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


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


name: Discourage use of multiple preceptors per student


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


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


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


name: Administer medication to terminate pregnancy, per protocol


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


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


name: Refer for psychological support or counseling, as needed


name: Consider cultural and religious beliefs and values


name: Identify individual needs, concerns, and preferences, foster involvement in decision making, and identify and address barriers to care


name: Discuss importance of participating in prenatal care throughout entire pregnancy and encourage involvement of patient's partner or other family member


name: Monitor for hypertensive disorder (e.g., blood pressure, edematous ankles, hands, and face, and proteinuria)


name: Instruct patient on quickening and importance of monitoring fetal activity


name: Review with patient changes noted on fetal growth and status


name: Discuss nutritional needs and concerns (e.g., balanced diet, folic acid, food safety, and supplements)


name: Instruct patient on effects of exposure to or ingestion of harmful substances (e.g., alcohol, illicit drugs, teratogens, medications, herbs, and tobacco)


name: Discuss activity level with patient (e.g., appropriate exercise, activities to avoid, and importance of rest)


name: Provide genetic counseling and testing if indicated


name: Instruct patient on routine laboratory testing to occur throughout pregnancy (e.g., urinalysis, hemoglobin level, ultrasound, gestational diabetes, and HIV)


name: Monitor psychosocial status of patient and patient's partner


name: Monitor for risk factors affecting patient or fetal health status (e.g., mental health disorder and intimate partner violence)


name: Offer support and counsel to the patient presenting with an unplanned or unwanted pregnancy


name: Offer anticipatory guidance about physiological and psychological changes and discomforts (e.g., nausea, vomiting, musculoskeletal changes, fears, and breast tenderness)


name: Assist patient in identifying strategies to cope with changes and relieve discomforts associated with pregnancy


name: Review safety precautions to be taken during pregnancy (e.g., seat belt use, avoidance of hot tubs and saunas, and travel restrictions)


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


name: Assist patient in preparing for labor and delivery (i.e., discuss pain management options, review labor signs and symptoms, discuss special circumstances requiring medical intervention, and encourage planned involvement of patient's partner or family)


name: Offer anticipatory guidance on infant care and considerations (e.g., circumcision, feeding, and selection of pediatric health care provider)


name: Discuss postpartal concerns and considerations (e.g., family planning and contraception, returning to work or school, and physiological and psychological changes)


name: Provide referral to appropriate service (e.g., supplemental food program, drug dependency treatment, and mental health counseling), if needed


name: Explain procedures in a way that the patient can understand


name: Communicate any concerns (e.g., abnormal laboratory or diagnostic test results, issues related to the patient's understanding of the planned procedure) to the surgeon


name: Involve patient in decisions related to surgery


name: Assure that patient has significant other for postoperative needs, such as transportation home as indicated


name: Link sensations to their cause when it may not be self-evident


name: Consider the status of the existing chronic health condition


name: Review past medical history, medications, allergies, and past diagnostic testing pertinent to the presenting condition


name: Evaluate the diagnostic utility of the test in addressing the specific clinical question (i.e., understand sensitivity and specificity of the diagnostic test for the presenting condition)


name: Consult with accepted evidence-based practice guidelines, specialists, and other health care professionals, as appropriate


name: Provide the patient or family members with the rationale for the proposed testing, including how the information would benefit clinical decision making or continued monitoring


name: Allow for discussion and questions of the testing


name: Provide alternatives to diagnostic testing, as appropriate


name: Consider the availability and cost of the diagnostic testing and include the patient and family in the discussion


name: Instruct the patient and family on what to expect of the diagnostic test


name: Have a system in place to ensure test results are received when expected


name: Identify a method that ensures accurate communication of test date, time, and location to the patient or caregiver


name: Instruct the patient and family on the test date, time, location, and how to expect test results to be reported


name: Employ a system that provides for the timely return of diagnostic test results and assurance that missing or delayed reports are noted and pursued


name: Monitor for adverse effects of the diagnostic test


name: Maintain knowledge of diagnostic testing used in practice (e.g., sensitivity or specificity, rationale, alternatives, standards of care, evidence based practice, side effects, monitoring and state regulations or policy issues)


name: Determine signs and symptoms of current health problem


name: Review past and current therapeutic treatments tried for the health problem, including the reasons for stopping treatment


name: Document the effects of other treatments on the health problem


name: Identify nonpharmacological treatments (e.g., exercise, diet, physical therapy, occupational therapy, heat and cold treatment) that are indicated for current health problems


name: Consider the availability and cost of the recommended treatment and include the patient and family in the discussion


name: Provide the patient and family members with the rationale for the proposed treatment, expected outcome, and duration of the treatment


name: Allow for questions and discussion related to the diagnosis and treatment and provide alternatives to the treatment


name: Monitor for adverse effects of the treatment


name: Ensure for follow up to assess response to treatment


name: Maintain knowledge of treatments commonly used in practice, including rationale, alternatives, standards of care, evidence-based practice, side effects, monitoring, and state regulations or policy issues


name: Ensure the presence of a person dedicated to provide support to the infant


name: Evaluate the need for painful procedures


name: Separate the number and grouping of laboratory and diagnostic procedures according to infant's tolerance


name: Avoid painful procedures at the same time as nonemergency routine care


name: Use minimal amounts of tape or adhesives


name: Use noninvasive monitoring devices whenever possible


name: Instruct parents about signs and symptoms of pain and the comfort that they can provide


name: Reduce light and noise whenever possible during painful procedures


name: Use facilitated tucking (i.e., hand swaddle to hold extremities flexed and contained close to the trunk)


name: Use blanket swaddling after a painful procedure


name: Use nonnutritive sucking with a pacifier


name: Use sucrose solution with pacifier before and throughout painful procedures


name: Facilitate breastfeeding or feed breast milk during painful procedures


name: Facilitate kangaroo care (i.e., skin-to-skin contact) with parent during painful procedures, when possible


name: Facilitate holding by parent, when possible


name: Assemble a multidisciplinary product selection and evaluation team if change will affect other providers


name: Gather information on use of the existing product that is being replaced


name: Establish criteria for product selection


name: Decide on a disposable versus a reusable product


name: Strive for standardization of inventory when within and across facilities, when possible


name: Select a product that has an uncomplicated user interface


name: Solicit input from other health care providers (e.g., biomedical engineers, pharmacists, physicians, other agencies), as needed


name: Determine whether a higher cost product achieves better patient outcomes


name: Report significant medical device adverse events to the FDA (Food and Drug Administration) as well as to the manufacturer


name: Explain the purpose and process of the technique to the patient


name: Instruct patient to wear comfortable, unrestricted clothing


name: Screen for neck or back orthopedic injuries to which hyperextension of the upper spine would add discomfort and complications


name: Screen for increased intracranial pressure, capillary fragility, bleeding tendencies, severe acute cardiac difficulties with hypertension, or other conditions in which tensing muscles might produce greater physiological injury and modify the technique, as appropriate


name: Ask patient to loosen any tight clothing


name: Instruct the patient to sit in a reclining chair or lie down on a comfortable surface


name: Instruct the patient to assume a passive attitude by focusing on achieving relaxation in specific body muscles and refrain from focusing on any other thoughts


name: Instruct the patient to take a deep breath through the abdomen and hold for a few seconds and then exhale slowly


name: Have the patient repeat the deep breathing several times, asking the patient to imagine the tension being released from the body with each exhale


name: Have the patient tense systematically, for 5 to 10 seconds, each of 8 to 16 major muscle groups progressively from head to toe


name: Begin by asking the patient to take a deep breath and tighten the muscles in the forehead by raising the eyebrows as high as possible for 5 to 10 seconds and then release the tension, focusing on the feeling of the muscles relaxing as he/she exhales


name: Pause for 10 seconds before moving on to the next muscle group


name: Establish interval of initial prompted voiding schedule based upon voiding pattern


name: Establish beginning and ending time for prompted voiding schedule if not for 24 hours


name: Prompt for maximum of three times, to use toilet or substitute regardless of continence status


name: Offer assistance with toileting regardless of continence status


name: Administer opiate antagonists, as indicated


name: Participate in selection and development of quality indicators appropriate to clinical setting and patient population


name: Include structure, process, and outcome quality indicators


name: Promote and use electronic health records for collection, exchange, and analysis of data


name: Negotiate solutions cognizant of local work loads


name: Participate on evidence-based practice and quality improvement committees, as appropriate


name: Participate on intradisciplinary and interdisciplinary problem-solving teams


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


name: Provide information to patient and family regarding radiation effect on malignant cells


name: Utilize recommended radiation precautions in the management of patients with cardiac pacemakers


name: Provide special skin care to tissue folds that are prone to infection (e.g., buttocks, perineum, and groin)


name: Avoid application of deodorants and aftershave lotions to treated areas


name: Discuss the need for skin care, such as maintenance of dye markings, avoidance of soap, and other ointments, and protection during sunbathing or heat application


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


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


name: Promote therapeutic diet to prevent complications


name: Encourage rest immediately after treatments


name: Assist patient in achieving adequate comfort levels through the use of pain management techniques that are effective and acceptable to the patient


