ATI RN LEADERSHIP PROCTORED: FOCUS REVIEW

Chapter 1, Managing client care:

 Prioritizing client care

o Systemic before local
o Acute before chronic
o Actual problems before potential ones
o Listen carefully to clients and do not assume
o Recognize and response to trends vs transit findings
o Recognize indications of medical emergencies and complications vs expected
findings
o Apply clinical knowledge to procedural standard to determine the priority
action

 Client care assignments

o Assigning is performed in a downward or lateral manner with regard to
members of the healthcare team
o Client factors are:
 Condition of client and level of care needed
 Specific care needs such as cardiac monitoring or ventilation
mechanical
 Special precaution needs such as isolation or fall precautions or
seizures, procedures requiring time commitments
o Health care team factors:
 Knowledge and skill levels of the team members
 Supervision that is necessary
 Nurse to client ratio
 Experience with similar clients
 Familiarity of staff member with unit
o Additional factors;
 If receiving an unsafe assignment the nurse should bring the unsafe
assignment to the attention of the scheduling charge nurse and
negotiate new assignment, if the issue is not resolve, take the concern
up the chain of command
 Nurse should file a written protest to the assignment such as an
assignment despite objection (ADO) or document of practice situation
(DOPS) with the appropriate administrator
 If not follow proper failure to accept the assignment following proper
channels could be considered client abandonment.

o Delegations to an assistive personnel

 ADLS
  Bathing, dressing, toileting, ambulating, feeding if it has no problems
with swallowing
 Positioning
 Routine task, bed making
 Specimen collection
 Intake and output
 Vital signs for stable clients

 Quality improvement
o Standard of care should reflect optimal goals and based on evidence
 Outcomes indicators-client outcomes related to standard under
review
 Structure indicators- setting in which care is provided and the
available human and material resources
 Process indicators- how client care is provided and are established by
policies and procedures( clinical practice guidelines)
 Benchmarks- are goals that are set to determine at what level the
outcome indicators should be met
 Focuses on assessment of outcomes and determines ways to improve
the delivery of quality care.
 All levels of employees are involved in the quality improvement
method
 Joint Commission accreditations standard require institutions to show
evidence of quality improvement in order to attain accreditation
status

Chapter 2 coordinating client care

 Reporting info. to the provider
o Assessment data integral to changes in client status
o Recommendations for changes in the plan of care
o Clarification of prescriptions
 The nurse role regarding consultation:
o Nurse initiates necessary consults or notify provided of clients needs so the
consul can be initiated. Provide the consultant with all pertinent info. about
the problem and incorporate the consultants recommendations in the clients
plan of care.
 The nurse role regarding Referrals
o Is a formal request for a service by another care provider, made so the client
can access the care identified by the provider or the consultant.
o The nurse role regarding referrals:
 Begin discharge planning upon clients admission
 Evaluate client and family competencies in relation to home care prior
to discharge
 Involve the client and family in care planning
  Collaborate with other health care team to ensure all health care
needs are met and necessary referrals are made
 Complete referral forms to ensure proper reimbursement for
prescribed services
 Priority for discharge planning
o Starts in admission
o Conduct discharge plan with patient and family
o Discharge planning serves as a starting point for continuity of care
o Need for additional services can be address before discharge so services is in
place when client arrives home
o Leaving without prescription (AMA) nurse should notify the provider. Nurse
needs to explain the risk of leaving. Individual should sign a form and nurse
should document all communication as well as advice that was provided for
the client.
o Nurses can be charged with legal charges of assault, battery and false
imprisonment.

Chapter 3 professional responsibilities

 Mandatory reporting of sexually transmitted infections
o Gonorrhea
o Trichinosis
o Syphilis
o AIDS/HIV
o Chlamydia trachomatis

Chapter 4 maintaining safe environments

 Temporary pacemaker- teach client to not touch the dials, keep wires and box dry
and client wont be able to shower
 Permanent pacemaker- battery will last 10 years, keep pacemaker identification
card, minimize shoulder movement initially to allow leads to anchor, asses clients
for hiccups which may indicate the generator placing the diaphragm. Before
discharge teach patient about taking pulse daily at the same time each day and
notify provider if hear rate is less than 5 beats below pacemaker rate, no contact
sports or heavy lifting for 2 months, restrict shoulder move 1-2 weeks to prevent
wire dislodgment, never place magnetic items directly over the pacemaker
generator, and inform airport security of your pacemaker.
 Use of a wheelchair for client transfer
o Lock wheels on beds, wheelchairs and carts to prevent the device form
rolling during transfers or stops
 Isolation guidelines
o Ensure proper equipment is available and that isolation procedures are
properly carried out by all health care team members
 o Airborne precautions require: private room, mask and respiratory
protection, negative pressure airflow exchange in the room of at least 6-12
exchanges per hour
o Type of airborne precautions: measles, varicella, pulmonary TB and laryngeal
TB
o Type of droplet precautions: pneumonia, h. influenza type b, scarlet fever,
rubella, pertussis, mumps, mycoplasma pneumonia, meningococcal
pneumonia, sepsis and pneumatic plague
o In dropet precautions; private room required with others with same disease,
ensure they use their own equipment

 Chapter 5 facility protocols

o Tools to prevent accident with needle sticks; use retractable needles, needles
with capping mechanisms, needleless syringe, IV tubing with needleless
syringes
o How to report a needle stick: by facility protocols and states laws, incident
report should be filed, and nurse need to undergo testing
o Triage:
 Emergent class- highest priority life threat but also have a high
survival rate
 Urgent class- second highest priority, major injuries that are not yet
life threat can wait 45-60minutes
 Not urgent class- minor injuries not life threat and do not need
immediate attention
 Expectant- lowest priority, not expected to live, comfort measures but
restorative care will not be use
o Tuberculosis
 Therapy full duration 6-12 months
 Sputum samples are needed every 2-4 weeks, clients are no longer
considered infectious after 3 consecutive negative sputum cultures
 Put in negative pressure room
 Contaminated tissues should be disposed of in plastic bags
 Wear a mask in public places or in contact with crowds.
 Ethambutol- need to watch for visual changes due to optic neuritis
 Isoniazid- tingling of the hands is an adverse effect
 Chapter 10
o Surgical asepsis
 Open sterile package with first edge of the wrapper is directed away
from the worker to avoid sterile surface touching unsterile cloths, the
outside of the sterile package is considered contaminates
 A wet field is contaminated if the surface immediately below it is not
sterile
 Hold sterile objects above the level of the waist
 Avoid talking, coughing or sneezing or reaching over sterile field
 Never walk away from or turn your back on a sterile field
 Consider the outer 1 inch to be contaminated
 Fluids flow in the direction of gravity