or iced towels


name: Lavage stomach, bladder, rectum, and open body cavities with sterile, iced, normal saline


name: Insert nasogastric tube, rectal tube, and urinary catheter, as necessary


name: Administer sufficient IV fluids to maintain urine output


name: Avoid use of drugs, including calcium chloride or gluconate, cardiac glycosides, adrenergics, atropine, and lactated ringer solutions


name: Provide patient and family education (i.e., discuss needed precautions for future anesthetic administration, discuss methods for determining malignant hyperthermia risk)


name: Refer patient and family to Malignant Hyperthermia Association of the United States


name: Report incident to the North American Malignant Hyperthermia Registry and the Medic Alert Hotline


name: Screen for contraindications such as decreased platelets, decreased skin integrity, deep vein thrombosis, areas with open lesions, redness or inflammation, tumors, and hypersensitivity to touch


name: Assess the client's willingness to have a massage


name: Prepare a warm, comfortable, private environment without distractions


name: Drape unexposed areas with blankets, sheets, or bath towels, as needed


name: Use lotion, oil, or dry powder to reduce friction (no lotion or oils on head or scalp), assessing for any sensitivity or contraindications


name: Warm lotion or oil in palm of hands or by running bottle under warm water for several minutes


name: Massage using continuous, even, long strokes; kneading; or vibration with palms, fingers, and thumbs


name: Encourage patient to advise of any part of the massage that is uncomfortable


name: Monitor for conditions indicating a need for ventilation support (e.g., respiratory muscle fatigue, neurological dysfunction secondary to trauma, anesthesia, drug overdose, refractory respiratory acidosis)


name: Consult with other health care personnel in selection of a ventilator mode (initial mode usually volume control with breath rate, FiO2 level and targeted tidal volume specified)


name: Obtain baseline total body assessment of patient initially and with each change of caregiver


name: Routinely monitor ventilator settings, including temperature and humidification of inspired air


name: Administer muscle paralyzing agents, sedatives, and narcotic analgesics, as appropriate


name: Monitor for activities that increase oxygen consumption (e.g., fever, shivering, seizures, pain, or basic nursing activities) that may supersede ventilator support settings and cause oxygen desaturation


name: Monitor for factors that increase patient/ventilator work of breathing (e.g., morbid obesity, pregnancy, massive ascites, lowered head of bed, biting of ET, condensation in ventilator tubes, clogged filters)


name: Monitor for symptoms that indicate increased work of breathing (e.g., increased heart or respiratory rate, increased blood pressure, diaphoresis, changes in mental status)


name: Provide care to alleviate patient distress (e.g., positioning, tracheobronchial toileting, bronchodilator therapy, sedation and/or analgesia, frequent equipment checks)


name: Ensure change of ventilator circuits every 24 hours


name: Use aseptic technique in all suctioning procedures and as appropriate


name: Monitor ventilator pressure readings, patient/ventilator synchronicity, and patient breath sounds


name: Monitor pulmonary secretions for amount, color, and consistency and regularly document findings


name: Stop NG feedings during suctioning and 30 to 60 minutes before chest physiotherapy


name: Monitor patient's progress on current ventilator settings and make appropriate changes, as ordered


name: Monitor for adverse effects of mechanical ventilation (e.g., tracheal deviation, infection, barotrauma, volutrauma, reduced cardiac output, gastric distension, subcutaneous emphysema)


name: Monitor for mucosal damage to oral, nasal, tracheal, or laryngeal tissue from pressure from artificial airways, high cuff pressures, or unplanned extubations


name: Use commercial tube holders rather than tape or strings to fixate artificial airways to prevent unplanned extubations


name: Collaborate routinely with physician and respiratory therapist to coordinate care and assist patient to tolerate therapy


name: Promote routine assessments for weaning criteria (e.g., hemodynamic, cerebral, metabolic stability, resolution of condition prompting intubation, ability to maintain patent airway, ability to initiate respiratory effort)


name: Provide routine oral care with soft moist swabs, antiseptic agent, and gentle suctioning


name: Document all changes to ventilator settings with rationale for changes


name: Document all patient responses to ventilator and ventilator changes (e.g., chest movement observation/auscultation, changes in x-ray, changes in ABGs)


name: Monitor for postextubation complications (e.g., stridor, glottic swelling, laryngospasm, tracheal stenosis)


name: Ensure emergency equipment at bedside at all times (e.g., manual resuscitation bag connected to oxygen, masks, suction equipment/supplies) including preparations for power failures


name: Monitor for conditions indicating appropriateness of noninvasive ventilation support (e.g., acute exacerbations of COPD, asthma, noncardiogenic and cardiogenic pulmonary edema, acute respiratory failure due to community acquired pneumonia, obesity hypoventilation syndrome, obstructive sleep apnea)


name: Monitor for contraindications to noninvasive ventilation support (e.g., hemodynamic instability, cardiovascular or respiratory arrest, unstable angina, acute myocardial infarction, refractory hypoxemia, severe respiratory acidosis, decreased level of consciousness, problems with securing/placing noninvasive equipment, facial trauma, inability to cooperate, morbidly obese, thick secretions, or bleeding)


name: Consult with other health care personnel in selection of a noninvasive ventilator type (e.g., pressure limited [bilevel positive airway pressure], volume-cycled flow-limited, or CPAP)


name: Consult with other health care personnel and patient in selection of noninvasive device (e.g., nasal or face mask, nasal plugs, nasal pillow, helmet, oral mouthpiece)


name: Instruct the patient and family about the rationale and expected sensations associated with use of noninvasive mechanical ventilators and devices


name: Apply noninvasive device, assuring adequate fit and avoidance of large air leaks (take particular care with edentulous or bearded patients)


name: Apply facial protection to avoid pressure damage to skin, as needed


name: Observe patient continuously in first hour after application to assess tolerance


name: Ensure periods of rest daily (e.g., 15 to 30 minutes every 4 to 6 hours)


name: Provide care to alleviate patient distress (e.g., positioning; treat side effects such as rhinitis, dry throat, or epistaxis; give sedation and/or analgesia; frequent equipment checks; cleansing or change of noninvasive device)


name: Monitor patient and ventilator synchronicity and patient breath sounds


name: Monitor for adverse effects (e.g., eye irritation, skin breakdown, occluded airway from jaw displacement with mask, dyspnea, anxiety, claustrophobia, gastric distension)


name: Monitor for mucosal damage to oral, nasal, tracheal, or laryngeal tissue


name: Promote routine assessments for weaning criteria (e.g., resolution of condition prompting ventilation, ability to maintain adequate respiratory effort)


name: Wash hands before and after patient care activity, particularly after emptying fluids from ventilator circuitry


name: Wear gloves and protective equipment and clothing for oral care and change gloves to prevent crosscontamination during oral care


name: Monitor oral cavity, lips, tongue, buccal mucosa, and condition of teeth


name: Monitor oral cavity for dental plaque, inflammation, bleeding, candidiasis, purulent matter, calculus, and staining


name: Brush teeth and tongue with toothpaste or an antiseptic oral rinse using circular motion with a soft toothbrush or suction toothbrush


name: Rinse toothbrush after each use and change at regular intervals


name: Brush gingiva gently if patient is edentulous


name: Assist with the application of a debriding agent or mouth wash to gingiva, teeth, and tongue with swab, according to agency protocol


name: Use water rinses instead of a debriding agent with patients who have mucositis or altered oral mucosa


name: Assist with swabbing perpendicular to gum line, applying gentle pressure to help facilitate the removal of debris and mucus


name: Consider providone-iodine oral antiseptic in patients with severe head injury


name: Apply oral moisturizer to oral mucosa and lips, as needed


name: Facilitate use of yankauer or soft suction for oral care, as needed


name: Facilitate subglottic suctioning before repositioning patient supine (bed, chair, road trip), repositioning endotracheal tube (ET), and deflating the ET cuff


name: Suction the trachea, then oral cavity, and then nasal pharynx to remove secretions above the endotracheal tube cuff to decrease the risk of aspiration


name: Rinse yankauer and inline, deep suction lines after each use and change every day


name: Consider use of continuous subglottic suctioning and drainage with specifically designed endotracheal tube in patients who have mechanical ventilation longer than 72 hours


name: Keep head of bed elevated to 30 to 45 degrees unless contraindicated (i.e., hemodynamic instability), particularly during enteral tube feedings


name: Turn patient frequently (at least every 2 hours)


name: Facilitate daily interruptions of sedation, in consultation with the physician team


name: Consider using a cuffed endotracheal tube with inline or subglottic suctioning


name: Maintain an endotracheal cuff pressure of at least 20 cm


name: Monitor the depth of the endotracheal tube


name: Consider use of oral intubation over nasal intubation


name: Keep endotracheal tube tapes clean and dry


name: Monitor the effectiveness of mechanical ventilation on patient's physiological and psychosocial status


name: Monitor daily for evidence of readiness for extubation


name: Monitor patient for signs and symptoms of respiratory infection (e.g., restlessness, coughing, fever, increased heart rate, change in secretions, leukocytosis, infiltrates in chest x-ray)


name: Avoid histamine receptor blocking agents and proton pump inhibitors unless patient is at high risk for developing a stress ulcer


name: Instruct patient and family about oral care routine


name: Determine patient readiness for weaning (hemodynamically stable, condition requiring ventilation resolved, current condition optimal for weaning)


name: Monitor predictors of ability to tolerate weaning based on agency protocol (e.g., degree of shunt, vital capacity, Vd/Vt, MVV, inspiratory force, FEV1, negative inspiratory pressure)


