name: Instruct patient about potential defibrillator complications from electromagnetic interference (inappropriate discharges, potential proarrhythmic effects of defibrillator, decreased defibrillator generator life, cardiac arrhythmia and arrest)


name: Instruct patient about basic safety in avoidance of electromagnetic interference (e.g., 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 defibrillator)


name: Instruct patient about 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 special considerations at airport or government building security gates (e.g., always inform security guard of implantable defibrillator; 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 defibrillator and cause malfunction


name: Instruct patient to check manufacturer warnings when in doubt about household appliances


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


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


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


name: Monitor for defibrillator problems that have occurred between scheduled checkup visits (e.g., inappropriate discharges, frequent discharges)


name: Instruct patient to keep a detailed log of all discharges (e.g., time, location, and activity of patient when discharge occurred; physical symptoms before and after discharge) to review with the physician


name: Instruct patient to consult primary cardiologist for all changes in medications


name: Instruct patient with new defibrillator to refrain from operating motor vehicles until permitted per primary cardiologist (usually 3-6 months after the last symptomatic arrhythmic event)


name: Instruct patient about the need for regular interrogation of defibrillator by cardiologist for routine maintenance


name: Instruct patient about the need to obtain chest x-ray annually for defibrillator placement confirmation


name: Avoid frightening family or friends about unexpected shocks


name: Instruct patient's family (particularly sexual partners) that no harm comes to a person touching a patient who is receiving a defibrillator discharge (e.g., may feel the shock, but it is not harmful)


name: Teach patient and family member(s) precautions and restrictions required


name: Explore psychological responses (e.g., changes in self-image, depression due to driving restrictions, fear of shocks, increased anxiety, concerns related to sexual activities, changes in partner relationships)


name: Encourage patient and family members to attend CPR classes


name: Encourage attendance at support group meetings


name: Estimate the effect on the nurse's time with the patient and subsequent development of a trusting relationship


name: Be familiar with the defined scope of practice, as outlined by state law and facility guidelines, of the health care provider that will assume the tasks, as appropriate


name: Explain the task to the health care worker


name: Ask questions to learn and clarify the other's understanding of the care to be provided


name: Identify etiological factors causing delirium (e.g., check hemoglobin oxygen saturation)


name: Recognize and document the motor subtype of the delirium (e.g., hypoactive, hyperactive, and mixed)


name: Increase surveillance with a delirium rating scale universally understood by nursing staff when confusion first appears so that acute changes can be easily tracked


name: Use family members or friendly hospital volunteers for surveillance of agitated patients instead of restraints


name: Acknowledge the patient's fears and feelings


name: Avoid demands for abstract thinking if patient can think only in concrete terms


name: Limit need for decision making if frustrating or confusing to patient


name: Administer PRN medications for anxiety or agitation, but limit those with anticholinergic side effects


name: Reduce sedation in general, but do control pain with analgesics, as indicated


name: Do not validate a delirium patient's misperceptions or inaccurate interpretations of reality (e.g., hallucinations or delusions)


name: Respond to the tone, rather than the content, of the hallucination or delusion


name: Remove stimuli that create excessive sensory stimuli (e.g., television or broadcast intercom announcements), when possible


name: Convey unconditional acceptance and support


name: Respond to the patient's delusions with calm, realistic statements


name: Encourage discussion of fears, anxiety, and anger without assuming that the delusion is right or wrong


name: Provide recreational, diversional activities that require attention or skill


name: Protect the patient and others from delusional behaviors that might be harmful


name: Provide appropriate level of surveillance and supervision to monitor patient


name: Administer antipsychotic and antianxiety medications on a routine and as needed basis


name: Provide illness teaching to patient and significant others, if delusions are illness-based (e.g., delirium, schizophrenia, or depression)


name: Avoid unfamiliar situations, when possible (e.g., room changes and appointments without familiar people present)


name: Give pain medication before bath if movement is painful


name: Identify usual patterns of wandering behavior


name: Facilitate caregiver's contact with community resources, as appropriate


name: Monitor prescribed medication regime, as appropriate


name: Instruct parent on what constitutes appropriate infant nutrition and nutritional habits


name: Discuss and support decision to breastfeed or bottle feed


name: Instruct on proper storage, preparation, and handling of breast milk or prepared infant formula


name: Introduce solid foods at approximately 6 months of age, instructing parent on the selection and preparation of foods, methods of introduction, and food storage


name: Instruct parent to avoid offering the infant a bottle containing juice or milk when in bed


name: Provide anticipatory guidance for infant weaning, including signs of readiness


name: Encourage establishment of bedtime rituals that reduce or eliminate disturbances in sleep-wake cycle


name: Assisting parent in identifying presence of sleep disturbance or disorder


name: Determine appropriate management technique for sleep disturbance or disorder


name: Provide visual, auditory, tactile, and kinetic stimulation during play


name: Structure play and care around infant's behavioral style and temperament patterns


name: Provide developmentally appropriate, safe toys and activities


name: Explain the need for fluoride supplementation beginning at 6 months of age


name: Instruct parent to begin cleaning infant's oral cavity with damp cloth upon eruption of first tooth


name: Determine appropriate scheduling for initial and subsequent dental examinations


name: Perform recommended screenings (e.g., anemia, lead exposure, and vision)


name: Provide accurate information pertaining to risks, benefits, contraindications, and side effects of scheduled immunizations


name: Identify need for additional immunizations for selected groups of children


name: Provide anticipatory guidance concerning discipline, dependency, increased mobility, and safety


name: Discuss timeout versus corporal punishment strategies for discipline, encouraging the former


name: Instruct parent on injury prevention strategies tailored to child's specific developmental stage and curiosity level


name: Encourage provision of safe space for infant exploration


name: Discuss injury prevention strategies for fire and electrical burns, suffocation and aspiration, poisoning, falls, bodily injury, drowning, and motor vehicle injury


name: Instruct parent on prevention strategies for sudden infant death syndrome (SIDS)


name: Instruct parent about child temperament and its association with infant's interaction type with others


name: Promote and facilitate family bonding and attachment with infant


name: Support and praise parent skills and efforts


name: Discuss parent return to work and childcare options


name: Identify and address presence of family strife, lack of support, and pathology


name: Provide information to parent about child development and child rearing


name: Refer for parenting education, as needed


name: Monitor access site for redness, edema, heat, drainage, bleeding hematoma, and decreased sensation


name: Teach patient about how to care for dialysis access site


name: Avoid venipuncture and blood pressures in peripheral access extremity


name: Clamp nasogastric tube and monitor tolerance, as appropriate


name: Determine whether patient is passing flatus


name: Find ways to include patient preferences in the prescribed diet


name: Make the environment in which the meal is offered as pleasant as possible


name: Institute NPO or sips of water only for the first 24 to 48 hours after surgery, according to agency policy


name: Administer solutions of dextrose, saline, or lactated Ringer's to provide adequate nutrition in first 24 hours and until patient can tolerate a full liquid diet


name: Progress to a liquid diet that lasts 2 to 3 weeks


name: Instruct patient to sip room-temperature liquids (e.g., broth, unsweetened juice, milk) slowly, consuming between two to three ounces at a time


name: Instruct patients to carry with them sugar-free beverages and drink often


name: Incorporate pureed foods (e.g., broth blended with well-cooked beans, fish, or ground meats; yogurt; blended fruits) in diet once the patient's body has adjusted to liquids


name: Instruct patient to eat the protein foods on the plate first


name: Progress to firmer foods that are low in sugar, low in saturated and trans-fat, and contain high-quality protein, maintaining this diet for life


name: Encourage patients to eat breakfast and at least four to five small meals daily


name: Instruct patients to take small bites, eat slowly, and chew solids that are well-cooked


name: Instruct patients to incorporate fresh fruits and vegetables in their fluid and food intake


name: Monitor for lactose intolerance as a possible postsurgical complication


name: Work with a dietitian after surgery to ensure that protein nutrition is optimal and to modify the diet as required


name: Instruct patient to avoid foods and beverages with large amounts of sugar (e.g., soda, juice drinks, milk shakes, regular ice cream) as these may cause a dumping syndrome


name: Instruct patient to avoid drinking approximately half an hour before eating, during the meal, and half an hour after the meal to reduce vomiting and diarrhea


name: Instruct patient about need to take an adult strength multivitamin with iron, a B-complex supplement, and added calcium


