name: Initiate and/or change medical treatment to maintain patient parameters within the limits ordered by the physician, using established protocols


name: Determine patient ability to participate in specific activities


name: Collaborate with occupational, physical, or recreational therapists in planning and monitoring an activity program, as appropriate


name: Determine patient's commitment to increasing frequency and range of activity


name: Assist patient to choose activities and achievement goals for activities consistent with physical, psychological, and social capabilities


name: Encourage creative activities, as appropriate


name: Assist patient to schedule specific periods for activities into daily routine


name: Assist patient and family to identify deficits in activity level


name: Identify strategies to promote patient participation in desired activities


name: Coordinate patient selection of age appropriate activities


name: Provide activities to increase attention span in consultation with occupational therapist


name: Facilitate activity substitution when patient has limitations in time, energy, or movement, in consultation with occupational, physical, or recreational therapists


name: Encourage involvement in group activities or therapies, as appropriate


name: Refer to community centers or activity programs, as appropriate


name: Promote a physically active lifestyle to avoid unneeded weight gain, as appropriate


name: Suggest methods of increasing daily physical activity, as appropriate


name: Provide activities with implicit and emotional memory components (e.g., specially selected religious activities) for dementia patients, as appropriate


name: Employ animal-assisted activity programs, as appropriate


name: Instruct family to provide positive reinforcement for participation in activities


name: Allow for family participation in activities, as appropriate


name: Assist patient to develop self-motivation and reinforcement


name: Monitor emotional, physical, social, and spiritual response to activity


name: Assist patient and family to monitor own progress toward goal achievement


name: Decide on purpose of acupressure for prevention or treatment of a particular individual (e.g., pain, headaches, nausea, asthma, colds and flu, arthritis, allergies, nervous tension, menstrual cramps, sinus problems, sprains, tennis elbow)


name: Describe the rationale, benefits, limits, and types of acupressure available (e.g., Shiatsu, Tui Na, Sujok, Jin Shin, Atmena)


name: Provide detailed description of chosen acupressure technique


name: Create a quiet, nondisrupting environment, when possible


name: Suggest that the individual assume a comfortable position with unrestricted clothing


name: Explain to individual that you will be searching for a tender area


name: Apply firm finger pressure in a slow, rhythmic manner to enable the layers of tissue to respond


name: Use thumbs, fingers, palms, the side of the hand, or knuckles to apply steady, stationary pressure at the pressure sensitive spot in the general location of the acupoint by using one's body weight to lean into the point to which pressure is applied


name: Apply pressure gradually and hold without any movement for several minutes at a time to relax an area or relieve pain


name: Observe verbal or postural cues (e.g., wincing, "ouch") to identify desired point or location


name: Instruct family/significant other(s) to provide acupressure treatments


name: Orient patient/family/significant other(s) to expectations of care


name: Provide appropriate privacy for the patient/family/significant other(s)


name: Orient patient/family/significant other(s) to immediate environment


name: Obtain admission history including past medical illnesses, medications, and allergies


name: Perform admission risk assessment (e.g., risk for falls, tuberculosis screening, skin assessment)


name: Provide patient with "Patient's Bill of Rights"


name: Use personal protective equipment (PPE) (gloves, goggles, and mask), as appropriate


name: Position patient and head, as appropriate


name: Insert a laryngeal mask airway (LMA), as appropriate


name: Limit insertion of endotracheal tubes and tracheostomies to qualified and credentialed personnel


name: Encourage physicians to place ETs via the oropharyngeal route, as appropriate


name: Hyperoxygenate with 100% oxygen for 3 to 5 minutes, as appropriate


name: Observe for systematic chest wall movement


name: Monitor oxygen saturation (SpO2) by noninvasive pulse oximetry and CO2 detection


name: Monitor respiratory status, as appropriate


name: Mark endotracheal tube at the position of the lips or nares, using the centimeter markings on the ET, and document


name: Use fun techniques to encourage deep breathing for children (e.g., blow bubbles with bubble blower; blow on pinwheel, whistle, harmonica, balloons, party blowers; have blowing contest using ping pong balls, feathers)


name: Use personal protective equipment (e.g., gloves, goggles, and mask), as appropriate


name: Hyperoxygenate with 100% oxygen for at least 30 seconds, using the ventilator or manual resuscitation bag before and after each pass


name: Hyperinflate using tidal volumes that are indexed to the size of the patient, as appropriate


name: Use closed-system suctioning, as indicated


name: Use the lowest amount of wall suction necessary to remove secretions (e.g., 80-120 mm Hg for adults)


name: Monitor patient's oxygen status (SaO2 and SvO2 levels), neurological status (e.g., mental status, ICP, cerebral perfusion pressure [CPP]) and hemodynamic status (e.g., MAP level and cardiac rhythms) immediately before, during, and after suctioning


name: Vary suctioning techniques based on the clinical response of the patient


name: Monitor and note secretion color, amount, and consistency


name: Monitor the patient after exposures to agents known to cause allergic responses for signs of generalized flush, angioedema, urticaria, paroxysmal coughing, severe anxiety, dyspnea, wheezing, orthopnea, vomiting, cyanosis, or shock


name: Keep patient under observation for 30 minutes after administration of an agent known to be capable of inducing an allergic response


name: Instruct the patient with medication allergies to question all new prescriptions for potential allergic reactions


name: Instruct patient and caregiver(s) on how to avoid situations that put them at risk and how to respond if an anaphylactic reaction should occur


name: Observe for signs of inadequate amniotic fluid volume (e.g., oligohydramnios, asymmetrical intrauterine growth retardation, postdatism, known fetal urinary tract abnormalities, and prolonged rupture of membranes)


name: Recognize potential contraindications for amnioinfusion (e.g., amnionitis, polyhydramnios, multiple gestation, severe fetal distress, fetal scalp pH less than 7.20, known fetal anomaly, known uterine anomaly)


name: Observe for variable or prolonged fetal heart decelerations during intrapartal electronic monitoring


name: Obtain cord blood gas levels at the time of delivery to evaluate effectiveness of intervention


name: Facilitate use of a pressure-relieving mattress


name: Monitor for phantom limb pain (i.e., check for burning, cramping, throbbing, crushing, or tingling pain where the limb was)


name: Administer pharmacological and nonpharmacological (e.g., TENS, phonophoresis, and massage) pain control, as needed


name: Monitor for psychological concerns (e.g., depression and anxiety) and adjustment related to change in body image


name: Place affected area in whirlpool bath, as appropriate


name: Monitor tissue for skin integrity (e.g., fungal infection, contact dermatitis, and scar management)


name: Instruct patient how to correctly perform postsurgical exercises (e.g., range of motion, endurance, and strengthening)


name: Encourage patient to perform range-of motion, endurance, and strengthening exercises after surgery, providing assistance, when necessary


name: Instruct in transfer techniques and assistive devices (e.g., trapeze)


name: Facilitate the identification of needed modifications in lifestyle and assistive devices (e.g., home and car)


name: Instruct patient on signs and symptoms to be reported to health care provider (e.g., chronic pain, skin breakdown, tingling, absent peripheral pulse, cool skin temperature, and changes in functional needs or goals)


name: Discuss potential long-term goals for rehabilitation (e.g., walking without a support device)


name: Encourage and facilitate interaction with persons with similar amputations, as appropriate


name: Supervise initial use and care of the prosthesis


name: Instruct patient and family how to care for and apply the prosthesis


name: Assess prosthesis regularly for stability, ease of movement, energy efficiency, and gait appearance


name: Remove prosthesis before surgery, as appropriate


name: Refer to specialist for modification of prosthesis or treatment of complications related to its use


name: Establish effective communication patterns among patient, family, and caregivers to achieve adequate pain management


name: Ensure holistic approach to pain management (i.e., adequate consideration of physiological, social, spiritual, psychological and cultural influences)


name: Adapt pain monitoring techniques to accommodate patients with communication impairments (e.g., pediatric, elderly, cognitively impaired, psychotic, critically ill, non-English speaking, dementia)


name: Determine pain onset, location, duration, characteristics, quality, intensity, pattern, relief measures, contributing symptoms, effects on patient, and severity before medicating patient


name: Determine patient's current level of comfort and desired level of comfort, using an appropriate pain rating scale


name: Determine patient's previous response to analgesics (e.g., if nonopioid medication as effective as opioid)


name: Determine patient's previous doses and routes of analgesic administration to avoid undertreatment or overtreatment


name: Involve patient in selection of analgesic, route, and dose, as appropriate


name: Assure that patient is not at risk for NSAID use (e.g., history of GI bleeding or renal insufficiency)


name: Assure that patient is not at risk for opioid use (e.g., history of obstructive or central sleep apnea)


name: Assure accurate 24-hour dosage is maintained (e.g., no more than 4000 mg acetaminophen and acetylsalicylic acid (ASA); 3200 mg for ibuprofen)


name: Assure appropriateness of opioid dosage (e.g., large doses acceptable in opioid-tolerant patients but not opioid-nave patients)


name: Titrate opioid to desired effect or to uncontrollable side effects (e.g., comfort versus respiratory depression)


name: Adjust dosages for children and older adults, as appropriate


name: Account for narcotics and other restricted drugs, according to agency protocol


name: Record pain level using appropriate pain scale before and after administering analgesics


name: Attend to comfort needs and other activities that assist relaxation to facilitate response to analgesia


name: Assist patient in selecting nonpharmacological activities that have relieved pain in the past (e.g., distraction, music, simple relaxation therapy)


name: Give analgesics before pain-producing procedures or activities


name: Administer adjuvant analgesics and medications to potentiate analgesia, when needed


name: Instruct to request PRN pain medication before the pain is severe


name: Correct misconceptions and myths patient or family members may hold regarding analgesics, particularly opioids (e.g., addiction and risks of overdose)


name: Implement measures to reduce noxious stimuli in patient environment (i.e., keep patients clean, dry, correctly positioned, and turned regularly; prevent constipation and urinary retention; loosen constrictive bandages or clothing, as indicated; tighten and smooth wrinkled bed linens)