name: Monitor to assure patient is free of significant infection before weaning


name: Collaborate with other health team members to optimize patient's nutritional status, assuring that 50% of the diet's nonprotein caloric source is fat rather than carbohydrate


name: Initiate weaning with trial periods (30 to 120 minutes of ventilator-assisted spontaneous breathing)


name: Monitor for signs of respiratory muscle fatigue (e.g., abrupt rise in PaCO2; rapid, shallow ventilation; paradoxical abdominal wall motion), hypoxemia, and tissue hypoxia when weaning is in process


name: Instruct patient about ventilator setting changes that increase the work of breathing, as appropriate


name: Maintain agency policies and procedures for accurate and safe administration of medications


name: Avoid interruptions when preparing, verifying, or administering medications


name: Prescribe or recommend medications according to prescriptive authority, as appropriate


name: Monitor for possible medication allergies, interactions, and contraindications, including over the counter medications and herbal remedies


name: Notify the patient of medication type, reason for administration, expected actions, and adverse effects before administering, as appropriate


name: Verify changes in medication form before administering (e.g., crushed enteric tablets, oral liquids in intravenous syringe, unusual packaging)


name: Use bar-code-assisted medication administration, when possible


name: Avoid administration of medications not properly labeled


name: Dispose of unused or expired drugs according to agency guidelines


name: Validate and document patient and family understanding of expected actions and adverse effects of the medication


name: Monitor patient for the therapeutic effect of all medications


name: Document medication administration and patient responsiveness (i.e., include medication generic name, dose, time, route, reason for administration, and effect achieved), according to agency protocol


name: Instill medication holding dropper 1 cm above ear canal


name: Instruct patient to remain in side-lying position 5 to 10 minutes


name: Determine patient's knowledge of medication and understanding of method of administration (e.g., nasogastric tube, orogastric tube, gastrostomy tube)


name: Prepare medication (e.g., crush or mix with fluids, as appropriate)


name: Place patient into high Fowler's position if not contraindicated


name: Administer medication by allowing medication to flow freely from barrel of syringe, using plunger only to facilitate flow, as needed


name: Flush tube with 30 mL of warm water, or appropriate amount for age, after medication administration


name: Have patient take slow, deep breaths, with a brief end-inspiratory pause, and passive exhalation when using a nebulizer


name: Follow agency policies and protocols for management and monitoring of interpleural catheters


name: Aspirate interpleural catheter fluid before all injections of medication


name: Check for no blood return before medication administration


name: Withhold medication if more than 2 cc of fluid returns when checking interpleural catheter


name: Administer medication for pain relief through interpleural catheter intermittently or by continuous drip


name: Use monitoring modalities to interpret physiological responses and initiate nursing interventions to ensure optimal patient care


name: Document medication administration in accordance with established agency policies


name: Provide for the patient's total care needs while receiving analgesia, as needed


name: Anticipate potential complications of the analgesia technique in relation to the device and medication(s) being used


name: Recognize emergency situations and institute treatment in compliance with established agency policies, procedures, and guidelines


name: Encourage early ambulation with the use of the interpleural catheter, as appropriate


name: Select appropriate injection site and inspect skin for bruises, inflammation, edema, lesions, or discoloration


name: Inject medication slowly, watching for small bleb on skin surface


name: Mark injection site and read site at the appropriate interval after the injection (e.g., 48 to 72 hours)


name: Position nondominant hand at proper anatomical landmark, spread skin tightly


name: Inject needle quickly at a 90 degree angle


name: Aspirate before injection; if no blood is aspirated, inject medication slowly, wait 10 seconds after injecting medication, then smoothly withdraw needle and release skin


name: Insert needle with stylet at 60 to 90 degree angle directed inferiorly


name: Determine flow rate and adjust accordingly


name: Document site, needle type and size, type of fluid and medication, flow rate, and patient response as per agency protocol


name: Report patient response to therapy according to agency protocol


name: Establish IV access and discontinue intraosseous line after patient condition stabilizes


name: Monitor patient's mobility, and motor and sensory functions, as appropriate


name: Aspirate cerebral spinal fluid before injection of medication and evaluate for blood or cloudy returns before administering an intrathecal bolus injection


name: Affirm catheter is secured to patient's skin


name: Check infusion pump for proper calibration and operation per agency protocol


name: Monitor IV set up, flow rate, and solution at regular intervals


name: Monitor for central nervous system infection (e.g., fever, change in level of consciousness, nausea, and vomiting)


name: Note expiration date of drugs and solutions


name: Select injection port of IV tubing closest to patient, occlude IV line above port, and aspirate before injecting intravenous bolus into an existing line


name: Flush intravenous lock with appropriate solution before and after medication administration as per agency protocol


name: Monitor IV setup, flow rate, and solution at regular intervals per agency protocol


name: Instruct patient to blow nose gently before administration of nasal medication unless contraindicated


name: Assist patient to supine position and position head appropriately, depending on which sinuses are to be medicated when administering nose drops


name: Instruct patient to breathe through mouth during administration when administering nose drops


name: Hold dropper 1 cm above nares and instill prescribed number of drops


name: Instruct patient to remain supine for 5 minutes after administering nose drops


name: Instruct patient to remain upright and to not tilt head backward when administering nasal spray


name: Insert nozzle into nostril and squeeze bottle quickly and firmly when administering nasal spray


name: Determine any contraindications to patient receiving oral medication (e.g., difficulty swallowing, nausea/vomiting, bowel inflammation, reduced peristalsis, recent gastrointestinal surgery, attached to gastric suction, NPO, decreased level of consciousness)


name: Instruct patient of proper administration of sublingual medication


name: Have client place buccal medication in mouth against mucous membranes of the cheek until it dissolves


name: Document medications administered and patient responsiveness according to agency protocol


name: Determine for any presenting signs and symptoms of gastrointestinal alterations (e.g., constipation or diarrhea)


name: Insert suppository gently through anus, past internal anal sphincter, and against rectal wall


name: Determine patient's skin condition over area that medication will be applied


name: Inject needle quickly at a 45 to 90 degree angle, depending on size of patient


name: Insert rounded end of suppository along posterior wall of vaginal canal 3 to 4 inches or insert applicator approximately 2 to 3 inches


name: Shave hair over reservoir as per agency protocol


name: Determine what drugs are needed and administer according to prescriptive authority and/or protocol


name: Consult with other health care professionals to minimize the number and frequency of drugs needed for a therapeutic effect


name: Provide patient and family members with written and visual information to enhance self-administration of medications, as appropriate


name: Determine effect of medication use on patient's lifestyle


name: Contact patient and family postdischarge to answer questions and discuss concerns associated with the medication regimen, as appropriate


name: Determine past health history and medication use


name: Utilize electronic prescribing methods, as available


name: Utilize standardized abbreviations, acronyms, and symbols


name: Use a standardized tool to elicit all medication information, including prescribed medications, over-the-counter medications, and dietary and herbal supplements


name: Obtain a complete medication history by examining medication vials or list, verifying with patient and family, and/or communicating with physicians and pharmacy, as needed


name: Document drug name, dosage, frequency, and route on medication list


name: Determine when medications were last taken


name: Compare medication list to indications and medical history to ensure list is accurate and complete


name: Reconcile medications at all transition points, including admission, transfer, and discharge


name: Reconcile medications with changes in patient condition or with medication changes


name: Communicate discrepancies to ordering practitioners, as needed


name: Instruct patient and family to maintain an updated medication list and reconcile with physician at each appointment or hospital admission


name: Instruct patient and family to obtain all medications through one pharmacy to decrease risk of error


name: Instruct patient and family to take an active role in medication management


name: Discuss the patient's previous experience with meditation


name: Discuss the patient's desire to learn meditation


name: Explain that during meditation one is calm, yet alert


name: Provide quiet time, free of interruptions


name: Suggest the patient wear comfortable clothing


name: Decide how long the meditation session will be


name: Instruct patient to sit in a comfortable position with the back straight and hands resting in the lap, if possible


name: Inform the patient that the eyes can be closed or open, gently glancing down about three feet in front


name: Help the patient choose an object to focus the attention on such as a breath, a word, or the body as a whole


name: Instruct the patient to focus attention on the chosen object, and when the mind wanders off in thought, to let go of the thought and gently bring attention back to the chosen object


name: Instruct the patient to just sit free of thought if the object of awareness becomes subtler or fades away


name: Instruct to return attention to the chosen object whenever thoughts arise in the mind rather than engaging in thinking or daydreaming


name: Encourage patient to meditate for about 10 minutes each day, eventually increasing the time as desired to about 25 minutes or twice a day


name: Suggest meditation groups in which the patient can receive support and further instruction in meditation


name: Implement appropriate memory techniques such as visual imagery, mnemonic devices, memory games, memory cues, association techniques, making lists, using computers or using name tags, or rehearsing information


name: Assist in associate-learning tasks such as practice learning and recalling verbal and pictorial information presented, as appropriate


name: Provide opportunity for concentration such as a game matching pairs of cards, as appropriate


name: Provide opportunity to use memory for recent events such as questioning patient about a recent outing


name: Regulate environmental factors to maximize adaptive behavior and minimize maladaptive behavior


name: Provide self-care resources for use by patient


name: Enhance the normality of the environment through use of clocks, calendars, railings, furniture, etc


name: Facilitate open communication among patient, nurses, and other staff


name: Build a therapeutic rapport with individuals conveying genuine regard, respect, care, and compassion


name: Model effective interpersonal, distress tolerance, and emotion regulation skills


name: Be neither too rigid nor too flexible with rules


name: Define clear and consistent rules and policies for patients, family members, and staff


name: Notice and reinforce new, adaptive behaviors


name: Provide descriptions of problematic behavior in objective, nonjudgmental, nonpejorative terms, avoiding stigmatizing labels


name: Define treatment goals collaboratively with the patient, linking privileges to goal progress and achievement, when appropriate


name: Communicate individual patient treatment goals with all staff members


name: Provide time and space for rehearsal of new behaviors in order to build mastery and adapt to future environments


name: Use empathy when interpreting the behaviors of patients and colleagues


name: Minimize restrictions that diminish privacy or self-control, when appropriate


name: Provide a telephone in a private space, when appropriate


name: Encouraging appropriate patient-to-patient interactions


name: Respond to disruptive or detrimental behavior safely, utilizing least restrictive measures


name: Prevent use of physical, mechanical, and chemical restraint, when possible


name: Evaluate mood (e.g., signs, symptoms, personal history) initially and on a regular basis as treatment progresses


name: Refer patient for evaluation and/or treatment of any underlying medical illness that may be contributing to a dysfunctional mood (e.g., thyroid disorders, etc.)


