name: Refer to physical and occupational therapy for vestibular habituation training exercises


name: Collaborate with physical therapy in developing and executing exercise program


name: Determine motivation level for maintaining or restoring joint movement


name: Explain purpose and plan for joint exercises


name: Monitor location and nature of discomfort or pain during movement or activity


name: Monitor breathing pattern while performing exercise


name: Assist to optimal body position for passive and active joint movement


name: Encourage active range-of-motion (ROM) exercises, according to regular, planned schedule


name: Perform passive ROM exercises, as indicated


name: Instruct how to systematically perform passive, assisted, or active ROM exercises


name: Provide written instructions for exercise


name: Assist to develop schedule for active ROM exercises


name: Encourage to visualize body motion before beginning movement


name: Determine readiness to engage in activity or exercise protocol


name: Consult physical therapy to determine optimal position during exercise and number of repetitions for each movement pattern


name: Explain rationale for type of exercise and protocol


name: Provide privacy for exercising, if desired


name: Adjust lighting, room temperature, and noise level to enhance concentration for exercise activity


name: Initiate pain control measures before beginning exercise or activity


name: Assist to maintain trunk and proximal joint stability during motor activity


name: Assist to sitting or standing position for exercise protocol, as appropriate


name: Reinforce instructions about proper performance of exercises to minimize injury and maximize effectiveness


name: Identify any misperceptions of body image


name: Reorient to body awareness and movement functions of body


name: Encourage to visually scan affected side of body when performing ADLs or exercises, if indicated


name: Instruct to recite each movement as performed


name: Use visual aids to facilitate learning methods to perform ADLs or exercise movements, as appropriate


name: Provide restful environment after periods of exercise


name: Assist to develop exercise protocol for strength, endurance, and flexibility


name: Encourage to practice exercises independently, as indicated


name: Encourage to use warm-up and cool-down activities before and after exercise protocol


name: Use tactile (e.g., tapping) stimuli to minimize muscle spasm


name: Assist to prepare and maintain progress graph or chart for adherence with exercise protocol


name: Monitor emotional, cardiovascular, and functional responses to exercise protocol


name: Monitor self-exercise for correct performance


name: Evaluate progress toward enhancement and restoration of body movement and function


name: Provide positive reinforcement for efforts in exercise and physical activity


name: Assist to make prescribed revisions in home exercise plan, as indicated


name: Determine hemodynamic status using multiple parameters to evaluate clinical status and appropriateness for extracorporeal membrane oxygenation therapy (ECMO) therapy (e.g., blood pressure, heart rate, pulses, jugular venous pressure, central venous pressure, right and left atrial and ventricular pressures, pulmonary artery pressure), as appropriate


name: Record baseline vital signs (e.g., temperature, pulse, respirations, blood pressure, weight)


name: Explain ECMO procedure and obtain informed consent


name: Determine type of ECMO needed (i.e., using a vein and an artery [VA ECMO] for problems with both heart and lungs, or using one or more veins near heart [VV ECMO] for problems only in lungs)


name: Assist as needed with initiation of ECMO cannulation, assuring time out for procedure and presence of properly trained staff (e.g., respiratory therapist, surgical team, nurses)


name: Ensure proper sedation, paralysis, anticoagulation and ventilation, as prescribed


name: Obtain post-cannulation radiology studies (e.g., anterior posterior chest or abdomen or both)


name: Initiate ECMO, according to protocol, increasing blood flow until respiratory and hemodynamic targets are met


name: Maintain blood flow at set rate determined by achievement of respiratory and hemodynamic targets, while providing continuous venous oximetry


name: Maintain anticoagulation with continuous IV infusion of unfractionated heparin or direct thrombin inhibitor to achieve an activated clotting time (ACT) of 180 to 210 seconds


name: Reduce ACT target if bleeding occurs, as prescribed


name: Monitor platelet counts and maintain level above 50,000/mL, per protocol


name: Monitor hemoglobin and maintain level within normal range


name: Adjust ventilator settings to prevent barotrauma, ventilator-induced lung injury, and oxygen toxicity, as prescribed


name: Monitor urine output and laboratory values to determine adequacy of kidney function


name: Monitor for signs of infection and poor perfusion such as increased lactic acid level, metabolic acidosis, decreased urine output, and increased liver enzymes


name: Monitor lower limbs for signs of ischemia, coolness, or mottling of feet


name: Conduct daily wakeup and hourly pupil checks to monitor neurological status


name: Practice diligent repositioning to prevent skin breakdown


name: Provide for care with two-member team (e.g., ECMO specialist, nurse)


name: Ensure team includes ECMO specialist nurse providing 24-hour, 7-day ECMO care and supported by perfusionist backup for technical aspects of circuit management


name: Ensure that ECMO order sets are available for machine priming, daily parameters, circuit settings, parameters for blood transfusions and orders for radiology (e.g., echocardiogram for symptoms)


name: Ensure instructions available for all perfusionists or nurses in charge of ECMO machine


name: Monitor daily and routine laboratory values per protocol


name: Monitor anticoagulation status and adjust settings per protocol and order sets


name: Ensure instructions available to alert ECMO health care providers, as needed


name: Check person-circuit interactions per protocols and order sets (e.g., flow rate, pressure, temperature, pH level, conductivity, clots, air detector, negative pressure for ultrafiltration, blood sensor) to ensure safety


name: Manage clinical needs through continuous surveillance and troubleshooting to prevent and manage circuit emergencies


name: Monitor blood pressure, pulse, respirations, temperature, and response continuously during ECMO therapy


name: Ensure interprofessional team is involved in plan of care (e.g., physical therapy, occupational therapy, nutritionist, case management)


name: Compare post-ECMO vitals and blood chemistries to pre-ECMO values


name: Document tolerance of procedure and achievement of outcomes, as appropriate


name: Explain procedures regardless of level of consciousness


name: Monitor corneal reflex and determine if pupils are equal, round, and reactive to light and accommodation (e.g., PERRLA)


name: Place in supine position prior to any procedures


name: Use clean warm washcloth or cotton balls moistened with warm water or saline to cleanse


name: Apply eye shield and alternate as needed for vision, as appropriate


name: Apply lubricating eye drops or ointments, as appropriate


name: Keep movement from inner aspect or nasal area to outer aspect when cleansing eye


name: Start with cleanest eye first when doing procedures to both eyes


name: Ensure new separate swab, cotton ball, or corner of washcloth used for each eye


name: Avoid sharing swabs or shields between eyes


name: Perform eye care every 4 hours or as prescribed


name: Adjust eye care frequency when receiving oxygen therapies that dry eyes


name: Instruct on wearing sunglasses and hats to avoid or reduce ultraviolet sun exposure


name: Instruct on proper eye care, as indicated


name: Instruct on regular eye examinations (i.e., age 65 and older need comprehensive dilated eye exams every year)


name: Follow six rights of medication administration if medication administered


name: Identify using at least two identifiers (e.g., name, birthdate)


name: Determine knowledge of medication and understanding of method of administration or procedure


name: Position lying on side with affected eye down


name: Place basin next to eye to catch drainage


name: Prepare to expose upper and lower lids if irrigating in stages (i.e., first hold lower lid down, then hold upper lid up)


name: Use slight pressure on bony prominences of eye orbits to keep eyelids in place and prevent reflexive blinking


name: Hold eye irrigator 2.5 cm (1 inch) above eye to avoid excessive pressure while irrigating


name: Irrigate eye directing solution onto conjunctival area from inner canthus to outer canthus


name: Avoid irrigating toward nasal lacrimal duct


name: Irrigate until solution leaving eye is clear, or as ordered for medication


name: Instruct to close and move eye periodically during irrigation to enhance secretion or debris removal


name: Wipe eyelids from inner to outer canthus when cleansing


name: Identify cognitive or physical deficits that may increase risk of falling


name: Identify characteristics of environment that increase potential for falls (e.g., slippery floors, rugs, open stairways)


name: Institute fall safety guideline (e.g., signage, colored clothing, bracelet), per facility policy


name: Evaluate gait, balance, and fatigue level with ambulation


name: Encourage use of cane, walker, or gait belt as appropriate


name: Instruct on use of cane, walker, or gait belt as appropriate


name: Lock wheels of wheelchair, bed, or gurney during transfer


name: Instruct to call for assistance with movement, as appropriate


name: Post signs to remind to call for help when getting out of bed, as appropriate


name: Provide elevated toilet seat for easy transfer, as needed


name: Provide sleeping surface close to floor, as needed


name: Remove low-lying furniture (e.g., footstools, tables) and clutter on floor surface


name: Provide nonslip surfaces in bathtub, shower, and floor surfaces


name: Ensure shoes fit properly, fasten securely, and have non-skid soles


name: Instruct to wear prescription glasses, as appropriate


name: Educate about risk factors that contribute to falls and ways to decrease risks


name: Instruct on importance of handrails for stairs, bathrooms, and walkways


name: Assist in identifying and modifying hazards in home


name: Instruct to avoid ice and other slippery outdoor surfaces


name: Develop ways to participate safely in leisure activities


name: Institute routine physical exercise program that includes walking


name: Collaborate with interprofessional team to minimize side effects of medications that contribute to falling (e.g., orthostatic hypotension, unsteady gait)


name: Provide close supervision and safety devices


name: Institute fall safety agreement, as appropriate


name: Maintain crib side rails in elevated position when caregiver not present, as appropriate


name: Fasten latches securely on access panel of incubator when leaving bedside of infant in incubator


name: Educate parents about the effects of sleep deprivation on family functioning


name: Obtain consensus from interprofessional team for family's presence and timing of family's presence


name: Apprise situation to determine when appropriate for family presence


name: Minimize risk of physical presence by following appropriate infection control guidelines


name: Communicate proactively so families are aware of any restrictions


name: Provide specifically trained team members (e.g., chaplain, nurse, social worker) to be designated for family, who can handle difficult and exceptional family situations


name: Clearly state compassionate exceptions to infection control or other restrictions