name: Evaluate the effectiveness of analgesic at regular, frequent intervals after each administration, but especially after the initial doses


name: Implement actions to decrease untoward effects of analgesics (e.g., respiratory depression, nausea and vomiting, dry mouth, constipation, gastric irritation)


name: Administer opioid reversal agents (e.g., naloxone) for respiratory depression or undesirable sedation, if indicated


name: Instruct patient and family about the use of analgesics, strategies to decrease side effects, and expectations for involvement in decisions about pain relief


name: Involve family/significant other(s) in pain control measures such as simple massage or heat/cold application techniques


name: Instruct patient and significant others about procedure


name: Check patency and function of intraspinal catheter, port, or pump


name: Label the intraspinal catheter and secure it appropriately


name: Ensure catheter site is visible and covered with a transparent dressing for monitoring purposes


name: Ensure that edges of site dressing are window-paned to prevent rolling of the dressing


name: Monitor catheter site and dressings to check for a loose catheter or wet dressing and notify appropriate personnel per agency protocol


name: Label tubing and site "Intraspinal Catheter-Do not Inject"


name: Avoid the use of alcohol on the catheter or connectors (i.e., alcohol is neurotoxic)


name: Start continuous infusion of analgesic agent after correct catheter placement has been verified and monitor rate to ensure delivery of prescribed dosage of medication


name: Monitor effectiveness of pain medication


name: Monitor respiratory status every hour for first 24 hours after catheter insertion, when patient is at highest risk for respiratory depression


name: Determine sensation every 2 hours using cold sensation with ice


name: Apply ice up from the toe and note where coldness is detected by the patient


name: Document numbness, tingling or normal sensation, and motor block using appropriate dermatomes


name: Determine the level of block to see if it is changing


name: Notify physician of sensation or motor block higher than the initial documented level


name: Identify weakness and sensation level for comparison (i.e., weakness should be correlated to the level of sensation)


name: Provide adjunct medications for pain relief (e.g., antidepressants, anticonvulsants, and nonsteroidal antiinflammatory agents), as appropriate


name: Administer aqueous epinephrine, 1:1000, subcutaneously, dosing appropriate for age


name: Apply tourniquet per protocol immediately proximal to the allergen point of entry (e.g., injection site, IV site, insect bite), when possible, as appropriate


name: Administer oxygen at high flow rate (10 to 15 L/min)


name: Administer spasmolytics, antihistamines, or corticosteroids, as indicated if urticaria, angioedema, or bronchospasm present


name: Evaluate patient preoperatively in advance of the scheduled surgical procedure, preferably one or more days before procedure


name: Verify that the information provided by the patient is the same as the information in the identification device (e.g., wristbands, bed tag, fingerprint recognition software, palm vein scanner) and medical record


name: Examine patient and the patient's record to determine preexisting conditions, allergies, and contraindications for specific anesthetic agents or techniques


name: Document patient's readiness for anesthesia (e.g., preoperative fasting, medication regime, absence of upper respiratory tract infections, airway history)


name: Request appropriate consultations, including diagnostic and laboratory studies, based on the patient's health status and proposed surgery


name: Start appropriate intravenous and invasive monitoring lines and initiate noninvasive monitoring modalities, per the American Society of Anesthesiologists Standards for Basic Anesthetic Monitoring


name: Ensure positioning of patient to prevent peripheral nerve damage and pressure injuries


name: Deliver anesthetic consistent with each patient's physiological needs, patient's requests, clinical judgment, and the American Association of Nurse Anesthetists Scope and Standards for Nurse Anesthesia Practice


name: Monitor vital signs, respiratory and circulatory adequacy, response to anesthesia, and other physiological parameters


name: Measure and evaluate appropriate laboratory values


name: Manage emergence from anesthesia by administering indicated medications, fluids, and ventilatory support


name: Accompany patient to the postanesthesia or intensive care unit with appropriate monitoring and oxygen therapy


name: Encourage patient to seek assistance of nursing staff or responsible others during periods of increasing tension


name: Discourage intense activities (e.g., punching bag, pacing, excessive exercise)


name: Educate on methods to modulate experience of intense emotion (e.g., assertiveness training, relaxation techniques, writing in a journal, distraction)


name: Encourage use of collaboration to solve problems


name: Use external controls (e.g., physical or manual restraint, time outs, and seclusion) to calm patient who is expressing anger in a maladaptive manner, as needed (as last resort)


name: Determine whether there are any allergies to animals


name: Enforce standards for health maintenance of animals in the therapy program


name: Assist the patient to identify possible upcoming, developmental or situational crisis and the effects the crisis may have on personal and family life


name: Suggest printed literature and electronic sources for the patient to read, as appropriate


name: Schedule visits at strategic developmental or situational points


name: Include the family and significant others, when possible


name: Establish that the least restrictive measure is being initiated (if a lower level was used, establish that it was deemed ineffective before advancing to the next level of restriction)


name: Obtain a licensed independent practitioner (LIP) order as required by selection of measure based on institutional policy and state, federal, and regulatory agencies (e.g., Centers for Medicare & Medicaid Services, The Joint Commission)


name: Identify for the patient and significant others the appropriate behaviors necessary for termination of the intervention, repeat as needed


name: Restrict to designated area that is appropriate


name: Modulate human and environmental sensory stimuli (e.g., visiting sessions, sights, sounds, lighting, temperature, etc.) in the designated area, as needed


name: Use protective devices and measures (e.g., motion detectors, alarms, fences, gates, side rails, mitts, closed chairs, locked doors, restraints)


name: Administer PRN medications (e.g., anxiolytics, antipsychotics, sedatives), as appropriate


name: Provide for the patient's physical needs and safety (e.g., cardiovascular, respiratory, neurological, elimination, and nutrition, and skin integrity), as appropriate


name: Provide for the patient's psychological comfort and safety


name: Offer structured activities within the designated area, as appropriate


name: Provide positive reinforcement for appropriate behavior


name: Monitor the need for changes (e.g., lower/higher level measure, continue, or discontinue) to the restrictive measure at regular intervals


name: Involve patient in decision to change a restrictive measure (e.g., lower/higher level measure, continue, or discontinue), when appropriate


name: Hold a debriefing session (e.g., covering behaviors leading to the measures, and patient concerns about the intervention) with patient and staff after termination of the intervention


name: Document (e.g., rationale for the restrictive measure, patient's physical and psychological condition, nursing care provided, and the rationale for terminating the intervention) at appropriate points in care according to institutional policy, state, federal, and/or regulatory agency requirements


name: Determine individual response to the selected aroma (e.g., like versus dislike) before use


name: Dilute essential oils with appropriate carrier oils before topical use


name: Monitor individual for preadmission and postadministration report of level of stress, mood, and anxiety, as appropriate


name: Identify form of art-based activity (e.g., preexisting, impromptu, directed, spontaneous)


name: Identify art medium to be used, such as drawings (e.g., self-portrait, human figure drawings, family kinetic drawings), photos and other media (e.g., photo journal, media journal), graphics (e.g., timeline, body maps), or artifacts (e.g., masks, sculpture)


name: Discuss with patient what to make, using direct or nondirect approach, as appropriate


name: Monitor patient's engagement during the art-making process, including verbal comments and behaviors


name: Record patient interpretation of drawings or artistic creation


name: Encourage patient to describe and talk about the art product and the art-making process


name: Incorporate patient's description and interpretation of the art activity into patient assessment data


name: Compare art product and art-making process to patient's developmental level and prior art making activities


name: Provide referral (e.g., social work, art therapy), as indicated


name: Provide 100% humidification of inspired air, oxygen, or gas


name: Inflate endotracheal/tracheostomy cuff using minimal occlusive volume (MOV) technique or minimal leak technique (MLT)


name: Maintain inflation of the endotracheal/tracheostomy cuff at 15 to 25 mm Hg during mechanical ventilation and during and after feeding


name: Monitor cuff pressures every 4 to 8 hours during expiration using a three-way stopcock, calibrated syringe, and manometer


name: Check cuff pressure immediately after delivery of any general anesthesia or manipulation of endotracheal tube


name: Suction the oropharynx and secretions from the top of the tube cuff before deflating the cuff


name: Change endotracheal tapes/ties every 24 hours, inspect the skin and oral mucosa, and reposition ET to the other side of the mouth


name: Loosen commercial endotracheal tube holders at least once a day and provide skin care


name: Assist with chest x-ray examination to monitor position of tube, as needed


name: Monitor secretions color, amount, and consistency


name: Perform oral care (e.g., use toothbrush, swabs, mouth and lip moisturizer), as needed


name: Monitor for decrease in exhale volume and increase in inspiratory pressure in patients receiving mechanical ventilation


name: Provide trachea care every 4 to 8 hours, as appropriate: clean the inner cannula, clean and dry the area around the stoma, and change tracheostomy ties


name: Inspect and palpate for air under skin every 8 hours


name: Tape the tracheostomy obturator to head of bed


name: Tape a second tracheostomy (same type and size) and forceps to head of bed


name: Elevate head of the bed equal to or greater than 30 degrees or assist patient to a sitting position in a chair during feedings, as appropriate


name: Minimize use of medications known to delay gastric emptying, as appropriate


name: Position upright equal to or greater than 30 (NG feedings) to 90 degrees or as far as possible


name: Keep tracheal cuff inflated, as appropriate


name: Supervise eating or assist, as necessary


name: Check NG or gastrostomy residual before feeding


name: Avoid feeding, if residuals are high (e.g., greater than 250 cc for feeding tubes or greater than 100 cc PEG tubes)


name: Use continuous NG pump feedings in place of gravity or bolus, if appropriate


name: Inspect oral cavity for retained food or medications


name: Determine barriers to assertiveness (e.g., developmental stage, chronic medical or psychiatric condition, lack of knowledge, and female socialization)


name: Differentiate between assertive, aggressive, passive, and passive-aggressive behaviors


name: Help to identify nonverbal communication (e.g., smiling, eye contact, tone and volume of voice) that will assist or hinder assertiveness


name: Help to build communication skills that will enable the patient to accurately articulate information


