Core Content With Inclusive Concepts

Core Content With Inclusive Concepts Part l. Safe and Effective Care Environment The nurse promotes achievement of client outcomes by providing and directing nursing care that enhances the care delivery setting in order to protect clients and health care personnel. Management of Care Part I, Subcategory #1 1. Management of Care ☐Management of Care – the nurse provides and directs nursing care that enhances the care delivery setting to protect the client and health care personnel. Major Activity Content. Did you act on this (actions are required)? ☐ Integrate advanced directives into client plan of care ☐ Assign and supervise care of client provided by others (e.g., LPN/VN, assistive personnel, other RNs) ☐ Organize workload to manage time effectively ☐ Practice and advocate for cost effective care ☐ Initiate, evaluate, and update client plan of care ☐ Provide education to clients and staff about client rights and responsibilities ☐ Advocate for client rights and needs ☐ Collaborate with interprofessional team members when providing client care ☐ Manage conflict among clients and health care staff ☐ Maintain client confidentiality and privacy ☐ Provide and receive hand off of care (report) on assigned clients ☐ Use approved abbreviations and standard terminology when documenting care ☐ Perform procedures necessary to safely admit, transfer and/or discharge a client ☐ Prioritize the delivery of client care ☐ Recognize ethical dilemmas and take appropriate action ☐ Practice in a manner consistent with a code of ethics for nurses ☐ Verify the client receives appropriate education and consents for care and procedures ☐ Receive and transcribe health care provider orders ☐ Utilize resources to enhance client care (e.g., evidenced-based research, information technology, policies and procedures) ☐Recognize limitations of self and others and utilize resources ☐Report client conditions as required by law (e.g., abuse/neglect, communicable disease) ☐Provide care within the legal scope of practice ☐Participate in performance improvement projects and quality improvement processes ☐Assess the need for referrals and obtain necessary orders Related action concepts include, but are not limited to the following. Did you do this as needed? ☐Advance Directives/Self-Determination/Life Planning Assess client and/or staff member knowledge of advance directives (e.g., living will, health care agent/proxy, Power of Attorney for Health Care) Integrate advanced directives into client plan of care* Provide client with information about advance directives, self-care determination, life planning ☐Advocacy Discuss identified treatment options with client and respect their decisions Provide information on advocacy to staff members Act in the role of client advocate Utilize advocacy resources appropriately (e.g., social worker, chain of command, interpreter) ☐Assignment, Delegation and Supervision Identify tasks for assignment or delegation based on client needs Delegate and assign appropriate task based on client’s needs to personnel with competency to perform task Assign and supervise care of client provided by others (e.g., LPN/VN, assistive personnel, other RNs)* Communicate tasks to be completed and report client concerns immediately Organize workload to manage time effectively* Utilize the rights of delegation (e.g., right task, right circumstances, right person, right direction/ communication, right supervision/evaluation) Evaluate delegated tasks to ensure correct completion of activity Evaluate ability of staff members to perform assigned tasks considering personnel’s allowable tasks/duties, competency and ability to use sound judgment and decision-making Evaluate effectiveness of staff members’ time management skills ☐Case Management Explore resources available to assist the client with achieving or maintaining independence Assess the client’s need for materials and equipment (e.g., oxygen, suction machine, wound care supplies) Practice and advocate for cost effective care* Plan individualized care for client based on need (e.g., client diagnosis, self-care ability, prescribed treatments) Provide client with information on discharge procedures to home or community setting Initiate, evaluate, and update client plan of care* ☐Client Rights Recognize the client’s right to refuse treatment/procedures Discuss treatment options/decisions with client Provide education to clients and staff about client rights and responsibilities* Evaluate client/staff understanding of client rights Advocate for client rights and needs* ☐Collaboration with Interdisciplinary Team Identify the need for interdisciplinary conferences Identify significant information to report to other disciplines (e.g., health care provider, pharmacist, social worker, respiratory therapist) Review plan of care to ensure continuity across disciplines Collaborate with interprofessional team members when providing client care* Serve as resource person to other staff ☐Concepts of Management Identify roles/responsibilities of health care team members Plan overall strategies to address client problems Act as liaison between client and others (e.g., coordinate or manage care) Manage conflict among clients and health care staff* valuate management outcomes ☐Confidentiality/Information Security Assess staff member and client understanding of confidentiality requirements Maintain client confidentiality and privacy* Intervene appropriately when confidentiality has been breached by staff members ☐Continuity of Care Provide and receive hand off of care (report) on assigned clients* Use documents to record and communicate client information (e.g., medical record, referral/ transfer form) Use approved abbreviations and standard terminology when documenting care* Perform procedures necessary to safely admit, transfer and/or discharge a client* Follow up on unresolved issues regarding client care (e.g., laboratory results, client requests) ☐Establishing Priorities Apply knowledge of pathophysiology when establishing priorities for interventions with multiple clients Prioritize the delivery of client care* Evaluate plan of care for multiple clients and revise plan of care as needed ☐Ethical Practice Recognize ethical dilemmas and take appropriate action* Inform client/staff members of ethical issues affecting client care Practice in a manner consistent with a code of ethics for nurses* Evaluate outcomes of interventions to promote ethical practice ☐Informed Consent Identify appropriate person to provide informed consent for client Provide written materials in client’s spoken language, when possible Describe components of informed consent Participate in obtaining informed consent Verify the client receives appropriate education and consents for care and procedures* ☐Information Technology Receive and transcribe health care provider orders* Apply knowledge of facility regulations when accessing client records Access data for client through online databases and journals Enter computer documentation accurately, completely and in a