name: Use shared decision-making approach to communicate risks and benefits in cases where family can be physically present


name: Invite family presence during resuscitation, as appropriate


name: Introduce self and other members of interprofessional team to family and person


name: Ensure family has been informed about what to expect (e.g., what they will see, hear, smell, condition of person, equipment used)


name: Inform family to report if they feel faint or ill


name: Ensure family members are not left unattended


name: Apprise interprofessional team of family's emotional reaction to person's condition, as appropriate


name: Obtain information concerning person's status, response to treatment, identified needs


name: Provide timely information and explanations to family of person's status, response to treatment and identified needs, in understandable terms


name: Enlist family to assist in assuring other members abide by established safety protocols, if indicated


name: Use person's name when speaking to family


name: Determine person's and family's emotional, physical, psychosocial, and spiritual support needs and initiate measures to meet those needs, as needed


name: Provide opportunity for family to ask questions, to see, touch, or speak to person before transfers


name: Assist person or family members in making telephone calls, as needed


name: Enhance discharge education and follow-up to support successful transitions of care (e.g., hospice)


name: Provide comfort measures and support, including appropriate referrals, as needed


name: Participate in evaluation of staff emotional needs


name: Assist in identifying need for critical incident stress debriefing and individual defusing of events


name: Determine food, cultural, or religious preferences and incorporate into feeding routines


name: Create pleasant environment during mealtime, removing unnecessary equipment and supplies


name: Provide oral hygiene before meals, as needed


name: Fix food on tray as prefers (e.g., cutting meat, opening packages)


name: Maintain in upright position with head and neck flexed slightly forward during feeding


name: Place food within vision area if has visual-field defect


name: Ask to indicate when finished, as appropriate


name: Provide drinking straw, as needed or desired


name: Provide finger foods or preferred foods and drinks, as appropriate


name: Maintain attention to person while they are eating


name: Encourage parents or family to feed person


name: Encourage to eat in dining room if available


name: Provide adaptive devices to facilitate feeding self (e.g., long handles, handle with large circumference, small strap on utensils) as needed


name: Monitor body weight, hydration status, and laboratory values, as appropriate


name: Instruct person and family on methods to assist with feeding needs


name: Determine current use of healthcare system and financial effect


name: Assist to identify financial needs, including analysis of assets and liabilities


name: Determine cognitive ability to read, fill out forms, manage money


name: Assist to develop plan to prioritize daily living needs


name: Devise plan of care to encourage person or family to access appropriate levels of care in most cost-effective manner


name: Inform of services available through state and federal programs


name: Determine whether eligible for waiver programs


name: Refer person who may be eligible for state or federally funded programs to appropriate individuals


name: Inform of available resources and assist in accessing resources (e.g., medication assistance program, county relief program)


name: Assist to develop budget or make referral to appropriate financial resource person (e.g., financial planner, estate planner, consumer counselor), as needed


name: Assist to fill out applications for available resources, as needed


name: Assist in long-term care placement planning, as needed


name: Assist to assure money in secure place (e.g., bank), as needed


name: Assist in obtaining burial fund, as appropriate


name: Represent economic needs at multidisciplinary conferences, as needed


name: Collaborate with community agencies to provide needed services


name: Administer medication (e.g., prophylactic antibiotic, vaccination, antihistamine, anti-inflammatory, and analgesic), as appropriate


name: Develop cost-benefit analysis of programs and services


name: Maintain budget appropriate to services provided


name: Solicit matched contributions that support programs and services


name: Use appropriate accounting methods to ensure accurate and designated use of funds


name: Determine baseline fluid status (e.g., overloaded, dehydrated, normovolemic)


name: Monitor for changes in fluid status using regularly obtained data (e.g., weights, laboratory values, vital signs)


name: Conduct medication reconciliation to determine medications influencing fluid balance


name: Treat underlying cause of fluid imbalance where possible (e.g., overuse of diuretics, congestive heart failure, hyperglycemia)


name: Maintain accurate intake (e.g., IV, oral) and output record (e.g., urinary void, urinary catheter, incontinence briefs, weighed diapers)


name: Monitor hydration status (e.g., moist mucous membranes, adequacy of pulses, orthostatic blood pressure, fontanel appearance, skin turgor), as appropriate


name: Monitor vital signs and hemodynamic status


name: Monitor for indications of fluid overload or retention (e.g., crackles, elevated CVP or pulmonary capillary wedge pressure, edema, neck vein distention, ascites), as appropriate


name: Monitor for indications of dehydration (e.g., dry mucous membranes, weak peripheral pulses, flat neck or hand veins, decreased urine output, dizziness, syncope)


name: Monitor location and extent of edema if present


name: Administer IV therapy at room temperature, as prescribed


name: Administer prescribed diuretics and fluid regulating medications (e.g., aldosterone, electrolytes, albumin), as appropriate


name: Promote oral intake (e.g., provide drinking straw; offer fluids between meals; change ice water routinely; make freezer pops using child's favorite juice; cut gelatin into fun squares; use small medicine cups), as appropriate


name: Provide fluids that observe prescribed dietary restrictions (e.g., sugar-free, low-sodium, thickened)


name: Instruct on nothing by mouth (NPO) status, as appropriate


name: Encourage significant other to assist with feedings, as appropriate


name: Monitor response to prescribed electrolyte therapy


name: Consult health care provider if signs and symptoms of fluid volume excess persist or worsen


name: Prepare for administration of blood products (i.e., check blood with identification and prepare infusion setup), as appropriate


name: Monitor response to therapies at least every 2 hours


name: Instruct related to fluid intake or restriction, medications influencing fluid balance and dietary intake for maintaining adequate fluid balance


name: Instruct related to signs and symptoms of fluid imbalances


name: Determine current foot care practices and routines


name: Inspect skin of feet, including ankles, for irritation, cracks, lesions, corns, calluses, deformities, or edema


name: Inspect shoes for proper fit, noting areas of wear


name: Monitor gait and weight distribution on feet


name: Monitor hydration level of feet, arterial insufficiency in lower legs, and lower extremity edema


name: Wash feet or administer foot soaks, as needed


name: Apply lotion or moisture-absorbing powder, if indicated


name: Inspect nails for thickness or discoloration


name: Clean nails and cut normal thickness toenails when soft, using toenail clipper and using curve of toe as guide, following agency protocol for trimming nails


name: Use emery board to file nails to ensure smooth corners


name: Recommend assistance of significant other with foot care if vision impaired or if mobility problems


name: Instruct to inspect inside of shoes for rough areas


name: Instruct to monitor temperature of feet using back of hand


name: Instruct in importance of regular inspection, especially when sensation diminished


name: Assist in developing plan for daily foot assessment and care at home


name: Instruct to use mirror or assistance of another to carry out foot inspection, as needed


name: Advise daily washing of feet using warm water and mild soap


name: Advise thoroughly drying feet after washing them, especially between toes


name: Instruct to hydrate skin daily by brief soaking, bathing in room-temperature water or application of emollient


name: Advise regarding when to contact health professional, including presence of nonhealing or infected lesions


name: Caution about potential sources of injury to feet, (e.g., heat, cold, cutting corns or calluses, chemicals, strong antiseptics or astringents, adhesive tape, going barefoot or wearing thongs or open-toe shoes)


name: Instruct on proper technique for toenail trimming, (i.e., cutting relatively straight across, following contour of toe, and filing sharp edges with emery board)


name: Instruct on care of soft calluses, including gentle buffing with towel or pumice stone after bath


name: Recommend specialist care for thick or ingrown toenails, corns, calluses, or bony deformities, as indicated


name: Recommend appropriate shoes (i.e., low heeled with shoe shape that matches foot shape; adequate depth of toe box; soles made of material that will absorb shock; adjustable fit by lace or straps; uppers made of breathable, soft, and flexible materials; changes made for gait and limb-length disorders; and potential for modification, if necessary)


name: Recommend appropriate socks, (i.e., absorbent and non-constricting)


name: Recommend guidelines to follow when purchasing new shoes, including having feet properly measured and fitted at time of purchase


name: Recommend wearing new shoes only few hours at a time for first 2 weeks


name: Communicate God's/higher power's or inner self 's forgiveness through prayer, scripture, other readings, as appropriate


name: Determine desired change in social, physical, behavioral, spiritual, or group dynamics (e.g., relaxation, stimulation, concentration, stress reduction, physical activity)


name: Describe purpose of gardening and skills needed for successful experience including pacing physical activity, observational skills and tasks needed for optimal plant growth, and time of activities


name: Identify gardening preferences (e.g., indoor, outdoor, seasonal, location, time commitment)


name: Choose plants (e.g., vegetables, flowers, herbs) and garden location (e.g., indoor, outdoor, raised beds) preferences


name: Limit exposure to extraneous physical stress (e.g., excessive heat, cold, rain, lightning)


name: Adapt gardening activities to endurance levels and abilities


name: Make gardening equipment, fertilizer, and water available


name: Provide educational materials at appropriate learning level


name: Allow time for self-reflection, group interchange, and therapeutic evaluation


name: Actively encourage participation with others to promote social interaction


name: Monitor quality, transformation, and quantity of plants and produce


name: Monitor physical, social, and therapeutic response


name: Debrief regularly on challenges and benefits of gardening


name: Determine knowledge base, myths, perceptions, and misperceptions related to genetic conditions


name: Explore confirmed genetic risk factors to determine level of understanding


name: Determine purpose, goals, and agenda for genetic counseling session


name: Determine presence and quality of support systems and previous coping skills


name: Explore estimates of risk, based upon phenotype (e.g., person characteristics), family history (e.g., pedigree analysis), calculated risk information, or genotype (e.g., genetic testing results)


name: Provide estimates of occurrence or recurrence risk for person and at-risk family members


name: Provide information on natural history of disease or condition, treatment and management strategies, prognostic information, and prevention strategies, if known


name: Provide information about risks, benefits, and limitations of treatment or management options, as well as options for dealing with recurrence risk


name: Provide decision-making support as persons consider their options


name: Monitor response when person learns about own genetic risk factors


name: Allow and stimulate expression of feelings


name: Record summary of genetic counseling session, as indicated


name: Assist in identifying nature of attachment to lost object or person


name: Consider social context of person experiencing loss


name: Assist to identify initial reaction to loss


name: Encourage expression of memories of loss, both past and current


name: Assure that grief is natural reaction to experiencing loss


name: Assure that everyone experiences grief in own unique way


name: Explain phases of grieving process, as appropriate


name: Encourage to implement cultural, religious, and social customs associated with loss


name: Recommend attending grief support group, if appropriate


name: Determine capability for doing non-nurse guided imagery (e.g., alone or with tape)


name: Determine willingness to engage in reflection processes


name: Determine if concern or experience appropriate for guided reflection process


name: Select strategies for engaging in reflection activities (e.g., in person, internet, telehealth, written reflection)


name: Establish therapeutic relationship based on trust and respect


name: Identify focus of guided reflection with person


name: Monitor feelings and emotions expressed during reflection


name: Assist to describe what occurred (e.g., What, where and when did this happen? What did you do? In what order did things occur? What was the result?)