name: Encourage patients to keep a record of types and quantities of foods that cause discomfort, distress, or intolerance


name: Encourage patients to do at least 35 minutes of daily aerobic exercise with strength training three times per week to maintain a good metabolic rate


name: Encourage the individual to choose the distraction technique(s) desired (e.g., music, engaging in conversation or telling a detailed account of event or story, recalling positive event, focusing on photo or neutral object, guided imagery, humor, or deep breathing exercises)


name: Use distraction techniques for children (e.g., play, activity therapy, reading stories, singing songs, or rhythm activities) that are novel, appeal to more than one sense, and do not require literacy or thinking ability


name: Identify with the patient a list of pleasurable activities (e.g., exercise, going for walks, bubble baths, talking to friends or family)


name: Instruct patient how to engage in the distraction (e.g., prompting neutral word, equipment, or materials) before the time needed, if possible


name: Use distraction alone or in conjunction with other measures or distractions, as appropriate


name: Take minutes with a laptop or tablet in addition to any recording device used


name: Ensure that any electronic devices and media are connected and working well


name: Sit close to the officiating officer so you can easily ask questions and get clarification


name: Circulate an attendance list labeled with the meeting's name and date


name: Take advantage of name tags or placards if participants' names are unfamiliar


name: Begin the document with the name of the facility or organization committee as well as the meeting's location, time, place, and date


name: List names of those who are present and possibly the names of those absent or excused


name: Identify the purpose of the meeting and the officiating officer


name: Use the agenda as a structure for the minutes, but record the minutes to reflect the actual sequence of events (e.g., approval of minutes of previous meetings, approval of agenda, unfinished business, new business)


name: Record all motions and the outcomes of all votes


name: Include key discussion items and actions that have been agreed upon including assignments and timelines


name: Record any additional items, including announcements and adjournment of the meeting


name: Create an attachments list of any reports distributed for the meeting


name: Keep the writing clear, objective, and succinct


name: Finish the minutes as soon as possible while the details are fresh in mind


name: Include your name at the end as the minute's recorder


name: Proofread the document and send to the chair for approval


name: Distribute the minutes to the membership before the next meeting


name: File approved minutes according to organizational policy


name: Consult the most current edition of Robert's Rules of Order for information on meeting protocol and taking minutes


name: Monitor signs and symptoms (e.g., redness, burning, itching, drainage, pain around and in the eye, difficulty in opening eyes on waking and moving lids, blurred vision) of dry eye


name: Identify personal characteristics (e.g., age, gender, hormones, autoimmune diseases, chemical burn) and environmental factors (e.g., dry air, air conditioning, sunlight) that may increase potential of dry eye


name: Monitor amount of tearing using tear strips


name: Screen the corneal epithelial damage using a standard test


name: Monitor patient's ability to wear, remove, and clean contact lenses, as appropriate


name: Instruct patient to avoid prolonged reading and lengthy computer use


name: Ensure the endotracheal bandages are not too tight in patients ventilated through an endotracheal tube


name: Monitor the mode and the pressure of the ventilator in mechanically ventilated patients


name: Identify the frequency and the type of the care according to the eyelid position in lagophthalmos (e.g., in comatose, under deep sedation and neuromuscular blockage, facial paralysis, Bell's palsy, thyrotoxic exophthalmos, paralytic ectropion)


name: Administer eye care at least twice a day, as appropriate


name: Apply lubricants (e.g., eye drops, ointments) to support tear production, as appropriate


name: Cover the eyes with effective devices (e.g., polyethylene cover, polyacrylamide gel, hypoallergenic tape), as appropriate


name: Prepare the patient for a tarsorrhaphy to protect the cornea


name: Inspect ocular surface and the cornea for effects of care and prophylactic treatment


name: Report abnormal signs and symptoms to the physician


name: Assist patient and family to identify a shared meaning of death


name: Seek to understand patient's actions, feelings, and attitudes


name: Facilitate care by others, as appropriate


name: Facilitate referral to hospice, as desired


name: Monitor for signs and symptoms of autonomic dysreflexia (e.g., paroxysmal hypertension, bradycardia, tachycardia, diaphoresis higher than the level of injury, facial flushing, pallor lower than the level of injury, headache, nasal congestion, engorgement of temporal and neck vessels, conjunctival congestion, chills without fever, pilomotor erection, and chest pain)


name: Investigate and remove offending cause (e.g., distended bladder, fecal impaction, skin lesions, constricting bed clothes, supportive stockings, and abdominal binders)


name: Place head of bed in upright position to decrease blood pressure and promote cerebral venous return, as appropriate


name: Apply electrocardiographic (ECG) "wireless" telemetry or "hardwired" electrodes and connect to a cardiac monitor, as indicated


name: Ensure appropriate lead selection in relation to patient needs


name: Ensure proper lead placement, and signal quality


name: Ensure ongoing monitoring of bedside ECG by qualified individuals


name: Monitor ECG changes that increase risk of dysrhythmia development (e.g., arrhythmia, ST-segment, ischemia, and QT-interval monitoring)


name: Facilitate acquisition of a 12-lead ECG, as appropriate


name: Ensure ready access of emergency dysrhythmia medications


name: Administer basic or advanced cardiac life support, if indicated


name: Instruct patient and family about the risks associated with the dysrhythmia(s)


name: Instruct patient and family about actions and side effects of prescribed medications


name: Instruct patient and family about self-care behaviors associated with use of permanent pacemakers and AICD devices, as indicated


name: Instruct patient and family about measures to decrease the risk of recurrence of the dysrhythmia(s)


name: Instruct patient and family about how to access the emergency medical system


name: Monitor anatomical structures for signs and symptoms of infection (e.g., inflamed tissue and drainage)


name: Instruct patient on the ear's anatomical structures and their function


name: Monitor for patient-reported signs and symptoms of dysfunction (e.g., pain, tenderness, itching, change in hearing, tinnitus, and vertigo)


name: Monitor episodes of chronic otitis media (i.e., ensure appropriate preventative measures and treatments are employed)


name: Instruct parent how to observe for signs and symptoms of auditory dysfunction or infection in child


name: Instruct patient on importance of annual hearing testing


name: Instruct women of childbearing age on importance of prenatal care (e.g., avoidance of ototoxic medications, adequate dietary intake, and strict control of alcoholism)


name: Inform parent about vaccinations, which eliminate the possibility of sensorineural hearing loss (e.g., vaccination against rubella, measles, and mumps)


name: Cleanse external ear using washcloth-covered finger


name: Monitor for an excessive accumulation of cerumen


name: Instruct parent to ensure child does not place foreign objects into ear


name: Instruct patient how to monitor for persistent exposure to loud noise


name: Instruct patient on importance of hearing protection during persistent exposure to loud noise


name: Instruct parent to avoid bottle-feeding or allowing infant to bottle-feed when in supine position


name: Encourage use of earplugs for swimming if patient is susceptible to ear infections


name: Instruct patient on appropriate use of and care for assistive devices or treatments (e.g., hearing aids, medication regimen, and ear tubes)


name: Instruct patient on signs and symptoms warranting reporting to health care provider


name: Refer patient to ear care specialist, as needed


name: Limit physical activity as needed to promote weight gain


name: Monitor for abnormal serum electrolytes, as available


name: Consult physician on administration of electrolyte-sparing medications (e.g., spironolactone), as appropriate


name: Minimize the amount of ice chips or oral intake consumed by patients with gastric tubes connected to suction


name: Teach patient and family about the type, cause, and treatments for electrolyte imbalance, as appropriate


name: Place on cardiac monitor, as appropriate


name: Monitor trends in serum levels of calcium (e.g., ionized calcium) in at risk populations (e.g., patients with malignancies, hyperparathyroidism, prolonged immobilization in severe or multiple fractures or spinal cord injuries)


name: Estimate the concentration of the ionized fraction of calcium when total calcium levels only are reported (e.g., use serum albumin and appropriate formulas)


name: Monitor patients receiving medication therapies that contribute to continued calcium elevation (e.g., thiazide diuretics, milk-alkali syndrome in peptic ulcer patients, Vitamin A and D intoxication, lithium)


