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June 25, 2018
Falls: initiate fall risk care plan if appropriate, make sure patient is safe to ambulate, initiate all fall precautions Electrical hazards Unsafe behavior from other patients or visitors
September 4, 2017
When a natural disaster strikes, patients don’t magically stop being sick.  I am honored to share the story of Erika RN BSN, who stayed in the hospital 108 hours during Hurricane Harvey providing care for her patients. I am honored … Continued
August 2, 2017
Evaluate routinely, based on kind of restraint IE if it’s a violent restraint, q15 min at minimum Assess skin q30min, remove q2hr and provide ROM, fluids, toileting, food, and so forth Renew order if still needed
July 26, 2017
Great reference for this:  Common Breaks in Sterile Techniques, published by the AORN Journal Common breaks Not noticing compromised packaging Not noticing moisture on or in the package Unsterile person touching the sterile field Outside, unsterile packaging, touching inside sterile … Continued
July 24, 2017
Hand washing compliance is being met Trash is disposed of properly Staff is consistently wearing appropriate PPE
July 21, 2017
Definition Sterile gloves, mask, and other necessary sterile supplies Maintain sterile technique Follow appropriate protocol if sterile field is broken
July 19, 2017
Varies depending upon facility.  Can include: No fresh flowers or fruits Ill visitors are not permitted Many people institute or order “reverse isolation” however, per the CDC it “was not found to improve outcomes for neutropenic patients, and isolation is … Continued
July 17, 2017
For example; if a patient is on contact isolation, we must educate the patient and family about the use of gowns, gloves, and hand washing, as well as ensure the staff is aware as well (HIPAA compliant signage) before providing … Continued
July 14, 2017
Inform appropriate personnel Infection Control department Center for Disease Control Summary of Notifiable Infectious Diseases, CDC (last updated 2014)
July 10, 2017
Airborne – isolation room, negative pressure room, must wear appropriate mask and additional PPE (gown, gloves) Measles Varicella Tuberculosis Droplet – isolation room, surgical mask okay, gown, gloves Meningitis Pertussis Pneumonia Influenza Contact – isolation room, gown and gloves Colonized … Continued
July 5, 2017
Whenever you’re providing care, ensure you’re keeping everything clean (or sterile, if required) Examples of situations… When you remove the cap from the spike on your IV tubing to start IV fluids, it cannot touch anything else other than sterile … Continued
July 3, 2017
Apply principles of triage and evacuation procedures/protocols Check out Episode 059 for triage principles Know how to evacuate patients Horizontally before vertically Know what to do for specific units Know how to use specific equipment to quickly transfer patients Medsleds … Continued
June 30, 2017
Examples of equipment include frayed electrical cords, loose/missing parts, IV pumps that malfunction, exposed wiring All equipment must be inspected and signed off on before using with a patient If a patient brings in their own electrical equipment (like a … Continued
June 28, 2017
Acknowledge and document practice error per policy For example, medication error, accidental needlestick, incorrect order entry, patient transferred to incorrect unit Evaluate response to error/event/occurrence Evaluate patient Does a process need to change to prevent this from occurring in the … Continued
June 26, 2017
Examples include lighting, handrails, kitchen safety Apply knowledge of patient pathophysiology to home safety interventions Are they hard of hearing, have visual deficits? Do they have the dexterity to use handrails or a LifeAlert? Can they use their home oxygen/respiratory … Continued
June 23, 2017
Never touch the device/implant Label things appropriately Follow protocol/policy/procedure specifically Ensure patient is in private room to prevent exposure to other patients and their loved ones Maintain distance between yourself and device consistently If necessary use shield (like lead apron) … Continued
June 21, 2017
Follow procedures for handling biohazardous materials Ensure proper labeling is in place For example, linen used with a patient with chemotherapy Demonstrate safe handling techniques to staff and patient Never recap needles, can result in a needlestick Utilize proper storage … Continued
June 16, 2017
Carpal tunnel, back injuries are common examples Encourage appropriate body mechanics and not merely treating pain when it occurs Proper posture is essential Encourage working with physician and deciding appropriate supportive devices
June 12, 2017
