Coordination of Care

State laws

~Nurse practice acts - define "reasonable care" in each state; scope of nursing practice, roles, rules, educational requirements ~Licensure requirement - differ slightly in requirements among states ~*Good Samaritan laws* - limit the liability of professionals in emergency situations ~*Tarasoff Act* - duty to warn of threatened suicide or harm to others

Coordination of Care

~Nurse/Client Relationship ~Client's Bill of Rights ~Restraints ~Advocacy ~Legal Issues ~Organ/Tissue Donation/Transplant ~Delegation and Care Teams ~Critical Thinking ~Documentation ~Incident Reports ~Change of Shift Report ~Cultural Norms ~Ethics

Nursing consideration of restraints

~Observe and document need for restrains (risk for falls, risk of injury to others, potential for removal of IV lines or other equipment) ~Consider and document use of alternative measures ~Health care provider's order is required specifying duration and circumstances under which restraints should be used ~*cannot order restraints to be used PRN* ~Monitor client closely, periodically observe for continued need for restraints, document ~Remove for skin care and range of motion exercises ~ use alternative measures prior to use of restraints (reorientation, family involvement, frequent assistance with toileting)

Restraints

~Omnibus Budget Reconciliation Act provides clients with the right to be free from physical and chemical restraints imposed for the purpose of discipline or convenience and not required to treat medical symptoms ~Informed consent is needed to use restraints ~If client is unable to consent, then consent of proxy must be obtained after full disclosure of risks and benefits ~Restraint of client without informed consent or sufficient justification is false imprisonment

RN responsibilities

~Performs assessments ~Admits new clients ~Discharge clients ~cares for complex clients ~retains care of clients with diagnosis unique to the unit ~performs client and family teaching about new diagnoses, diagnostic tests, medications, skills for self-care, and discharge/home care

Ethics

~Principles of right and wrong, good and bad ~Used to identify solutions to problems arising from conflicts ~Based on personal beliefs and cultural values that guide decision - making and determine conduct ~As cultural diversity increases, need to understand ethical principles increases

Client's Bill of Rights

~Privacy ~Informed consent ~confidentiality ~Refusal of treatment ~Reasonable response to a request for services ~Right to know hospital/clinic regulations

Nurse/Client Relationship

~Professionalism ~Therapeutic nature

Functional method

~RN of previous shift reports to RN of oncoming shift ~Other staff may attend report or be given report according to assignments from RN

Change of Shift Report

~Regularly scheduled, structured exchange of information ~Focus on anticipated needs of individual clients in next 24 hours ~Information must be pertinent, current, and accurate

Face-to-Face

~Reporting nurse answers questions from oncoming staff ~Provides flexibility to report to a number of different oncoming staff ~Provides flexibility in pacing and sequencing of report

Team nursing method

~All members of oncoming shift attend report ~Reduces amount of time and communication needed to make changes in nursing care for client

Nursing assistive personnel (NAP) responsibilities

~Assist with direct client care activities (bathing, transferring, ambulating, feeding, toileting, obtaining vital signs, height, weight, intake and output, housekeeping, transporting, stocking supplies) ~includes nurses aides, assistants, technicians, orderlies, nurse extenders ~Scope of nursing practice is limited

Beliefs

~Basic assumptions or personal convictions that the individual thinks are factual or takes for granted ~Used to determine values ~Handed down from generation to generation

False imprisonment

~Client is denied discharge from a health care facility ~Client is denied discharge after signing an against medical advice (AMA) document ~Client is placed in restraints without appropriate medical need

Medical - legal incident

~Client or family refuses treatment as ordered and refuses to sign consent ~Client or family voices dissatisfaction with care and situation cannot be or has not been resolved

Incident Reports Charting

~Don't include a reference ~Don't use words such as "error" or "inappropriate" ~Don't include inflammatory words or judgmental statements ~If there are adverse reactions to incident, chart follow-up note updating client's status ~Documentation of client's reactions should be included as status changes and should be continued until client returns to original status

Aggressive treatment

~Extraordinary support measures used to maintain individual's physiologic process ~may be withheld to avoid prolonging life without dignity ~supportive care is provided to promote comfort and reduce suffering

Levels of delegation (in ascending order)

~Gather information for delegatee so you can decide what needs to be done ~List alternative courses of action and allow delegatee to choose course of action ~Have delegatee perform part of task and obtain approval before proceeding with the rest of the task ~Have delegatee outline entire course of action for the task and approve it before proceeding ~Allow delegatee to perform entire task using any preferred method, and report only results

Documentation considerations

~If an error is made in charting, use a single line through the error and doc your initials, date, and time - do not erase, white out, or scratch out an error ~Do not chart for anyone else ~Keep your electronic access private ~Do not leave your electronic chart open when you are not in attendance

Change-of-Shift reports should NOT contain

~Information already known by the oncoming shift ~Descriptions of routines (am or pm care) ~Rumors or gossip ~Opinions or value judgements (about client's lifestyle) ~Client information that does not relate to health condition, needs, or treatments

Living Wills

~Legal document signed by competent individual indicates treatment or life-saving measures (e.g., surgery, CPR, antibiotics, dialysis, respirator, tube feedings) to be used if individual's ability to make decisions is lost due to terminal illness or a permanently unconscious state ~indicates who is authorized to make health care decisions if individual becomes incapacitated ~legally binding in most states

Taped

~Less time-consuming because of lack of interruptions ~Nurse is frequently more systematic and thorough ~Gives nurse more sense of control over the process ~Reporting nurse can perform nursing activities while next shift is listening to report ~Reporting nurse returns to clarify information, answer questions, update information that changed since report was recorded

Advanced directives

~Living Wills ~Durable power of attorney for health care

Minors who can provide own consent for treatment

~Married minors ~Over a specific age for STIs, HIV testing, AIDS treatment, drug and alcohol treatment ~Emancipated and mature minors ~Minors seeking birth control services ~Minors seeking outpatient psychiatric services or inpatient voluntary admissions to a psychiatric facility ~pregnant minor

Common situations that require an incident report

~Medication errors (omitted medication, wrong medication, wrong dosage, wrong route) ~Complications from diagnostic or treatment procedures ~Incorrect sponge count in surgery ~Failure to report change in client's condition ~Falls ~Client is burned ~Break in aseptic technique ~Medical - legal incident

Legal Issues

~Negligence ~Malpractice ~Invasion of privacy ~Assault and battery ~False imprisonment ~Laws ~Accountability ~State laws

Accountability

~Nurse is responsible for using reasonable care in practicing nursing ~To remain competent, nurse needs to participate in lifelong learning programs

Responsibility and Accountability

Responsibility - obligation to accomplish a task Accountability - accept ownership for results or lack of results ~In delegation, responsibility is transferred; in accountability, it is shared.