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


name: Monitor for digitalis toxicity (e.g., report serum levels higher than therapeutic range, monitor heart rate and rhythm before administering dose, and monitor for side effects)


name: Observe for clinical manifestations of hypercalcemia (e.g., excessive urination, excessive thirst, muscle weakness, poor coordination, anorexia, intractable nausea [late sign], abdominal cramps, obstipation [late sign], confusion)


name: Monitor for psychosocial manifestations of hypercalcemia (e.g., confusion, impaired memory, slurred speech, lethargy, acute psychotic behavior, coma, depression, and personality changes)


name: Monitor for cardiovascular manifestations of hypercalcemia (e.g., dysrhythmias, prolonged PR interval, shortening of QT interval and ST segments, cone-shaped T wave, sinus bradycardia, heart blocks, hypertension, and cardiac arrest)


name: Monitor for GI manifestations of hypercalcemia (e.g., anorexia, nausea, vomiting, constipation, peptic ulcer symptoms, abdominal pain, abdominal distention, paralytic ileus)


name: Monitor for neuromuscular manifestations of hypercalcemia (e.g., weakness, malaise, paresthesias, myalgia, headache, hypotonia, decreased deep tendon reflexes, and poor coordination)


name: Monitor for electrolyte imbalances associated with hypercalcemia (e.g., hypophosphatemia or hyperphosphatemia, hyperchloremic acidosis, and hypokalemia from diuresis), as appropriate


name: Provide therapies to promote renal excretion of calcium and limit further buildup of excess calcium (e.g., IV fluid hydration with normal saline or half-normal saline and diuretics; mobilizing the patient; restricting dietary calcium intake), as appropriate


name: Monitor for systemic allergic reactions to calcitonin


name: Avoid false reports of hyperkalemia resulting from improper collection methodology (e.g., prolonged use of tourniquets during venous access; unusual exercise of extremity before venous access; delay in delivery of sample to laboratory)


name: Verify all highly abnormal elevations of potassium


name: Monitor gastrointestinal manifestations of hyperkalemia (e.g., nausea, intestinal colic)


name: Monitor fluid status (e.g., intake and output, weight, adventitious breath sounds, shortness of breath), as appropriate


name: Encourage adherence to dietary regimens (e.g., avoiding high-potassium foods, meeting dietary needs with salt substitutes and low-potassium foods), as appropriate


name: Monitor for digitalis toxicity (e.g., report serum levels higher than therapeutic range; monitor heart rate and rhythm before administering dose; and monitor for side effects), as appropriate


name: Monitor for unintentional potassium intake (e.g., penicillin G potassium or dietary), as appropriate


name: Monitor potassium levels after therapeutic interventions (e.g., diuresis, dialysis, electrolyte-binding and electrolyte-excreting resins)


name: Monitor for rebound hypokalemia (e.g., excessive diuresis, excessive use of cation-exchanging resins, and postdialysis)


name: Monitor for cardiac instability and/or arrest and be prepared to institute ACLS, as appropriate


name: Assess dietary and pharmaceutical intake of magnesium


name: Monitor for causes of increased magnesium levels (e.g., magnesium infusions, parenteral nutrition, magnesium rich dialysate solutions, antacids, laxatives, frequent magnesium sulfate enemas, lithium therapy, renal insufficiency or failure)


name: Monitor for causes of impaired magnesium excretion (e.g., renal insufficiency, advanced age)


name: Monitor urinary output in patients on magnesium therapy


name: Monitor for cardiovascular manifestations of hypermagnesemia (e.g., hypotension, flushing, bradycardia, heart blocks, widened QRS, prolonged QT, and peaked T waves)


name: Monitor for CNS manifestations of hypermagnesemia (e.g., drowsiness, lethargy, confusion, and coma)


name: Monitor for neuromuscular manifestations of hypermagnesemia (e.g., weak-to-absent deep tendon reflexes, muscle paralysis, and respiratory depression)


name: Administer prescribed calcium chloride or calcium gluconate IV to antagonize neuromuscular effects of hypermagnesemia, as appropriate


name: Increase fluid intake to promote dilution of serum magnesium levels and urine output, as indicated


name: Maintain bed rest and limit activities, as appropriate


name: Position patient to facilitate ventilation, as indicated


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


name: Monitor trends in serum levels of sodium in at-risk populations (e.g., unconscious patients, very old or very young patients, cognitively impaired patients, patients receiving hypertonic intravenous infusions)


name: Monitor sodium levels closely in the patient experiencing conditions with escalating effects on sodium levels (e.g., diabetes insipidus, ADH deficiency, heatstroke, near drowning in sea water, dialysis)


name: Monitor for neurological or musculoskeletal manifestations of hypernatremia (e.g., restlessness, irritability, weakness, disorientation, delusions, hallucinations, increased muscle tone or rigidity, tremors and hyperreflexia, seizures, coma [late signs])


name: Monitor for cardiovascular manifestations of hypernatremia (e.g., orthostatic hypotension, flushed skin, peripheral and pulmonary edema, mild elevations in body temperature, tachycardia, flat neck veins)


name: Monitor for GI manifestations of hypernatremia (e.g., dry swollen tongue and sticky mucous membranes)


name: Obtain appropriate laboratory specimens for analysis of altered sodium levels (e.g., serum and urine sodium, serum and urine chloride, urine osmolality, and urine specific gravity)


name: Monitor for electrolyte imbalances associated with hypernatremia (e.g., hyperchloremia and hyperglycemia), as appropriate


name: Monitor for insensible fluid loss (e.g., diaphoresis and respiratory infection)


name: Offer fluids at regular intervals for debilitated patients


name: Administer adequate water intake for patients receiving enteral feeding therapy


name: Collaborate for alternate routes of intake when oral intake is inadequate


name: Administer isotonic (0.9%) saline, hypotonic (0.45% or 0.3%) saline, hypotonic (5%) dextrose, or diuretics based on fluid status and urine osmolality


name: Administer prescribed antidiuretic agents (e.g., desmopressin [DDAVP] or vasopressin [Pitressin]) in the presence of diabetes insipidus


name: Avoid administration/intake of high-sodium medications (e.g., sodium polystyrene sulfonate [Kayexalate], sodium bicarbonate, hypertonic saline)


name: Maintain sodium restrictions, including monitoring medications with high-sodium content


name: Administer prescribed diuretics in conjunction with hypertonic fluids for hypernatremia associated with hypervolemia


name: Instruct patient on appropriate use of salt substitutes, as appropriate


name: Institute seizure precautions in severe cases of hypernatremia, if indicated


name: Instruct the family or significant other on signs and symptoms of hypovolemia (if hypernatremia is related to abnormal fluid intake or output)


name: Monitor trends in serum levels of phosphorus (e.g., inorganic phosphorus) in at risk-populations (e.g., patients receiving chemotherapy, patients with high phosphate intake, patients with high vitamin D intake)


name: Monitor phosphate levels closely in the patient experiencing conditions with escalating effects on phosphate levels (e.g., acute and chronic renal failure, hypoparathyroidism, diabetic ketoacidosis, respiratory acidosis, profound muscle necrosis, rhabdomyolysis)


name: Monitor for electrolyte imbalances associated with hyperphosphatemia


name: Monitor for manifestations of hyperphosphatemia (e.g., tingling sensations in fingertips and around mouth, anorexia, nausea, vomiting, muscle weakness, hyperreflexia, tetany, tachycardia)


name: Monitor for symptoms of soft tissue, joint, and artery calcifications (e.g., decreased urine output, impaired vision, palpitations)


name: Administer prescribed phosphate-binding and diuretic medications with food to decrease absorption of dietary phosphate


name: Avoid laxatives and enemas that contain phosphate


name: Administer prescribed calcium and vitamin D supplements to reduce phosphate levels


name: Avoid phosphate-rich foods (e.g., dairy products, whole grain cereal, nuts, dried fruits or vegetables, and organ meats)


name: Instruct patient and/or family on signs and symptoms of impending hypocalcemia (e.g., changes in urine output)


name: Monitor trends in serum levels of calcium (e.g., ionized calcium) in at-risk populations (e.g., primary or surgically induced hypoparathyroidism; radical neck dissection [particularly first 24 to 48 hours postoperatively]; any thyroid or parathyroid surgery; patients receiving massive transfusions of citrated blood; cardiopulmonary bypass)


name: Monitor calcium levels closely in the patient experiencing conditions with depleting effects on calcium levels (e.g., osteoporosis, pancreatitis, renal failure, inadequate vitamin D consumption, hemodilution, chronic diarrhea, small bowel disease, medullary thyroid cancer, low serum albumin, alcohol abuse, renal tubular dysfunction, severe burns or infections, prolonged bed rest)


