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


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


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


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


name: Determine patient knowledge about reasons for antepartum testing


name: Encourage the mother to empty the bladder


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


name: Ensure that the mother is in a comfortable position


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


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


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


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


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


name: Score ultrasound based on protocol for biophysical profile criteria


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


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


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


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


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


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


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


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


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


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


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


name: Maintain consistent daily routine and caregivers


name: Implement an exercise program to setting, as appropriate


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Refrain from massaging or compressing affected limb muscles


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Obtain arterial blood gas levels, as indicated


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


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


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


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


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


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


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


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


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


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


name: Maintain thromboprophylaxis after an embolus


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


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


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


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


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


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


name: Perform a comprehensive appraisal of pulmonary status


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


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


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


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


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


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


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


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


name: Evaluate any unresponsive patient to determine appropriate action


name: Check for signs and symptoms of cardiac arrest


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


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


name: Assure rapid defibrillation, as appropriate


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


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


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


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


name: Provide age-appropriate care for elderly and children


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


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


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


name: Monitor vital signs, if possible and appropriate


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


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


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


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


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


name: Remove overheated patient from direct sunlight and heat source


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


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


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


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


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


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


name: Provide reassurance and emotional support to patient or family


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


name: Coordinate medical transport, as appropriate


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Gather and assemble equipment specific to type of enema


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


name: Place waterproof or absorbent pad under hips and buttocks


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


name: Ascertain appropriate temperature of irrigating solution


name: Instruct patient to exhale before inserting solution


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


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


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


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


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


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


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


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


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


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


name: Use valid instruments to measure fatigue, as indicated


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


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


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


name: Encourage aerobic workouts, as tolerated


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


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


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


name: Provide calming diversional activities to promote relaxation


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


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


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


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


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


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


name: Consider aesthetics of environment when selecting roommates


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


name: Prevent unnecessary interruptions and allow for rest period


name: Provide choice whenever possible for social activities and visitation


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


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


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


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


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


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


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


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


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


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


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


name: Notify agencies authorized to protect environment of known hazards


name: Include parent or significant other, as appropriate


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


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


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


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


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


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


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


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


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


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


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


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


name: Assist with ankle strengthening and walking programs


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


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


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


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


name: Determine family understanding of condition


name: Determine family feelings regarding their situation


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


name: Determine typical family relationships for each family


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


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


name: Collaborate with family in problem solving and decision making


name: Respect and support family's cultural value system


name: Assist family in identifying strengths and weaknesses


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


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


name: Promote self-efficacy in carrying out parental role


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


name: Assist parents in having realistic role expectations about parenthood


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


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


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


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


name: Identify effect of newborn on family dynamics and equilibrium


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


name: Encourage parents to discuss household maintenance role responsibilities


name: Give family information on sibling rivalry, as appropriate


name: Encourage family to use support systems, as appropriate


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


name: Create a culture of flexibility for the family


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


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


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


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


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


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


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


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


name: Refer family members to support groups, as appropriate


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


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


name: Conduct relevant physical examination if indicated by patient history


name: Determine ability and motivation for using a method


name: Determine level of commitment to consistently use method


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


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


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


name: Provide contraception to patient, if indicated


name: Discuss emergency contraception, as needed


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


name: Instruct on safe sex activities, as indicated


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


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


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


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


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


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


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


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


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


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


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


name: Clarify any misinformation about contraceptive use


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


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


name: Encourage continued contact with family members, as appropriate


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


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


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


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


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


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


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


name: Promote open, trusting relationship with family


name: Create a supportive therapeutic environment for family


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


name: Assist the family in prioritizing family health needs


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


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


name: Assist family to identify family strengths and coping abilities


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


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


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


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


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


name: Inform family members how to reach the nurse


name: Support the family member's need for privacy


name: Use family-history taking to encourage family discussion


name: Determine whether abuse is occurring in the family


name: Identify usual roles within the family system


name: Identify specific disturbances related to role expectations


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


name: Identify areas of dissatisfaction and/or conflict


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


name: Help family members communicate more effectively


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


name: Help family enhance existing positive coping strategies


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


name: Provide challenges within family discussion to encourage new behavior


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


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


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


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


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


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


name: Facilitate rest, applying activity restrictions, if needed


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


name: Provide close supervision if patient is allowed to smoke


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


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


name: Institute appropriate care of wound or burn


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


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


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


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


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


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


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


name: Provide instructions for necessary follow-up care


name: Evaluate outcomes and cost effectiveness of program


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


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


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


name: Advise to cut back on fried and fatty foods


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Monitor BP, heart rate, and respiratory status