name: Educate patient on the use of the PERF meter at home


name: Instruct client/family on antiinflammatory and bronchodilator medications and their appropriate usage


name: Encourage verbalization of feelings about diagnosis, treatment, and effect on lifestyle


name: Teach client to identify and avoid triggers, as possible


name: Discuss with patient culture-based expressions of attachment before and after birth


name: Determine patient's image of unborn child


name: Discuss patient's experience of hearing fetal heart tones


name: Discuss patient's experience of viewing fetal ultrasound image


name: Discuss patient's experience of fetal movements


name: Encourage patient to attend prenatal classes


name: Instruct patient's partner on ways to participate during labor and delivery


name: Place newborn skin-to-skin with parent immediately after birth


name: Provide opportunity for parent to see, hold, and examine newborn immediately after birth (i.e., delay unnecessary procedures and provide privacy)


name: Facilitate eye contact between parent and newborn immediately after birth (i.e., demonstrate en face positioning; dim room lights; and provide a quiet, private environment)


name: Complete maternal and newborn assessments while allowing parent to hold newborn


name: Share information gained from physical assessments of infant with parent


name: Inform parent of care being given to infant


name: Encourage mother to breastfeed, if appropriate


name: Provide adequate breastfeeding education and support, if appropriate


name: Instruct parent on infant cues for feeding (e.g., rooting, sucking on fingers, crying)


name: Instruct parent on importance of feeding as nurturing activity, as it provides opportunity for extended eye contact and physical closeness


name: Assist parent in identifying infant's need when crying (e.g., hunger, pain, fatigue, fussiness)


name: Encourage consistent, prompt response to infant crying


name: Demonstrate infant soothing techniques to parent


name: Point out infant cues that show responsiveness to parent


name: Encourage frequent, sustained physical closeness between infant and parent (e.g., skin-to-skin contact, breastfeeding, child carrying, and sleeping in close proximity to infant)


name: Instruct parent on various ways of providing skin-to-skin contact (e.g., kangaroo care, massaging, and cobathing)


name: Instruct parent on infant cares (e.g., diaper changing, feeding, holding, massaging)


name: Encourage use of family members and friends for infant caregiving


name: Assist parent of multiples in recognizing individuality of each infant


name: Facilitate parent's complete access to and care of hospitalized infant


name: Explain equipment used to monitor hospitalized infant


name: Provide visual objects depicting infant (e.g., photograph of infant, infant footprint) to parent of hospitalized infant


name: Update parent frequently on status of hospitalized infant


name: Instruct parent on attachment development, emphasizing its complexity, ongoing nature, and opportunities


name: Provide anticipatory guidance on developmental milestones that will occur


name: Determine how family is coping with transitions


name: Provide opportunity for parent to discuss topics of concern (e.g., fears, questions pertaining to infant care, feelings of exhaustion, pain management, and ways to interact with and respond to infant)


name: Monitor factors that may interfere with optimal attachment (e.g., mental health disturbance in parent, financial strain, parent and child separation due to medical or surgical intervention, difficulties with breastfeeding, providing foster care, and adopting)


name: Provide referral to services (e.g., financial, pastoral care, and counseling), if appropriate


name: Use statements in the script which elicit feelings of heaviness, lightness, or floating of specific body parts


name: Encourage patient to practice session three times a day


name: Instruct patient to keep a diary to document progress made with each session


name: Adhere to institutional policy for qualifications, training, and procedures to perform salvage and autotransfusion


name: Assure proper personnel are available before initiation of procedure


name: Screen for appropriateness of salvage (i.e., contraindications include sepsis, infection, tumor at the site, blood containing an irrigant that is not injectable, hemostatic agents, or microcrystalline collagen)


name: Use appropriate blood retrieval system per institutional policy


name: Monitor patient and blood retrieval system frequently during retrieval


name: Screen blood for appropriateness of reinfusion (i.e., contraindications include contaminants, pharmacologic agents, malignancy, hematologic disorders)


name: Use fun bathing techniques with children (e.g., wash dolls or toys; pretend a boat is a submarine; punch holes in bottom of plastic cup, fill with water, and let it "rain" on child)


name: Place on an appropriate therapeutic mattress or bed


name: Use devices on the bed that protect the patient


name: Monitor for complications of bed rest (e.g., loss of muscle tone, back pain, constipation, increased stress, depression, confusion, sleep cycle changes, urinary tract infections, difficulty with urination, pneumonia)


name: Place in upright posture intermittently for patients unable to be out of bed every day to protect against orthostatic intolerance


name: Increase physical activity, as appropriate


name: Apply wrist/leg/chest restraints, as necessary


name: Provide a structured and physically safe environment


name: Develop an evidence-based behavioral management plan that is carried out consistently by all care providers


name: Give any instructions or explanations slowly, using simple and concrete language


name: Allow patient to carry out one instruction before being given another


name: Provide assistance to complete task(s), as necessary


name: Use external controls to calm patient (e.g., time out, seclusion, and physical restraint), as necessary


name: Provide information about the illness (e.g., attention deficit disorder, hyperactivity, mania, and schizophrenia) to patient and significant others, as appropriate


name: Provide medication instruction to patient and significant others


name: Demonstrate behavioral management techniques to significant others


name: Collaborate with providers in schools and others in the community who can enhance treatment management


name: Identify previous history of self-mutilating behaviors


name: Apply mitts, splints, helmets, or restraints to limit mobility and ability to initiate self-harm, if necessary


name: Monitor patient for self-harmful impulses that may progress to suicidal thoughts or gestures


name: Communicate risk for self-harm to other care providers


name: Identify cues that precede self-mutilating behavior


name: Anticipate trigger situations that may prompt self-harm and intervene to prevent these


name: Use a calm, nonpunitive approach when dealing with self-harmful behaviors


name: Assist patient to identify situations and feelings that may prompt self-harm or that prompted self-harmful behavior


name: Assist patient to identify more appropriate coping strategies and their consequences


name: Contract with patient for "no self-harm" to enable the patient to stay physically safe


name: Provide close, one-to-one observation of the patient to maintain safety, when necessary


name: Encourage patient to seek out care providers to talk when urge to harm self occurs


name: Explain and reinforce effective coping behaviors and appropriate expression of feelings


name: Formulate a plan of care with patient including goals for preventing undesired self-harm behaviors


name: Suggest alternative behaviors, such as seeking interpersonal support or engaging in an adaptive anxiety-reducing activity


name: Use appropriate strategies of dialectical behavior therapy (DBT) (e.g., psychological education, problem solving, training in social skills, exercises in monitoring moods, modeling by the therapist, homework assignments, and meditation)


name: Involve patient in individual and group therapies, as appropriate


name: Administer medications to decrease anxiety, stabilize mood, and decrease self-stimulation, as appropriate


name: Assist patient to assume responsibility for the consequences of behavior (e.g., dress own self-inflicted wound)


name: Avoid giving positive reinforcement to self-harmful behaviors


name: Provide care for patient's wounds in a neutral, matter-of-fact manner by refraining from being punitive, overly sympathetic, or providing additional attention


name: Reinforce the patient's positive behaviors that decrease or eliminate self-mutilating or self-abusive behaviors


name: Develop a plan for safety with the patient to effectively deal with precursors to undesired behavior when in their home environment


name: Identify sexual behaviors that are unacceptable (e.g., makes inappropriate remarks in public places, says inappropriate things to people they know, makes unwanted advances to people they know or to strangers, kisses or hugs more than is appropriate, attempts to have sexual intercourse with others, masturbates in public) given the particular setting and patient population


name: Specify explicit expectations (based on developmental stage, level of cognitive functioning, and capacity for self-control) related to sexual behavior or verbalizations that might be directed toward others or objects in the environment


name: Provide parents information about age appropriate sexual behavior


name: Discuss with parents and children the importance of Internet safety and prevention of access to sexual material


name: Encourage parents to not punish or admonish the children for normative sexual behaviors


name: Instruct parents to use gentle distraction, such as asking the child to hold hands with them, to redirect the behavior


name: Discuss, based on the patient's developmental and cognitive ability, the negative effect that socially unacceptable sexual behavior may have on others, as appropriate


name: Avoid assigning roommates with communication difficulties, history of inappropriate sexual activity, or heightened vulnerabilities


name: Limit patient's physical mobility to decrease opportunity for socially unacceptable sexual behaviors, as needed


name: Provide appropriate level of supervision to monitor patient


name: Redirect from any socially unacceptable sexual behaviors or verbalizations


name: Discourage initiation of sexual or intimate relationships when under severe stress


name: Provide counseling for patient who has been sexually abused, as needed


name: Consider pharmacological treatment, as needed


name: Assist patient to identify strengths and reinforce these strengths


name: Ensure that the intervention is implemented consistently by all staff


name: Encourage the patient to participate in monitoring and recording behaviors


name: Discuss the behavior modification process with the patient and significant other(s)


name: Administer positive reinforcers on a predetermined schedule (continuous or intermittent) for desired behaviors


name: Withdraw positive reinforcers from undesired behaviors and attach reinforcers to a more desirable replacement behavior


name: Encourage the patient to participate in the selection of meaningful reinforcers


name: Determine changes in behavior by comparing baseline occurrences with postintervention occurrences of behavior


name: Document and communicate modification process to treatment team, as necessary


name: Consider using a standardized evidenced based interpersonal skills behavioral training program


name: Assist patient to identify possible courses of action and their social and interpersonal consequences


name: Identify specific social skills using guided discussion and examples that will be the focus of training


name: Assist patient to identify the behavioral steps for the targeted social skills


name: Provide models (e.g., role play, video presentation) demonstrating the behavioral steps in the context of situations that are meaningful to the patient


name: Provide feedback (e.g., praise or rewards) to patient about performance of targeted social skills


name: Identify the patient's emotional, cognitive, developmental, and situational needs


name: Determine ability for reading independently


name: Set therapy goals (e.g., emotional change; personality development; learn new values and attitudes)


name: Consult sources to recommend literature for therapy


name: Select stories, poems, essays, articles, self-help books, or novels that reflect the situation or feelings the patient is experiencing


name: Assist in helping the patient identify with the characters and emotional content in the literature