timely manner Utilize resources to enhance client care (e.g., evidenced-based research, information technology, policies and procedures)* ☐Legal Rights and Responsibilities Identify legal issues affecting the client (e.g., refusing treatment) Identify and manage the client’s valuables according to facility/agency policy Recognize limitations of self and others and utilize resources* Review facility policy and legal considerations prior to agreeing to serve as an interpreter for staff or primary health care provider Educate client/staff on legal issues Report client conditions as required by law (e.g., abuse/neglect, communicable disease)* provide care within the legal scope of practice* ☐Performance Improvement (Quality Improvement) Define performance improvement/quality assurance activities Participate in performance improvement projects and quality improvement processes* Report identified client care issues/problems to appropriate personnel Utilize research and other references for performance improvement actions Evaluate the impact of performance improvement measures on client care and resource utilization ☐Referrals Assess the need to refer clients for assistance with actual or potential problems (e.g., physical therapy, speech therapy) Assess the need for referrals and obtain necessary orders* Identify community resources for the client (e.g., respite care, social services, shelters) Identify which documents to include when referring a client (e.g., medical record, referral form) Part I, Subcategory #2 2. Safety and Infection Control ☐ Safety and Infection Control – the nurse protects clients and health care personnel from health and environmental hazards Major Content Concepts. Did you act on this (actions are required)? ☐Assess client for allergies and intervene as needed (e.g., food, latex, environmental allergies) ☐ Protect client from injury (e.g., falls, electrical hazards) ☐ Ensure proper identification of client when providing care ☐ Verify appropriateness and accuracy of a treatment order ☐ Participate in emergency response plans (e.g., internal/external disaster, bomb threat, community planning) ☐ Use ergonomic principles when providing care (e.g., safe patient handling, proper lifting) ☐ Follow procedures for handling biohazardous and hazardous materials ☐ Educate client on safety issues ☐ Acknowledge and document practice errors and near misses (e.g., incident report for medication error) ☐ Report unsafe practice of health care personnel and intervene as appropriate (e.g., substance abuse, improper care, staffing practices) ☐ Facilitate appropriate and safe use of equipment ☐ Follow security plan and procedures (e.g., newborn nursery security, violence, controlled access) ☐ Apply principles of infection control (e.g., hand hygiene, aseptic technique, isolation, sterile technique, universal/standard precautions) ☐ Educate client and staff regarding infection control measures ☐ Follow requirements for use of restraints Related action concepts include, but are not limited to the following. Did you do this as needed? ☐Accident/Error/Injury Prevention Assess client for allergies and intervene as needed (e.g., food, latex, environmental allergies)* Determine client/staff member knowledge of safety procedures Identify factors that influence accident/injury prevention (e.g., age, developmental stage, lifestyle, mental status) Identify deficits that may impede client safety (e.g., visual, hearing, sensory/perceptual) Identify and verify prescriptions for treatments that may contribute to an accident or injury (does not include medication) Identify and facilitate correct use of infant and child car seats Provide client with appropriate method to signal staff members Protect client from injury (e.g., falls, electrical hazards)* Review necessary modifications with client to reduce stress on specific muscle or skeletal groups (e.g., frequent changing of position, routine stretching of the shoulders, neck, arms, hands, fingers) Implement seizure precautions for at-risk clients Make appropriate room assignments for cognitively impaired clients Ensure proper identification of client when providing care* Verify appropriateness and accuracy of a treatment order* ☐Emergency Response Plan Determine which client(s) to recommend for discharge in a disaster situation Identify nursing roles in disaster planning Use clinical decision-making/critical thinking for emergency response plan Participate in emergency response plans (e.g., internal/external disaster, bomb threat, community planning)* Participate in disaster planning activities/drills ☐Ergonomic Principles Assess client ability to balance, transfer and use assistive devices prior to planning care (e.g., crutches, walker) Provide instruction and information to client about body positions that eliminate potential for repetitive stress injuries Use ergonomic principles when providing care (e.g., safe client handling, proper lifting)* ☐Handling Hazardous and Infectious Materials Identify biohazardous, flammable and infectious materials Follow procedures for handling biohazardous and hazardous materials* Demonstrate safe handling techniques to staff and client Ensure safe implementation of internal radiation therapy ☐Home Safety Assess need for client home modifications (e.g., lighting, handrails, kitchen safety) Apply knowledge of client pathophysiology to home safety interventions Educate client on safety issues* Encourage client to use protective equipment when using devices that can cause injury Evaluate client care environment for fire/environmental hazard ☐Reporting of Incident/Event/Irregular Occurrence/Variance Identify need/situation where reporting of incident/event/irregular occurrence/variance is appropriate Acknowledge and document practice errors and near misses (e.g., incident report for medication error)* Evaluate response to error/event/occurrence Report unsafe practice of health care personnel and intervene as appropriate (e.g., substance abuse, improper care, staffing practices)* ☐Safe Use of Equipment Inspect equipment for safety hazards (e.g., frayed electrical cords, loose/missing parts) Teach client about the safe use of equipment needed for health care Facilitate appropriate and safe use of equipment* Remove malfunctioning equipment from client care area and report the problem to appropriate personnel ☐Security Plan Use clinical decision making/critical thinking in situations related to security planning Apply principles of triage and evacuation procedures/protocols Follow security plan and procedures (e.g., newborn nursery security, violence, controlled access)* ☐Standard Precautions/Transmission-Based Precautions/Surgical Asepsis Assess client care area for sources of infection Understand communicable diseases and the modes of organism transmission (e.g., airborne, droplet, contact) Apply principles of infection control (e.g., hand hygiene, aseptic technique, isolation, sterile technique, universal/standard precautions)* Follow correct policy and procedures when reporting a client with a communicable disease