name: Inform patient to consider the potential or lack of potential reversibility of different methods of sterilization


name: Monitor temperature and other vital signs


name: Monitor intake and output, being aware of changes in insensible fluid loss


name: Administer medications or IV fluids (e.g., antipyretics, antibacterial agents, and antishivering agents)


name: Cover the patient with blanket or light clothing, depending on phase of fever (i.e., provide warm blanket for chill phase; provide light clothing or bed linens for fever and flush phases)


name: Facilitate rest, applying activity restrictions, if needed


name: Administer a tepid sponge bath with caution (i.e., administer for patients with very high temperature, do not administer during chill phase, and avoid chilling patient)


name: Monitor for fever-related complications and signs and symptoms of fever-causing condition (e.g., seizure, decreased level of consciousness, abnormal electrolyte status, acid-base imbalance, cardiac arrhythmia, and abnormal cellular changes)


name: Ensure other signs of infection are monitored in elderly persons, as they may display only a low-grade fever or no fever during infection


name: Ensure safety measures are in place should patient become restless or delirious


name: Determine patient's current use of health care system and the financial effect of this use


name: Assist patient to assure money is in secure place (i.e., bank), as needed


name: Search patient for incendiary materials (e.g., matches or lighters) on admission and each time that patient returns to care environment (i.e., from a pass or a recreational activity)


name: Provide close supervision if patient is allowed to smoke


name: Increase surveillance and security (e.g., area restriction or seclusion) if risk of fire-setting behavior increases


name: Note characteristics of the wound or burn including drainage, color, size, and odor


name: Institute appropriate care of wound or burn


name: Use rest, ice, compression, and elevation (RICE) for extremity bone, joint, and muscle injuries


name: Cleanse skin exposed to poison ivy, oak, or sumac (i.e., use water and soap or liberal amount of rubbing alcohol) and stinging nettle (i.e., use water and soap)


name: Flush tissue exposed to chemicals (except lye or white phosphorous) with water


name: Remove embedded stinger and venom sac from insect sting or tentacles from marine animal sting by scraping a hard object over site (e.g., fingernail, credit card, or comb)


name: Remove tick from the skin using tweezers or specialized tick-removal tool


name: Administer medication (e.g., prophylactic antibiotic, vaccination, antihistamine, antiinflammatory, and analgesic), as appropriate


name: Relieve itching (i.e., administer medication, apply calamine lotion or baking soda paste, and instruct patient to bathe in colloidal oatmeal)


name: Report animal bites to appropriate authority (e.g., police or animal control)


name: Provide instructions for necessary follow-up care


name: Use appropriate accounting methods to assure accurate and designated use of funds


name: Evaluate outcomes and cost effectiveness of the program


name: Inform patient how flatus is produced and methods for alleviation


name: Inform patient that passing gas around 13 to 21 times a day is normal


name: Advise to discontinue use of artificial sweeteners found in some sugar free goods, gums, and candies


name: Advise to cut back on fried and fatty foods


name: Discuss cutting back temporarily on high fiber foods and slowly adding these back to diet monitoring gas increase


name: Advise to take fiber supplements with a glass of water and to drink plenty of liquids throughout the day


name: Advise patient to keep a diary of food and drinks consumed and times of day that gas is passed


name: Insert lubricated rectal tube into the rectum; tape in place; insert distal end of tube into a receptacle, as appropriate


name: Discuss use of probiotic food (e.g., soy sauce, yogurt, pickled vegetables) and probiotics (e.g., PreScript-Assist, VSL#3) to lessen abnormal intestinal gas


name: Notify physician if gas is accompanied by prolonged abdominal pain, bloody stools, weight loss, chest pain, or persistent nausea or vomiting


name: Monitor for changes in pulmonary or cardiac status indicating fluid overload or dehydration


name: Monitor for signs and symptoms of worsening overhydration or dehydration (e.g., moist crackles in lung sounds, polyuria or oliguria, behavior changes, seizures, frothy or thick viscous saliva, edematous or sunken eyes, rapid shallow breathing)


name: Irrigate nasogastric tubes with normal saline, per agency policy and as indicated


name: Provide free water with tube feedings, per agency policy and as indicated


name: Minimize intake of foods and drinks with diuretic or laxative effects (e.g., tea, coffee, prunes, herbal supplements)


name: Maintain an appropriate intravenous infusion, blood transfusion, or enteral flow rate especially if not regulated by a pump


name: Ensure that intravenous solution containing electrolytes is administered at a constant flow rate, as appropriate


name: Administer prescribed electrolyte binding or excreting resins, as appropriate


name: Monitor for side effects (e.g., nausea, vomiting, diarrhea) of prescribed supplemental electrolytes


name: Watch patient's buccal membranes, sclera, and skin for indications of altered fluid and electrolyte balance (e.g., dryness, cyanosis, and jaundice)


name: Institute measures to rest the bowel (i.e., restrict food or fluid intake and decrease intake of milk products), if appropriate


name: Assist patients with impaired mental or physical conditions (e.g., dysphagia, cognitive impairment, mentally challenged, reduction in physical strength or coordination) to achieve adequate fluid balance


name: Assist patients with undesirable sequelae from prescribed therapeutic regimen (e.g., patient with fear of urinary frequency or incontinence from diuretic limits own fluid intake) to achieve adequate fluid balance


name: Instruct patient and family about rationale for fluid restrictions, hydration measures, or supplemental electrolyte administration, as indicated


name: Monitor patient's weight change before and after dialysis if appropriate


name: Consult physician if signs and symptoms of fluid volume excess persist or worsen


name: Determine possible risk factors for fluid imbalance (e.g., albumin loss state, burns, malnutrition, sepsis, nephrotic syndrome, hyperthermia, diuretic therapy, renal pathologies, cardiac failure, diaphoresis, liver dysfunction, strenuous exercise, heat exposure, infection, postoperative state, polyuria, vomiting, and diarrhea)


name: Determine whether patient is experiencing thirst or symptoms of fluid changes (e.g., dizziness, change of mentation, lightheadedness, apprehension, irritability, nausea, twitching)


name: Examine capillary refill by holding the patient's hand at the same level as their heart and pressing on the pad of their middle finger for 5 seconds, releasing pressure, and counting time until color returns (i.e., should be less than 2 seconds)


name: Examine skin turgor by grasping tissue over a bony area such as the hand or shin, pinching the skin gently, holding it for a second and releasing (i.e., skin will fall back quickly if patient is well hydrated)


name: Monitor BP, heart rate, and respiratory status


name: Keep an accurate record of intake and output (e.g., oral intake, enteral intake, IV intake, antibiotics, fluids given with medications, NG tubes, drains, vomit, rectal tubes, colostomy drainage, and urine)


name: Insure to measure all intake and output on all patients with intravenous therapy, subcutaneous infusions, enteral feedings, NG tubes, urinary catheters, vomiting, diarrhea, wound drains, chest drains, and medical conditions that affect fluid balance (e.g., heart failure, renal failure, malnutrition, burns, sepsis)


name: Record incontinence episodes in patients requiring accurate intake and output


name: Correct mechanical problems (e.g., kinked or blocked catheter) in patients experiencing sudden cessation of urine output


name: Assure that all IV and enteral intake devices are operating at the correct rates, especially if not regulated by a pump


name: Consult physician for urine output less than 0.5 mL/kg/hr or adult fluid intake less than 2000 in 24 hours, as appropriate


name: Maintain accurate fluid container reference charts to assure standardization of container measurements


name: Audit intake and output graphs periodically to ensure good practice patterns


name: Collaborate with physicians to ensure administration of both crystalloids (e.g., normal saline and lactated Ringer's) and colloids (e.g., Hesban, and Plasmanate), as appropriate


name: Obtain blood specimens for crossmatching, as appropriate


name: Monitor BUN, creatinine, total protein, and albumin levels


name: Monitor patient's gait and weight distribution on feet


name: Cut normal thickness toenails when soft, using a toenail clipper and using the curve of the toe as a guide


name: Establish rapport with the patient or significant other, as appropriate


name: Establish collaborative working relationship with all additional examiners


name: Complete all parts of the examination, including normals


name: Record omissions in examinations, including rationale for omission


name: Provide facts only (e.g., what was examined, what was normal [pertinent negatives], what was abnormal) as seen at the time of examination


name: Describe physical injuries by size, color, type of injury, location (add depth and trajectory if indicated)


name: Measure in inches and increments of inches, including the greatest perpendicular dimensions of irregular wounds


name: Describe wounds simply and with basic colors as much as possible (e.g., red, blue, purple, maroon)


name: Determine wound location in two dimensions (length and midline standpoint) with body divided into anterior midline and posterior midline, describing in terms of how far right or left of midline


name: Measure consistently from center of the lesion being described


name: Record all contusions immediately as marks will fade and be lost as evidence


name: Record directionality in abrasions using piling up of skin cells on the side opposite of the force


name: Differentiate lacerations from incised wounds and stab wounds


name: Note the order of wounds and why each is known to be first, second, etc., if possible


name: Avoid long lists of probable injurious instruments (implies uncertainty and incompetence with examination)


name: Describe gunshot wounds completely (e.g., sooting, stippling, abrasion ring, or absence of sooting, etc.)


