name: Instruct parent on various ways of providing skin-to-skin contact (e.g., kangaroo care, massaging, and cobathing)


name: Instruct parent on infant cares (e.g., diaper changing, feeding, holding, massaging)


name: Encourage use of family members and friends for infant caregiving


name: Assist parent of multiples in recognizing individuality of each infant


name: Facilitate parent's complete access to and care of hospitalized infant


name: Explain equipment used to monitor hospitalized infant


name: Provide visual objects depicting infant (e.g., photograph of infant, infant footprint) to parent of hospitalized infant


name: Update parent frequently on status of hospitalized infant


name: Instruct parent on attachment development, emphasizing its complexity, ongoing nature, and opportunities


name: Provide anticipatory guidance on developmental milestones that will occur


name: Determine how family is coping with transitions


name: Provide opportunity for parent to discuss topics of concern (e.g., fears, questions pertaining to infant care, feelings of exhaustion, pain management, and ways to interact with and respond to infant)


name: Monitor factors that may interfere with optimal attachment (e.g., mental health disturbance in parent, financial strain, parent and child separation due to medical or surgical intervention, difficulties with breastfeeding, providing foster care, and adopting)


name: Provide referral to services (e.g., financial, pastoral care, and counseling), if appropriate


name: Use statements in the script, which elicit feelings of heaviness, lightness, or floating of specific body parts


name: Encourage patient to practice session three times a day


name: Instruct patient to keep a diary to document progress made with each session


name: Adhere to institutional policy for qualifications, training, and procedures to perform salvage and autotransfusion


name: Assure proper personnel are available before initiation of procedure


name: Screen for appropriateness of salvage (i.e., contraindications include sepsis, infection, tumor at the site, blood containing an irrigant that is not injectable, hemostatic agents, or microcrystalline collagen)


name: Use appropriate blood retrieval system per institutional policy


name: Monitor patient and blood retrieval system frequently during retrieval


name: Screen blood for appropriateness of reinfusion (i.e., contraindications include contaminants, pharmacologic agents, malignancy, hematologic disorders)


name: Place on an appropriate therapeutic mattress or bed


name: Use devices on the bed that protect the patient


name: Monitor for complications of bed rest (e.g., loss of muscle tone, back pain, constipation, increased stress, depression, confusion, sleep cycle changes, urinary tract infections, difficulty with urination, pneumonia)


name: Place in upright posture intermittently for patients unable to be out of bed every day to protect against orthostatic intolerance


name: Increase physical activity, as appropriate


name: Give any instructions or explanations slowly, using simple, concrete language


name: Demonstrate behavioral management techniques to significant others


name: Apply mitts, splints, helmets, or restraints to limit mobility and ability to initiate self-harm, if necessary


name: Communicate risk for self-harm to other care providers


name: Identify cues that precede self-mutilating behavior


name: Anticipate trigger situations that may prompt self-harm and intervene to prevent these


name: Explain and reinforce effective coping behaviors and appropriate expression of feelings


name: Use appropriate strategies of dialectical behavior therapy [DBT] (e.g., psychological education, problem solving, training in social skills, exercises in monitoring moods, modeling by therapist, homework assignments, meditation)


name: Administer medications to decrease anxiety, stabilize mood, and decrease self-stimulation, as appropriate


name: Avoid giving positive reinforcement to self-harmful behaviors


name: Specify explicit expectations (based on developmental stage, level of cognitive functioning, and capacity for self-control) related to sexual behavior or verbalizations that might be directed toward others or objects in environment


name: Provide parents information about age-appropriate sexual behavior


name: Discuss with parents and children importance of internet safety and prevention of access to sexual material


name: Encourage parents not to punish or admonish children for normative sexual behaviors


name: Instruct parents to use gentle distraction such as asking child to hold hands with them to redirect behavior


name: Avoid assigning roommates with communication difficulties, history of inappropriate sexual activity, or heightened vulnerabilities


name: Provide appropriate level of supervision to monitor patient


name: Redirect from any socially unacceptable sexual behaviors or verbalizations


name: Determine changes in behavior by comparing baseline occurrences with postintervention occurrences of behavior


name: Document and communicate modification process to treatment team, as necessary


name: Identify specific social skills using guided discussion and examples that will be focus of training


name: Identify the patient's emotional, cognitive, developmental, and situational needs


name: Determine ability for reading independently


name: Set therapy goals (e.g., emotional change; personality development; learn new values and attitudes)


name: Consult sources to recommend literature for therapy


name: Select stories, poems, essays, articles, self-help books, or novels that reflect the situation or feelings the patient is experiencing


name: Assist in helping the patient identify with the characters and emotional content in the literature


name: Examine and talk about the feelings expressed by the characters


name: Facilitate dialogue to help the patient compare and contrast the image, character, situation, or concept in the literature with his/ her situation


name: Assist in helping the patient recognize how the situation in the literature can help with making desired changes


name: Interview patient to obtain a health history


name: Analyze nature of the specific health condition to be treated


name: Determine abilities and willingness for using the biobehavioral treatment


name: Discuss rationale for using biofeedback and type of feedback


name: Decide on the specific monitoring device to be used (e.g., thermal feedback; electrodermal response or galvanic skin response; electromyography feedback; finger pulse feedback; breathing biofeedback; electroencephalograph biofeedback)


name: Explain the procedure concerning the specific monitoring equipment used


name: Operate the biofeedback device according to instructions


name: Discuss timing, frequency, length, and setting for sessions with patient/family


name: Provide feedback of progress after each session


name: Integrate biological and chemical terrorism into agency disaster preparedness planning and evaluation


name: Report suspicious symptoms to appropriate triage officers and health agencies


name: Perform vaginal examination to determine fetal position and station


name: Apply controlled umbilical cord traction while guarding the fundus of uterus


name: Perform rectal examination to ensure tissue integrity


name: Maintain privacy and assure uninterrupted time during procedure


name: Position patient in comfortable, lying, semirecumbent posture


name: Cleanse site of entry or end of Y-connector with alcohol wipe before and after procedure