name: Ask to describe what they were thinking and feeling about event (e.g., What was your initial reaction? What were you thinking or feeling during and after situation? What do you think about it now?)


name: Support expression of thoughts and feelings through use of silence and active listening


name: Encourage to think-aloud while examining experience to enhance clarity


name: Assist in evaluating experience (e.g., What went well? What were the challenges? Who or what was unhelpful? What needs improvement?)


name: Assist in clarifying misinformation or inaccuracies, if indicated


name: Assist in seeking needed information and resources


name: Assist in finding meaning in situation (e.g., What similarities or differences are there between this experience and other experiences? What choices did you make and what effect did they have? What did you do well? What went wrong or did not turn out how it should have done?)


name: Explore other actions or choices that could have been taken (e.g., What factors do you believe affected the outcome? What are some alternative actions or approaches?)


name: Explore different choices for future occurrences of same situation (e.g., If similar situation or experience arose again, what would you do? What might you do to increase likelihood of positive outcomes and minimize likelihood of undesirable outcomes? What did you learn from this experience?)


name: Explore progress toward resolution at appropriate intervals


name: End session by encouraging reflection on discussion and what was learned, as appropriate


name: Refer to counseling, support group, or other health care providers at end of session, if indicated


name: Touch the patient's body to help him or her ground or connect with the earth's energy if they experience dizziness when getting up


name: Establish working relationship with interprofessional team


name: Participate in orientation of interprofessional team


name: Assist health care providers to learn routines of care unit


name: Encourage use of structured communication tool (e.g., Situation, Background, Assessment, Recommendation [SBAR]) to foster clear communication as needed


name: Create and use system to inform interprofessional team of assigned caregivers


name: Coach residents and health care providers through unfamiliar routines


name: Alert interprofessional team to changes in scheduled procedures


name: Discuss care concerns or practice-related issues directly with health care provider involved


name: Encourage to voice concerns to interprofessional team


name: Report changes in status, as appropriate


name: Participate in bedside rounds and interprofessional care teams, as appropriate


name: Participate on interprofessional committees to address clinical issues


name: Use interprofessional projects and committees as forums


name: Provide information to appropriate interprofessional team


name: Follow up interprofessional team requests for new equipment or supplies


name: Provide feedback to interprofessional team about changes in practice, equipment, and staffing


name: Include interprofessional team on in-services for new equipment or practice changes


name: Encourage interprofessional team to participate in collaborative education programs


name: Support collaborative research and quality improvement activities


name: Target needs identified in United Nations' Sustainable Development Goals, Healthy People 2030: National Health Promotion and Disease Prevention Objectives, or other local, state, and national needs


name: Identify internal or external individual, group or community factors that may enhance or reduce motivation for healthy behavior


name: Determine type and focus of health education program (e.g., physical health, social health, emotional and mental health, spiritual health)


name: Determine personal context and social-cultural history of health behavior


name: Determine current health knowledge and lifestyle behaviors


name: Assist in clarifying health beliefs and values


name: Identify ethnic and cultural background, family and community support, social environment, accommodation, religion, spiritual beliefs and lifestyle factors


name: Prioritize individual learner needs based on person preference and needs, skills of nurse, resources available, and likelihood of successful goal attainment


name: Formulate clear and achievable goals for health education program


name: Identify resources (e.g., personnel, space, equipment, money) needed to conduct program


name: Use strategies to motivate people to change health or lifestyle behaviors


name: Discuss group rules before starting health education group


name: Emphasize immediate or short-term positive health benefits rather than long-term benefits or negative effects of noncompliance


name: Determine model, methodology, modality (individual or group), and length of education session


name: Design modules, number of sessions and schedule of health educational intervention considering needs of individuals, family or caregivers, community and health care professionals


name: Use best available information (e.g., high quality research), understandable, adjusted to language and culture needs, using facilitative counseling and didactic teaching skills


name: Develop educational materials written at readability level appropriate to target audience


name: Incorporate strategies for resisting unhealthy behavior or risk taking


name: Facilitate dialogue, interaction, social learning, space for support and cooperation within group intervention


name: Provide knowledge on specific illness (e.g., course of disease, etiological factors, effects and impact, common signs and symptoms, role of treatment in recovery, myths and misconceptions about specific illness), as necessary


name: Instruct on medication management (e.g., teach about medications, compliance and adverse effects, when and how to seek treatment, answer questions, prepare for self-management), as necessary


name: Provide knowledge related to relapse (e.g., identification and management of triggers, consequences, early signs and symptoms, early identification of impending relapse), as necessary


name: Encourage group activities to provide support and alleviate insecurities


name: Use peer leaders, teachers, and support groups in implementing programs to groups less likely to listen to health professionals or adults (e.g., adolescents), as appropriate


name: Encourage personal exchange of experiences


name: Involve in planning and implementing plans for lifestyle or health behavior modification


name: Use social and family support systems to enhance effectiveness of lifestyle or health behavior modification


name: Emphasize importance of healthy patterns of eating, sleeping, and exercising, to persons who model these values and behaviors to others, particularly children


name: Plan long-term follow-up to reinforce health behavior or lifestyle changes


name: Implement strategies to measure outcomes at regular intervals during and after completion of program


name: Implement strategies to measure program and cost effectiveness of education, using data to improve effectiveness of subsequent programs


name: Influence development of policy that guarantees health education as employee benefit


name: Determine qualifying services available by location


name: Determine current knowledge of health care system and health care needs


name: Explain immediate health care services, how they work, and what to expect


name: Assist to coordinate health care and communication


name: Assist to choose appropriate health care professionals


name: Instruct on what type of services to expect from each type of health care provider


name: Inform about different types of health care facilities (e.g., general hospital, specialty hospital, teaching hospital, walk-in clinic, outpatient surgical clinic), as appropriate


name: Inform of accreditation and state health department requirements for judging facility quality


name: Inform of recognitions and awards for judging facility quality (e.g., Leapfrog Safety, Magnet, Pathway to Excellence)


name: Inform of appropriate community resources and contact persons


name: Encourage use of second opinion as appropriate


name: Inform how to access emergency services, as appropriate


name: Facilitate communication among health care providers and person, as appropriate


name: Coordinate or schedule time needed by each service to deliver care, as appropriate


name: Inform about cost, time, alternatives, and risks involved in specific test or procedure


name: Give written or printed instructions for purpose and location of posthospitalization or outpatient activities, as appropriate


name: Give written or printed instructions for purpose and location of health care activities, as appropriate


name: Facilitate transportation needs for obtainment of health care services


name: Provide follow-up contact, as appropriate


name: Assist to complete forms for assistance (e.g., housing, financial aid), as needed


name: Notify of scheduled appointments, as appropriate


name: Provide written or printed instructions as appropriate


name: Compare post-dialysis vitals and blood chemistries to predialysis values


name: Recognize presence of early warning signs and symptoms of compromised hemodynamic system (e.g., dyspnea, decreased ability to exercise, orthopnea, profound fatigue, dizziness, light-headedness, edema, palpitations, paroxysmal nocturnal dyspnea, sudden weight gain)


name: Involve person in deciding home maintenance requirements


name: Identify basic sanitation needs in place of residence


name: Assist family members to develop realistic expectations in performance of their roles


name: Monitor for therapeutic and adverse effects


name: Review knowledge regarding beneficial and adverse effects of different hormonal components (e.g., estrogen, progesterone, androgen)


name: Review knowledge regarding interaction effects of adjunct therapies (e.g., calcium and vitamin D supplementation, exercise, thiazide use)


name: Review knowledge regarding different methods and routes of administration (e.g., oral continuous combined, oral sequential, dermal, vaginal)


name: Review diet and suggest limiting caffeine, saturated fats, and sugar


name: Facilitate decision to continue or discontinue


name: Ensure dose and regimen of therapy are individualized, choosing lowest appropriate dose in relation to severity of symptoms and menopause onset age


name: Recommend short-term annual decisions about continuation


name: Determine at-risk populations (e.g., people who endured emotional, physical and psychological trauma)


name: Identify indicators of possible trafficking (e.g., bruises or wounds consistent with application of physical restraints; untreated infections; urinary difficulties, pregnancy, rectal trauma, malnourishment, lack of health care)


name: Be alert for person accompanied by another person who is controlling, provides all information, or does all communicating


name: Note unusual circumstances such as persons with no identification or fake identification, or controller has person's identification with them


name: Identify persons who seem confused, submissive or fearful, refuse to make eye contact, seem afraid to speak in presence of others, or are reluctant to discuss injuries


name: Be alert for persons who do not state an address, claim to just be visiting, or seem unable to identify their location


name: Consider risk factors for possible trafficking (e.g., frequent truancy or runaway, recurrent sexually transmitted infections, reports high number of sex partners, far along in pregnancy with no prenatal care, inappropriately dressed, accompanied by someone who will not leave person alone or let person speak, improper dress for weather)