name: Describe gunshot wounds as the face of a clock and identify in the report where 12:00 is on the body


name: Describe any surrounding bruising or discolorations to gunshot wounds, including any muzzle imprints


name: Use body diagrams and photographs to supplement written report


name: Adhere to rules about information that must be added to each body diagram (e.g., case number, victim name, examination date and time, time finished, names and identification numbers of those present during examination)


name: Draw in all identifying features (e.g., scars, tattoos, nail polish, body piercings, skin lesions)


name: Draw scars in their orientation on the body


name: Take injury photos similarly to crime scene photography (e.g., victim as part of crime scene, case number in every photograph) assuring case number does not cover or shadow injuries


name: Obtain initial photographs as overall entire body photographs before the injuries are cleaned


name: Obtain next set of photos as midrange and closer up with identifiers or landmarks (e.g., nipple in a chest wound)


name: Obtain final photos as close-up photos (injury fills nearly entire frame with small identifying number) before and after cleaning


name: Ensure that two photographs are obtained in pointer shots (one with and one without pointer) assuring nothing covered in photo with pointer


name: Ensure that photographs of injuries are taken perpendicular to the skin surface to prevent distortion


name: Ensure that photographs include a measuring scale for perspective


name: Ensure that color scales are added to photographs of colored injuries to avoid color distortion


name: Wash injured areas and blot dry before photographing to avoid wetness glare and ensure jury use


name: Describe clothing (e.g., brand, size), jewelry, and personal property


name: Record where items found (e.g., yellow metal watch on the left wrist)


name: Record pertinent information related to items (e.g., gunshot wound with soot on the shirt)


name: Diagram all medical interventions (e.g., EKG pads, endotracheal tubes, IVs, Foleys)


name: Collect and package all specimens in clearly labeled paper bags


name: Record date, time, type, and collection method for all specimens


name: Use correct chain-of-evidence protocol for all specimens


name: Record additional information or events that unfold later as an addendum report


name: Describe all responses to additional information or events that unfold later (e.g., sexual assault examination completed 24 hours later after evidence presented indicating a sexual assault occurred)


name: Plan daily follow-up visits with victims to document developing injury patterns, if possible


name: Prepare reports as customary for state legal evidence requirements (e.g., complete date; military time; black ink; no correction fluid; numbered pages, including all diagrams and worksheets; all pages initialed; no blanks)


name: Follow hospital or medical examiner protocol for saving original reports; if self-employed, save own originals


name: Provide log sheet on which all contact about case is recorded in file with case


name: Generate a report entitled "Amended Report" for any report that needs to be rewritten or corrected due to an error, including date and time of new report, why generated, description of error in original report, and correction


name: Obtain information from additional examiners (e.g., medical examiner, emergency room physician, emergency room nurse) when unable to obtain information per self (e.g., wound trajectory, wound depth)


name: Document information, informant and title, date and time of data collection, when obtaining information from additional examiners


name: Provide for appropriate counseling and follow-up care for victims and family, as indicated


name: Acknowledge when anger and resentment are justifiable


name: Identify source of anger and resentment, when possible


name: Assist patient to overcome blocks to healing by using spiritual practices (e.g., prayers of praise, guidance, and discernment; healing, touch, visualization of healing, and thanksgiving), as appropriate


name: Establish realistic functional goals with a plan to achieve these


name: Address risk factors that affect goal achievement (e.g., side effects of multiple medications, recent hospitalization visit, depression, impaired cognition, nutritional problems, fear of falling)


name: Address disease processes (e.g., thyroid disease, infection, cardiac or pulmonary conditions, metabolic disturbances, anemia) that may be the cause of functional decline


name: Determine need for glasses, hearing aids, and mobility devices (e.g., cane, walker)


name: Ensure adequate lighting, nonglare flooring, nonslip carpets, and handrails, where needed


name: Address problems in sleep-wake cycle (e.g., excessive daytime napping, nocturnal wakefulness), as needed


name: Address use of alcohol, tobacco, and illicit drugs


name: Increase pulmonary function through aerobic exercises and muscle reconditioning, as needed


name: Advise older adults about ways to optimize cognitive abilities in aging, including puzzles, word games, computer use


name: Counsel patients on cognitive benefits of social engagement, balanced nutrition, and physical activities


name: Educate older adults to promote understanding of age-related changes, appropriate lifestyle adjustments, and effective coping


name: Assist in planning a well-balanced diet, if needed


name: Encourage regularly scheduled visits with a health care provider


name: Institute crisis support skills, as needed


name: Assist to identify personal coping strategies


name: Discuss what to expect with parents and family if the loss is impending or likely


name: Encourage parents in holding infant while dying, as appropriate


name: Support parents and family in whatever attachment they may or may not have to the pregnancy and fetus


name: Discuss plans that have been made (e.g., burial, funeral, infant name)


name: Prepare infant for viewing by bathing and dressing, including parents in activities, as appropriate


name: Offer to complete a commemorative birth certificate if state law does not require one at the gestational age of delivery


name: Notify laboratory or funeral home for disposition of body, as appropriate


name: Screen for severe emotional problems, history of psychiatric illness, or hallucinations


name: Screen for current decreased energy level, inability to concentrate, or other symptoms that may interfere with cognitive ability to create focus on mental images


name: Discuss ability to create vivid mental images and to experience them as if they were real


name: Determine capability for doing nonnurse guided imagery (e.g., alone or with tape)


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


name: Provide comfortable environment without interruptions (e.g., using headphones), as possible


name: Discuss an image the patient has experienced that is pleasurable and relaxing, such as lying on a beach, watching a new snowfall, floating on a raft, or watching the sun set


name: Described the scene using as many of the five senses as possible


name: Make suggestions to induce relaxation (e.g., peaceful images, pleasant sensations, or rhythmic breathing), as appropriate


name: Have the patient slowly experience the scene: how does it look? smell? sound? feel? taste?


name: Develop cleansing or clearing portion of imagery (e.g., all pain appears as red dust and washes downstream in a creek as you enter)


name: Assist the patient to develop a method of ending the imagery technique, such as counting slowly while breathing deeply, slow movements, and thoughts of being relaxed, refreshed, and alert


name: Tape-record the imaged experience if useful


name: Use guided imagery as an adjuvant strategy to pain medications or in conjunction with other measures, as appropriate


name: Help patient/family understand that guilt is a common reaction to trauma, abuse, grief, catastrophic illness, or accidents


name: Refer patient/family to the appropriate trauma, abuse, grief, illness, caregiver, or survivor group for education and support


name: Teach patient to use thought stopping technique and thought substitution in conjunction with deliberate muscle relaxation when persistent thoughts of guilt enter the mind


name: Guide the patient through steps of self-forgiveness when one's guilt is valid


name: Assist the patient/family to identify options for prevention, restitution, atonement, and resolution, when appropriate


name: Monitor condition of hair and scalp, including abnormalities (e.g., dry, course, or brittle hair, pest infestation, dandruff, and nutritional deficiencies)


name: Provide treatment for abnormalities or notify appropriate health care provider


name: Prepare supplies for cleansing hair (e.g., basin, shampoo board, waterproof pad, towel, shampoo, and conditioner)


name: Assist patient into comfortable position


name: Use hydrogen peroxide or alcohol to dissolve matted blood, if present, before cleansing hair


name: Place commercially prepared, disposable cleansing cap on patient's head and massage head to work solution through hair and scalp, being sure to use cap according to manufacturer's instructions


name: Wash and condition hair, massaging shampoo and conditioner into scalp and hair


name: Avoid chilling during cleansing (i.e., adjust room temperature and provide warmed towels)


name: Dry hair with hair dryer on a low setting to avoid burning scalp


name: Brush or comb hair, using wide-toothed comb or pick, as needed


name: Apply small amount of oil to dry or flaking areas of scalp


name: Monitor patient response to hair loss, providing support (i.e., assist in selecting a hat, wig, or scarf, refer to community agency, and discuss hair transplants and drugs to stimulate hair growth), if indicated


name: Arrange for barber or hairdresser to cut hair


name: Prepare supplies for shaving (e.g., shaving cream, towel, and safety or electric razor)


name: Shave bodily hair using an electric razor for patients at-risk for excessive bleeding, if desired


name: Perform hair removal procedures using scissors, hair clippers, or chemical depilatory agents before surgical procedure, being sure to refer to institutional policies and physician order


name: Instruct patient or parent on hair care (e.g., cleansing infant scalp and hair and preventing pest infestation)


name: Use concrete statements rather than abstract statements when speaking to the patient


name: Encourage patient to develop control and responsibility over own behavior, if ability allows


name: Focus discussion upon the underlying feelings, rather than the content of the hallucinations (e.g., "It appears as if you are feeling frightened")


name: Provide medication information to patient and significant others


name: Provide illness information to patient and significant others if hallucinations are illness based (e.g., delirium, schizophrenia, depression)


name: Monitor physical status of patient (e.g., body weight, hydration, soles of feet in patient who paces)


name: Select the type of reporting (e.g., face to face, audiotape, at patient's bedside, walking rounds, electronic health record summary, team huddle) to use


name: Introduce self to oncoming staff, as needed


name: Identify chief complaint, reason for admission, and recent surgeries, as appropriate


name: Identify attending and consulting physicians


name: Summarize significant past health history, as necessary


name: Encourage patient to contribute to report and to ask questions if it is given at bedside


name: Use a standardized report format, tool, or mnemonic (e.g., SBAR: Situation, Background, Assessment, Recommendation)


name: Review the tubes the patient has, where they are, when they were placed, and when containers need to be emptied, as appropriate


name: Describe health status data, including vital signs and signs and symptoms present during the recent care period


name: Train nurses new to the clinical setting in the handoff process


name: Evaluate the handoff process periodically and revise, as indicated


name: Create a comfortable, private environment without distractions


name: Determine willingness to have body touched


name: Advise the patient to ask questions whenever they arise


name: Place patient in a comfortable and safe position that facilitates relaxation (e.g., chair, recliner, or massage table may be used if the body can be safely supported)


name: Remove constricting items (e.g., eyeglasses, shoes, and belt)


name: Drape only to provide temperature comfort


name: Center self by focusing awareness on inner self


name: Ground self by attuning to earth's energy


name: Set intention to work for the patient's highest good


name: Conduct an assessment of the patient's energy field (aura) and energy centers to determine whether clearing, balancing, or energizing techniques are to be used


name: Determine the specific healing touch approach to promote healing (e.g., unruffling or smoothing the energy field, full body connection, Etheric Vitality, magnetic unruffled, magnetic pain drain, spiral meditation, pyramid technique)


name: Use hands to clear, balance, and energize the patient's field


name: Continue until the energy fields and energy centers feel balanced, smooth, connected, symmetrical, and flowing


name: Repeat an energy assessment to identify what changes have occurred


name: Instruct the patient to gently move his or her body and stretch before one gets up


name: Touch the patient's body to help him or her ground or connect with the earth's energy if they experience dizziness when geting up


name: Offer client a glass of water to replenish the water lost with the energy movement


name: Provide feedback to the patient regarding the energetic work in terms he or she understands


name: Ask the patient to describe what he or she experienced or noted during and after the session