name: Instill irrigating fluids, per agency protocol


name: Keep patient fully informed of each irrigation, if repetition is necessary


name: Monitor patient level of comfort and ease of irrigation with each instillation, if repetition is necessary


name: Discontinue irrigations if procedure becomes too difficult or if it appears the catheter is obstructed


name: Notify physician if catheter is obstructed


name: Monitor and maintain correct flow rate with continuous infusions


name: Connect catheter to new drainage bag at end of irrigation


name: Assure patient comfort at end of procedure


name: Review patient history for specific risk factors (e.g., surgery, trauma, ulcers, hemophilia, poor clotting function, clotting inhibition from medication regime)


name: Monitor the patient closely for signs and symptoms of internal and external hemorrhage (e.g., distension or swelling of affected body part, change in type or amount of drainage from a surgical drain, bloody saturation of dressings, pooling of blood beneath patient)


name: Monitor for signs and symptoms of persistent bleeding (e.g., hypotension, weak and rapid pulse, cool and clammy skin, rapid breathing, restlessness, reduced urine output)


name: Monitor coagulation studies, including prothrombin time, partial thromboplastin time, fibrinogen, fibrin degradation and split products, and platelet counts, as appropriate


name: Avoid injections (IM or SQ), as appropriate


name: Use electric razor, instead of straight edge, for shaving


name: Instruct patient to avoid invasive procedures; if they are necessary, monitor closely for bleeding


name: Instruct patient to avoid lifting heavy objects


name: Instruct patient to avoid constipation (e.g., encourage fluid intake and stool softeners), as appropriate


name: Apply ice pack to affected area, as appropriate


name: Note hemoglobin/hematocrit levels before and after blood loss


name: Monitor for signs and symptoms of persistent bleeding (i.e., check all secretions for frank or occult blood)


name: Hematest all excretions and observe for blood in emesis, sputum, feces, urine, NG drainage, and wound drainage, as appropriate


name: Instruct the patient and family on signs of bleeding and appropriate actions (i.e., notify the nurse), should further bleeding occur


name: Instruct the patient on activity restrictions


name: Obtain client history of vaginal bleeding (e.g., onset, amount, frequency of changing peri pads, color of bleeding, presence and location of pain, and presence of clots)


name: Review for risk factors related to late pregnancy bleeding (e.g., abruptio placentae, smoking, cocaine use, hypertension, diabetes, multiparity, previous cesarean birth, prior and current placenta previa, infertility treatment, multiple gestations, short interval between pregnancies, greater than 35 years of age)


name: Inspect perineum, clothing, sheets or pads for amount and characteristic of bleeding


name: Weigh blood-soaked materials and clots to quantify blood loss


name: Continually monitor characteristic and amount of bleeding


name: Initiate continuous electronic fetal monitoring


name: Report client status and any changes in amount and frequency of bleeding, as appropriate


name: Delay digital cervical examination until location of placenta has been verified by ultrasound


name: Perform or assist with speculum examination to visualize blood loss and cervical status


name: Initiate IV access for fluid replacement


name: Obtain diagnostic blood studies (e.g., CBC, clotting studies, Rh, type and cross match, Kleihauer-Betke test), as ordered


name: Provide empathy, understanding and emotional support


name: Provide information on procedures, diagnostic tests, and treatments


name: Instruct woman to differentiate between old and fresh bleeding


name: Inform woman to monitor fetal movement to evaluate fetal well-being


name: Monitor for signs of hypovolemic shock (e.g., decreased blood pressure; rapid, thready pulse; increased respiratory rate; diaphoresis; restlessness; cool, clammy skin)


name: Monitor coagulation studies and complete blood count (CBC) with WBC differential, as appropriate


name: Avoid extremes in gastric pH level by administration of appropriate medication (e.g., antacids or histamine-2 blocking agent), as appropriate


name: Maintain pressure in cuffed/balloon nasogastric tube, if appropriate


name: Apply manual pressure over the bridge of the nose


name: Administer humidified oxygen, if appropriate


name: Place patient in mid-Fowler's position, as appropriate


name: Instruct patient to avoid traumatizing nares (e.g., avoid scratching, blowing, or touching nose)


name: Perform fundal massage to ensure firm consistency


name: Increase frequency of fundal massage until the uterus becomes firm


name: Inspect placenta for intactness and missing fragments


name: Notify primary practitioner of excessive blood loss


name: Initiate IV infusion with needles suitable for blood transfusion


name: Administer a uterotonic drug, per protocol or order


name: Monitor maternal color, level of consciousness, pain, and anxiety level


name: Insert Foley catheter with urometer to monitor urine output, as appropriate


name: Order emergency laboratory tests or units of blood


name: Identify mother's beliefs about blood transfusions


name: Prepare the woman for transfer to the operating room for surgical intervention


name: Maintain continuous bladder irrigation, if appropriate


name: Identify means of reducing effect of any disfigurement through clothing, wigs, or cosmetics, as appropriate


name: Determine patient's understanding of body mechanics and exercises (e.g., return demonstration of correct techniques when performing activities/exercises)


name: Use the principles of body mechanics in conjunction with safe patient handling and movement aids


name: Determine fluoride content of water used to dilute concentrated or powdered formula and refer for fluoride supplementation, if indicated


name: Perform rectal examination, as appropriate


name: Formulate a bowel retraining plan with the family (e.g., mineral oil, high fiber diet, regular toileting routine)


name: Encourage child to sit on toilet 10 to 15 minutes after meals for intervals of 10 minutes


name: Place a footstool below the feet to relax the abdomen


name: Provide positive reinforcement (e.g., stickers, praise, special activities) to encourage the child to participate in the bowel regime


name: Evaluate for fecal incontinence, as necessary


name: Instruct patient on techniques to use to calm an infant (e.g., speak to infant, hand on belly, restraining arms, picking up, and holding and rocking)


name: Provide time and space to be alone, as appropriate


name: Select puncture site (e.g., outer lower aspect of heel, sides of distal phalanges of fingers or toes, alternative sites such as forearm)


name: Follow manufacturer's guidelines regarding timing on tests and preservation of blood sample (e.g., sealing blood tubes), as necessary


name: Monitor patient physically and psychologically per agency policy


name: Ensure activity level that does not compromise cardiac output or provoke cardiac events


