VATI RN 2ND COMPREHENSIVE PREDICTOR FOCUSED REVIEW
Management of Care – (5)
Case Management – (1)
▪ Cardiovascular Disorders: Tetralogy of Fallot (RM NCC RN 10.0 Chp 20)
• Defects that decreases pulmonary blood flow have an obstruction of pulmonary
blood flow and an anatomic defect (ASD or VSD) between the right and left sides
of the heart. In these defects, there is a right to left shift allowing deoxygenated
blood to enter the systemic circulation. Hypercyanotic spells (blue, or “Tet,”
spells) manifest as acute cyanosis and hyperpnea
• Tetralogy of fallot – four defects that result in mixed blood flow: Pulmonary
stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
Cyanosis at birth: progressive cyanosis over the first year of life
Systolic murmur
Episodes of acute cyanosis and hypoxia (blue or “Tet” spells)
• Surgical procedures – shunt placement until able to undergo primary repair;
complete repair within first year of life
Collaboration with Interdisciplinary Team – (1)
▪ Communicable Diseases, Disasters, and Bioterrorism: CDC Reportable Diagnoses
(RM CH RN 7.0 Chp 6)
• Anthrax, Botulism, Cholera, Congenital rubella syndrome (CRS), Diphtheria,
Giardiasis, Gonorrhea, Hepatitis A, B, C, HIV infection, influenza-associated
pediatric mortality, Legionellosis/Legionnaires’ disease, Lyme disease, Malaria,
Meningococcal disease, Mumps, Pertussis (whooping cough), Poliomyelitis,
paralytic, Poliovirus infection, nonparalytic, Rabies (human or animal), Rubella
(German measles), Salmonellosis, Severe acute respiratory syndrome-associated
coronavirus disease (SARS-CoV), Shigellosis, Smallpox, Syphillis, Tetanus/C.
Tetani, Toxic Shock Syndrome (TSS) (other than streptococci), Tuberculosis
(TB), Typhoid fever, Vancomycin-intermediate and vancomycin-resistant
Staphylococcus aureus (VISA/VRSA)
Concepts of Management – (1)
▪ Managing Client Care: Conflict Management Between Health Care Workers (RM
Leadership 7.0 Chp 1)
• Conflict is the result of opposing thoughts, ideas, feelings, perceptions, behaviors,
values, opinions, or actions between individuals. Conflict is an inevitable part of
professional, social, and personal life and can have constructive or destructive
results. Nurses must understand conflict and how to manage it. Nurses can use
problem-solving and negotiation strategies to prevent a problem from evolving
into a conflict. Lack of conflict can create organizational stasis, while too much
conflict can be demoralizing, produce anxiety, and contribute to burnout. Conflict
can disrupt working relationships and create a stressful atmosphere. If conflict
exists to the level that productivity and quality of care are compromised, the unit
manager must attempt to identify the origin of the conflict and attempt to resolve
it.
, Continuity of Care – (1)
▪ Information Technology: Change-of-Shift Report (RM FUND 9.0 Chp 5)
• Nurses give this report at the conclusion of each shift ot the nurse assuming
responsibility for the clients. Formats include face to face, audiotaping, or
presentation during walking rounds in each client’s room (unless the client has a
roommate or visitors are present). An effective report should: include significant
objective information about the client’s health problems, proceed in a logical
sequence, include no gossip or personal opinion, and relate recent changes in
medications, treatments, procedures, and the discharge plan.
Establishing Priorities – (1)
▪ Managing Client Care: Prioritizing Care of Postoperative Clients (RM Leadership 7.0
Chp 1)
• Prioritize systemic before local (“life before limb”)
• Prioritize acute (less opportunity for physical adaptation) before chronic (greater
opportunity for physical adaptation)
• Prioritize actual problems before potential future problems
• Listen carefully to clients and don’t assume
• Recognize and respond to trends vs. transient findings
• Recognize indications of medical emergencies and complications vs. expected
findings
• Apply clinical knowledge to procedural standards to determine the priority actions
Safety and Infection Control – (8)
Accident/Error/Injury Prevention – (1)
▪ Seizures: Maintaining Seizure Precautions (RM NCC RN 10.0 Chp 13)
• Maintain seizure precautions, including placing the bed in the lowest position and
padding the side rails to prevent future injury.
Emergency Response Plan – (1)
▪ Client Safety: Priority Action for Fire (RM FUND 9.0 Chp 12)
• R: rescue and protect clients in close proximity to the fire by moving them to a
safer location. Clients who are ambulatory may walk independently in a safe
location
• A: alarm: activate the facility’s alarm system and then report the fire’s details and
location
• C: contain/confine the fire by closing doors and windows and turning off any
sources of oxygen and any electrical devices. Ventilate clients who are on life
support with a bag valve mask
• E: extinguish the fire is possible using the appropriate fire extinguisher
Handling Hazardous and Infectious Materials – (1)
▪ Cancer Treatment Options: Implanted Internal Radiation Device (RM AMS RN 10.0
Chp 91)
• Brachytherapy describes internal radiation that is placed close to the target tissue.