name: Record the characteristics of the energy work


name: Record the physical, mental, and emotional responses to session


name: Identify yourself or other referring professional and location


name: Obtain physician order for referral, if required


name: Identify patient's essential demographic data


name: Identify anticipated date of discharge or transfer, as appropriate


name: Transfer information via electronic technology if available


name: Participate in the development and improvement of electronic patient records


name: Maintain education related to knowledge of health information technology


name: Create a relationship that promotes trust and intimacy


name: Respect the individual as the authority on his own health and well-being


name: Listen carefully and validate understanding of the individual's experience


name: Review all aspects of the individual's life pertinent to health enhancement


name: Refer the individual to other professionals and services, as appropriate


name: Help the individual consider the stage of readiness for change (e.g., precontemplation, contemplation, preparation, action, maintenance)


name: Help the individual to consider personal strengths, resources, and barriers to change


name: Track the individual's concerns in a manner that leads to identification of goals that will be the focus of the coaching process


name: Involve the individual in formulating goals that are specific, measurable, realistic, and time-lined


name: Support the individual's inner wisdom, intuition, and innate ability for knowing what is best for self


name: Assist the individual to identify strategies to attain goals


name: Create with the individual an action plan with clearly defined steps and anticipated results


name: Reinforce individual strengths and resources for the direction and action chosen


name: Request that the individual commit to the plan and take action to move forward


name: Provide support for new ideas, behaviors, and actions that involve risk taking or fear of failure


name: Facilitate the individual to take action that will lead to achievement of desired goals and prevent relapse


name: Assist the individual to evaluate the effectiveness of actions in relation to attainment of the expected goals


name: Support autonomy by recognizing the individual is the determinant of progress and success


name: Document evaluation of progress and attainment of coaching goals


name: Target needs identified in Healthy People 2010: National Health Promotion and Disease Prevention Objectives, or other local, state, and national needs


name: Identify resources (e.g., personnel, space, equipment, money, etc.) needed to conduct program


name: Develop educational materials written at a readability level appropriate to target audience


name: Use lectures to convey the maximum amount of information, when appropriate


name: Design and implement strategies to measure program and cost effectiveness of education, using this data to improve the effectiveness of subsequent programs


name: Encourage policy in which insurance companies give consideration for premium reductions or benefits for healthful lifestyle practices


name: Create a health care environment in which a patient with impaired literacy can seek help without feeling ashamed or stigmatized


name: Avoid medical jargon and use of acronyms


name: Communicate with consideration for culture, age, and gender suitability


name: Determine patient's experience with the health care system, including health promotion, health protection, disease prevention, health care and maintenance, and health care system navigation


name: Determine health literacy status at initiation of contact with the patient through informal and/or formal assessments


name: Observe for impaired health literacy cues (e.g., failing to complete written forms, missing appointments, not taking medications appropriately, inability to identify medications or describe reasons for taking them, deferring to family members for information about health condition, asking multiple questions about topics already covered in handouts and brochures, avoiding reading things in front of health care providers)


name: Provide essential written and oral information to a patient in his/her first language


name: Determine what the patient already knows about his/her health condition or risks and relate new information to what is already known


name: Provide one-to-one teaching or counseling whenever feasible


name: Provide understandable written materials (i.e., use short sentences and common words with fewer syllables, highlight key points, use an active voice, use large print, have a user-friendly layout and design, group similar content into segments, emphasize behaviors and action that should be taken, use pictures or diagrams to clarify and decrease the reading burden)


name: Use strategies to enhance understanding (i.e., start with the most important information first, focus on key messages and repeat, limit the amount of information presented at any one time, use examples to illustrate important points, relate to the individual's experience, use a storytelling style)


name: Use multiple communication tools (e.g., audiotapes, videotapes, digital video devices, computers, pictograms, models, diagrams)


name: Evaluate patient understanding by having patient repeat back in own words or demonstrate skill


name: Encourage the individual to ask questions and seek clarification (e.g., What is my main problem? What do I need to do? Why is it important for me to do this?)


name: Assist the individual in anticipating his or her experiences in the health care system (e.g., being asked questions, seeing different health professionals, needing to let providers know when information is not understood, getting the results from laboratory tests, making and keeping appointments)


name: Encourage use of effective measures for coping with impaired health literacy (e.g., being persistent when asking for help, bringing a written list of questions or concerns to each health care encounter, depending on oral explanations or demonstrations of tasks, seeking the assistance of family or friends in getting health information)


name: Monitor online relevant websites (e.g., Centers for Medicare and Medicaid Services, home state governmental policy websites) for ongoing policy changes that may affect patient care


name: Compare requirements of new policies and standards with current practices


name: Submit written comments on pending rules and actions related to health policy changes


name: Testify in organizational, professional, and public forums to influence the formulation of health policies and standards that benefit patients


name: Support and participate in the efforts of nursing organizations, such as the ANA, to respond to and influence national health policy


name: Help elect nurses to key leadership positions on health care boards and committees


name: Advertise health screening services to increase public awareness


name: Provide detail on screening services to enhance attendance (e.g., special screening tools, presence of advanced practitioners)


name: Use valid, reliable health screening instruments appropriate for specific conditions (e.g., cardiovascular disease, immunization, health literacy, depression, malnutrition, obesity, drug and alcohol use, prenatal health, health-related quality of life, partner violence, risk assessment), as indicated


name: Follow appropriate guidelines from relevant groups (e.g., government agency, specialty organization, clinical practice) for proper time frame and type of screenings


name: Determine patient level of understanding before initiating screening


name: Accommodate cultural diversity in screening interviews and interpretation of findings


name: Obtain informed consent for health screening procedures, as appropriate


name: Obtain detailed health history including description of health habits, risk factors, and medications, as appropriate


name: Obtain specimens for analysis by assessments, as indicated


name: Provide follow-up contact for all patients


name: Encourage patient to go to the emergency room, if appropriate


name: Give written instructions for purpose and location of posthospitalization/outpatient activities, as appropriate


name: Identify and facilitate transportation needs for obtainment of health care services


name: Wrap the heat or cold application device with a protective cloth, if appropriate


name: Use a moist cloth next to the skin to increase the sensation of cold or heat, when appropriate


name: Use ice after an ankle sprain to reduce edema, followed by rest, compression, and elevation


name: Apply cold or heat directly on or near the affected site, if possible


name: Avoid using heat or cold on tissue that has been exposed to radiation therapy


name: Finish with a cold treatment to encourage vasoconstriction when alternating heat and cold applications for an injured athlete


name: Change sites of cold or heat application or switch form of stimulation if relief is not achieved


name: Evaluate and document response to heat and cold application


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


name: Institute appropriate protocol if patient becomes hypotensive


name: Discontinue hemodialysis, according to protocol


name: Compare postdialysis vitals and blood chemistries to predialysis values


name: Perform a comprehensive appraisal of hemodynamic status (i.e., check blood pressure, heart rate, pulses, jugular venous pressure, central venous pressure, right and left atrial and ventricular pressures, and pulmonary artery pressure), as appropriate


name: Use multiple parameters to determine patient's clinical status (i.e., proportional pulse pressure is considered the definitive parameter)


name: Monitor and document proportional pulse pressure (i.e., systolic blood pressure minus diastolic blood divided by systolic blood pressure, resulting in a proportion or percentage)


name: Provide frequent physical examination in at-risk populations (e.g., heart failure patients)


name: Instruct patient and family on hemodynamic monitoring (e.g., medications, therapies, purposes of equipment)


name: Explain the aims of care and how progress will be measured


name: Recognize presence of early warning signs and symptoms of compromised hemodynamic system (e.g., dyspnea, decreased ability to exercise, orthopnea, profound fatigue, dizziness, lightheadedness, edema, palpitations, paroxysmal nocturnal dyspnea, sudden weight gain)


name: Determine volume status (i.e., Is patient hypervolemic, hypovolemic, or in a balanced fluid level?)


name: Monitor for signs and symptoms of volume status problems (e.g., neck vein distension, elevated pressure in the right internal jugular vein, positive abdominal jugular neck vein reflex, edema, ascites, crackles, dyspnea, orthopnea, paroxysmal nocturnal dyspnea)


name: Determine perfusion status (i.e., Is patient cold, lukewarm, or warm?)


name: Monitor for signs and symptoms of perfusion status problems (e.g., symptomatic hypotension; cool extremities, including arms and legs; mental obtundation or constant sleepiness; elevation in serum levels of creatinine and urea nitrogen; hyponatremia; narrow pulse pressure; and proportional pulse pressure of 25% or less)


name: Recognize that adventitious lung sounds are not the sole indicator of hemodynamic issues


name: Monitor and document blood pressure, heart rate, rhythm, and pulses


name: Monitor cardiac output and cardiac index and left-ventricular stroke work index, as appropriate


name: Administer positive inotropic and contractility medications


name: Monitor for peripheral edema; jugular vein distension; S3 and S4 heart sounds; dyspnea; gains in weight; and organ distension, especially in the lungs or liver


name: Monitor pulmonary capillary and artery wedge pressure and central venous and right-atrial pressure, as appropriate


