Medical Surgical Remediation Safety and Infection Control (4 items) Accident/Error/Injury Prevention (2 items) Meningitis: Clarify Prescription With Provider (RN QSEN - Safety, Active Learning Template - Basic Concept, R
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Medical Surgical Remediation Safety and Infection Control (4 items) Accident/Error/Injury Prevention (2 items) Meningitis: Clarify Prescription With Provider (RN QSEN - Safety, Active Learning Template - Basic Concept, RM AMS RN 10.0 Chp 5) • Repeat prescription back to the provider clearly Handling Hazardous and Infectious Materials (1 item) Cancer Treatment Options: Interventions for Internal Radiation Therapy (RN QSEN - Safety , Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 91) • Place the client in a private room. Keep door closed • Place a sign on the door warning of the radiation source • Wear a dosimeter film badge that records personal amount of radiation exposure • Limit visitors to 30-min and 6 feet • No visitors under 18yrs or who are pregnant • Have a lead apron Health Promotion and Maintenance (2 items) Health Promotion/Disease Prevention (1 item) Osteoporosis: Promoting Musculoskeletal Health (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 70) • Ensure the clients diet has calcium and vitamin D together • Limit carbonated beverages, which contain phosphates and can cause calcium loss • Encourage client to expose area of skin to sun 5-30 minutes twice a week. • Encourage female clients to discuss the pros and cons of hormone replacement therapy postmenopausal • Encourage weight-bearing exercises Basic Care and Comfort (6 items) Mobility/Immobility (2 items) Musculoskeletal Trauma: Caring for a Client in Continuous Buck’s Traction (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 71) • Assess neurovascular status of the affected part every hour for 24hr and every 4hr after that • Maintain body alignment and realign if the client seems uncomfortable or reports pain • Avoid lifting or removing weights Non-Pharmacological Comfort Interventions (1 item) Osteoarthritis and Low-Back Pain: Potential Contraindications to Chondroitin and Glucosamine (RN QSEN - Safety, Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 72) • Question concurrent use of chondroitin with NSAIDs, heparin, and warfarin Nutrition and Oral Hydration (3 items) Peptic Ulcer Disease: Complications of Dumping Syndrome (RN QSEN - Safety, Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 49) • Client can report full sensation, weakness, diaphoresis, palpitations, dizziness, and diarrhea • Late symps: rapid release of glucose, followed by an increase in insulin production resulting in hypoglycemia Pharmacological and Parenteral Therapies (23 items) Adverse Effects/Contraindications/Side Effects/Interactions (6 items) Blood and Blood Product Transfusions: Manifestation of Allergic Transfusion Reaction (RN QSEN – Safety, Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 40) • Itching, urticaria, and flushing • Anaphylactic transfusion resulting in bronchospasm, laryngeal edema, and shock Medications Affecting Coagulation: Medication Interactions With Warfarin (RN QSEN - Safety, Active Learning Template - Medication, RM Pharm RN 7.0 Chp 25) • Increases effects: heparin, aspirin, acetaminophen, glucocorticoids, sulfonamides, and parenteral cephalosporins • Decreases effects: phenobarbital, carbamazepine, phenytoin, oral contraceptives, and vitamin K Skin Disorders: Teaching About Adverse Effects of Topical Glucocorticoid Therapy (RN QSEN - Safety, Active Learning Template - Medication, RM AMS RN 10.0 Chp 74) • Avoid use if infection is present • Discontinue use when rash clears • Avoid direct sunlight and the use of tanning beds Blood and Blood Products (2 items) Blood and Blood Product Transfusions: Monitoring a Client Receiving a Blood Transfusion (RN QSEN - Safety, Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 40) • Explain the procedure • Assess vital signs and temp prior to transfusion • Remain with client in initial 15-30 min of the transfusion • An 18 or 20 gauge • Y-tubing with a filter Medication Administration (6 items) Antibiotics Affecting the Bacterial Cell Wall: Client Education About Cephalosporins (RN QSEN – Safety, Active Learning Template - Medication, RM Pharm RN 7.0 Chp 44) • Avoid if allergic to penicillin • Avoid alcohol • Oral cephalosporin with food Antilipemic Agents: Teaching About Colesevelam (Active Learning Template - Medication, RM Pharm RN 7.0 Chp 24) • Take other meds 4hr before taking bile sequestrants • Advise client to inform HCP of all meds currently taken • Is pregnancy risk Category B • Contraindicated in bowel obstruction or pancreatitis caused by high triglycerides Hypothyroidism: Client Education About Levothyroxine (RN QSEN - Safety, Active Learning Template - Medication, RM AMS RN 10.0 Chp 79) • Avoid fiber laxatives, which interfere with absorption • Increases the effects of warfarin and can increase the need for insulin and digoxin Medications Affecting Coagulation: Client Teaching About Self-Administration of Enoxaparin (RN QSEN - Safety, Active Learning Template - Medication, RM Pharm RN 7.0 Chp 25) • Advise to observe for bleeding, increased HR, decreased BP, bruising • Use a 20 to 22-gauge