name: Observe for clinical manifestations of hypocalcemia (e.g., tetany [classic sign]; tingling in tips of fingers, feet, or mouth; spasms of muscles in face or extremities; Trousseau's sign; Chvostek's sign; altered deep tendon reflexes; seizures [late sign])


name: Monitor for psychosocial manifestations of hypocalcemia (e.g., personality disturbances, impaired memory, confusion, anxiety, irritability, depression, delirium, hallucinations, and psychosis)


name: Monitor patients receiving medications that contribute to continued calcium loss (e.g., loop diuretics, aluminum-containing antacids, aminoglycosides, caffeine, cisplatin, corticosteroids, mithramycin, phosphates, isoniazid)


name: Administer appropriate prescribed calcium salt (e.g., calcium carbonate, calcium chloride, and calcium gluconate) using only calcium diluted in D5W, administered slowly with a volumetric infusion pump, as indicated


name: Maintain bed rest for patients receiving parenteral calcium replacement therapy to control side effect of postural hypotension


name: Monitor blood pressure in patients receiving parenteral calcium replacement therapy


name: Monitor infusions of calcium chloride closely for adverse effects (higher incidence of tissue sloughing with IV infiltration; not usually initial medication of choice in treatment plans)


name: Avoid administration of medications that decrease serum ionized calcium (e.g., bicarbonate and citrated blood), as appropriate


name: Avoid administration of calcium salts with phosphates or bicarbonates to prevent precipitation


name: Monitor for exacerbation of tetany resulting from hyperventilation or pressure on efferent nerves (e.g., by crossing legs), as appropriate


name: Initiate seizure precautions in patients with severe hypocalcemia


name: Initiate safety precautions in patients with potentially harmful psychosocial manifestations (e.g., confusion)


name: Encourage increased oral intake of calcium (e.g., at least 1000 to 1500 mg/day from dairy products, canned salmon, sardines, fresh oysters, nuts, broccoli, spinach, and supplements), as appropriate


name: Administer phosphate-decreasing medications (e.g., aluminum hydroxide, calcium acetate, or calcium carbonate) as indicated in chronic renal failure patients


name: Instruct the patient on need for life-style changes to control hypocalcemia (regular weight-bearing exercises, decreased alcohol and caffeine intake, decreased cigarette smoking, strategies to reduce risks for falls)


name: Instruct patient on medications that decrease the rate of bone loss (e.g., calcitonin, alendronate, raloxifene, risedronate)


name: Monitor for early presence of hypokalemia to prevent life-threatening sequelae in at-risk patients (e.g., fatigue, anorexia, muscle weakness, decreased bowel motility, paresthesias, dysrhythmias)


name: Monitor intracellular shifts causing decreasing serum potassium levels (e.g., metabolic alkalosis; dietary [especially carbohydrate] intake; and administration of insulin), as appropriate


name: Administer supplemental potassium, as prescribed


name: Collaborate with physician and pharmacist for appropriate potassium preparations when supplementing potassium (e.g., IV potassium supplements only for severe or symptomatic hypokalemia or when the GI tract cannot be used)


name: Prevent/reduce irritation from oral potassium supplement (e.g., administer PO or NG potassium supplements during or after meals to minimize GI irritation; controlled-release microencapsulated tablets are preferred to decrease GI irritation and erosion; divide larger daily oral doses)


name: Prevent/reduce irritation from intravenous potassium supplement (e.g., consider infusion via central line for concentrations greater than 10 mEq/L; dilute IV potassium adequately; administer IV supplement slowly; apply topical anesthetic to IV site), as appropriate


name: Provide continuous cardiac monitoring if potassium replacement rate exceeds 10 mEq/hour


name: Monitor cardiac manifestations of hypokalemia (e.g., hypotension, T wave flattening, T wave inversion, presence of U wave, ectopy, tachycardia, and weak pulse)


name: Provide patient education related to hypokalemia resulting from laxative or diuretic abuse


name: Monitor for electrolyte imbalances associated with hypomagnesemia (e.g., hypokalemia, hypocalcemia), as appropriate


name: Monitor for reduced intake due to malnutrition, prolonged IV fluid therapy, or, use of enteral or parenteral nutrition containing insufficient amounts of magnesium, as appropriate


name: Monitor for decreased levels of magnesium resulting from inadequate absorption of magnesium (e.g., surgical resection of bowel, pancreatic insufficiency, inflammatory bowel disease, and excess dietary intake of calcium), as appropriate


name: Monitor for increased urinary excretion of magnesium (e.g., diuretics, renal disorders, renal excretion after transplant, diabetic ketoacidosis, hyperparathyroidism, hypoparathyroidism), as appropriate


name: Monitor for increased GI loss of magnesium (e.g., NG suctioning, diarrhea, fistula drainage, acute pancreatitis), as appropriate


name: Monitor renal sufficiency in patients receiving magnesium replacement


name: Administer prescribed oral supplements as indicated, continuing for several days after magnesium level returns to normal


name: Administer prescribed IV magnesium for symptomatic hypomagnesemia, as appropriate


name: Avoid administration of magnesium-depleting medications (e.g., loop and thiazide diuretics, aminoglycoside antibiotics, amphotericin B, digoxin, and cisplatin), as appropriate


name: Monitor for CNS manifestations of hypomagnesemia (e.g., lethargy, insomnia, auditory and visual hallucinations, agitation, and personality change)


name: Monitor for cardiovascular manifestations of hypomagnesemia (e.g., widened QRS complexes, torsades de pointes, ventricular tachycardia; flattened T waves; depressed ST segments; prolonged QT; ectopy; tachycardia; elevated serum digoxin level)


name: Monitor trends in serum levels of sodium in at-risk populations (e.g., confused elderly, patients on low-salt diet or diuretics)


name: Monitor sodium levels closely in the patient experiencing conditions with depleting effects on sodium levels (e.g., oat-cell lung cancer; aldosterone deficiency; adrenal insufficiency; syndrome of inappropriate antidiuretic hormone [SIADH]; hyperglycemia; vomiting; diarrhea; water intoxication; fistulas; excessive sweating)


name: Monitor for neurological or musculoskeletal manifestations of hyponatremia (e.g., lethargy; increased ICP; altered mental status; headache; apprehension; fatigue; tremors; muscle weakness or cramping; hyperreflexia; seizures; coma [late signs])


name: Monitor for cardiovascular manifestations of hyponatremia (e.g., orthostatic hypotension, elevated blood pressure, cold and clammy skin, poor skin turgor, hypovolemia, hypervolemia)


name: Monitor for electrolyte imbalances associated with hyponatremia (e.g., hypokalemia, metabolic acidosis, and hyperglycemia)


name: Monitor hemodynamic status, including CVP, MAP, PAP, and PCWP, as available


name: Restrict water intake as safest first line treatment of hyponatremia in patients with normal or excess fluid volume (800 mL/ 24 hours)


name: Monitor all parenteral fluids for sodium content


name: Administer hypertonic (3% to 5%) saline at 3 mL/kg/hr or per policy for cautious correction of hyponatremia in intensive care settings under close observation only, as appropriate


name: Administer plasma expanders cautiously and only in the presence of hypovolemia


name: Avoid excessive administration of hypotonic IV fluids, especially in the presence of SIADH


name: Administer diuretics (e.g., thiazides, loop diuretics similar to furosemide, or ethacrynic acid), only as indicated


name: Institute seizure precautions if indicated in severe cases of hyponatremia


name: Monitor trends in serum levels of inorganic phosphorus in at-risk populations (e.g., alcoholics, anorexia nervosa patients, severely debilitated elderly)


name: Monitor phosphate levels closely in the patient experiencing conditions with depleting effects on phosphate levels (e.g., hyperparathyroidism; diabetic ketoacidosis; major thermal burns; prolonged intense hyperventilation; overzealous administration of simple carbohydrates in severe protein-calorie malnutrition)


name: Monitor for electrolyte imbalances associated with hypophosphatemia (e.g., hypokalemia; hypomagnesemia; respiratory alkalosis; metabolic acidosis)


name: Monitor for decreasing levels of phosphate resulting from reduced intake and absorption (e.g., starvation; hyperalimentation without phosphate; vomiting; small bowel or pancreatic disease; diarrhea; and ingestion of aluminum or magnesium hydroxide antacids)