name: Provide social skills and/or assertiveness training as needed


name: Monitor patient for medication side effects and effect on mood


name: Draw and monitor serum blood levels of medications (e.g., tricyclic antidepressants, lithium, anticonvulsants), as appropriate


name: Assist physician with the provision of electroconvulsive therapy (ECT) treatments when they are indicated


name: Provide illness teaching to patient/significant others, if dysfunctional mood is illness based (e.g., depression, mania, and premenstrual syndrome)


name: Designate a leader who plans and schedules regular and as needed patient care conferences involving the core health care professionals


name: Arrange for the health care team members to meet face to face or by videoconference


name: Facilitate communication and collaboration among multidisciplinary team members to assure effective and focused discussions that enable the team members to problem solve and efficiently provide for patient's needs


name: Summarize health status data pertinent to planning patient care


name: Involve patient's family members in planning care, as appropriate


name: Use the appropriate clinical protocols and evidence-based practice guidelines in planning treatment and care options


name: Seek input from all multidisciplinary team members involved in the planning conference


name: Provide data to facilitate evaluation of patient's plan of care


name: Discuss progress toward desired patient outcomes


name: Revise the patient's critical pathway or plan of care, as necessary


name: Document treatment plans in the interdisciplinary progress notes


name: Clarify with the patient the roles of the health care provider and the patient respectively


name: Facilitate the patient in identification of individualized, expected outcomes for each goal


name: Monitor or assist with cleaning of nails according to individual's self-care ability


name: Consider contraindications before procedure (e.g., patients with facial trauma not fully healed and patients with neurological or musculoskeletal problems that increase aspiration risk)


name: Prepare irrigating solution using premade packets or household ingredients


name: Mix 1 teaspoon salt and teaspoon baking soda with 1 pint lukewarm, potable water, adjusting salinity and temperature of solution according to institutional guidelines or patient preference, if necessary


name: Use salt that does not contain iodine, anticaking agents, or preservatives to avoid irritation to the nasal mucosa (i.e., use kosher, canning, or pickling salt)


name: Draw up solution using low positive pressure device (e.g., bulb syringe or spray bottle) or gravity-based pressure device (e.g., Neti Pot or other commercial nasal saline rinse product)


name: Position patient over sink or basin with head tilted downward and rotated so that one nostril is higher than the other


name: Gently insert applicator tip or spout into upper most nostril until a comfortable seal is formed, avoiding pressing tip or spout into the septum


name: Instill approximately half of prepared solution into nostril


name: Instruct patient to breathe normally through mouth


name: Monitor evacuation of fluid return from lower nostril (e.g., amount, color, consistency)


name: Adjust head position, to avoid the draining of solution into back of throat or ears, as needed


name: Irrigate nasal passages 1 to 3 times per day or as prescribed


name: Cleanse irrigating device after each use


name: Discontinue if patient experiences pain, nosebleeds, or other problems


name: Instruct patient on techniques for self-irrigation


name: Administer nasal medication, if necessary


name: Provide referral to health care provider


name: Verify that the patient has no contraindications for nasal placement (e.g., basilar skull fracture; facial, nasal or sinus trauma; esophageal varices or stricture; or clotting abnormalities)


name: Select type and size of tube to insert (i.e., small bore tubes are used for feeding and administering medications whereas large bore tube are used for gastric drainage; some have electromagnetic guidance systems)


name: Explain to the patient and family the rationale for using a nasogastric tube


name: Place patient in a supine position with head of bed elevated at least 30 degrees unless contraindicated


name: Determine the length of tube to be inserted into stomach by measuring the tube from the tip of the nose to the tip of the earlobe and to the bottom of the xiphoid process


name: Add additional length if the tube is to pass through the pyloric sphincter


name: Provide the patient with a glass of water to swallow during insertion, as appropriate


name: Lubricate the distal end of the tube with water or water soluble jelly


name: Insert the tube into the naris and advance along the base of the nostril to the posterior pharynx


name: Instruct patient to swallow and advance the tube to the predetermined marking


name: Apply skin preparation to the nose and securing surface of the face


name: Tape the tube securely to the nose so that the tube does not press against the skin of the naris


name: Label the tube with the date and time of placement


name: Obtain radiograph to confirm placement of the tube in the gastrointestinal tract


name: Encourage to monitor own nausea experience


name: Encourage to learn strategies for managing own nausea


name: Perform complete assessment of nausea, including frequency, duration, severity, and precipitating factors; use such tools as Self-Care Journal, Visual Analog Scales, Duke Descriptive Scales, and Rhodes Index of Nausea and Vomiting (INV) Form 2


name: Consider the cultural influence on nausea response when implementing intervention


name: Encourage not to tolerate nausea but to be assertive with health providers in obtaining pharmacological and nonpharmacological relief


name: Use frequent oral hygiene to promote comfort unless it stimulates nausea


name: Instruct in high carbohydrate and low fat food, as appropriate


name: Provide information about the nausea such as causes of the nausea and how long it will last


name: Monitor for visual disturbance (e.g., diplopia, nystagmus, visual-field cuts, blurred vision, visual acuity)


name: Monitor muscle tone, motor movement, gait, and proprioception, comparing both sides of body simultaneously


name: Monitor for pronator drift, comparing both sides of body simultaneously


name: Monitor grip strength, comparing both sides of body simultaneously


name: Monitor for tremor, comparing both sides of body simultaneously


name: Monitor vital signs (e.g., temperature, blood pressure, pulse, respirations)


name: Monitor respiratory status (e.g., ABG levels, pulse oximetry, depth, pattern, rate, effort)


name: Monitor speech characteristics (e.g., fluency, presence of aphasias, or word-finding difficulty)


name: Monitor response to stimuli (e.g., verbal, tactile, noxious)


name: Monitor sharp and dull or hot and cold discrimination


name: Monitor for Cushing response (i.e., rising systolic pressure with widening pulse and bradycardia)


name: Monitor craniotomy or laminectomy dressing for drainage


name: Increase frequency of neurological monitoring, as appropriate


name: Institute agency protocol for specific neurological condition (e.g., stroke, tumor, aneurism, trauma), as needed


name: Move infant's tongue rhythmically with the pacifier to encourage sucking, if needed


name: Provide pacifier to encourage sucking during tube feeding and for 5 minutes after the tube feeding


name: Rock and hold baby while infant sucks on pacifier when possible


name: Inform parent(s) on importance of meeting infant sucking needs


name: Encourage breastfeeding mother to allow nonnutritive sucking at breast after feeding complete


name: Inform parents of alternatives to nipple sucking (e.g., thumb, parent's finger, pacifier)


name: Assist the family in accepting the child's condition


name: Assist family to view the child as a child first, rather than as a chronically ill or disabled individual


name: Encourage interaction with healthy peers


name: Encourage the family to modify preconceived developmental expectations by focusing more on smaller unexpected achievements


name: Assist family in altering prescribed therapeutic regime to fit normal schedule, when appropriate


name: Encourage parents to have same parenting expectations and techniques for all children in family


name: Determine patient's nutritional status and ability to meet nutritional needs


name: Identify patient's food allergies or intolerances


name: Instruct patient about nutritional needs (i.e., discuss dietary guidelines and food pyramids)


name: Assist patient in determining guidelines or food pyramids (e.g., Vegetarian Food Pyramid, Food Guide Pyramid, and Food Pyramid for Seniors over 70) most suited in meeting nutritional needs and preferences


name: Determine number of calories and type of nutrients needed to meet nutrition requirements


name: Provide food selection, offering guidance toward healthier choices, if necessary


name: Adjust diet (i.e., provide high protein foods, suggest using herbs and spices as an alternative to salt, provide sugar substitute, increase or decrease calories, increase or decrease vitamins, minerals, or supplements), as necessary


name: Provide optimal environment for meal consumption (e.g., clean, well-ventilated, relaxed, and free from strong odors)


name: Perform or assist patient with oral care before eating


name: Ensure patient uses well-fitting dentures, if appropriate


name: Administer medications before eating (e.g., pain relief, antiemetics), if needed


name: Encourage patient to sit in upright position in chair, if possible


name: Ensure food is served in attractive manner and at temperature most suited for optimal consumption


name: Encourage family to bring patient's favorite foods while in hospital or care facility, as appropriate


name: Assist patient with opening packages, cutting food, and eating, if needed


name: Instruct patient on necessary diet modifications (e.g., NPO, clear liquid, full liquid, soft, or diet as tolerated), as necessary


name: Instruct patient on diet requirements for disease state (i.e., for patients with renal disease, restrict sodium, potassium, protein, and fluids)