name: Address any emergency regarding person's physical needs or immediate safety concerns (i.e., call authorities if indicated)


name: Provide safe, non-judgmental environment


name: Speak to person alone in appointment and address any concerns, in private room with closed doors


name: Ask partner to fill out forms in separate lobby or firmly state need for private exam


name: Communicate with person using professional interpreter and do not permit family member or accompanying partner to translate


name: Make eye contact, practice active listening, and convey attitude of caring


name: Provide with confidential questionnaire with human trafficking screening questions if indicated


name: Determine potential danger and care needs


name: Involve authorities when person is a minor, reports self or family in danger, trafficker present, or staff or other persons are in danger


name: Respect limits of confidentiality, but explain legal requirements to report suspected abuse, neglect, or violence to external agencies, including mandated reporting obligations


name: Do not violate Health Insurance Portability and Accountability Act (HIPAA) regulations


name: Gain consent and permission from any adult patient before disclosing personal health information (PHI)


name: Report PHI in known or suspected child abuse or neglect to public health authority or other appropriate government authority authorized by law to receive such reports


name: Offer methods to seek help when ready, if unwilling to discuss captive situation, or if declines or denies need for assistance


name: Use discreet methods of help to avoid further danger to person if abuser discovers (i.e., hide National Human Trafficking Hotline number on barcode of personal item, such as lipstick, soap, box of bandages)


name: Document all findings and suspicions to create legal record for future reference


name: Ensure yearly education for staff concerning red flags to identify possible trafficking victims and, if indicated, assist them to report


name: Ensure ability to offer victims community supports and resources to meet needs revealed during health care encounter


name: Work to develop policies and protocols within organizations to streamline screening, assessment, and response and ensure systematic approach to human trafficking identification and intervention


name: Promote community health and wellness, child welfare, gender equality, and violence prevention with community leaders


name: Identify persons at risk for hyperglycemia


name: Determine ability for recognition of hyperglycemia signs and symptoms


name: Monitor for signs and symptoms of hyperglycemia (e.g., polyuria, polydipsia, polyphagia, weakness, lethargy, malaise, blurring of vision, headache)


name: Monitor ABG, electrolyte, and glycated or glycosylated hemoglobin (A1C) levels, as indicated


name: Administer medications (e.g., insulin, oral hyperglycemic), as prescribed


name: Administer IV electrolytes, as appropriate


name: Consult health care provider if signs and symptoms of hyperglycemia persist or worsen


name: Anticipate situations in which insulin requirements will increase (e.g., stress, illness)


name: Instruct person and significant others on prevention, recognition, and management of hyperglycemia


name: Assist to interpret blood glucose levels and signs or symptoms of hyperglycemia


name: Review blood glucose records with person and family


name: Instruct to report moderate or large urine ketone levels to health professional


name: Instruct on diabetes management during illness and episodes of high stress (e.g., use of insulin and oral agents, monitoring fluid intake, carbohydrate replacement, when to seek health professional assistance)


name: Provide educational interventions on glucose awareness training


name: Provide feedback regarding appropriateness of self-management of hyperglycemia


name: Instruct on signs and symptoms, risk factors, and treatment of hyperglycemia


name: Instruct to obtain and carry or wear appropriate emergency identification


name: Determine educational needs about medication, supplies, and appointments


name: Educate about usual lack of symptoms and the need for longterm follow-up and therapy


name: Determine cause of increased body temperature (e.g., infection, heat stroke, dehydration, exposure to elements)


name: Monitor fever response including body temperature, heart rate, respiratory rate, mental status, thermal comfort, and recently tested microbiology or immunologic lab tests


name: Administer oral or IV medications (e.g., antipyretics, antibacterial agents, shiver prevention medications)


name: Discontinue physical activity and remove from heat source to cooler environment


name: Apply external cooling methods (e.g., cold packs to neck, chest, abdomen, scalp, armpits, and groin; hydrogel or air-circulating cooling blankets), as appropriate


name: Apply water compresses or sponges in conjunction with antipyretics


name: Use antipyretic and shiver prevention with physical cooling for increased efficacy


name: Wet body surface and fan but avoid shivering


name: Monitor for fever-related complications and signs and symptoms of fever-causing condition (e.g., seizure, decreased level of consciousness, abnormal electrolyte status, acid-base imbalance, cardiac arrhythmia)


name: Ensure other signs of infection are monitored in elderly persons, as may not display fever during infection


name: Ensure safety measures are in place if becomes restless or delirious


name: Instruct on risk factors for heat-related illness (e.g., high environmental temperature, high humidity, dehydration, physical exertion, extremes of age)


name: Instruct on measures to prevent heat-related illness (e.g., prevent sun overexposure; ensure adequate fluid intake; seek settings in which air conditioning available; wear lightweight, light-colored, and loose-fitting clothing)


name: Instruct on early signs and symptoms of heat-related illness and when to seek assistance from health care professional


name: Identify person at risk for hypoglycemia


name: Determine ability for recognizing signs and symptoms of hypoglycemia


name: Administer glucagon or intravenous glucose, as indicated


name: Provide simple carbohydrate if able to eat, utilizing the 15-15 rule (i.e., 15 grams of carbohydrate and check blood sugar after 15 minutes, if below 70 mg/dL, provide another 15 grams)


name: Instruct person and significant others on signs and symptoms, risk factors, and treatment of hypoglycemia


name: Instruct to have simple carbohydrate available at all times


name: Instruct on interaction of diet, insulin or oral agents, and exercise


name: Provide assistance in making self-care decisions to prevent hypoglycemia, (i.e., reducing insulin or oral agents and increasing food intake when exercising)


name: Provide interdisciplinary team access and approach for consultation regarding adjustments in treatment regimen


name: Collaborate with person and diabetes education team to make changes in insulin regimen, (e.g., multiple daily injections), as indicated


name: Inform of need for routine checks of glycosylated hemoglobin (HbA1c), as prescribed


name: Inform of increased risk of hypoglycemia with intensive therapy and normalization of blood glucose levels


name: Instruct regarding probable changes in hypoglycemia symptoms with intensive therapy and normalization of blood glucose levels


name: Explain procedure using sensory preparation


name: Administer analgesic medications 30 to 60 minutes prior to incision care


name: Inspect incision site for redness, swelling, signs of dehiscence, evisceration, or drainage


name: Monitor healing process and signs and symptoms of infection at incision site


name: Cleanse area around incision with appropriate non-cytotoxic cleansing solution and gentle friction


name: Swab from clean area toward less clean area (i.e., from incision to surrounding skin; from drain insertion in circular motion spiraling outward)


name: Direct any irrigation fluid to flow from least to most contaminated area


name: Use swab or gauze piece only once across incision and discard


name: Maintain position of drainage tube, if indicated


name: Apply incision closure strips, as appropriate


name: Use reusable tape or skin barriers to avoid repeated removal of tape from sensitive skin areas


name: Apply antiseptic ointment, as prescribed


name: Apply appropriate dressing to protect incision


name: Instruct on how to care for incision during bathing or showering


name: Educate how to minimize stress on incision site


name: Instruct how to care for incision, including signs and symptoms of infection


name: Educate on reasons to notify health care provider (e.g., fever redness, swelling, wound dehiscence)


name: Document incision care, incision status and education provided


name: Schedule eye examination for preterm infant


name: Inform parents or guardians about eye screening and examination procedures


name: Adjust ambient light to moderate-low level


name: Obtain baseline heart rate, oxygen saturation, and respiratory rate


name: Apply eye drops 1 hour before examination to dilate pupils and at appropriate intervals thereafter, per manufacturer instructions and per agency protocol


name: Place supine on flat surface with appropriate swaddling and arms and legs flexed


name: Place small pad under head to support cervical spine and thoracic first and second vertebrae


name: Offer oral glucose 10 to 15 minutes before procedure, and before body restraint


name: Offer pacifier before beginning examination


name: Leave pacifier in place throughout examination if suckles


name: Ensure warm temperature of nurse hands and use only gentle touch


name: Apply local anesthetic drops to eyes as indicated


name: Monitor heart rate, oxygen saturation, and respiratory rate during procedure


name: Wait until ophthalmologist places eyelid retractor on left or right eye before examination


name: Rate pain using appropriate pain scale for neonates or premature infants (e.g., Premature Infant Pain Profile, N-PASS, CRIES)


name: Provide oxygen if oxygen saturation <85% due to maneuvers made during examination (e.g., scleral depression, traction of extraocular muscles, globe pressure)


name: Stop procedure and rest infant if heart rate >200 bpm


name: Maintain swaddling position throughout examination for both eyes, as indicated


name: Give pacifier and maintain swaddling position until calmed down after completion of examination


name: Closely monitor nausea, apnea, increase in gastric residue, temporary changes in heart rate and desaturation for 24 hours after eye examination


name: Obtain weight, length, and fronto-occipital circumference


name: Maintain adequate body temperature of newborn (i.e., dry infant immediately after birth, wrap in blanket if not to be placed in warmer or skin to skin with parent)


name: Apply stockinette cap and instruct parent to keep head covered


name: Place skin-to-skin with parent for first 1-2 hours after birth, as appropriate


name: Administer vitamin K injection, as appropriate


name: Determine gestational age within 2 hours after birth (e.g., New Ballard Score)


name: Compare weight with estimated gestational age


name: Put to breast immediately after birth if breastfeeding preferred method of feeding


name: Hold infant during feedings, attempt to burp during and after


name: Assist parent in giving initial bath after temperature has stabilized


name: Swaddle to promote sleep and provide sense of security


name: Position on back or hold in reclined position after feeding


name: Provide information about nutritional needs, feeding techniques, and signs of infant stress during feeding