name: Monitor for decreasing phosphate levels resulting from renal loss (e.g., hypokalemia; hypomagnesemia; heavy metal poisoning; alcohol; hemodialysis with phosphate-poor dialysate; thiazide diuretics; and vitamin D deficiency)


name: Monitor for neuromuscular manifestations of hypophosphatemia (e.g., weakness, lassitude, malaise, tremors, paresthesias, ataxia, muscle pain, increased creatinine phosphokinase, abnormal EMG, and rhabdomyolysis)


name: Monitor for CNS manifestations of hypophosphatemia (e.g., irritability, fatigue, memory loss, reduced attention span, confusion, convulsions, coma, abnormal EEG, numbness, decreased reflexes, impaired sensory function, and cranial nerve palsies)


name: Monitor for hematological manifestations of hypophosphatemia (e.g., anemia; increased hemoglobin affinity with oxygen leading to increased SaO2; increased risk of infection resulting from impaired WBC functioning; thrombocytopenia; bruising and hemorrhage resulting from platelet dysfunction)


name: Administer prescribed phosphate supplements IV (replacement rate not to exceed 10 mEq/hr), as appropriate


name: Administer PO phosphate replacement therapy when possible (preferred route)


name: Monitor IV sites carefully for extravasation as tissue sloughing and necrosis occur with infiltration of phosphate supplements


name: Monitor renal function during parental phosphate supplementations, as appropriate


name: Avoid phosphate-binding and diuretic medications (e.g., Amphojel, PhosLo cookie, and Basaljel)


name: Institute preventive care for infection avoidance as hypophosphatemia causes severe depletion of granulocytes


name: Monitor for Chvostek's and/or Trousseau's sign


name: Note changes such as numbness and tremors in peripheral sensation


name: Monitor for signs and symptoms of hypokalemia: muscular weakness; cardiac irregularities (PVC); prolonged QT interval; flattened or depressed T wave; depressed ST segment; presence of U wave; fatigue; paresthesia; decreased reflexes; anorexia; constipation; decreased GI motility; dizziness; confusion; increased sensitivity to digitalis; and depressed respirations


name: Monitor for signs/symptoms of hyperkalemia: irritability; restlessness; anxiety; nausea; vomiting; abdominal cramps; weakness; flaccid paralysis; circumoral numbness and tingling; tachycardia progressing to bradycardia; ventricular tachycardia/fibrillation; tall peaked T waves; flattened P wave; broad slurred QRS complex; and heart block progressing to asystole


name: Monitor for signs and symptoms of hypocalcemia: irritability; muscle tetany; Chvostek's sign (facial muscle spasm); Trousseau's sign (carpal spasm); peripheral numbness and tingling; muscle cramps; decreased cardiac output; prolonged ST segment and QT interval; bleeding; and fractures


name: Monitor for signs and symptoms of hypomagnesemia: respiratory muscle depression; mental apathy; Chvostek's sign (facial muscle spasm); Trousseau's sign (carpal spasm); confusion; facial tics; spasticity; and cardiac dysrhythmias


name: Monitor for signs and symptoms of hypermagnesemia: muscle weakness; inability to swallow; hyporeflexia; hypotension; bradycardia; CNS depression; respiratory depression; lethargy; coma; and depression


name: Monitor for signs and symptoms of hyperphosphatemia: tachycardia; nausea; diarrhea; abdominal cramps; muscle weakness; flaccid paralysis; and increased reflexes


name: Instruct patient and family on specific dietary modifications, as appropriate


name: Determine patient knowledge about reasons for antepartum testing


name: Encourage the mother to empty the bladder


name: Perform Leopold maneuver to determine fetal position, as appropriate


name: Ensure that the mother is in a comfortable position


name: Apply toco transducer snugly at the fundus to observe contraction frequency and duration


name: Apply ultrasound transducer to area of uterus in which fetal heart sounds are audible and trace clearly


name: Obtain baseline tracing of fetal heart rate per protocol for specific testing procedure


name: Increase oxytocin infusion, per protocol, until the appropriate number of contractions are achieved (i.e., usually three contractions in 10 minutes)


name: Perform ultrasound for biophysical profile testing, per protocol or physician or midwife order


name: Score ultrasound based on protocol for biophysical profile criteria


name: Provide written discharge instructions to remind patient of future testing times and other reasons to return for care (e.g., labor onset, spontaneous leaking of the bag of waters, bleeding, decreased fetal movement)


name: Apply toco transducer snugly at the fundus to observe contraction frequency, intensity, and duration


name: Evaluate the strip every 30 minutes in the first stage and every 15 minutes during second stage


name: Document elements of the external tracing (e.g., baseline heart rate, oscillatory patterns, long-term variability, accelerations, decelerations, contraction frequency and duration)


name: Remove electronic monitors before ambulation, after verifying that the tracing is normal


name: Apply internal uterine pressure catheter after rupture of membranes for obtaining pressure data for uterine contractions and resting tone, when necessary


name: Monitor patient's mental status (e.g., dementia, delirium, developmental disabilities, altered mental status due to brain injury or illness, psychosis, depression)


name: Monitor patient for indicators of elopement potential (e.g., verbal indicators, loitering near exits, multiple layers of clothing, packing belongings, disorientation, separation anxiety, homesickness, suicidal ideation)


name: Limit patient to a physically secure environment (e.g., locked or alarmed doors at exits, locked windows), as needed


name: Provide adaptive devices to increase safety (e.g., side rails, cribs, gates, camouflaged exits, physical restraint) while always maintaining the least restrictive environment


name: Increase supervision when patient is outside secure environment (e.g., hold hands, increase staff-to-patient ratio)


name: Maintain consistent daily routine and caregivers


name: Implement an exercise program to setting, as appropriate


name: Engage the patient in structured activities (e.g., music therapy, reading, painting, drawing, supervised outdoor activities), as appropriate for setting


name: Encourage patient to seek care providers for assistance when experiencing feelings (e.g., anxiety, anger, fear) that may lead to elopement


name: Identify with patient the positive and negative consequences of leaving treatment, as appropriate


name: Encourage patient to make a commitment to continue treatment, as appropriate


name: Elicit a detailed patient health history in order to plan current and future preventative care


name: Evaluate changes in respiratory and cardiac status (e.g., new-onset wheezing, hemoptysis, dyspnea, tachypnea, tachycardia, syncope) as patients who experience DVT are at a higher risk of recurrence and PE


name: Evaluate all chest, shoulder, back, or pleuritic pain (i.e., check for intensity, location, radiation, duration, and precipitating and alleviating factors)


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


name: Monitor for signs of decreased venous circulation in affected extremity (e.g., increased extremity circumference; painful swelling and tenderness; pain worsening in dependent position; pain persisting with extremity use; palpable hard vein; enlargement of the superficial veins; severe cramping; redness and warmth; numbness and tingling; discoloration of skin; fever)


name: Elevate any suspected affected limb 20 degrees or greater, higher than the level of the heart, to improve venous return


name: Apply the Wells Prediction Rule to assist with diagnosing DVT


name: Instruct the patient and family regarding diagnostic procedures (e.g., plethysmography; computerized strain gauze; venography; d-dimer assay; multidetector spiral computerized tomography; magnetic resonance imaging; ultrasonographies), as appropriate


name: Apply graduated elastic compression stockings or sleeves to reduce the risk of postthrombotic syndrome or recurrence of DVT


name: Remove graduated elastic compression stockings or sleeves for 15 to 20 minutes every 8 hours or per organizational policy and protocol


name: Avoid antecubital intravenous access and instruct radiology and laboratory personnel to limit access of antecubital veins for tests, if possible


name: Administer intravenous promethazine only in a 25 cc to 50 cc saline solution at a slow rate and avoid giving in less than 10 cc saline dilution


name: Maintain patient on bed rest and change position every 2 hours


name: Provide for early ambulation and exercise under the direction and supervision of a physiotherapist


name: Refrain from massaging or compressing affected limb muscles


name: Instruct the patient not to massage or compress the affected area


name: Keep protamine sulfate and vitamin K available in case of emergency


name: Instruct patient not to cross legs and to avoid sitting for long periods with legs dependent


name: Instruct the patient and family on appropriate precautions (e.g., walking; drinking plenty of fluids; avoiding alcohol; avoiding long periods of immobility, especially with legs dependently positioned such as in air travel or long automobile trips)