Case management method

Scheduled structured discussions with nursing team and interdisciplinary team in addition to change-of-shift reports

The LPN/LVN cares for a client 24 hours post appendectomy. The client has severe abdominal pain, a temperature of 101°F (38.2°C), and a rigid abdomen. Which action should the LPN/LVN take first? Assist the client with ambulation down the hallway. Assess the client's level of pain. Assess the client's bowel sounds. Assess the wound for odor and drainage.

Strategy: "FIRST" indicates priority. (1) more appropriate if client experiences abdominal pain related to excessive flatus (2) appendectomy, if appendix not ruptured, normally does not result in severe pain; especially not 24 hours postop; pain only along with sympathetic response would be the expected clinical picture (3)* CORRECT*—peritonitis can be caused by ruptured appendix; signs and symptoms of peritonitis include severe abdominal pain, abdominal rigidity, decreased bowel sounds, nausea and vomiting, increased temperature, shock, paralytic ileus; monitor vital signs, administer antibiotics and IVs, NG tube to suction, NPO, surgery to correct cause (4) not likely to have odor and drainage the day after surgery; if signs and symptoms of peritonitis, impaired bowel sounds are likely; paralytic ileus is likely and life-threatening

A neighbor of the LPN/LVN calls because the neighbor's 3-year-old daughter has been vomiting and has had frequent diarrhea for the past 3 days. Which of the following actions should the LPN/LVN take FIRST? Measure the vital signs. Offer her electrolyte-balanced fluid. Take the child to the emergency room. Call the child's pediatrician.

(1) regardless of the vital-sign range, can offer no treatment (2) commonly used as replacement fluid in pediatric clients; should be seen by health care provider (3) CORRECT—due to length of illness, child should be seen by health care provider (4) after this time period, is at risk for serious health alterations; needs care as soon as possible; make not be able to reach pediatrician; needs to be directly assessed physically

The LPN/LVN is asked by the health care provider to assist with a lumbar puncture. It is most important for the LPN/LVN to take which action? (1) Inform the supervising nurse. (2) Inform the assigned nursing assistive personnel. (3) Inform assigned team of clients. (4) Encourage client to take slow, deep breaths.

(1) *CORRECT*—procedure takes 20-30 minutes; client will need assistance lying motionless; LPN/LVN will need to remain with client; assigned clients will need care while LPN/LVN is occupied with procedure; transfers duties to appropriate level (2) chain of command requires LPN/LVN to report to supervisor (3) notifying clients would delegate the responsibility of their care to themselves (4) would help client relax and reduce movement; needs to make sure other clients' needs are met before beginning procedure that will cause LPN/LVN to be inaccessible for 20-30 minutes

The LPN/LVN participates in the discharge planning for a 76-year-old client diagnosed with anemia related to inadequate dietary intake. Because the client lives alone, which of the following suggestions by the LPN/LVN is MOST appropriate? 1. "Invite others over during mealtime." 2. "Meals-on-Wheels can provide meals for you." 3. "Is there someone available to grocery shop for you?" 4. "Why are you not eating?"

(1) eating with another person may help increase the client's intake, but client must assume the responsibility for meals (2) CORRECT—elderly individuals often do not prepare wholesome meals; anemia results in reduced energy and client will be less likely to prepare meals (3) preparation of meals is more of an issue than procurement of groceries (4) do not ask "why" questions

The LPN/LVN cares for clients in the outpatient clinic. A client who appears to be in severe pain states, "I think I have a piece of glass in my eye." Which action should the LPN/LVN take first? 1. Attempt to remove the impaled glass using tweezers. 2. Douse the affected eye with artificial tears. 3. Assess visual losses in the affected eye. 4. Place client in safe and comfortable position.

(1) is outside the competencies as well as the legal role of the LPN/LVN (2) primary principle is to prevent further damage to the eye; any activity that could cause movement of the foreign object should be avoided (3) is at risk for loss of vision or loss of the eye; role of LPN/LVN is to maintain circumstances as they are until the appropriate person can attend to the client (4) CORRECT—the LPN/LVN should make sure client is in a position that prevents movement of the object, then notify the nearest RN or health care provider

When witnessing the client's signing of an informed consent form, it is MOST important for the LPN/LVN to make which of the following assessments? Does the client understand the procedure? Does the client have any questions? Does the client give consent voluntarily? Is the client able to write his name?

(1)it is the physician's responsibility to explain the procedure and the risks and benefits associated with the procedure (2)should not obtain the signature if client has questions LPN/LVN cannot or is not authorized to answer *(3)CORRECT*—LPN/LVN's signature indicates that the client voluntarily gave consent, the client's signature is authentic, and the client indicates an understanding of what is being signed (4)client legally able to place mark on consent form or write out name

The LPN/LVN cares for clients in a physician's office. Four clients are waiting to see the physician. The LPN/LVN should ask the physician to see which of the following clients FIRST? 1. A 50-year-old who is diaphoretic and complaining of nausea. 2. A 60-year-old with a history of asthma complaining of a productive cough. 3. A 65-year-old complaining of a temperature of 101 ° F (38 ° C). 4. A 70-year-old complaining of vaginal bleeding.

(1.) *CORRECT*— Although most clients who experience a heart attack complain of some type of chest discomfort, some clients present with slightly atypical symptoms; client should be treated as a potential MI, and a cardiac evaluation should be performed immediately (2.) has a history of asthma, and therefore, increased risk of respiratory compromise; a productive cough alone (indicative of a probably upper respiratory infection) does not take precedence over the patient with a potential MI; treatment of the URI with antibiotics and a MDI will likely prevent an asthma exacerbation (3.) potential MI takes priority (4.) vaginal bleeding after menopause can indicate cancer of uterus; biopsy or aspiration will be done

After making rounds, the LPN/LVN needs to report status changes on several clients to the supervising nurse. The LPN/LVN should report which of the following changes FIRST? (1) A client who has developed an irregular heart rhythm. (2) A client whose serum high-density lipids is 170 mg/dL. (3) A client who has slight oozing of blood from a cardiac catheterization site. (4) A client who has inflammation at the insertion site of total parenteral nutrition (TPN) catheter.