name: Encourage gradual increase in activity when condition stabilized (i.e., encourage slower paced activities or shorter periods of activity with frequent rest periods after exercise)


name: Evaluate any episodes of chest pain (e.g., 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) per agency policy


name: Instruct the patient and family on treatment modalities, activity restriction and progression


name: Screen patients for anxiety and depression, encouraging treatment with suitable antidepressants, as indicated


name: Encourage noncompetitive activities for patients at risk for impaired cardiac function


name: Instruct patient and family on the aims of care and how progress will be measured


name: Ensure that all staff are aware of these goals and are working together to provide consistent care


name: Refer to heart failure program or cardiac rehabilitation program for education, evaluation, and guided support to increase activity and rebuild life, as appropriate


name: Offer spiritual support to the patient and family (e.g., contact a member of the clergy), as appropriate


name: Provide immediate and continuous means to summon nurse and let the patient and family know calls will be answered immediately


name: Perform a comprehensive appraisal of cardiac status including peripheral circulation


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


name: Select best EKG lead for continuous monitoring, as appropriate


name: Draw serum, CK, LDH, and AST levels, as appropriate


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


name: Monitor liver function tests, if appropriate


name: Monitor laboratory values for electrolytes that may increase the risk of dysrhythmias (e.g., serum potassium and magnesium), as appropriate


name: Monitor trends in blood pressure and hemodynamic parameters, if available (e.g., central venous pressure and pulmonary capillary or artery wedge pressure)


name: Provide appropriate cardiac diet (i.e., limit intake of caffeine, sodium, cholesterol, and food high in fat)


name: Substitute artificial salt, if appropriate


name: Prevent peripheral thrombus formation (i.e., turn every 2 hours and administer low-dose anticoagulants)


name: Instruct the patient on self-care of chest pain (i.e., take sublingual nitroglycerine every 5 minutes three times; if chest pain is unrelieved, seek emergency medical care)


name: Instruct the patient and family on any special considerations with activities of daily living (e.g., isolate activities and allow rest periods), if appropriate


name: Screen patient for anxiety and depression, as appropriate


name: Screen patient for risk behaviors associated with adverse cardiac events (e.g., smoking, obesity, sedentary lifestyle, high blood pressure, history of previous cardiac events, family history of cardiac events)


name: Identify patient's readiness to learn lifestyle modification (e.g., diet, smoking, alcohol intake, exercise, and cholesterol levels)


name: Instruct patient and family on signs and symptoms of early cardiac disease and worsening cardiac disease, as appropriate


name: Instruct patient and family on cardiac risk factor modification, as appropriate


name: Prioritize areas for risk reduction in collaboration with patient and family


name: Instruct patient and family to monitor blood pressure and heart rate routinely and with exercise, as appropriate


name: Encourage exercise, as indicated by patient cardiac risk factor


name: Instruct the patient on regular and progressive exercise, as appropriate


name: Encourage 30 minutes of exercise daily, as appropriate


name: Instruct patient on need to achieve exercise goals in incremental periods of 10 minutes multiple times daily, if intolerant to sustained 30-minute activities


name: Instruct patient and family on strategies for restricting or eliminating smoking


name: Instruct patient and family on strategies for a heart healthy diet (e.g., low sodium, low fat, low cholesterol, high fiber, adequate fluid, appropriate caloric intake)


name: Encourage patient to keep caloric intake at a level that achieves desired weight


name: Instruct patient and family on therapies to reduce cardiac risk (e.g., medication therapies, blood pressure monitoring, fluid restrictions, alcohol restrictions, cardiac rehabilitation)


name: Provide both verbal and written information to patient, family, and caregivers for all pertinent cares, as indicated


name: Focus care and treatment goals to enable the patient to maintain weight control, to remain a nonsmoker, and to remain as active as possible


name: Refer to heart failure program or cardiac rehabilitation program for lifestyle changes, as appropriate


name: Alleviate patient anxieties by providing accurate information and correcting any misconceptions


name: Monitor patient's progress at regular intervals


name: Document cost effectiveness of case management


name: Monitor for signs of infection (foul-smelling cast, erythema, fever)


name: Monitor for signs of cast impairment of circulation or neurological function (e.g., pain, pallor, pulselessness, paresthesias, paralysis, and pressure) on affected extremity


name: Monitor circulation and neurological function of tissues above and below cast


name: Offer alternatives to scratching (e.g., cold air from a hair dryer)


name: Avoid getting a plaster cast wet (e.g., use appropriate protection for bathing or toileting, protective socks or gloves)


name: Position cast on pillows to lessen strain on other body parts with cast heel off pillow


name: Apply ice for first 24 to 36 hours to reduce swelling or inflammation


name: Elevate casted extremity at or higher than heart level to reduce swelling or inflammation


name: Pad rough cast edges and traction connections


name: Document cast care instructions given to patient and family


name: Document observations of patient ability to perform cast care


name: Address compromised circulation and pain symptoms immediately, to avoid permanent damage in neurovascular status (e.g., reposition cast, report unresolved symptoms as needing immediate cast pressure relieving action)


name: Handle the casted extremity with palms only until the cast is dry to avoid causing finger indentations that can lead to pressure sores


name: Explain the need for limited activity as cast dries


name: Apply ice for first 24 to 35 hours to reduce swelling or inflammation, as indicated


name: Elevate casted extremity at or higher than heart level to reduce swelling or inflammation, as indicated


name: Use self-adhesive anchoring devices, when appropriate or per agency policy


name: Obtain chest x-ray immediately in event of suspected line infiltration, compromise, or migration