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


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


name: Institute neutropenic and bleeding precautions, as indicated


name: Initiate and maintain protection according to agency protocol for patient receiving internal radiation treatment (e.g., gold seed placement or radiopharmaceutical agents)


name: Explain protection protocols to patient, family, and visitors


name: Limit visitor time in room, as appropriate


name: Limit staff time in the room if patient is isolated for radiation precautions


name: Distance oneself from the radiation sources while giving care (e.g., stand at the head of the bed of patient with uterine implants), as appropriate


name: Use a consistent approach (e.g., kind firmness, active friendliness, passive friendliness, matter-of-fact, and no demands) that reflects the particular needs and capabilities of the patient


name: Speak in a distinct manner with an appropriate pace, volume, and tone


name: Avoid frustrating the patient by demands that exceed capacity (e.g., repeated orientation questions that cannot be answered, abstract thinking when patient can think only in concrete terms, activities that cannot be performed, decision making beyond preference or capacity)


name: Present reality in manner that preserves the patient's dignity (e.g., provides an alternate explanation, avoids arguing, and avoids attempts to convince the patient)


name: Repeat patient's last expressed thought, as appropriate


name: Interrupt confabulation by changing the subject or responding to the feeling or theme rather than the content of the verbalization


name: Engage patient in concrete "here and now" activities (e.g., ADLs) that focus on something outside self that is concrete and reality oriented


name: Provide physical prompting and posturing (e.g., moving patient's hand through necessary motions to brush teeth), as necessary for task completion


name: Recommend patient wear personal clothing and assist, as needed


name: Provide objects that symbolize gender identity (e.g., purse or cap), as appropriate


name: Provide for adequate rest and sleep, including short-term, daytime naps, as needed


name: Encourage family to participate in care based on abilities, needs, and preferences


name: Modulate human and environmental sensory stimuli (e.g., visiting sessions, sights, sounds, lighting, smells, and tactile stimulation) based on patient's needs


name: Remove stimuli (e.g., pictures on the wall and television) that create misperception in a particular patient, when possible.


name: Provide psychoeducation to family and significant others regarding promotion of reality orientation


name: Monitor for changes in orientation, cognitive and behavioral functioning, and quality of life


name: Identify any deficits that may limit participation in recreational activities (e.g., mobility, cognitive, economic)


name: Assist patient to identify meaningful recreational activities (e.g., sports, drama, games, arts and crafts)


name: Monitor patient's physical and mental capacities while participating in recreational activities


name: Provide new recreational activities that are age and ability appropriate


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


name: Place a warm water or saline soaked cloth over the protruding bowel to protect it from drying


name: Determine whether appropriate supportive care is available in the home or community


name: Evaluate accessibility of environmental needs for the patient in the home or community


name: Inform patient of appropriate Internet sites for use after discharge


name: Contact appropriate agency or health care provider


name: Minimize time between discharge and appointment with next provider


name: Send written referral and patient's plan of care electronically, as appropriate


name: Provide patient or family member with a copy of the referral information, as appropriate


name: Create a calm and comfortable environment


name: Use aroma or gentle music to create a healing atmosphere


name: Ask about the chief complaints, such as the presence of pain in certain areas or the presence of a particular illness


name: Have the Reiki receiver sit comfortably or lay down on a massage table, fully clothed, in a supine position


name: Relax your mind and take a few deep breaths to focus yourself


name: Remember: the Reiki does the work, not the practitioner


name: Begin by sending Reiki from about 3 feet away as a gentle way of beginning the session, if possible


name: Follow a specific series of hand placements: over eyes, over ears, one hand on forehead and one hand on top of head, hands under head, over the neck, upper chest, upper abdomen, lower abdomen, thighs (one at a time), knees (one at a time), lower legs, ankles, feet, bottoms of feet, have client roll over on to stomach, shoulders, waist area, lower back, backs of legs, and front of legs


name: Draw or visualize Reiki symbols (e.g., power, mental or emotional, distance) as guided by your intuition


name: Allow your intuition to guide your movements by placing hands on (or a few inches over) the part of the body that most requires healing


name: Stay in each area for 5 to 15 minutes or until you feel the energy flow more slowly or your intuition informs you it is time to move hand position


name: Ask for specific permission during the session to work on sexual organs or parts of the body that would be considered inappropriate, if so guided


name: Move one hand at a time so that you maintain contact as much as possible


name: Note whether the patient has experienced a relaxation response and any related changes


name: Describe the rationale for relaxation and the benefits, limits, and types of relaxation available (e.g., music, meditation, rhythmic breathing, jaw relaxation, and progressive muscle relaxation)


name: Screen for current decreased energy level, inability to concentrate, or other concurrent symptoms that may interfere with cognitive ability to focus on relaxation technique


name: Use soft tone of voice with a slow, rhythmical pace of words


name: Provide undisturbed time because patient may fall asleep


name: Regularly evaluate individual's report of relaxation achieved, and periodically monitor muscle tension, heart rate, blood pressure, and skin temperature, as appropriate


name: Use relaxation as an adjuvant strategy with pain medication or in conjunction with other measures, as appropriate


name: Identify, with the patient, a theme for each session (e.g., work life)


name: Determine which method of reminiscence (e.g., taped autobiography, journal, structured life review, scrapbook, open discussion, and storytelling) is most effective


name: Introduce props (e.g., music for auditory, photo albums for visual, perfume for olfactory), addressing all five senses to stimulate recall


name: Encourage verbal expression of both positive and negative feelings of past events


name: Maintain focus of sessions, more on the process than on an end product


name: Assist the patient in creating or adding to a family tree, or to write his/her oral history


name: Use direct questions to refocus back to life events, as necessary


name: Instruct patient about ovulation prediction and detection techniques (e.g., basal temperature and urine testing)


name: Schedule tests based on the menstrual cycle, as needed


name: Collaborate with in vitro fertilization team in screening and selecting gamete donors


name: Draw specimens for endocrine determination


name: Perform ultrasound examinations to ascertain follicular growth


name: Inform about ectopic pregnancy precautions


name: Schedule follow-up medication, tests, and ultrasound examinations


name: Refer for genetic counseling related to maternal age at conception, as needed


name: Monitor breathing patterns (e.g., bradypnea, tachypnea, hyperventilation, Kussmaul respirations, Cheyne-Stokes respirations, apneustic, Biot's respiration, ataxic patterns)


name: Monitor oxygen saturation levels continuously in sedated patients (e.g., SaO2, SvO2, SpO2), per agency policy and as indicated


name: Provide for noninvasive continuous oxygen sensors (e.g., finger, nose, or forehead devices) with appropriate alarm systems in patients with risk factors (e.g., morbidly obese, confirmed obstructive sleep apnea, history of respiratory problems requiring oxygen therapy, extremes of age), per agency policy and as indicated


name: Monitor for diaphragmatic muscle fatigue, as indicated by paradoxical motion


name: Note changes in SaO2, SvO2, end tidal CO2, and ABG values, as appropriate


name: Provide frequent intermittent monitoring of respiratory status in at-risk patients (e.g., opioid therapy, newborn, mechanical ventilation, facial or chest burns, neuromuscular disorders)


name: Establish a therapeutic relationship with patient and family


name: Inform patient and family of available state funding for respite care


name: Coordinate community support services (i.e., meals, day care, summer camp)


name: Monitor skill level of respite care provider


name: Provide a program of suitable activities, as appropriate


name: Evaluate unresponsiveness to determine appropriate action


name: Obtain the automated external defibrillator (AED)


name: Attach the AED and implement specified actions


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


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


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


name: Monitor patient response to resuscitation efforts


name: Clear oral, nasal, and tracheal secretions when possible and without interfering with chest compressions, as appropriate


name: Administer manual ventilation when possible and without interfering with chest compressions, as appropriate


name: Connect the person to an ECG monitor if needed when defibrillation is completed


name: Interpret ECG and deliver cardioversion or defibrillation, as needed


name: Assist with insertion of endotracheal tube (ET), as indicated


name: Assess lung sounds after intubation for proper ET position


name: Assure organized post cardiac arrest care (e.g., safe transport to appropriate nursing care unit)


name: Offer family members opportunities to be present during resuscitation when in the best interests of the patient


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


name: Monitor fetal vital signs using auscultation and palpation or electronic fetal monitor, as appropriate


name: Discontinue syntocinon to decrease uterine activity


name: Reposition mother to left lateral or hands-and-knees position


name: Give a bolus of 1 L crystalloid IV fluid


name: Administer IV vasopressor if blood pressure is low


name: Perform a vaginal examination with fetal scalp stimulation


name: Use fetal scalp electrode if fetal heart rate tracing is suboptimal


name: Open the airway by slightly extending the neck, placing in the "sniffing" position


name: Monitor oxygen saturations by placing an oximeter probe on the right wrist


name: Initiate positive-pressure ventilation for apnea, gasping, or heart rate lower than 100 beats per minute


name: Set oxygen blender at 21% at 5 to 8 L to fill resuscitation bag and titrate based on oxygen saturations, as necessary


name: Give chest compression for heart rate of less than 60 beats per minute or if greater than 80 beats per minute with no increase


name: Continue compressions until heart rate is greater than or equal to 60 beats per minute


name: Prepare medications (e.g., narcotic antagonists, epinephrine, volume expanders, and sodium bicarbonate), as needed


name: Review past health history and documents for evidence of existing or previous medical and nursing diagnoses and treatments


name: Review data derived from routine risk assessment measures


name: Determine availability and quality of resources (e.g., psychological, financial, education level, family and other social, and community)


name: Identify biological, environmental, and behavioral risks and their interrelationships


name: Instruct on risk factors and plan for risk reduction


name: Consider criteria useful in prioritizing areas for risk reduction (e.g., awareness and motivation level, effectiveness, cost, feasibility, preferences, equity, stigmatization, and severity of outcomes if risks remain unaddressed)


name: Discuss and plan for risk reduction activities in collaboration with individual or group


name: Plan for long-term monitoring of health risks


name: Plan for long-term follow-up of risk reduction strategies and activities


name: Determine residential status of mother (e.g., place of residence, homelessness, living with someone, immigration status)


name: Determine outcomes of all prior pregnancies


name: Determine prior history of abuse and violence


name: Determine prior history of depression or other mental illness


name: Review, update, and complete information as pregnancy develops and at intrapartum, postpartum, and neonatal admissions, as needed