name: Instruct patient on specific dietary needs based on development or age (e.g., increased calcium, protein, fluid, and calories for lactating women; increased fiber intake to prevent constipation among older adults)


name: Instruct patient to monitor calorie and dietary intake (e.g., food diary)


name: Assist patient in accessing community nutritional programs (e.g., Women, Infants, and Children, food stamps, and home-delivered meals)


name: Determine in collaboration with the dietitian, the number of calories and type of nutrients needed to meet nutrition requirements, as appropriate


name: Monitor laboratory values, as appropriate


name: Establish realistic short-term and long-term goals for change in the nutritional status


name: Discuss patient's knowledge of the basic four food groups, as well as perceptions of the needed diet modification


name: Discuss nutritional requirements and patient's perceptions of prescribed or recommended diet


name: Encourage use of the Internet to access useful information on diet, recipes, and lifestyle modification, as appropriate


name: Provide referral or consultation with other members of the health care team, as appropriate


name: Obtain anthropometric measurements of body composition (e.g., body mass index, waist measurement, and skinfold measures)


name: Monitor trends in weight loss and gain (i.e., in pediatric patients, plot height and weight on standardized growth chart)


name: Determine appropriate amount of weight gain during antepartum period


name: Identify abnormalities in skin (e.g., excessive bruising, poor wound healing, and bleeding)


name: Identify abnormalities in hair (e.g., dry, thin, course, and breaks easily)


name: Identify abnormalities in bowel elimination (e.g., diarrhea, blood, mucus, and irregular or painful elimination)


name: Identify recent changes in appetite and activity


name: Discuss role of social and emotional aspects of food consumption


name: Determine meal patterns (e.g., food likes and dislikes, overconsumption of fast food, missed meals, hurried eating, parent-child interaction during feeding, frequency and length of infant feedings)


name: Identify abnormalities in nails (e.g., spoon-shaped, cracked, split, broken, brittle, and ridged nails)


name: Perform swallowing evaluation (e.g., motor function of facial, oral, and tongue muscles, swallowing reflex, and gag reflex)


name: Identify abnormalities in oral cavity (e.g., inflammation; spongy, receding, or bleeding gums; dry, cracked lips; sores; scarlet, raw tongue; and hyperemic and hypertrophic papillae)


name: Monitor mental state (e.g., confusion, depression, and anxiety)


name: Identify abnormalities in musculoskeletal system (e.g., muscle wasting, painful joints, bone fractures, poor posture)


name: Conduct laboratory testing, monitoring results (e.g., cholesterol, serum albumin, transferrin, prealbumin, 24-hour urinary nitrogen, blood urea nitrogen, creatinine, hemoglobin, hematocrit, cellular immunity, total lymphocyte count, and electrolyte levels)


name: Determine energy recommendation (e.g., Recommended Dietary Allowance) based on patient factors (e.g., age, weight, height, gender, and physical activity level)


name: Determine factors affecting nutritional intake (e.g., knowledge, availability, and accessibility of quality food products in all food categories; religious and cultural influences; gender; ability to prepare food; social isolation; hospitalization; inadequate chewing; impaired swallowing; periodontal disease; poor-fitting dentures; decreased taste sensitivity; use of drugs or medications; and disease or postsurgical states)


name: Review other sources of data pertaining to nutritional status (e.g., patient food diary and written logs)


name: Initiate treatment or provide referral, as appropriate


name: Recommend the use of a soft-bristled toothbrush


name: Monitor condition of patient's mouth (e.g., lips, tongue, mucous membranes, teeth, gums, and dental appliances and their fit)


name: Provide oral health screening and risk assessment


name: Determine patient's usual dental hygiene routine, identifying areas to be addressed, if necessary


name: Instruct patient or patient's family on frequency and quality of proper oral health care (e.g., flossing, brushing, and rinsing; adequate nutrition; use of fluoride-containing water, supplement, or other preventive product; and other considerations based on patient's developmental level and self-care ability)


name: Assist patient in brushing (teeth, gums, and tongue), rinsing, and flossing, as needed


name: Assist patient wearing dentures in oral care, as needed (i.e., remove, cleanse, and reinsert dentures; brush gums, remaining teeth, and tongue; and massage gums with brush or fingers)


name: Provide oral care for unconscious patient using appropriate precautions (i.e., turn patient's head to side or place in side-lying position when possible, insert bite block or padded tongue blade, avoid putting fingers in mouth, use small amounts of liquid, and use bulb syringe or other suction device)


name: Cleanse infant's mouth using dry gauze or washcloth


name: Assist patient or patient's family in identifying and obtaining oral care products most suited to meet needs (e.g., toothbrush with easy-to-grasp handle, powered toothbrush, dental floss holder, immersion cleanser for dentures, and athletic mouthguard)


name: Discuss role of sugar in development of caries (i.e., encourage patient to limit natural sugar intake; suggest use of artificial sweeteners in diet, particularly xylitol; and instruct parent on appropriate use of bottles and sippy cups and their contents)


name: Discourage smoking and tobacco chewing (i.e., instruct patient on effects of tobacco use, implement tobacco-use prevention measures, and provide tobacco-cessation assistance)


name: Discuss importance of regular dental checkups, including timing of child's first visit to dental health professional


name: Provide community-level services (i.e., assist patient in meeting needs for transportation and translational services, use health fairs and cultural events as opportunities for education, and develop public service announcements)


name: Monitor condition of patient's mouth (e.g., lips, tongue, mucous membranes, teeth, gums, and dental appliances and their fit), including character of abnormalities (e.g., size, color, and location of internal or external lesions or inflammation, and other signs of infection)


name: Monitor changes in taste, swallowing, quality of voice, and comfort


name: Obtain order from health care provider to perform oral hygiene, if applicable


name: Determine necessary frequency for oral care, encouraging patient or patient's family to adhere to schedule, or assisting with oral care, as needed


name: Instruct patient to use soft-bristled toothbrush or disposable mouth sponge


name: Instruct patient on appropriate selection of floss use and type (i.e., avoid use if at-risk for bleeding; use waxed floss to prevent tissue trauma)


name: Administer mouth rinse to patient (e.g., anesthetic, effervescent, saline, coating, antifungal, or antibacterial solution)


name: Administer medication (e.g., analgesics, anesthetics, antimicrobials, and antiinflammatory agents), if needed


name: Remove dentures, encouraging patient to use only for meals


name: Instruct patient to avoid oral hygiene products containing glycerin, alcohol, or other drying agents


name: Instruct patient to keep toothbrushes and other cleaning equipment clean


name: Discuss importance of adequate nutritional intake (i.e., address malnutrition caused by deficiencies in folate, zinc, iron, and complex B vitamins; encourage consumption of high-protein, high vitamin C-containing foods)


name: Encourage avoidance of spicy, salty, acidic, dry, rough, or hard foods


name: Instruct patient to avoid foods causing allergenic response (e.g., coffee, cheese, nuts, citrus fruits, gluten, and potatoes), if applicable


name: Encourage patient to increase water intake


name: Instruct patient to avoid hot foods and liquids, preventing burns and further irritation


name: Instruct patient on signs and symptoms of stomatitis, including when to report to health care provider


name: Assist a physician who lacks computer skills with computerized order entry using the physician's log-in name and confirmation that the order is correct


name: Transfer order to appropriate electronic document, worksheet, medication form, laboratory slip, care plan, or Kardex


name: Participate in the development and improvement of a computerized order entry system for physicians and other providers who write orders


name: Review regulatory requirements and institutional policy and procedures for organ donation (i.e., in the United States, Center for Medicare and Medicaid Services and the Joint Commission mandate that every patient for whom death is imminent must be referred to the local Organ Procurement Organization (OPO) responsible for approaching the patient and family for possible organ donation)


name: Participate in health care team discussions concerning the patient's condition, prognosis, and plan of care so all can speak with uniformity


name: Verify that the OPO coordinator has been alerted if the patient has a life-threatening illness or injury


name: Obtain laboratory samples as prescribed (e.g., CBC, electrolyte levels, liver and renal function tests, hepatitis and HIV testing)


name: Assist with the determination of brain death, as appropriate


name: Ensure that brain death criteria have been met and documented


name: Realize that the OPO coordinator will make the request for donation and prescribe the appropriate testing for donation


name: Provide a private space where the OPO coordinator can approach the family to discuss organ donation


name: Obtain blood samples for blood and tissue typing as directed by the OPO coordinator


name: Administer IV fluids and vasoactive medications as prescribed


name: Prepare the family for what to expect during withdrawal of life-support therapy, as appropriate


name: Support the family through the end-of-life process


name: Assist with transfer of the patient to the operating room as directed by the OPO coordinator


name: Provide a mechanism for the family to obtain information about the organ recovery procedures


name: Offer family postmortem viewing of the body, when possible


name: Understand that ethical dilemmas may arise related to organ allocation, transplant candidacy, and available technologies


name: Help patients and families access quality health care information about organ donation and transplant


name: Conduct community education programs about organ donation and transplant


name: Monitor for postop complications, such as intestinal obstruction, paralytic ileus, anastomotic leaks, or mucocutaneous separation, as appropriate


name: Instruct patient to intubate and drain Indiana pouch whenever it feels full (every 4 to 6 hours)


name: Assure replacement of oxygen mask/cannula whenever the device is removed


name: Monitor patient's ability to tolerate removal of oxygen when eating


name: Provide information to patient and family related to pacemaker implantation (e.g., indications, functions, universal programming codes, potential complications)


name: Provide concrete, objective information related to the effects of pacemaker therapy to reduce patient uncertainty, fear, and anxiety about treatment-related symptoms