(1.) *CORRECT*— can be drug-induced or related to cardiac hypoxia or cardiac damage; because any sign of pump failure could be life-threatening, needs to be addressed immediately; because etiology is not known, would need involvement of physician and complex assessment methods along with potentially complex interventions (2.) within normal limits; HDL levels are not as health-impairing as LDL (3.) although could become life-threatening, can be resolved by reapplying dressing without additional input from physician (4.) can develop sepsis, but no immediate life-threatening risks exist

The LPN/LVN cares for clients in the long-term care facility. When delegating care of clients to other staff members, the LPN/LVN should utilize which of the following techniques? Select all that apply: (1) The LPN/LVN maintains eye contact with the staff member. (2) The LPN/LVN asks staff members to report any problems. (3) The LPN/LVN states what, how, and when a task should be performed. (4) The LPN/LVN tells the nursing staff that feedback is not required after completing care. (5) The LPN/LVN tells the staff the reason the task is to be completed. (6) The LPN/LVN tells the staff to establish a timeline to complete the task.

(1.) *CORRECT*— eye contact is important; state exactly what is being delegated and what the expected outcome is, convey recognition of the authority to perform what is expected (2.) delegator should clearly define complications and the appropriate action(s) for the staff to take if complications occur (3.) *CORRECT*— delegator should obtain feedback to ensure the staff understands the assignment; identify priorities, acknowledge monitoring activities required, specify any performance limitations (such as time limits), specify deadlines, specify report timelines and data expected, specify parameter deviations (including when immediate action must take place), and be clear about what may not be delegated (4.) feedback is essential to ensure continuity of care; inform staff if a verbal or written report is required at completion of task (5.) *CORRECT*— gives incentive to the staff for accepting responsibility and authority for completing the task (6.) describing expected outcome and timeline for completion of the task is the responsibility of the delegator

The nursing team consists of two RNs, two LPN/LVNs, and two patient care technicians. The LPN/LVN determines that delegation is appropriate if the LPN/LVN is assigned which of the following? 1. Perform a sterile dressing change. 2. Obtain vital signs. 3. Stock supplies of syringes and dressings. 4. Transfer a stable patient to x-ray.

(1.) CORRECT— assist with implementation of care, perform procedures, differentiate normal from abnormal, care for stable patients with predictable outcomes, has knowledge of asepsis and dressing changes, and may administer medications which vary with educational background and state nurse practice acts (2.) appropriate activity for nursing assistants; assist with direct patient care activities such as bathing, transferring, ambulating, feeding, toileting, obtaining vital signs, height and weight, intake and output, housekeeping, transporting stable patients, and stocking supplies (3.) appropriate activity for nursing assistants; assist with direct patient care activities such as bathing, transferring, ambulating, feeding, toileting, obtaining vital signs, height and weight, intake and output, housekeeping, transporting stable patients, and stocking supplies (4.) appropriate activity for a nursing assistant; assist with direct patient care activities such as bathing, transferring, ambulating, feeding, toileting, obtaining vital signs, height and weight, intake and output, housekeeping, transporting stable patients, and stocking supplies

The LPN/LVN in the outpatient clinic cares for a client who is diagnosed with hepatitis A. The client relates to the nurse that she is the single parent of five children under the age of 9 and that she is unable to care for the children due to the illness. The client decides that her children should stay with their father until she recovers. It is MOST important for the LPN/LVN to take which of the following actions? 1. Determine where the client contracted hepatitis A. 2. Remind the client to send the children's favorite toys with them. 3. Inform the client that her children have already been exposed and should remain with her. 4. Instruct the client to dispose of sanitary napkins by placing them in separate plastic bag.

(1.) although relevant to disease control, is not the LPN/LVN's priority; primary focus is to help children adapt to being away from their mother (2.) CORRECT— during a crisis, children are often comforted and soothed by familiar items; maintains a degree of connection with the old environment (3.) children may or may not be infected; signs/symptoms include fatigue and malaise; client may not feel well enough to provide for five small children; no food preparation allowed during illness (4.) is transmitted via enteric route; hepatitis B is transmitted via serum

The nursing team consists of an RN, one LPN/LVN and two nursing assistants. The LPN/LVN should question which of the following client assignments? (1) The RN assigns the LPN/LVN to care for a client in Buck's traction. (2) The RN assigns the LPN/LVN to administer digoxin (Lanoxin) and furosemide (Lasix) via an NG tube. (3) The RN assigns the LPN/LVN to care for a client 48 hours after a hip replacement. (4) The RN assigns the LPN/LVN to care for a client 12 hours after a laminectomy with spinal fusion who is having difficulty voiding.

(1.) appropriate client for the LPN/LVN; stable client with expected outcome (2.) appropriate assignment for the LPN (3.) appropriate assignment for the LPN (4.) *CORRECT*— unstable patient, requires skills of RN

The LPN/LVN comes upon a multi-vehicle accident. Because the emergency response team has not yet arrived on the scene, the LPN/LVN cares for the victims. Which of the following victims should the LPN/LVN see FIRST? (1) A 75-year-old male with an apparent fracture of the clavicle. (2) A 20-year-old with burns to the chest and face area. (3) A 10-year-old with an apparent elbow dislocation. (4) A 3-year-old with a hip dislocation.

(1.) does not require immediate attention (2.) *CORRECT*— airway compromised; see most unstable patient first (3.) most stable patient of the this group (4.) see this patient second; greatest risk after this injury is the potential loss of blood supply to the head of the femur

The LPN/LVN cares for clients in the outpatient clinic. Several clients exhibit signs/symptoms that may indicate early stage cancer. Although all of the clients are instructed to make appointments with their personal health care providers, the LPN/LVN STRONGLY encourages which of the following clients to make an IMMEDIATE follow-up appointment? A. A client who complains of heavy menstrual periods. B. A client who tests positive for occult blood in stool. C. A client who develops spoon-shaped nails. D. A client who has an increased white blood cell count.

(1.) may indicate uterine cancer or fibroids (2.) can have variable meanings; could be upper gastric bleeding from PUD or could be colon cancer (3.) *CORRECT*— early indication of lung cancer; number-one cause of cancer deaths (4.) can indicate inflammatory or infectious process, as well as leukemia

The LPN/LVN cares for clients in the long-term care facility. After receiving report, which of the following clients should the LPN/LVN see FIRST? (1) A client due to receive blood pressure medicine. (2) A client due to receive a metered dose inhaler (MDI). (3) A client whose family member is threatening to sue the institution if the LPN/LVN doesn't talk to them immediately. (4) A client who has been verbally abusive to staff and is becoming increasingly more agitated.