name: Review maternal history of chemical dependency, noting duration, type of drugs used (including alcohol), and time and strength of last dose before delivery


name: Document psychosocial adaptation to pregnancy by the patient, the father, other children and adults in the household, family members, and others in close relationship to the pregnant woman


name: Note presence of multiple gestation and consider challenges of raising multiples


name: Note any medications (e.g., sedative, anesthetic, or analgesic) administered to mother during intrapartal period


name: Note maternal morbidities that could delay attachment (e.g., prolonged labor, infection, sedating medications)


name: Note fetal and neonatal morbidities (e.g., fetal distress, hypoxia, oligohydramnios or polyhydramnios, hyperglycemia or hypoglycemia) that could delay its ability to interact with caretakers


name: Note attachment behaviors to multiples (e.g., twins, triplets)


name: Promote family attachment through patient education


name: Implement activities that promote attachment


name: Evaluate behavioral assessment of neonates during early pediatric visits for possible indications of parenting adjustment problems


name: Promote a postpartum maternal follow-up at 2 to 6 weeks to a qualified health care professional


name: Promote newborn follow-up at 2 and 6 weeks by a qualified health care professional


name: Prioritize areas for risk reduction in collaboration with the individual or family


name: Promote newborn safety by requiring newborn discharge into an approved car seat


name: Refer to the appropriate community agency for follow-up if risk of parenting problems or a lag in attachment has been identified


name: Discuss issues in testing other family members as relevant


name: Refer to genetic health care specialists for genetic counseling, as needed


name: Assist patient to identify various roles in life cycle


name: Assist patient to identify role transition periods throughout the lifespan


name: Assist patient to identify behaviors needed for role development


name: Remove all items from seclusion area that patient might use to harm self or others


name: Inform patient of video surveillance, as appropriate


name: Explain reasons for the video monitoring


name: Give careful consideration to who is responsible for watching the video monitor for changes in patient status


name: Reassure patient of safety within the seclusion area during monitoring


name: Distinguish direct visual inspection from checks performed through video monitoring and document appropriately


name: Reduce sensory stimuli around the seclusion area


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


name: Document rationale for restrictive intervention, patient's response to intervention, patient's physical condition, nursing care provided throughout intervention, and rationale for terminating the intervention


name: Provide written discharge instructions, as per agency protocol


name: Record seizure characteristics (e.g., body parts involved, motor activity, and seizure progression)


name: Assist patient to identify the effect of illness on self-concept


name: Consider the culture of the patient when promoting self-care activities


name: Provide social interaction, as appropriate


name: Use unbreakable and weighted dishes and glasses as necessary


name: Determine needs for safety-related changes in home (e.g., wider door frames to allow for wheelchair access to bathroom, removal of scatter-rugs)


name: Obtain transportation enhancements to offset disabilities (e.g., hand controls on cars, wide rear-view mirror), as appropriate


name: Verify adequacy of lighting throughout house, especially in working areas (e.g., kitchen, bathroom) and at night (e.g., appropriately placed nightlights)


name: Determine current ability of patient to transfer self (e.g., mobility level, limitations of movement, endurance, ability to stand and bear weight, medical or orthopedic instability, level of consciousness, ability to cooperate, ability to comprehend instructions)


name: Select transfer technique that is appropriate for patient


name: Instruct patient in all appropriate techniques with the goal of reaching the highest level of independence


name: Instruct individual on techniques for transfer from one area to another (e.g., bed to chair, wheelchair to vehicle)


name: Instruct individual in use of ambulatory aids (e.g., crutches, wheelchairs, walkers, trapeze bars, cane)


name: Make sure equipment works before using it


name: Provide privacy, avoid drafts, and preserve the patient's modesty


name: Use proper body mechanics during movements


name: Keep patient body in proper alignment during movements


name: Raise and move patient with a hydraulic lift as necessary


name: Move patient using a transfer board as necessary


name: Evaluate patient at end of transfer for proper body alignment, nonocclusion of tubes, wrinkled linens, unnecessarily exposed skin, adequate patient level of comfort, raised side rails, and call bell within reach


name: Provide encouragement to patient as he/she learns to transfer independently


name: Explore individual's perception of his/her capability to perform the desired behavior


name: Explore individual's perception of benefits of executing the desired behavior


name: Identify individual's perception of risks of not executing the desired behavior


name: Provide information about the desired behavior


name: Assist individual to commit to a plan of action for changing behavior


name: Reinforce confidence in making behavior changes and taking action


name: Provide an environment supportive to learning knowledge and skills needed to carry out the behavior


name: Use teaching strategies that are culturally and age appropriate (e.g., games, computer-assisted instruction, or conversation maps)


name: Engage in role play to rehearse behavior


name: Provide positive reinforcement and emotional support during the learning process and while implementing the behavior


name: Provide opportunities for mastery experiences (e.g., successful implementation of the behavior)


name: Use positive persuasive statements regarding the individual's ability to carry out the behavior


name: Encourage interaction with other individuals who are successfully changing their behavior (e.g., support group or group education participation)


name: Prepare individual for the physiological and emotional states that may be experienced during initial attempts to carry out a new behavior


name: Encourage patient to engage in self-talk and to verbalize positive affirmations daily to self


name: Assist the patient to cope with bullying or teasing


name: Explore previous achievements of success


name: Assist patient to identify significance of culture, religion, race, gender, and age on self-esteem


name: Instruct parents to recognize children's accomplishments


name: Determine whether the patient is an appropriate candidate for self-hypnosis


name: Utilize self-hypnosis as an adjunct to other treatment modalities (e.g., individual hypnotherapy by a therapist, individual psychotherapy, group therapy, family therapy, etc.)


name: Obtain history of the problem to be treated by self-hypnosis


name: Determine goals for self-hypnosis with patient


name: Determine patient's receptivity about using self-hypnosis


name: Correct myths and misconceptions of self-hypnosis


name: Assist the patient to identify appropriate induction techniques (e.g., Chevreul's pendulum illusion, relaxation, imagining walking down a staircase, eye closure, arm levitation, simple muscle relaxation, visualization exercises, attention to breathing, repetition of key words/phrases, and others)


name: Assist the patient to evaluate progress made toward therapy goals


name: Encourage the patient to examine personal values and beliefs and his or her satisfaction with them


name: Assist the patient in identifying the target behaviors' effects on social and environmental surroundings


name: Assist the patient in identifying the stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination


name: Encourage the patient to identify appropriate, meaningful reinforcers and rewards


name: Encourage the patient to choose a reinforcer or reward that is significant enough to sustain the behavior


name: Foster moving toward primary reliance on self-reinforcement instead of family or nurse for rewards


name: Encourage the patient to adjust the shaping plan to enhance behavior change (e.g., size of steps or reward), if needed


name: Explore with the patient the option of using a technological device in organizing coding sheets, change data, cue analysis, and visual measures of change (e.g., computer, smart phone)


name: Explore with the patient the potential use of imagery, meditation, or progressive relaxation in attempting behavior change


name: Facilitate the patient and family to make choices concerning their care, as appropriate


name: Ensure patients and family members have the appropriate resources to assume more responsibility


name: Provide opportunities for self-evaluation and self-reflection


name: Assist parents in identifying age-appropriate tasks for which a child could be responsible, as appropriate


name: Encourage patient to verbalize fears and to ask questions about sexual functioning


name: Collect the client's sexual history paying close attention to normal patterns of functioning and the terms used by the patient to describe sexual function


name: Determine the duration of sexual dysfunction and potential causes


name: Monitor for stress, anxiety, and depression as possible causes of sexual dysfunction


name: Determine the knowledge level of the patient and understanding about sexuality in general


name: Discuss the effect of the health and illness on sexuality


name: Discuss the effect of medications and supplements on sexuality, as appropriate


name: Discuss the effect of changes in sexuality on significant other


name: Help patient to express grief and anger about alterations in body functioning or appearance, as appropriate


name: Instruct the patient on use of medication(s) and devices to enhance ability to perform sexually, as appropriate


name: Include the significant other in the counseling as much as possible, as appropriate


name: Use humor and encourage patient to use humor to relieve anxiety or embarrassment, being careful to use humor that is appropriate to the situation, tactful, and respectful of patient beliefs and cultural background


name: Draw arterial blood gases and monitor tissue oxygenation


name: Monitor trends in hemodynamic parameters (e.g., CVP, MAP, pulmonary capillary/artery wedge pressure)


name: Monitor determinants of tissue oxygen delivery (e.g., PaO2, SaO2, hemoglobin levels, CO), if available


name: Monitor sublingual carbon dioxide levels and/or gastric tonometry, as appropriate


name: Monitor laboratory values (e.g., CBC with differential, coagulation profile, ABG, lactate level, cultures, and chemistry profile)


name: Administer IV fluid challenge while monitoring hemodynamic pressures and urinary output, as appropriate


name: Administer crystalloid or colloid intravenous fluids, as appropriate


name: Administer packed red blood cells, fresh frozen plasma, and/or platelets, as appropriate


name: Monitor for hyperdynamic state of septic shock post fluid resuscitation (e.g., increased CO, decreased SVR, flushed skin, or increased temperature)


name: Monitor fluid status, including daily weights, hourly urine output, I&O


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


name: Administer continuous renal replacement therapy or hemodialysis, as appropriate


name: Insert nasogastric tube to suction and monitor secretions, as appropriate


name: Administer recombinant activated protein C, as appropriate


name: Administer low dose vasopressin, as appropriate


name: Administer corticosteroids, as appropriate


name: Administer DVT and stress ulcer prophylaxis, as appropriate


name: Offer emotional support to the patient and family, encouraging realistic expectations