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


name: Collaborate with physician, as indicated


name: Draw blood sample and review blood chemistries (e.g., BUN, serum creatinine, serum Na, Ca, K, and PO4 levels) before therapy


name: Adjust technology to account for patient's multiple system pathologies (e.g., place patient on rotating-airflow bed)


name: Monitor and care for access sites and lines, according to protocol


name: Instruct patient/family about precautions posttreatment


name: Determine the presence of medical factors that are related to poor pregnancy outcome (e.g., diabetes, thyroid disease, hypertension, obesity, thrombophilias or history of DVT, autoimmune conditions, herpes, hepatitis, HIV, cardiac conditions or history of cardiac surgery, chronic pain conditions managed with opioid analgesics, use of opioid substitution therapies, seizure disorder)


name: Review obstetrical history for pregnancy-related risk factors (e.g., recurrent pregnancy loss, prematurity, postmaturity, preeclampsia, multifetal pregnancy, intrauterine growth retardation, placental abruption, placenta previa, hyperemesis, Rh sensitization, premature rupture of membranes, family history of genetic disorder)


name: Recognize demographic and social factors related to poor pregnancy outcome (e.g., young or advanced maternal age, race, ethnicity, low socioeconomic status, late or no prenatal care, physical abuse, substance abuse)


name: Determine patient's understanding of identified risk factors


name: Encourage expression of feelings and fears about lifestyle changes of pregnancy and parenting, fetal well-being, financial changes, family functioning, and personal safety


name: Refer as appropriate for specific programs (e.g., smoking cessation, substance abuse treatment, diabetes education, preterm birth prevention education; abuse shelter, pain management providers, genetic counseling, sexually transmitted disease clinic)


name: Instruct patient on use of prescribed medication (e.g., insulin, tocolytics, antihypertensives, antibiotics, anticoagulants, anticonvulsants)


name: Instruct patient on self-monitoring skills (e.g., vital signs, blood glucose testing, uterine activity monitoring), as appropriate


name: Conduct tests to evaluate fetal status and placental function (e.g., nonstress, biophysical profiles, ultrasound tests)


name: Assist with fetal diagnostic procedures (e.g., blood draws, amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling, Doppler blood flow studies)


name: Assist with fetal therapy procedures (e.g., fetal transfusions, fetal surgery, selective reduction, termination procedure)


name: Administer Rho(D) immune globulin (e.g., RhoGAM or Gamulin Rh) to prevent Rh sensitization after invasive procedures, as appropriate


name: Provide anticipatory guidance for likely treatments during birth process


name: Refer to home care agencies (e.g., specialized perinatal nursing services, perinatal case management, public health nursing)


name: Assist patient and family to identify areas of hope in life


name: Make available a selection of humorous games, cartoons, jokes, videos, tapes, books, etc


name: Monitor fluid status (including I&O), as appropriate


name: Restrict exercise when blood glucose levels are greater than 250 mg/dL, especially if urine ketones are present


name: Instruct patient and significant others on diabetes management during illness, including use of insulin and/or oral agents, monitoring fluid intake, carbohydrate replacement, and when to seek health professional assistance, as appropriate


name: Elicit a detailed patient health history to determine presence of hyperlipidemia or risk level of patient, including medication use and laboratory values


name: Identify possible causes of hyperlipidemia (e.g., diet high in saturated fats, red meats, fried foods, dairy products, low in fiber; smoking; obesity; sedentary lifestyle; family history of high cholesterol levels), including metabolic conditions and drugs affecting lipid metabolism (e.g., hypothyroidism, liver or renal disease, anorexia nervosa, untreated diabetes, glucocorticoids, estrogens)


name: Perform thorough physical examination, including vital signs, height, weight, waist-to-hip ratio, and body mass index (BMI)


name: Determine at-risk patients (e.g., diet high in saturated fats, red meats, fried foods, dairy products and low in fiber; obesity; sedentary lifestyle; family history of high cholesterol levels; smoking or exposure to smoke)


name: Use the National Cholesterol Education Expert Adult Treatment Panel III guidelines to determine risk categories and treatment options


name: Apply treatment guidelines to determine treatment goals (e.g., lifestyle changes as preventative measures versus lifestyle changes with medications)


name: Advise at-risk patients to practice lifestyle modification to reduce risk of developing hyperlipidemia (e.g., increase exercise, decrease weight, modify diet, avoid or stop smoking, avoid overconsumption of alcohol)


name: Advise at-risk patients to seek appropriate drug therapy if a trial of lifestyle modification fails to reduce hyperlipidemia from at-risk levels


name: Assist patients with hyperlipidemia to practice lifestyle modifications and to use appropriate drug therapy, as indicated per treatment guidelines


name: Monitor blood chemistry, including cholesterol, triglycerides, LDL and HDL, as indicated per treatment guidelines


name: Instruct at-risk patients to have regular preventative health screenings including cholesterol levels


name: Encourage patient to follow the American Heart Association recommendation of cholesterol testing every 4 to 6 years starting at age 20


name: Instruct related to healthy dietary pattern (e.g., calorie intake appropriate for height and weight; adequate fiber intake; no saturated fats; cook with vegetable oils; select lean cuts of meat; limit red meat intake; limit dairy products; moderate to low alcohol intake)


name: Instruct related to proper weight, weight management, and relationship of weight to hyperlipidemia


name: Instruct related to proper physical activity (e.g., moderate exercise 30 to 45 minutes a day)


name: Instruct related to contributing lifestyle habits that should be avoided (e.g., use of tobacco in any form and overconsumption of alcohol)


name: Provide information on possible changes in lifestyle necessary to avoid future complications and control the disease process


name: Provide information related to the purpose and benefit of the lifestyle changes


name: Instruct the patient on possible causes and sequelae of hyperlipidemia


name: Educate about usual lack of symptoms and the need for long term follow-up and therapy


name: Instruct patient and family to take an active role in management of disease process


name: Instruct patient and family on medication usage and indications, as appropriate


name: Inform patient that hyperlipidemia is a major controllable risk factor for coronary artery disease and stroke


name: Encourage patient and family to maintain a list of current medications and reconcile routinely at wellness checks, hospital visits, or hospital admissions


name: Elicit a detailed patient health history to determine risk level of patient, including medication use


name: Identify possible causes of hypertension


name: Evaluate for associated risk factors and contributing factors (e.g., diabetes mellitus, dyslipidemia, obesity, metabolic syndrome, age over 60 years, gender, race, smoking, hyperuremia, sedentary lifestyle, family history of hypertension, cardiovascular disease, history of stroke)


name: Measure BP to determine presence of hypertension (e.g., normal, less than 120/80; elevated, 120 to 129/80 or less; hypertension stage 1, 130 to 139/80 to 89; hypertension stage 2, equal or greater than 140/90)


name: Assure proper assessment of blood pressure (i.e., classification is based on the average of two or more properly measured, seated, BP readings on each of two or more office visits)


name: Avoid measurement of blood pressure for classification when contributing factors are present (e.g., consumption of caffeine, migraine headache, insomnia, agitation)


name: Implement proper nursing care for patients based on classification of hypertension


name: Assist patients with prehypertensive classification to practice lifestyle modification in order to reduce their risk of developing hypertension in the future (e.g., increase exercise, decrease weight, modify diet, obtain adequate sleep)


name: Advise patients with prehypertensive classification and comorbid conditions (e.g., heart failure, diabetes, kidney disease) to seek appropriate drug therapy if a trial of lifestyle modification fails to reduce BP to 130/80 mm Hg or less


name: Assist patients with hypertensive stage 1 classification and no comorbid conditions (e.g., heart failure, diabetes, kidney disease) to practice lifestyle modifications and to use appropriate drug therapy (e.g., thiazide-type diuretics for most, possibly angiotensin-converting enzyme inhibitor; angiotensin receptor blocker; beta blocker; calcium channel blocker; or combinations of previous)


name: Assist patients with hypertensive stage 2 classification and no comorbid conditions (e.g., heart failure, diabetes, kidney disease) to practice lifestyle modifications and to use appropriate drug therapy (e.g., combinations of angiotensin converting enzyme inhibitor, angiotensin receptor blocker, beta blocker, calcium channel blocker)


name: Assist patients with hypertensive stage 1 or 2 classification and comorbid conditions (e.g., heart failure, diabetes, kidney disease) to practice lifestyle modifications as able and to follow recommended drug regime protocols for comorbid condition with hypertension


name: Monitor at-risk patients for signs and symptoms of hypertension crisis (e.g., severe headache, dizziness, nausea or vomiting, pallor, sweating, cold skin, changes in vision, epistaxis, confusion, nervousness, restlessness, visual disturbances, altered level of consciousness, chest pain, seizures, cardiac arrest)


name: Monitor vital signs such as heart rate, respiratory rate, oxygen saturation, temperature, and blood panels for early identification of complications


name: Instruct at-risk patients to have regular preventative health screenings, including electrocardiogram, echocardiogram, electrolytes, urinalysis, as indicated


name: Monitor patient for signs and symptoms of hypertension or hypotension after administering prescribed hypertension medication


name: Instruct related to healthy dietary pattern


name: Instruct related to proper physical activity (e.g., exercise 30 to 45 minutes a day)


name: Instruct related to contributing lifestyle habits that should be avoided (e.g., use of tobacco in any form and alcohol)


name: Instruct the patient on lifestyle modification related to sleep and rest patterns (e.g., 8 hours per night is recommended)


name: Instruct related to self-blood pressure monitoring and to report abnormal findings


name: Instruct the patient on possible causes of hypertension


name: Instruct the patient and family to take an active role in the management of disease process, (e.g., medication indications and administration, maintaining proper diet, exercise and healthy habits, quitting smoking, reducing stress, reducing weight, reducing sodium intake, reducing alcohol consumption, increasing exercise, as indicated)


name: Instruct the patient and family on medication usage and indications


name: Instruct the patient to recognize and avoid situations that can cause increased BP (e.g., stress or sudden discontinuation of drug treatment)


name: Discontinue presumed causative medication (e.g., selective serotonin reuptake inhibitors [SSRI], monoamine oxidase inhibitors [MAOI], or tricyclic antidepressant) for patient experiencing neuroleptic malignant syndrome


name: Remove patient from heat source, moving to cooler environment


name: Apply external cooling methods (e.g., cold packs to neck, chest, abdomen, scalp, armpits, and groin; cooling blanket), as appropriate


name: Place patient in cooled water as tolerated to avoid shivering


name: Provide oral rehydrating solution (e.g., sports drink) or other cold fluid


name: Do not offer flood or liquid by mouth for patient with neurological impairment


name: Administer IV fluids, using cooled solutions, as appropriate


name: Apply internal cooling methods (e.g., iced gastric, bladder, peritoneal, or thoracic lavage), as appropriate


name: Administer anti shivering medication, as needed


name: Do not administer aspirin or other antipyretic


name: Discontinue cooling activities when core body temperature reaches 39° C


name: Monitor for abnormalities in mental status (e.g., confusion, bizarre behavior, anxiety, loss of coordination, agitation, seizure, and coma)


name: Monitor core body temperature using appropriate device (e.g., rectal or esophageal probe)


name: Obtain laboratory values for serum electrolytes, urinalysis, cardiac enzymes, liver enzymes, and complete blood count and monitor results