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


name: Monitor neurologic status closely and compare to baseline


name: Monitor patient's ICP and neurologic response to care activities


name: Position with head of bed up 30 degrees or greater


name: Encourage family/significant other(s) to talk to patient


name: Monitor laboratory values: serum and urine osmolality, sodium, potassium


name: Perform passive range-of-motion exercises


name: Titrate barbiturate to achieve suppression or burst suppression of EEG as ordered


name: Consult with physician to determine hemodynamic parameters


name: Administer and titrate vasoactive drugs, as prescribed, to maintain hemodynamic parameters


name: Monitor for anticoagulant therapy side effects (e.g., test stool and NG drainage for blood)


name: Administer rheologic agents (e.g., low-dose mannitol or low molecular weight dextrans), as prescribed


name: Draw blood to monitor hematocrit level, electrolytes, and blood glucose


name: Maintain hematocrit level for hypervolemic hemodilution therapy per protocol


name: Avoid neck flexion or extreme hip or knee flexion


name: Administer calcium channel blockers and vasopressors, as prescribed


name: Administer anticoagulant, antiplatelet, and thrombolytic medication, as prescribed


name: Monitor laboratory values for changes in oxygenation or acid-base balance, as appropriate


name: Monitor respiratory status (e.g., rate, rhythm, and depth of respirations; partial oxygen pressure, PCO2, pH, and bicarbonate levels)


name: Discuss feelings, questions, and concerns patient has about surgery


name: Obtain necessary blood work and document results


name: Encourage intimate partner or support person to be present during delivery


name: Give information about events taking place and sensations patient may be experiencing during surgery


name: Transfer patient to recovery room or labor room


name: Monitor physiological aspects of recovery (e.g., pain, uterine changes, airway patency, and lochia)


name: Inspect condition of surgical incision and dressing


name: Assist in performing leg exercises, turning, coughing, and deep breathing


name: Provide adequate breastfeeding education and support, if appropriate (i.e., demonstrate infant positioning adaptations according to mobility limitations)


name: Facilitate family bonding and attachment by minimizing maternal-infant separation (e.g., present infant en face to mother, provide unobstructed view of infant, facilitate skin-to-skin contact, and transfer mother and infant together)


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


name: Promote activities to modify the identified risk factors


name: Monitor for side effects and toxic effects of treatment


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


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


name: Administer medications to control side effects (e.g., antiemetics for nausea and vomiting), as needed


name: Administer chemotherapeutic drugs in the late evening so the patient may sleep at the time emetic effects are greatest


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


name: Teach patient on self-assessment of oral cavity, including signs and symptoms to report for further evaluation (e.g., burning, pain, and tenderness)


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


name: Teach patient to avoid temperature extremes and chemical treatments of the hair when receiving treatment


name: Inform patient that hair loss is expected, as determined by type of therapy


name: Reassure patient that hair will grow back after treatment is terminated, as appropriate


name: Teach patient and family to monitor for organ toxicity, as determined by type of therapy


name: Discuss potential aspects of sexual dysfunction, as appropriate


name: Teach implications of therapy on sexual function, including the time frame for contraceptive use, as appropriate


name: Monitor fatigue level by soliciting the patient's description of fatigue


name: Teach patient and family techniques of energy management, as appropriate


name: Facilitate expression of fears about prognosis or success of treatments


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


name: Determine presence of contraindications for use of chest physiotherapy (e.g., acute exacerbation of COPD, pneumonia without evidence of excess sputum production, osteoporosis, lung cancer, and cerebral edema)


name: Perform chest physiotherapy at least 2 hours after eating


name: Explain purpose and procedures used during chest physiotherapy to patient


name: Position any necessary equipment nearby (e.g., suctioning equipment, sputum container, and tissues)


name: Monitor respiratory and cardiac status (e.g., rate, rhythm, breath sounds, and depth of breath)


name: Monitor amount and character of secretions


name: Determine lung segment(s) containing excessive secretions


name: Position patient with the lung segment to be drained in uppermost position, making modifications for patients unable to tolerate prescribed position (i.e., avoid placing patient with COPD, acute head injury, and cardiac problems in Trendelenburg position as it can increase shortness of breath, intracranial pressure, and stress, respectively)


name: Strike chest rhythmically and in rapid succession using cupped hands over area(s) to be drained for 3 to 5 minutes, avoiding percussion over spine, kidneys, female breasts, incisions, and broken ribs


name: Apply pneumatic, acoustical, or electrical chest percussors


name: Rapidly and vigorously vibrate hands, keeping shoulders and arms straight and wrists stiff, on area(s) to be drained while patient exhales or coughs 3 to 4 times


name: Instruct patient to expectorate loosened secretions via deep breathing


name: Encourage coughing during and after procedure


name: Monitor patient tolerance during and after procedure (e.g., pulse oximetry, vital signs, and reported comfort level)


name: Teach the mother and partner about the physiology of labor and delivery


name: Explore childbirth plan for labor and delivery (e.g., the birthing environment, who will assist mother, who will be in attendance, what technology will be used, who will cut the cord, feeding preferences, and discharge plans)


name: Educate mother and partner about signs of labor


name: Inform mother about when to come to the hospital in preparation for delivery


name: Discuss pain control options with mother


name: Inform mother about delivery options if complications arise


name: Explain routine monitoring that may occur during labor and delivery


name: Teach mother and partner breathing and relaxation techniques to be used during labor and delivery


name: Review American Academy of Pediatrics recommendations for breastfeeding


name: Encourage mother to put the infant to breast after delivery


name: Provide opportunity for mother to be in close proximity to infant during postpartum hospitalization to facilitate bonding and breastfeeding


name: Promote parent's self-efficacy in taking on parental role


name: Discuss arrangements for sibling care during hospitalization


name: Assist parent(s) in planning strategies to prepare siblings for newborn


name: Assist parent to select a physician or clinic to receive child health supervision for newborn


name: Encourage mother to obtain an approved infant car safety seat to transport newborn home from hospital