(1.) safety takes precedence over administration of routine; non-emergent medications (2.) safety takes precedence over administration of routine; non-emergent medications (3.) although angry, the family member does not pose an immediate physical threat to the clients, staff, or other visitors (4.) *CORRECT*— client poses a potentially immediate physical threat to himself, staff members, and/or other clients and visitors if the situation is allowed to escalate further; intervene and initiate protocols prescribed by the individual facility to maintain a safe environment

The RN makes assignments for a group of clients. The RN assigns care for clients to an LPN/LVN, nursing assitive personnel (NAP), and other RN. Which client assignments will the LPN/LVN question? Select all that apply. 1. Client with pneumonia requiring frequent suctioning to NAP. 2. Client with dressing changes every eight (8) hours to LPN/LVN. 3. Client preparing for discharge requiring teaching to the LPN/LVN. 4. Client newly admitted needing complete assessment to the RN. 5. Client requiring complete physical care to the NAP. 6. Client with five (5) IV medications and hourly assessments to LPN/LVN.

1) CORRECT— The NAP does not suction clients. 2) Dressing changes are appropriate for the LPN/LVN. 3) CORRECT— Discharge teaching is done by the RN. 4) Admission assessments are done by the RN. 5) Complete physical care is appropriate for the NAP. 6) CORRECT—The LPN/LV does not give IV medications or do assessments.

The LPN/LVN makes assignments for a group of clients in a long-term care facility. Which client assignments does the LPN/LVN make for the nursing asstive personnel (NAP)? Select all that apply. (1) Client with a dressing change every 8 hours. (2) Client needing careful intake and output. (3) Client requiring a complete bedbath. (4) Client needing blood glucose monitoring. (5) Client preparing for discharge to home.

1) Dressing changes are not assigned to a NAP. 2) *CORRECT*— Intake and output are duties of the NAP. 3) *CORRECT*— Bedbaths are activities appropriate for NAP. 4) *CORRECT*— Blood glucose testing is done by NAP. 5) IV medications are the responsibility of the nurse. 6) Discharge teaching and instructions are the responsibility of the nurse.

An LPN/LVN gives care to a group of clients. In which order will the LPN/LVN care for these clients? Place in order starting with the first client to be seen. All options must be used. (1) 12 hours after surgery, pt asking for pain medication. (2) Newly admitted pt needs first set of vital signs. (3) Client with catheter has urge to void, and the catheter is irrigated. (4) Discharge a pt.

1) First priority is client newly admitted; need first set of vital signs and first check. 2) Pain medication is second priority; client needs to be observed, also. 3) If client with catheter has urge to void, the catheter may be blocked and an irrigation is important, but not first priority. 4) Discharge is the last priority of these clients.

The LPN/LVN cares for a terminal client concerned about having care wishes respected as the disease progresses. The LPN/LVN helps the client think about advance directives. Which information does the LPN/LVN share with the client related to advance directives? Select all that apply. (1) May make plans, but hospitals do not need to follow them. (2) May write a Living Will. (3) May write documents without witnesses. (4) May select a Durable Power of Attorney. (5) May choose treatments to refuse or accept. (6) May plan for all possible situations.

1) Health care providers and institutions are obligated to follow instructions in valid documents. 2) *CORRECT*— Living Wills identify a client's wishes. 3) Documents need to be witnessed to be valid. 4) *CORRECT*— A Durable Power of Attorney speaks for the client when the client is unable to speak. 5) *CORRECT*— Part of the Living Will indicates treatments to accept or refuse. 6) It is impossible to plan for all possible situations; wishes are usually more general in nature.

An LPN/LVN obtains a client's signature on an informed consent form prior to a minor surgical procedure. Which statements are true concerning the informed consent? Select all that apply. (1) The LPN/LVN has provided correct information about the procedure. (2) The LPN/LVN verifies the client signed the form. (3) The client understands all about the procedure. (4) The LPN/LVN verifies the client gave consent voluntarily. (5) The client verifies a competence to sign the form. (6) The client states the LPN/LVN is not liable.

1) It is the responsibility of the health care provider to supply information about the procedure. *2) CORRECT*— By witnessing the consent, the LPN/LVN verifies it was the client who signed the form. 3) Prior to signing the consent, the client is usually asked if there are any questions, but signing the consent does not imply the client understands all about the procedure. *4) CORRECT*— The LPN/LVN attests the client gave consent voluntarily. 5) The LPN/LVN cannot determines competency to sign the form. 6) The consent has no relation to LPN/LVN liability.

Types of decision making

1. Prescriptive ~involves routine decisions with objective information ~options are known and predictable ~decision made according to standard procedures or analytical tools 2. Behavior ~involves nonroutine and unstructured information ~options are unknown or unpredictable ~decisions made by obtaining more data, using past experiences, using creative approach 3. Satisficing ~solution minimally meets objectives ~expedient; use when time is an issue 4. optimizing ~goal is to select ideal solution ~best decision comes from this process but is the most time consuming

Methods of problem solving

1. Trial and error ~repeated attempts at different solutions until it is identified that one solution works best ~used by inexperienced staff 2. Experimentation ~study problem using trial periods or pilot projects to determine best outcome ~will have greater probability of achieving best outcome if sufficient time devoted to the process 3. Purposeful inaction ~do-nothing approach ~use when problem is judged to be insignificant or outside a person's control

Decision Making

Purposeful and goal-directed; Nurse identifies and selects options and alternatives

Ethical Principles

Autonomy: support of client's independence to make decisions and take action for themselves Beneficence: duty to help others by doing what is best for them; client advocacy for refusal of care, autonomy overrides beneficence Nonmaleficence: "do no harm"; act with empathy toward client and staff without resentment or malice; violated by acts performed in bad faith or with ill will, or when making false accusations about client or employee Justice: use available resources fairly and reasonably Veracity: communicate truthfully and accurately Confidentiality: safeguard the client's privacy Fidelity: following through on what the nurse says will be done; carefully attending to the details of the client's care

Primary nursing method

RN assigned to direct care of individual clients reports to RN assigned to direct care of same individual clients

Assault and battery

assault: intentional threat to cause harm or offensive unwanted contact; battery: intentional touching without consent