name: Document pertinent data in patient permanent record for initial insertion of pacemaker (e.g., manufacturer, model number, serial number, implant date, mode of operation, programmed parameters, upper and lower rate limits for rate-responsive devices, type of lead fixation, unipolar or bipolar lead system, capability for pacing and/or shock delivery, delivery system for shocks)


name: Assure confirmation of pacemaker placement postimplantation in initial insertion with baseline chest x-ray


name: Monitor for signs of improved cardiac output at specified intervals after initiation of pacing (e.g., improved urine output, warm and dry skin, freedom from chest pain, stable vital signs, absence of JVD and crackles, improved level of consciousness), per facility protocol


name: Palpate peripheral pulses at specified intervals per facility protocol to ensure adequate perfusion with paced beats


name: Monitor for failure to pace and determine cause (e.g., lead dislodgement, fracture, or migration), as appropriate


name: Monitor for failure to capture and determine cause (e.g., lead dislodgement or malposition, pacing at voltage lower than capture threshold, faulty connections, lead fracture, ventricular perforation), as appropriate


name: Monitor for failure to sense and determine cause (e.g., sensitivity set too high, malposition of catheter lead, lead fracture, lead insulation break), as appropriate


name: Obtain chest x-ray immediately in the event of suspected lead fracture, patch crinkling, lead dislodgement, or lead migration


name: Monitor for pacemaker problems that have occurred between scheduled checkup visits


name: Monitor for arm swelling or increased warmth on side ipsilateral to implanted endovascular leads


name: Perform a comprehensive appraisal of peripheral circulation (i.e., check peripheral pulses, edema, capillary refill, skin temperature. and diaphoresis) in any initial assessment of pacemaker patients and before initiating corrective actions


name: Determine type and mode of pacemaker, including universal pacemaker code information for the five positions, before initiating corrective actions


name: Gather additional data if possible from patient's permanent record (e.g., date of implantation, frequency of use, programming changes and parameters) before initiating corrective actions


name: Monitor heart rate and rhythm at specified intervals and with changes in patient condition


name: Monitor for metabolic conditions with adverse effects on pacemakers (acid-base disturbances, myocardial ischemia, hyperkalemia, severe hyperglycemia [greater than 600 mg/dL], renal failure, hypothyroidism)


name: Instruct patient regarding the potential hazards for electromagnetic interference from outside sources (i.e., keep at least 6 inches away from sources of interference, do not leave cell phones in the "on" mode in a shirt pocket over the pacemaker)


name: Instruct patient regarding the sources of highest electromagnetic interference (e.g., arc welding equipment, electronic muscle stimulators, radio transmitters, concert speakers, large motor-generator systems, electric drills, handheld metal detectors, magnetic resonance imaging, radiation treatments)


name: Instruct patient regarding the potential hazards from environmental interactions (e.g., inappropriate pacing or rhythm sensing, shortened generator life, cardiac arrhythmias, cardiac arrest)


name: Instruct patient regarding the potential hazards from metabolic disruptions (e.g., potential to increase pacer or capture thresholds)


name: Instruct patient on the need for regular checkups with primary cardiologist


name: Instruct patient with new pacemaker to refrain from operating motor vehicles until permitted, per primary cardiologist (usually 3 months minimally)


name: Instruct patient in the need for regular monitoring of pacemaker sensing and capture thresholds


name: Instruct patient in the need for regular interrogation of pacemaker by cardiologist for evidence of electromagnetic interference


name: Instruct patient in the need to obtain chest x-ray at least annually for continued pacemaker placement confirmation


name: Instruct patient of the signs and symptoms of dysfunctional pacemaker (e.g., bradycardia less than 30 beats per minute, dizziness, weakness, fatigue, chest discomfort, angina, shortness of breath, orthopnea, pedal edema, paroxysmal nocturnal dyspnea, dyspnea on exertion, hypotension, near-syncope, frank syncope, cardiac arrest)


name: Instruct patient to wear a medical alert bracelet or necklace that identifies patient as a pacemaker patient


name: Instruct patient on the special considerations at government security gates or the airport (e.g., always inform security guard of implantable pacemaker, walk through security gates, DO NOT allow handheld metal detectors near the device site, always walk quickly through metal detection devices or ask to be searched by hand, do not lean on or stand near detection devices for long periods)


name: Instruct patient that handheld metal detectors contain magnets that can reset the pacemaker and cause malfunction


name: Instruct patient's family that no harm comes to a person touching a patient who is receiving a pacemaker discharge


name: Determine indications for temporary pacing and duration of intended pacing support


name: Determine intended mechanics of pacing (e.g., internal or external, unipolar or bipolar, transthoracic, epicardial, or central venous catheter), including appropriateness of type of pulse generator selected


name: Perform a comprehensive appraisal of peripheral circulation (i.e., check peripheral pulses, edema, capillary refill), skin temperature, and diaphoresis


name: Instruct patient regarding the chosen pacemaker (e.g., purpose, indications, mechanics, duration)


name: Ensure externally paced patients are aware of possibility of discomfort and availability of sedation for comfort and/or relaxation


name: Obtain informed consent for insertion of the selected temporary pacemaker


name: Prepare the chosen pacemaker for use, per facility protocol (i.e., ensure battery is fresh, identify atrial and ventricular wire sets, identify positive and negative leads for each pair of wires, identification labels, as indicated/preferred)


name: Assist with insertion or placement of selected device, as appropriate


name: Apply external transcutaneous pacemaker electrodes to clean, dry skin on the left anterior chest and to the posterior chest, as appropriate


name: Provide sedation and analgesia for patients with external transcutaneous pacemaker, as indicated


name: Set rate according to patient need as directed by physician (general guidelines: 90 to 110 beats per minute surgical patients, 70 to 90 beats per minute medical patients, 80 beats per minute cardiac arrest patients)


name: Set the milliamperage according to patient (general adult guidelines: nonurgent 10 mA; emergent 15 to 20 mA); increase mA until capture is present


name: Monitor patient response to mA setting at regular intervals in anticipation of fluctuations resulting from endothelial sheath formation around electrode tips


name: Set the sensitivity (general adult guidelines: 2 to 5 millivolt, if failure to sense occurs, turn millivolt DOWN; if sensing beats not actually present, turn millivolt UP)


name: Initiate pacing by slowly increasing mA level delivered until consistent capture (capture threshold) occurs (general guidelines of mA output at 1.5 to 3 times higher than threshold, and minimally 15 to 20 mA in emergent conditions)


name: Obtain chest x-ray examination after insertion of invasive temporary pacemaker


name: Observe for changes in cardiac or hemodynamic status that indicate a need for modifications in pacemaker status


name: Monitor for failure to pace and determine cause (e.g., battery failure, lead dislodgement, wire fracture, disconnected wire or cable), as appropriate


name: Monitor for failure to capture and determine cause (e.g., lead dislodgement or malposition, battery failure, pacing at voltage lower than capture threshold, faulty connections, lead fracture, ventricular perforation), as appropriate


name: Monitor for conditions that potentially influence capture and sensing (e.g., fluid status changes, pericardial effusion, electrolyte or metabolic abnormalities, certain medications, tissue inflammation, tissue fibrosis, tissue necrosis)


name: Perform capture and sensitivity threshold testing every 24 to 48 hours with newly inserted pacers to determine best generator settings (contraindicated in patients paced 90% or more of the time)


name: Perform threshold testing separately for atrial and ventricular chambers


name: Provide appropriate incisional care for pacemakers with insertion sites (e.g., dressing change, antimicrobial and sterile occlusive dressing per facility protocol)


name: Ensure that all equipment is grounded, in good working order, and carefully located (e.g., in a location from which it will not be dropped on the floor)


name: Ensure that wires are of a length to deter inadvertent dislodging of electrodes


name: Insulate electrode wires when not in use (e.g., cover unused thoracic wires with the fingertip of a disposable glove)


name: Teach patient and family member(s) precautions and restrictions required when temporary pacemaker is in place (e.g., limitation of movement, avoid handling the pacemaker)


name: Identify pain intensity during movements such as required recovery activities (e.g., coughing and deep breathing, ambulation, transfers to chair)


name: Explore patient's knowledge and beliefs about pain, including cultural influences


name: Monitor pain using a valid and reliable rating tool appropriate for age and ability to communicate


name: Question patient regarding the level of pain that allows a state of comfort and appropriate function and attempt to keep pain at or lower than identified level


name: Ensure that the patient receives prompt analgesic care before the pain become severe or before pain-inducing activities


name: Administer analgesics around-the-clock the first 24 to 48 hours after surgery, trauma, or injury except if sedation or respiratory status indicates otherwise


name: Monitor sedation and respiratory status before administering opioids and at regular intervals when opioids are administered


name: Follow agency protocols in selecting analgesic and dosage


name: Use combination analgesics (e.g., opioids plus nonopioids), if pain level is severe


name: Select and implement intervention options tailored to the patient's risks benefits and preferences (e.g., pharmacological, nonpharmacological, interpersonal) to facilitate pain relief, as appropriate


name: Avoid use of analgesics that may have adverse effects in older adults


name: Administer analgesics using the least invasive route available, avoiding the intramuscular route


name: Provide PCA and intraspinal routes of administration, when appropriate


name: Incorporate nonpharmacological interventions to the pain etiology and patient preference, as appropriate


name: Modify pain control measures on the basis of the patient's response to treatment


name: Prevent or manage medication side effects


name: Notify physician if pain control measures are unsuccessful


name: Provide accurate information to the family about the patient's pain experience


name: Use a valid and reliable chronic pain assessment tool (e.g., Brief Pain Inventory-Short Form, McGill Pain Questionnaire-Short Form, Fibromyalgia Impact Questionnaire)