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


name: Target at-risk patients (e.g., diabetics, smokers, elderly, hypertensive patients and those with elevated cholesterols levels) for comprehensive peripheral assessments and modification of risk factors


name: Encourage smoking cessation and regular exercise in patients with claudication


name: Encourage walking to the point of claudication and a little bit more each time to assist in the development of collateral circulation in the lower extremities


name: Instruct patient and family on medication therapies for blood pressure control, anticoagulation, and reduction of cholesterol levels


name: Instruct patient on avoidance of beta blockers for blood pressure control, as they cause constriction of peripheral vessels and worsens claudication


name: Instruct patient on diet measures to improve circulation (e.g., diet low in saturated fat and good intake of omega 3 fish oils)


name: Instruct diabetic patients on the need for proper management of blood sugar


name: Instruct patient on proper skin care (e.g., moisturizing dry skin on legs, prompt attention to wounds and potential ulcers)


name: Provide patient and family with smoking cessation information, if applicable


name: Instruct patient on signs and symptoms indicating a need for emergent care (e.g., pain that does not go away upon rest, wound complications, loss of feeling)


name: Encourage patient participation in vascular rehabilitation programs


name: Evaluate patient's responsiveness to determine appropriate action


name: Call for help if no breathing or no normal breathing and no response


name: Call a code according to agency standard when obtaining the automated external defibrillator (AED) or assuring that someone is obtaining the automated external defibrillator


name: Perform cardiopulmonary resuscitation that focuses on chest compressions in adults and compressions with breathing efforts for children, as appropriate


name: Deliver cardioversion or defibrillation as soon as possible


name: Minimize the interval between stopping chest compressions and delivering a shock, if indicated


name: Attach the cardiac monitor and determine the rhythm, assuring defibrillations will not be interrupted


name: Assure that someone is oxygenating the patient and assisting with intubation, as indicated


name: Ensure that someone is: (1) setting up medications; (2) delivering medications; (3) interpreting EKG and delivering cardioversion/defibrillation, as needed; and (4) documenting care


name: Remind personnel of current Advanced Cardiac Life Support protocols, as appropriate


name: Ensure that special resuscitation protocols (e.g., asthma, anaphylaxis, pregnancy, morbid obesity, pulmonary embolism, electrolyte imbalance, ingestion of toxic substances, trauma, accidental hypothermia, avalanche, drowning, electric shock or lightning strikes, percutaneous coronary interventions, cardiac tamponade, cardiac surgery) are instituted, when appropriate


name: Offer family members and significant other(s) opportunities to be present during resuscitation when in the best interests of the patient


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


name: Ensure that someone is coordinating care of other patients on the nursing unit


name: Terminate code by patient condition, as indicated


name: Assure organized post cardiac arrest care (e.g., cardiopulmonary and neurological support, therapeutic hypothermia, tapering of inspired oxygen concentration to avoid harmful hyperoxia, avoidance of hyperventilation)


name: Implement appropriate procedures for possible tissue and organ donation that are timely, effective, and supportive of the family members' and patient's desires


name: Review actions after code to identify areas of strength and those which need to be improved


name: Provide opportunities for team members to be involved in team debriefings or reflect on resuscitation efforts after event


name: Perform emergency cart check per agency protocol


name: Demonstrate caregiver sensitivity by responding promptly and appropriately to cues


name: Stimulate development by engaging in activities to enhance achievement and learning by being attuned to the patent's needs


name: Offer cognitive stimulation at work, such as training opportunities, cognitive richness to work content, opportunities for growth, and multitasking


name: Encourage cognitive stimulation outside of work, such as reading or active participation in cultural and artistic activities


name: Ask for opinions and views rather than factual answers


name: Seek input and respect the contributions of others


name: Build teams of approximately 5 to 9 members


name: Design group work spaces that easily support 5 to 9 people with everyone having equal access to digital and analog information displays and being able to see each other eye to eye


name: Ensure that work spaces have easy projection and teleconferencing capabilities


name: Encourage group members to switch where they sit on a regular basis to build stronger networks


name: Provide individual workstations for private focused work with visual eyesight to others and a place for a visitor to sit (e.g., bench)


name: Provide a social space in which individuals can talk casually


name: Enable workers to have choice and control of where they work by providing a range of settings


name: Support programs of interdisciplinary education including interprofessional orientation days and social events, joint faculty appointments, and interdisciplinary coursework and clinic activities


name: Provide web-based tools (e.g., calendar, agendas, committee assignments, appropriate forms and documents) to help workers coordinate and communicate


name: Include the patient as a teammate, as appropriate


name: Use communication tools (e.g., daily huddles; repeat back; Situation, Background, Assessment, Recommendation [SBAR]; opportunity for questions), as needed


name: Continue dialogue of legal and ethical matters as they apply to the situation


name: Address misconceptions and stereotypes among team members


name: Use negotiation as a strategy for conflict resolution


name: Value the enhanced benefits of the collaborative efforts of the team


name: Recognize resourcefulness in coping with present situation


name: Assist individuals to realize their personal strengths, potential, and capacity


name: Demonstrate your valuing of individual or family


name: Build collaborative relationship with individual or family


name: Recognize individual's strength in modifying behavior to address the situation


name: Provide positive feedback to encourage and sustain new behavior


name: Acknowledge the capacity to live with chronic, long-term health issue or illness, as appropriate


name: Congratulate one in achieving improved outcome


name: Reinforce a behavior or outcome to increase the probability that it will be sustained


name: Facilitate motivation to continue with improved behavioral changes to attain the main goal


name: Apply strategies to reinforce learning and promote confidence and worth in learner


name: Write up statements of praise and send to individual or other persons (e.g., supervisor, award program), as appropriate


name: Promote legislation that ensures appropriate monitoring and treatment for communicable diseases


name: Perform or arrange for routine hearing assessments and screenings


name: Monitor for excessive accumulation of cerumen


name: Instruct patient not to use foreign objects smaller than patient's fingertip (e.g., cotton-tipped applicators, bobby pins, toothpicks, and other sharp objects) for cerumen removal


name: Remove excessive cerumen with twisted end of washcloth while pulling down the auricle


name: Consider ear irrigation for the removal of excessive cerumen if watchful waiting, manual removal, and ceruminolytic agents are ineffective


name: Note and document patient's preferred method of communication (e.g., verbal, written, lip reading, or American Sign Language) in plan of care


name: Gain patient's attention before speaking (e.g., obtain attention through touch)


name: Avoid noisy backgrounds when communicating


name: Avoid communicating more than 2 to 3 feet from patient


name: Listen attentively, allowing patient adequate time to process communication and respond


name: Facilitate lip reading by facing patient directly in good lighting


name: Ask patient to suggest strategies for improved communication (e.g., speaking toward better ear and moving to well-lit area)