name: Monitor for signs and symptoms of decreased cardiac output


name: Monitor for inadequate coronary artery perfusion (ST changes on EKG, elevated cardiac enzymes, angina), as appropriate


name: Monitor and evaluate indicators of tissue hypoxia (mixed venous oxygen saturation, central venous oxygen saturation, serum lactate levels, sublingual capnometry)


name: Administer supplemental oxygen, as appropriate


name: Maintain optimal preload by administering IV fluids or diuretics, as appropriate


name: Prepare patient for cardiac revascularization (percutaneous coronary intervention or coronary artery bypass graft)


name: Administer positive inotropic/contractility medications, as appropriate


name: Promote optimal preload while minimizing afterload (e.g., administer nitrates while maintaining pulmonary artery occlusion pressure within prescribed range), as appropriate


name: Promote adequate organ system perfusion (with fluid resuscitation and/or vasopressors to maintain mean arterial pressure greater than or equal to 60 mm Hg, as appropriate


name: Monitor for physiological changes related to loss of vascular tone (e.g., note decreased BP, bradycardia, tachypnea, reduced pulse pressure, anxiety, oliguria)


name: Consider Trendelenburg position if head injury has been ruled out


name: Administer high flow oxygen, as appropriate


name: Administer epinephrine via SQ, IV, or ET routes for anaphylaxis, if appropriate


name: Assist in early endotracheal intubation, as appropriate


name: Administer atropine for bradycardia, as appropriate


name: Utilize transcutaneous pacing, as appropriate


name: Monitor pneumatic antishock garment, as appropriate


name: Maintain two large-bore intravascular access sites


name: Administer isotonic crystalloids as bolus doses, keeping systolic pressure at 90 mm Hg or more, as appropriate


name: Administer antihistamine and/or corticosteroid, as appropriate


name: Treat overdoses with appropriate reversal agent


name: Insert NG tube and administer charcoal lavage, as appropriate


name: Monitor trends in hemodynamic parameters (e.g., CVP, MAP, PAWP, or PCWP wedge pressure)


name: Avoid stimuli that will precipitate neurogenic reaction (e.g., skin stimulation, distended bladder, or constipation)


name: Monitor for sudden loss of blood, severe dehydration, or persistent bleeding


name: Check all secretions for frank or occult blood


name: Monitor for fall in systolic blood pressure to less than 90 mm Hg or a fall of 30 mm Hg in hypertensive patients


name: Monitor sublingual carbon dioxide levels


name: Monitor for signs/symptoms of hypovolemic shock (e.g., increased thirst, increased HR, increased SVR, decreased urine output, decreased bowel sounds, decreased peripheral perfusion, altered mental status, or altered respirations)


name: Administer IV fluids such as isotonic crystalloids or colloids, as appropriate


name: Administer warmed IV fluids and blood products, as indicated


name: Administer blood products (e.g., packed red blood cells, platelets, or fresh frozen plasma), as appropriate


name: Monitor laboratory studies (e.g., serum lactate, acid-base balance, metabolic profiles, and electrolytes)


name: Monitor for early compensatory shock responses (e.g., normal blood pressure, narrowed pulse pressure, mild orthostatic hypotension [15 to 25 mm Hg], slight delayed capillary refill, pale/cool skin or flushed skin, slight tachypnea, nausea and vomiting, increased thirst, or weakness)


name: Monitor for early signs of systemic inflammatory response syndrome (e.g., increased temperature, tachycardia, tachypnea, hypocarbia, leukocytosis, or leucopenia)


name: Monitor for early signs of cardiac compromise (e.g., declining CO and urinary output, increasing SVR and PCWP, crackles in the lungs, S3 and S4 heart sounds, and tachycardia)


name: Monitor possible sources of fluid loss (e.g., chest tube, wound, and nasogastric drainage; diarrhea; vomiting; and increasing abdominal and extremity girth, hematemesis, or hematochezia)


name: Monitor for signs of inadequate tissue oxygenation (e.g., apprehension, increased anxiety, changes in mental status, agitation, oliguria, and cool, mottled periphery)


name: Monitor daily weights, intake, and output


name: Monitor laboratory values, especially Hgb and Hct levels, clotting profile, ABG, lactate level, electrolyte levels, cultures, and chemistry profile


name: Monitor invasive hemodynamic parameters (e.g., CVP, MAP, and central/mixed venous oxygen saturation), as appropriate


name: Monitor sublingual CO2 or gastric tonometry, as appropriate


name: Test urine for blood, and protein, as appropriate


name: Monitor for signs/symptoms of ascites and abdominal or back pain


name: Place patient in supine, legs elevated position (volume, vasogenic) or supine, head and shoulders elevated (cardiogenic), as appropriate


name: Insert and maintain large-bore IV access, as appropriate


name: Administer antiarrhythmics, diuretics, and/or vasopressors, as appropriate


name: Monitor blood glucose and administer insulin therapy, as appropriate


name: Administer IV, intraosseous, or endotracheal epinephrine, as appropriate


name: Advise patients at risk to wear or carry medical alert information


name: Inspect dressing daily, as per agency protocol


name: Inspect skin and mucous membranes for redness, extreme warmth, edema, or drainage


name: Use an assessment tool to identify patients at risk for skin breakdown (e.g., Braden Scale)


name: Monitor skin and mucous membranes for areas of discoloration, bruising, and breakdown


name: Document skin or mucous membrane changes


name: Institute measures to prevent further deterioration (e.g., overlay mattress, repositioning schedule)


name: Maintain focus on the target audience through all activities


name: Cultivate partnerships with the target audience and appropriate professionals


name: Identify the overall goal to be achieved in collaboration with the target audience


name: Identify the key formal, social, and governmental groups involved


name: Conduct a needs assessment of the environment, identifying target audience desires


name: Conduct organization or group assessment


name: Identify appropriate quantitative and qualitative research to provide information, support, and indicators of success


name: Design a plan of action based on mutually agreed-upon goals


name: Nurture the voluntary basis of the planned social change


name: Identify the product (behavior change), the price (consumer's actions), and the place (how the product reaches the consumer)


name: Consider the financial resources necessary and available


name: Identify specific activities for each goal, including naming of appropriate participants


name: Implement the plan in collaboration with the target population


name: Control the plan through monitoring of assigned tasks


name: Provide appropriate reports on a timely basis


name: Evaluate the plan for achievement of goals with consideration of sustainability and affordability


name: Promote relationships with persons who have common interests and goals


name: Promote sharing of common problems with others


name: Promote involvement in totally new interests


name: Facilitate the use of sensory deficit aids, such as eyeglasses and hearing aids


name: Encourage participation in group and/or individual reminiscence activities


name: Facilitate patient participation in storytelling groups


name: Apply special specimen collection devices for infants, toddlers, or impaired adults, as needed


name: Label specimen with appropriate data before leaving the patient


name: Refer to support groups, mutual self-help, or other spiritually based programs, as appropriate


name: Use therapeutic communications to establish trust and empathic caring


name: Monitor circulation (e.g., pulse, capillary refill, and sensation) in injured body part


name: Cover open wound with dressing and control bleeding before applying splint


name: Minimize movement of patient, especially injured body part


name: Identify most appropriate splint material (e.g., rigid, soft, anatomical, or traction)


name: Immobilize joint above and joint below injury site


name: Place injured hand or wrist in position of function


name: Apply splint in position injured body part is found, using hands to support injury site, minimizing movement, and using the assistance of another health care team member when possible


name: Instruct patient or family how to care for the splint


name: Ensure that staff members provide care within their approved scopes of practice


name: Ensure that staff members have current licensure, as appropriate


name: Incorporate understanding of generational differences when assigning and evaluating work


name: Initiate disciplinary action, as appropriate, adhering to policies and procedures


name: Ensure the product to be infused has been prepared, labeled, and classified according to institution protocol


name: Explain the procedure and the aim of the infusion of hematopoietic stem cells to patients and caregivers


name: Inform the patient and the family about the possible negative effects (e.g., transfusion reaction, volume overload, pulmonary embolism, changes in vital signs, and nausea/vomiting) that may appear during infusion


name: Use peppermint oil or hard candy to counteract the offensive smell and taste of preservative


name: Prepare infusion equipment without filter and other necessary materials (e.g., physiological serum 0.9%, venous pressure measurement systems, sphygmomanometer, phonendoscope, thermometer, and pulsometer)


name: Verify that the infusion equipment has no filter and no infusion pumps to avoid cellular damage


name: Use saline solution to flush the equipment


name: Prepare emergency material and drugs to treat serious negative reactions, including anaphylaxis kit, oxygen administration equipment, and suction equipment


name: Use gloves during the manipulation of the infusion product


name: Ensure aseptic manipulation of equipment, connections, and product


name: Administer prehydration solution according to the protocol


name: Coordinate immediate administration of the defrosted infusion product


name: Administer premedication prescribed according to the protocol of the institution


name: Avoid irradiation and any type of mechanical or physical damage to the infusion product


name: Make sure that the infusion product is received in optimal isolation and refrigeration conditions (1° to 24° C)


name: Verify the labeling and the identification of both the bags and the patient (using patient name and hospital number) immediately before infusion


name: Administer the infusion through a central venous catheter through the largest lumen available for ease of flow


name: Infuse each bag at the rate, sequence, and time established in the protocol guidelines of the institution and according to the tolerance of the patient


name: Monitor for possible adverse reactions (e.g., nausea, vomiting, abdominal cramps, diarrhea, facial flare, arrhythmia, dyspnea) and stop the infusion and call the physician, if necessary


name: Irrigate the infusion catheter with saline solution after the infusion of each bag