Educate client and staff regarding infection control measures* Utilize appropriate precautions for immunocompromised clients Use appropriate technique to set up a sterile field/maintain asepsis Evaluate infection control precautions implemented by staff members Evaluate whether aseptic technique is performed correctly ☐Use of Restraints/Safety Devices Assess appropriateness of the type of restraint/safety device uses Follow requirements for use of restraints* Monitor/evaluate client response to restraints/safety device Part II. Health Promotion and Maintenance ☒Health Promotion and Maintenance – the nurse provides and directs nursing care of the client that incorporates knowledge of expected growth and development; prevention and early detection of health problems, and strategies to achieve optimal health. Major Content Concepts. Did you act on this (actions are required)? ☐ Provide care and education for the newborn, infant, and toddler client from birth through 2 years ☐ Provide care and education for the preschool, school age and adolescent client ages 3 through 17 years ☐ Provide care and education for the adult client ages 18 through 64 years ☐ Provide care and education for the adult client ages 65 years and over ☐ Provide prenatal care and education ☐ Provide care and education to an antepartum client or a client in labor ☐ Provide postpartum care and education ☐ Assess and educate clients about health risks based on family, population, and community characteristics ☐ Assess client’s readiness to learn, learning preferences and barriers to learning ☐ Plan and/or participate in community health education ☐ Educate client about health promotion and maintenance recommendations (e.g., physician visits, immunizations) ☐ Perform targeted screening assessments (e.g., vision, nutrition) ☐ Educate client about prevention and treatment of high risk health behaviors (e.g., smoking cessation, safe sexual practices, needle exchange) ☐ Assess client ability to manage care in home environment and plan care accordingly ☐ Perform comprehensive health assessments Related action concepts include, but are not limited to the following. Did you do this as needed? ☐Aging Process Assess client’s reactions to expected age-related changes Provide care and education for the newborn, infant and toddler client from birth through 2 years* Provide care and education for the preschool, school age and adolescent client ages 3 through 17 years* Provide care and education for the adult client ages 18 through 64 years* Provide care and education for the adult client ages 65 years and over* ☐Ante/Intra/Postpartum and Newborn Care Assess client’s psychosocial response to pregnancy (e.g., support systems, perception of pregnancy, coping mechanisms) Assess client for symptoms of postpartum complications (e.g., hemorrhage, infection) Recognize cultural differences in childbearing practices Calculate expected delivery date Check fetal heart rate during routine prenatal exams Assist client with performing/learning newborn care (e.g., feeding) Provide prenatal care and education* Provide care and education to an antepartum client or a client in labor* Provide postpartum care and education* Provide discharge instructions (e.g., postpartum and newborn care) Evaluate client’s ability to care for the newborn ☐Developmental Stages and Transitions Identify expected physical, cognitive and psychosocial stages of development Identify expected body image changes associated with client developmental age (e.g., aging, pregnancy) Identify family structures and roles of family members (e.g., nuclear, blended, adoptive) Compare client development to expected age/developmental stage and report any deviations Assess impact of change on family system (e.g., one-parent family, divorce, ill family member) Recognize cultural and religious influences that may impact family functioning Assist client to cope with life transitions (e.g., attachment to newborn, parenting, puberty, retirement) Modify approaches to care in accordance with client developmental stage (use age appropriate explanations of procedures and treatments) Provide education to client/staff members about expected age-related changes and age-specific growth and development (e.g., developmental stages) Evaluate client’s achievement of expected developmental level (e.g., developmental milestones) Evaluate impact of expected body image changes on client and family ☐Health Promotion/Disease Prevention Identify risk factors for disease/illness (e.g., age, gender, ethnicity, lifestyle) Assess and educate clients about health risks based on family, population, and/or community characteristics* Assess client’s readiness to learn, learning preferences and barriers to learning* Plan and/or participate in community health education* Educate client on actions to promote/maintain health and prevent disease (e.g., smoking cessation, diet, weight loss) Inform client of appropriate immunization schedules Integrate complementary therapies into health promotion activities for the well client Educate client about health promotion and maintenance recommendations (e.g., physician visits, immunizations)* Provide follow up to the client following participation in health promotion program (e.g., diet counseling) Assist client in maintaining an optimum level of health Evaluate client understanding of health promotion behaviors/activities (e.g., weight control, exercise actions) ☐Health Screening Apply knowledge of pathophysiology to health screening Identify risk factors linked to ethnicity (e.g., hypertension, diabetes) Perform health history/health and risk assessments (e.g., lifestyle, family and genetic history) Perform targeted screening assessments (e.g., vision, nutrition)* Utilize appropriate procedure and interviewing techniques when taking the client health history ☐High Risk Behaviors Assess client lifestyle practice risks that may impact health (e.g., excessive sun exposure, lack of regular exercise) Assist client to identify behaviors/risks that may impact health Educate client about prevention and treatment of high risk health behaviors (e.g., smoking cessation, safe sexual practices, needle exchange)* ☐Lifestyle Choices Assess client’s lifestyle choices Assess client’s attitudes/perceptions on sexuality Assess client’s need/desire for contraception Identify contraindications to chosen contraceptive method (e.g., smoking, compliance, medical conditions) Identify expected outcomes for family planning methods Recognize client who is socially or environmentally isolated Educate client on sexuality issues (e.g., family planning, safe sexual practices, menopause, impotence) Evaluate client alternative or homeopathic health care practices (e.g., massage therapy, acupuncture, herbal medicine and minerals) ☐Self-Care Assess client ability to manage care in home environment and plan care accordingly* Consider client self-care needs before developing or revising care plan Assist primary caregivers working with the client to meet self-care goals ☐Techniques of Physical Assessment Apply knowledge