name: Face the patient directly, establishing eye contact, and avoid turning away midsentence


name: Simplify language (i.e., do not use slang and use short, simple sentences), as appropriate


name: Avoid "baby talk" and exaggerated expressions


name: Verify what was said or written using patient's response before continuing


name: Facilitate use of hearing aids and assistive listening devices (e.g., phone amplifier, hardwire device, personal frequency modulation, and computers)


name: Remove hearing aid battery when hearing aid is not in use for several days


name: Clean detachable earmold using a mild soapy solution, removing moisture or debris with soft cloth, and avoiding isopropyl alcohol, solvents, and oil


name: Clean nondetachable earmold using a damp cloth, removing moisture or debris with soft cloth, and avoiding isopropyl alcohol, solvents, and oil


name: Check hearing aid batteries routinely, replacing, when necessary


name: Refer to manufacturer's guidelines on proper use of, care for, and maintenance of hearing aids and assistive listening devices


name: Instruct patient, nursing personnel, and family on use of, care for, and maintenance of hearing aids and assistive listening devices


name: Assist patient or family in acquiring hearing aid and assistive listening device


name: Refer to primary care provider or specialist for evaluation, treatment, and hearing rehabilitation


name: Monitor speech speed, pressure, pace, quantity, volume, and diction


name: Monitor cognitive, anatomical, and physiological processes associated with speech capabilities (e.g., memory, hearing, and language)


name: Instruct patient or family on cognitive, anatomical, and physiological processes involved in speech capabilities


name: Monitor patient for frustration, anger, depression, or other responses to impaired speech capabilities


name: Recognize emotional and physical behaviors as forms of communication


name: Provide alternative methods of speech communication (e.g., writing tablet, flash cards, eye blinking, communication board with pictures and letters, hand signals or other gestures, and computer)


name: Provide alternative methods of writing or reading, as appropriate


name: Adjust communication style to meet needs of client (i.e., stand in front of patient when speaking; listen attentively; present one idea or thought at a time; speak slowly but avoid shouting; use written communication; or solicit family's assistance in understanding patient's speech)


name: Maintain structured environment and routines (i.e., ensure consistent daily schedules; provide frequent reminders; and provide calendars and other environmental cues)


name: Modify environment to minimize excess noise and decrease emotional distress (i.e., limit visitors and excessive equipment noise)


name: Ensure call light is within reach and central call light system is marked to indicate patient cannot speak


name: Repeat what patient said to ensure accuracy


name: Phrase questions so patient can answer using a simple "yes" or "no," being aware that patient with expressive aphasia may provide automatic responses that are incorrect


name: Collaborate with family and speech language pathologist or therapist to develop a plan for effective communication


name: Provide one-way valve for patient with tracheostomy, replacing need for finger occlusion over tube


name: Instruct patient or family on use of speech aids after laryngectomy (e.g., esophageal speech, electrolarynges, tracheoesophageal fistulas)


name: Provide positive reinforcement, as appropriate


name: Refer patient to community support systems (e.g., The International Association of Laryngectomees and American Cancer Society)


name: Provide referral to speech language pathologist or therapist


name: Coordinate rehabilitation team activities


name: Perform or arrange for routine vision assessments and screenings


name: Monitor functional implications of diminished vision (e.g., risk of injury, depression, anxiety, and ability to perform activities of daily living and valued activities)


name: Identify yourself when entering the patient's space


name: Assist patient in enhancing stimulation of other senses (e.g., savoring aroma, taste, and texture of food)


name: Ensure that patient's eyeglasses or contact lens have current prescription, are cleaned, and stored properly when not in use


name: Minimize glare (i.e., offer sunglasses or draw window covering)


name: Avoid rearranging items in patient's environment without notifying patient


name: Provide daily living aids (e.g., clock and telephone with large numbers)


name: Apply labels to distinguish frequently used items (i.e., color-code dials on appliances, mark medication bottles using high-contrasting colors or rubber bands, and safety-pin labels on similar-colored clothing)


name: Use bright, contrasting colors in environment


name: Provide magnifying devices (e.g., handheld, stand, and video magnifier)


name: Provide sight substitutes (e.g., Braille materials, audio books, talking watches, and tactile markers)


name: Assist parents, family, educators, and caretakers involved with a child with diminished vision in meeting informational needs (e.g., how to teach child, anticipatory guidance, and developmental considerations)


name: Instruct parents, family, educators, and caretakers to recognize and respond to nontraditional expressive forms of communication (e.g., movements and facial expressions)


name: Assist parents, family, educators, and caretakers in developing reliable, functional communication systems (e.g., microswitches or speech-output devices)


name: Assist patient or family in identifying available resources for vision rehabilitation


name: Provide referral for the patient in need of surgical or other medical treatment


name: Provide referral for supportive services (e.g., social, occupational, and psychological)


name: Assist to prepare shelters and emergency aid stations


name: Define the objectives of the advocacy and the specific community to be assisted


name: Assist community members to navigate the health care system (e.g., to access low-cost or free care, to solve billing issues, to understand patient rights


name: Provide access to translation services, when needed


name: Work with lay community health workers and community leaders to identify needs and provide services


name: Assist community leaders to conduct a needs assessment whereby needs can be prioritized and activities to be identified


name: Understand the cultural health beliefs and practices of the identified community members


name: Help to mobilize resources in a community that will assist in achieving goals


name: Seek consultation, training, and support for community advocacy efforts to build coalitions


name: Participate in media campaigns to increase public awareness


name: Attend school board meetings to share the negative effect of not having enough school nurses to monitor students' health statuses


name: Attend and speak at public forums about the positive effect of proposed health care services, projects, and legislation


name: Provide appropriate health care information and education to the public and legislators


name: Assist in the introduction and passage of health care legislation by finding sponsors and persuading potential cosponsors to sign on with their support


name: Use real-life examples from clinical practice to illustrate the needs of patients and the outcomes of public policy on patient care


name: Identify obstacles that prevent success and implement strategies to reduce barriers


name: Establish time of next interaction before ending meeting each time


name: Summarize conversation at end of discussion


name: Monitor eyes and surrounding area for open lesions and ecchymosis


name: Determine patient's understanding of required lens care


name: Determine patient's physical and emotional capability to learn and perform required lens care