Steps for delegation

Define task to be delegated ~can delegate only work for which you have responsibility and authority ~delegate what you know best so you can provide guidance and feedback Determine who should receive delegated task ~identify what the task involves, determine its complexity ~Match task to individual by assessing individual skills and abilities ~Provide clear communication about your expectations regarding the task, answer questions

Types of change-of-shift reports

Face-to-Face Taped

Method of service delivery and change-of-shift reports

Functional method Team nursing method Primary nursing method Case management method

Types of restrains

Mechanical restraint ~Needed to meet the client's therapeutic needs or ensure safety ~least restrictive type of restraint to meet needs ~accurate and thorough documentation needed Chemical restraint ~psychotropic drugs cannot be used to control behavior ~can be used only for diagnoses-related conditions ~inappropriate use causes deep sedation, agitation, combativeness

Advocacy

Nurse as client advocate should ~actively support client's rights ~defend clients' participation in decision affecting them ~communicate clients' needs to interdisciplinary team ~safeguard clients' autonomy and independence ~provide clients with information about needs and available options so that clients can make informed decisions about health care

The community health LPN/LVN plans visits for the day. Which of the following clients should the LPN/LVN see FIRST? 1. A client diagnosed with type 2 diabetes who is complaining of GI upset after taking chlorpropamide (Diabinese). 2. A client complaining of vomiting after chemotherapy. 3. A client with a tonometer reading of 21 mm Hg. 4. A client with a laryngectomy who is complaining of a greenish-yellow discharge.

Strategy: "FIRST" indicates priority. (1.) Diabinese is an oral hypoglycemic; side effects include diarrhea, GI upset, and hypoglycemia; administer in divided doses to relieve GI upset; does not require immediate attention (2.) common side effect of chemotherapy; does not require immediate attention (3.) used to diagnose glaucoma; tonometer measures intraocular pressure; normal IOP reading is 10 to 21 mm Hg (4.) *CORRECT— most unstable patient; assess breath sounds and amount, color, and character of drainage*

The LPN/LVN cares for clients in the long-term care facility. After receiving report, which of the following clients should the LPN/LVN see FIRST? 1. A client with right-sided weakness requires assistance with A.M. care. 2. A client requires administration of digoxin (Lanoxin) and furosemide (Lasix). 3. The daughter of a client is upset because her father is diagnosed with terminal cancer. 4. A client is suddenly confused and sees spiders on the wall.

Strategy: "FIRST" indicates priority. (1.) stable client (2.) medications usually given once per day; no indication client is unstable (3.) physical needs take priority over psychosocial needs (4.) *CORRECT— sudden confusion and hallucinations indicate delirium, which is a medical emergency *

An LPN/LVN cares for residents in an assisted living facility. The LPN/LVN discovers an unconscious client lying on the floor beside the bed with a small, open lesion on the right side of the head. After caring for the client, the LPN/LVN prepares to write an incident report. Which entry is most appropriate for the incident report? A. "The client apparently fell out of bed." B. "Notified supervisor of the accidental head injury." C. "Apparently struck right side of head during fall." D. "Nonresponsive client found lying on floor beside bed."

Strategy: "MOST appropriate" indicates that discrimination may be required to answer the question. (1) nurse did not make this observation; should only chart the facts (2) documenting notification of supervisor is appropriate for nurses' notes; no data to support conclusion of accidental head injury (3) no evidence that client fell nor that the head was struck in the process (4) *CORRECT—incident should reflect exactly what the person completing the report saw, heard, touched, etc.*

The LPN/LVN instructs a client about the prescribed antihypertensive medication. The client begins to cry, expresses grief about the death of her spouse 1 year ago, and states she is having difficulty sleeping. Which of the following responses by the LPN/LVN is MOST appropriate? (1) "You are still upset after a full year?" (2) "How much sleep are you getting?" (3) "What are you doing to manage your grief?" (4) "Have you thought about dating?"

Strategy: "MOST appropriate" indicates that discrimination may be required to answer the question. (1.) has undertones of judgmental conclusions regarding the client's grieving experience (2.) the primary focus is the loss of the spouse, which probably has other associated elements; loss of sleep is probably only one outcome (3.) *CORRECT— acknowledges client's concerns; provides opportunity to explore past coping behaviors; can provide evidence of the need for further intervention or referral to other team members* (4.) if continues to be very disturbed about the loss, is not likely to be interested in replacing the spouse with another person; reflects insensitivity

*The LPN/LVN assists in the management of the health care of an older adult client suspected of having syndrome of inappropriate antidiuretic hormone (SIADH). The LPN/LVN is MOST concerned if which of the following is observed?* The client's serum sodium level is 137 mEq/L. The client is drinking water. The client is oriented to person, place, and time. The client is lying in bed with the rails up.

Strategy: "MOST concerned" indicates something is wrong. (1.) normal range for sodium is 135 to 145 mEq/L (2.) * CORRECT— SIADH causes a dilutional hyponatremia; water intake monitored closely * (3.) would indicate the absence of cerebral edema commonly associated with excessive fluid retention related to SIADH (4.) implement safety measures to prevent injury caused by potential changes in level of consciousness

The LPN/LVN cares for a middle-aged adult diagnosed with Buerger's disease. Because of rapid progression of the disease, the client's wife and three adolescent children begin working to meet the family's financial needs. After observing the client and his family at home, it is MOST important for the LPN/LVN to report which of the following information to the supervising nurse? (1) The client spends most of the day on the internet. (2) At times the client is verbally abusive to his wife. (3) The client watches television most of the day. (4) The client is withdrawn and sleeps most of the day.

Strategy: "MOST important" indicates discrimination may be required to answer the question. (1.) may indicate maladaptive coping, but can be a distractor from the pain associated with the disease (2.) *CORRECT* — without intervention, verbal abuse can progress to physical abuse; can migrate to the children also (3.) may indicate maladaptive coping; often takes several months to adjust to extensive role changes (4.) illustrates signs/symptoms of clinical depression, which is common following a significant loss

*Which of the following nursing actions is MOST important for the LPN/LVN to take to provide effective pain relief for a client?* (1) Teach the client about pain. (2) Establish a trusting relationship with the client. (3) Determine how various relaxation techniques affect the pain. (4) Administer pharmacological agents.