This is done via placement in a body orifice (vagina) or body cavity (abdomen) or
, delivered via IV such as with radionuclide iodine, which is absorbed by the
thyroid.
Brachytherapy provides radiation to the tumor and a limited amount to
surrounding normal tissues.
Waste products are radioactive until the isotope has been completely
eliminated from the body. Waste products should not be touched by anyone.
• Nursing considerations:
Place the client in a private room away from other clients when possible. Keep
door closed as much as possible.
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 visits, and have visitors maintain a distance of 6 feet
from the source.
Visitors and health care personnel who are pregnant or under the age of 18
should not come into contact with the client or radiation source.
Wear a lead apron while providing care keeping the front of the apron facing
the source of radiation.
Keep a lead container in the client’s room if the delivery method could allow
spontaneous loss of radioactive material. Tongs are available for placing
radioactive material into this container.
Follow protocol for proper removal of dressings and bed linens from the
room.
• Client education:
Inform the client of the need to remain in an indicated position to prevent
dislodgement of the radiation implant.
Instruct the client to call the nurse for assistance with elimination.
Instruct the client and family about radiation precautions needed in health care
and home environments.
Home Safety – (1)
▪ Home Safety: Identifying Potential Hazards in the Home (RM FUND 9.0 Chp 13)
• Remove items that could cause the client to trip, such as throw rugs and loose
carpets. Place electrical cords and extension cords against a wall behind furniture.
Monitor gait and balance, and provide aids as needed. Make sure that steps and
sidewalks are in good repair. Place grab bars near the toilet and in the tub or
shower, and install a stool riser. Use a nonskid mat in the tub or shower. Place a
shower chair in the shower and provide a bedside commode if needed. Ensure that
lighting is adequate inside and outside the home.
Standard Precautions/Transmission-Based Precautions/Surgical Asepsis – (3)
▪ Acute Neurological Disorders: Priority Intervention for Meningitis (RM NCC Rn
10.0 Chp 12)
• The presence of petechiae or a purpuric-type rash requires immediate medical
attention. Isolate the client as soon as meningitis is suspected, and maintain
Management of Care – (5)
Case Management – (1)
▪ Cardiovascular Disorders: Tetralogy of Fallot (RM NCC RN 10.0 Chp 20)
• Defects that decreases pulmonary blood flow have an obstruction of pulmonary
blood flow and an anatomic defect (ASD or VSD) between the right and left sides
of the heart. In these defects, there is a right to left shift allowing deoxygenated
blood to enter the systemic circulation. Hypercyanotic spells (blue, or “Tet,”
spells) manifest as acute cyanosis and hyperpnea
• Tetralogy of fallot – four defects that result in mixed blood flow: Pulmonary
stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
Cyanosis at birth: progressive cyanosis over the first year of life
Systolic murmur
Episodes of acute cyanosis and hypoxia (blue or “Tet” spells)
• Surgical procedures – shunt placement until able to undergo primary repair;
complete repair within first year of life
Collaboration with Interdisciplinary Team – (1)
▪ Communicable Diseases, Disasters, and Bioterrorism: CDC Reportable Diagnoses
(RM CH RN 7.0 Chp 6)
• Anthrax, Botulism, Cholera, Congenital rubella syndrome (CRS), Diphtheria,
Giardiasis, Gonorrhea, Hepatitis A, B, C, HIV infection, influenza-associated
pediatric mortality, Legionellosis/Legionnaires’ disease, Lyme disease, Malaria,
Meningococcal disease, Mumps, Pertussis (whooping cough), Poliomyelitis,
paralytic, Poliovirus infection, nonparalytic, Rabies (human or animal), Rubella
(German measles), Salmonellosis, Severe acute respiratory syndrome-associated
coronavirus disease (SARS-CoV), Shigellosis, Smallpox, Syphillis, Tetanus/C.
Tetani, Toxic Shock Syndrome (TSS) (other than streptococci), Tuberculosis
(TB), Typhoid fever, Vancomycin-intermediate and vancomycin-resistant
Staphylococcus aureus (VISA/VRSA)
Concepts of Management – (1)
▪ Managing Client Care: Conflict Management Between Health Care Workers (RM
Leadership 7.0 Chp 1)
• Conflict is the result of opposing thoughts, ideas, feelings, perceptions, behaviors,
values, opinions, or actions between individuals. Conflict is an inevitable part of
professional, social, and personal life and can have constructive or destructive
results. Nurses must understand conflict and how to manage it. Nurses can use
problem-solving and negotiation strategies to prevent a problem from evolving
into a conflict. Lack of conflict can create organizational stasis, while too much
conflict can be demoralizing, produce anxiety, and contribute to burnout. Conflict
can disrupt working relationships and create a stressful atmosphere. If conflict
exists to the level that productivity and quality of care are compromised, the unit
manager must attempt to identify the origin of the conflict and attempt to resolve
it.