Nurses must participate so their role is known and appropriate Help to identify must-have equipment, potential issues or obstacles to providing care Have an emergency contact tree to contact all staff when/if disaster occurs
June 9, 2017
Nurses frequently use a color-coding system to triage patients, as identified by the facility Example: Red: highest priority, life-threatening yet survivable injuries Yellow: medium priority, injuries but not life-threatening Green: low priority, can wait an extended time, non life threatening … Continued
June 5, 2017
Important that only the sickest ones are in the facility Think patients on ventilators or respiratory support, on vasoactive medications, patients that would likely die or have profound, life-altering effects  if not receiving care they can only receive in the … Continued
May 31, 2017
Do not blindly follow orders; practice with a questioning attitude Quote from Scrubs, the TV show Nurse (to doctor): “Doug wanted me to give him 500,000 mg of morphine… I thought I’d check with you first before I killed a … Continued
May 29, 2017
You must check their appropriate ID before doing anything Medications: check name, birthday, and so forth Check patient’s armband (or other identifying device) if patient is unable to speak Many facilities require scanning the armband before giving any medications Always … Continued
May 26, 2017
Can I be honest? I had an amazing experience last month.   It was one of those moments when you are filled with thousands of emotions ranging from happiness to sadness all at the same time.  Have you ever felt … Continued
May 26, 2017
If a patient is confused, impulsive, forgetful, or agitated, make sure they have a room close to the nurse’s station Do not put these patients at the end of the hall, where it’s harder to hear them if they call … Continued
May 24, 2017
Many disease processes can put patients at an increased risk for seizures Brain injury or trauma Drugs, medication Withdrawing from alcohol or other drugs Fevers History seizure activity See this list from John Hopkins about various causes of seizures Patients … Continued
May 22, 2017
Change positions Pillow support Active and passive range of motion Routine stretching of the shoulders, neck, arms, hands, fingers
May 19, 2017
Falls: initiate fall risk care plan if appropriate, make sure patient is safe to ambulate, initiate all fall precautions Electrical hazards Unsafe behavior from other patients or visitors
May 1, 2017
Really important, especially with first time parents Can be easily done incorrectly, not as straightforward as some anticipate Some facilities may have it as part of policy to make sure family knows how to properly use before leaving
April 28, 2017
(This does not include medications) At home oxygen and supplies, CPAP’s, assistive devices, drains, tubes, and so forth. Make sure assistive devices are sized appropriately Crutches not too tall, walker not to short, and so forth Make sure they know … Continued
April 26, 2017
Visual: can they see what’s in front of them while walking? Can they see that they are taking the appropriate medication? Hearing: can they hear someone speaking to them or yelling at them? Can they hear if they are in … Continued
April 24, 2017
Various factors can influence the likelihood that a  patient will get injured Age and developmental stage: elderly as well patients that may physically be older, but mentally younger Lifestyle: do they use seat belts? Do they drive impaired (alcohol, texting/using … Continued
April 21, 2017
Many facilities have various protocols on how to deal with various safety issues Falls Armed intruder Large patient influx/at capacity Infant abduction Weather issues Acts of terrorism Unsafe/violent patients or visitors Know what you need to do as a nurse … Continued
April 19, 2017
Important to ask about all allergies, not just medication allergies Some medications may have ingredients from different foods in their coating or capsules Must ask about allergies to IV dyes or contrast Ask about all food, environmental, and medication allergies … Continued
April 14, 2017
Examples of necessary referrals include therapy services (physical, occupational, speech), wound care, nutritional services, and so forth Recognize the need for referrals and obtain necessary orders Identify community resources for the client with health care team (Meals on Wheels, respite … Continued
March 13, 2017
Call lights Adaptive call lights can be used for patients with poor dexterity Phones, or other technology
March 13, 2017
(This does not include medications) At home oxygen and supplies, CPAP’s, assistive devices, drains, tubes, and so forth. Make sure assistive devices are sized appropriately Crutches not too tall, walker not to short, and so forth Make sure they know … Continued
March 13, 2017
