Leadership ATI-A – Flashcards

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confidentiality
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tell client's partner that his wife's lab results cannot be disclosed w/o her permission
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advance directives
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will take effect when pt is unable to make health care decisions; client can make changes to it any time, signature with witness for the changes to take effect are necessary; can specify both desired and undesired care and medical treatment; upon admission, advance directive form is offered, but it is not a legal requirement to have one
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before administering insulin
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obtain a capillary blood glucose reading
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this client is a priority
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peripheral vascular disease pt that has absent pulse in the R foot
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ok to delegate to AP
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measuring output of a mother's first voiding
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AP upset that she has to care for all the incontinent patients, what to tell her:
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"I delegate tasks to the personnel based on their job descriptions" (RN will say this)
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pt before tubal ligation that is unsure if thats the right thing for her to do, what to do about it..
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discuss with her about feelings about the procedure
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stages of conflict
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stage 1-latent conflict (awareness of potential situations that can create conflict) stage 2-perceived conflict (those affected are discussing the situation but at an impersonal matter) stage 3-felt conflict (those affected become personally involved) stage 4-manifest conflict (those involved begin to take action) stage 5-conflict aftermath (those involved recognize the positive and negative outcomes in how the situation was managed)
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orientation class for new clients/patients and their families; client rights:
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the right to be treated with respect and dignity; client does not have access to full facility but only to common areas of the facility; right to refuse their medications/treatment; right to leave regardless of provider recommendations (against medical advice); right to be fully informed (nurse has the responsibility to inform clients of their health conditions)
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nurse is signing consent with client before a procedure; client has questions about alternative treatments:
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call the surgeon to discuss alternative treatments with client
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RA client that has problems with buttoning her clothing; or needs help with ADL
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refer to occupational therapy
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A client who had a R knee amputation 24 hrs ago
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can be given to a nurse with no experience (from different floor); the residual limb does not require special care now, initial dressing stays on for 48-72 hrs
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Quality, cost effective care for a pt asking for supplies for his wound dressing, aat discharge time
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provide supplies for 1-2 days
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case manager role for a pt discharged at home that needs daily IV antibiotics through PICC line
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ensure home infusion therapy has been arranged; make sure necessary referrals have been made so transition to home care is easy for client
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home health nurse role
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assess client's home environment for possible reservoir of infection
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environmental hazard at home-discuss it with parents
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the toilet seat lid is in the raised position
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collaboration, mediation, negotiation
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conflict resolution strategies
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Nurse performs the leadership task of Advocacy when:
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presenting an in service about preventing readmission of clients due to complications after joint replacement surgery
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Safe use of wheel chair
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raise the footplates before transferring the pt-will prevent injury; lock brakes on both wheels when transferring pt; back the wheelchair into the elevator with the rear wheels first; stand between the wheelchair and the bottom of the incline when moving down the ramp;
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staff members verbalize displeasure with changes on a unit-charge nurse action:
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role model a positive approach to the changes; encourage staff members to support the changes to discuss the issue with the resistant staff
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Task ok to assign to LPN
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enteral feeding for a client with Crohn's disease; Reinforce teaching
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Task ok to assign to RN
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blood transfusions initial teaching about insulin administration; PE client receiving IV Heparin
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Client with diverticulitis si scheduled for surgery in 2 hrs, wants to leave hospital, nurse action
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notify the surgeon first; inform client about risks she may encounter-peritonitis
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Sterile dressing change
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correct action: pick up the sterile glove by grasping the folded cuff edge First; use sterile gloves to apply the transparent dressing; open the top flap of the sterile package away from the body; maintain a 2.5 cm/1 in border around the edges of the sterile field
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client in ER with weakness, vomiting, diarrhea for last three days
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priority assessment: serum K level
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client that refuses blood transfusions due to religious beliefs
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RN should support client's decision to forego transfusions
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charge nurse response to a nurse who thinks her client is in the ER just to seek drugs and not actually experiencing pain
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Clients are the experts on their own pain
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INTRApersonal conflict example
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"I'm not sure whether I want to apply for the unit manager's position or start a family this year"
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client in ER arriving with stage IV pressure ulcers, maggots presence (brought by family member), nurse's responsability
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notify Adult Protective Services, provider and social worker; no need to call police or confront family member
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Chlamydia trachomatis
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nationally notifiable infectious disease (notify state health dept) (RSV, MRSA or Cdif are not)
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advance directives
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a family member of a client can have the living will overturned in some cases (family members can question the mental capacity of the client at the time a living will was completed-this might get the will revoked); no prescription necessary;
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Dementia client best spot
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private room near nurse's station
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ok to delegate to AP
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ambulating a client who uses a walker; adding thickener to thin liquids on a client's food tray; ambulate a client who is 12 hrs postop eye surgery
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RN will
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complete an admission assessment for a client who has just transferred from the emergency department
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LPN
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inserts an indwelling catheter for a client who has not voided for 6 hrs; obtain sterile specimen from a client's infected surgical wound
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nurse suspects that her coworker is impaired-responsibility
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notify charge nurse
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Priority client
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abdominal surgery 6 hrs ago with HR of 120/min for the last 2 hrs
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pump that infused too much solution
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after notifying provider, tag the pump for maintenance and acquire a new pump for the client; don't use again
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critical pathway
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include treatment milestones (time bound activities, interventions, outcomes)
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priority client
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fractured hip with recently developed slurred speach
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UTI increased # of cases on a floor; manager first action
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perform a chart review to gather data about clients who develop the infections
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this is wrong-requires intervention
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photocopying clients dignostic test results
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report to charge nurse
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client 2 days post of with urine 20 ml/hr-risk for acute kidney injury
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priority client
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arm contusions with asymmetrical thoracic movement=tension pneumothorax
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quality improvement process first step (reducing UTI on a unit)
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establish best practices guidelines for reducing the incidence of UTI's-this will create a standard in order to measure performance
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LPN
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can irrigate wounds
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Effective time management skills shown by new RN when:
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she makes a list of non-essential tasks to perform later
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In case of a major accident, when a disaster plan has been activated, what a charge nurse can do in PACU
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identify stable clients to transfer to a surgical unit
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Report for transferring client thats 3 days postop; this should include
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objective data: eg. level of consciousness, vitals for current shift, essential background info that pertains to client status, dont include routine care procedures like dressing change schedule
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client on warfarin most important to include in plan of care
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scheduling follow up test for prothrombin time and INR
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Authoritarian manager that needs to address increased meds errors
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will inform the staff of the penalties that can result from meds errors (penalties for behaviour change)
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this requires completion of an incidence report
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a client's IV solution infused over 6 hrs instead of 8 hrs
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in a disaster
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LPN can provide care to class III (green tag) clients
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LPN report very high BP to RN on a client; RN initial action
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recheck BP
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Meningococcal pneumonia
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droplet precautions
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shigella
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contact precautions
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MRSA
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contact
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respiratory syncytial virus
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contact
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when applying restraints
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place restraint ties on a movable part of the bed frame; on the wrist; quick release knot, not square; over client's clothing
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critical pathways
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prevent unnecessary expense, Evidence based strategies for common dx
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to promote employee hand hygiene
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first thing: set a goal for improvement in adherence
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class about strategies to promote client rights
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verify that a provider prescription is in the medical record for clients who have restraints
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Fire in a unit: priority
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instruct ambulatory clients to go to a safe area (RACE)
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informed consent for a child
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must be given by a legal guardian and not by a friend's parent
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active herpes simplex lesions
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contact precautions: gown and gloves
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client with cancer decides not to continue treatment
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"tell me what this is like for you?"
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