name: Instruct the patient and family on all prophylactic, low-dose anticoagulant and/or antiplatelet medication


name: Instruct the patient to report excessive bleeding (e.g., unusual nosebleeds; vomiting blood; blood in the urine; bleeding gums; unexpected vaginal bleeding; unusually heavy menstrual bleeding; bloody or tarry bowel movements), unusual bruising, unusual pain or swelling, blue or purple color of the toes, pain in the toes, ulcers or white spots in the mouth or throat


name: Instruct the patient to wear a medical-alert bracelet


name: Instruct patient to maintain a consistent diet (i.e., eat a consistent amount of green leafy vegetables that are high in vitamin K and can interfere with anticoagulants as the medication dosage will be adjusted to dietary intake)


name: Instruct patient to take anticoagulant medication at the same time each day and not to double up the next day if a dose is missed


name: Instruct patient to check with health care provider: before taking any medication or herbal preparations, including over-the-counter products; before changing brands of medication; and before discontinuing a medication


name: Instruct the patient and family on graduated elastic compression stockings


name: Prepare for thrombolytic therapy (e.g., streptokinase, urokinase, activase), as indicated


name: Evaluate changes in respiratory and cardiac status (e.g., new-onset wheezing, hemoptysis, dyspnea, tachypnea, tachycardia, syncope) as patients who experience PE or DVT are at a higher risk of recurrence


name: Assist with diagnostic tests and assessments to rule out conditions with similar signs and symptoms (e.g., acute myocardial infarction; pericarditis; aortic dissection; pneumonia; pneumothorax; anxiety with hyperventilation; asthma; heart failure; pericardial tamponade; and gastrointestinal abnormalities such as peptic ulcer, esophageal rupture, gastritis)


name: Obtain arterial blood gas levels, as indicated


name: Monitor determinants of tissue oxygen delivery (e.g., PaO2, SaO2, hemoglobin levels, and cardiac output)


name: Initiate appropriate thromboprophylaxis regimen immediately per organizational policy and protocol


name: Apply graduated elastic compression stockings or sleeves (GECS) to reduce the risk of DVT or recurrence of DVT per organizational policy and protocol


name: Maintain graduated elastic compression stockings or sleeves to avoid development of postthrombotic syndrome (PTS)


name: Apply intermittent pneumatic compression device stockings per organizational policy and protocol


name: Remove graduated elastic compression stockings or sleeves and intermittent pneumatic compression device stockings for 15 to 20 minutes every 8 hours or per organizational policy and protocol


name: Encourage flexion and extension of feet and legs at least 10 times every hour


name: Change patient position every 2 hours, encourage early mobilization or ambulate as tolerated


name: Encourage good ventilation (e.g., incentive spirometry, cough and deep breath every 2 hours)


name: Instruct the patient and/or family regarding any planned treatments to remove the embolus (e.g., fibrinolysis, catheter embolectomy, or surgical pulmonary embolectomy)


name: Maintain thromboprophylaxis after an embolus


name: Instruct patient and family on need for anticoagulation after an embolus for a minimum of 3 months


name: Provide detailed education for patient and family related to prevention of future emboli and thrombi


name: Elicit a detailed patient health history to determine risk level of patient (e.g., recent surgery, bone fractures, current cancer treatment, pregnancy, postpartum, immobility, paralysis, edematous extremities, COPD, stroke, CVAD, history of previous DVT or PE, or obesity put patients at high risk)


name: Implement agency protocol for patients who are found at risk


name: Critically evaluate any reports of: new-onset wheezing, hemoptysis, or pain with inspiration; chest, shoulder, back, or pleuritic pain; dyspnea, tachypnea, tachycardia, or syncope


name: Evaluate for the presence of Virchow's triad: venous stasis, hypercoagulability, and trauma resulting in intimal damage


name: Perform a comprehensive appraisal of pulmonary status


name: Perform a comprehensive appraisal of peripheral circulation (i.e., check peripheral pulses, edema, capillary refill, color, presence of pain in the affected extremity, and temperature of extremity)


name: Initiate appropriate thromboprophylaxis regimen in at risk patients immediately per organizational policy and protocol


name: Maintain graduated elastic compression stockings or sleeves to avoid development of postthrombotic syndrome (PTS), which is precipitated by long-term clots in the affected extremity and poor venous flow


name: Administer intravenous promethazine in a 25 cc to 50 cc saline solution at a slow rate and avoid giving in less than 10 cc saline dilution


name: Instruct the patient and/or family on appropriate precautions (e.g., walking; drinking plenty of fluids; avoiding alcohol; avoiding long periods of immobility, especially with legs dependently positioned such as in air travel or long automobile trips)


name: Instruct the patient and/or family on all prophylactic low-dose anticoagulant and/or antiplatelet medication new


name: Obtain the automated external defibrillator (AED) or assure that someone is obtaining the automated external defibrillator, if possible and appropriate


name: Initiate rescue actions to the most critically ill patients in the case of multiple victims


name: Evaluate any unresponsive patient to determine appropriate action


name: Check for signs and symptoms of cardiac arrest


name: Employ precautionary measures to reduce risk of infection when giving care


name: Attach the AED and implement specified actions, as appropriate


name: Assure rapid defibrillation, as appropriate


name: Initiate 30 chest compressions at specified rate and depth, allowing for complete chest recoil between compressions, minimizing interruptions in compressions, and avoiding excessive ventilation, as appropriate


name: Tailor rescue actions to the most likely cause of arrest (e.g., cardiac or respiratory)


name: Check for signs and symptoms of severely compromised breathing (e.g., pneumothorax or flailing chest)


name: Provide two rescue breaths after initial 30 chest compressions completed, as appropriate


name: Provide age-appropriate care for elderly and children


name: Check for signs and symptoms of severely compromised hemodynamic status (e.g., arterial trauma or rupture)


name: Institute measures (e.g., pressure, pressure dressing, positioning) to reduce or minimize bleeding


name: Institute measures for management of shock (e.g., positioning for optimal perfusion, MAST trousers), as needed


name: Monitor vital signs, if possible and appropriate


name: Check for signs and symptoms of compromised neurological status (e.g., paralysis, paresthesia, bowel or bladder incontinence)


name: Immobilize patient with suspected head or spine injury using appropriate devices and techniques (i.e., apply cervical collar, move patient as a unit, and transport patient in supine position on backboard)


name: Position patient's body part or body-as-unit in appropriate position (e.g., body part affected with insect sting lower than heart level, and left-side lying for poison ingestion or alcohol and drug intoxication)


name: Move patient only using appropriate technique and body mechanics, when necessary


name: Monitor for signs and symptoms of hypoglycemia (e.g., shakiness, tachycardia, chills, clamminess, drowsiness, dizziness, blurred vision, confusion)


name: Remove overheated patient from direct sunlight and heat source


name: Fan the patient and give cool oral fluids, as needed


name: Administer medication (e.g., nitroglycerin, bronchodilator, activated charcoal, insulin, epinephrine, and antivenin), as needed


name: Determine type of motor vehicle accident and use of restraining devices, if appropriate


name: Determine the exact nature of trauma involved, if appropriate


name: Send suspected drugs involved with patient to treatment facility, as appropriate


name: Contact poison control center, proceeding with treatment as directed


name: Provide reassurance and emotional support to patient or family


name: Assist with ongoing treatment, providing pertinent information surrounding life-threatening situation to other health care providers


name: Coordinate medical transport, as appropriate


name: Ensure ease of usability of equipment and supplies per proper cart design and location of supplies during initial cart setup and with all checks


name: Ensure that latex-free products are stocked when available, per agency protocol


name: Ensure that equipment is operational via trial run (i.e., assemble laryngoscope and check light bulb function), as indicated


name: Ensure that defibrillator remains plugged in and charging between all uses


name: Test defibrillator per machine and agency protocol, including a trial discharge of low energy joules (less than 200)


name: Ensure safeguarding of cart supplies, equipment, and patient information per agency protocol and governmental regulations (e.g., Health Insurance Portability and Accountability Act [HIPAA])


name: Assure that the patient has the device removed at the earliest appropriate time


name: Assure that the patient is capable of maintaining a patent airway and adequate spontaneous ventilation and does not require high levels of positive airway pressure to maintain normal arterial blood oxygenation


name: Assure that extubation readiness criteria are met (e.g., stability in hemodynamic status, respiratory status, vital capacity, peak expiratory flow; respiratory frequency to tidal volume; maximal expiratory pressure)


