VATI Leadership and Management Remediation
A client asks the nurse what the difference is between a durable power of attorney for health care and a living will. What should the nurse teach the client to differentiate the two components of advanced directives?
A living will is a legal document that expresses the clients wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues. Types of treatments that often addressed in a living will are those that have the ability to prolong life, for example cardiopulmonary resuscitation, mechanical ventilation, and feeding by artificial means. Whereas a durable power of attorney for health care or a healthcare proxy is a legal document that designates a health care surrogate which is an individual authorized to make health care decisions for a client who is unable to. The person who serves in this role of the health care surrogate to make decisions for the client should be very familiar with the client’s wishes. Living wills can be difficult to interpret, especially in the face of unexpected circumstances. A durable power of attorney for health care, as an adjunct to a living will, can be a more effective way of ensuring that the client’s decisions about their health care are honored.
Describe the steps a nurse should take when preparing to administer a blood transfusion.
The steps a nurse should take when preparing to administer a blood transfusion involve explaining the procedure to the client, in addition to, assessing the client’s vital signs and lab values. The nurse should review lab values to ensure the client still requires transfusion and to compare to post-transfusion values. The nurse should also obtain consent for the procedure as well as blood samples for compatibility determination such as a type and cross match. Other steps include starting a large bore 18 or 20-gauge IV, obtaining blood products from the blood bank, and inspecting that blood for discoloration, excessive bubbles, or cloudiness. Prior to transfusion two RN’s (Or an RN and a PN, depending on facility policy) must identify the correct blood product and client by looking at the hospital identification number (noted on the blood product) and the number identified on the client's identification band to makes sure the numbers match. The nurse completing the blood product verification must be one of the nurses who administers the blood product. The nurse should prime the blood administration set with 0.9% sodium chloride only. Medications should also never be added to blood products. Lastly, nurse should start the transfusion within 30 minutes of obtaining the blood product to reduce to risk of bacterial growth, and remain with the client during the initial 15-30 minutes of the transfusion. Most severe reactions occur within this time frame for blood products.
A nurse is delegating tasks to the unlicensed assistive personnel (UAP). Which of the following tasks should the nurse delegate to the UAP?
Checking NG tube patency
Feeding a client with dysphagia
What actions should be taken by the nurse when a client decides to leave the facility against medical advice (AMA)?
A client who leaves a hospital or health care facility without an order for discharge from the provider is considered leaving against medical advice (AMA). One action that should be carried out by the nurse when a client decides to leave the facility against medical advice consists of immediately notifying the primary care provider. Other actions that should be taken by the nurse involve discussing with the client the risks involved in leaving the facility in addition to documenting all the information and education that was provided to the client. Lastly, the individual should sign an “Against Medical Advice” form relinquishing responsibility for any complications that could arise from discontinuing prescribed care.
Describe three (3) ways the nurse can protect their client’s confidentiality and Protected Health Information.
Electronic records should be password protected and codes should not be shared with other health care workers. Use screen savers to protect client information. Log off from computer before leaving workstation to ensure that others cannot view protected health information (PHI) on monitor. Never share user ID or password. Never leave client’s chart or other printed or written PHI where others can access it. Change-of-shift reports can be performed at the bedside as long as client does not have roommate or unsolicited visitors are present. Communication regarding client should only be done in private area. Discuss client information in private locations and only with those clients have agreed upon. Place written reports/records in protected area. Shred any printed or written client information used for reporting or client- care after it is no longer needed. No part of client chart can be copied except for authorized exchange of documents between health care institutions.
You are working with a coworker you suspect is using the substance alcohol while working. What is your next step to ensure client safety?
Impaired health care providers pose a significant risk to client safety. A nurse who suspects a coworker of using alcohol or drugs or any behavior that jeopardizes client care or could indicate substance use disorder while working has a duty to report the coworker to appropriate healthcare management personnel as specified by institutional policy. At the time of the infraction, the report should be made to the immediate supervisor, such as the charge nurse, or nurse manager, to ensure client safety. Many health care facility policies provide access to assistance programs that facilitate entry into a treatment program. Each state has laws and regulations that govern the disposition of nurses who have substance use disorders.
What steps should the nurse follow when admitting a client with tuberculosis?
When admitting a client with tuberculosis, the nurse should use airborne precautions to protect against droplet infections smaller than 5 mcg. (ex. Measles, Varicella, Pulmonary or Laryngeal Tuberculosis). Airborne precautions require a private room, in addition to, masks and respiratory protection devices for caregivers and visitors. An N95 or high-efficiency particulate air (HEPA) respirator if the client is known or suspected to have tuberculosis. The client should also be placed in a negative pressure airflow exchange in the room of at least 6-12 exchanges per hour depending on the age of the structure. If splashing or spraying is a possibility with the patient, the nurse should wear a full-face protection mask which covers the eyes, nose, and mouth. Lastly, clients who have an airborne infection should wear a mask while outside of their patient room or home.
Unintentional Torts/Malpractice: Unintentional torts are those acts which fall below the established standard of care or duty owed to a client and include both negligence and malpractice. Malpractice is an unintentional tort, defined as the failure to provide the expected standard of care, resulting in an injury to the client. When nurses deviate from the standards of care it is most often unintentional. When a nurse deliberately violates a client’s rights, however, it is an intentional tort. However, unintentional torts including negligence, is the misconduct or failure to standards of care places a client at high risk for harm, and safety.
Partial Hospitalization Program: The nurse should identify that a client who has been newly diagnosed with schizophrenia and is ready for discharge from an inpatient setting will still require intensive care. Therefore, the nurse should include information about partial hospitalization programs as part of the continuum of care. These programs are designed to assist clients to transition from an inpatient setting. Partial hospitalization programs meet 5 days per week, for about 6 hours per day. It is important for the nurse to develop an understanding of the continuum of psychiatric mental health care and recognize what resource would best meet the needs of the client. Typically, clients who require an acute level of care should gradually decrease the intensity of care provided in order to maintain initial improvement. Failure to gradually reduce the level of care and continue outpatient treatment increases the risk of relapse.