name: Examine and talk about the feelings expressed by the characters


name: Facilitate dialogue to help the patient compare and contrast the image, character, situation, or concept in the literature with his/her situation


name: Assist in helping the patient recognize how the situation in the literature can help with making desired changes


name: Interview patient to obtain a health history


name: Analyze nature of the specific health condition to be treated


name: Determine abilities and willingness for using the biobehavioral treatment


name: Discuss rationale for using biofeedback and type of feedback


name: Decide on the specific monitoring device to be used (e.g., thermal feedback; electrodermal response or galvanic skin response; electromyography feedback; finger pulse feedback; breathing biofeedback; electroencephalograph biofeedback)


name: Explain the procedure concerning the specific monitoring equipment used


name: Operate the biofeedback device according to instructions


name: Discuss timing, frequency, length, and setting for sessions with patient/family


name: Provide feedback of progress after each session


name: Identify potential types of biological agents that are likely terrorism agents (e.g., anthrax, smallpox, botulism, plague)


name: Integrate biological and chemical terrorism into agency disaster preparedness planning and evaluation


name: Consider current WHO and CDC recommended strategies to contain natural or deliberate disease and chemical events


name: Monitor clients with vague flu-like symptoms


name: Report suspicious symptoms to appropriate triage officers and health agencies


name: Maintain current knowledge of protective equipment, protective procedures, and isolation techniques


name: Ensure that protective equipment (e.g., hazmat suits, headgear, gloves, respirators) are available and in good working order


name: Familiarize and follow all decontamination policies, procedures, and protocols


name: Perform vaginal examination to determine fetal position and station


name: Apply controlled umbilical cord traction while guarding the fundus of uterus


name: Perform rectal examination to ensure tissue integrity


name: Maintain privacy and assure uninterrupted time during procedure


name: Position patient in comfortable, lying, semirecumbent posture


name: Cleanse site of entry or end of Y-connector with alcohol wipe before and after procedure


name: Instill irrigating fluids, per agency protocol


name: Keep patient fully informed of each irrigation, if repetition is necessary


name: Monitor patient level of comfort and ease of irrigation with each instillation, if repetition is necessary


name: Discontinue irrigations if procedure becomes too difficult or if it appears the catheter is obstructed


name: Notify physician if catheter is obstructed


name: Monitor and maintain correct flow rate with continuous infusions


name: Connect catheter to new drainage bag at end of irrigation


name: Assure patient comfort at end of procedure


name: Review patient history for specific risk factors (e.g., surgery, trauma, ulcers, hemophilia, poor clotting function, clotting inhibition from medication regime)


name: Monitor the patient closely for signs and symptoms of internal and external hemorrhage (e.g., distension or swelling of affected body part, change in type or amount of drainage from a surgical drain, bloody saturation of dressings, pooling of blood beneath patient)


name: Monitor for signs and symptoms of persistent bleeding (e.g., hypotension, weak and rapid pulse, cool and clammy skin, rapid breathing, restlessness, reduced urine output)


name: Monitor coagulation studies, including prothrombin time, partial thromboplastin time, fibrinogen, fibrin degradation and split products, and platelet counts, as appropriate


name: Avoid injections (IM or SQ), as appropriate


name: Avoid administering medications that will further compromise clotting times (e.g., clopidogrel, heparin, warfarin, or nonsteroidal antiinflammatory drugs [NSAIDs] such as aspirin)


name: Instruct patient to avoid medications that will further compromise clotting times (e.g., clopidogrel, heparin, warfarin, or nonsteroidal antiinflammatory drugs [NSAIDs] such as aspirin), as appropriate


name: Use electric razor, instead of straight edge, for shaving


name: Instruct patient to avoid invasive procedures; if they are necessary, monitor closely for bleeding


name: Instruct patient to avoid lifting heavy objects


name: Instruct patient to avoid constipation (e.g., encourage fluid intake and stool softeners), as appropriate


name: Apply ice pack to affected area, as appropriate


name: Note hemoglobin/hematocrit levels before and after blood loss


name: Monitor for signs and symptoms of persistent bleeding (i.e., check all secretions for frank or occult blood)


name: Hematest all excretions and observe for blood in emesis, sputum, feces, urine, NG drainage, and wound drainage, as appropriate


name: Instruct the patient and family on signs of bleeding and appropriate actions (i.e., notify the nurse), should further bleeding occur


name: Instruct the patient on activity restrictions


name: Obtain client history of vaginal bleeding (e.g., onset, amount, frequency of changing peri pads, color of bleeding, presence and location of pain, and presence of clots)


name: Review for risk factors related to late pregnancy bleeding (e.g., abruptio placentae, smoking, cocaine use, hypertension, diabetes, multiparity, previous cesarean birth, prior and current placenta previa, infertility treatment, multiple gestations, short interval between pregnancies, greater than 35 years of age)


name: Inspect perineum, clothing, sheets or pads for amount and characteristic of bleeding


name: Weigh blood soaked materials and clots to quantify blood loss


name: Continually monitor characteristic and amount of bleeding


name: Initiate continuous electronic fetal monitoring


name: Report client status and any changes in amount and frequency of bleeding, as appropriate


name: Initiate fetal resuscitation for abnormal (nonreassuring) signs of uteroplacental insufficiency


name: Delay digital cervical examination until location of placenta has been verified by ultrasound


name: Perform or assist with speculum examination to visualize blood loss and cervical status


name: Initiate IV access for fluid replacement


name: Obtain diagnostic blood studies (e.g., CBC, clotting studies, Rh, type and cross match, Kleihauer-Betke test), as ordered


name: Provide empathy, understanding and emotional support


name: Provide information on procedures, diagnostic tests, and treatments


name: Instruct woman to differentiate between old and fresh bleeding


name: Inform woman to monitor fetal movement to evaluate fetal well-being


name: Monitor for signs of hypovolemic shock (e.g., decreased blood pressure; rapid, thready pulse; increased respiratory rate; diaphoresis; restlessness; cool, clammy skin)


name: Monitor coagulation studies and complete blood count (CBC) with WBC differential, as appropriate


name: Avoid extremes in gastric pH level by administration of appropriate medication (e.g., antacids or histamine-2 blocking agent), as appropriate


name: Maintain pressure in cuffed/balloon nasogastric tube, if appropriate


name: Apply manual pressure over the bridge of the nose


name: Administer humidified oxygen, if appropriate


name: Place patient in mid-Fowler's position, as appropriate


name: Instruct patient to avoid traumatizing nares (e.g., avoid scratching, blowing, or touching nose)


name: Review obstetrical history and labor record for risk factors for postpartum hemorrhage (e.g., prior history of postpartum hemorrhage, over distention of the uterus, rapid labor, prolonged third stage, uterine infection, lacerations, retained placenta, labor, induction, use of anesthesia, preeclampsia, prolonged second stage, assistive birth, cesarean birth, or precipitous birth)


name: Perform fundal massage to ensure firm consistency


name: Increase frequency of fundal massage until the uterus becomes firm


name: Inspect placenta for intactness and missing fragments


name: Notify primary practitioner of excessive blood loss


name: Initiate IV infusion with needles suitable for blood transfusion


name: Administer a uterotonic drug, per protocol or order


name: Monitor maternal color, level of consciousness, pain, and anxiety level


name: Insert Foley catheter with urometer to monitor urine output, as appropriate


name: Order emergency laboratory tests or units of blood


name: Identify mother's beliefs about blood transfusions


name: Prepare the woman for transfer to the operating room for surgical intervention


name: Maintain continuous bladder irrigation, if appropriate


name: Verify that blood product has been prepared, typed, and crossmatched (if applicable) for the recipient


name: Verify correct patient, blood type, Rh type, unit number, and expiration date, and record per agency protocol


name: Instruct patient about signs and symptoms of transfusion reactions (itching, dizziness, shortness of breath and/or chest pain)


name: Monitor vital signs (e.g., baseline, throughout and after transfusion)


name: Notify laboratory immediately in the event of a blood reaction


name: Determine whether perceived dislike for certain physical characteristics creates a dysfunctional social paralysis for teenagers and other high-risk groups


name: Determine whether a recent physical change has been incorporated into patient's body image


name: Assist patient to discuss changes caused by puberty, as appropriate


name: Determine whether a change in body image has contributed to increased social isolation


name: Identify means of reducing the effect of any disfigurement through clothing, wigs, or cosmetics, as appropriate


name: Assist the hospitalized patient to apply cosmetics before seeing visitors, as appropriate


name: Determine patient's understanding of body mechanics and exercises (e.g., return demonstration of correct techniques when performing activities/exercises)


name: Use the principles of body mechanics in conjunction with safe patient handling and movement aids


name: Determine infant state before initiating feeding


name: Determine fluoride content of water used to dilute concentrated or powdered formula and refer for fluoride supplementation, if indicated


name: Determine onset and type of incontinence, frequency of episodes, and any related change in bowel function or stool consistency


name: Eliminate the cause of the incontinence (e.g., medication, infection, fecal impaction), if possible


name: Use nonionic detergent preparation (e.g., Peri-Wash) for cleansing, as appropriate


name: Protect the skin from excess moisture of urine, stool, or perspiration with a moisture barrier cream (e.g., petrolatum, lanolin, dimethicone), as needed


name: Monitor perianal skin for development of pressure ulcer and for infection


name: Schedule toileting with a commode at bedside or a bedpan, as appropriate


name: Administer prescribed medication for diarrhea (e.g., loperamide, atropine)


name: Use rectal tube, anal plug device, or fecal collection device (e.g., FlexiSeal Fecal Management System, Zossi Bowel Management System) with persons with intact skin, as appropriate


name: Perform rectal examination, as appropriate


name: Formulate a bowel retraining plan with the family (e.g., mineral oil, high fiber diet, regular toileting routine)


name: Encourage child to sit on toilet 10 to 15 minutes after meals for intervals of 10 minutes


name: Place a footstool below the feet to relax the abdomen


name: Provide positive reinforcement (e.g., stickers, praise, special activities) to encourage the child to participate in the bowel regime