name: Irrigate the intravenous line with saline solution if syringes were used to infuse the product in order to reduce the loss of stem cells that could remain in the lumen of the catheter or infusion system


name: Dispose of spare material and hazardous waste according to agency protocol


name: Monitor vital signs according to institutional protocol during and after the procedure


name: Record volume of stem cells and normal saline administered


name: Monitor the elimination of urine, paying attention to volume, color, and osmolality


name: Observe for signs and symptoms of circulatory overload


name: Record the patient's response (e.g., tolerance and negative effects) according to the protocol of the institution


name: Document adverse events according to agency protocol


name: Bed rest with bedside commode, as appropriate


name: Restrict television, radio, and other stimulants


name: Provide information to patient and family regarding need for environmental modifications and visiting limitations


name: Notify physician of neurological deterioration


name: Monitor CSF output and characteristics, if indicated


name: Instruct patient not to strain or perform Valsalva maneuver


name: Foster a trusting relationship while setting clear limits (i.e., provide gentle but firm evidence of dysfunction, stay focused on substance abuse or dependency, and inspire hope)


name: Consider presence of comorbidity, or cooccurring psychiatric or medical disorder, making changes in treatment accordingly


name: Assist patient in understanding disorder as a disease related to several factors (e.g., genetic, psychological, and situational circumstances)


name: Inform patient that the volume and frequency of substance use leading to dysfunction varies greatly between people


name: Instruct patient on effects of substance used (e.g., physical, psychological, and social)


name: Discuss treatment needs for associated medical, psychological, social, vocational, housing, and legal difficulties


name: Encourage or praise patient efforts to accept responsibility for substance use-related dysfunction and treatment


name: Administer medications (e.g., disulfiram, acamprosate, methadone, naltrexone, nicotine patches or gum, or buprenorphine), as indicated


name: Instruct patient or family about medications used for treatment


name: Provide therapy (e.g., cognitive therapy, motivational therapy, counseling, family support, family therapy, or adolescent community reinforcement approach), as indicated


name: Establish multidisciplinary programs (e.g., short-term inpatient residential therapy, detoxification program, or residential therapeutic community treatment), if appropriate


name: Encourage patient to participate in self-help support program during and after treatment (e.g., 12-step programs, Women for Sobriety, or Rational Recovery)


name: Discuss importance of abstaining from substance use, identifying most appropriate treatment goal (e.g., complete abstinence, day-by-day sobriety, or use of substance in moderation)


name: Coordinate and facilitate group confrontation strategy to address use of and role defenses play in substance use (e.g., denial)


name: Instruct patient on stress management techniques (e.g., exercise, meditation, and relaxation therapy)


name: Assist patient in developing healthy, effective coping mechanisms


name: Identify and address dysfunctional relationship patterns in patient's familial or other social ties (e.g., codependency and enabling)


name: Assist in identifying and facilitating connections with supportive persons


name: Assist in resocialization, rebuilding relationships, and decreasing self-centeredness


name: Monitor for substance use during treatment (e.g., urine screens and breath analysis)


name: Monitor for infectious disease (e.g., HIV/AIDS, hepatitis B and C, and tuberculosis), treating and providing assistance to modify behaviors, if necessary


name: Assist patient in developing self-worth, encouraging positive efforts and motivation


name: Participate in efforts to remain abreast of available programs, resources, and legislation aimed at education, prevention, and treatment of substance use disorders


name: Instruct patient on symptoms or behaviors that increase chances of relapse (e.g., exhaustion, depression, dishonesty, and complacency)


name: Develop plan for relapse prevention (e.g., contracting, identify resources for various needs in stressful situation, and identify health promoting activities to take place of substance use)


name: Instruct family on substance use disorder and related dysfunction and include in treatment planning and activities


name: Encourage family to participate in recovery efforts


name: Monitor respiratory and cardiac systems (e.g., hypertension, tachycardia, and bradypnea)


name: Monitor for changes in level of consciousness


name: Implement precautions for patient at risk for suicide


name: Monitor withdrawal symptoms (e.g., fatigue, sensory disturbances, irritability, violence, depression, panic attacks, cravings, insomnia, agitation, muscle pain, appetite changes, yawning, weakness, headache, runny nose, dilated pupils, chills, anxiety, sweating, nausea, vomiting, tremors, psychosis, and ataxia)


name: Implement precautions for patient at risk for seizures


name: Provide adequate nutrition (e.g., small amounts of fluids frequently and high-calorie foods)


name: Implement precautions for patient at risk for falling


name: Maintain low-stimulation environment (e.g., talk in a low, calm voice; provide reassurance about safety; and ensure a comfortable, darkened, quiet, and nonthreatening environment)


name: Encourage patient to participate in follow-up support (e.g., peer group therapy, individual or family counseling, and drug recovery educational programs)


name: Offer supportive assistance (e.g., provision of food and shelter, structured psychotherapy)


name: Facilitate support by family and significant others


name: Instruct patient and family on process of drug use and dependency


name: Monitor respiratory, cardiac, gastrointestinal, renal, and neurological status


name: Place patient in most appropriate position (e.g., semi-Fowler's position if patient is awake; left lateral recumbent position if patient is unresponsive)


name: Provide safe environment (i.e., pad side rails, keep bed in lowest position, remove dangerous objects, and position safety officer near patient's room)


name: Establish rapport with patient or family (i.e., use nonjudgmental approach; do not reprimand)


name: Perform necessary toxicology screening and system function tests (e.g., urine and serum drug screening, arterial blood gases, electrolyte levels, liver enzymes, blood urea nitrogen, and creatinine)


name: Contact poison control center for assistance in determining definitive treatment


name: Establish intravenous access, administering infusions, as prescribed


name: Monitor for symptoms specific to drug consumed (e.g., constricted pupils, hypotension, and bradycardia for opiate overdose; nausea, vomiting, diaphoresis, and right upper quadrant pain 48 to 72 hours after acetaminophen overdose; and dilated pupils, tachycardia, seizures, and chest pain for cocaine overdose)


name: Administer agents specific to substance consumed and patient symptoms (e.g., antiemetics, naloxone, thiamine, glucose, flumazenil, calcium, vasopressors, antiarrhythmics, and inotropics)


name: Administer agents or perform procedures to impair drug absorption and increase drug excretion (e.g., ipecac, activated charcoal, gastric lavage, hemodialysis, cathartics, exchange transfusion, altering urine and serum pH, and whole-bowel irrigation)


name: Communicate with patient, providing reassurance, addressing hallucinations or delusions, and conveying understanding of fears or other feelings


name: Treat hyperthermia (i.e., apply ice packs for fever caused by amphetamine or cocaine intoxication)


name: Provide instruction on proper use of drug


name: Assist patient in identifying ways to minimize potential for accidental overdose (e.g., store medications in original container, address issues with confusion or memory, and store medications out of children's reach)


name: Instruct family or caregiver on patient's need for follow-up care


name: Instruct family or caregiver on aspiration and seizure precautions


name: Provide referral (e.g., home health agency, social worker, psychiatry, or drug use treatment program)


name: Advocate for quality of life and pain control issues


name: Provide small amounts of prescriptive medications that may be lethal to those at risk, to decrease opportunity for suicide, as appropriate


name: Avoid repeated discussion of past suicide history by keeping discussions focused on present and future


name: Discuss plans for dealing with suicidal ideation in future (e.g., precipitating factors, who to contact, where to go for help, ways to alleviate feelings of self-harm)


name: Work with physicians and others to standardize the specifications for products and reduce total number of supplies


name: Assist in the automation and upkeep of the inventory list to avoid overstocking and overspending


name: Coordinate purchases with other departments to reduce costs, as appropriate


name: Work with suppliers and vendors to ensure best product at lowest cost, as needed


name: Have supplies shipped directly to patient's home, as appropriate


name: Review supply budget and inventory costs, as appropriate


name: Participate in the value analysis process to determine whether it is the "right product" at the "right price"


name: Participate in the governing agency's integrated supply chain management process, as appropriate


name: Understand how the use of GS1 Global Traceability Standard to identify items and locations can improve patient safety and reduce costs of supplies


name: Determine the most appropriate venue for the group's meeting (e.g., face to face or online)


name: Identify faith-based groups as available options for clients, as appropriate


name: Use a written contract, if deemed appropriate


name: Form a group of optimal size (e.g., 5 to 12 members)


name: Schedule a limited number of sessions (e.g., 6 to 12) in which the work of the group will be accomplished


name: Assist the group to progress through the stages of group development, from orientation through cohesiveness to termination


name: Refer the patient to other specialist, as appropriate


name: Identify psychological response to situation and availability of support system


name: Identify degree of family support, financial support, and other resources


name: Determine barriers to unused and underused support systems


name: Monitor current family situation and the support network


name: Refer to a self-help group or Internet-based resource, as appropriate


name: Identify community resource strengths and weaknesses and advocate for change, when appropriate


name: Refer to a community-based prevention or treatment program, as appropriate


name: Involve family/significant other(s) and friends in the care and planning


name: Identify available resources for caregiver support


name: Perform surgical hand antisepsis in accordance with the hospital protocol or rules


name: Don a sterile gown and gloves using aseptic technique


name: Assist the surgical team while they don gown and gloves


name: Adopt a position that allows you to keep the surgical field in sight throughout the surgery


name: Ensure that appropriate instruments, supplies, and equipment are sterile and in good working order


name: Transfer the scalpel or dermatographic pencil to the surgeon, as appropriate


name: Provide the instruments in an appropriate safe manner


name: Maintain the sterility of the surgical field throughout the procedure, disposing of contaminated elements, and taking measures to preserve surgical integrity and asepsis


name: Remove soiled sponges and deposit them in an appropriate place, replacing them with clean ones