name: Instruct patient to perform hand hygiene before touching lenses


name: Instruct patient on proper care of contact lenses depending on type (e.g., hard or soft)


name: Instruct patient to remove lenses at appropriate interval (e.g., remove daily wear lenses at night and do not wear disposable lenses more than once)


name: Instruct patient wearing extended-wear contacts of increased risks (e.g., corneal ulcers and infection-caused eruptions)


name: Instruct patient wearing hard contacts of increased risks (e.g., corneal edema and corneal abrasions)


name: Instruct patient on symptoms to report to health care professional (e.g., eye and conjunctiva redness, discomfort or pain, excessive tearing, and visual changes)


name: Instruct patient to use recommended solutions to clean, moisten, rinse, and disinfect lenses


name: Instruct patient to rub and rinse lenses with recommended solution before and after storage


name: Instruct patient on importance of monitoring for and discontinuing use of recalled contact lens care products


name: Instruct patient not to use saliva, tap water, or sterile saline found in health care agencies for rinsing or storing lenses


name: Instruct patient to avoid exposing eyes to tap water, swimming pool water, or spa water when wearing lenses


name: Instruct patient to store lenses in lens container with recommended solution


name: Instruct on care of lens container (e.g., clean daily, leave open to air, and replace regularly)


name: Instruct the patient who wears eye cosmetics to use caution in their selection and application (i.e., choose cosmetics without irritating properties and apply before lens insertion)


name: Instruct patient to avoid exposure to or use of damaging or irritating environmental contaminants (e.g., dust, smoke, soaps, lotions, creams, and sprays)


name: Instruct patient to carry appropriate identification on type and care for lenses


name: Provide lens care for the patient unable to do so for self (e.g., removal, cleaning, storing, and insertion)


name: Account for access to controlled substances at all times


name: Follow agency protocol for resolving discrepancies


name: Keep abreast of federal and state regulations regarding the use of controlled substances


name: Monitor for evidence of misadministration or diversion of controlled substances (e.g., provider arriving early, staying late, coming to work on day off; volunteering to give medication to other's patients; frequent bathroom breaks; patients reporting unrelieved pain despite adequate prescription of pain medication)


name: Review computer reports, when available, to identify outliers regarding individual practitioner's use of controlled agents


name: Assist the patient in identifying appropriate short-term and long-term goals


name: Appraise the effect of the patient's life situation on roles and relationships


name: Determine the risk of the patient's inflicting self-harm


name: Use supplies and equipment efficiently and effectively


name: Provide factual information, as necessary and appropriate


name: Encourage new skill development, as appropriate


name: Place relevant variables (e.g., outcomes, interventions, laboratory and diagnostic tests, consultations, patient and family education) sequentially on a decision tree


name: Keep the decision tree as simple as possible, even when the clinical events are complex (i.e., provide important details but minimize wordiness and length)


name: Include key decision points in which provider judgment is critical


name: Calculate variances and report through appropriate channels


name: Determine newborn state before initiating feeding


name: Use clean cup without lid, spout, or lip


name: Pour expressed milk at room temperature or formula into cup


name: Hold swaddled newborn upright or semi-upright while supporting newborn's back, neck, and head


name: Hold cup to newborn's lip, resting slightly on the lower lip with cup's edges touching outer parts of upper lip


name: Monitor for newborn signs of feeding readiness (e.g., increased alertness, open mouth and eyes, movements with mouth and face)


name: Tip cup so that milk touches newborn's lips


name: Monitor newborn's intake mechanism (i.e., preterm/low birth weight newborn tends to lap milk, whereas full-term/older infant tends to sip or suck milk)


name: Burp the newborn frequently during and after the feeding


name: Monitor for newborn signs of fullness (e.g., closing mouth, not taking in more milk, change in infant state, infant not responding to verbal or tactile stimulation)


name: Discontinue feeding upon newborn sign of distress or infant sign of fullness


name: Measure newborn's milk intake over 24 hours


name: Instruct parent on cup feeding procedures


name: Instruct parent about feeding readiness, distress, and feeding termination signs


name: Select a specific cutaneous stimulation strategy based on the individual's willingness to participate, ability to participate, preference, support of significant others, and contraindications


name: Ensure that the electrical stimulation device is in good working order, as appropriate


name: Determine the individual's interest in the dance therapy


name: Inform the individual about purpose of the dance experience


name: Discuss with individual the desired goals (e.g., relaxation, stimulation, concentration, pain reduction)


name: Determine the individual's capabilities for movement


name: Identify preferences for the type of music and dance related to desired goals


name: Determine the time intervals between each session


name: Recommend the wearing of comfortable and appropriate clothing and shoes for dancing


name: Limit distracting visual and auditory stimuli


name: Select a suitable place and the necessary equipment (e.g., sound equipment, music selections, mirrors, chairs), as applicable


name: Plan sessions according to progress in the execution of movements


name: Allow time for pauses and breaks, if applicable


name: Instruct the individual to perform the dance therapy at home, if applicable


name: Incorporate family participation in the sessions, if applicable


name: Monitor continuously the achievement of the objectives and targets


name: Assist patient to clarify values and expectations that may assist in making critical life choices


name: Inform patient of alternative views or solutions in a clear and supportive manner


name: Use interactive computer software or web-based decision aides as an adjunct to professional support


name: Initiate cardiopulmonary resuscitation, as indicated


name: Prepare for immediate defibrillation of pulseless, unresponsive patient in conjunction with cardiopulmonary resuscitation


name: Maintain cardiopulmonary resuscitation when not administering external defibrillation


name: Determine type and operation techniques for available defibrillator


name: Apply pads or paddles according to machine recommendations (e.g., paddles need conduction agent; pads are ready-made with conduction agent)


name: Place appropriate monitoring devices on patients (automated external defibrillator pads or monitor leads)


name: Place paddles or pads to avoid clothing or bed linens, as appropriate


name: Determine need for shock per defibrillator instructions or interpretation of arrhythmia


name: Use safety precautions before discharging (e.g., call "clear" three times; ensure no one is touching the patient including self)


name: Monitor results and repeat, as indicated


name: Minimize interruptions to chest compressions in unresponsive patients


name: Assist in patient recovery (e.g., activate emergency medical systems when out of hospital for transport of patient to emergency care institution; arrange for transport within hospital to appropriate nursing unit for intensive cardiac care) as indicated


name: Instruct new nursing staff on type and operation techniques for available defibrillator


name: Assist in education of public related to proper use and indications of external defibrillation in cardiopulmonary arrest


name: Provide information to patient and family related to defibrillator implantation (e.g., indications, functions, cardioversion experience, required lifestyle changes, potential complications)


