VATI RN COMPREHENSIVE PREDICTOR FOCUSED REVIEW

 Management of Care – (9)

 Advance Directives – (1)

 Legal Responsibilities: Purpose of a Living Will (RM FUND 9.0 Chp 4)

 A living will is a legal document that expresses the client’s wishes regarding

medical treatment in the event the client becomes incapacitated and is facing endof-life issues. Most state laws include provisions that protect health care providers

who follow a living will from liability.

 Assignment, Delegation and Supervision – (2)

 Delegation and Supervision: Delegating Tasks to an Assistive Personnel (RM FUND

9.0 Chp 6)

 Examples of tasks nurses may delegate to Aps (provided the facility’s policy and

state’s practice guidelines permit)

 Activities of daily living (ADLs) – bathing, grooming, dressing, toileting,

ambulating, feeding (without swallowing precautions), positioning

 Routine tasks – bed making, specimen collection, intake and output, vital

signs (for stable clients)

 Managing Client Care: Delegation Strategy for Effective Task Management (RM

Leadership 7.0 Chp 1)

 Consideration for selection of an appropriate delegate include the following:

education, training, and experience; knowledge and skill to perform the task; level

of critical thinking required to complete the task; ability to communicate with

others as it pertains to the task; demonstrated competence; the delegatee’s culture;

agency policies and procedures and licensing legislation (state nurse practice acts)

 Case Management – (1)

 Cardiovascular Disorders: Tetralogy of Fallot (RM NCC RN 10.0 Chp 20)

 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 the 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. Syphilis. Tetanus/C.

tetani. Toxic shock syndrome (TSS) (other than Streptococcal). Tuberculosis

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(TB). Typhoid fever. Vancomycin-intermediate and vancomycin-resistant.

Staphylococcus aureus (VISA/VRSA)

 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 to 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; relate recent changes in medications, treatments,

procedures, and the discharge plan

 Establishing Priorities – (1)

 Managing Client Care: Determining Priority Care for a Group of Clients (RM

Leadership 7.0 Chp 1)

 Prioritize systemic before local (“life before limb”)

 Prioritizing interventions for a client in shock over interventions for a client

who has a localized limb injury

 Prioritize acute (less opportunity for physical adaptation) before chronic (greater

opportunity for physical adaptation)

 Prioritizing the care of a client who has a new injury/illness (e.g. mental

confusion, chest pain) or an acute exacerbation of a previous illness over the

care of a client who has a long-term chronic illness

 Prioritize actual problems before potential future problems

 Prioritizing administration of medication to a client experiencing of

medication to a client experiencing acute pain over ambulation of a client at

risk for thrombophlebitis

 Listen carefully to clients and don’t assume

 Asking a client who has a new diagnosis of diabetes mellitus what he feels is

most important to learn about disease management

 Recognize and respond to trends vs. transient findings

 Recognizing a gradual deterioration in a client’s level of consciousness and/or

Glasgow Coma Scale score

 Recognize indications of medical emergencies and complications vs. expected

findings

 Recognizing indications of increasing intracranial pressure in a client who has

a new diagnosis of a stroke vs. the findings expected following a stroke

 Apply clinical knowledge to procedural standards to determine the priority action

 Recognizing that the timing of administration of antidiabetic and

antimicrobial medications is more important than administration of some

other medications

 Ethical Practice – (1)

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 Professional Responsibilities: Demonstration of Veracity (RM Leadership 7.0 Chp 3)

 Veracity: the nurse’s duty to tell the truth

 Legal Rights and Responsibilities – (1)

 Professional Responsibilities: Rights of Clients (RM Leadership 7.0 Chp 3)

 Client rights are the legal guarantees that clients have with regard to their health

care

 Clients using the services of a health care institution retain their rights as

individuals and citizens of the United States. The America Hospital

Association (AHA) identifies client rights in health care settings in the Patient

Care Partnership (www.aha.org)

 Residents in nursing facilities that participate in Medicare programs similarly

retain resident rights under statutes that govern the operation of these facilities

 Nurse are accountable for protecting the rights of clients. Situations that require

particular attention include informed consent, refusal of treatment, advance

directives, confidentiality, and information security.

 Safety and Infection Control – (5)

 Accident/Error/Injury Prevention – (2)

 Medications Affecting Urinary Output: Indications for the Use of a Diuretic (RM

Pharm RN 7.0 Chp 19)

 High-ceiling loop diuretics work in the ascending limb of loop of Henle – block

reabsorption of sodium and chloride and prevent reabsorption of water. Causes

extensive diuresis even with severe renal impairment

 They are used when there is an emergent need for rapid mobilization of fluid –

pulmonary edema caused by heart failure; conditions not responsive to other

diuretics, such as edema caused by liver, cardiac, or kidney disease; or

hypertension

 Unlabeled use – hypercalcemia

 Seizures: Maintaining Seizure Precautions (RM NCC RN 10.0 Chp 13)

 Seizure precautions for any child at risk – pad side rails of bed, crib, and

wheelchair; keep bed free of objects that could cause injury; have suction and

oxygen equipment available

 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

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