name: Evaluate for fecal incontinence, as necessary


name: Note preexisting bowel problems, bowel routine, and use of laxatives


name: Teach patient about specific foods that are assistive in promoting bowel regularity


name: Individualize the bowel program with patient and appropriate others


name: Initiate an uninterrupted, consistent scheduled time for defecation


name: Use a bisacodyl suppository based in polyethylene glycol if tolerable


name: Instruct patient about digital rectal dilatation, as appropriate


name: Assess possible risk factors for the development of breast cancer, including age, age at first pregnancy, age at menarche, age at menopause, family history, history of breast disease, parity status, and history of breastfeeding


name: Ascertain whether or not patient has noticed any pain, lump, thickening, or tenderness of the breast, discharge, distortion, retraction, or scaling of the nipple


name: Assist patient to positions of comfort as examination proceeds, always allowing privacy and sensitivity, as needed


name: Explain specific steps of examination as you proceed


name: Conduct examination when patient is in upright then supine position


name: Instruct patient to utilize four different positions for visual inspection-arms at side, hands at waist and push inward toward hips, hands behind the head, and arms across waist with chest falling forward


name: Using a systematic approach, palpate breast tissue with the palmar surface of the first three fingers of the examiner's dominant hand


name: Instruct the patient about the importance of regular breast self-examination


name: Instruct patient on techniques to use to calm an infant (e.g., speak to infant, hand on belly, restraining arms, picking up, and holding and rocking)


name: Provide time and space to be alone, as appropriate


name: Select puncture site (e.g., outer lower aspect of heel, sides of distal phalanges of the fingers or toes, alternative sites such as the forearm)


name: Follow manufacturer's guidelines regarding timing on tests and preservation of blood sample (e.g., sealing blood tubes), as necessary


name: Label specimen according to agency protocol, as necessary


name: Monitor patient physically and psychologically per agency policy


name: Ensure activity level that does not compromise cardiac output or provoke cardiac events


name: Encourage gradual increase in activity when condition stabilized (i.e., encourage slower paced activities or shorter periods of activity with frequent rest periods after exercise)


name: Evaluate any episodes of chest pain (e.g., intensity, location, radiation, duration, and precipitating and alleviating factors)


name: Monitor ECG for ST changes, as appropriate


name: Perform a comprehensive appraisal of peripheral circulation (i.e., check peripheral pulses, edema, capillary refill, color, and temperature of extremity) per agency policy


name: Instruct the patient and family on treatment modalities, activity restriction and progression


name: Screen patients for anxiety and depression, encouraging treatment with suitable antidepressants, as indicated


name: Encourage noncompetitive activities for patients at risk for impaired cardiac function


name: Instruct patient and family on the aims of care and how progress will be measured


name: Ensure that all staff are aware of these goals and are working together to provide consistent care


name: Refer to heart failure program or cardiac rehabilitation program for education, evaluation, and guided support to increase activity and rebuild life, as appropriate


name: Offer spiritual support to the patient and family (e.g., contact a member of the clergy), as appropriate


name: Provide immediate and continuous means to summon nurse and let the patient and family know calls will be answered immediately


name: Perform a comprehensive appraisal of cardiac status including peripheral circulation


name: Monitor intake and output, urine output, and daily weight, as appropriate


name: Select best EKG lead for continuous monitoring, as appropriate


name: Draw serum, CK, LDH, and AST levels, as appropriate


name: Monitor renal function (e.g., BUN and Cr levels), as appropriate


name: Monitor liver function tests, if appropriate


name: Monitor laboratory values for electrolytes that may increase the risk of dysrhythmias (e.g., serum potassium and magnesium), as appropriate


name: Monitor trends in blood pressure and hemodynamic parameters, if available (e.g., central venous pressure and pulmonary capillary or artery wedge pressure)


name: Provide appropriate cardiac diet (i.e., limit intake of caffeine, sodium, cholesterol, and food high in fat)


name: Substitute artificial salt, if appropriate


name: Prevent peripheral thrombus formation (i.e., turn every 2 hours and administer low-dose anticoagulants)


name: Instruct the patient on self-care of chest pain (i.e., take sublingual nitroglycerine every 5 minutes three times; if chest pain is unrelieved, seek emergency medical care)


name: Instruct the patient and family on any special considerations with activities of daily living (e.g., isolate activities and allow rest periods), if appropriate


name: Screen patient for anxiety and depression, as appropriate


name: Screen patient for risk behaviors associated with adverse cardiac events (e.g., smoking, obesity, sedentary lifestyle, high blood pressure, history of previous cardiac events, family history of cardiac events)


name: Identify patient's readiness to learn lifestyle modification (e.g., diet, smoking, alcohol intake, exercise and cholesterol levels)


name: Instruct patient and family on signs and symptoms of early cardiac disease and worsening cardiac disease, as appropriate


name: Instruct patient and family on cardiac risk factor modification, as appropriate


name: Prioritize areas for risk reduction in collaboration with patient and family


name: Instruct patient and family to monitor blood pressure and heart rate routinely and with exercise, as appropriate


name: Encourage exercise, as indicated by patient cardiac risk factor


name: Instruct the patient on regular and progressive exercise, as appropriate


name: Encourage 30 minutes of exercise daily, as appropriate


name: Instruct patient on need to achieve exercise goals in incremental periods of 10 minutes multiple times daily, if intolerant to sustained 30 minute activities


name: Instruct patient and family on strategies for restricting or eliminating smoking


name: Instruct patient and family on strategies for a heart healthy diet (e.g., low sodium, low fat, low cholesterol, high fiber, adequate fluid, appropriate caloric intake)


name: Encourage patient to keep caloric intake at a level that achieves desired weight


name: Instruct patient and family on therapies to reduce cardiac risk (e.g., medication therapies, blood pressure monitoring, fluid restrictions, alcohol restrictions, cardiac rehabilitation)


name: Provide both verbal and written information to patient, family, and caregivers for all pertinent cares, as indicated


name: Focus care and treatment goals to enable the patient to maintain weight control, to remain a nonsmoker, and to remain as active as possible


name: Refer to heart failure program or cardiac rehabilitation program for lifestyle changes, as appropriate


name: Alleviate patient anxieties by providing accurate information and correcting any misconceptions


name: Monitor patient's progress at regular intervals


name: Revise interventions and goals to meet patient's needs, as necessary


name: Coordinate care with other pertinent health care providers (e.g., other nurses, physicians, social workers, third-party payers, physical therapists)


name: Modify care to increase cost effectiveness, as needed


name: Document cost effectiveness of case management


name: Monitor for signs of infection (foul-smelling cast, erythema, fever)


name: Monitor for signs of cast impairment of circulation or neurological function (e.g., pain, pallor, pulselessness, paresthesias, paralysis, and pressure) on affected extremity


name: Monitor circulation and neurological function of tissues above and below cast


name: Address compromised circulation and pain symptoms immediately (e.g., reposition cast, perform range of motion [ROM] to extremity, immediate cast pressure-relieving action)


name: Offer alternatives to scratching (e.g., cold air from a hair dryer)


name: Avoid getting a plaster cast wet (e.g., use appropriate protection for bathing or toileting, protective socks or gloves)


name: Position cast on pillows to lessen strain on other body parts with cast heel off pillow


name: Apply ice for first 24 to 36 hours to reduce swelling or inflammation


name: Elevate casted extremity at or higher than heart level to reduce swelling or inflammation


name: Pad rough cast edges and traction connections


name: Document cast care instructions given to patient and family


name: Document observations of patient ability to perform cast care


name: Address compromised circulation and pain symptoms immediately, to avoid permanent damage in neurovascular status (e.g., reposition cast, report unresolved symptoms as needing immediate cast pressure relieving action)


name: Handle the casted extremity with palms only until the cast is dry to avoid causing finger indentations that can lead to pressure sores


name: Explain the need for limited activity as cast dries


name: Apply ice for first 24 to 35 hours to reduce swelling or inflammation, as indicated


name: Elevate casted extremity at or higher than heart level to reduce swelling or inflammation, as indicated


name: Determine the type of Central Venous Access Device (CVAD) in place


name: Determine manufacturer and agency recommendations, guidelines, protocols, policies, and procedures related to the particular device


name: Determine patient's and/or family's understanding of the purpose, care, and maintenance of the CVAD


name: Provide information to patient and family related to the device (e.g., indications, functions, type of device to be used, care of device, potential complications) to reduce patient uncertainty, fear, and anxiety


name: Explain the entire procedure to patient when inserting, providing care for, accessing for medication or fluid therapy, or removing a device


name: Avoid use of the line until confirmation of tip placement postimplantation with baseline chest x-ray


name: Assure subclavian and jugular vein tips located within the lower third of the superior vena cava


name: Report catheter tips positioned within the heart as they have an increased risk of mortality


name: Report catheter tips positioned perpendicular to the vein wall as there is an increased risk of vessel erosion, hydrothorax, hydromediastinum, tamponade, and extravasation


name: Employ strict aseptic technique whenever device is handled, accessed or used to administer medications, to reduce potential for catheter-related bloodstream infections


name: Adapt care to the type of device (i.e., use clamp at all times with open-ended or midline CVADs; use Huber needles for port access; use saline flushes with nonreturn valves; use clear transparent dressing to anchor nontunneled, midline, and PICC CVADs)


name: Check patency of the CVAD immediately before administering prescribed medications/infusions


name: Aspirate blood from the device to check patency before administering prescribed therapy, as indicated per device type


name: Employ further actions to ensure patency if difficulty encountered with aspiration or no blood return, per manufacturer and agency protocol for occluded devices


name: Administer saline flush for valved catheter maintenance as valve prevents blood reflux into the lumen of the catheter, thus preventing thrombotic occlusion


name: Flush nonvalved (or open-ended) CVADs with heparinized saline weekly with the strength of heparin per agency policy


name: Flush implanted ports with heparinized saline monthly with the strength of heparin per agency policy


name: Flush PICCs weekly with heparinized saline if not in use, with the strength of heparin per agency policy