Visual: can they see what’s in front of them while walking? Can they see that they are taking the appropriate medication? Hearing: can they hear someone speaking to them or yelling at them? Can they hear if they are in … Continued
March 13, 2017
Various factors can influence the likelihood that a  patient will get injured Age and developmental stage: elderly as well patients that may physically be older, but mentally younger Lifestyle: do they use seat belts? Do they drive impaired (alcohol, texting/using … Continued
March 13, 2017
Many facilities have various protocols on how to deal with various safety issues Falls Armed intruder Large patient influx/at capacity Infant abduction Weather issues Acts of terrorism Unsafe/violent patients or visitors Know how to safely exit building and expectations of … Continued
March 13, 2017
Important to ask about all allergies, not just medication allergies Some medications may have ingredients from different foods in their coating or capsules Must ask about allergies to IV dyes or contrast Ask about all food, environmental, and medication allergies … Continued
March 13, 2017
Participate in performance improvement/quality improvement process Utilize research and other references for performance improvement actions Report identified patient care issues and problems (utilize chain of command) Evaluate the impact of performance improvement measures on patient care and resource utilization
March 13, 2017
Examples of necessary referrals include therapy services (physical, occupational, speech), wound care, nutritional services, and so forth Recognize the need for referrals and obtain necessary orders Identify community resources for the client with health care team (Meals on Wheels, respite … Continued
March 7, 2017
Know your state board of nursing Do not attempt to provide care outside of this scope – it is illegal Example: Texas Board of Nursing https://www.bon.texas.gov/practice_scope_of_practice_rn.asp
January 6, 2017
Substance abuse/diversion Improper care Staffing practices
January 4, 2017
Abuse and neglect Child, elderly, domestic Know your local reporting agencies (Child Protective Services) Communicable diseases Vaccine Adverse Event Reaction System (VAERS, vaers.hhs.gov) Report to Center for Disease Control (CDC) 2016 list of reportable conditions: https://wwwn.cdc.gov/nndss/conditions/notifiable/2016/ Adverse reactions to vaccinations … Continued
January 2, 2017
To be clinically appropriate medical interpreter, you must have appropriate credentials This is important because medical jargon is very different from fluency in a language, therefore competency and knowledge of specific medical jargon in various languages must be verified prior … Continued
December 23, 2016
Be able to know when something is outside of your comfort zone High risk, low frequency procedures Know your chain of command for both clinical “how-to” situations and also administration issues Document appropriately
December 21, 2016
Most facilities have policies and procedures to properly secure valuables Ideally, valuables are given to family/friends to be taken home and secured If this is not possible, there should be a secured and locked location within the facility to keep … Continued
December 19, 2016
Refusing treatment HCPOA disputes/living wills Mental illness and inability to sign own consents
December 16, 2016
This includes evidenced-based research, information technology, policies and procedures) Access data for client through online databases and journals Most hospitals have subscriptions to journals Professional organization journals have a plethora of information available, directly related to nursing Consistent review of … Continued
December 12, 2016
Each facility may have a different process Identify inappropriate and/or unclear treatments or medications A nurse must administer treatments unless they believe they are inappropriate or unclear If this occurs, you must contact the prescriber and discuss further, document appropriately, … Continued
November 23, 2016
What is informed consent?  Basically the patient is giving permission for treatment and acknowledging that they understand the risks and benefits of the procedure as well as the consequences for not receiving the treatment. Wikipedia The patient must be an … Continued
November 21, 2016
Two codes of ethics for nurses Last updated 2015 First developed in 1953 Last updated 2012 The American Nurses Association Code of Ethics The Code of Ethics for Nurses (International Council of Nurses) Remember, these codes are not laws Different … Continued
November 11, 2016
Issues arise frequently that require the nurse to address them and ensure the problem has been resolved Examples Lab problems: unable to get serum sample, sample obtained hemolyzed, came to draw lab and patient at another test Nutrition issues: patient … Continued
November 4, 2016