name: Monitor for complications (e.g., renal impairment, acid-base imbalance, coagulopathy, pulmonary edema, cerebral edema, and multiple organ dysfunction syndrome)


name: Provide or arrange for transportation to hospital for further treatment


name: Instruct patient on risk factors for heat-related illness (e.g., high environmental temperature, high humidity, dehydration, physical exertion, obesity, extremes of age, certain drugs, and heart disease)


name: Instruct patient on measures to prevent heat-related illness (e.g., prevent sun overexposure; ensure adequate intake of nutritious foods and fluids before, during, and after physical activity; seek settings in which air conditioning is available; and wear lightweight, light-colored, and loose-fitting clothing)


name: Instruct patient on early signs and symptoms of heat-related illness and when to seek assistance from health care professional


name: Weigh daily at consistent times (e.g., after voiding, before breakfast) and monitor trends


name: Monitor hemodynamic status, including HR, BP, MAP, CVP, PAP, PCWP, CO, and CI, if available


name: Monitor respiratory pattern for symptoms of pulmonary edema (e.g., anxiety, air hunger, orthopnea, dyspnea, tachypnea, cough, frothy sputum production, and shortness of breath)


name: Monitor for laboratory evidence of hemoconcentration (e.g., sodium, BUN, hematocrit; urine specific gravity), if available


name: Monitor for laboratory evidence of the potential for increased plasma oncotic pressure (e.g., increased protein and albumin), if available


name: Monitor for laboratory evidence of the underlying cause for hypervolemia (e.g., B-type natriuretic peptide for heart failure; BUN, Cr, and GFR for renal failure), if available


name: Administer prescribed medications to reduce preload (e.g., furosemide, spironolactone, morphine, and nitroglycerin)


name: Monitor for evidence of reduced preload (e.g., increased urine output; improvement in adventitious lung sounds; decreased BP, MAP, CVP, PCWP, CO, CI)


name: Monitor for evidence of excessive medication effect (e.g., dehydration, hypotension, tachycardia, hypokalemia)


name: Instruct patient on the use of medications to reduce preload


name: Administer intravenous infusions (e.g., fluids, blood products) slowly to prevent a rapid increase in preload


name: Restrict free water intake in patients with dilutional hyponatremia


name: Facilitate endotracheal intubation and initiation of mechanical ventilation for patients with severe pulmonary edema, as appropriate


name: Maintain prescribed mechanical ventilator settings (e.g., FiO2, mode, volume or pressure settings, PEEP), as appropriate


name: Prepare patient for dialysis (e.g., assist with dialysis catheter insertion), as appropriate


name: Maintain dialysis vascular access device


name: Determine patient's weight change before and after each dialysis session


name: Monitor patient's hemodynamic response during and after each dialysis session


name: Determine volume of infused dialysate and returned effluent after each peritoneal dialysis exchange


name: Monitor returned peritoneal effluent for indications of complications (e.g., infection, excessive bleeding, and clots)


name: Reposition the patient with dependent edema frequently, as appropriate


name: Monitor skin integrity in immobile patients with dependent edema


name: Promote skin integrity (e.g., prevent shearing, avoid excessive moisture, and provide adequate nutrition) in immobile patients with dependent edema, as appropriate


name: Instruct the patient and family on use of intake and output record, as appropriate


name: Instruct patient and family on the planned interventions to treat hypervolemia


name: Restrict dietary intake of sodium, as indicated


name: Promote a positive body image and self-esteem if concerns are expressed as a result of excessive fluid retention


name: Determine patient's receptivity to using hypnosis


name: Correct myths and misconceptions of hypnosis


name: Ensure the patient has accepted the treatment


name: Evaluate the suitability of the patient by assessing his or her hypnotic suggestibility


name: Confirm the presence of a trusting relationship


name: Sit comfortably, half-facing the patient, when appropriate


name: Select an induction technique (e.g., Chevreul pendulum illusion, relaxation, imaging walking down a staircase, eye closure, arm levitation, simple muscle relaxation, visualization exercises, attention to breathing, repetition of key words/phrases, and others)


name: Use a rhythmical, soothing, monotone voice during patient induction


name: Assist the patient to identify appropriate deepening techniques (e.g., movement of a hand to the face, imagery escalation technique, fractionation, and others)


name: Identify situations, such as painful procedures, where patient requires additional staff support for effective induction


name: Monitor for signs and symptoms of hypoglycemia, (e.g., shakiness, tremor, sweating, nervousness, anxiety, irritability, impatience, tachycardia, palpitations, chills, clamminess, light-headedness, pallor, hunger, nausea, headache, tiredness, drowsiness, weakness, warmth, dizziness, faintness, blurred vision, nightmares, crying out in sleep, paresthesia, difficulty concentrating, difficulty speaking, incoordination, behavior change, confusion, coma, seizure)


name: Review events before hypoglycemia to determine probable cause


name: Elicit a detailed patient health history to determine hypotension risk level of patient, including medication use


name: Identify possible causes of hypotension (e.g., diabetes, coronary artery disease, peripheral artery disease, heart failure, previous stroke, chronic kidney disease, proteinuria, age greater than 50 years, smokers, obesity, treatment of Parkinson's disease, treatment of epilepsy, treatment of depression; nocturnal urination)


name: Measure BP to determine presence of hypotension (defined as less than 90 mm Hg systolic and or less than 60 mm Hg diastolic in the general population)


name: Assure proper assessment of blood pressure (i.e., hypotensive classification is based on the average of two or more properly measured with position change, BP readings on each of two or more office visits)


name: Instruct patients to keep a blood pressure diary with orthostatic blood pressure measurements taken over several days and at various different time points to increase the sensitivity for detection pending issues


name: Perform an electrocardiogram, if applicable


name: Perform analytical chemistry, if applicable


name: Perform additional diagnostic tests, as indicated


name: Avoid measurement of BP for classification when contributing factors are present (e.g., recent ingestion of influential medications, allergic responses, blood loss, dehydration)


name: Elicit patient's descriptive experience of hypotension (e.g., occurrences, situations, causes, time of day, food or medication intake, sleep patterns)


name: Determine medication regime and influences on hypotension (e.g., diuretics, alpha blockers, beta blockers, medications for Parkinson's disease, tricyclic antidepressants)


name: Address any conditions influencing hypotension, as needed


name: Consider nonpharmacological treatments as first approach


name: Discontinue medications that predispose to or exacerbate hypotension, as appropriate


name: Educate patient on physical countermeasures to reduce gravitational blood pooling in the lower extremities (e.g., moving gradually from supine to standing positions, avoiding standing motionless, standing with legs crossed, squatting, active tensing of leg muscles)


name: Encourage patient to employ approaches to improve central volume (e.g., increase salt consumption to 6 to 9 g of sodium chloride per day with 1 g sodium chloride tablets taken with each meal, if needed; increase water intake up to 2 to 3 liters per day, with rapid water ingestion [16 ounces in 3 to 4 minutes] used as a rescue measure)


name: Monitor for complications (e.g., blurred vision, confusion, dizziness, syncope, pallor, cold sweating, tachycardia, dizziness, drowsiness, weakness, altered level of consciousness, seizure, shortness of breath, chest pain)


name: Be alert to the need to treat worsening symptoms urgently


name: Administer pharmacological agents (e.g., fludrocortisone, midodrine) and monitor effects, if applicable


name: Instruct the patient and family to communicate worsening blood pressure numbers or symptoms


name: Promote oral fluid intake recommended by age


name: Encourage healthy eating and adequate fluid intake


name: Instruct patient and family on the need to avoid tobacco, illicit drugs, and alcohol


name: Instruct the patient on lifestyle modification


name: Provide information and education on possible changes in lifestyle necessary to avoid future complications and control the disease process


name: Evaluate as indicated vital signs, such as blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, and other parameters, such as capillary blood glucose, for possible complications


name: Refer to a specialist unit, as indicated


name: Monitor patient's temperature, using a continuous core temperature monitoring device, as appropriate


name: Institute active external cooling measures (e.g., ice packs, water cooling blanket, circulating water cooling pads) as appropriate


name: Institute active internal cooling measures (e.g., intravascular cooling catheters), as appropriate


name: Use facial or hand warming or insulative wraps to diminish shivering response, as appropriate


name: Monitor for and treat arrhythmias, as appropriate


name: Monitor coagulation studies, including prothrombin time, activated partial thromboplastin time, and platelet counts, as indicated


name: Monitor the patient closely for signs and symptoms of persistent bleeding


name: Monitor white blood cell count, as appropriate


name: Monitor hemodynamic status (e.g., PCWP, CO, SVR), using invasive hemodynamic monitoring, as appropriate


name: Monitor patient's temperature, using most appropriate measuring device and route


name: Place patient in supine position, minimizing orthostatic changes


name: Encourage patient with uncomplicated hypothermia to consume warm, high carbohydrate liquids without alcohol or caffeine


name: Share body heat, using minimal clothing to facilitate heat transfer between victim and rescuer


name: Apply passive rewarming (e.g., blanket, head covering, and warm clothing)


name: Apply active external rewarming (e.g., heating pad placed on truncal area before extremities, hot water bottles, forced air warmer, warmed blanket, radiant light, warmed packs, and convective air heaters)


name: Avoid active external rewarming for the severely hypothermic patient


name: Apply active internal rewarming or "core rewarming" (e.g., warmed IV fluids, warmed humid oxygen, cardiopulmonary bypass, hemodialysis, continuous arteriovenous rewarming, and warm lavage of body cavities)


name: Monitor for complications associated with extracorporeal rewarming (e.g., acute respiratory distress syndrome, acute renal failure, and pneumonia)


name: Initiate CPR for patients without spontaneous circulation, remaining aware that defibrillation attempts may be ineffective until core temperature is higher than 30° C


name: Administer medications using caution (e.g., be aware of unpredictable metabolism, monitor for increased action or toxicity, and consider withholding IV medications until core temperature is higher than 30° C)


name: Monitor for symptoms associated with mild hypothermia (e.g., tachypnea, dysarthria, shivering, hypertension, and diuresis), moderate hypothermia (e.g., atrial arrhythmias, hypotension, apathy, coagulopathy, and decreased reflexes), and severe hypothermia (e.g., oliguria, absent neurological reflexes, pulmonary edema, and acid-base abnormalities)