name: Clean the incision site and drains of blood, secretions, and residual skin antiseptic


name: Assist in the closing of the surgical wound


name: Dry the skin at the incision site and drains


name: Apply reinforcement bands, dressings, or bandages to the surgical wound


name: Connect the drains to their collection systems, attach them, and keep them in the appropriate position


name: Assist in transferring patient to the cart or bed and transport to appropriate postanesthesia or postoperative area


name: Document information, as per agency policy


name: Consult surgical schedules, check operating room assignments, and obtain information on the surgical procedure and anesthetic technique


name: Change into the scrubs, footwear, cap, and mask specific to the surgical area before entering the operating room


name: Place tables containing instruments and equipment in the appropriate areas


name: Keep sharp and pointed objects (e.g., scalpel blades and needles) separate from other objects in order to avoid injuries during preparation


name: Verify the safety and proper operation of the equipment and instruments required for patient care (e.g., surgical table, perfusion pumps, temperature regulating equipment, electric scalpels)


name: Obtain the sterile supplies and materials appropriate to the surgery, observing aseptic technique


name: Confirm the integrity of the packages or wrappings, expiration dates, and sterility controls, and follow the traceability of the materials in keeping with hospital regulations


name: Prepare the consumable clothing and supplies appropriate to the type of surgery


name: Drape the instrument tables, Mayo tables, and auxiliary tables with sterile cloth or impermeable fields, as appropriate


name: Establish a safety perimeter around the tables and materials with regard to other professional and nonsterile areas


name: Provide towels/pads for the surgical team to dry their hands on


name: Secure devices in the surgical field (e.g., cables, circuit cameras, aspirators)


name: Remove instruments and supplies from the surgical table once the surgery is finished


name: Remove field forceps, aspirator tube, electric scalpel, and other elements from the surgical field after the conclusion of the operation


name: Roll up the fields, sheets, and surgical drapes used in the surgery, avoiding the spread and contamination of the air, and dispose of them in an appropriate container


name: Remove scalpel blades from their handles, needles, sharp and pointed objects and deposit them in appropriate containers


name: Separate the clean materials and instruments from the dirty or highly contaminated ones to facilitate cleaning, disinfection, and later sterilization


name: Coordinate and assist in the cleaning and preparation of the operating room for the next patient (i.e., collect and put away machines, supports, and other supplies)


name: Arrange the oxygenation and artificial ventilation equipment and material (e.g., laryngoscopes, tubes, aspirator, masks, Magill forceps, stiffening wires, phonendoscope)


name: Monitor the accessories specific to the required surgical position (e.g., supports, stirrups, fasteners)


name: Participate in a preoperative briefing with others, as per agency policy


name: Welcome the patient, establishing a relationship of trust and offering counsel


name: Ask patient or appropriate other to state patient's name and birth date


name: Participate in the preoperative "time out" to verify correct patient, procedure, and site, as per agency policy


name: Assist in the transfer of the patient to the surgical table while monitoring devices


name: Preserve the patient's privacy, avoiding unnecessary exposure or chills


name: Count sponges, sharps, and instruments before, during, and after surgery, as per agency policy


name: Record results of counts, as per agency policy


name: Provide a sterile container for depositing sharp objects


name: Verify that prep solutions are nonflammable or that flammable prep agents have evaporated before draping


name: Remove residual flammable prep agents before the start of surgery


name: Evacuate oxygen from under surgical drapes


name: Take precautions before the surgery starts against ionizing radiation or use protective equipment in situations that require it


name: Deposit waste materials in the appropriate containers


name: Assist in the transfer of the patient, verifying the proper position of tubes, catheters, and drains, and adopting the position appropriate to the surgery performed


name: Cover the patient to avoid unnecessary exposure and loss of heat


name: Participate in a postoperative debriefing, as per agency policy


name: Identify patient's level of anxiety or fear concerning the surgical procedure


name: Ensure that a completed history and physical is recorded in the chart


name: Assure that the surgical site is marked with a permanent marker by the surgeon, as indicated


name: Involve the patient in marking the surgical site, as indicated


name: Verify that the required laboratory and diagnostic test results are in the chart


name: Verify that an ECG has been completed, as appropriate


name: Communicate special care considerations such as blindness, hearing loss, or handicap to operating room staff, as appropriate


name: Remove jewelry and tape rings in place, as appropriate


name: Remove dentures, glasses, contacts, or other prostheses, as appropriate


name: Send required medications or equipment with patient to the operating room, as appropriate


name: Administer surgical shave, scrub, shower, enema, or douche, as appropriate


name: Instruct patient to void immediately before preoperative medications, as appropriate


name: Check that patient is in proper attire based on institutional policy


name: Support patient with high anxiety or fear level


name: Assist patient onto cart for transport, as appropriate


name: Provide time for family members to speak with patient before transport


name: Encourage parents to accompany child to the operating room, as appropriate


name: Prepare room for patient's return postoperative


name: Activate rapid response team if indicated by presence of trigger areas, per agency protocol


name: Institute appropriate treatment using standing protocols


name: Determine maternal-fetal health risks through patient interview


name: Monitor behavior of patient and support person


name: Implement electronic fetal monitoring, as appropriate


name: Retrieve and interpret laboratory data and contact physician, as appropriate


name: Initiate interventions for IV therapy, fluid resuscitation, and medication administration, as needed


name: Perform speculum examination for diagnosis of spontaneous rupture of amniotic membranes unless there is evidence of frank bleeding


name: Prioritize actions based on patient status (e.g., treat, continue to observe, admit, or discharge)


name: Determine need and establish time intervals for further intermittent assessment


name: Inform individual/families about how to access local food pantries and free lunch programs


name: Inform about rental laws and protections


name: Arrange for individual/families transportation to job services, if necessary


name: Assist individual/families to complete forms for assistance, such as forms for housing and financial aid


name: Identify patient allergies to anesthetics, suture materials, sterile adhesive strips, tape, and povidone-iodine or other topical solutions


name: Shave hair from the immediate wound site using proper technique


name: Use sterile technique during suture procedure


name: Select an appropriate gauge suture needle and suturing material


name: Pull the suture tight enough to avoid buckling the skin


name: Apply sterile adhesive strips to enhance wound closure (e.g., place perpendicular to incision line; place across suture ends to prevent slippage or excessive pulling), as appropriate


name: Cleanse the sutured area before applying an antiseptic or dressing


name: Instruct patient concerning care of the suture line or sterile adhesive strips, including signs and symptoms of infection


name: Instruct patient on sutures or sterile adhesive strips removal


name: Remove sutures within 1 to 2 weeks of their placement, depending on the anatomical location (on the face, remove in 5 to 7 days; on the neck, 7 days; on the scalp, 10 days; on the trunk and upper extremities, 10 to 14 days; and on the lower extremities, 14-21 days), as indicated


name: Use proper technique in removing sutures (i.e., gently elevate with forceps, cut, grasp by knot pull toward suture line)


name: Assist to maintain sitting position for 30 minutes after completing meal


name: Monitor for signs of fatigue during eating, drinking, and swallowing


name: Determine capacity to carry out foot care, (e.g., visual acuity, physical mobility, judgment)


name: Instruct to inspect inside shoes daily for foreign objects, nail points, torn linings, and rough areas


name: Instruct to change shoes two times, (e.g., 12 noon and 5 p.m.) each day to avoid local repetitive pressure


name: Caution about activities that cause pressure on nerves and blood vessels, including elastic bands on socks or crossing legs


name: Revise teaching strategies and learning activities to increase learning, if necessary


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


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


name: Refer the patient to other specialists or agencies to meet the learning objectives, as appropriate


name: Instruct parent/caregiver to avoid fruit drinks and flavored milk


name: Instruct parent/caregiver to select toys according to manufacturer's age recommendations


name: Instruct parent/caregiver to ensure multiple barriers to pool/ hot tub area


name: Instruct parents to provide opportunities for infant to reach for objects


name: Inform the patient and family of the scheduled date, time, and location of surgery


name: Inform the patient and family how long the surgery is expected to last


name: Determine the patient's previous surgical experiences, background, culture, and level of knowledge related to surgery


name: Appraise the patient's and family's anxiety relating to surgery


name: Inform the family of the location to wait for the results of the surgery, as appropriate


name: Conduct a tour of the postsurgical unit and waiting area, as appropriate


name: Describe the postoperative routines and equipment (e.g., medications, respiratory treatments, tubes, machines, support hose, surgical dressings, ambulation, diet, family visitation) and explain their purpose


name: Evaluate the patient's ability to demonstrate splinting incision, coughing, and deep breathing


name: Evaluate the patient's ability to demonstrate proper use of the incentive spirometer


name: Evaluate the patient's ability to demonstrate leg exercises


name: Inform the patient how to assist in recuperation


name: Instruct patient in regard to smoking cessation, as appropriate


name: Instruct in a way that matches the patient's style of learning, including the use of holistic approaches and educational materials, as appropriate


name: Document teaching, including patient's response to teaching


name: Appraise the patient's current and past eating patterns as well as preferred foods and current eating habits


name: Determine the patient's and family's perspectives, cultural backgrounds, and other factors that may affect the patient's willingness to follow prescribed diet


name: Determine any financial limitations that may affect food purchases


name: Explain the purpose of diet adherence to overall health


name: Reinforce the importance of continued monitoring and changing needs that may require further alteration of dietary plan of care


name: Refer patient to dietitian, as appropriate


name: Monitor the patient for physiological and psychological limitations, as well as background and culture


name: Assist the patient in setting goals for slow, steady increase in exercise


name: Instruct patient regarding use of pain medication and alternative methods of pain control before exercise, as needed


name: Instruct patient to report signs of possible problems, (e.g., pain, dizziness, and swelling) to health care provider