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


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


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


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


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


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


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


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


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


name: Obtain blood specimens for crossmatching, as appropriate


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


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


name: Establish collaborative working relationship with all additional examiners


name: Complete all parts of the examination, including normals


name: Record omissions in examinations, including rationale for omission


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


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


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


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


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


name: Measure consistently from center of the lesion being described


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


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


name: Differentiate lacerations from incised wounds and stab wounds


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


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


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


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


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


name: Use body diagrams and photographs to supplement written report


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


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


name: Draw scars in their orientation on the body


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


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


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


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


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


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


name: Ensure that photographs include a measuring scale for perspective


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Acknowledge when anger and resentment are justifiable


name: Identify source of anger and resentment, when possible


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Encourage regularly scheduled visits with a health care provider


name: Institute crisis support skills, as needed


name: Assist to identify personal coping strategies


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Tape-record the imaged experience if useful


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


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


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


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


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


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


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


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


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


name: Assist patient into comfortable position


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


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


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


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


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


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


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


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


name: Arrange for barber or hairdresser to cut hair


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


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


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


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


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


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


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


name: Provide medication information to patient and significant others


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


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


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


name: Introduce self to oncoming staff, as needed


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


name: Identify attending and consulting physicians


name: Summarize significant past health history, as necessary


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


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


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


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


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


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


name: Create a comfortable, private environment without distractions


name: Determine willingness to have body touched


name: Advise the patient to ask questions whenever they arise


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


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


name: Drape only to provide temperature comfort


name: Center self by focusing awareness on inner self


name: Ground self by attuning to earth's energy


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


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


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


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


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


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


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


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


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


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


name: Record the characteristics of the energy work


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


name: Identify yourself or other referring professional and location


name: Obtain physician order for referral, if required


name: Identify patient's essential demographic data


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


name: Transfer information via electronic technology if available


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


name: Maintain education related to knowledge of health information technology


name: Create a relationship that promotes trust and intimacy


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


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


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


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


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


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


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


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


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


name: Assist the individual to identify strategies to attain goals


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


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


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


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


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


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


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


name: Document evaluation of progress and attainment of coaching goals


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


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


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


name: Avoid medical jargon and use of acronyms


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Advertise health screening services to increase public awareness


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


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


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


name: Determine patient level of understanding before initiating screening


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


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


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


name: Obtain specimens for analysis by assessments, as indicated


name: Provide follow-up contact for all patients


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


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


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


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


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


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


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


name: Evaluate and document response to heat and cold application


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


name: Institute appropriate protocol if patient becomes hypotensive


name: Discontinue hemodialysis, according to protocol


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Administer positive inotropic and contractility medications


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


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


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


name: Collaborate with physician, as indicated


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


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


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


name: Instruct patient/family about precautions posttreatment


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


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


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


name: Determine patient's understanding of identified risk factors


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


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


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


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


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


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


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


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


name: Provide anticipatory guidance for likely treatments during birth process


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Identify possible causes of hypertension


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Instruct related to healthy dietary pattern


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


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


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


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


name: Instruct the patient on possible causes of hypertension


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Restrict free water intake in patients with dilutional hyponatremia


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


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


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


name: Maintain dialysis vascular access device


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


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


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


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


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


name: Monitor skin integrity in immobile patients with dependent edema


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


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


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


name: Restrict dietary intake of sodium, as indicated


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


name: Determine patient's receptivity to using hypnosis


name: Correct myths and misconceptions of hypnosis


name: Ensure the patient has accepted the treatment


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


name: Confirm the presence of a trusting relationship


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


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


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


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


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


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


name: Review events before hypoglycemia to determine probable cause


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


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


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


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


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


name: Perform an electrocardiogram, if applicable


name: Perform analytical chemistry, if applicable


name: Perform additional diagnostic tests, as indicated


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


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


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


name: Address any conditions influencing hypotension, as needed


name: Consider nonpharmacological treatments as first approach


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


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


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


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


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


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


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


name: Promote oral fluid intake recommended by age


name: Encourage healthy eating and adequate fluid intake


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


name: Instruct the patient on lifestyle modification


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


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


name: Refer to a specialist unit, as indicated


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


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


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


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


name: Monitor for and treat arrhythmias, as appropriate


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


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


name: Monitor white blood cell count, as appropriate


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


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


name: Place patient in supine position, minimizing orthostatic changes


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


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


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


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


name: Avoid active external rewarming for the severely hypothermic patient


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


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


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


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


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


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


name: Monitor for orthostatic hypotension and dizziness upon standing


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Monitor skin integrity in immobile patients with dry skin


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Encourage consistent assignment of professional caregivers


name: Incorporate parent preferences for bathing, when possible


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


name: Provide developmentally appropriate safe toys and activities for infant


name: Structure play and care around infant's temperament


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


name: Reinforce parent skill in performing special care for infant


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


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


name: Apply restraints when indicated and monitor throughout use


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


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


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


name: Encourage family to visit and stay overnight in hospital


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