of nursing procedures and psychomotor skills to techniques of physical assessment Choose physical assessment equipment and technique appropriate for the client (e.g., age of client, measurement of vital signs) Perform comprehensive health assessments* Part III. Psychosocial Integrity ☐ Psychosocial Integrity – the nurse provides and directs nursing care that promotes and supports the emotional, mental and social well-being of the client experiencing stressful events, as well as clients with acute or chronic mental illness. Major Content Concepts. Did you act on this (actions are required)? ☐Assess client for abuse or neglect and intervene as appropriate ☐ Incorporate behavioral management techniques when caring for a client ☐ Assess client’s ability to cope with life changes and provide support ☐ Assess the potential for violence and use safety precautions ☐ Incorporate client cultural practices and beliefs when planning and providing care ☐ Provide end-of-life care and education to clients ☐ Assess family dynamics to determine plan of care ☐ Provide care for a client experiencing grief or loss ☐ Provide care and education for acute and chronic psychosocial health issues (e.g., addictions/dependencies, depression, dementia, eating disorders) ☐ Assess psychosocial, spiritual, and/or occupational factors affecting care and plan interventions ☐ Provide care for a client experiencing visual, auditory, and/or cognitive distortions ☐ Recognize nonverbal cues to physical and/or psychological stressors ☐ Assess client for substance abuse, dependency, withdrawal, or toxicities and intervene as appropriate ☐ Use therapeutic communication techniques ☐ Promote a therapeutic environment Related action concepts include, but are not limited to the following. Did you do this as needed? ☐Abuse/Neglect Assess client for abuse or neglect and intervene as appropriate* Identify risk factors for domestic, child, elder abuse/neglect and sexual abuse Plan interventions for victims/suspected victims of abuse Counsel victims/suspected victims of abuse and their families on coping strategies Provide a safe environment for the abused/neglected client Evaluate client response to interventions ☐Behavioral Interventions Assess client’s appearance, mood and psychomotor behavior and identify/respond to Inappropriate/abnormal behavior Assist client with achieving and maintaining self-control of behavior (e.g., behavior modification) Assist client to develop and use strategies to decrease anxiety Orient the client to reality Participate in group sessions (e.g., support groups) Incorporate behavioral management techniques when caring for a client* Evaluate client’s response to treatment plan ☐Coping Mechanisms Assess client’s support systems and available resources Assess client’s ability to adapt to temporary/permanent role changes Assess client’s reaction to a diagnosis of acute or chronic mental illness (e.g., rationalization, hopefulness, anger) Assess client’s ability to cope with life changes and provide support* Identify situations which may necessitate role changes for a client (e.g., spouse with chronic illness, death of parent) Provide support to the client with unexpected altered body image (e.g., alopecia, amputation, burns) Evaluate the constructive use of defense mechanisms by a client Evaluate whether the client has successfully adapted to situational role changes (e.g., accept dependency on others) ☐Crisis Intervention Assess the potential for violence and use safety precautions* Identify the client in crisis Use crisis intervention techniques to assist the client in coping Apply knowledge of client psychopathology to crisis intervention Guide the client to resources for recovery from crisis (e.g., social supports) ☐Cultural Awareness/Cultural Influences on Health Assess the importance of client culture/ethnicity when planning/providing/evaluating care Recognize cultural issues that may impact the client’s understanding/acceptance of psychiatric diagnosis Incorporate client cultural practices and beliefs when planning and providing care* Respect cultural background/practices of the client Evaluate and document how client language needs were met ☐End-of-Life Care Assess client’s ability to cope with end-of-life interventions Identify end-of-life needs of the client (e.g., financial concerns, fear, loss of control, role changes) Recognize the need for and provide psychosocial support to the family/caregiver Assist client in resolution of end-of-life issues Provide end-of-life care and education to clients* ☐Family Dynamics Assess barriers/stressors that impact family functioning (e.g., meeting client care needs, divorce) Assess family dynamics to determine plan of care* Assess parental techniques related to discipline Encourage the client’s participation in group/family therapy Assist client to integrate new members into family structure (e.g., new infant, blended family) Evaluate resources available to assist family functioning ☐Grief and Loss Provide care for a client experiencing grief or loss* Support the client in anticipatory grieving Inform the client of expected reactions to grief and loss (e.g., denial, fear) Provide the client with resources to adjust to loss/bereavement (e.g., individual counseling, support groups) Evaluate the client’s coping and fears related to grief and loss ☐Mental Health Concepts Identify signs and symptoms of impaired cognition (e.g., memory loss, poor hygiene) Recognize signs and symptoms of acute and chronic mental illness (e.g., schizophrenia, depression, bipolar disorder) Recognize client use of defense mechanisms Assess client adherence to treatment plan Assess client for alterations in mood, judgment, cognition and reasoning Apply knowledge of client psychopathology to mental health concepts applied in individual/ group/family therapy Provide care and education for acute and chronic psychosocial health issues (e.g., addictions/ dependencies, depression, dementia, eating disorders)* Evaluate client’s ability to adhere to treatment plan Evaluate client’s abnormal response to the aging process (e.g., depression) ☐Religious and Spiritual Influences on Health Identify the emotional problems of client or client needs that are related to religious/spiritual beliefs (e.g., spiritual distress, conflict between recommended treatment and beliefs) Assess psychosocial, spiritual, and/or occupational factors affecting care and plan interventions* Assess and plan interventions that meet the client’s emotional and spiritual needs Evaluate whether the client’s religious/spiritual needs are met ☐Sensory/Perceptual Alterations Identify time, place, and stimuli surrounding the appearance of symptoms Assist client to develop strategies for dealing with sensory and thought disturbances Provide care for a client experiencing visual, auditory and/or cognitive distortions* Provide care in a nonthreatening and nonjudgmental manner Provide reality-based diversions ☐Stress Management Recognize nonverbal cues to physical and/or psychological stressors* Assess stressors, including