name: Employ needle-free devices to promote a closed system


name: Employ 10 cc syringes for access of CVADs as smaller gauge silastic catheters appear to create greater pressure of pounds/square inch which may result in the rupture of the catheter and clots forced into bloodstream


name: Assure that intravenous tubing line is securely taped into position


name: Assure tubing is lying on the bed or arm of the treatment chair; do not allow intravenous tubing to dangle or pull


name: Use self-adhesive anchoring devices, when appropriate or per agency policy


name: Change clear fluid administration sets every 72 hours, blood sets every 12 hours, and parenteral nutrition administration sets every 24 hours, or per agency policy


name: Use new IV solutions and administration sets for new CVADs


name: Discard existing infusion sets, assuring that infusion sets from old devices to new devices are not exchanged


name: Do not allow the CVAD to be inserted near to a stoma or to areas such as diapers in children in which contact with fecal material may occur


name: Apply gauze dressing for the first 24 hours after operative insertion


name: Apply a clear dressing under strict aseptic technique weekly thereafter or sooner if soiled, perforated, or the dressing is lifting off


name: Use transparent semipermeable dressings with nontunneled devices and change every 7 days or sooner if wet or dirty, or per agency policy


name: Use 2% chlorhexidine in 70% isopropyl alcohol solution for cleansing the exit wound and catheter at all dressing changes and to decontaminate the skin before CVAD insertion, unless patient has a known allergy to chlorhexidine


name: Decontaminate CVADs with 2% chlorhexidine gluconate in 70% isopropyl and allow to dry before accessing, unless contraindicated by the manufacturer


name: Obtain chest x-ray immediately in the event of suspected line infiltration, compromise, or migration


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


name: Monitor for complications of CVADs (e.g., pneumothorax, cardiac tamponade, arterial puncture, hemorrhage, hemothorax, hydrothorax, air embolus, brachial nerve plexus injury, thoracic duct injury, infection, misplacement)


name: Inspect entry site daily for redness, pain, tenderness, warmth, or swelling as devices are associated with increased risk of infection


name: Remove device if any signs of inflammation, leakage, or discharge from the entry site


name: Ensure any infusions attached to the CVAD have been switched off before removing a device


name: Position patient supine, head down for insertion and removal of nontunneled CVADs, if possible


name: Place gauze over the entry site and apply light to moderate pressure to remove CVAD to avoid catheter fracture, tearing, and/or embolization


name: Place CVAD tip in sterile container and send for culture if infection is suspected


name: Apply firm pressure to the puncture site after removing the CVAD for at least 2 minutes until hemostasis is achieved


name: Apply an airtight transparent dressing immediately after CVAD removal, ensuring a good seal is achieved, and keep in place for 72 hours


name: Monitor x-rays for pinch-off sign in catheters that are occluded or before removal as pinch-off catheters are more likely to tear or fracture


name: Use an antimicrobial-impregnated catheter for patients considered to be at-risk for catheter related sepsis


name: Consider length of time device is needed before recommending device (e.g., less than 7 days-use peripheral IV; 1 to 4 weeks-use midline catheter or PICC line; 1 month to 1 year-use PICC, tunneled CVAD, implantable port; longer than 1 year-use tunneled CVAD, implantable port)


name: Document pertinent data in patient permanent record for initial insertion of central venous access device (e.g., manufacturer, model number, serial number, implant date)


name: Instruct patient of the signs and symptoms of dysfunctional central venous access device (e.g., tachycardia, hypotension, dyspnea, agitation, independent filling of access needle with fluid or blood, shoulder or back pain, cardiac arrest)


name: Instruct patient to carry CVAD manufacturer identification card at all times


name: Instruct patient to wear a medical alert bracelet or necklace that identifies patient as a central venous access device patient


name: Monitor neurologic status closely and compare to baseline


name: Monitor patient's ICP and neurologic response to care activities


name: Position with head of bed up 30 degrees or greater


name: Encourage family/significant other(s) to talk to patient


name: Monitor laboratory values: serum and urine osmolality, sodium, potassium


name: Perform passive range-of-motion exercises


name: Titrate barbiturate to achieve suppression or burst suppression of EEG as ordered


name: Consult with physician to determine hemodynamic parameters


name: Administer and titrate vasoactive drugs, as prescribed, to maintain hemodynamic parameters


name: Monitor for anticoagulant therapy side effects (e.g., test stool and NG drainage for blood)


name: Administer rheologic agents (e.g., low-dose mannitol or low molecular weight dextrans), as prescribed


name: Draw blood to monitor hematocrit level, electrolytes, and blood glucose


name: Maintain hematocrit level for hypervolemic hemodilution therapy per protocol


name: Avoid neck flexion or extreme hip or knee flexion


name: Administer calcium channel blockers and vasopressors, as prescribed


name: Administer anticoagulant, antiplatelet, and thrombolytic medication, as prescribed


name: Monitor laboratory values for changes in oxygenation or acid-base balance, as appropriate


name: Monitor respiratory status (e.g., rate, rhythm, and depth of respirations; partial oxygen pressure, PCO2, pH, and bicarbonate levels)


name: Monitor for signs of fluid overload (e.g., rhonchi, jugular venous distention (JVD), edema, and increase in pulmonary secretions)


name: Discuss feelings, questions, and concerns patient has about surgery


name: Obtain necessary blood work and document results


name: Encourage intimate partner or support person to be present during delivery


name: Give information about events taking place and sensations patient may be experiencing during surgery


name: Transfer patient to recovery room or labor room


name: Monitor physiological aspects of recovery (e.g., pain, uterine changes, airway patency, and lochia)


name: Inspect condition of surgical incision and dressing


name: Assist in performing leg exercises, turning, coughing, and deep breathing


name: Provide adequate breastfeeding education and support, if appropriate (i.e., demonstrate infant positioning adaptations according to mobility limitations)


name: Facilitate family bonding and attachment by minimizing maternal-infant separation (e.g., present infant en face to mother, provide unobstructed view of infant, facilitate skin-to-skin contact, and transfer mother and infant together)


name: Provide divisional activities before the use of restraints (e.g., television, visitors)


name: Explain the procedure, purpose, and duration of the intervention to patient and significant other in understandable terms


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


name: Monitor pretreatment screening workups for patients at risk for earlier onset, longer duration, and more distressing side effects


name: Promote activities to modify the identified risk factors


name: Monitor for side effects and toxic effects of treatment


name: Teach patient and family about the effects of therapy on bone marrow functioning


name: Instruct patient and family on ways to prevent infection, such as avoiding crowds, using good hygiene, and handwashing techniques


name: Administer medications to control side effects (e.g., antiemetics for nausea and vomiting), as needed


name: Administer chemotherapeutic drugs in the late evening so the patient may sleep at the time emetic effects are greatest


name: Encourage good oral hygiene with use of dental cleansing devices, such as unwaxed, nonshredding floss, sonic toothbrushes or water Pik, as appropriate


name: Initiate oral health restoration activities, such as use of artificial saliva, saliva stimulants, nonalcohol-based mouth sprays, sugarless mints, and fluoride treatments, as appropriate


name: Teach patient on self-assessment of oral cavity, including signs and symptoms to report for further evaluation (e.g., burning, pain, and tenderness)


name: Teach patient need for frequent dental follow-up care as dental caries form rapidly


name: Teach patient to avoid temperature extremes and chemical treatments of the hair when receiving treatment


name: Inform patient that hair loss is expected, as determined by type of therapy


name: Reassure patient that hair will grow back after treatment is terminated, as appropriate


name: Teach patient and family to monitor for organ toxicity, as determined by type of therapy


name: Discuss potential aspects of sexual dysfunction, as appropriate


name: Teach implications of therapy on sexual function, including the time frame for contraceptive use, as appropriate


name: Monitor fatigue level by soliciting the patient's description of fatigue


name: Teach patient and family techniques of energy management, as appropriate


name: Facilitate expression of fears about prognosis or success of treatments


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


name: Determine presence of contraindications for use of chest physiotherapy (e.g., acute exacerbation of COPD, pneumonia without evidence of excess sputum production, osteoporosis, lung cancer, and cerebral edema)


name: Perform chest physiotherapy at least 2 hours after eating


name: Explain purpose and procedures used during chest physiotherapy to patient


name: Position any necessary equipment nearby (e.g., suctioning equipment, sputum container, and tissues)


name: Monitor respiratory and cardiac status (e.g., rate, rhythm, breath sounds, and depth of breath)


name: Monitor amount and character of secretions


name: Determine lung segment(s) containing excessive secretions


name: Position patient with the lung segment to be drained in uppermost position, making modifications for patients unable to tolerate prescribed position (i.e., avoid placing patient with COPD, acute head injury, and cardiac problems in Trendelenburg position as it can increase shortness of breath, intracranial pressure, and stress, respectively)


name: Strike chest rhythmically and in rapid succession using cupped hands over area(s) to be drained for 3 to 5 minutes, avoiding percussion over spine, kidneys, female breasts, incisions, and broken ribs


name: Apply pneumatic, acoustical, or electrical chest percussors


name: Rapidly and vigorously vibrate hands, keeping shoulders and arms straight and wrists stiff, on area(s) to be drained while patient exhales or coughs 3 to 4 times


name: Instruct patient to expectorate loosened secretions via deep breathing


name: Encourage coughing during and after procedure


name: Monitor patient tolerance during and after procedure (e.g., pulse oximetry, vital signs, and reported comfort level)


name: Teach the mother and partner about the physiology of labor and delivery


name: Explore childbirth plan for labor and delivery (e.g., the birthing environment, who will assist mother, who will be in attendance, what technology will be used, who will cut the cord, feeding preferences, and discharge plans)


name: Educate mother and partner about signs of labor


name: Inform mother about when to come to the hospital in preparation for delivery


name: Discuss pain control options with mother


name: Inform mother about delivery options if complications arise


name: Explain routine monitoring that may occur during labor and delivery


name: Teach mother and partner breathing and relaxation techniques to be used during labor and delivery


name: Review American Academy of Pediatrics recommendations for breastfeeding


name: Encourage mother to put the infant to breast after delivery


name: Provide opportunity for mother to be in close proximity to infant during postpartum hospitalization to facilitate bonding and breastfeeding