name: Evaluate with patient the effectiveness of past pain control measures


name: Control environmental factors that may influence the patient's pain experience


name: Question the patient regarding pain at frequent intervals, often at the same time as checking vital signs or at every office visit


name: Instruct patient and family about principles of pain management


name: Encourage patient to monitor own pain and to use self-management approaches


name: Encourage appropriate use of nonpharmacological techniques (e.g., biofeedback, TENS, hypnosis, relaxation, guided imagery, music therapy, distraction, play therapy, activity therapy, acupressure, heat and cold application, and massage) and pharmacological options as pain control measures


name: Collaborate with patient, family, and other health professionals to select and implement pain control measures


name: Evaluate the effectiveness of pain control measures through ongoing monitoring of the pain experience


name: Watch for signs of depression (e.g., sleeplessness, not eating, flat affect statements of depression, or suicidal ideation)


name: Watch for signs of anxiety or fear (e.g., irritability, tension, worry, fear of movement)


name: Incorporate the family in the pain relief modality, when possible


name: Consider referrals for patient and family to support groups and other resources, as appropriate


name: Evaluate patient satisfaction with pain management at specified intervals


name: Understand the relationship between the parent's behavior and child's age appropriate goals


name: Identify personal factors that effect on the success of the educational program (e.g., cultural values, presence of any negative experiences with social service providers, language barriers, time commitment, scheduling issues, travel, and general lack of interest)


name: Identify the presence of family stressors (e.g., parental depression, drug addiction, alcoholism, low literacy, limited education, domestic violence, marital conflict, blending of families after divorce, and excessive punishment of children)


name: Instruct parent on normal physiological, emotional, and cognitive characteristics of adolescents


name: Provide online resources, books, and literature designed to teach parents about teen parenting


name: Instruct parents about essential communication skills that will increase their ability to empathize with their adolescent and assist their adolescent to problem solve


name: Instruct parents about methods of communicating their love to adolescents


name: Instruct parents to use reality and consequences to manage adolescent behavior


name: Ask parent to describe the behaviors of the child


name: Design an education program that builds on the family's strengths


name: Involve parents in the design and content of the education program


name: Identify personal factors that effect on the success of the education program (e.g., cultural values, presence of any negative experiences with social service providers, language barriers, time commitment, scheduling issues, travel, and general lack of interest)


name: Instruct parent on normal physiological, emotional, and behavioral characteristics of child


name: Provide online resources, books, and literature designed to teach parents about parenting


name: Instruct parents on the importance of a balanced diet, three meals a day, and nutritious snacks


name: Discuss approaches parents can use to assist children to express feelings positively


name: Discuss alternatives to a bedtime bottle to prevent nursing bottle caries


name: Reinforce ability of parent(s) to apply teaching to child care skills


name: Provide parent(s) with information about making home environment safe for infant


name: Place follow-up telephone call 1 to 2 weeks after encounter


name: Make home visits, as indicated by level of risk


name: Refer to male home visitors to work with fathers, as appropriate


name: Provide information on Medicare coverage for leave or "bedhold" fee, as appropriate


name: Discuss pass with responsible person describing nursing care and self-care, as needed


name: Obtain medications to be taken on pass and instruct responsible person


name: Provide assistive devices and equipment, as appropriate


name: Instruct appropriate person on the information that is needed about medication, food, alcohol intake, and activities when on pass


name: Document on sign-out form the date and time of departure; name, strength, dose, and quantity of medications provided; directions given; and other pertinent actions


name: Verify that medications were taken as instructed on return


name: Assist the individual in identifying appropriate short-term and long-term goals


name: Clarify with the individual the roles of the health care provider and the individual respectively


name: Assist the individual in identifying present circumstances in the environment, which may interfere with the achievement of goals


name: Specify with the individual the timing of delivery of reinforcers/rewards


name: Assist the individual in developing some form of flowchart to assist in tracking the progress toward goals


name: Explore with the individual reasons for success or lack of it


name: Recommend discontinuation of opioid administration by other routes


name: Avoid use of meperidine hydrochloride (Demerol)


name: Instruct patient and family to monitor pain intensity, quality, and duration


name: Instruct patient and family to monitor respiratory rate and blood pressure


name: Validate that the patient can use a PCA device (i.e., is able to communicate, comprehend explanations, and follow directions)


name: Instruct patient and family members how to use the PCA device


name: Instruct patient and family members about the action and side effects of pain-relieving agents


name: Monitor closely for respiratory depression in at-risk patients (e.g., older than 70 years; history of sleep apnea; concurrent use of PCA with a central nervous system depressant; obesity; upper abdominal or thoracic surgery and PCA bolus of greater than 1 mg; history of renal, hepatic, pulmonary, or cardiac impairment)


name: Explain to the patient the importance of proper identification throughout the health encounter


name: Ask the patient his/her first name, last name, and date of birth


name: Select the most appropriate location(s) for placing the identification device(s)


name: Ensure that identification devices are put in appropriate locations


name: Have on hand a number of replacement bands and an easy process for a new bracelet to be stamped and applied should a wristband be removed


name: Standardize the format of the wristbands across the health care institution


name: Compare the information provided by the patient with the information in the identification device before every administration of care (e.g., administering medications, performing invasive procedures, conducting diagnostic tests, transferring patient)


name: Use at least two patient identifiers when laboratory samples are obtained or when medications or blood products are administered


name: Conduct verification of patient at multiple points in time when procedure is complex and involves several stages


name: Use identification by family member or good friend when patient cannot provide information


name: Institute a "stop-the-line" policy if a misidentification error is suspected (i.e., do not carry out the intended action until positive identification is made)


name: Educate the patient about the risks related to an incorrect identification


name: Compare the information provided by a family member with the information in the identification device to confirm a patient's death


name: Ensure a best practice for patient identification by instituting a clearly written, easy to understand, agency policy


name: Honor written "Do Not Resuscitate" orders


name: Note on medical record any observable facts bearing on the testator's mental competency to make a will


name: Observe peer during performance of service as required for evaluation


name: Focus evaluation on quality, safety, and patient satisfaction outcomes


name: Consider the nurse's developmental stage (novice to expert) when conducting the evaluation


name: Instruct individual to tighten then relax the ring of muscle around urethra and anus, as if trying to prevent urination or bowel movement


name: Assure that the individual can differentiate between the desired drawing up-and-in muscle contraction and the nondesired bearing down effort


name: Provide cushion for chair, as appropriate


name: Inspect condition of incision or tear(s) (e.g., episiotomy, laceration, circumcision)


name: Provide and assist with sitz baths, as necessary


name: Apply protective barrier (e.g., zinc oxide, petrolatum), as appropriate


name: Apply prescribed medication (e.g., antibacterial, antifungal), as appropriate


name: Document characteristics of drainage, as appropriate


name: Instruct patient or significant other, as appropriate, regarding inspection of perineum for pathology (e.g., infection, skin breakdown, rash, abnormal discharge)


name: Monitor sharp or dull and hot or cold discrimination


name: Monitor for paresthesia (e.g., numbness, tingling, hyperesthesia, hypoesthesia, and level of pain), as appropriate


name: Encourage patient to use the unaffected body part to determine temperature of food, liquids, bathwater, etc


name: Instruct patient or family to monitor position of body parts when bathing, sitting, lying, or changing position


name: Monitor fit of bracing devices, prosthesis, shoes, and clothing


name: Administer analgesics, corticosteroids, anticonvulsants, tricyclic antidepressants, or local anesthesias, as necessary


name: Monitor for thrombophlebitis and venous thromboembolism


name: Identify the intended use of the catheter to determine the type needed (i.e., vesicants or potentially irritating drugs should be run through a centrally inserted line, not a peripheral line)


name: Obtain consent for the insertion procedure


name: Assure patient is appropriate candidate for insertion (i.e., veins must be visible or palpable; skin site should not have evidence of infection or bruising; patient should not have underlying sepsis, abnormal bleeding, history of noncompliance with previous line, or absence of proper consent)


name: Position patient supine for insertion with arm at a 90 degree angle to body


name: Flush with prepared heparin and saline, as appropriate and per agency protocol


name: Secure the catheter and apply a sterile transparent dressing, per agency protocol


name: Verify catheter tip placement by x-ray examination, as appropriate and per agency protocol


name: Monitor for immediate complications such as bleeding, nerve or tendon damage, cardiac decompression, respiratory distress, or catheter embolism


name: Flush the line after each use with an appropriate solution per agency protocol


name: Remove catheter according to manufacturer's instructions and per agency protocol


name: Obtain a skin culture and blood culture (sample from the line and other arm) if purulent drainage is noted


name: Draw laboratory samples and review blood chemistries (e.g., blood urea nitrogen, serum creatinine, and serum Na, K, and PO4 levels)


name: Monitor for signs of infection (e.g., peritonitis and exit site inflammation/drainage)


name: Review patient history for contraindications for pessary therapy (e.g., pelvic infections, lacerations, or space-occupying lesions; noncompliance; or endometriosis)


name: Discuss maintenance regimen with patient before fitting pessary (e.g., fit is trial and error; frequent follow-up visits are required; cleaning procedures)


name: Perform speculum examination to visualize status of vaginal mucosa


name: Insert pessary according to manufacturer's instructions


name: Perform second examination in upright position to verify fit


name: Recommend yearly Pap examinations, as appropriate


name: Insert needle directly over pulse at 45 degree to 60 degree angle


name: Arrange for immediate transport of specimen to laboratory


name: Obtain demographical information from donor


name: Cleanse skin with an iodine preparation before venipuncture, according to agency protocol