name: Assist the patient to incorporate exercise regimen into daily routine


name: Refer the patient to physical therapist, occupational therapist, or exercise physiologist, as appropriate


name: Provide written information or diagrams for continued reference


name: Provide frequent feedback to prevent bad habits from forming


name: Provide distraction for child that will divert attention away from procedure


name: Provide information on when and where results will be available and who will explain them


name: Establish level of patient ability in performing skill


name: Adjust teaching methodology to accommodate patient age and ability, as needed


name: Guide patients' bodies so that they can experience the physical sensations that accompany the correct motions, as appropriate


name: Provide frequent feedback to patients on what they are doing correctly and incorrectly, so that bad habits are not formed


name: Obtain sexual history, including number of past sexual partners, frequency of intercourse, and past occurrences of and treatments for sexually transmitted infections (STIs)


name: Instruct patient on anatomy and physiology of human reproduction


name: Instruct patient on STI and conception, as necessary


name: Instruct patient on factors that increase risk of STI (e.g., unprotected sexual intercourse, increased genital mucosal surface area, increased number of sexual contacts, presence of genital sores, advanced illness, and sexual intercourse during menstruation)


name: Discuss patient's knowledge, understanding, motivation, and commitment level regarding various sexual protection methods


name: Discuss methods of sexual protection for sexual intercourse and oral sex (e.g., medication-free, barrier, vaccination, hormonal, intrauterine device, abstinence, and sterilization), including effectiveness, side effects, contraindications, and signs and symptoms that warrant reporting to a health care professional


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


name: Provide accurate information pertaining to the implications of having multiple sexual partners


name: Instruct patient on the importance of good hygiene, using a water-soluble lubricant, and voiding after intercourse to decrease the susceptibility to infections


name: Instruct patient on proper use of condoms (e.g., how to choose, keep intact, apply, and remove)


name: Provide patient with sexual protection products (e.g., condoms and dental dams)


name: Encourage patient to obtain routine examinations and report signs and symptoms of STIs to a health care provider


name: Encourage patient to discuss sexual histories and safe sex practices with partner


name: Discuss with patient importance of sexual partner notification when diagnosed with STI


name: Consider population-based factors affecting safe sex education (e.g., culturally tailored interventions, ethnically matched providers)


name: Use social networks (e.g., Internet, phone) to reach marginalized or geographically isolated populations


name: Use appropriate questions to assist the child and adolescent to reflect on what is important personally


name: Educate about sexually transmitted diseases and AIDS


name: Inform about effective contraceptives, as appropriate


name: Instruct accessibility of contraceptives and how to obtain them


name: Assist in choosing an appropriate contraceptive, as appropriate


name: Discuss how aging changes (e.g., medications, medical conditions, chronic illness) may affect sexual desires and actions, as appropriate


name: Identify helpful resources on the Internet provided by responsible organizations (e.g., Center for Parent Education and Resources, Health World Education, National Association of School Nurses, Planned Parenthood of Northern New England)


name: Instruct parent/caregiver to discontinue bottle feeding


name: Instruct parent/caregiver to offer textured solids


name: Instruct parent/caregiver to continue use of spoon and self-feeding


name: Instruct parent/caregiver to introduce dairy products


name: Instruct parent/caregiver to provide healthy snacks


name: Instruct parent/caregiver to offer small portions and frequent feedings


name: Instruct parent/caregiver to avoid "diet" food/drinks (e.g., nonfat milk, diet soda)


name: Instruct parent/caregiver to avoid force feeding as there is decreased appetite


name: Instruct parent/caregiver to encourage drinking water for thirst


name: Instruct parent/caregiver to limit fluids before meals


name: Instruct parent/caregiver to offer foods high in iron and protein


name: Instruct parent/caregiver to have regular mealtimes and eat as a family


name: Instruct parent/caregiver to increase or decrease foods, as appropriate


name: Instruct parent/caregiver to read the labels for nutritive content


name: Instruct parent/caregiver to give child healthy food choices


name: Instruct parent/caregiver to encourage raw/cooked vegetables


name: Instruct parent/caregiver to provide healthy snacks between meals


name: Instruct parent/caregiver to be creative in food preparation for picky eater


name: Instruct parent/caregiver to offer small portions of food


name: Instruct parent/caregiver to limit fat content in foods


name: Instruct parent/caregiver to have child participate in food preparation


name: Instruct parent/caregiver to offer iron-fortified cereals, avoiding high-sugar cereals


name: Instruct parent/caregiver to increase protein foods


name: Instruct parent/caregiver to include all food groups


name: Instruct parent/caregiver to avoid use of food as rewards


name: Instruct parent/caregiver to supervise child outdoors


name: Instruct parent/caregiver to educate child about dangers of throwing and hitting


name: Instruct parent/caregiver to prevent access to electrical outlets, cords, and electrical equipment/appliances/tools


name: Instruct parent/caregiver to store weapons and weapon-like items under lock and key


name: Instruct parent/caregiver to educate child about safe ways of interacting with pets


name: Instruct parent/caregiver to secure doors/gates to prevent child's access to dangerous areas (e.g., street, driveway, pool)


name: Instruct parent/caregiver to dispose of and/or remove the doors to unused refrigerators, ice chests, and other air-tight containers


name: Instruct parent/caregiver to use back burners of the stove, install knob covers, and/or restrict child's access to kitchen


name: Instruct parent/caregiver to set home water heater temperature to between 120 degrees and 130 degrees Fahrenheit


name: Instruct parent/caregiver to install car seat and use it according to manufacturer's recommendations


name: Instruct parent/caregiver to store sharp objects, appliances, and kitchen items out of child's reach


name: Instruct parent/caregiver to instruct child on dangers of the street


name: Instruct parent/caregiver to store all cleaning supplies, medications, and personal care products out of child's reach


name: Instruct parent/caregiver to instruct child on dangers of weapons


name: Instruct parent/caregiver to provide supervision and instruct about safe use of large climbing and riding toys


name: Instruct parent/caregiver to store matches/lighters out of child's reach and instruct child about the dangers of fire and fire starters


name: Instruct parent/caregiver to always supervise child around swimming pools, ponds, and hot tubs


name: Instruct parent/caregiver to instruct child about stranger danger and good touch/bad touch


name: Instruct parent/caregiver to provide an approved helmet for bike riding and instruct child to always wear it


name: Instruct parent/caregiver to prevent child's access to upper story windows, balconies, and stairs


name: Instruct parent/caregiver to closely supervise child when out in public settings


name: Instruct parent/caregiver to instruct child how to get adult help when he or she feels scared or in danger


name: Instruct parent about how to determine the child's physical readiness for toilet training (e.g., child is at least 18- to 24 months of age; shows evidence of being able to hold urine before void; recognizes urge to go or that he or she has just voided or defecated; shows some regularity in elimination patterns; is able to navigate to the toilet/potty, sit on it, and get off when completed; is able to remove and replace clothing before and after elimination; is able to wipe self and wash hands after elimination)


name: Instruct parent about how to determine the child's psychosocial readiness for toilet training (e.g., child expresses interest in and desire to participate/cooperate in toileting; has vocabulary to communicate need to eliminate; is anxious to please parents; imitates the behaviors of others)


name: Instruct parent about how to determine parental/family readiness for toilet training: (e.g., parent has knowledge and time to devote to training process; parent/family is experiencing no major transitions during or shortly after the process such as change of job or residence, divorce, birth of another child; has realistic expectations about child development and the time and energy needed to successfully complete the process; understands child may regress during times of stress or illness)


name: Provide information on strategies to promote toilet training


name: Provide information on how to agree on vocabulary to be used during training process


name: Provide information on opportunities for child to observe others during the toileting process


name: Provide information on how to take the child to the potty to introduce him or her to the equipment and process


name: Provide information on how to take the child to the potty on a regular basis and encourage him or her to sit


name: Provide information on how to reinforce the child's success with any part of the process


name: Provide information on how to consider the child's temperament or behavior style when planning strategies


name: Provide information on how to expect and ignore accidents


name: Provide information on how to communicate strategies, expectations, and progress to other care providers


name: Follow guidelines for investigating or reporting suspected child, geriatric, or spousal abuse situations


name: Maintain humidity at 50% or greater in incubator to reduce evaporative heat loss


name: Prewarm items (e.g., blankets, snugglies) placed next to infant in incubator


name: Identify and discuss type of anesthesia planned for patient with surgical team


name: Identify patient risk factors for experiencing abnormalities in body temperature (e.g., general or major regional anesthesia, age, major trauma, burns, low body weight, personal or familial risk for malignant hyperthermia)


name: Prewarm the patient with active warming device (e.g., forced-air warming) for at least 15 minutes before start of anesthesia, as appropriate


name: Transport patient using warming device (e.g., heated isolette), as appropriate


name: Apply and regulate active warming device (e.g., forced-air warming)


name: Adjust ambient room temperature to minimize the risk of hypothermia (i.e., in addition to forced-air warming, when large surface areas are exposed, maintain room temperature at or above 73.4 degrees Fahrenheit or 23 degrees Celsius)


name: Minimize exposure of patient during surgical prepping and procedure, when possible


name: Provide warm or cool irrigating solutions, as appropriate


name: Monitor the temperature of irrigating solutions


name: Warm or cool intravenous fluids, as appropriate


name: Provide or assist in provision of heated, humidified anesthetic gases, as appropriate


name: Provide heated intraperitoneal gases (e.g., carbon dioxide) for laparoscopy


name: Discontinue active warming activities (e.g., forced air warming), when appropriate


name: Monitor vital signs, including continuous core body temperature


name: Monitor for abnormal or unintentional increases or decreases in body temperature


name: Monitor expired carbon dioxide (capnography)