name: Promote parent's self-efficacy in taking on parental role


name: Discuss arrangements for sibling care during hospitalization


name: Assist parent(s) in planning strategies to prepare siblings for newborn


name: Assist parent to select a physician or clinic to receive child health supervision for newborn


name: Encourage mother to obtain an approved infant car safety seat to transport newborn home from hospital


name: Monitor degree of discomfort or pain with exercise, at night, or when resting


name: Instruct the patient on factors that interfere with circulation (e.g., smoking, restrictive clothing, exposure to cold temperatures, and crossing of legs and feet)


name: Observe for hemolysis, as indicated by blood in the urine, hemolyzed blood specimens, increase in daily serum hemoglobin, frank bleeding, and hyperkalemia


name: Collect blood, urine, sputum, and wound cultures for temperatures greater than 38 degrees C, as appropriate


name: Apply dressing for wound size and type, as appropriate


name: Elevate affected limb 20 degrees or greater higher than the level of the heart, as appropriate


name: Encourage passive or active range-of-motion exercises especially of the lower extremities exercises, during bed rest


name: Perform a comprehensive appraisal of peripheral circulation (i.e., check peripheral pulses, edema, capillary refill, color, temperature of extremity, and ankle brachial index, if indicated)


name: Target at risk patients (e.g., diabetics, smokers, elderly, hypertensive patients and those with elevated cholesterols levels) for comprehensive peripheral assessments and modification of risk factors


name: Encourage smoking cessation and regular exercise in patients with claudication


name: Encourage walking to the point of claudication and a little bit more each time to assist in the development of collateral circulation in the lower extremities


name: Instruct patient and family on medication therapies for blood pressure control, anticoagulation and reduction of cholesterol levels


name: Instruct patient on avoidance of beta blockers for blood pressure control, as they cause constriction of peripheral vessels and worsens claudication


name: Instruct patient on diet measures to improve circulation (e.g., diet low in saturated fat and good intake of omega 3 fish oils)


name: Instruct diabetic patients on the need for proper management of blood sugar


name: Instruct patient on proper skin care (e.g., moisturizing dry skin on legs, prompt attention to wounds and potential ulcers)


name: Provide patient and family with smoking cessation information, if applicable


name: Instruct patient on signs and symptoms indicating a need for emergent care (e.g., pain that does not go away upon rest, wound complications, loss of feeling)


name: Encourage patient participation in vascular rehabilitation programs


name: Verify that the surgical consent is properly signed


name: Administer preprocedure pain control approximately 1 hour before the procedure (e.g., acetaminophen)


name: Use a pacifier dipped in sucrose during the procedure and until the next feeding with permission from parent/guardian


name: Administer a topical local analgesia agent (e.g., eutectic mixture of local anesthetics [EMLA]), as ordered


name: Monitor for bleeding every 30 minutes for a least 2 hours post procedure


name: Provide post procedure pain control every 4 to 6 hours for 24 hours (e.g., acetaminophen)


name: Evaluate patient's responsiveness to determine appropriate action


name: Call for help if no breathing or no normal breathing and no response


name: Call a code according to agency standard when obtaining the automated external defibrillator (AED) or assuring that someone is obtaining the automated external defibrillator


name: Perform cardiopulmonary resuscitation that focuses on chest compressions in adults and compressions with breathing efforts for children, as appropriate


name: Deliver cardioversion or defibrillation as soon as possible


name: Minimize the interval between stopping chest compressions and delivering a shock, if indicated


name: Attach the cardiac monitor and determine the rhythm, assuring defibrillations will not be interrupted


name: Assure that someone is oxygenating the patient and assisting with intubation, as indicated


name: Ensure that someone is: (1) setting up medications; (2) delivering medications; (3) interpreting EKG and delivering cardioversion/defibrillation, as needed; and (4) documenting care


name: Remind personnel of current Advanced Cardiac Life Support protocols, as appropriate


name: Ensure that special resuscitation protocols (e.g., asthma, anaphylaxis, pregnancy, morbid obesity, pulmonary embolism, electrolyte imbalance, ingestion of toxic substances, trauma, accidental hypothermia, avalanche, drowning, electric shock or lightning strikes, percutaneous coronary interventions, cardiac tamponade, cardiac surgery) are instituted, when appropriate


name: Offer family members and significant other(s) opportunities to be present during resuscitation when in the best interests of the patient


name: Support family members who are present during resuscitation (i.e., ensure safe environment, provide explanations and commentary, allow appropriate communication with patient, continually assess needs, provide opportunities to reflect on resuscitation efforts after event)


name: Ensure that someone is coordinating care of other patients on the nursing unit


name: Terminate code by patient condition, as indicated


name: Assure organized post cardiac arrest care (e.g., cardiopulmonary and neurological support, therapeutic hypothermia, tapering of inspired oxygen concentration to avoid harmful hyperoxia, avoidance of hyperventilation)


name: Implement appropriate procedures for possible tissue and organ donation that are timely, effective, and supportive of the family members' and patient's desires


name: Review actions after code to identify areas of strength and those which need to be improved


name: Provide opportunities for team members to be involved in team debriefings or reflect on resuscitation efforts after event


name: Perform emergency cart check per agency protocol


name: Help patient understand the inability to attain desirable behaviors frequently results from irrational self-statements


name: Demonstrate caregiver sensitivity by responding promptly and appropriately to cues


name: Stimulate development by engaging in activities to enhance achievement and learning by being attuned to the patent's needs


name: Offer cognitive stimulation at work, such as training opportunities, cognitive richness to work content, opportunities for growth, and multitasking


name: Encourage cognitive stimulation outside of work, such as reading or active participation in cultural and artistic activities


name: Encourage the use of a multistimulation program (e.g., singing and listening to music, creative activities, exercise, conversation, social interactions, or problem solving) to promote and protect cognitive capacity


name: Ask for opinions and views rather than factual answers


name: Seek input and respect the contributions of others


name: Build teams of approximately 5 to 9 members


name: Design group work spaces that easily support 5 to 9 people with everyone having equal access to digital and analog information displays and being able to see each other eye to eye


name: Ensure that work spaces have easy projection and teleconferencing capabilities


name: Encourage group members to switch where they sit on a regular basis to build stronger networks


name: Provide individual workstations for private focused work with visual eyesight to others and a place for a visitor to sit (e.g., bench)


name: Provide a social space in which individuals can talk casually


name: Enable workers to have choice and control of where they work by providing a range of settings


name: Support programs of interdisciplinary education including interprofessional orientation days and social events, joint faculty appointments, and interdisciplinary coursework and clinic activities


name: Provide web-based tools (e.g., calendar, agendas, committee assignments, appropriate forms and documents) to help workers coordinate and communicate


name: Include the patient as a teammate, as appropriate


name: Use communication tools (e.g., daily huddles; repeat back; Situation, Background, Assessment, Recommendation [SBAR]; opportunity for questions), as needed


name: Continue dialogue of legal and ethical matters as they apply to the situation


name: Address misconceptions and stereotypes among team members


name: Use negotiation as a strategy for conflict resolution


name: Value the enhanced benefits of the collaborative efforts of the team


name: Recognize resourcefulness in coping with present situation


name: Assist individuals to realize their personal strengths, potential, and capacity


name: Demonstrate your valuing of individual or family


name: Build collaborative relationship with individual or family


name: Recognize individual's strength in modifying behavior to address the situation


name: Provide positive feedback to encourage and sustain new behavior


name: Acknowledge the capacity to live with chronic, long-term health issue or illness, as appropriate


name: Congratulate one in achieving improved outcome


name: Reinforce a behavior or outcome to increase the probability that it will be sustained


name: Facilitate motivation to continue with improved behavioral changes to attain the main goal


name: Apply strategies to reinforce learning and promote confidence and worth in learner


name: Write up statements of praise and send to individual or other persons (e.g., supervisor, award program), as appropriate


name: Promote legislation that ensures appropriate monitoring and treatment for communicable diseases


name: Perform or arrange for routine hearing assessments and screenings


name: Monitor for excessive accumulation of cerumen


name: Instruct patient not to use foreign objects smaller than patient's fingertip (e.g., cotton-tipped applicators, bobby pins, toothpicks, and other sharp objects) for cerumen removal


name: Remove excessive cerumen with twisted end of washcloth while pulling down the auricle


name: Consider ear irrigation for the removal of excessive cerumen if watchful waiting, manual removal, and ceruminolytic agents are ineffective


name: Note and document patient's preferred method of communication (e.g., verbal, written, lip reading, or American Sign Language) in plan of care


name: Gain patient's attention before speaking (e.g., obtain attention through touch)


name: Avoid noisy backgrounds when communicating


name: Avoid communicating more than 2 to 3 feet from patient


name: Listen attentively, allowing patient adequate time to process communication and respond


name: Facilitate lip reading by facing patient directly in good lighting


name: Ask patient to suggest strategies for improved communication (e.g., speaking toward better ear and moving to well-lit area)


name: Face the patient directly, establishing eye contact, and avoid turning away midsentence


name: Simplify language (i.e., do not use slang and use short, simple sentences), as appropriate


name: Avoid "baby talk" and exaggerated expressions


name: Verify what was said or written using patient's response before continuing


name: Facilitate use of hearing aids and assistive listening devices (e.g., phone amplifier, hardwire device, personal frequency modulation, and computers)


name: Remove hearing aid battery when hearing aid is not in use for several days


name: Clean detachable earmold using a mild soapy solution, removing moisture or debris with soft cloth, and avoiding isopropyl alcohol, solvents, and oil


name: Clean nondetachable earmold using a damp cloth, removing moisture or debris with soft cloth, and avoiding isopropyl alcohol, solvents, and oil


name: Check hearing aid batteries routinely, replacing, when necessary


name: Refer to manufacturer's guidelines on proper use of, care for, and maintenance of hearing aids and assistive listening devices


name: Instruct patient, nursing personnel, and family on use of, care for, and maintenance of hearing aids and assistive listening devices


name: Assist patient or family in acquiring hearing aid and assistive listening device