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


name: Document pertinent data in patient's permanent record regarding initial insertion of defibrillator (e.g., manufacturer, model number, serial number, implant date, mode of operation, capability for pacing and/or shock delivery, delivery system for shocks, upper and lower rate limits for rate-responsive devices)


name: Confirm defibrillator placement postimplantation with baseline chest x-ray


name: Monitor for potential complications associated with defibrillator insertion (e.g., pneumothorax, hemothorax, myocardial perforation, cardiac tamponade, hematoma, PVCs, infections, hiccups, muscle twitches)


name: Observe for changes in cardiac or hemodynamic status, which indicate a need for modifications of defibrillator parameters


name: Monitor for conditions that potentially influence sensing (e.g., fluid status changes, pericardial effusion, electrolyte or metabolic abnormalities, certain medications, tissue inflammation, tissue fibrosis, tissue necrosis)


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


name: Monitor for redness or swelling at the device site


name: Instruct patient to avoid tight or restrictive clothing that might cause friction at insertion site


name: Instruct patient on activity restrictions (e.g., initial arm movement restrictions for pectoral implantations, avoidance of heavy lifting, avoid contact sports, adhere to driving restrictions)


name: Monitor for symptoms of arrhythmias, ischemia, or heart failure (e.g., dizziness, syncope, palpitations, chest pain, shortness of breath) particularly with each outpatient contact


name: Instruct patient about emergent symptoms and what to do if symptoms occur (e.g., call emergency responders if dizzy)


name: Monitor drug and electrolyte levels for patients receiving concurrent antiarrhythmic medications


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


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


name: Instruct patient about basic safety in avoidance of electromagnetic interference (e.g., keep at least 6 inches away from sources of interference; do not leave cell phones in the "on" mode in a shirt pocket over the defibrillator)


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Avoid frightening family or friends about unexpected shocks


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


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


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


name: Encourage patient and family members to attend CPR classes


name: Encourage attendance at support group meetings


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


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


name: Explain the task to the health care worker


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


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


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


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


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


name: Acknowledge the patient's fears and feelings


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


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


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


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


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


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


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


name: Convey unconditional acceptance and support


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


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


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


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


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


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


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


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


name: Give pain medication before bath if movement is painful


name: Identify usual patterns of wandering behavior


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


name: Monitor prescribed medication regime, as appropriate


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


name: Discuss and support decision to breastfeed or bottle feed


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


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


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


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


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


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


name: Determine appropriate management technique for sleep disturbance or disorder


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


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


name: Provide developmentally appropriate, safe toys and activities


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


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


name: Determine appropriate scheduling for initial and subsequent dental examinations


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


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


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


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


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


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


name: Encourage provision of safe space for infant exploration


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


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


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


name: Promote and facilitate family bonding and attachment with infant


name: Support and praise parent skills and efforts


name: Discuss parent return to work and childcare options


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


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


name: Refer for parenting education, as needed


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


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


name: Avoid venipuncture and blood pressures in peripheral access extremity


name: Clamp nasogastric tube and monitor tolerance, as appropriate


name: Determine whether patient is passing flatus


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Monitor for lactose intolerance as a possible postsurgical complication


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Record all motions and the outcomes of all votes


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


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


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


name: Keep the writing clear, objective, and succinct


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


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


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


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


name: File approved minutes according to organizational policy


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


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


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


name: Monitor amount of tearing using tear strips


name: Screen the corneal epithelial damage using a standard test


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


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


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


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


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


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


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


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


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


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


name: Report abnormal signs and symptoms to the physician


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


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


name: Facilitate care by others, as appropriate


name: Facilitate referral to hospice, as desired


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


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


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


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


name: Ensure appropriate lead selection in relation to patient needs


name: Ensure proper lead placement, and signal quality


name: Ensure ongoing monitoring of bedside ECG by qualified individuals


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


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


name: Ensure ready access of emergency dysrhythmia medications


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


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


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


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


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


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


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


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


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


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


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


name: Instruct patient on importance of annual hearing testing


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


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


name: Cleanse external ear using washcloth-covered finger


name: Monitor for an excessive accumulation of cerumen


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


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


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


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


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


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


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


name: Refer patient to ear care specialist, as needed


name: Limit physical activity as needed to promote weight gain


name: Monitor for abnormal serum electrolytes, as available


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


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


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


name: Place on cardiac monitor, as appropriate


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


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


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


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


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


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


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


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


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


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


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


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


name: Monitor for systemic allergic reactions to calcitonin


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


name: Verify all highly abnormal elevations of potassium


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


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


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


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


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


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


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


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


name: Assess dietary and pharmaceutical intake of magnesium


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


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


name: Monitor urinary output in patients on magnesium therapy


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


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


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


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


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


name: Maintain bed rest and limit activities, as appropriate


name: Position patient to facilitate ventilation, as indicated


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


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


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


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


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


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


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


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


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


name: Offer fluids at regular intervals for debilitated patients


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


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


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


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


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


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


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


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


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


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


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


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


name: Monitor for electrolyte imbalances associated with hyperphosphatemia


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


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


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


name: Avoid laxatives and enemas that contain phosphate


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


name: Initiate seizure precautions in patients with severe hypocalcemia


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


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


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


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


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


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


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


name: Administer supplemental potassium, as prescribed


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


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


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


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


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


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


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


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


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


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


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


name: Monitor renal sufficiency in patients receiving magnesium replacement


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


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


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


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


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


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


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


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


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


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


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


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


name: Monitor all parenteral fluids for sodium content


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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