name: Determine condition of cord before transfusion using umbilical vein


name: Keep umbilical cord dry and exposed to air by diapering below cord


name: Monitor response to circumcision and signs of bleeding


name: Monitor for signs of hyperbilirubinemia every 8-12 hours


name: Protect from sources of infection in hospital environment


name: Determine readiness state before providing care


name: Respond to cues for care to facilitate development of trust


name: Provide information and facilitate screening for metabolic disorders


name: Instruct parent to place newborn alone and on back when sleeping, with no loose pillows or blankets


name: Keep bulb syringe accessible and instruct parents on use


name: Complete critical congenital heart disease screening test at 24 and 48 hours of age


name: Discourage pacifier use until breastfeeding well established


name: Encourage frequent diaper changes and provide education on stool transition expectation


name: Ensure hearing screening conducted prior to discharge


name: Conduct monitored car seat evaluation with infant, as needed


name: Instruct parents on post-circumcision monitoring and care, as appropriate


name: Complete discharge planning and education


name: Use teach-back to ensure parental understanding


name: Follow universal precautions for all care activities


name: Wash hands or use antimicrobial hand sanitizer before and after each care activity


name: Promote easy access to antimicrobial hand sanitizers (i.e., hang dispenser on wall or place by doors to all care areas)


name: Use PPE whenever expectation of possible exposure to infectious material


name: Ensure easy access to appropriate PPE to provide care for persons with known infectious material or disease (e.g., gloves, face masks, goggles, isolation gowns)


name: Promote protection of eyes, nose, and mouth


name: Position persons to direct sprays and splatter away from face of caregiver


name: Provide mouthpieces, pocket resuscitation masks with one-way valves, and other ventilation devices to ensure alternatives to mouth-to-mouth resuscitation and prevent exposure of caregiver's nose and mouth to oral and respiratory fluids during resuscitation efforts


name: Employ particulate respirator masks (e.g., N-95) during aerosol-generating procedures when aerosol likely to contain certain respiratory pathogens (e.g., M. tuberculosis, COVID-2019, avian or pandemic influenza viruses)


name: Employ safe work practices to prevent needlesticks and other sharps-related injuries (e.g., safety engineered sharps devices, appropriate disposal areas for sharps)


name: Provide single person rooms when concern about transmission of infectious agent, per organization policy and ability


name: Prioritize single person rooms for persons who have conditions that facilitate transmission of infectious material to other persons (e.g., draining wounds, stool incontinence, uncontained secretions, poor personal hygiene habits)


name: Prioritize single person rooms for those who are at increased risk of acquisition and adverse outcomes resulting from hospital acquired infections (HAIs) (e.g., persons with immunosuppression, open wounds, indwelling catheters)


name: Allocate appropriate square feet per person, as indicated by CDC guidelines (i.e., avoid overcrowding care areas)


name: Isolate persons exposed to communicable disease or with diagnosis of communicable disease, per the appropriate isolation precautions (e.g., contact, airborne, droplet, bloodborne)


name: Clean care area environment appropriately after each use, per agency policy


name: Clean and disinfect surfaces contaminated with pathogens, including those close to person (e.g., bed rails, over bed tables) and frequently touched surfaces in care environment (e.g., door knobs, surfaces in and surrounding toilets in rooms) more frequently, compared to other surfaces (e.g., horizontal surfaces in waiting rooms)


name: Use Environmental Protection Agency (EPA)-registered disinfectants that have microbiocidal activity against pathogens most likely to contaminate care environment, in accordance with manufacturer's instructions


name: Clean and disinfect all contact or care items or equipment, including toys in pediatric areas and multi-use mobile devices moved in and out of rooms


name: Contain, transport, and handle care equipment and instruments or devices that may be contaminated with infectious materials, per agency policy


name: Remove organic material from critical and semi-critical instruments or devices, using recommended cleaning agents prior to high level disinfection and sterilization, to enable effective disinfection and sterilization processes


name: Handle used textiles and fabrics with minimum agitation to avoid contamination of air, surfaces, and persons


name: Post written notices indicating type of isolation for each isolated person, including visitor restrictions or activities required by anyone entering room (e.g., handwashing, PPE use, length of allowed stay, distance to maintain from person)


name: Maintain isolation techniques for isolated persons, as appropriate


name: Limit the number of visitors for isolated persons, as appropriate


name: Post signs in public areas (e.g., entrances, cafeterias, elevators) with instructions to limit visitation if symptoms of respiratory infection, cough, or sneezing


name: Provide tissues and no-touch receptacles (e.g., foot-pedal-operated lid, open, plastic-lined waste basket) for disposal of tissues


name: Instruct persons on appropriate handwashing techniques and to cleanse hands on entering and leaving rooms


name: Maintain basic principles of aseptic technique for preparation and administration of parenteral medications (e.g., use of sterile, single-use, disposable needle and syringe for each injection given; prevent contamination of injection equipment and medication; use only single-dose vials)


name: Use fluid infusion and administration sets (e.g., IV bags, tubing, connectors) for one person only and dispose appropriately after use


name: Maintain an optimal aseptic environment during bedside insertion of central lines or any parenteral access


name: Maintain an aseptic environment and aseptic handling of all IV lines and when changing all IV tubing and bottles


name: Limit use of invasive devices (e.g., urinary catheters, feeding tubes) to decrease susceptibility to infection and colonization where possible


name: Discontinue invasive devices (e.g., urinary catheters, IV sites) when clinically indicated, to reduce risk for infection


name: Use urinary catheter care protocols and evidence-based guidelines to reduce risk of infection


name: Administer antibiotic therapy or immunizing agents, as appropriate


name: Instruct to take antibiotics as prescribed and until finished


name: Instruct person and family about signs and symptoms of infection and when to report them to health care provider


name: Instruct person and family members how to avoid infections


name: Promote immunizations and vaccinations as preventative infection measures, as appropriate


name: Offer immunization and vaccination opportunities to health care workers


name: Provide employee health services related to infection prevention (e.g., assessment of risk, administration of recommended treatment following exposure, tuberculosis screening, influenza vaccination, respiratory protection fit testing)


name: Provide and attend education annually related to control and transmission of pathogens (e.g., handwashing, use of PPE, types of isolation)


name: Damp dust flat surfaces and lights in operating room daily


name: Limit and control traffic into operating suite arenas


name: Verify integrity of sterile packaging and sterilization indicators


name: Scrub, gown, and glove, per agency policy


name: Follow agency policy related to artificial nail enhancements and polishes for staff


name: Assist with draping, ensuring protection of eyes and minimizing pressure to body parts


name: Document incidences of contamination and level of break in technique


name: Maintain neat and orderly room to limit contamination


name: Coordinate cleaning and preparation of operating room after procedure


name: Verify risk level using health history questions, including international and local travel


name: Determine current level of knowledge related to acquisition and transmission of infectious agents


name: Monitor aspects of preexisting conditions that increase person's infection risk (e.g., pancytopenia, immunosuppressive drugs)


name: Monitor vulnerability to infection (e.g., decreased ability for self-care, open wounds, recent surgery)


name: Avoid close contact between pets and immunocompromised hosts


name: Maintain appropriate isolation techniques


name: Inspect condition of any surgical incision or wound at regular intervals


name: Promote sufficient rest, nutritional and fluid intake, as appropriate


name: Administer immunizing agent, as appropriate


name: Instruct to take antibiotics as prescribed


name: Avoid antibiotic treatment for viral infections


name: Instruct about differences between viral and bacterial infections


name: Instruct about signs and symptoms of infection and when to report to health care provider


name: Eliminate fresh fruits, vegetables, and pepper in diets of persons with neutropenia


name: Remove fresh flowers and plants from care areas, as appropriate


name: Ensure water safety by instituting hyperchlorination and hyper-heating, as appropriate


name: Determine stage of labor, risk status, and presence of ruptured membranes


name: Determine childbirth preparation and goals


name: Encourage family participation in labor, if consistent with personal goals


name: Prepare for labor per protocol, practitioner request, and preference


name: Identify emotional and psychological needs throughout labor


name: Educate that length of first stage of labor varies between women


name: Provide ice chips, wet washcloth, or hard candy as needed


name: Encourage to empty bladder every 2 hours


name: Assist labor coach or family in providing comfort and support


name: Perform vaginal exam to determine complete cervical dilation, effacement, fetal position, and station after abdominal palpation


name: Use partogram once labor established to document frequency of contractions and fetal heart rate, per protocol


name: Document cervical examination per protocol


name: Ask permission to perform exams as needed


name: Perform vaginal exams at admission and as necessary during labor, avoiding excessive manipulation


name: Monitor vital signs and pain level per protocol


name: Palpate contractions to determine frequency, duration, intensity, and resting tone as needed


name: Perform intermittent auscultation of fetal heart rate per protocol


name: Monitor fetal heart rate between contractions to establish baseline, and during and after contractions to detect decelerations or accelerations


name: Apply electronic fetal monitor per protocol


name: Instruct on fetal heart monitoring process and equipment


name: Assist with position changes to correct abnormal fetal heart rate


name: Provide clear, consistent, and evidence-based explanation about possible positions during labor


name: Inform of benefits of positioning and ambulation (e.g., sitting, standing, kneeling)


name: Use childbirth tools (e.g., birthing ball, peanut ball, birthing bar, hydrotherapy) to support comfortable positioning


name: Educate on importance of avoiding long periods supine or in one position


name: Instruct on breathing, relaxation, and visualization techniques


name: Perform or assist with amniotomy per protocol


name: Document characteristics of amniotic fluid, fetal heart rate, and contraction pattern


name: Instruct on pushing techniques for second stage labor


name: Monitor effectiveness of pushing and length of time in second stage


name: Offer warm compresses for back and suprapubic region, according to preference


name: Identify allergies to any medications, iodine, or tape


name: Identify if clotting problem or taking any medications that would affect clotting


name: Ask parents to hold and comfort child, as appropriate


name: Ask to hold still when performing venipuncture


name: Select appropriate vein for venipuncture, considering preference, past experience with IVs, and nondominant hand


name: Consider assessment factors when examining veins for cannula insertion (e.g., age, purpose of catheter, cannula gauge, cannula material, cannula proximity to joints, condition of extremity, condition, skill of practitioner)