If it wasn’t documented, it wasn’t done!   Nurses are responsible for documenting many things. Some of which include: Care plans Medications (many facilities use barcode scanning) Nursing notes Assessments (focused, head to toe, vascular access devices, lines, tubes, … Continued
November 2, 2016
Report will look different in various areas of the hospital ED report is very short and concise Critical care report is very detailed Floor report is more detailed than the ED, but less detailed than critical care Some facilities use … Continued
October 28, 2016
Keep your password of EHR’s protected and confidential Don’t talk about sensitive information in public areas Speak with patient about which members of their support system they want involved in their care and identify anyone they may not want visiting … Continued
October 26, 2016
Make sure the patient knows that their privacy is a priority to us It is one of their rights, it is not optional Intervene if necessary (episode 018)
October 24, 2016
The nurse is at the bedside with the patient 24 hours/day and they typically feel most comfortable with their nursing staff.  Therefore, if a problem or personality conflict arises, the patient will most likely verbalize this to the nurse and … Continued
October 21, 2016
Nursing staff Continual care provider, advocate, administer medications and orders placed by medical team, evaluate effectiveness, notify medical staff of concerns, facilitate collaboration of entire healthcare team, work with health care team to optimize care Manage additional nursing support staff, … Continued
October 19, 2016
This needs to be done daily to ensure we are facilitating the appropriate plan of care As other members of the health care team assess the patient and develop plans and goals, we need to update our plans and goals, … Continued
October 12, 2016
Discuss treatment options with the health care team and make sure you understand them fully, then the physician (or support staff) will present to the patient The patient and their support system may have few questions when they hear the … Continued
October 10, 2016
Care plans / clinical pathways must be initiated upon admission and are complete at discharge Complete an initial evaluation to assess their current situation, read the notes from the health care team to understand what potential needs and realistic goals … Continued
October 7, 2016
The patient and their support system must have all information related to the discharge process as early on as possible Location, contact information (and contact info for after-hours situations), financial information, transportation, follow-up appointments, equipment (ensure understanding of proper use … Continued
October 5, 2016
Consider diagnosis, prescribed treatment recommendations, ability to remain compliant, patient’s understanding of situation, support system available, ability to utilize resources when questions or concerns arise, affordability, level of self care Patient situations differ widely and it is not a “one … Continued
October 3, 2016
Consider cost when setting up care/resources Is this sustainable? How does their insurance coverage, Medicare, or Medicaid factor in? Do so in a non-judgemental way Speak with the patient and support system about finances, what they can realistically afford and … Continued
September 28, 2016
Become familiar with your community’s resources that can be helpful to patients attempting to maintain independence Nursing homes, respite care, SNF, home health agencies, Meals on Wheels Consider insurance coverage, Medicare, Medicaid, family support and availability to utilize resources
September 26, 2016
NCSBN Delegation | ANA: Developing Delegation Skills You will be responsible for delegating tasks to others; nursing assistants, other nurses, and so forth Not all tasks are appropriate to delegate You can only delegate tasks for which you are responsible … Continued
September 16, 2016
Advocating – help the patient and their support system understand the clinical picture and identified treatment options, identify their wants/needs, support the patient, speak on their behalf if needed, and uphold and protect their rights The foundation of being an … Continued
September 16, 2016
It is the nurse’s job and part of the law (Client Self-Determination Act) to assess for existing advanced directives and integrate them into the patient’s care, and inform and educate about them if the patient is unfamiliar with advanced directives … Continued
September 16, 2016
Welcome to our brand new . . . hot off the presses podcast.  This podcast is designed to provide you with a step-by-step outline for the majority of the key points the NCSBN wants nursing students to know before taking … Continued
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