name: Refer to primary care provider or specialist for evaluation, treatment, and hearing rehabilitation


name: Monitor speech speed, pressure, pace, quantity, volume, and diction


name: Monitor cognitive, anatomical, and physiological processes associated with speech capabilities (e.g., memory, hearing, and language)


name: Instruct patient or family on cognitive, anatomical, and physiological processes involved in speech capabilities


name: Monitor patient for frustration, anger, depression, or other responses to impaired speech capabilities


name: Recognize emotional and physical behaviors as forms of communication


name: Provide alternative methods of speech communication (e.g., writing tablet, flash cards, eye blinking, communication board with pictures and letters, hand signals or other gestures, and computer)


name: Provide alternative methods of writing or reading, as appropriate


name: Adjust communication style to meet needs of client (i.e., stand in front of patient when speaking; listen attentively; present one idea or thought at a time; speak slowly but avoid shouting; use written communication; or solicit family's assistance in understanding patient's speech)


name: Maintain structured environment and routines (i.e., ensure consistent daily schedules; provide frequent reminders; and provide calendars and other environmental cues)


name: Modify environment to minimize excess noise and decrease emotional distress (i.e., limit visitors and excessive equipment noise)


name: Ensure call light is within reach and central call light system is marked to indicate patient cannot speak


name: Repeat what patient said to ensure accuracy


name: Phrase questions so patient can answer using a simple "yes" or "no," being aware that patient with expressive aphasia may provide automatic responses that are incorrect


name: Collaborate with family and speech language pathologist or therapist to develop a plan for effective communication


name: Provide one-way valve for patient with tracheostomy, replacing need for finger occlusion over tube


name: Instruct patient or family on use of speech aids after laryngectomy (e.g., esophageal speech, electrolarynges, tracheoesophageal fistulas)


name: Provide positive reinforcement, as appropriate


name: Refer patient to community support systems (e.g., The International Association of Laryngectomees and American Cancer Society)


name: Provide referral to speech language pathologist or therapist


name: Coordinate rehabilitation team activities


name: Perform or arrange for routine vision assessments and screenings


name: Monitor functional implications of diminished vision (e.g., risk of injury, depression, anxiety, and ability to perform activities of daily living and valued activities)


name: Identify yourself when entering the patient's space


name: Assist patient in enhancing stimulation of other senses (e.g., savoring aroma, taste, and texture of food)


name: Ensure that patient's eyeglasses or contact lens have current prescription, are cleaned, and stored properly when not in use


name: Minimize glare (i.e., offer sunglasses or draw window covering)


name: Avoid rearranging items in patient's environment without notifying patient


name: Provide daily living aids (e.g., clock and telephone with large numbers)


name: Apply labels to distinguish frequently used items (i.e., color-code dials on appliances, mark medication bottles using high-contrasting colors or rubber bands, and safety-pin labels on similar-colored clothing)


name: Use bright, contrasting colors in environment


name: Provide magnifying devices (e.g., handheld, stand, and video magnifier)


name: Provide sight substitutes (e.g., Braille materials, audio books, talking watches, and tactile markers)


name: Assist parents, family, educators, and caretakers involved with a child with diminished vision in meeting informational needs (e.g., how to teach child, anticipatory guidance, and developmental considerations)


name: Instruct parents, family, educators, and caretakers to recognize and respond to nontraditional expressive forms of communication (e.g., movements and facial expressions)


name: Assist parents, family, educators, and caretakers in developing reliable, functional communication systems (e.g., microswitches or speech-output devices)


name: Assist patient or family in identifying available resources for vision rehabilitation


name: Provide referral for the patient in need of surgical or other medical treatment


name: Provide referral for supportive services (e.g., social, occupational, and psychological)


name: Identify all community medical and social agency resources available to respond to a disaster


name: Encourage community members to have a personal preparedness plan (e.g., emergency telephone numbers, battery-operated radio, working flashlight, first aid kit, medical information, physician information, persons to be notified in an emergency)


name: Assist to prepare shelters and emergency aid stations


name: Define the objectives of the advocacy and the specific community to be assisted


name: Assist community members to navigate the health care system (e.g., to access low-cost or free care, to solve billing issues, to understand patient rights


name: Provide access to translation services, when needed


name: Work with lay community health workers and community leaders to identify needs and provide services


name: Assist community leaders to conduct a needs assessment whereby needs can be prioritized and activities to be identified


name: Understand the cultural health beliefs and practices of the identified community members


name: Help to mobilize resources in a community that will assist in achieving goals


name: Seek consultation, training and support for community advocacy efforts to build coalitions


name: Participate in media campaigns to increase public awareness


name: Attend school board meetings to share the negative effect of not having enough school nurses to monitor students' health statuses


name: Attend and speak at public forums about the positive effect of proposed health care services, projects, and legislation


name: Provide appropriate health care information and education to the public and legislators


name: Assist in the introduction and passage of health care legislation by finding sponsors and persuading potential cosponsors to sign on with their support


name: Use real-life examples from clinical practice to illustrate the needs of patients and the outcomes of public policy on patient care


name: Identify obstacles that prevent success and implement strategies to reduce barriers


name: Identify and develop potential community leaders


name: Provide an environment, creating situations in which individuals and groups feel safe expressing their views


name: Assure that community members maintain control of decision making


name: Identify own attitude toward the patient and situation; repeat as needed


name: Determine the ethical boundaries of the relationship, as needed


name: Deal with personal feelings evoked by the patient that may interfere with the effectiveness of therapeutic interactions


name: Discuss confidentiality of information shared


name: Return at established time to demonstrate trustworthiness and interest in the patient


name: Adjust physical distance between nurse and patient, as appropriate


name: Develop special ways of communicating (e.g., images, other words), as needed


name: Assist patient to identify areas of need to be addressed during meetings


name: Establish time of next interaction before ending the meeting each time


name: Summarize conversation at end of the discussion


name: Identify patient's readiness to explore identified problems and develop strategies for change


name: Encourage patient to take the time needed to express him/herself


name: Assist the patient to identify feelings that impede ability to interact with others (e.g., anger, anxiety, hostility, or sadness)


name: Collect data and identify problem which is focus of consultation


name: Monitor eyes and surrounding area for open lesions and ecchymosis


name: Determine patient's understanding of required lens care


name: Determine patient's physical and emotional capability to learn and perform required lens care


name: Instruct patient to perform hand hygiene before touching lenses


name: Instruct patient on proper care of contact lenses depending on type (e.g., hard or soft)


name: Instruct patient to remove lenses at appropriate interval (e.g., remove daily wear lenses at night and do not wear disposable lenses more than once)


name: Instruct patient wearing extended-wear contacts of increased risks (e.g., corneal ulcers and infection-caused eruptions)


name: Instruct patient wearing hard contacts of increased risks (e.g., corneal edema and corneal abrasions)


name: Instruct patient on symptoms to report to health care professional (e.g., eye and conjunctiva redness, discomfort or pain, excessive tearing, and visual changes)


name: Instruct patient to use recommended solutions to clean, moisten, rinse, and disinfect lenses


name: Instruct patient to rub and rinse lenses with recommended solution before and after storage


name: Instruct patient on importance of monitoring for and discontinuing use of recalled contact lens care products


name: Instruct patient not to use saliva, tap water, or sterile saline found in health care agencies for rinsing or storing lenses


name: Instruct patient to avoid exposing eyes to tap water, swimming pool water, or spa water when wearing lenses


name: Instruct patient to store lenses in lens container with recommended solution


name: Instruct on care of lens container (e.g., clean daily, leave open to air, and replace regularly)


name: Instruct the patient who wears eye cosmetics to use caution in their selection and application (i.e., choose cosmetics without irritating properties and apply before lens insertion)


name: Instruct patient to avoid exposure to or use of damaging or irritating environmental contaminants (e.g., dust, smoke, soaps, lotions, creams, and sprays)


name: Instruct patient to carry appropriate identification on type and care for lenses


name: Provide lens care for the patient unable to do so for self (e.g., removal, cleaning, storing, and insertion)


name: Account for access to controlled substances at all times


name: Follow agency protocol for resolving discrepancies


name: Keep abreast of federal and state regulations regarding the use of controlled substances


name: Monitor for evidence of misadministration or diversion of controlled substances (e.g., provider arriving early, staying late, coming to work on day off; volunteering to give medication to other's patients; frequent bathroom breaks; patients reporting unrelieved pain despite adequate prescription of pain medication)


name: Review computer reports, when available, to identify outliers regarding individual practitioners use of controlled agents


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


name: Appraise the effect of the patient's life situation on roles and relationships


name: Determine the risk of the patient's inflicting self-harm


name: Use supplies and equipment efficiently and effectively


name: Determine whether supplies should be disposable or reusable


name: Determine whether supplies should be purchased or leased


name: Use standardized documentation (e.g., critical paths) to contain costs and maintain quality, as appropriate


name: Evaluate services and programs for cost effectiveness on an ongoing basis


name: Inform patient of the cost and alternatives of when and where to acquire health care services


name: Compress abdomen below the xiphoid with the flat hand while assisting the patient to flex forward as the patient coughs


name: Provide factual information, as necessary and appropriate


name: Reveal selected aspects of one's own experiences or personality to foster genuineness and trust, as appropriate


name: Encourage new skill development, as appropriate


name: Discourage decision-making when the patient is under severe stress, when possible


name: Initiate necessary precautions to safeguard the patient or others at risk from physical harm


name: Encourage patient to focus on one implication at a time


name: Link the patient and family with community resources, as needed


name: Place relevant variables (e.g., outcomes, interventions, laboratory and diagnostic tests, consultations, patient and family education) sequentially on a decision tree


name: Keep the decision tree as simple as possible, even when the clinical events are complex (i.e., provide important details but minimize wordiness and length)


name: Include key decision points in which provider judgment is critical


name: Calculate variances and report through appropriate channels


name: Identify, with the patient, cultural practices that may negatively effect health so the patient can make informed choices


name: Negotiate, when conflicts cannot be resolved, an acceptable compromise of treatment based on biomedical knowledge, knowledge of the patient's belief systems, and ethical standards