name: Assure that patient is a candidate for problem-free extubation (e.g., breathing spontaneously, well oxygenated, CO2 normal, awake and responsive, following commands, adequate cough strength to clear secretions, adequate laryngeal function, adequate nutritional status, clearance of sedative and neuromuscular blocking effects)


name: Evaluate for known risk factors for extubation failure (e.g., age less than 70 or less than 24; Hgb less than 10 mg/dL; use of continuous IV sedation; longer duration of mechanical sedation; presence of a syndrome or chronic medical condition; known medical or surgical airway condition; frequent pulmonary toilet; loss of airway protective reflexes)


name: Provide environment in which patient can be physiologically monitored and in which emergency equipment and appropriately trained health care providers with airway management skills are immediately available


name: Provide equipment to assure patient oxygenation during extubation (e.g., oxygen source; devices to deliver oxygen; high volume suction source and catheters for tracheal and pharyngeal suctioning; appropriately sized face masks; intubation equipment such as laryngoscope blades, handles, batteries)


name: Provide equipment for emergency surgical airway procedures during extubation (e.g., scalpel, lidocaine, emergency surgical airway)


name: Provide equipment for adequate patient monitoring during extubation (e.g., pulse oximeter, cardiac monitor, supplies for ABGs)


name: Provide for patient comfort during extubation (e.g., medications for sedation, proper positioning)


name: Monitor airway protective reflexes for depression immediately after extubation and for some time after extubation to avoid aspiration complications (i.e., high risk period immediately after extubation)


name: Monitor for respiratory distress, including frequent respiratory evaluation that includes vital signs, assessment of neurological status, patency of airway, auscultatory findings, work of breathing, and hemodynamic status


name: Exercise standard precautions for all patients, using the Centers for Disease Control and Prevention recommendations for control of exposure to tuberculosis and droplet nuclei


name: Institute appropriate precautions empirically for airborne, droplet, and contact agents ending confirmation of diagnosis in patients suspected of having serious infections


name: Interact with patient and family to determine needs for home care


name: Determine reason for enema (e.g., gastrointestinal cleansing; medication administration; distention reduction)


name: Verify practitioner order for enema and absence of any contraindications (e.g., glaucoma and increased intracranial pressure)


name: Explain procedure to patient or family, including expected sensations during and after procedure (e.g., distention and urge to defecate)


name: Gather and assemble equipment specific to type of enema


name: Assist patient into appropriate position (e.g., left side-lying position with right knee flexed for adults and dorsal recumbent for children)


name: Place waterproof or absorbent pad under hips and buttocks


name: Cover patient with bath blanket leaving only rectal area uncovered


name: Ascertain appropriate temperature of irrigating solution


name: Instruct patient to exhale before inserting solution


name: Insert lubricated tip of solution container or tubing into rectum, angling tip toward umbilicus and inserting appropriate length based on patient's age


name: Squeeze bottle until all solution has entered rectum and colon


name: Determine appropriate height of enema bag, solution volume, instillation rate, and handling of tubing


name: Encourage patient to retain fluid until urge to defecate, assisting by squeezing buttocks, if necessary


name: Provide bedpan, commode, or easy access to toilet


name: Monitor character of feces and solution (e.g., color, amount, and appearance)


name: Monitor patient response to procedure, including signs of intolerance (e.g., rectal bleeding, distention, and abdominal pain), diarrhea, constipation, and impaction


name: Provide instruction to patient, caregiver, or unlicensed assistive personnel on enema administration


name: Instruct on signs that warrant ending the procedure and reporting to health care practitioner (e.g., palpitations, diaphoresis, pallor, and shortness of breath)


name: Assess patient's physiological status for deficits resulting in fatigue within the context of age and development


name: Use valid instruments to measure fatigue, as indicated


name: Correct physiological status deficits (e.g., chemotherapy-induced anemia) as priority items


name: Select interventions for fatigue reduction using combinations of pharmacological and nonpharmacological categories, as appropriate


name: Negotiate desired mealtimes, which may or may not coincide with standard hospital schedules


name: Encourage aerobic workouts, as tolerated


name: Consider electronic communication (e.g., e-mail or instant messaging) to maintain contact with friends when visits are not practical or advisable


name: Limit number of and interruptions by visitors, as appropriate


name: Promote bed rest/activity limitation (e.g., increase number of rest periods) with protected rest times of choice


name: Provide calming diversional activities to promote relaxation


name: Offer aids to promote sleep (e.g., music or medications)


name: Encourage physical activity (e.g., ambulation, performance of activities of daily living) consistent with patient's energy resources


name: Monitor patient's oxygen response (e.g., pulse rate, cardiac rhythm, respiratory rate) to self-care or nursing activities


name: Instruct the patient and/or significant other on fatigue, its common symptoms, and latent recurrences


name: Instruct patient and significant other on techniques of self-care that will minimize oxygen consumption (e.g., self-monitoring and pacing techniques for performance of activities of daily living)


name: Instruct the patient/significant other on stress and coping interventions to decrease fatigue


name: Consider aesthetics of environment when selecting roommates


name: Provide prompt attention to call bells that should always be within reach


name: Prevent unnecessary interruptions and allow for rest period


name: Provide choice whenever possible for social activities and visitation


name: Follow up to assure that plans were feasible and carried out


name: Remove potential weapons from environment (e.g., sharp and ropelike objects such as guitar strings)


name: Search environment routinely to maintain it as hazard-free


name: Identify worksite environmental hazards and stressors (e.g., physical, biological, psychological, chemical, ergonomic)


name: Understand state and local regulations related to issues such as pharmaceutical and vaccine storage, workplace safety requirements, and medical waste


name: Inform workers of their rights and responsibilities under OSHA (i.e., provide an OSHA poster, copies of Act, and copies of standards)


name: Maintain records of occupational injuries and illnesses on forms acceptable to OSHA and participate in OSHA inspections


name: Initiate modification of the environment to eliminate or minimize hazards (e.g., training programs to prevent back injuries or workplace violence)


name: Initiate worksite screening programs for early detection of work-related and nonoccupational illnesses and injuries (e.g., blood pressure, hearing and vision, pulmonary function tests)


name: Initiate worksite health promotion programs based on health risk assessments (e.g., smoking cessation, stress management, immunizations)


name: Bring unsafe working conditions to employer's attention, preserving worker confidentiality in discussions


name: Notify agencies authorized to protect environment of known hazards


name: Include parent or significant other, as appropriate


name: Alert physician to any abnormal findings (e.g., laboratory values, radiology results, patient and family concerns) away from the patient, as appropriate


name: Ensure that follow-up tests (e.g., x-ray examinations, laboratory work) are done


name: See that the examination room is cleaned and disinfected, as needed


name: Assist to set realistic short-term and long-term goals and to take ownership of exercise plan


name: Specify type and duration of warm-up and cool-down activity (e.g., stretches, walking, calisthenics)


name: Assist to develop realistic short-term and long-term goals, based on current fitness level and lifestyle


name: Stretch major muscle groups, including hip extensors, knee extensors, ankle plantar flexors, biceps, triceps, shoulders, back extensor, and abdominal muscles


name: Instruct to avoid quick, forceful, or bouncing movement to prevent overstimulation of myotatic reflex or excessive muscle soreness


name: Instruct in ways to monitor own adherence to schedule and progress toward goals (e.g., increments in joint ROM; awareness of releasing muscle tension; increasing duration of "hold" phase and number of repetitions without pain and fatigue; increases in tolerance to vigorous exercise)


name: Provide cueing cards at head of bed to facilitate learning to transfer


name: Provide opportunity to discuss factors that influence fear of falling


name: Encourage low-intensity exercise programs with opportunities to share feelings


name: Assist with ankle strengthening and walking programs


name: Provide information on alternative therapies such as yoga and Tai Chi


name: Provide resources for balance, exercise, or falls education programs


name: Provide step-by-step cueing for each motor activity during exercise or ADLs


name: Provide chairs of proper height with backrests and armrests for easy transfer


name: Determine family understanding of condition


name: Determine family feelings regarding their situation


name: Assist family to resolve unrealistic feelings of guilt or responsibility, as warranted


name: Determine typical family relationships for each family


name: Tell family members that it is safe and acceptable to use typical expressions of affection when in a hospital setting


