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: 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: 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: 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 30-45 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: 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: Apply external cooling methods (e.g., cold packs to neck, chest, abdomen, scalp, armpits, and groin; cooling blanket), as appropriate


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


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: 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, coma)


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


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


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


name: Compare maternal and newborn blood groups and types


name: Monitor umbilical cord for redness and drainage


name: Apply restraints when indicated and monitor appropriately throughout use


name: Monitor for hypoglycemia and anomalies if mother has diabetes


name: Instruct parent to recognize symptoms of hyperbilirubinemia


name: Promote and facilitate family bonding and attachment with newborn


name: Instruct parent to recognize signs of breathing difficulty


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


name: Monitor for change in energy level or malaise


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


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 enough tourniquet pressure to impede venous circulation but not arterial flow


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


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


name: Monitor intravenous flow rate and intravenous site during infusion


name: Record intake and output, as appropriate


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


name: Encourage free expression of different opinions and ideas


name: Provide verbal prompts and reminders, 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


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


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


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


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


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


name: Screen for depression to establish baseline


name: Establish the purpose and proposed number of visits


name: Establish an agreeable place and time for the visits


name: Maintain patient confidentiality and privacy


name: Use personal strengths to establish relationship with patient


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


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


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


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


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


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


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


name: Assist patient to identify most important problem


name: Assist patient to generate a list of solutions


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


name: Encourage patient to select desired solutions


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


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


name: Evaluate depression symptoms at appropriate intervals


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


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


name: Notify surgical team of patient history or risk status


name: Maintain emergency equipment for malignant hyperthermia, per protocol


name: Monitor vital signs, including core body temperature


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


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


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


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


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


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


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


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


name: Apply cooling blanket or commercial cooling device over torso


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


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


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


name: Administer sufficient IV fluids to maintain urine output


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Ensure change of ventilator circuits every 24 hours


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Monitor patient and ventilator synchronicity and patient breath sounds


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


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


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


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


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


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


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


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


name: Brush gingiva gently if patient is edentulous


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Monitor the depth of the endotracheal tube


name: Consider use of oral intubation over nasal intubation


name: Keep endotracheal tube tapes clean and dry


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


name: Monitor daily for evidence of readiness for extubation


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


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


name: Instruct patient and family about oral care routine


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


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


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


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


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


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


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


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


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


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


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


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


name: Aspirate interpleural catheter fluid before all injections of medication


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


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


name: Anticipate potential complications of analgesia technique in relation to device and medications being used


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


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


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


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


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


name: Inject needle quickly at a 90-degree angle


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


name: Determine flow rate and adjust accordingly


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


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


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


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


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


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


name: Determine past health history and medication use


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


name: Determine when medications were last taken


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


name: Communicate discrepancies to ordering practitioners as needed


name: Discuss the patient's previous experience with meditation


name: Discuss the patient's desire to learn meditation


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


name: Provide quiet time, free of interruptions


name: Suggest the patient wear comfortable clothing


name: Decide how long the meditation session will be


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


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


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


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


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


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


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


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


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


name: Provide self-care resources for use by patient


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


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


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


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


name: Be neither too rigid nor too flexible with rules


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


name: Notice and reinforce new, adaptive behaviors


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


name: Communicate individual patient treatment goals with all staff members


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


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


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


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


name: Encouraging appropriate patient-to-patient interactions


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


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


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


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


name: Summarize health status data pertinent to planning patient care


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


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


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


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


name: Discuss progress toward desired patient outcomes


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


name: Document treatment plans in the interdisciplinary progress notes


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


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


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


name: Prepare irrigating solution using premade packets or household ingredients


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


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


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


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


name: Instill approximately half of prepared solution into nostril


name: Instruct patient to breathe normally through mouth


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


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


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


name: Cleanse irrigating device after each use


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


name: Instruct patient on techniques for self-irrigation


name: Administer nasal medication, if necessary


name: Provide referral to health care provider


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Encourage to learn strategies for managing own nausea


name: Consider cultural influence on nausea response when implementing interventions


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


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


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


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


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


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


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


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


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


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


name: Monitor sharp and dull or hot and cold discrimination


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


name: Monitor craniotomy or laminectomy dressing for drainage


name: Increase frequency of neurological monitoring, as appropriate


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


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


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


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


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


name: Encourage interaction with healthy peers


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


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


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


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


name: Identify patient's food allergies or intolerances


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


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


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


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


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


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


name: Perform or assist patient with oral care before eating


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Determine appropriate amount of weight gain during antepartum period


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


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


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


name: Identify recent changes in appetite and activity


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


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


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


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


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


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


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


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


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


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


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


name: Initiate treatment or provide referral, as appropriate


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Administer IV fluids and vasoactive medications as prescribed


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


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


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


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


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


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


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


name: Conduct community education programs about organ donation and transplant


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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