environmental, that affect client care (e.g., noise, fear, uncertainty, change, lack of knowledge) Implement measures to reduce environmental stressors (e.g., noise, temperature) Provide information to client on stress management techniques (e.g., relaxation techniques, exercise, meditation) Evaluate client’s use of stress management techniques ☐Substance Use and Other Disorders and Dependencies Assess client’s reactions to the diagnosis/treatment of substance-related disorder Assess client for substance abuse, dependency, withdrawal, or toxicities and intervene as appropriate* Plan and provide care to clients experiencing substance-related withdrawal or toxicity (e.g., nicotine, opioid, sedative) Educate client on substance use diagnosis and treatment plan Provide care and/or support for a client with non-substance-related dependencies (e.g., gambling, sexual addiction) Provide symptom management for clients experiencing withdrawal or toxicity Encourage client to participate in support groups Evaluate client’s response to a treatment plan and revise as needed ☐Support Systems Assist family to plan care for client with impaired cognition (e.g., Alzheimer’s disease) Encourage client’s involvement in the health care decision-making process Evaluate client’s feelings about the diagnosis/treatment plan ☐Therapeutic Communication Assess verbal and nonverbal client communication needs Respect the client’s personal values and beliefs Allow time to communicate with the client Use therapeutic communication techniques* Encourage client to verbalize feelings (e.g., fear, discomfort) Evaluate the effectiveness of communications with the client ☐Therapeutic Environment Identify external factors that may interfere with client recovery (e.g., stressors, family dynamics) Make client room assignments that support the therapeutic milieu Promote a therapeutic environment* Part IV. ☐Physiological Integrity The nurse promotes physical health and wellness by providing care and comfort, reducing client risk potential and managing health alterations Part IV, Subcategory #1 1. Basic Care and Comfort ☐Basic Care and Comfort – the nurse provides comfort and assistance in the performance of activities of daily living. Major Content Concepts. Did you act on this (actions are required)? ☐Assist client to compensate for a physical or sensory impairment (e.g., assistive devices, positioning, compensatory techniques) ☐ Assess and manage client with an alteration in elimination ☐ Perform irrigations (e.g., of bladder, ear, eye) ☐ Perform skin assessment and/or implement measures to maintain skin integrity and prevent skin breakdown ☐ Apply, maintain or remove orthopedic devices ☐ Implement measures to promote circulation (e.g., active or passive range of motion, positioning and mobilization) ☐ Assess client for pain and intervene as appropriate ☐ Recognize complementary therapies and identify potential contraindications (e.g., aromatherapy, acupressure, supplements) ☐ Provide non-pharmacological comfort measures ☐ Monitor the client’s nutritional status ☐ Provide client nutrition through tube feedings ☐ Evaluate client intake and output and intervene as needed ☐ Assess and/or intervene in client performance of activities of daily living ☐ Perform postmortem care ☐ Assess client sleep/rest pattern and intervene as needed Related action concepts include, but are not limited to the following. Did you do this as needed? ☐Assistive Devices Assess the client for actual/potential difficulty with communication and speech/vision/hearing problems Assess the client’s use of assistive devices (e.g., prosthetic limbs, hearing aid) Assist client to compensate for a physical or sensory impairment (e.g., assistive devices, positioning, compensatory techniques)* Manage the client who uses assistive devices or prostheses (e.g., eating utensils, telecommunication devices, dentures) Evaluate the correct use of assistive devices by the client ☐Elimination Assess and manage client with an alteration in elimination* Perform irrigations (e.g., of bladder, ear, eye)* Provide skin care to clients who are incontinent (e.g., wash frequently, barrier creams/ointments) Use alternative methods to promote voiding Evaluate whether the client’s ability to eliminate is restored/maintained ☐Mobility/Immobility Identify complications of immobility (e.g., skin breakdown, contractures) Assess the client for mobility, gait, strength and motor skills Perform skin assessment and/or implement measures to maintain skin integrity and prevent skin breakdown* Apply knowledge of nursing procedures and psychomotor skills when providing care to clients with immobility Apply, maintain or remove orthopedic devices* Educate the client regarding proper methods used when repositioning an immobilized client Maintain the client’s correct body alignment Maintain/correct the adjustment of client’s traction device (e.g., external fixation device, halo traction, skeletal traction) Implement measures to promote circulation (e.g., active or passive range of motion, positioning and mobilization)* Evaluate the client’s response to interventions to prevent complications from immobility ☐Non-Pharmacological Comfort Interventions Assess the client’s need for alternative and/or complementary therapy Assess the client’s need for palliative care/symptom management or non-curative treatments Assess client for pain and intervene as appropriate* Recognize differences in client perception and response to pain Apply knowledge of pathophysiology to non-pharmacological comfort/palliative care interventions Incorporate alternative/complementary therapies into client plan of care (e.g., music therapy, relaxation therapy) Recognize complementary therapies and identify potential contraindications (e.g., aromatherapy, acupressure, supplements)* Counsel client regarding palliative/symptom management, non-curative treatments or care Respect client palliative care/symptom management or non-curative treatment choices Assist client in receiving appropriate end-of-life physical symptom management Plan measures to provide comfort interventions to clients with anticipated or actual impaired comfort Provide non-pharmacological comfort measures* Evaluate the client’s response to non-pharmacological interventions (e.g., pain rating scale, verbal reports) Evaluate the outcomes of alternative and/or complementary therapy practices Evaluate outcome of palliative care/symptom management or non-curative treatments ☐Nutrition and Oral Hydration Assess client ability to eat (e.g., chew, swallow) Assess client for actual/potential specific food and medication interactions Consider client choices regarding meeting nutritional requirements and/or maintaining dietary restrictions, including mention of specific food items Monitor client hydration status (e.g., edema, signs and symptoms of dehydration) Initiate calorie counts for clients Apply knowledge of mathematics to client nutrition (e.g., body mass index) Monitor the client’s nutritional status* Promote the client’s independence in eating Provide/maintain special diets