name: Instruct individual to elevate arm and apply firm pressure for 2 to 3 minutes after completion of blood or blood product donation process


name: Instruct individual to remain recumbent for another 1 to 2 minutes, or longer if faintness or weakness is experienced


name: Instruct individual to leave the pressure bandage on for several hours after donation


name: Stop any intravenous infusion that could contaminate the blood sample


name: Remove cap or tubing to access port, cleanse port with alcohol, and allow to dry


name: Review previous venipuncture experiences and patient preferences for venipuncture site


name: Avoid areas prone to nerve injury (e.g., 3 inch area above thumb or inner aspect of wrist just above the palm)


name: Position targeted extremity lower than level of heart


name: Avoid tourniquet application time of greater than 1 minute to minimize hemolysis of sample


name: Cleanse area with an appropriate solution, per agency protocol


name: Insert needle at a 20 to 30 degree angle in the direction of venous blood return


name: Remove needle from the vein and immediately apply pressure to the site with dry gauze for a minimum of 1 minute


name: Advise patient to leave dressing in place for at least an hour


name: Label specimen(s) with patient name, date and time of collection, and other information, per agency protocol


name: Supervise the patient during the treatment, as needed


name: Terminate the treatment if patient develops side effects


name: Order serum bilirubin levels, as appropriate per protocol or primary practitioner request


name: Report laboratory values to primary practitioner


name: Monitor vital signs, per protocol or as needed


name: Monitor serum bilirubin levels, per protocol or practitioner request


name: Obtain a physician's order or confer with a physician within 1 hour after the restraint is initiated


name: Renew orders for physical restraint according to state rules and regulations and professional standards of care


name: Ensure face to face evaluation is conducted by an appropriately credentialed provider within 1 hour of initiating use of physical restraints


name: Do not tie restraints to side rails of bed


name: Provide appropriate level of supervision to monitor patient and to allow for therapeutic actions, as needed


name: Provide for movement of extremities in patient with multiple restraints by rotating the removal and reapplication of one restraint at a time as safety permits


name: Involve patient in making decisions to move to a more or less restrictive form of intervention, when appropriate


name: Implement alternatives to restraints, such as sitting in a geri-chair or close observation, as appropriate


name: Inform family about the risks and benefits of restraints and restraint reduction


name: Follow-up important electronic messages (e.g., texts, e-mails) with verbal contact


name: Encourage use of a structured communication tool (e.g., SBAR [Situation, Background, Assessment, and Recommendation]) to foster clear communication, as needed


name: Create and use a system to inform physicians of the specific nurse assigned to each of their patients


name: Participate in efforts to establish a comprehensive and easy to use communication system between physicians and nurses that might include handheld phones, text messaging, wireless voice-controlled electronic devices, a single page number


name: Participate in bedside medical rounds, multidisciplinary rounds, and interdisciplinary patient care teams, as appropriate


name: Use health history to determine the suitability of herbal or flower essence therapy


name: Instruct the patient about therapeutic use of herbs or flower essences (e.g., background, philosophy, modes of action, contraindications)


name: Select variety of plant indicated in relation to the individual's state of health


name: Obtain medicinal substances from reputable source


name: Consider using prepared stock flower essences such as the Bach collection of 38 flower essences


name: Prepare medicinal herbs or flowers (e.g., gather, wash, cut, cook), as indicated


name: Determine the form in which the medicinal plant or plant part is prepared (e.g., infusion, decoction, maceration)


name: Store preparations out of direct sunlight in a moderate environment


name: Determine dose and guidelines for the administration of herbal products


name: Assist the patient on the correct use of herbal products (e.g., preparation, time of administration, method of administration)


name: Explain the effects of interaction with other prescribed medicines, if necessary


name: Monitor for the expected response or potential adverse effects


name: Record in the clinical history the action and response to phytotherapy


name: Confirm the need for pneumatic tourniquet use in the physician's or anesthesia professional's plan of care


name: Verify that the entire tourniquet system is complete, clean, and functioning according to the manufacturer's instructions for use


name: Select a tourniquet cuff of appropriate width and length for extremity (e.g., as wide as possible without inhibiting surgical site exposure; use contoured cuffs for patient extremities that taper between the upper and lower edge of the cuff; cuff length should provide bladder overlap on limb and full engagement of hook-and-loop fasteners)


name: Evaluate patient for considerations related to tourniquet use (e.g., planned location of the tourniquet, condition of skin under and distal to the planned cuff site, size and shape of the extremity, peripheral pulses and sensation distal to the planned cuff site, ability to move digits in the involved extremity)


name: Screen for potential contraindications for tourniquet use (e.g., risk factors for deep vein thrombosis, ischemic extremities)


name: Assure that tourniquet tubing and connectors are incompatible with other tubing (e.g., IV tubing, vacuum system) or labeled to clearly identify that they are part of the tourniquet system


name: Label tourniquet tubing clearly to indicate that tubing belongs to which cuff and which is associated with which components of the tourniquet system(s) during procedures involving tourniquet control on two extremities


name: Position cuff tubing on or near the lateral aspect of the extremity


name: Verify the correct surgical site before application of tourniquet cuff


name: Wrap a low-lint, soft padding (e.g., limb protection sleeve, two layers of stockinet, cotton roll) around extremity under site of tourniquet cuff, ensuring that padding is wrinkle-free and does not pinch skin


name: Apply and secure tourniquet cuff snugly around the extremity, avoiding neurovascular sites and ensuring that skin is not pinched


name: Protect patient skin under the tourniquet cuff to prevent fluid accumulation (e.g., skin prep solutions, irrigation)


name: Protect reusable tourniquet cuffs from contamination by fluid, blood, and other potentially infectious material during surgery


name: Apply tourniquet protectors (e.g., U-shaped drapes, adhesive drapes, tourniquet covers) to minimize soiling, as indicated


name: Set the tourniquet pressure to maintain the minimum effective pressure as instructed by physician, anesthesia professional, or per agency policy and based on patient's systolic blood pressure and limb circumference


name: Alert anesthesia professional before wrapping the extremity


name: Inflate the cuff under the direction of physician or anesthesia professional


name: Monitor patient continuously during use and on deflation of tourniquet for physiological responses to tourniquet cuff inflation


name: Assure that activation indicators and pressure displays are visible and audible alarms sufficiently loud to be heard over other sounds in the operating room


name: Assure pneumatic tourniquet inflation time kept to a minimum


name: Inform physician of tourniquet inflation time at regular, established intervals


name: Confer with the surgeon and anesthesia professional about deflating the tourniquet for 10 to 15 minutes to allow tissue reperfusion when the duration of tourniquet inflation is longer than 2 hours


name: Verify the tourniquet inflation pressure during the time-out process


name: Avoid overheating patient when the tourniquet cuff is inflated, particularly in pediatric patients


name: Deflate the tourniquet cuff under the direction of the physician and anesthesia professional


name: Confirm sequence and timing of deflation of each tourniquet when tourniquets are used on two extremities


name: Document tourniquet equipment identification number, cuff site, pressure, inflation and deflation times, condition of skin under cuff, and peripheral circulatory and neurological evaluation, as per agency policy


name: Provide a report on pressure settings, duration of the pneumatic tourniquet inflation, and patient outcomes when transferring the care of the patient to other caregivers


name: Monitor patient for systemic responses and blood loss after cuff has been deflated


name: Report complications to the physician and anesthesia professional and to other caregivers when the patient care is transferred


name: Inspect and clean pneumatic tourniquet after use and according to manufacturer's written instructions


name: Clean reusable cuffs and bladders using a U.S. Environmental Protection Agency registered hospital disinfectant, per agency policy


name: Participate in proficiency testing programs as required by institution


name: Use appropriate specimen for the test being performed


name: Perform testing on collected specimens in a timely manner


name: Store reagents according to manufacturer's requirements or as stated in institution's procedure manual


name: Follow manufacturer guidelines and institutional procedures for instrument calibration


name: Document quality control checks as required


name: Perform test according to manufacturer directions or as stated in institutional procedures


name: Verify the results of the point of care test with use of a central laboratory when a critical clinical decision is to be made


name: Perform cleaning and maintenance of instruments according to manufacturer guidelines or as stated in institutional procedure


name: Document cleaning and maintenance as required


name: Establish a multidisciplinary team including representation from relevant laboratory groups to oversee appropriate resources (e.g., equipment, space available, documentation needs) and training of personnel, as needed in particular setting


name: Establish operational teams to oversee day to day operations, including training, proficiency testing, quality assurance, stock management, computer needs and Internet connectivity, and safety, as needed in particular setting


name: Incorporate preferred sleeping position into the plan of care if not contraindicated


name: Avoid placing the amputation stump in the flexion position


name: Turn the immobilized patient at least every 2 hours according to a specific schedule, as appropriate


name: Determine length and type of procedure, anesthesia requirements, patient's age, body weight, and current medication regime


name: Note nutritional status, presence of chronic illness, comorbidities, preexisting pressure ulcers, and at-risk conditions (e.g., obesity, diabetes, anemia, advanced age, demineralizing bone conditions, pediatric patients)


name: Identify high risk surgical situations (e.g., procedure greater than 2 hours, morbidly obese patients, vascular surgeries, excessive sustained pressure to certain body areas, cool environment with exposure of large body surfaces)


name: Determine patient's range of motion, stability of joints, or presence of prostheses or implants


name: Document specific risk factors that may predispose patient to position-related injuries


name: Check operating room table before patient transfer to ensure it is functioning, locked, and properly prepared with correct padded attachments


name: Assure all needed equipment is clean and in good working order


name: Assure a minimum of four persons to assist with transferring patient to the operating room table