name: Identify medical, environmental, and other factors that may precipitate hypothermia (e.g., cold water immersion, illness, traumatic injury, shock states, immobilization, weather, extremes of age, medications, alcohol intoxication, malnutrition, hypothyroidism, diabetes, and malnutrition)


name: Monitor for orthostatic hypotension and dizziness upon standing


name: Monitor for sources of fluid loss (e.g., bleeding, vomiting, diarrhea, excessive perspiration, and tachypnea)


name: Monitor vascular access device insertion site for infiltration, phlebitis, and infection, as appropriate


name: Monitor for laboratory evidence of blood loss (e.g., hemoglobin, hematocrit, fecal occult blood test), if available


name: Monitor for laboratory evidence of hemoconcentration (e.g., sodium, BUN, urine specific gravity), if available


name: Monitor for laboratory and clinical evidence of impending acute kidney injury (e.g., increased BUN, increased creatinine, decreased GFR, myoglobinemia, and decreased urine output)


name: Encourage oral fluid intake (i.e., distribute fluids over 24 hours and give fluids with meals), unless contraindicated


name: Offer a beverage of choice every 1 to 2 hours when awake, unless contraindicated


name: Administer prescribed isotonic IV solutions (e.g., normal saline or lactated Ringer's solution) for extracellular rehydration at an appropriate flow rate, as appropriate


name: Administer prescribed hypotonic IV solutions (e.g., 5% dextrose in water or 0.45% sodium chloride) for intracellular rehydration at an appropriate flow rate, as appropriate


name: Administer prescribed isotonic IV fluid bolus at an appropriate flow rate to maintain hemodynamic integrity


name: Administer prescribed colloid suspensions (e.g., Hespan, albumin, or Plasmanate), for replacement of intravascular volume, as appropriate


name: Administer prescribed blood products to increase plasma oncotic pressure and replace blood volume, as appropriate


name: Monitor for evidence of blood transfusion reaction, as appropriate


name: Monitor for evidence of hypervolemia and pulmonary edema during IV rehydration


name: Use an IV pump to maintain a steady intravenous infusion flow rate


name: Monitor skin integrity in immobile patients with dry skin


name: Promote skin integrity (e.g., prevent shearing, avoid excessive moisture, and provide adequate nutrition) in immobile patients with dry skin, as appropriate


name: Implement modified Trendelenburg positioning (e.g., legs elevated higher than heart level with rest of body supine) when hypotensive to optimize cerebral perfusion while minimizing myocardial oxygen demand


name: Monitor oral cavity for dry and/or cracked mucous membranes


name: Provide oral fluids (or moistened mouth swabs) frequently to maintain oral mucous membrane integrity, unless contraindicated


name: Facilitate oral cleaning (e.g., toothbrush with toothpaste, nonalcohol based mouthwash) twice daily


name: Administer prescribed vasodilators with caution (e.g., nitroglycerin, nitroprusside, and calcium channel blockers) when rewarming a postoperative patient, as appropriate


name: Administer prescribed atrial natriuretic peptide (ANP) to prevent acute kidney injury, as appropriate


name: Instruct the patient and/or family on the use of intake and output record, as appropriate


name: Teach parent(s) recommended immunizations necessary for children, their route of medication administration, reasons and benefits of use, adverse reactions, and side effects schedule (e.g., hepatitis B, diphtheria, tetanus, pertussis, H. influenza, polio, measles, mumps, rubella, and varicella)


name: Inform individuals of immunization protection against illness that is not presently required by law (e.g., influenza, pneumococcal, and hepatitis B vaccinations)


name: Document vaccination information per agency protocol (e.g., manufacturer, lot number, expiration date, etc.)


name: Determine immunization status at every health care visit (including emergency room and hospital admission) and provide immunizations, as needed


name: Use a behavior modification plan to reinforce the problem-solving strategy that is being taught, as appropriate


name: Instruct patient to cue self to "stop and think" before acting impulsively


name: Instruct patient to consider own thoughts and feelings before acting impulsively


name: Demonstrate the steps of the problem-solving strategy in the context of situations that are meaningful to the patient


name: Provide positive reinforcement (e.g., praise, rewards) for successful outcomes


name: Provide opportunities for patient to practice problem solving (e.g., role playing) within the therapeutic environment


name: Encourage patient to practice impulse control strategies in social and interpersonal situations outside the therapeutic environment, followed by evaluation of outcome


name: Identify events (e.g., patient falls, blood transfusion reactions, and equipment malfunction) that compromise patient safety and thereby require reporting, as defined in agency policy


name: Document factual information about the event in the patient record, as appropriate


name: Provide feedback to all staff about lessons learned and organizational changes resulting from an incident report, as appropriate


name: Promote a culture that supports the idea that voluntary event reporting is a form of passive surveillance for near misses and unsafe conditions


name: Combine event reports with active surveillance methods (e.g., direct observation, chart audits) to identify and prioritize patient safety threats


name: Understand that a higher workload may be related to a higher number of patient safety incidents


name: Encourage consistent assignment of professional caregivers


name: Incorporate parent preferences for bathing, when possible


name: Remove small items from crib (e.g., syringe covers and alcohol wipes)


name: Provide developmentally appropriate safe toys and activities for infant


name: Structure play and care around infant's temperament


name: Encourage parent to participate in care activities (e.g., bathing, feeding, medication administration, or dressing changes)


name: Reinforce parent skill in performing special care for infant


name: Involve parent in decision making, providing support throughout process


name: Give parent the option of being present for procedure or returning upon its completion


name: Apply restraints when indicated and monitor throughout use


name: Comfort infant through rocking, holding, cuddling, swaddling


name: Monitor infant for signs of pain, including kicking, legs drawn up, steady crying, and difficulty consoling


name: Use pain management strategies (e.g., distraction, parent's involvement, positioning, swaddling, or environmental manipulation)


name: Encourage family to visit and stay overnight in hospital


name: Provide emotional and spiritual support to parent (e.g., be available to listen, assist with maintaining or creating coping strategies, or referral)


name: Maintain infant's daily routine during hospitalization, when possible


name: Provide quiet, uninterrupted environment during nap time and nighttime


name: Clear secretions from oral and nasal passages


name: Maintain adequate body temperature of newborn (i.e., dry infant immediately after birth, wrap newborn in blanket if not to be placed in warmer, apply stockinette cap and instruct parent to keep head covered, and place newborn in isolette or under warmer, as needed)


name: Respond to signs of respiratory distress (e.g., tachypnea, nasal flaring, grunting, retractions, rhonchi, and rales)


name: Place newborn skin-to-skin with parent, as appropriate


name: Put newborn to the breast immediately after birth


name: Monitor newborn's suck reflex during feeding


name: Assist parent in giving newborn initial bath after temperature has stabilized


name: Regularly hold or touch newborn in isolette


name: Compare maternal and newborn blood groups and types


name: Swaddle newborn to promote sleep and provide a sense of security


name: Use blanket roll at newborn's back to position on side, placing dependent arm forward to decrease likelihood of rolling into prone position


name: Determine condition of newborn's cord before transfusion using umbilical vein


name: Monitor umbilical cord for redness and drainage


name: Apply restraints when indicated and monitor appropriately throughout use


name: Monitor newborn's response to circumcision


name: Monitor for hypoglycemia and anomalies if mother has diabetes


name: Monitor for signs of hyperbilirubinemia, if appropriate


name: Instruct parent to recognize symptoms of hyperbilirubinemia


name: Promote and facilitate family bonding and attachment with newborn


name: Provide information and facilitate the screening of newborn for metabolic disorder(s)


name: Instruct parent to recognize signs of breathing difficulty


name: Instruct parent to place newborn on back when sleeping


name: Create a therapeutic and supportive relationship with parent


name: Provide space for parent on unit and at infant's bedside


name: Provide parent with accurate, factual information regarding the infant's condition, treatment, and needs


name: Inform parent about developmental considerations in preterm infants


name: Instruct parent to recognize infant cues and states


name: Assist parent in planning care that is responsive to infant cues and states


name: Instruct parent how to console infant using behavioral quieting techniques (e.g., placing hand on infant, positioning, and swaddling)


name: Create individualized development plan and update regularly (e.g., Neonatal Individualized Development Care and Assessment Program [NIDCAP])


name: Avoid overstimulation by stimulating one sense at a time (i.e., avoid talking while handling and looking at while feeding)


name: Provide boundaries that maintain flexion of extremities while still allowing room for extension (e.g., nesting, swaddling, bunting, hammock, hat, and clothing)


name: Provide supports to maintain positioning and prevent deformities (e.g., back rolls, nesting, bunting, and head donuts)


name: Monitor stimuli (e.g., light, noise, handling, and procedures) in infant's environment and reduce, when possible


name: Shield eyes of infant when using lights with high, foot-candles wattage


name: Decrease environmental noise (i.e., turn down and respond quickly to monitor alarms and telephones and move conversation away from bedside)


name: Position incubator away from sources of noise (e.g., sinks, doors, telephone, high activity, radio, and traffic pattern)


name: Time infant care and feeding around sleep and wake cycle


name: Position infant for sleeping in prone upright position on parent's bared chest, if appropriate


name: Use a pacifier during gavage feeding and between feedings for nonnutritive sucking to promote physiological stability and nutritional status


name: Facilitate state transition and calming during painful, stressful-but-necessary procedures


name: Establish consistent and predictable routines to promote regular sleep and wake cycles


name: Provide stimulation using recorded instrumental music, mobiles, massage, rocking, and touch


name: Cover eyes and genitalia with opaque shield for child receiving phototherapy


name: Remove eye mask during feedings and regularly to monitor for discharge or corneal irritation


name: Monitor hematocrit and administer blood transfusions, when necessary


name: Inform parent about prevention measures for SIDS (Sudden Infant Death Syndrome)


name: Allocate the appropriate square feet per patient, as indicated by Centers for Disease Control and Prevention (CDC) guidelines


name: Instruct patient on appropriate handwashing techniques


name: Shave and prep the area, as indicated in preparation for invasive procedures and/or surgery