based on the client diagnosis/nutritional needs and cultural considerations (e.g., low sodium, high protein, calorie restrictions) Provide nutritional supplements as needed (e.g., high protein drinks) Provide client nutrition through tube feedings* Evaluate side effects of client tube feedings and intervene as needed (e.g., diarrhea, dehydration) Evaluate client intake and output and intervene as needed* Evaluate the impact of disease/illness on nutritional status of a client ☐Personal Hygiene Assess the client for personal hygiene habits/routine Assess and/or intervene in client performance of activities of daily living* Provide information to the client on required adaptations for performing activities of daily living (e.g., shower chair, hand rails) Perform postmortem care* ☐Rest and Sleep Assess client sleep/rest pattern and intervene as needed* Apply knowledge of client pathophysiology to rest and sleep interventions Schedule client care activities to promote adequate rest Part IV, Subcategory #2 2. Pharmacological and Parenteral Therapies ☐Pharmacological and Parenteral Therapies – the nurse provides care related to the administration of medications and parenteral therapies. Major Content Concepts. Did you act on this (actions are required)? ☐Administer blood products and evaluate client response ☐ Access central venous access devices ☐ Perform calculations needed for medication administration ☐ Evaluate client response to medication ☐ Educate client about medications ☐ Prepare and administer medications using rights of medication administration ☐ Review pertinent data prior to medication administration (e.g., contraindications, lab results, allergies, potential interactions) ☐ Participate in medication reconciliation process ☐ Titrate dosage of medication based on assessment and ordered parameters ☐ Handle and maintain medication in a safe and controlled environment ☐ Evaluate appropriateness and accuracy of medication order for client ☐ Handle and/or administer high-risk medications ☐ Monitor intravenous infusion and maintain site ☐ Administer medications for pain management ☐ Handle and/or administer controlled substances within regulatory guidelines ☐ Administer parenteral nutrition and evaluate client response Related action concepts include, but are not limited to the following. Did you do this as needed? ☐Adverse Effects/Contraindications/Side Effects/Interactions Identify a contraindication to the administration of a medication to the client Identify actual and potential incompatibilities of prescribed client medications Identify symptoms/evidence of an allergic reaction to medications Assess the client for actual or potential side effects and adverse effects of medications (e.g., prescribed, over-the-counter, herbal supplements, preexisting condition) Provide information to the client on common side effects/adverse effects/potential interactions of medications and inform the client when to notify the primary health care provider Notify the primary health care provider of side effects, adverse effects and contraindications of medications and parenteral therapy Document side effects and adverse effects of medications and parenteral therapy Monitor for anticipated interactions among the client’s prescribed medications and fluids (e.g., oral, topical, subcutaneous, IM, IV) Evaluate and document the client’s response to actions taken to counteract side effects and adverse effects of medications and parenteral therapy ☐Blood and Blood Products Identify the client according to facility/agency policy prior to administration of red blood cells/ blood products (e.g., prescription for administration, correct type, correct client, cross matching complete, consent obtained) Check the client for appropriate venous access for red blood cell/blood product administration (e.g., correct gauge needle, integrity of access site) Document necessary information on the administration of red blood cells/blood products Administer blood products and evaluate client response* ☐Central Venous Access Devices Educate the client on the reason for and care of a venous access device Access central venous access devices* Provide care for client with a central venous access device ☐Dosage Calculation Perform calculations needed for medication administration* Use clinical decision making/critical thinking when calculating dosages ☐Expected Actions/Outcomes Obtain information on a client’s prescribed medications (e.g., review formulary, consult pharmacist) Use clinical decision making/critical thinking when addressing expected effects/outcomes of medications (e.g., oral, intradermal, subcutaneous, IM, topical) Evaluate the client’s use of medications over time (e.g., prescription, over-the-counter, home remedies) Evaluate client response to medication* ☐Medication Administration Educate client about medications* Educate client on medication self-administration procedures Prepare and administer medications using rights of medication administration* Review pertinent data prior to medication administration (e.g., contraindications, lab results, allergies, potential interactions)* Mix medications from two vials when necessary Administer and document medications given by common routes (e.g., oral, topical) Administer and document medications given by parenteral routes (e.g., intravenous, intramuscular, subcutaneous) Participate in medication reconciliation process* Titrate dosage of medication based on assessment and ordered parameters* Dispose of unused medications according to facility/agency policy Handle and maintain medication in a safe and controlled environment* Evaluate appropriateness and accuracy of medication order for client* Handle and/or administer high-risk medications* ☐Parenteral/Intravenous Therapies Identify appropriate veins that should be accessed for various therapies Educate client on the need for intermittent parenteral fluid therapy Apply knowledge and concepts of mathematics/nursing procedures/psychomotor skills when caring for a client receiving intravenous and parenteral therapy Prepare the client for intravenous catheter insertion Monitor the use of an infusion pump (e.g., IV, patient-controlled analgesia device) Monitor intravenous infusion and maintain site* Evaluate the client’s response to intermittent parenteral fluid therapy ☐Pharmacological Pain Management Assess client need for administration of a PRN pain medication (e.g., oral, topical, subcutaneous, IM, IV) Administer and document pharmacological pain management appropriate for client age and diagnoses (e.g., pregnancy, children, older adults) Administer medications for pain management* Handle and/or administer controlled substances within regulatory guidelines* Evaluate and document the client’s use and response to pain medications ☐Total Parenteral Nutrition (TPN) Identify side effects/adverse events related to TPN and intervene as appropriate (e.g., hyperglycemia, fluid imbalance, infection) Educate client on the need for and use of TPN Apply knowledge of nursing procedures and psychomotor skills when caring for