name: Lock wheels of stretcher and operating room bed during transfer of patient


name: Document mode of operating room table transfer and number of persons assisting


name: Check with anesthesia before moving an anesthetized patient


name: Maintain body mechanics and employ ergonomic theory to prevent injury to self


name: Provide warmth, privacy, and reassurance, as needed


name: Protect all tubes, drains, lines, breathing circuits, and other devices


name: Use assistive devices for immobilization, securing patient to operating room bed without compromising circulation underneath any restraining straps


name: Employ restraining straps to prevent slippage of extremities


name: Support all body parts and maintain body alignment when moving an anesthetized patient


name: Avoid pulling or dragging patients during transfers


name: Maintain patient's proper body alignment at all times


name: Place on an appropriate therapeutic mattress or pad, as indicated


name: Position patient for comfort whether asleep or awake


name: Assure operative field adequately exposed


name: Assure no awkward position, undue pressure on a body part, or use of stirrups or traction will obstruct the vascular supply to any body part


name: Assure that respirations are not impeded by pressure of arms on the chest or by patient gown constricting neck or chest


name: Employ padded shoulder braces to prevent irreparable nerve injury when Trendelenburg position employed


name: Place in the proper surgical position for specific surgery (e.g., supine, prone, lateral chest, lithotomy, Kraske jacknife position)


name: Apply padding or position patient to avoid pressure to superficial nerves


name: Monitor physiological effects of positioning and traction devices, as appropriate


name: Intervene in situations in which position compromises patient outcomes


name: Ensure access to airway, intravenous catheters, and monitoring devices


name: Ensure that equipment or personnel do not create or impose pressure on patient during the procedure


name: Monitor position, straps, and padding to assure placement is maintained throughout procedure


name: Document all intraoperative assessments related to positioning and safety measures


name: Reposition patient slowly at procedure end to allow for adequate hemodynamic accommodation


name: Use appropriate body mechanics when positioning patient


name: Provide the patient with an adapted call system (e.g., low pressure, voice control, sip-and-puff straw like switch, chin movement switch) depending on level of motor function


name: Use heel boots to maintain ankles in neutral position


name: Position the head of bed as low as possible (measured by pulmonary function) to increase the surface area of the body and decrease pressure on bony prominences


name: Turn using the log roll technique every 2 hours or more frequently, as indicated


name: Stabilize the spine during position changes by keeping the spine in anatomical alignment (e.g., zero rotation)


name: Monitor brain tissue oxygen and intracranial pressure in critically ill patients during positioning changes, as appropriate


name: Monitor skin integrity under bracing device or orthosis collar


name: Brace traction weights when moving patient


name: Monitor for skin breakdown over bony prominences (e.g., sacrum, ischial tuberosities, heels)


name: Provide passive range of motion to affected limbs as determined by rehabilitation staff


name: Instruct family members on how to assist patient to turn in bed and how to provide range of motion, as appropriate


name: Encourage patient to participate in position changes (i.e., remind staff when it is time to be turned) as feasible


name: Instruct on ways (e.g., tilt, recline) to provide pressure relief to decrease potential for skin breakdown when using a wheelchair


name: Monitor for orthostatic hypotension when transferring to a sitting position in wheelchair


name: Use a slide board to assist transfer to a chair or wheel chair for those patients with fair balance


name: Select the appropriate wheelchair for the patient (e.g., standard adult, semi reclining, fully reclining, amputee, extra wide, narrow)


name: Select a wheelchair with seat low to floor for patient who will get around using foot propelling


name: Ensure that there is at least 2 to 3 inches of clearance on each side of the chair


name: Monitor for effects of prolonged sitting (e.g., pressure ulcers, skin tears, bruises, contractures, discomfort, incontinence, social isolation, falls)


name: Provide padding and other enhancements (e.g., contoured padded backs, padded leg rest panels, arm troughs, padded trays) for patients with special needs


name: Determine appropriate time frame for patient to remain in wheelchair based on health status


name: Provide trapeze or slide board to assist with transfer, as appropriate


name: Determine airway and circulatory adequacy


name: Obtain handoff report from the operating room nurse and anesthetist or anesthesiologist


name: Clarify any postoperative orders to be initiated in the post anesthesia care unit


name: Administer warming measures (e.g., warm blankets, convection blanket), as needed


name: Administer narcotic antagonists per agency protocol, as appropriate


name: Administer IV medication to control shivering, as per agency protocol


name: Remove external objects from body (e.g., clothing, tubes, monitors), as needed


name: Place incontinent pad under buttocks and between legs


name: Respect the family's religious beliefs and rituals


name: Monitor lochia for color, amount, odor, and presence of clots


name: Have patient empty bladder before postpartum check and frequently


name: Monitor fundal location, height, and tone, being sure to support the lower uterine segment during palpation


name: Monitor perineum or surgical incision and surrounding tissue (i.e., monitor for redness, edema, ecchymosis, discharge, and approximation of wound edges)


name: Encourage early and frequent ambulation, assisting patient, when needed


name: Encourage the postoperative patient to perform respiratory exercises, assisting patient, when needed


name: Comfort the patient experiencing shaking chills (i.e., provide warm blankets and offer beverages)


name: Instruct patient on nonpharmacological relief of pain (e.g., sitz baths, ambulation, massage, imagery, ice packs, witch hazel pads, and distraction)


name: Instruct patient on perineal care to prevent infection and reduce discomfort


name: Perform or assist with perineal care (i.e., apply ice pack, encourage patient to take sitz baths, and apply dry heat)


name: Monitor breasts for temperature and color and nipple condition


name: Monitor bladder, including intake and output (e.g., emptying of bladder, palpable, color, odor, input and output)


name: Facilitate return to normal urinary functioning (i.e., assist with sitz baths, promote hydration, pour warm water on perineum, and encourage ambulation)


name: Monitor bowels (e.g., date and time of last bowel movement, bowel sounds, presence of flatus)


name: Facilitate return to normal bowel functioning (i.e., administer stool softener or laxative, instruct patient to increase consumption of fluids and fiber, encourage ambulation)


name: Provide measures to reduce likelihood of deep vein thrombosis development (e.g., leg exercises and compression boot application)


name: Monitor legs for Homans' sign and arrange for further testing, if needed


name: Offer reassurance to patient on her ability to care for self and infant


name: Provide information about mood changes (e.g., postpartum "blues," depression, and psychosis), including symptoms warranting further evaluation and treatment


name: Monitor for symptoms of postpartum depression or psychosis


name: Provide anticipatory guidance on physiological and psychological changes and their management


name: Discuss sexuality and contraceptive choices


name: Monitor parent-infant attachment behaviors


name: Facilitate optimal parent-infant attachment


name: Instruct patient on nutritional needs, including the importance of a balanced diet and supplements, if indicated


name: Instruct patient on infant's nutritional needs


name: Provide adequate education and support on chosen feeding method


name: Refer patient to lactation consultant, if indicated


name: Instruct patient on danger signs that warrant immediate reporting (e.g., fever, depression)


name: Administer Rh immune globulin and Rubella vaccine, if indicated


name: Assist parent in scheduling newborn examination and postpartal examination


name: Refer to appropriate resources for community support or follow-up care


name: Describe clinical focus of the unit and agency


name: Communicate goals of the unit and agency


name: Display an accepting attitude to individual assigned to the unit and agency


name: Discuss clinical ladder and types of care providers and their specific responsibilities


name: Review emergency code procedures, as appropriate


name: Shape expectations for workload and scheduling


name: Be aware of own personality and how that affects teaching style


name: Be alert as to how generational differences may influence work attitudes and relationships


name: Share clinical stories and lessons learned to help shape clinical judgment


name: Provide emotional support, especially during highly stressful times


name: Determine student's knowledge and skill level before delegating a task


name: Provide as many opportunities as possible to practice complex skills (e.g., IV insertion, catheter insertion, leading team meetings, presentations to staff)


name: Ensure that students know and understand fire and disaster policies and emergency procedures


name: Discuss care plan for assigned patients, as appropriate


name: Facilitate student's communication with physicians and giving of patient reports


name: Establish and use electronic technologies (e.g., e-mail, text messages, social networks) to keep in touch with faculty member and students, as appropriate


name: Encourage student to work same days and same hours as preceptor


name: Discourage use of multiple preceptors per student


name: Develop a preconception, pregnancy-oriented, health risk profile based on history, prescription drug use, ethnic background, occupational and household exposures, diet, specific genetic disorders, and habits (e.g., smoking and alcohol and drug intake)


name: Obtain a thorough sexual history, including frequency and timing of intercourse, use of spermicidal lubricants, and postcoital habits such as douching


name: Refer for prenatal diagnostic tests for genetic, medical, or obstetrical risk factors, as needed


name: Counsel about avoiding pregnancy until appropriate treatment has been given (e.g., rubella vaccine, Rho[D] immune globulin, immune serum globulin, or antibiotics)


name: Screen individuals at risk or in populations at risk for tuberculosis, sexually transmitted disease, hemoglobinopathies, Tay-Sachs, and genetic defects


name: Support decision making about advisability of pregnancy based on identified risk factors


name: Evaluate the need for a screening mammogram based on the woman's age and desire for prolonged breastfeeding


name: Encourage dental examination during preconception to minimize exposure to x-ray examinations and anesthetics


name: Administer medication to terminate pregnancy, per protocol


name: Encourage significant other to support patient before, during, or after abortion, if desired or with consent from the patient


name: Provide information for referral to support groups (e.g., Resolve through Sharing, Compassionate Friends, SHARE Pregnancy and Infant Loss Support)


name: Refer for psychological support or counseling, as needed