, Continuity of Care – (1)
▪ Information Technology: Change-of-Shift Report (RM FUND 9.0 Chp 5)
• Nurses give this report at the conclusion of each shift ot the nurse assuming
responsibility for the clients. Formats include face to face, audiotaping, or
presentation during walking rounds in each client’s room (unless the client has a
roommate or visitors are present). An effective report should: include significant
objective information about the client’s health problems, proceed in a logical
sequence, include no gossip or personal opinion, and relate recent changes in
medications, treatments, procedures, and the discharge plan.
Establishing Priorities – (1)
▪ Managing Client Care: Prioritizing Care of Postoperative Clients (RM Leadership 7.0
Chp 1)
• Prioritize systemic before local (“life before limb”)
• Prioritize acute (less opportunity for physical adaptation) before chronic (greater
opportunity for physical adaptation)
• Prioritize actual problems before potential future problems
• Listen carefully to clients and don’t assume
• Recognize and respond to trends vs. transient findings
• Recognize indications of medical emergencies and complications vs. expected
findings
• Apply clinical knowledge to procedural standards to determine the priority actions
Safety and Infection Control – (8)
Accident/Error/Injury Prevention – (1)
▪ Seizures: Maintaining Seizure Precautions (RM NCC RN 10.0 Chp 13)
• Maintain seizure precautions, including placing the bed in the lowest position and
padding the side rails to prevent future injury.
Emergency Response Plan – (1)
▪ Client Safety: Priority Action for Fire (RM FUND 9.0 Chp 12)
• R: rescue and protect clients in close proximity to the fire by moving them to a
safer location. Clients who are ambulatory may walk independently in a safe
location
• A: alarm: activate the facility’s alarm system and then report the fire’s details and
location
• C: contain/confine the fire by closing doors and windows and turning off any
sources of oxygen and any electrical devices. Ventilate clients who are on life
support with a bag valve mask
• E: extinguish the fire is possible using the appropriate fire extinguisher
Handling Hazardous and Infectious Materials – (1)
▪ Cancer Treatment Options: Implanted Internal Radiation Device (RM AMS RN 10.0
Chp 91)
• Brachytherapy describes internal radiation that is placed close to the target tissue.
This is done via placement in a body orifice (vagina) or body cavity (abdomen) or
, delivered via IV such as with radionuclide iodine, which is absorbed by the
thyroid.
Brachytherapy provides radiation to the tumor and a limited amount to
surrounding normal tissues.
Waste products are radioactive until the isotope has been completely
eliminated from the body. Waste products should not be touched by anyone.
• Nursing considerations:
Place the client in a private room away from other clients when possible. Keep
door closed as much as possible.
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 visits, and have visitors maintain a distance of 6 feet
from the source.
Visitors and health care personnel who are pregnant or under the age of 18
should not come into contact with the client or radiation source.
Wear a lead apron while providing care keeping the front of the apron facing
the source of radiation.
Keep a lead container in the client’s room if the delivery method could allow
spontaneous loss of radioactive material. Tongs are available for placing
radioactive material into this container.
Follow protocol for proper removal of dressings and bed linens from the
room.
• Client education:
Inform the client of the need to remain in an indicated position to prevent
dislodgement of the radiation implant.
Instruct the client to call the nurse for assistance with elimination.
Instruct the client and family about radiation precautions needed in health care
and home environments.
Home Safety – (1)
▪ Home Safety: Identifying Potential Hazards in the Home (RM FUND 9.0 Chp 13)
• Remove items that could cause the client to trip, such as throw rugs and loose
carpets. Place electrical cords and extension cords against a wall behind furniture.
Monitor gait and balance, and provide aids as needed. Make sure that steps and
sidewalks are in good repair. Place grab bars near the toilet and in the tub or
shower, and install a stool riser. Use a nonskid mat in the tub or shower. Place a
shower chair in the shower and provide a bedside commode if needed. Ensure that
lighting is adequate inside and outside the home.
Standard Precautions/Transmission-Based Precautions/Surgical Asepsis – (3)
▪ Acute Neurological Disorders: Priority Intervention for Meningitis (RM NCC Rn
10.0 Chp 12)
• The presence of petechiae or a purpuric-type rash requires immediate medical
attention. Isolate the client as soon as meningitis is suspected, and maintain