a client receiving ☐TPN Apply knowledge of client pathophysiology and mathematics to TPN interventions Administer parenteral nutrition and evaluate client response* Part IV, Subcategory #3 3. Reduction of Risk Potential ☐Reduction of Risk Potential – the nurse reduces the likelihood that clients will develop complications or health problems related to existing conditions, treatments or procedures Major Content Concepts. Did you act on this (actions are required)? ☐Assess and respond to changes and/or trends in client vital signs ☐ Perform diagnostic testing (e.g., electrocardiogram, oxygen saturation, glucose monitoring) ☐ Monitor the results of diagnostic testing and intervene as needed ☐ Obtain blood specimens (e.g., venipuncture, venous access device, central line) ☐ Obtain specimens other than blood for diagnostic testing (e.g., wound, stool, urine) ☐ Insert, maintain, or remove a nasal/oral gastrointestinal tube ☐ Insert, maintain, or remove a urinary catheter ☐ Insert, maintain, or remove a peripheral intravenous line ☐ Maintain percutaneous feeding tube ☐ Apply and/or maintain devices used to promote venous return (e.g., anti-embolic stockings, sequential compression devices) ☐ Use precautions to prevent injury and/or complications associated with a procedure or diagnosis ☐ Evaluate responses to procedures and treatments ☐ Recognize trends and changes in client condition and intervene as needed ☐ Perform focused assessments ☐ Educate client about treatments and procedures ☐ Provide preoperative or postoperative education ☐ Provide preoperative care ☐ Manage client during a procedure with moderate sedation ☐ Manage client following a procedure with moderate sedation Related action concepts include, but are not limited to the following. Did you do this as needed? ☐Changes/Abnormalities in Vital Signs Assess and respond to changes and/or trends in client vital signs* Apply knowledge needed to perform related nursing procedures and psychomotor skills when assessing vital signs Apply knowledge of client pathophysiology when measuring vital signs Evaluate invasive monitoring data (e.g., pulmonary artery pressure, intracranial pressure) ☐Diagnostic Tests Apply knowledge of related nursing procedures and psychomotor skills when caring for clients undergoing diagnostic testing Compare client diagnostic findings with pre-test results Perform diagnostic testing (e.g., electrocardiogram, oxygen saturation, glucose monitoring)* Perform fetal heart monitoring Monitor results of maternal and fetal diagnostic tests (e.g., non-stress test, amniocentesis, ultrasound) Monitor the results of diagnostic testing and intervene as needed* ☐Laboratory Values Identify laboratory values for ABGs (pH, PO2, PCO2, SaO2, HCO3), BUN, cholesterol (total), creatinine, glucose, glycosylated hemoglobin (HgbA1C), hematocrit, hemoglobin, INR, platelets, potassium, PT, PTT & APTT, sodium, WBC Compare client laboratory values to normal laboratory values Educate client about the purpose and procedure of prescribed laboratory tests Obtain blood specimens (e.g., venipuncture, venous access device, central line)* Obtain specimens other than blood for diagnostic testing (e.g., wound, stool, urine)* Monitor client laboratory values (e.g., glucose testing results for the client with diabetes) Notify primary health care provider about laboratory test results ☐Potential for Alterations in Body Systems Identify client potential for aspiration (e.g., feeding tube, sedation, swallowing difficulties) Identify client potential for skin breakdown (e.g., immobility, nutritional status, incontinence) Identify client with increased risk for insufficient vascular perfusion (e.g., immobilized limb, postsurgery, diabetes) Educate client on methods to prevent complications associated with activity level/diagnosed illness/disease (e.g., contractures, foot care for client with diabetes mellitus) Compare current client data to baseline client data (e.g., symptoms of illness/disease) Monitor client output for changes from baseline (e.g., nasogastric tube, emesis, stool, urine) Potential for Complications of Diagnostic Tests/Treatments/Procedures Assess client for an abnormal response following a diagnostic test/procedure (e.g., dysrhythmia following cardiac catheterization) Apply knowledge of nursing procedures and psychomotor skills when caring for a client with potential for complications Monitor the client for signs of bleeding Position the client to prevent complications following tests/treatments/procedures (e.g., elevate head of bed, immobilize extremity) Insert, maintain, or remove a nasal/oral gastrointestinal tube* Insert, maintain, or remove a urinary catheter* Insert, maintain, or remove a peripheral intravenous line* Maintain tube patency (e.g., nasogastric tube for decompression, chest tubes) Maintain percutaneous feeding tube* Apply and/or maintain devices used to promote venous return (e.g., anti-embolic stockings, sequential compression devices)* Use precautions to prevent injury and/or complications associated with a procedure or diagnosis* Provide care for client undergoing electroconvulsive therapy (e.g., monitor airway, assess for side effects, teach client about procedure) Intervene to manage potential circulatory complications (e.g., hemorrhage, embolus, shock) Intervene to prevent aspiration (e.g., check nasogastric tube placement) Intervene to prevent potential neurological complications (e.g., foot drop, numbness, tingling) Evaluate responses to procedures and treatments* ☐Potential for Complications from Surgical Procedures and Health Alterations Apply knowledge of pathophysiology to monitoring for complications (e.g., recognize signs of thrombocytopenia) Evaluate the client’s response to postoperative interventions to prevent complications (e.g., prevent aspiration, promote venous return, promote mobility) ☐System Specific Assessments Assess the client for abnormal peripheral pulses after a procedure or treatment Assess the client for abnormal neurological status (e.g., level of consciousness, muscle strength, mobility) Assess the client for peripheral edema Assess the client for signs of hypoglycemia or hyperglycemia Identify factors that result in delayed wound healing Recognize trends and changes in client condition and intervene as needed* Perform a risk assessment (e.g., sensory impairment, potential for falls, level of mobility, skin integrity) Perform focused assessments* ☐Therapeutic Procedures Assess client response to recovery from local, regional or general anesthesia Apply knowledge of related nursing procedures and psychomotor skills when caring for clients undergoing therapeutic procedures Educate client about treatments and procedures* Educate client about home management of care Use precautions to prevent further injury when moving a client with a musculoskeletal condition (e.g., log-rolling, abduction pillow) Monitor the client before and after a procedure/surgery (e.g., casted extremity) Monitor effective functioning of therapeutic devices (e.g., chest tube, drainage tubes, wound drainage