Strategy: "MOST important" indicates that discrimination is required to answer the question. (1)important to convey to the client in pain that the LPN/LVN believes the client's pain is real and that the LPN/LVN determines the effectiveness of the intervention for pain on the basis of the client's response (2)*CORRECT—to effectively develop a plan of care for relieving a client's pain, trust is essential; pain is subjective, therefore decisions are based solely on client's report* (3)is appropriate action, but LPN/LVN first establishes a trusting relationship (4)common pharmacological agents include aspirin, Tylenol, NSAIDs, and opiates; drug therapy is more effective when communication of needs is accurate

The LPN/LVN assists in the preparation of four clients for surgery. Because anxiety can significantly influence client recovery from a surgical procedure, anxiety-reducing techniques will be emphasized. It is MOST important for the LPN/LVN to use anxiety-reducing techniques with which of the following clients? A 13-year-old girl scheduled to have a wart removed from her nose. A 26-year-old man scheduled for the Whipple procedure due to cancer of the pancreas. A 42-year-old woman scheduled to have a benign cyst removed from the left breast. An 80-year-old man scheduled for a colostomy due to severe diverticular disease.

Strategy: "MOST important" indicates that discrimination is required to answer the question. (1)may be concerned about disfigurement; anxiety level likely to be lower than youthful client facing change in bowel habits as well as death *(2)CORRECT*—client has life-threatening illness with potentially poor outcome; should assist client in managing responses to surgery-related physical changes, as well as the threat of dying* (3)outcome of surgery is good; disease process is self-contained (4)although surgical outcome is life-changing; the disease process is not terminal

*The community health LPN/LVN assists a bedridden client to manage peripheral edema associated with heart disease. It is most important for the LPN/LVN to include which statement when instructing the client? * 1. "Eat smaller feedings more frequently." 2. "Regular exercise plays an important role in reducing the retention of fluid in your body." 3. "Your legs swell more than the rest of your body because of the effects of gravity." 4. "If your feet are still swollen after a good night's sleep, the problem is related to the heart."

Strategy: "MOST important" indicates that discrimination is required to answer the question. (1.) *CORRECT— requires less effort to eat; offer foods that have a relatively soft texture and encourage client to eat slowly* (2.) because peripheral edema is often related to kidney or cardiac disease, regular exercise does not contribute significantly to reduction in fluid volume (3.) true of ambulating client; bedridden client retains fluid near sacral area (4.) if peripheral edema is related to venous insufficiency, fluid in legs and feet may resolve during the night while the legs are at the same level as the heart

The LPN/LVN learns during the change-of-shift report that a client with a "do not resuscitate" advance directive was resuscitated by a nursing assistant. To prevent this from happening again, it is MOST important for the LPN/LVN to recommend which of the following to the supervising nurse? (1) Remind staff about the advance directives at the beginning of each shift. (2) Place a sign about the advance directive above each client's bed. (3) Attach a small blue banner to appropriate clients' bedside stands and wheelchairs. (4) Check the client's chart before initiating resuscitation.

Strategy: "MOST important" indicates that discrimination may be required to answer the question. (1.) advance directive is a written statement by a competent person that states decisions about an individual's treatment in the event of a serious illness or injury; all staff members do not receive report on every client; may not be able to recall the information during a crisis (2.) does not maintain client confidentiality (3.) *CORRECT— staff would recognize that the client has advance directive; errors could still occur but this will reduce the risk* (4.) need a way to provide immediate communication of the information so that staff can initiate CPR on clients without advance directives

The LPN/LVN notes that the serum sodium level of a client diagnosed with heart failure (HF) is decreased. Which of the following activities should the LPN/LVN perform NEXT? (1) Notify the health care provider. (2) Assess the client's lung sounds and respiratory rate. (3) Assess for peripheral edema. (4) Compare current weight to the weight of the day before.

Strategy: "NEXT" indicates priority. (1.) hyponatremia is commonly associated with HF, related to hemodilution (2.) because of decreased pump efficiency, fluid retention is common in CHF, which could result in respiratory congestion (3.) right-sided heart failure could occur related to decreased pump failure; peripheral edema occurs (4.) *CORRECT— rapid weight gain can occur with HF, related to retention of free water resulting in hyponatremia; is best indicator of the etiology of the hyponatremia and takes priority; LPN/LVN should closely monitor disease progression*

The LPN/LVN cares for clients in the long-term care facility. Which of the following clients should the LPN/LVN see FIRST? (1) A client diagnosed with type 2 diabetes has pale, cool skin and is complaining of a headache. (2) A client diagnosed with a CVA has frequent watery diarrhea. (3) A client diagnosed with asthma has labored breathing. (4) A client diagnosed with chronic renal failure has a B/P of 150/90 mm Hg.

Strategy: Determine the most unstable client. (1.) experiencing hypoglycemia; offer client a glass of milk (2.) second client to be seen; at risk for dehydration (3.) *CORRECT — place client on oxygen; assess breath sounds* (4.) no indication client is unstable

The LPN/LVN on the medical/surgical unit has just received report. Which of the following clients should the LPN/LVN see FIRST? (1) A 29-year-old female undergoing peritoneal dialysis. The outflow appears bloody. (2) A 35-year-old male diagnosed with acute postinfectious glomerulonephritis. The client's BP is 150/90. (3) A 45-year-old female diagnosed with P. carinii pneumonia. The client complains of a persistent dry cough. (4) A 56-year-old male diagnosed with angina. The client is scheduled for discharge today.

Strategy: Determine the most unstable client. (1.) not unusual that due to tonicity of dialysate; endometrial lining may be pulled through the fallopian tubes (2.) hypertension due to volume overload; give antihypertensives and diuretics, restrict salt (3.) *CORRECT*— opportunistic infection associated with AIDS; causes progressive hypoxemia and cyanosis (4.) stable client; requires teaching regarding importance of weight reduction, regular exercise, and medication

The LPN/LVN on the medical surgical unit has just received report. Which of the following clients should the LPN/LVN see FIRST? A client one day post-op after an appendectomy. A client who had a detached retina surgically repaired 4 hours ago. A client with an esophagogastric tube inserted. A client 2 days post-op after a laminectomy with spinal fusion.

Strategy: Determine the most unstable client. (1.) stable client (2.) administer analgesics and antiemetics as prescribed; report increase in pain and instruct client not to bend from waist, cough or sneeze, or strain to have a bowel movement (3.) *CORRECT*— used to treat bleeding esophageal varices; assess vital signs for decreased blood pressure and elevated pulse; ensure that balloon pressure and volume is maintained (4.) maintain body alignment; assess for sensation and circulatory status of lower extremities

*The home care LPN/LVN visits a client undergoing external radiation for treatment of lung cancer. It is MOST important for the LPN/LVN to instruct the client about which of the following?* (1) Use a washcloth to gently cleanse the irradiated area. (2) Apply cream to the irradiated area daily. (3) Apply sunscreen to the irradiated area if exposed to the sun. (4) Use a patting motion to dry the irradiated area.