name: Provide family members with information about the patient's condition regularly, according to patient preference


name: Collaborate with family in problem solving and decision making


name: Respect and support family's cultural value system


name: Assist family in identifying strengths and weaknesses


name: Assist family in developing adaptive coping mechanisms to deal with the transition to parenthood


name: Educate parent(s) about potential role conflict and role overload


name: Promote self-efficacy in carrying out parental role


name: Encourage parents to articulate their values, beliefs, and expectations regarding parenthood


name: Assist parents in having realistic role expectations about parenthood


name: Assist parents in dealing with suggestions, criticisms, and concerns about parental role expectations and performance from others (e.g., parents, grandparents, co-workers, friends)


name: Assist parents in gaining skills needed to perform tasks appropriate to family developmental stage


name: Assist parents in balancing work, parental, and marital roles


name: Assist mother in making plans for returning to work, as appropriate


name: Identify effect of newborn on family dynamics and equilibrium


name: Encourage parents to spend time together as a couple to maintain marital satisfaction


name: Encourage parents to discuss household maintenance role responsibilities


name: Give family information on sibling rivalry, as appropriate


name: Encourage family to use support systems, as appropriate


name: Assist family in developing new support networks, as appropriate


name: Create a culture of flexibility for the family


name: Encourage the family members and the patient to assist in the development of a plan of care, including expected outcomes, and implementation of the plan of care


name: Monitor involvement in patient's care by family members


name: Provide crucial information to family members about the patient in accordance with patient preference


name: Provide the support needed for the family to make informed decisions


name: Identify family members' perception of the situation, precipitating events, patient's feelings, and patients' behaviors


name: Determine level of patient dependence on family members for age or illness, as appropriate


name: Identify with family members the patient's strengths and abilities with family


name: Explain to family members the need for continuing of professional health care, as appropriate


name: Refer family members to support groups, as appropriate


name: Appraise patient's knowledge and understanding of contraceptive choices


name: Instruct patient on physiology of human reproduction, including both female and male reproductive systems, as needed


name: Conduct relevant physical examination if indicated by patient history


name: Determine ability and motivation for using a method


name: Determine level of commitment to consistently use method


name: Discuss religious, cultural, developmental, socioeconomical, and individual considerations pertaining to contraceptive choice


name: Discuss methods of contraception (e.g., medication-free, barrier, hormonal, intrauterine device, and sterilization), including effectiveness, side effects, contraindications, and signs and symptoms that warrant reporting to a health care professional


name: Assist adolescents to obtain contraceptive information in a confidential manner


name: Provide contraception to patient, if indicated


name: Discuss emergency contraception, as needed


name: Provide emergency contraception (e.g., morning after pill, copper intrauterine device), as appropriate


name: Instruct on safe sex activities, as indicated


name: Refer patient to other health care professional or community resources (e.g., social worker and home health care professional), as needed


name: Determine financial resources for contraception and refer, as appropriate


name: Support couple through infertility history and evaluation, acknowledging stress often experienced in obtaining detailed history and during lengthy evaluation and treatment process


name: Explain types of infertility (e.g., primary or secondary, male or female)


name: Assist female patient to determine ovulation through basal body temperature, changes in vaginal secretions, midluteal phase serum progesterone level, and other physiological indicators


name: Assist male partner to complete semen analysis and medical workup


name: Determine couple's understanding of test results and recommended therapy


name: Determine extent to which partners are able and willing to participate in complex infertility treatment


name: Assist with problem solving to help couple evaluate alternatives to biologic parenthood


name: Discuss with patient and significant other (if involved) the options regarding outcomes of pregnancy, including termination of pregnancy, keeping the infant, or relinquishing the infant for adoption


name: Discuss factors related to unplanned pregnancy (e.g., multiple partners, substance abuse, intimate partner violence, likelihood of sexually transmitted disease)


name: Clarify any misinformation about contraceptive use


name: Refer to community agencies that have services that will support patient in acting on decision regarding pregnancy outcome, as well as other health concerns (e.g., sexually transmitted diseases, substance abuse, intimate partner violence)


name: Accompany family to and from treatment or resuscitation area and announce their presence to treatment staff each time family enters treatment area


name: Encourage continued contact with family members, as appropriate


name: Minimize family routine disruption by facilitating family routines and rituals, such as private meals together or family discussions for communication and decision-making


name: Provide mechanisms for family members staying to communicate with other family members (e.g., telephones, e-mail messages, and pictures, tape recordings, photographs, and videotapes)


name: Provide opportunities for ongoing parental care of hospitalized children, when the patient is a child


name: Provide opportunities for adult family members to maintain ongoing commitments to their jobs if possible, or to use the Family Leave Act in the United States


name: Identify home care needs and how these might be incorporated into family lifestyle


name: Design schedules of home care activities that minimize disruption of family routine


name: Teach family time management/organization skills when performing home care, as needed


name: Promote open, trusting relationship with family


name: Create a supportive therapeutic environment for family


name: Facilitate communication of concerns and feelings between patient and family or among family members


name: Assist the family in prioritizing family health needs


name: Assist in organizing a network of resources designed to provide support services


name: Identify congruence among patient, family, and health professional expectations


name: Assist family to identify family strengths and coping abilities


name: Provide opportunities for family to apply coping strategies that may work in the current situation


name: Instruct the medical and nursing plans of care to family


name: Consider using a communication and information technology support system as a means to provide in home family support


name: Give care to patient when family is unable to give care


name: Initiate and coordinate referrals to social service, respite care, family therapy, financial counselors, support groups, home health care, and other community resource agencies, if indicated


name: Inform family members how to reach the nurse


name: Support the family member's need for privacy


name: Use family-history taking to encourage family discussion


name: Determine whether abuse is occurring in the family


name: Identify usual roles within the family system


name: Identify specific disturbances related to role expectations


name: Determine whether any family members are dealing with substance abuse


name: Identify areas of dissatisfaction and/or conflict


name: Determine recent or impending events that have threatened the family


name: Help family members communicate more effectively


name: Help members prioritize and select the most immediate family issue to address


name: Help family enhance existing positive coping strategies


name: Ask family members to participate in homework assignments of experiential activities such as eating some of their meals together


name: Provide challenges within family discussion to encourage new behavior


name: Assist family members to change how they relate to other family members


name: Help family set goals toward a more competent way of handling dysfunctional behavior


name: Choose different-colored dishes to help distinguish items, if perceptual deficit


name: Avoid presenting drink or bite up to mouth when still chewing


name: Advise patient to have partner treated for sexually transmitted disease, if culture positive


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


name: Facilitate rest, applying activity restrictions, if needed


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


name: Provide close supervision if patient is allowed to smoke


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


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


name: Institute appropriate care of wound or burn


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


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


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


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


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


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


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


name: Provide instructions for necessary follow-up care


name: Evaluate outcomes and cost effectiveness of program


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


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


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


name: Advise to cut back on fried and fatty foods


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Monitor BP, heart rate, and respiratory status


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


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


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


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


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


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


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


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


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


name: Obtain blood specimens for crossmatching, as appropriate


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


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


name: Establish collaborative working relationship with all additional examiners


name: Complete all parts of the examination, including normals


name: Record omissions in examinations, including rationale for omission


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


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


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


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


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


name: Measure consistently from center of the lesion being described


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


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


name: Differentiate lacerations from incised wounds and stab wounds


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


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


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


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


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


name: Use body diagrams and photographs to supplement written report


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


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


name: Draw scars in their orientation on the body


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


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


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


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


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


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


name: Ensure that photographs include a measuring scale for perspective


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Acknowledge when anger and resentment are justifiable


name: Identify source of anger and resentment, when possible


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Encourage regularly scheduled visits with a health care provider


name: Institute crisis support skills, as needed


name: Assist to identify personal coping strategies


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Tape-record the imaged experience if useful


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


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


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


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


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


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


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


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


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


name: Assist patient into comfortable position


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


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


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


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


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


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


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


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


name: Arrange for barber or hairdresser to cut hair


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


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


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


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


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


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


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


name: Provide medication information to patient and significant others


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


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


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


name: Introduce self to oncoming staff, as needed


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


name: Identify attending and consulting physicians


name: Summarize significant past health history, as necessary


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


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


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


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


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


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


name: Create a comfortable, private environment without distractions


name: Determine willingness to have body touched


name: Advise the patient to ask questions whenever they arise


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


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