devices, continuous bladder irrigation) Provide preoperative or postoperative education* Provide preoperative care* Manage client during a procedure with moderate sedation* Manage client following a procedure with moderate sedation* Part IV, Subcategory #4 4. Physiological Adaptation ☐Physiological Adaptation – the nurse manages and provides care for clients with acute, chronic or life threatening physical health conditions. Major Content Concepts. Did you act on this (actions are required)? ☐Assist with invasive procedures (e.g., central line, thoracentesis, bronchoscopy) ☐ Implement and monitor phototherapy ☐ Maintain optimal temperature of client ☐ Monitor and care for clients on a ventilator ☐ Monitor and maintain devices and equipment used for drainage (e.g., surgical wound drains, chest tube suction, negative pressure wound therapy) ☐ Perform and manage care of client receiving peritoneal dialysis ☐ Perform suctioning ☐ Perform wound care and/or dressing change ☐ Provide ostomy care and/or education (e.g., tracheal, enteral) ☐ Provide pulmonary hygiene (e.g., chest physiotherapy, incentive spirometry) ☐ Provide postoperative care ☐ Manage the care of the client with a fluid and electrolyte imbalance ☐ Monitor and maintain arterial lines ☐ Manage the care of a client with a pacing device ☐ Manage the care of a client on telemetry ☐ Manage the care of a client receiving hemodialysis or continuous renal replacement therapy ☐ Manage the care of a client with alteration in hemodynamics, tissue perfusion and/or hemostasis ☐ Educate client regarding an acute or chronic condition ☐ Manage the care of a client with impaired ventilation/oxygenation ☐ Evaluate the effectiveness of the treatment plan for a client with an acute or chronic diagnosis ☐ Perform emergency care procedures ☐ Identify pathophysiology related to an acute or chronic condition ☐ Recognize signs and symptoms of client complications and intervene Related action concepts include, but are not limited to the following. Did you do this as needed? Alterations in Body Systems Assess adaptation of a client to health alteration, illness and/or disease Assess tube drainage during the time the client has an alteration in body systems (e.g., amount, color) Assess client for signs and symptoms of adverse effects of radiation therapy Identify signs of potential prenatal complications Identify signs, symptoms and incubation periods of infectious diseases Apply knowledge of nursing procedures, pathophysiology and psychomotor skills when caring for a client with an alteration in body systems Educate client about managing health problems (e.g., chronic illness) Assist with invasive procedures (e.g., central line, thoracentesis, bronchoscopy)* Implement and monitor phototherapy* Implement interventions to address side/adverse effects of radiation therapy (e.g., dietary modifications, avoid sunlight) Maintain optimal temperature of client* Monitor and care for clients on a ventilator* Monitor wounds for signs and symptoms of infection Monitor and maintain devices and equipment used for drainage (e.g., surgical wound drains, chest tube suction, negative pressure wound therapy)* Perform and manage care of client receiving peritoneal dialysis* Perform suctioning* Perform wound care and/or dressing change* Promote client progress toward recovery from an alteration in body systems Provide ostomy care and/or education (e.g., tracheal, enteral)* Provide care to client who has experienced a seizure Provide care to a client with an infectious disease Provide pulmonary hygiene (e.g., chest physiotherapy, incentive spirometry)* Provide care for client experiencing complications of pregnancy/labor and/or delivery (e.g., eclampsia, precipitous labor, hemorrhage) Provide care for client experiencing increased intracranial pressure Provide postoperative care* Remove sutures or staples Evaluate client response to surgery Evaluate achievement of client treatment goals Evaluate client response to treatment for an infectious disease (e.g., acquired immune deficiency syndrome [AIDS], tuberculosis [TB]) Evaluate and monitor client response to radiation therapy Fluid and Electrolyte Imbalances Identify signs and symptoms of client fluid and/or electrolyte imbalance Apply knowledge of pathophysiology when caring for the client with fluid and electrolyte imbalances Manage the care of the client with a fluid and electrolyte imbalance* Evaluate the client’s response to interventions to correct fluid or electrolyte imbalance Hemodynamics Assess client for decreased cardiac output (e.g., diminished peripheral pulses, hypotension) Identify cardiac rhythm strip abnormalities (e.g., sinus bradycardia, premature ventricular contractions, ventricular tachycardia, atrial fibrillation, ventricular fibrillation) Apply knowledge of pathophysiology to interventions in response to client abnormal hemodynamics Provide client with strategies to manage decreased cardiac output (e.g., frequent rest periods, limit activities) Intervene to improve client cardiovascular status (e.g., initiate protocol to manage cardiac arrhythmias, monitor pacemaker functions) Monitor and maintain arterial lines* Manage the care of a client with a pacing device* Manage the care of a client on telemetry* Manage the care of a client receiving hemodialysis or continuous renal replacement therapy* Manage the care of a client with alteration in hemodynamics, tissue perfusion and/or hemostasis* Illness Management Identify client data that needs to be reported immediately Apply knowledge of client pathophysiology to illness management Educate client regarding an acute or chronic condition* Educate client about managing illness Implement interventions to manage the client’s recovery from an illness Perform gastric lavage Promote and provide continuity of care in illness management activities Manage the care of a client with impaired ventilation/oxygenation* Evaluate the effectiveness of the treatment plan for a client with an acute or chronic diagnosis* Medical Emergencies Apply knowledge of pathophysiology when caring for a client experiencing a medical emergency Apply knowledge of nursing procedures and psychomotor skills when caring for a client experiencing a medical emergency Explain emergency interventions to a client Notify primary health care provider about unexpected client response/emergency situation Perform emergency care procedures* Provide emergency care for wound disruption (e.g., dehiscence) Evaluate and document the client’s response to emergency interventions (e.g., restoration of breathing, pulse) Pathophysiology Identify pathophysiology related to an acute or chronic condition* Understand general principles of pathophysiology (e.g., injury and repair, immunity, cellular structure) Unexpected Response to Therapies Assess the client for unexpected adverse response to therapy (e.g., increased intracranial pressure, hemorrhage) Recognize signs and symptoms of client complications and intervene* Promote recovery of the client from unexpected response to therapy (e.g., urinary tract infection)