name: Start IVs in opposite arm of arteriovenous fistulas or shunts, or conditions contraindicating cannulation (e.g., lymphedema, mastectomy, radiation therapy)


name: Choose needle based on purpose and length of use (e.g., larger bore for blood administration)


name: Apply tourniquet 3 to 4 inches higher than anticipated puncture site, as appropriate


name: Instruct to hold extremity below heart to allow for maximum blood flow to selected site


name: Massage arm from proximal to distal end, as appropriate


name: Request to open and close hand several times, as appropriate


name: Cleanse area with appropriate solution based on agency protocol


name: Use ultrasound-guided peripheral intravenous catheter insertion for individuals with difficult intravenous access, per agency protocol


name: Obtain blood sample from cannulated vein, if ordered


name: Connect cannula to IV tubing or flush and connect to saline lock, as appropriate and per agency protocol


name: Apply small transparent dressing over insertion site


name: Label site dressing with date, gauge, and initials per agency protocol


name: Check accuracy and completeness of each medication administration record (MAR) prior to administering any medications


name: Note medical history and history of allergies


name: Determine knowledge of medication and understanding of method of administration


name: Perform necessary pre-medication assessments (e.g., blood pressure, pulse)


name: Follow agency guidelines regarding requirements for special monitoring of person while medication administered (i.e., telemetry with heart medications)


name: Use standardized concentrations and dosages of IV fluids and medications, preferably prepared and dispensed from pharmacy or commercially prepared when possible


name: Identify if currently taking medication incompatible with medication ordered


name: Review information regarding how to administer solution safely, as needed


name: Verify calculations and rates with another RN, if indicated


name: Select and prepare IV infusion pump, as indicated


name: Maintain strict aseptic technique with supplies that will potentially be in contact with blood stream (e.g., IV cannula, IV insertion site, IV tubing connections, IV tubing access ports, IV fluids)


name: Examine solution for type, amount, expiration date, character of solution, and intact container


name: Open tubing clamp slowly to prime tubing


name: Check for IV patency before administration of IV medication


name: Administer IV medications as prescribed, monitor during infusion, and monitor for results


name: Trace all catheters or administration sets or add-on devices between person and fluid container before connecting or reconnecting any infusion device


name: Label administration sets with infusing solution or medication both near person connection and near solution container


name: Instruct person, caregivers, and unlicensed assistive personnel to obtain assistance from licensed staff whenever real or perceived need to connect or disconnect devices or infusions unless person or caregiver independently administering infusion medications (e.g., in home care setting)


name: Document which solutions and medications are being infused through which device or lumen, when multiple vascular access devices (VADs) or catheter lumens are used


name: Route tubing having different purposes in different directions (i.e., IV catheters routed toward head, feeding tubes routed toward feet)


name: Use technology according to organizational policies and procedures (e.g., bar code, smart pump with dose-error reduction software, volume-control administration set, mini-infusion administration set), when available


name: Monitor for possible complications of IV therapy (e.g., fluid overload, allergic reaction, site discomfort, infusion phlebitis, local infection)


name: Maintain sterile, occlusive dressing for IV sites


name: Perform IV site checks and care according to agency protocol


name: Perform site change, tubing change and site with dressing care changes, according to agency protocol


name: Follow strict drug guidelines when administering high-alert IV medications (e.g., heparin, dopamine, dobutamine, nitroglycerine, potassium, antibiotics, magnesium)


name: Stop IV fluids and clamp IV line if IV medication found to be incompatible with IV fluids during administration (i.e., IV fluid becomes cloudy in tubing)


name: Restart IV fluids with new tubing if incompatible medications in current tubing


name: Documentation condition of IV site prior, during, and after infusion therapy


name: Maintain universal precautions when providing IV site care or therapy


name: Provide person and caregiver education including infusion administration and signs and symptoms to report, including those that may occur after person leaves health care setting


name: Explain purpose and procedure of hemodynamic monitoring


name: Assist with insertion of invasive hemodynamic lines


name: Monitor blood pressure (e.g., systolic, diastolic, mean), central venous and right atrial pressure, pulmonary artery pressure (e.g., systolic, diastolic, mean), and pulmonary capillary and artery wedge pressure


name: Zero and calibrate equipment every 4 to 12 hours, per policy


name: Compare clinical signs and symptoms with hemodynamic parameters


name: Reposition to address catheter or tubing problems (e.g., tubing kinks, air bubbles, clot)


name: Monitor peripheral perfusion distal to catheter insertion site every 4 hours or per protocol


name: Monitor for balloon rupture (i.e., assess for resistance when inflating balloon and allow balloon to passively deflate after obtaining pulmonary capillary or artery wedge pressure)


name: Prevent air emboli (i.e., remove air bubbles from tubing; if balloon rupture is suspected, refrain from attempts to reinflate balloon and clamp balloon port)


name: Maintain sterility of closed-pressure system, as appropriate


name: Perform sterile dressing changes and site care, per protocol


name: Inspect insertion site for signs of bleeding, hematoma, pain, or infection


name: Change IV solution and tubing every 24 to 72 hours, per protocol


name: Administer fluid or pharmacological agents to maintain hemodynamic parameters within specified range, as prescribed


name: Instruct on therapeutic use of hemodynamic monitoring catheters


name: Instruct on activity restriction while catheters remain in place


name: Assist with removal of invasive hemodynamic lines


name: Review initial level of labor pain with multidimensional scale (e.g., location, characteristics, onset, duration, frequency, intensity, severity, precipitating factors)


name: Discuss initial plans for pain management during labor


name: Monitor for nonverbal cues of discomfort


name: Use therapeutic communication strategies to acknowledge pain experience and convey acceptance of response to pain


name: Evaluate pain measures that have been used and helped in past labor experience


name: Explore and consider knowledge, beliefs, cultural influences, and values on labor pain


name: Explore factors that impact pain throughout labor


name: Provide information about causes of labor pain and anticipated likely discomforts from procedures


name: Eliminate factors that could increase labor pain experience (e.g., fear, lack of knowledge, environmental factors, procedures, absence of family or labor coach)


name: Provide continuous emotional support during labor (e.g., comfort measures, information, advocacy)


name: Encourage to use whatever positions facilitate pain relief, unless not clinically indicated


name: Monitor pain level during labor with multidimensional scale, as possible


name: Inform about all possible non-pharmacological methods of pain management (e.g., immersion in water, massage, warm compresses, relaxation, aromatherapy, guided imagery)


name: Inform about risks, benefits and efficacy of each method of pain relief


name: Provide alternative methods of pain relief consistent with preferences


name: Administer analgesics of choice (e.g., oral, IV, epidural)


name: Monitor effects of pharmacological and non-pharmacological analgesia on person and fetus


name: Assist with regional analgesia or anesthesia, as appropriate


name: Monitor fetal heart rate and progression of labor during epidural analgesic effects


name: Monitor satisfaction with pain management


name: Review history for risk factors commonly related to preterm labor (e.g., prior patient or family history of preterm birth or abortion; multifetal gestation; uterine cervical anomalies; early cervical change; uterine irritability; infection, including periodontal disease; short interpregnancy interval; technology-induced conception; history of vaginal bleeding in first and or second trimester; positive fetal fibronectin results; extremes of pre-pregnancy body weight)


name: Discuss techniques to avoid or minimize engorgement and associated discomfort (e.g., frequent feedings, breast massage, warm compresses, milk expression, ice packs applied after feeding or pumping, and anti-inflammatory medications)


name: Instruct mother to consult her health care practitioner before taking any medications when breastfeeding, including overthe-counter medications and oral contraceptives


name: Provide anticipatory guidance on physiological changes (i.e., uterine cramping and presence of scant milk post-lactation suppression)


name: Provide for ease of access to the emergency shut off switch to disable the laser in case of a component breakdown or untoward event


name: Determine if history of neural tube defect (e.g., spina bifida) or congenital urological condition (e.g., exstrophy of the bladder)


name: Determine allergies to foods such as bananas, kiwi, avocado, mango, and chestnuts


name: Determine type of reaction to latex or other allergies in the past


name: Determine history of systemic reactions to natural rubber latex (e.g., facial or scleral edema, tearing eyes, urticaria, rhinitis, wheezing)


name: Refer to allergist for allergy testing, as appropriate


name: Record allergy or risk in medical record


name: Use non-latex substitutes in environment wherever possible (i.e., avoid balloons, rubber bands, review bandage packages for content, ensure emergency kits in schools have only latex free products)


name: Monitor for signs and symptoms of systemic reaction


name: Report information to health care provider, pharmacist, and other care providers, as indicated


name: Instruct about risk factors for developing latex allergy


name: Instruct about signs and symptoms of reaction


name: Instruct about latex content in household products and substitution with nonlatex products, as appropriate


name: Provide written list of non-latex substitutes for household products


name: Instruct person and family about emergency treatment (e.g., epinephrine), as appropriate


name: Ensure yearly education for staff related to latex allergic reactions and treatments


name: Evaluate readiness and willingness of individual or group


name: Identify mutual goals and desired specific change in behavior or physiology with individual (e.g., stress reduction, increased sense of well-being, decreased pain, better sleep quality)


name: Provide calm, comfortable, and private environment to ensure personal comfort


name: Determine frequency and duration of sessions (i.e., usually 25-30 minutes)


name: Begin with 10 minutes warm-up exercises (e.g., deep belly breathing, body stretching, gentle neck and shoulder stretches, smiling to loosen up face muscles)


name: Vary warmup with additional stretches, sounds, and movements (e.g., lion roar with belly laugh, clapping hands rhythmically with chanted words, deep breathing using abdomen to fill lungs)


name: Follow warmup with 15 minutes of physical activity (i.e., use left hand to tap five times from shoulder to wrist on right side and repeat for left side; next tap five times down both legs) while chanting repetitively


name: Ensure repeated chanting with physical activity, and progressively increase tapping and chanting