Strategy: Determine the outcome of each answer. Is it desired? (1)wash gently with water or mild soap and water daily; washcloth too irritating, use hand (2)do not use powders, ointments, lotions, or creams on the irradiated area (3)do not expose area to sun or to heat (4)*CORRECT—after washing, pat dry with soft towel or cloth; wear soft clothing that does not bind or rub*

*The LPN/LVN admits a middle-aged client with terminal lung cancer to the hospital. The spouse states the client did not want to come to the hospital and has no desire to "slow down." The LPN/LVN should give priority to which measure?* Encourage the client to participate in planning own care. Set limits on the client's excessive activities. Encourage the client to accept help from others. Promote rest and relaxation for the client.

Strategy: Determine the outcome of each answer. Is it the priority? (1) *CORRECT— this client obviously thrives on independence; would be most helpful to support the desire for a sense of control over the care; give choices wherever possible, and allow self-care when feasible* (2) encourage clients to be independent; this client is apparently able to make proper decisions (3) provide opportunities for client to participate in decision-making (4) if that is what the client desires

The LPN/LVN assists in the teaching of a client recently diagnosed with type 1 diabetes about proper meal planning. Which of the following actions should the LPN/LVN have taken FIRST? 1. Instruct the client about the importance of eating regular meals. 2. Inform the client that 50 to 60% of calories should come from carbohydrates. 3. Obtain a diet history that includes the client's favorite foods and usual meals. 4. Teach the client how to use the Exchange List for Meal Planning.

Strategy: Gather data before implementing. (1.) implementation; if client is on conventional insulin regimen (one or two injections per day), important to eat regular meals to cover the peak time of the insulin (2.) implementation; caloric distribution for diabetic diet of 50 to 60% carbohydrates, 20 to 30% fat, and 10 to 20% protein (3.) CORRECT — assessment; before beginning teaching, should obtain a thorough diet history and obtain client's weight and determine whether there is a need for weight loss, weight gain, or weight maintenance; goal of diet is for client to maintain a reasonable body weight and control blood glucose; client more likely to make the lifestyle changes required (4.) implementation; appropriate after assessment is completed

*The LPN/LVN cares for clients on the medical/surgical floor. The LPN/LVN determines assignments are appropriate if the nurse assigns the LPN/LVN to which of the following clients?* A client receiving tissue plasminogen activator (tPA). A client diagnosed with Raynaud's disease who had a sympathectomy. A client admitted in sickling crisis. A client diagnosed with dysrhythmia who had a permanent pacemaker implanted.

Strategy: LPN/LVN cares for stable client with expected outcomes. (1.) thrombolytic given to treat embolism; side effects include anaphylaxis, spontaneous bleeding, and dysrhythmias; client is not stable *(2.) CORRECT *— Raynaud's disease is a form of intermittent arteriolar vasoconstriction; sympathectomy interrupts the sympathetic nerves; stable client with an expected outcome (3.) unstable client (4.) assess client's cardiac output and hemodynamic stability to evaluate the success of the pacemaker

The LPN/LVN identifies which nursing goal as the highest priority when caring for a client with a history of seizures? Prevent the occurrence of fractures. Protect the head and neck from injury. Provide adequate emotional support. Protect from physical exposure or social bias.

Strategy: Physical needs take priority over psychosocial needs. (1) fractures can occur during attempts at restraint or if the client falls and strikes the head, the trunk, or the limbs against firm objects (2) *CORRECT—during a seizure, the nursing objective is to prevent injury* (3) seizures occur during reduced level of consciousness in which clients are unable to protect themselves physically; the LPN/LVN provides the needed protection; emotional support is needed to deal with the social issues often imposed on clients with a history of seizures (4) while the LPN/LVN should cover the client during a seizure and shield from curiosity seekers, the first priority includes airway protection or protection from injury

A client is admitted to the hospital with symptoms of myasthenia gravis. When caring for this client, the LPN/LVN should give first priority to which nursing goal? 1. Provide meticulous personal hygiene. 2. Maintain balance between activity and rest. 3. Maintain respiratory function. 4. Promote adequate hydration.

Strategy: Remember ABCs. (1) usually unable to perform ADLs and will need assistance (2) prevents excessive fatigue and assures high quality of life; maintaining respiratory function takes priority (3) CORRECT—affects respiratory muscles resulting in risk for hypoxia; also affects facial muscles together with laryngeal function; maintaining oxygenation and prevention of aspiration should be given highest priority (4) because swallowing may be a problem, hydration may be an issue; oxygenation takes priority

*The LPN/LVN comes on a multi-vehicle accident on the freeway. Which accident victim should the LPN/LVN see first?* (1) A client with a 2-inch-long scalp laceration. (2) A client with clear fluid draining from the right ear. (3) A client with a hematoma on the forehead. (4) A client whose pupils are equal and reactive to light.

Strategy: Select the most unstable client. (1) unless is bleeding profusely, tending to client can be delayed (2) *CORRECT—clear fluid from the ears could be a sign of a basilar skull fracture; should be suspicious of leaking cerebrospinal fluid, which is indicative of a serious head injury* (3) could indicate a possible head injury; draining clear liquid could indicate the ventricles have been penetrated and takes priority (4) normal finding

A client is admitted to the hospital with a white blood cell count of 1,500/mm3. When caring for the client, the LPN/LVN should consider which of the following nursing diagnoses as the highest priority? Ineffectual individual coping. Fatigue. Self-care deficit. Risk for infection.

Strategy: Think about each answer. (1)physical needs take priority over psychosocial needs (2)may be fatigued due to bone marrow depression, but no information is given to support this nursing diagnosis (3)no data given to support this nursing diagnosis (4)*CORRECT—client's white blood cell count is far below range of 5,000 to 10,000/mm3, placing him/her at high risk for developing a life-threatening infection*

*The nursing team consists of two RNs, one LPN/LVN, and two nursing assistants. The LPN/LVN should consider the assignment appropriate if the RN assigns which of the following to the LPN/LVN? * 1. Obtain vital signs for a patient immediately after ECT. 2. Assist a patient with bathing and feeding. 3. Administer a tube feeding for a patient with dysphagia. 4. Discharge a patient diagnosed with multiple sclerosis.