name: Maintain an aseptic environment when changing TPN tubing and bottles


name: Maintain a closed system when doing invasive hemodynamic monitoring


name: Change peripheral IV and central line sites and dressings according to current Centers for Disease Control and Prevention guidelines


name: Monitor and maintain room temperature between 20° and 24° C


name: Monitor and maintain relative humidity between 20% and 60%


name: Inspect skin and tissue around surgical site


name: Review histories of international and global travel


name: Monitor absolute granulocyte count, WBC, and differential results


name: Avoid close contact between pet animals and immunocompromised hosts


name: Monitor for change in energy level or malaise


name: Do not attempt antibiotic treatment for viral infections


name: Teach the patient and patient's family the differences between viral and bacterial infections


name: Eliminate fresh fruits, vegetables, and pepper in the diet of patients with neutropenia


name: Determine whether patient's insurance company requires authorization before use of a particular service or equipment


name: Understand the changes in insurance authorization as a result of the Patient Protection and Affordable Care Act of 2010


name: Notify appropriate health professional if approval refused by the third-party payer


name: Negotiate alternative modalities of care if approval is refused (e.g., outpatient status or change in acuity level), as appropriate


name: Assist in the filing of an appeal if claim is denied, as appropriate


name: Assist patient to access needed health services or equipment


name: Support the simplification and standardization of the preauthorization process by adopting and using standardized paper forms or Health Insurance Portability and Accountability Act (HIPAA) electronic standard transactions


name: Provide information to patient and family and significant others


name: Level external transducer to consistent anatomical reference point


name: Monitor quality and characteristics of ICP waveform


name: Monitor patient's ICP and neurological response to care activities and environmental stimuli


name: Monitor amount, rate, and characteristics of cerebrospinal fluid (CSF) drainage


name: Maintain position of CSF collection chamber as ordered


name: Monitor pressure tubing for air bubbles, debris, or clotted blood


name: Change transducer, flush system, and drainage bag, as indicated


name: Monitor insertion site for infection or leakage of fluid


name: Obtain cerebrospinal fluid drainage samples, as appropriate


name: Position the patient with head and neck in a neutral position, avoiding extreme hip flexion


name: Adjust head of bed to optimize cerebral perfusion


name: Monitor effect of environmental stimuli on ICP


name: Monitor CO2 levels and maintain within specified parameters


name: Perform vaginal examination, as appropriate


name: Monitor maternal and fetal vital signs between contractions, per protocol or as needed


name: Auscultate the fetal heart every 30 to 60 minutes in early labor, every 15 minutes during active labor, and every 5 minutes in second stage, depending on risk status


name: Apply electronic fetal monitor, per protocol or as appropriate


name: Monitor pain level per protocol during labor


name: Provide alternative methods of pain relief consistent with patient's goals (e.g., simple massage, effleurage, aromatherapy, hypnosis, transcutaneous electrical nerve stimulation [TENS])


name: Perform vaginal examination to determine complete cervical dilation, fetal position, and station


name: Notify extra assistants to attend birth (e.g., neonatologist, neonatal intensive care nurses, anesthesiologist)


name: Perform ultrasound to locate fetal position, as appropriate


name: Perform McRoberts maneuver, suprapubic pressure per request of physician or nurse-midwife


name: Assist with administration of maternal anesthetic (e.g., intubation), as needed


name: Document procedures (e.g., anesthesia, forceps, vacuum extraction, suprapubic pressure, McRoberts maneuver, neonatal resuscitation) used to facilitate birth


name: Assist mother to recover from anesthetic, as appropriate


name: Remove all clothing from the targeted extremity


name: Select an appropriate vein for venipuncture, considering the patient's preference, past experience with IVs, and nondominant hand


name: Consider assessment factors when examining veins for cannula insertion (e.g., patient age, purpose of catheter, cannula gauge, cannula material, cannula proximity to joints, condition of extremity, condition of patient, skill of practitioner)


name: Start IVs in the opposite arm for patients with arteriovenous fistulas or shunts, or conditions contraindicating cannulation (e.g., lymphedema, mastectomy, lymphectomy, radiation therapy)


name: Choose an 18-gauge needle for blood administration in adults, if possible


name: Apply heat compresses for increased blood flow for vein visualization (e.g., warm dry towels), if needed


name: Apply topical analgesia, as indicated per agency protocol


name: Adhere to time requirements for topical analgesia effectiveness (i.e., some topical analgesic medications require 2 hours to take effect)


name: Apply a tourniquet 3 to 4 inches higher than the anticipated puncture site, as appropriate


name: Apply enough tourniquet pressure to impede venous circulation but not arterial flow


name: Instruct patient to hold the extremity lower than the heart to allow for maximum blood flow to the selected site


name: Request patient to open and close hand several times, as appropriate


name: Administer 1% or 2% lidocaine at the insertion site based on agency protocol


name: Insert needle according to manufacturer's instructions, using only needles with sharps injury prevention features


name: Connect needle to IV tubing or flush and connect to saline lock, as appropriate and per agency protocol


name: Label IV site dressing with date, gauge, and initials per agency protocol


name: Perform the five rights before starting infusion or administering medications (right drug, dose, patient, route, and frequency)


name: Administer IV fluids at room temperature unless otherwise ordered


name: Monitor intravenous flow rate and intravenous site during infusion


name: Record intake and output, as appropriate


name: Monitor for forward progression of pulmonary catheter resulting in spontaneous wedge and notify physician if it occurs


name: Change IV solution and tubing every 24 to 72 hours based on protocol


name: Discuss experiences with similar interventions and receptiveness to intervention


name: Explain various approaches to journaling and decide on a journaling technique (e.g., free flowing, topical, or intensive journaling)


name: Encourage writing without interruption at least three times a week for 20 minutes


name: Ensure the environment is optimal for task completion (e.g., client is in a comfortable position, room is well lit, client has glasses)


name: Minimize emotional, visual, audio, olfactory, and visceral distractions


name: Maintain privacy and assure confidentiality


name: Allow the person to select media and method (e.g., pen, pencil, marker, journal, computer, tape recorder, etc.)


name: Instruct the person to date journal entries for future reference and reflection


name: Encourage writing in the order that things occur without topic restrictions


name: Encourage the describing and telling of events in terms of stories, images, and associated thoughts and feelings


name: Describe experiences in terms of the five senses, as applicable


name: Promote expressing deepest thoughts and feelings


name: Instruct to pay no attention to punctuation, spelling, sentence structure, and/or grammar


name: Determine ability to continue with intervention independently in the future


name: Review journal entries at defined intervals


name: Monitor achievement of the established goals


name: Explain advantages and implications of providing skin-to-skin contact with infant


name: Monitor parent factors influencing involvement in care (e.g., willingness, health, availability, and presence of support system)


name: Ensure that infant's physiological status meets guidelines for participation in care


name: Prepare a quiet, private, and warm environment


name: Instruct parent to wear comfortable, open-front clothing


name: Turn infant head to one side in a slightly extended position to facilitate eye contact with parent and keep airway open


name: Avoid forward flexion and hyperextension of infant head


name: Secure infant and parent position (i.e., tie binding cloth around infant-parent dyad, wrap parent's clothing around infant, and place blanket over dyad)


name: Instruct parent how to move infant in and out of binding cloth


name: Encourage parent to focus on infant rather than high technological setting and equipment


name: Encourage parent to gently stroke infant in prone upright position


name: Encourage parent to gently rock infant in prone upright position


name: Encourage auditory stimulation of infant


name: Encourage parent to sit, stand, walk, and engage in other activities of interest while providing skin-to-skin contact


name: Encourage postpartum mothers to ambulate every 90 minutes while providing skin-to-skin contact to prevent thrombolytic disease


name: Encourage parent to let the infant sleep during care


name: Encourage breastfeeding during care, as appropriate


name: Encourage parent to provide care at least 60 minutes to avoid frequent and potentially stressful changes, if possible


name: Instruct parent to gradually increase time of each skin-to-skin contact, with length eventually becoming as continuous, as possible


name: Monitor parent's emotional reaction to and concerns regarding kangaroo care


name: Monitor infant's physiological status (e.g., color, temperature, heart rate, and apnea)


name: Instruct parent how to monitor infant's physiological status


name: Support parent to continue skin-to-skin contact at home


name: Discontinue care if infant becomes physiologically compromised or agitated


name: Determine medical and obstetrical indications for induction


name: Determine Bishop score to rate readiness of cervix for labor induction (i.e., a score of 8 or greater is more favorable for vaginal delivery)


name: Perform or assist with application of mechanical or pharmacological agents at the appropriate intervals to enhance cervical readiness, as needed


name: Assist with membrane stripping if greater than or equal to 39 weeks gestation


name: Perform or assist with amniotomy if cervical dilatation is adequate and vertex is well engaged


name: Determine fetal heart rate by auscultation or electronic fetal monitoring postamniotomy and per protocol


name: Initiate IV medication (e.g., oxytocin) to stimulate uterine activity according to protocol, as needed


name: Avoid uterine tachysystole by using low dose protocol to infuse oxytocin to achieve adequate contraction frequency, duration, and relaxation


name: Monitor data provided by intrauterine pressure catheter


name: Monitor for water retention during oxytocin administration


name: Review history for risk factors commonly related to preterm labor (e.g., prior patient or family history of preterm birth or abortion; multifetal gestation; uterine cervical anomalies; early cervical change; uterine irritability; infection, including periodontal disease; short interpregnancy interval; technology-induced conception; history of vaginal bleeding in first and or second trimester; positive fetal fibronectin results; extremes of prepregnancy body weight)


name: Document uterine activity using palpation as well as electronic fetal monitoring


name: Initiate oral, subcutaneous, or IV tocolytics, per physician order or protocol, if hydration does not reduce uterine activity


name: Monitor for side effects of tocolytic therapy, including loss of deep tendon reflexes and depressed respirations, if magnesium sulfate is administered


name: Provide interventions to reduce discomforts of normal side effects (e.g., relaxation therapy, anxiety reduction, therapeutic touch)


name: Administer corticosteroid therapy, if indicated and ordered to hasten maturity of fetal lungs


name: Instruct contraction palpation techniques


name: Provide referrals to assist family with child care, home maintenance, and diversional activities, as appropriate