name: Increase activity slowly to include playful exercises (e.g., singing a nonsense song and laughing after each verse, dancing around room while laughing, miming pretend scenario and laughing throughout or at end)


name: Encourage individual to use deep breathing exercises throughout session


name: Incorporate various exuberant and amusing laughs with movements


name: Demonstrate movements and laughter if needed to facilitate understanding


name: Encourage happy feelings and upbeat mood using cheerful activities (i.e., make wishes and rejoice as if wishes had come true)


name: Stop session immediately if anyone uncomfortable or having pain


name: Use body relaxation, smiling, and deep breathing in final 5 minutes


name: Monitor physical, social, mental, emotional, spiritual responses


name: Determine willingness and ability to receive, process, and comprehend information


name: Provide environment conducive to learning and void of distractions


name: Meet basic physiological needs (e.g., hunger, thirst, warmth, pain, fatigue)


name: Enlist participation of family and others, as appropriate


name: Establish mutual, realistic learning goals and objectives


name: Tailor content to cognitive, psychomotor, and emotional abilities


name: Adapt information to comply with lifestyle, routines, and beliefs


name: Provide instructional pamphlets, videos, and online resources, as appropriate


name: Ensure that educational material current


name: Use plain language, short words and sentences, and avoid medical jargon


name: Encourage sharing of valid experiences throughout learning experience


name: Ensure that consistent information provided by interprofessional team


name: Answer questions in clear, concise manner


name: Refer to appropriate resources including support groups


name: Reassure that leech therapy accepted health care treatment


name: Obtain complete blood cell count and other laboratory tests, per agency protocol


name: Administer prophylactic antibiotic, as prescribed


name: Cleanse treatment site with soap and water, and rinse


name: Direct head of leech toward treatment site and allow to attach


name: Use petrolatum or transparent adhesive dressing to cover treatment site, as prescribed


name: Place drop of blood on treatment site if slow to attach


name: Keep in place for 30-90 minutes or as prescribed


name: Dispose in biohazardous waste according to agency policy


name: Monitor for adverse reactions (e.g., excessive bleeding, hypersensitivity reactions, infection)


name: Instruct not to touch or remove leeches once applied


name: Remove leeches that do not drop off by gently stroking with alcohol pad


name: Refrigerate unused leeches in container filled with salt solution (using spring or distilled water) covered with netting


name: Place leeches in small container of alcohol for incineration


name: Cleanse treated area every 1 to 2 hours with half-and-half solution of hydrogen peroxide and sterile water to prevent bloody drainage from hardening and constricting blood flow


name: Monitor hemoglobin and hematocrit at least daily, as appropriate


name: Review history of lower extremity injuries and recent changes


name: Determine current mobility and perception of mobility status (i.e., walks without assistance, walks with assistance of device, does not walk, uses wheelchair)


name: Determine evidence of poor hygiene, edema, presence of toenail changes (e.g., thickening, fungal infection, improper trimming, nail care)


name: Determine color, temperature, hydration, hair growth, texture, deformities, and skin condition


name: Monitor muscle strength and joint mobility in ankle and foot


name: Determine evidence of lower extremity pressure areas (i.e., presence of localized redness, increased temperatures, blisters, corns, or callus formation)


name: Inquire about paresthesia (e.g., numbness, tingling, burning)


name: Determine ankle brachial index, as prescribed


name: Determine presence of intermittent claudication, rest pain, or night pain


name: Monitor level of protective sensation using approved tests of sensory loss (e.g., Semmes-Weinstein nylon monofilament)


name: Monitor appropriateness and condition of shoes and socks


name: Perform ongoing surveillance of lower extremities to determine need for referral at least four times per year or as prescribed


name: Determine specialty foot care services required


name: Consult with health care provider regarding recommendation for further evaluation and therapy (e.g., x-ray), as needed


name: Provide with information about recommended specialty foot care services


name: Determine preference for referral to health professional or agency, as appropriate


name: Provide assistance in obtaining necessary financial resources, as appropriate


name: Use non-triggering anesthetic agents for patient at-risk for or experiencing malignant hyperthermia (e.g., opioids, benzodiazepines, local anesthetics, nitrous oxide, and barbiturates)


name: Monitor for post-extubation complications (e.g., stridor, glottic swelling, laryngospasm, tracheal stenosis)


name: Wear gloves and protective equipment and clothing for oral care and change gloves to prevent cross-contamination during oral care


name: Collaborate with other health team members to optimize patient's nutritional status, assuring that 50% of the diet's non-protein caloric source is fat rather than carbohydrate


name: Follow agency policies and procedures for accurate and safe administration of medications


name: Promote environment that maximizes safe and efficient administration of medications


name: Familiarize self with condition of person receiving medications, and indications and information related to medication (e.g., dosage ranges, expected therapeutic effects, possible adverse reactions, interactions with other medications)


name: Instruct on each medication's purpose, and answer questions appropriately


name: Follow six rights of medication administration (e.g., right person, right medication, right dose, right route, right time, right documentation)


name: Prepare medications for only one person at a time


name: Prepare medications using appropriate equipment and techniques for medication administration modality


name: Ensure medication prescriptive orders contain person name, medication name, amount and frequency of dose, route of administration, reason for medication, and appropriate signature for authorization


name: Clarify medication prescriptive orders that are missing any required information, prior to administration


name: Decline to administer medications that may jeopardize person safety


name: Look only at one person's medication administration record (MAR), computer printouts or computer medication administration screen at a time


name: Use medication distribution system as required by institution policies and procedures (e.g., unit dose, automated medication-dispensing system)


name: Avoid administering any medication not properly labeled, with broken medication seals, or expired


name: Dispose of unused or expired medications according to agency guidelines


name: Administer medications according to prescriptive authority, protocol, policy, and procedure


name: Use health provider prescriptions, agency policies, and procedures to guide appropriate method of medication administration (i.e., scan patient ID bracelet and scan medication bar-code)


name: Note allergies before delivery of medication and hold medications, as appropriate


name: Verify with person or caregivers of each medication type, reason for administration, expected actions, and adverse effects before administering, as persons often able to identify inappropriate medications


name: Answer all questions before administering medications to ensure knowledge of medication regime


name: Check record for previous medication count when preparing controlled substance medications, and ensure current count and available supply match


name: Sign out controlled substances according to agency protocol


name: Report any discrepancies in controlled substance counts immediately


name: Document medications only after given and observed


name: Stay with person until all medications ingested


name: Give time-critical medications at exact time ordered (i.e., no later than 30 minutes before or after time ordered)


name: Monitor vital signs and laboratory values before and after medication administration, as appropriate


name: Assist person in taking medication, as needed


name: Use aseptic technique for all parenteral medication administration


name: Instruct person and family about expected actions and adverse effects of medication


name: Validate and document understanding of expected actions and adverse effects of medication


name: Monitor to determine need for PRN medications, as appropriate


name: Monitor for therapeutic effect of all medications


name: Monitor for adverse effects, toxicity, and interactions of administered medications


name: Document medication administration and person responsiveness (i.e., include medication generic name, dose, time, route, reason for administration, and effect achieved), according to agency protocol


name: Check accuracy and completeness of each medication administration record (MAR) prior to giving any medications


name: Review health history and history of allergies


name: Determine person's knowledge of medication and understanding of method of administration


name: Instruct on medication purpose and answer questions appropriately


name: Perform necessary pre-medication evaluations (e.g., blood pressure, pulse, blood sugar assessment, pain level)


name: Obtain and program medication administration pump


name: Ensure medication administration pump has safety features (e.g., lockout intervals, warning alarms)


name: Verify prefilled medication container with MAR and one other licensed staff


name: Obtain small winged IV catheter with attached tubing


name: Use needle with shortest length and smallest gauge necessary to establish and maintain infusion


name: Prime needle and pump tubing using aseptic technique


name: Position person supine, drape and provide privacy


name: Select appropriate injection site free from irritation, bony prominences and waistline (i.e., most common sites are under subclavian and abdomen)


name: Select injection site considering medication (i.e., pain medications best delivery in upper chest, insulin absorbed most consistently in abdomen)


name: Select injection site where pump tubing not disturbed


name: Clean injection site twice (i.e., alcohol followed by antiseptic) and allow both to dry


name: Insert needle at 45-to-90-degree angle, release skinfold and secure wings of needle


name: Place occlusive, transparent dressing over insertion site


name: Instruct to alert staff if site becomes painful, red, swollen, or leaks


name: Rotate sites as needed for complications


name: Remove needle and place new needle in different site if complains of localized pain or burning at site, or site appears red, swollen, or leaking


name: Stop infusion immediately if signs of allergic reactions and follow agency guidelines for appropriate response to allergic reaction


name: Instruct on need for medication alert bracelet


name: Document medication administration and responsiveness according to agency guidelines


name: Position in side-lying position with ear to be treated facing up or have sit in chair


name: Cleanse pinna and meatus of ear canal with cotton tipped applicators


name: Warm medication prior to instilling (i.e., place in warm water for short time, hold tightly in hand)


name: Instill medication holding dropper above ear canal and placing drops on side of auditory canal to allow drops to flow in (i.e., avoid instilling drops into auricular opening as causes increased discomfort)


name: Use flexible rubber tip where possible to avoid injury due to sudden motion


name: Instruct to remain in side-lying position 5 to 10 minutes


name: Place cotton ball or wick in outer ear to keep medication in ear canal, as indicated


name: Wait 5 to 10 minutes to instill drops in other ear, as prescribed


name: Instruct related to self-administration technique as appropriate


name: Determine any contraindications to receiving oral medication via tube (e.g., bowel inflammation, reduced peristalsis, recent gastrointestinal surgery, attached to gastric suction)


name: Ensure correct tubes selected for medications


name: Ensure medication compatibility with enteral tube feeding solution, if indicated


name: Schedule medication to be in accord with formula feeding times, if indicated


name: Obtain liquid dosage form of medication if available


name: Consult with pharmacist before deciding to alter form of any medication, as needed


