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RN Comprehensive Predictor 2019 Remediation
Professional Responsibilities: Identifying Client Advocacy
• Support of clients’ health, wellness, safety, and personal rights, including privacy
• Autonomy: the right to make one’s own personal decisions, even when those decisions
might not be in that person’s best interest
• Beneficence: action that promotes good for others, without an self interest
• Fidelity: fulfillment of promises
• Justice: fairness in care delivery and use of resources
• Nonmaleficence: a commitment to do no harm
• Veracity: a commitment to tell the truth
1) Ensures the client has the information they need to make decisions about healthcare
2) Advocate even when they disagree with the client’s decision
3) Advocate when clients are unable to speak or act for themselves
Managing Client Care: Action Requiring Intervention during Tracheostomy Suctioning
• Provide tracheostomy care every 8 hours to reduce risk of infection
• Use sterile suctioning supplies
• Remove soiled dressings and excess secretions
• Apply the oxygen source loosely if the client’s SpO2 decreases during procedure
• Use cotton tip[ed applicators and gauze pads to clean exposed outer cannula surfaces.
Clean in a circular motion from the stoma site outward
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• Use surgical asepsis to remove and clean the inner canula . Use a new inner cannula if it
is disposable.
• Clean the stoma site and then the tracheostomy plate
• Place a fresh split gauze tracheostomy dressing of nonraveling material under and around
the tracheostomy holder and plate
1) An open airway is necessary for breathing so it is the highest priority
2) Breathing is necessary for oxygenation of the blood to occur
3) Circulation is necessary for oxygenated blood to reach the body’s tissues
Managing Client Care: Effective Time Management
1) Taking time to plan care and taking priorities into consideration
2) Making repeated trips to the supply room
3) Completing one task before beginning another task for equipment
Coordinating Client Care: Planning Care for a Client Following a Stroke
• Assess swallow and gag reflex before feeding
• Can have thin (water, juice), nectar like (cream soups, nectars), honey like (honey,
yogurt), spoon thick ( pudding, cooked cereals)
• Pureed, mechanically soft, regular
1) Initiation revision and evaluations of the plan of care
2) Facilitating referrals and the use of community resources
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3) Facility to another, such as from an acute care facility to a skilled facility
Coordinating Client Care: Information to Report to Occupational Therapist
• Assess and plans for clients to regain activities of daily living skills, especially motor
skills of the upper extremities
• Ex. A client has difficulties with using an eating utensil with her dominant hand
following a stoke.
1) Client medical diagnosis and care providers
2) Overview of health status, plan of care, and recent progress
3) Most recent vital signs and medications
Multiple Sclerosis: Priority Referral for a Client who has Amyotrophic Lateral Sclerosis
• Degenerative neurological disorder of upper and lower motor neurons, resulting in
progressive paralysis
• Eventually causes respiratory paralysis within 3-5 years. Cognitive function is not
impacted. No cure.
• Palliative care is top priority
1) Plan for disease progression
2) Consider referral to occupational and physical therapy for home environment assessment to
determine safety and ease of mobility.
3) Refer to speech language therapist for dysarthria and dysphagia.
RN Comprehensive Predictor 2019 Remediation
Professional Responsibilities: Identifying Client Advocacy
• Support of clients’ health, wellness, safety, and personal rights, including privacy
• Autonomy: the right to make one’s own personal decisions, even when those decisions
might not be in that person’s best interest
• Beneficence: action that promotes good for others, without an self interest
• Fidelity: fulfillment of promises
• Justice: fairness in care delivery and use of resources
• Nonmaleficence: a commitment to do no harm
• Veracity: a commitment to tell the truth
1) Ensures the client has the information they need to make decisions about healthcare
2) Advocate even when they disagree with the client’s decision
3) Advocate when clients are unable to speak or act for themselves
Managing Client Care: Action Requiring Intervention during Tracheostomy Suctioning
• Provide tracheostomy care every 8 hours to reduce risk of infection
• Use sterile suctioning supplies
• Remove soiled dressings and excess secretions
• Apply the oxygen source loosely if the client’s SpO2 decreases during procedure
• Use cotton tip[ed applicators and gauze pads to clean exposed outer cannula surfaces.
Clean in a circular motion from the stoma site outward
, 2
• Use surgical asepsis to remove and clean the inner canula . Use a new inner cannula if it
is disposable.
• Clean the stoma site and then the tracheostomy plate
• Place a fresh split gauze tracheostomy dressing of nonraveling material under and around
the tracheostomy holder and plate
1) An open airway is necessary for breathing so it is the highest priority
2) Breathing is necessary for oxygenation of the blood to occur
3) Circulation is necessary for oxygenated blood to reach the body’s tissues
Managing Client Care: Effective Time Management
1) Taking time to plan care and taking priorities into consideration
2) Making repeated trips to the supply room
3) Completing one task before beginning another task for equipment
Coordinating Client Care: Planning Care for a Client Following a Stroke
• Assess swallow and gag reflex before feeding
• Can have thin (water, juice), nectar like (cream soups, nectars), honey like (honey,
yogurt), spoon thick ( pudding, cooked cereals)
• Pureed, mechanically soft, regular
1) Initiation revision and evaluations of the plan of care
2) Facilitating referrals and the use of community resources
, 3
3) Facility to another, such as from an acute care facility to a skilled facility
Coordinating Client Care: Information to Report to Occupational Therapist
• Assess and plans for clients to regain activities of daily living skills, especially motor
skills of the upper extremities
• Ex. A client has difficulties with using an eating utensil with her dominant hand
following a stoke.
1) Client medical diagnosis and care providers
2) Overview of health status, plan of care, and recent progress
3) Most recent vital signs and medications
Multiple Sclerosis: Priority Referral for a Client who has Amyotrophic Lateral Sclerosis
• Degenerative neurological disorder of upper and lower motor neurons, resulting in
progressive paralysis
• Eventually causes respiratory paralysis within 3-5 years. Cognitive function is not
impacted. No cure.
• Palliative care is top priority
1) Plan for disease progression
2) Consider referral to occupational and physical therapy for home environment assessment to
determine safety and ease of mobility.
3) Refer to speech language therapist for dysarthria and dysphagia.