name: Recognize physiological factors that can affect laboratory values, including race, gender, age, pregnancy, menstrual cycle, diet (especially hydration), time of day, activity level, and stress


name: Compare test results with other related laboratory and diagnostic tests


name: Consult appropriate references for clinical implication of unfamiliar tests


name: Report results of laboratory tests to patient, as appropriate


name: Provide information about psychological and physiological benefits of breastfeeding


name: Determine mother's desire and motivation to breastfeed as well as perception of breastfeeding


name: Encourage mother's significant other, family, or friends to provide support (i.e., offer praise, encouragement, and reassurance, perform household tasks, and ensure that mother is receiving adequate rest and nutrition)


name: Encourage attendance to breastfeeding classes and support groups


name: Provide mother the opportunity to breastfeed after birth, when possible


name: Instruct on infant's feeding cues (e.g., rooting, sucking, and quiet alertness)


name: Assist in ensuring proper infant attachment to breast (i.e., monitor proper infant alignment, areolar grasp and compression, and audible swallowing)


name: Instruct on various feeding positions (e.g., cross-cradle, football hold, and side-lying)


name: Instruct mother on signs of milk transfer (e.g., milk leakage, audible swallowing, and "let down" sensations)


name: Discuss ways to facilitate milk transfer (e.g., relaxation techniques, breast massage, and a quiet environment)


name: Inform about the difference between nutritive and nonnutritive sucking


name: Instruct mother to allow infant to finish first breast before offering second breast


name: Monitor for nipple pain and impaired skin integrity of nipples


name: Discuss techniques to avoid or minimize engorgement and associated discomfort (e.g., frequent feedings, breast massage, warm compresses, milk expression, ice packs applied after feeding or pumping, and antiinflammatory medications)


name: Instruct on signs, symptoms, and management strategies for plugged ducts, mastitis, and candidiasis infection


name: Discuss needs for adequate rest, hydration, and well-balanced diet


name: Assist in determining need for supplemental feedings, pacifiers, and nipple shields


name: Encourage mother to wear a well-fitting, supportive bra


name: Instruct on record keeping of nursing and pumping sessions, if indicated


name: Discuss frequency of normal feeding patterns, including cluster feedings and growth spurts


name: Discuss options for milk expression, including nonelectrical pumping (e.g., hand and manual) and electrical pumping (e.g., single and double; hospital-grade pump for mother of preterm infant)


name: Instruct on appropriate handling of expressed milk (e.g., collection, storage, thawing, preparation, fortification, and warming)


name: Instruct patient to contact lactation consultant to assist in determining status of milk supply (i.e., whether insufficiency is perceived or actual)


name: Discuss strategies aimed at optimizing milk supply (e.g., breast massage, frequent milk expression, complete emptying of breasts, kangaroo care, and medications)


name: Provide instruction and support in accordance with health care institution's policy on lactation for the mother of preterm infant (i.e., instruct on frequency of pumping, when to expect milk supply to increase, normal feeding patterns based on gestational age, and weaning from pump when infant is able to nurse well)


name: Instruct on signs and symptoms warranting reporting to a health care practitioner or lactation consultant


name: Provide discharge instructions and arrange for follow-up care tailored to patient's specific needs (e.g., mother of healthy term infant, multiples, preterm infant, or ill infant)


name: Encourage employers to provide opportunities for lactating mothers to express and store breast milk during the workday


name: Discuss options for milk expression (e.g., hand, manual, and electrical pumping)


name: Instruct patient to express enough milk via hand, manual, or electrical pumping to reduce breast pressure but not enough to empty breast


name: Assist patient in securing a good quality breast pump for use


name: Assist patient in determining schedule (e.g., frequency and duration) for milk expression based on individual factors (e.g., length of time after giving birth, frequency of emptying breasts, and amount of milk currently being produced)


name: Monitor breast engorgement and associated discomfort or pain


name: Instruct patient on measures to reduce discomfort or pain (i.e., ice packs or cold cabbage leaves applied to breasts; analgesics)


name: Provide anticipatory guidance on physiological changes (i.e., uterine cramping and presence of scant milk postlactation suppression)


name: Discuss feelings, concerns, or issues patient may have pertaining to lactation cessation


name: Assure all personnel working in a laser environment have knowledge of established laser safety, including review of safety information supplied by the laser manufacturer


name: Assure all personnel operating laser equipment have proper training


name: Determine the nominal hazard zone (i.e., the space in which the level of direct, reflected, or scattered radiation used during normal laser operation exceeds the applicable maximum permissible exposure)


name: Place clearly marked laser signs at all entrances to laser treatment areas when lasers are in use


name: Assure that all doors and windows in the nominal hazard zone remain closed


name: Assure that windows, including door windows, are covered with a barrier that blocks transmission of a beam to the type of laser being used, as appropriate


name: Implement procedures to prevent accidental activation or misdirection of laser beams


name: Restrict access to laser keys to authorized personnel


name: Place lasers in standby mode when not in active use


name: Place laser foot switch in a position convenient to the operator, with the activation mechanism identified


name: Assure laser user is the only one to activate the device with the foot pedal


name: Assure that laser assistant does not have competing responsibilities that would require leaving the laser unattended during active use


name: Provide for ease of access to the emergency shut off switch to disable the laser in case of a component breakdown or unto-ward event


name: Minimize reflective surfaces during laser surgery


name: Provide appropriate laser, fibers, filters, lenses, and attachments, as appropriate


name: Assure that persons in the nominal hazard zone wear protective eyewear or use filters of specific wavelength and optical density for the laser in use


name: Assure that correct laser wavelength and optical density eye protection is available at the entrance to a room where a laser is in use


name: Assure that patient's eyes and eyelids are protected from the laser beam


name: Verify that instruments and supplies are laser safe


name: Remove surgical smoke by use of a smoke evacuation system in both open and minimally invasive procedures to prevent occupational exposure to laser-generated airborne contaminants


name: Consider used smoke evacuator filters, tubing, and wands potentially infectious waste and handle using standard precautions; dispose of as biohazardous waste


name: Assure that personnel wear respiratory protection (e.g., fit-tested surgical N95 filtering face piece respirator, high-filtration surgical mask) during procedures that generate surgical smoke


name: Check fire-extinguishing supplies and equipment


name: Assure that personnel are prepared to extinguish fires using the appropriate extinguisher per laser type based on manufacturer's suggestions


name: Protect exposed tissues around surgical site with saline-saturated materials when lasers with a thermal effect are being used


name: Monitor environment for possible fire, adhering to local, state and federal regulations pertaining to laser use


name: Monitor environment for flammable substance or breaks in precautions, assuring that laser surgery is not performed in an oxygen-rich environment


name: Assure that laser-resistant endotracheal tubes are used to minimize the potential for fire during laser procedures involving the patient's airway or digestive tract


name: Provide a laser log as an adjunct to the perioperative documentation, as appropriate


name: Document service and maintenance activities


name: Instruct visitors about latex-free environment (e.g., latex balloons)


name: Tailor the content to the patient's cognitive, psychomotor, and affective abilities


name: Adapt the information to comply with the patient's lifestyle and routines


name: Relate the information to the patient's personal desires and needs


name: Incorporate animation in multimedia presentations, when possible and appropriate


name: Provide instructional pamphlets, videos, and online resources, when appropriate


name: Encourage the patient to share valid experiences throughout the learning experience


name: Encourage free expression of different opinions and ideas


name: Provide verbal prompts and reminders, as appropriate


name: Refer the patient to appropriate online resources including support groups


name: Administer antibiotics to prevent iatrogenic A. hydrophilia infection, as appropriate


name: Monitor hemoglobin and hematocrit at least once a day, as appropriate


name: Establish rapport by using empathy, warmth, spontaneity, organization, patience, and persistence


name: Determine the life skill learning needs of the patient, family, group, or community


name: Determine level of knowledge of the life skill


name: Appraise the patient's current level of skill and understanding of the content


name: Mutually agree upon goals for the life skills program


name: Determine number of sessions and length of time of the program


name: Enhance motivation by setting achievable incremental goals


name: Appraise the patient's cognitive, psychomotor, and affective abilities and disabilities


name: Determine the patient's ability to learn specific information (i.e., consider the patient's developmental level, physiological status, orientation, pain, fatigue, unfulfilled basic needs, emotional state, and adaptation to illness)


name: Determine the patient's motivation to learn specific information (i.e., consider the patient's health beliefs, past noncompliance, bad experiences with health care or learning, and conflicting goals)


name: Tailor the content to the patient's cognitive, psychomotor, and affective abilities and disabilities


name: Break more complex skills into their stepwise components to enable incremental progress


name: Use role-playing of appropriate behaviors with scenarios that simulate real life interpersonal interactions


name: Provide positive feedback contingent on improvements in the patient's improved learning skill


name: Use assignments to practice and enhance the performance of new skills in real life situations


name: Instruct on strategies designed to enhance communication skills, if needed


name: Provide assertiveness training, if needed


name: Use strategies to enhance the patient's self awareness


name: Provide appropriate social skills training, if needed


name: Instruct patient how to manage conflict, if needed


name: Instruct patient in setting priorities and decision making


name: Provide instruction on time management, if needed


name: Provide instruction on diet, nutrition, and food preparation, if needed


name: Instruct patient in the use of stress management techniques, as appropriate


name: Instruct patient on how to manage his or her illness symptoms, if appropriate


name: Instruct patient on medication management, if appropriate


name: Instruct the patient on workplace fundamentals (e.g., improving job performance, leaning about specific workplace and performance expectations, making friends and appropriate socializing)


name: Identify and arrange for participation in leisure activities


name: Provide assistance in managing finances and creating a budget, if indicated


name: Include the family or significant others, as appropriate


name: Use a consistent, matter-of-fact, nonjudgmental approach


name: State limit or identify (with patient input, when appropriate) undesirable patient behavior


name: Communicate the limit in positive terms (e.g., "keep your clothes on," rather than "that behavior is inappropriate")


name: Discuss concerns with patient about behavior


name: Establish consequences (with patient input, when appropriate) for occurrence or nonoccurrence of desired behaviors


name: Discuss with patient what is desirable behavior in a given situation or setting, when appropriate