name: Avoid crushing sublingual, sustained-release, chewable, long-acting, or enteric-coated medications


name: Contact health care provider for substitute medication if formulation alternatives are unavailable for medications that cannot be altered


name: Prepare medication (e.g., crush, mix with fluids, open capsules, pierce gel capsule with sterile needle or dissolve) as noted in pharmacological instructions


name: Adjust water amount if needed for fluid restrictions


name: Stop enteral tube feeding and flush tube with 15 mL water prior to administering medication


name: Administer medications individually to avoid clogging enteral tube


name: Ensure medications are dissolved before administering


name: Inform of expected actions and possible adverse effects of each medication


name: Use correct syringe for enteral tube medication administration


name: Check placement of tube by aspirating gastrointestinal contents, checking pH level and color of 5 to 10 mL of aspirate (i.e., gastric content pH < or = 5.5, color greenish to tan or off white; pulmonary content pH >6, color clear to light yellow with mucus), or obtaining x-ray film, as per agency guidelines


name: Place in high Fowler's position during medication administration if not contraindicated


name: Determine gastric residual volume and hold medications if greater that 200 mL


name: Recheck gastric residual volume in 30 to 60 minutes if holding medications for excessive residual volume, assuring feedings also held


name: Contact health care provider if medications held for excessive gastric residual volume after second check


name: Remove plunger from syringe and connect to pinched or kinked tube


name: Flush tube with 15 to 30 mL of water after releasing pinched or kinked tube


name: Raise or lower barrel of syringe to adjust flow as needed


name: Pinch or clamp tube before all water instilled to avoid excess air entering stomach


name: Pour medication into syringe and release pinched tube


name: Flush tube with 15 to 30 mL of warm water, or appropriate amount for age, after each medication administration


name: Follow last dose of medication with 30 to 60 mL of water or appropriate amount for age


name: Record total amount of fluid flushes on I & O record


name: Hold feeding solution for additional 30 to 60 minutes if medications not compatible with feeding solution


name: Disconnect suction and keep tube clamped for 20 to 30 minutes to enhance adsorption if medications given through tube used for decompression


name: Rinse and replace syringe to storage area at bedside


name: Keep head of bed elevated a minimum of 30 degrees for 1 hour after medication administration


name: Monitor for therapeutic effects, adverse effect, drug toxicity, and drug interactions


name: Position supine or sitting in chair with neck slightly hyperextended and eyes looking up


name: Provide with tissues to blot medication or tears as indicated


name: Cleanse eyelid and eyelashes of any drainage, ensuring that each area of cleansing surface used only once and moving from inner toward outer canthus


name: Place finger or thumb on lower bony orbit and gently pull lower lid down


name: Place other hand on forehead holding medication container in this hand


name: Avoid touching eyelids, lashes, or eyeball with either hand or with medication applicator


name: Avoid dropping solution directly onto cornea as this causes increased discomfort


name: Release lower lid and instruct to close eye


name: Repeat medication administration if blinks or closes eye, causing medication to land on outer lid margins


name: Instruct to close eye gently to help distribute medication


name: Tape eye patch securely, avoiding pressure to eye


name: Explain that some medications may cause blurred vision


name: Advise that wearing sunglasses decreases photophobia effect of dilation medications


name: Instruct not to drive or perform activities that require acute vision if receiving medications that affect vision (i.e., medications that dilate pupil or paralyze ciliary muscles)


name: Determine ability to manipulate and administer medication


name: Have demonstrate how to use device if previously instructed


name: Correct techniques as needed for current device and medication


name: Instruct on use of aero-chamber or spacer with inhaler, as appropriate


name: Instruct on use of breath-activated metered dose-inhalers, as appropriate


name: Shake inhaler, remove inhaler cap and hold inhaler upside down to administer medication


name: Assist to position inhaler in mouth or nose, tilt head back slightly and exhale completely


name: Instruct to press down on inhaler to release medication while inhaling slowly


name: Have person take slow, deep breaths, with brief end-inspiratory pause, and passive exhalation when using nebulizer


name: Have person hold breath for 10 seconds, as appropriate


name: Have person exhale slowly through nose or pursed lips


name: Instruct to repeat inhalations as ordered, per inhalation medication instructions


name: Instruct to wait between inhalations if two metered-dose inhalers are prescribed, per agency protocol


name: Instruct in removing medication canister and cleaning inhaler in warm water


name: Instruct in determining if inhaler actually releasing spray


name: Instruct in determining when inhaler empty


name: Instruct on use of nebulizer as needed (e.g., breathing through mouth or nose during use, medications and dosage, use and cleaning of nebulizer and equipment)


name: Monitor respirations and auscultate lungs, as appropriate


name: Monitor for effects of medication and instruct person and caregivers on desired effects and possible side effects of medication


name: Instruct and monitor self-administration technique, as appropriate


name: Instruct about purpose, benefits, and rationale for use of inter-pleural catheter and medication


name: Monitor pain before and after catheter insertion, as appropriate


name: Conduct time-out immediately before starting procedure to perform final assessment that correct person, site, positioning, and procedure are identified and all relevant information and necessary equipment are available


name: Check for absence of blood return before medication administration


name: Position to avoid pressure on interpleural catheter


name: Use monitoring modalities to interpret physiological responses and initiate nursing interventions to ensure optimal care


name: Document medication administration following established agency policies


name: Provide for total care needs while receiving analgesia, as needed


name: Determine understanding of purpose of skin testing


name: Prepare dose correctly from ampule or vial following manufacturer's directions


name: Select appropriate injection site and inspect skin to avoid areas with bruises, inflammation, edema, lesions, or discoloration


name: Inject only small amounts of medication (e.g., 0.01-0.1 mL)


name: Watch carefully for bleeding at site after needle withdrawal, or lack of bleb appearance, which invalidates test results as medication entering SQ tissue


name: Select correct needle and syringe based on person and medication information (e.g., viscosity of medication, amount of medication, injection site, person weight, amount of adipose tissue)


name: Investigate alternative routes when unable to select longer and heavier gauge needle for obese persons where amount of fat interferes with ability to reach muscle tissue


name: Avoid emaciated or atrophied muscles for injection


name: Prepare dose correctly from ampule, vial, or prefilled syringe per manufacturer's directions


name: Select appropriate injection site (e.g., ventrogluteal, vastus lateralis, deltoid)


name: Rotate injection sites to decrease risk for hypertrophy when giving regularly scheduled injections


name: Palpate site for edema, masses, or tenderness to avoid areas of scarring, bruising, abrasion, or infection


name: Follow agency policy related to aspiration before injection as no longer recommended due to increased discomfort with aspiration


name: Inject medication slowly if no blood aspirated


name: Wait 10 seconds after injecting medication, then smoothly withdraw needle and release skin


name: Monitor for acute pain at injection site


name: Avoid injecting large volumes of medication (i.e., maximum dosages are 4-5 mL for adults, 2 mL for children, older adults and thin persons, 1 mL for small children and older infants, 0.5 mL for smaller infants)


name: Use Z-track method (i.e., pull overlying skin and SQ tissue approximately 2.5-3.5 cm [1-1.5 inches] laterally to side with ulnar side of non-dominant hand, hold skin in place until injection complete then release skin) as indicated


name: Monitor for sensory or motor alteration at or distal to injection site


name: Cleanse eyelid and eyelashes of any drainage, assuring that each area of cleansing surface used only once, moving from inner toward outer canthus


name: Gently press fingertip against disk to assure adherence to finger


name: Moisten fingertip as needed with sterile saline if disk not adhering


name: Position convex side of disk on fingertip


name: Pull lower eyelid down and away from eye


name: Place disk in conjunctival sac so floats on sclera between iris and lower eyelid


name: Pull lower eyelid out and over disk, ensuring disk covered by lower eyelid and no longer visible


name: Ensure disk not placed on cornea or under upper eye lid


name: Remove after prescribed time period unless disk to be dissolved in eye


name: Pinch disk between thumb and forefinger to remove


name: Administer medications within scope of practice and agency guidelines


name: Determine appropriateness of person for therapy, establishing responsiveness and emergent need


name: Restrict intraosseous access in contraindicated situations (e.g., compartment syndrome in target extremity, previously used intraosseous site or recent failed intraosseous attempt, fractures at or above site, previous orthopedic surgery or hardware, presence of infection or severe burns near insertion site, local vascular compromise)


name: Avoid use of intraosseous access in presence of bone diseases (e.g., osteogenesis imperfecta, osteopetrosis, osteoporosis)


name: Use appropriate intraosseous device for age and condition, preferably safety-engineered intraosseous device


name: Select appropriate intraosseous site based on clinical situation and in accordance with manufacturers' directions for device use


name: Consider sites most commonly used in both adults and children (e.g., proximal and distal tibia, proximal humerus, distal femur for children, sternum in adults)


name: Ensure proper landmarks identified prior to insertion, when clinically possible, to avoid complications related to improper placement


name: Ensure correct needle size with drill or driver for intraosseous device, matching with body mass index


name: Choose appropriate size needle with stylet for non-drill or driver devices


name: Consider use of subcutaneous lidocaine as local anesthetic prior to insertion at intended site


name: Immobilize extremity and perform skin antisepsis using an appropriate solution (e.g., alcohol-based chlorhexidine, povidoneiodine, 70% alcohol) based on agency policies and procedures


name: Confirm correct placement of intraosseous device using correct needle position, sensation of loss of resistance upon bone penetration, and absence of any signs of infiltration upon flushing with 5 to 10 mL (adult) or 2 to 5 mL (pediatric) preservative-free 0.9% sodium chloride


name: Aspirate blood or bone marrow to confirm placement where possible, although not an indication of improper placement if other indications of placement confirmation are present


name: Consider use of color Doppler ultrasound to confirm initial placement and confirm position after person movement


name: Secure needle in place with tape and apply appropriate sterile dressing according to agency protocol


name: Ensure compatibility of medications and fluids in infusion