Study guide

ATI RN LEADERSHIP

ATI RN LEADERSHIP ATI RN LEADERSHIP PROCTORED FOCUS REVIEW Chapter 1, Managing client care: • Prioritizing client care o Systemic before... [Show More] local o Acute before chronic o Actual problems before potential ones o Listen carefully to clients and do not assume o Recognize and response to trends vs transit findings o Recognize indications of medical emergencies and complications vs expected findings o Apply clinical knowledge to procedural standars to determine the priority action • Client care assignments o Assigning is performed in a downward or lateral manner with regard to members of the healthcare team o Client factors are:  Condition of client and level of care needed  Specific care needs such as cardiac monitoring or ventilation mechanical  Special precaution needs such as isolation or fall precautions or seizures, procedures requiring time commitments o Health care team factors:  Knowledge and skill levels of the team members  Supervision that is necessary  Nurse to client ratio  Experience with similar clients  Familiarity of staff member with unit o Additional factors;  If receiving an unsafe assignment the nurse should bring the unsafe assignment to the attention of the scheduling charge nurse and negotiate new assignment, if the issue is not resolve, take the concern up the chain of command  Nurse should file a written protest to the assignment such as an assignment despite objection (ADO) or document of practice situation (DOPS) with the appropriate administratior  If not follow proper failure to accept the assignment following proper channels could be considered client abandonment. o Delegations to an assistive personnel  ADLS  Bathing, dressing, toileting, ambulating, feeding if pt has no problems with swallowing  Positioning  Routine task, bed making  Specimen colletion  Intake and output  Vital signs for stable clients • Quality improvement o Standars of care should reflect optimal goals and based on evidence • Outcomes indicators-client outcomes related to standard under review • Structure indicators- setting in which care is provided and the available humand and material resources • Process indicators- how client care is provided and are established by policies and procedures( clinical practice guidelines) • Benchmarks- are goals that are set to determine at what level the outcome indicators should be met  Focuses on assessment of outcomes and determines ways to improve the delivery of quality care.  All levels of employees are involved in the quality improvement method  Joint Comission accreditations standars require institutions to show evidence of quality improvement in order to attain accreditation status Chapter 2 coordinating client care • Reporting info. to the provider o Assesmend data integral to changes in client status o Recommendations for changes in the plan of care o Clarification of prescriptions • The nurse role regarding consultation: o nurse intitates necessary consults or notify provided of clients needs so the consul can be initiated. Provide the consultant with all pertinent info. about the problem and incorporate the consultants recommendations in the clients plan of care. • The nurse role regarding Referrals o is a formal request for a service by another care provider, made so the client can access the care identified by the provider or the consultant. o The nurse role regarding referreals:  Begin discharge planning upon clients admission  Evaluate client and family competencies in relation to home care prior to discharge  Involve the client and family in care planning  Collaborate with other health care team to ensure all health care needs are met and necessary referrals are made  Complete referral forms to ensure proper reimbursement for prescribed services • Priority for discharge planning o Starts in admission o Conduct discharge plan with patient and family o Discharge planning serves as a starting point for contiuity of care o Need for additional services can be address before discharge so services is in place when client arrives home o Leaving without prescription (AMA) nurse should notify the provider. Nurse needs to explain the risk of leaving. Individual should sign a form and nurse should document all communication as well as advice that was provided for the client. o Nurses can be charged with legal charges of assault, battery and false imprisonment. Chapter 3 professional responsibilities • Mandatory reporting of sexually transmitted infections o Gonorrhea o Trichinosis o Syphilis o AIDS/HIV o Chlamydia trachomatis Chapter 4 maintaining safe environments • Temporary pacemaker- teach client to not touch the dials, keep wires and box dry and client wont be able to shower • Permanent pacemaker- battery will last 10 years, keep pacemaker identification card, minimize shoulder movement initially to allow leads to anchor, asses clients for hiccups which may indicate the generator placing the diaphragm. Before discharge teach patient about taking pulse daily at the same time each day and notify provider if hear rate is less than 5 beats below pacemaker rate, no contact sports or heavy lifting for 2 months, restrict shoulder move 1-2 weeks to prevent wire dislodgment, never place magnetic items directly over the pacemaker generator, and inform airport security of your pacemaker. • Use of a wheelchair for client transfer o Lock wheels on beds, wheelchairs and carts to prevent the device form rolling during transfers or stops • Isolation guidelines o Ensure proper equipment is available and that isolation procedures are properly carried out by all health care team members o Airborne precautions reuire: private room, mask and respiratory protection, negative pressure airflow exchange in the room of at least 6-12 exchanges per hour o Typer of airbone precautions: measles, varicella, pulmonary tb and laryngeal tb o Type of droplet precautions: pneumonia, h. influenza type b, scarlet fever, rubella, pertussis, mumps, mycloplasma pneumonia, meningococcal pneumonia, sepsis and pneumatic plague o In dropet precautions; private room required with others with same disease, ensure they use their own equipment • Chapter 5 facility protocols o Tools to prevent accident with needle sticks; use retractable needles, needles with capping mechanisms, needlesless syringe, IV tubing with needleless syringes o How to report a needle stick: by facility protocols and states laws, incident report should be filed, and nurse need to undergo testing o Triage:  Emergent class- highest priority life threat but also have a hight survival rate  Urgent class- second highest priority, major injuries that are not yet life threat can wait 45-60minutes  Norurgent class- minor ingjures not life threat and do not need immediate attention  Expectant- lowest priority, not expected to live, comfort measures but restorative care will not be use o Tuberculosis  Therapy full duration 6-12 months  Sputum samples are needed every 2-4 weeks, clients are no longer considered infectious after 3 consecutive negative sputum cultures  Put in negative pressure room  Contaminated tissues should be disposed of in plastic bags  Wear a mask in public places or in contact with crowds.  Ethambutol- need to watch for visual changes due to optic neuritis  Isoniazid- tingling of the hands is an adverse effect • Chapter 10 o Surgical asepsis  Open sterile package with first edge of the wrapper is directed away from the worker to avoid sterile surface touching unsterile cloths, the outside of the sterile package is considered contaminates  A wet field is contaminated if the surface immediately below it is not sterile  Hold sterile objects above the level of the waist  Avoid talking, coughing or sneezing or reaching over sterile field  Never walk away from or turn your back on a sterile field  Consider the outer 1 inch to be contaminated  Fluids flow in the direction of gravity [Show Less]

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