name: Monitor laboratory results (e.g., arterial blood gases, electrolytes)


name: Ensure active warming equipment and supplies are in place and in good working order


name: Maintain emergency equipment and supplies for malignant hyperthermia, per protocol, including dantrolene sodium, in perioperative and perianesthesia areas


name: Initiate malignant hyperthermia protocol, as appropriate


name: Provide handoff communication regarding patient risk of abnormalities in temperature (e.g., personal or familial risk for malignant hyperthermia)


name: Ensure proper body temperature until patient is awake and alert


name: Provide real or simulated hospital operating-room medical equipment to encourage expression of knowledge and feelings about hospitalization, treatments, or illness


name: Identify child's misconceptions or fears through comments made during hospital role-play session


name: Create a comfortable environment without distractions


name: Determine willingness to experience the intervention


name: Place patient in either a comfortable sitting or supine position


name: Place hands with palms facing the patient 3 to 5 inches from the patient's body


name: Begin the 1- to 2-minute assessment by moving the hands slowly and steadily over as much of the patient as possible, from head to toe and front to back


name: Move the hands in very gentle downward movements through the patient's energy field, thinking of the patient as a unitary whole and facilitating an open and balanced energy flow


name: Note the overall pattern of the energy flow, especially any areas of disturbance such as congestion or unevenness, which may be perceived through very subtle cues in the hands (e.g., temperature change, tingling, or other subtle feelings of movement)


name: Finish when it is judged that the appropriate amount of change has taken place (i.e., for an infant, 1-2 minutes; for an adult, 5-10 minutes), keeping in mind the importance of gentleness


name: Encourage the patient to rest for 20 minutes or more after treatment


name: Determine the purpose of the group (e.g., maintenance of reality testing, facilitation of communication, examination of interpersonal skills, and support) and the nature of the group process


name: Create specific group rules and guidelines (e.g., confidentiality, respectful communication and behavior, attendance, socialization of members outside the group, participation) to ensure that all members are compliant


name: Provide a manual that includes the group rules and guidelines for all group members


name: Give the group a sense of direction that enables them to identify and resolve each step of development


name: Use the technique of "here-and-now activation" to move the focus from the generic to the personal, from the abstract to the specific


name: Provide social reinforcement (e.g., verbal and nonverbal) for desired behaviors/responses


name: Obtain history of present illness and medical history


name: Perform physical examination (e.g., general appearance, heart rate, blood pressure, respiratory rate, temperature, pain level, height, and weight)


name: Explain all procedures to the patient and significant other(s)


name: Allow significant other(s) at patient's bedside, if possible


name: Obtain pulse oximetry and apply oxygen, as appropriate


name: Perform targeted assessment of the system that is indicated by the history of present illness


name: Initiate intravenous line and obtain blood samples for laboratory tests


name: Obtain stat computerized tomography head scan, as appropriate


name: Consider guidelines for candidacy (e.g., therapy inclusion and exclusion criteria)


name: Determine whether the patient will receive the therapy


name: Prepare for thrombolytic therapy, if indicated


name: Obtain additional intravenous access site


name: Avoid arterial sampling to prevent bleeding complications


name: Prepare thrombolytic agents, per facility protocol


name: Administer thrombolytic agents, according to specific guidelines for administration


name: Administer additional medications, as ordered


name: Continually monitor cardiac rhythm, vital signs, level of pain, heart and lung sounds, level of consciousness, peripheral perfusion, intake and output, change in neurological status, and resolution of symptoms, as indicated


name: Obtain additional radiological tests (e.g., chest x-ray), as indicated


name: Prepare to initiate basic and advanced life support measures, if indicated


name: Prepare to transfer for definitive care (e.g., cardiac catheterization lab, ICU)


name: Assure placement of proper intravenous line related to duration of nutrients to be infused (e.g., centrally placed line preferred; peripheral lines only in well-nourished individuals expecting to need TPN for less than 2 weeks)


name: Use central lines only for infusion of high caloric nutrients or hyperosmolar solutions (e.g., 10% dextrose, 2% amino acids with standard additives)


name: Assure TPN solutions infused in a noncentral catheter are limited to osmolarity less than 900 mOsm/L


name: Insert peripheral intravenous central catheter, per agency protocol


name: Ascertain correct placement of intravenous central catheter by x-ray examination


name: Monitor for infiltration, infection, and metabolic complications (e.g., hyperlipidemia, elevated triglycerides, thrombocytopenia, platelet dysfunction)


name: Provide regular, aseptic, and meticulous care of the central venous catheter, particularly the catheter exit site, to assure prolonged, safe, and complication-free use


name: Avoid use of the catheter for purposes other than delivery of TPN (e.g., blood transfusions and blood sampling)


name: Avoid rapid replacement of TPN solution when interrupted for supplemental infusions


name: Monitor serum albumin, total protein, electrolyte, lipid profiles, glucose levels, and chemistry profile


name: Maintain a small oral nutritional intake during TPN, whenever possible


name: Encourage a gradual transition from parenteral to enteral feeding, if indicated


name: Report abnormal signs and symptoms associated with TPN to the physician and modify care accordingly


name: Instruct patient and family about care of and indications for TPN


name: Assure patient and family comprehension and competency before discharge home with ongoing TPN


name: Evaluate one's own personal comfort in using touch with patients and family members


name: Evaluate the readiness of the patient when offering touch


name: Evaluate the environmental context before offering touch


name: Determine which body part is best to touch and the length of touch that produces the most positive responses in the recipient


name: Provide oral stimulation exercises before tube feedings in premature infants


name: Ensure that the ropes and pulleys are working properly and hang freely off the floor


name: Monitor traction system at least once per shift


name: Remove skin traction devices at least daily for skin inspection and cleansing of skin


name: Perform pin insertion site care at least daily


name: Monitor for body image disturbances and need for counseling


name: Discuss the rationale for limits and potential problems of TENS with the patient and family


name: Do not use TENS if the patient has a pacemaker


name: Discuss therapy with provider and obtain prescription for TENS, if appropriate


name: Verify that the TENS unit has full battery charge


name: Inspect the wires for first signs of wear, replacing wires, as needed


name: Select stimulation site, considering alternate sites when direct application is not possible (e.g., adjacent to, distal to, bracketing the site, between affected areas and the brain, and contralateral to the pain)


name: Apply disposable or reusable electrodes to the site of stimulation


name: Apply wires to electrodes and TENS unit, making sure wires are securely plugged into connections


name: Adjust the amplitude, rate, and pulse width to predetermined settings indicated


name: Maintain stimulation for predetermined interval (e.g., continuous or intermittent)


name: Secure TENS unit to the patient (e.g., on patient's belt or waistband of pants), if continuous application is necessary


name: Discontinue use when sensation is strong yet tolerable


name: Adjust the site and settings to achieve the desired response based on individual tolerance


name: Inspect sites of electrodes for possible skin irritation at every application or at least every 12 hours


name: Provide verbal and written instruction on the use of TENS and its operation


name: Determine mobility level and limitations of movement


name: Determine level of consciousness and ability to cooperate


name: Discuss need for relocation with patient and/or family


name: Discuss with patient and helpers how the move will be done


name: Adjust equipment to working heights and lock all wheels, as needed


name: Raise side rail on opposite side of nurse to prevent patient from falling out of bed


name: Raise and move patient with hydraulic lift, as necessary


name: Move patient using transfer board, as necessary


name: Evaluate patient at end of transfer for proper body alignment, nonocclusion of tubes, wrinkle-free linens, unnecessarily exposed skin, adequate patient level of comfort, raised side rails, and call bell within reach


name: Assure that a medical screening examination has been performed and documented


name: Assure that the patient has been stabilized within the capabilities of the transferring facility or has met the conditions under which unstable patients may be transferred under the Emergency Treatment and Labor Act (EMTALA)


name: Determine need for transfer of patient, ensuring that the patient requires treatment at the receiving facility and the benefits of the transfer outweigh the risks


name: Obtain written order from physician to transport patient


name: Identify preference of patient or significant other(s) for receiving facility and physician, as appropriate


name: Document that the receiving facility will accept the patient and has the necessary equipment and staff to handle the clinical situation


name: Obtain written consent for transfer from patient or significant other(s)


name: Obtain written consent for transfer of minors, as appropriate


name: Obtain written consent for release of patient information to receiving facility


name: Facilitate the contact of receiving physician by attending physician, as indicated per EMTALA laws, and document this contact


name: Provide a nurse-to-nurse clinical report about the patient to the receiving facility and document this contact


name: Mobilize and provide necessary personnel, transfer equipment, and pharmaceuticals


name: Copy medical records for receiving facility, including current record of events


name: Assure that the medical records accompany the patient to the receiving facility


name: Complete the certification for transfer that is signed, timed, and dated by the physician


name: Document the medical reason for transfer, as well as the medical benefits and risks of the transfer, as indicated per EMTALA laws


name: Document all information pertaining to patients refusing transfer


name: Attempt to secure written statement of refusal to transfer from patient, if indicated


name: Continue to treat patients refusing transfer within the capability of the facility


name: Obtain physician order before transport, as appropriate


name: Provide appropriate personnel to assist in transport


name: Provide appropriate equipment to assist in transport


name: Discuss need for relocation with patient and significant other(s)


name: Move patient using required equipment, as necessary


name: Monitor, as appropriate, during transport


name: Document pertinent information related to transport


name: Evacuate patients in emergencies such as fire, hurricane, or tornado according to agency disaster plan


name: Teach specific stress-management techniques before trauma exploration to restore a sense of control over thoughts and feelings


name: Involve the parents or caretakers in therapy, as appropriate


name: Educate the parents about their child's response to the trauma and to the process of therapy