needle to withdraw med from the vial, then change to a small needle 25 or 26 gauge, ½ to 5/8 inches long. • Deep subq in the abdomen, ensuring a distance of 2 inches from the umbilicus. Do not aspirate Parenteral/Intravenous Therapies (2 items) Chronic Neurologic Disorders: Administering Phenytoin for Seizure Disorder (RN QSEN - Safety, Active Learning Template - Medication, RM Pharm RN 7.0 Chp 13) • Monitor for manifestation of CNS effects, and notify the HCP if they occur • Teratogenic: Cleft palate, heart defects, developmental deficiencies • For absence seizures and simple seizures too Total Parenteral Nutrition (TPN) (3 items) Gastrointestinal Therapeutic Procedures: Assessing for Fat Overload Syndrome (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 47) • Monitor for new onset of confusion or seizures • Assess for shallow respirations • Monitor for increased muscular weakness Reduction of Risk Potential (21 items) Changes/Abnormalities in Vital Signs (1 item) Esophageal Disorders: Priority Intervention for Esophageal Variceal Bleeding (RN QSEN - Safety, Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 48) • If suspected bleeding, establish IV access with a large bore needle, monitor vital signs and hematocrit, type and cross-match for possible blood transfusion, and monitor for overt and occult bleeding • Endoscopic variceal ligation for acute bleeding Laboratory Values (4 items) Cardiovascular Diagnostic and Therapeutic Procedures: Obtaining Blood Cultures from a Central Line (Active Learning Template - Diagnostic Procedure, RM AMS RN 10.0 Chp 27) • Use distal port because it has the biggest gauge so it has the greatest flow rate • Turn off the infusion and clamp the tubing for a few minutes before obtaining the blood sample Potential for Alterations in Body Systems (1 item) Respiratory Diagnostic Procedures: Client Teaching About Bronchoscopy (RN QSEN - Patient-centered Care, Active Learning Template - Diagnostic Procedure, RM AMS RN 10.0 Chp 17) • Permits visualization of the larynx, trachea, and the bronchi • Instruct clients that gargling with salt water or using throat lozenges can provide comfort for soreness of the throat • Report bronchospasm after bronchoscopy; blood tinged sputum is expected after Potential for Complications from Surgical Procedures and Health Alterations (4 items) Cancer Disorders: Postoperative Mastectomy Exercises (Active Learning Template - Diagnostic Procedure, RM AMS RN 10.0 Chp 92) • Affected arm elevated on pillow for 24hrs to allow fluid to drain • Flex and extend finger in recovery room • Exercise prevent contractures, muscle shortening, maintain muscle tone, and promote lymph drainage • Squeezing a rubber ball, elbow flexion and extension, and hand-wall climbing Diabetes Mellitus Management: Identifying Microvascular Complication (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 82) • Complications of insulin pump are accidental cessation of insulin administration, obstruction of the tubing/needle, pump failure, and infection • HTN, MI, and Stroke Esophageal Disorders: Preventing Further Complications (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 48) • Avoid alcohol or limit tobacco use • Eat a low-fat diet • Avoid tight-fitting clothing • Maintain a weight below BMI of 30 • Avoid large meals System Specific Assessments (6 items) Cancer Disorders: Description of Basal Cell Carcinoma (Active Learning Template - Basic Concept, RM AMS RN 10.0 Chp 92) • Small, waxy nodule with superficial blood vessels, well-defined borders • Erythema and ulcerations • Affects the lips and skin around the mouth Physiological Adaptation (34 items) Alterations in Body Systems (13 items) Benign Prostatic Hyperplasia: Care Following a Transurethral Resection of the Prostate (Active Learning Template - Basic Concept, RM AMS RN 10.0 Chp 66) • Monitor vital signs and urinary output • Administer/provide increased fluids • Monitor for bleeding and report to the provider • Assist the client to ambulate as soon as possible to reduce the risk of DVT Burns: Performing Hydrotherapy (Active Learning Template - Nursing Skill, RM AMS RN 10.0 Chp 75) • Assist the client into a warm tub of water or use warm running water, as if to shower, to cleanse the wound o Use the mild soap or detergent to wash burns gently, and then rinse with room-temperature water o Encourage the client to exercise his joints during treatment Gastrointestinal Therapeutic Procedures: Providing Client Teaching About an Ileostomy (RN QSEN - Patient-centered Care, Active Learning Template - Basic Concept, RM AMS RN 10.0 Chp 47) • Assess for fluid and electrolyte imbalances, particularly with a new ileostomy • More than 1000ml/day • Can be bile-colored and liquid Hemodialysis and Peritoneal Dialysis: Planning Care for a Peritoneal Dialysis Catheter Site (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 57) • Monitor weight, serum electrolytes, creatinine, BUN, and blood glucose • Teach to follow instructions carefully and to take all meds • Instruct the client to take essential minerals, and vitamins with supplements of phosphorus, calcium, sodium, and potassium Fluid and Electrolyte Imbalances (4 items) .................................Continued
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