Strategy: Think about each answer. (1.) requires assessment of the RN; immediately after procedure, orient patient, take blood pressure and respirations, stay with patient during times of confusion; nursing assistant can obtain vital signs after patient alert and oriented (2.) appropriate assignment for the nursing assistant; assign standard, unchanging procedures (3.) *CORRECT— assign stable patients with expected outcomes * (4.) appropriate activity for the RN; the RN cannot delegate assessment, teaching, or nursing judgment

Self-determination act

federal law requiring health care facilities to provide written information to adult clients about their rights to make health care decisions

problem solving

focus is trying to solve immediate problems; includes decision making

ANA Code of Ethics

decision-making framework for solving ethical problems

Phases of decision making

define objectives generate options analyze options (adv and disadv; rank options) select option that will successfully meet the obj implement the selected option evaluate the outcome

steps of problem solving

define the problem gather data analyze data develop solutions select and implement a solution evaluate the results

Rule of determining delegatee

delegate to lowest person on hierarchy who has the required skills and abilities and who is allowed to do the task legally and according to the organization

Cultural norms

group of individuals' values and beliefs that strongly influence individual's actions and behaviors

Critical Thinking

involves creativity, problem-solving, decision-making

Depending on state Nurse Practice Acts, LPN/PNs may delegate task to

nursing assistive personnel (NAP)

Values

personal preferences, commitments, motivations, patterns of using resources, objects, people, or events that have special meaning and influence individual's choices, behaviors, actions

pregnant minor informed consent

pregnant minor can sign consent for themselves and the fetus. After delivery, ~the mother retains right to provide consent for infant ~Mother *cannot* give own consent unless she fits into one of the other exemptions

Malpractice

professional negligence involving misconduct or lack of skill in carrying out professional responsibilities Required elements: ~duty - relationship between nurse and client ~Breach of duty ~causation - nurse conduct causes injury ~injury

Invasion of privacy

release of information on an unauthorized person without the client's consent

Delegation

responsibility and authority for performing a task (function, activity, decision) is transferred to another individual who accepts that responsibility and authority ~Delegator remains accountable for task ~Delegatee is accountable to delegator for responsibilities assumed

Rights of delegation

right task right person right time (not in a crisis) right information right supervision right follow-up

Incident Reports

~Agency record of unusual occurrence or accident and physical response ~Accurate and comprehensive report on any unexpected or unplanned occurence that affects or could potentially affect a client, family member, or staff person

Negligence

unintentional failure of individual to perform an act that a reasonable person would or would not perform in similar circumstances; can be act of omission or commission

Ethical Standards

~Respect for human dignity - give respectful service regardless of client's personal characteristics ~Confidentiality - does not discuss condition with anyone not involved with care ~competence - has knowledge and skill to provide care ~Advocacy - protects client from incompetent or unethical practice ~Research - participates in process of scientific inquiry ~Promotion of public health - committed to local and global goals for health of community

ineffective delegation

~Reverse delegation - lower person on hierarchy delegates to person higher on hierarchy ~Over delegation - delegator loses control of the situation by delegating too much authority and responsibility to delegatee

Privacy

~Right to be left alone without unwarranted or uninvited publicity ~Right to make personal choices without interference (e.g., contraception, abortion, right to refuse treatment) ~Right to have personal information kept confidential and distributed only to authorized personnel (HIPAA)

Laws

~Rules of conduct established and enforced by authority ~reflect public policy ~indicates what society views as good and bad, right and wrong behavior

Refusal of treatment

~Self-determination act ~Aggressive treatment ~Advanced directives

Professionalism

~Specific knowledge and skills = foundation of nursing science ~Person-centered ~Autonomy and accountability - adheres to standards of practice and is responsible for care given ~Nurse practice act ~Ethical standards

Health Insurance Portability and Accountability Act (HIPAA)

~Violated when confidential information revealed to unauthorized persons, or unauthorized personnel directly or indirectly observes client without permission ~Authorized personnel - people involved in diagnosis and treatment (related to care of client) ~Health care team can't use data, photographs, videotapes, research data without explicit permission of client ~Be cautious about release of information on the phone (difficult to identify caller accurately) ~Necessary to obtain client's permission to release information to family members or close friends ~For employees, can only verify employment and comply with a legal investigation

LPN/LVN responsibilities

~assist with implementation of defined plan of care ~perform procedures according to protocol ~differentiate normal from abnormal; report data to RN ~care for physiologically stable clients with predictable conditions ~has knowledge of asepsis and dressing changes ~ability to administer medications varies with educational background and state nurse practice act

Informed consent requirements

~capacity - age, competence ~Voluntary ~Information must be given in understandable form (lay terminology) ~cannot sign informed consent if client has been drinking alcohol or has been premedicated ~informed consent may not be required in emergency situation

informed consent includes

~explanation of treatment and expected results ~anticipated risks and discomforts ~potential benefits ~possible alternatives ~answers to questions ~statements that consent can be withdrawn at any time

Hierarchy or chain of command

~organizational hierarchy - designed to promote smooth functioning within a large and complex organization ~Hierarchy - employees are ranked according to their degrees of authority within an organization ~chain of command - emphasis on vertical relationships (e.g., nurse reports to nurse manager who reports to nursing supervisor)

Durable power of attorney for health care

~permits a competent adult to appoint surrogate or proxy in the event that the adult becomes incompetent ~health care provide must follow decisions stated in documents ~in most states proxy can perform all legal actions needed to fulfill adult's wishes

Therapeutic nature of the nurse/client relationship

~professional ~characterized by genuineness ~Nurse acts as a role model ~Nurse copes with own feelings ~Protected relationship - nurse or client cannot be forced to reveal communication between them unless person who would benefit from relationship agrees to reveal it

Organ/Tissue Donation/Transplant

~pt has a right to decide to become an organ donor ~pt has a right to decide to refuse organ donation or transplant ~pt 18 years of older may choose to donate organs ~requests to the family are usually completed by the HCP or a specially trained nurse ~religious beliefs should be taken into consideration when approaching the family

legal responsibility of informed consent

~rests with individuals who will perform treatment ~when nurse witnesses a signature, it means that there is reason to believe that the client is informed about upcoming treatment

confidentiality

~right to privacy of records ~information used only for purpose of diagnosis and treatment ~not released to others without permission; verify identify of persons asking for information