Annual Revalidation Case Study for Adult Ambulatory Areas

1. Annual Revalidation Case Study for Adult Ambulatory Areas

2. Mr. James, a 55 year old patient, and his wife are being seen in the clinic.

3. As you are talking with his wife you notice that she has sneezed a couple of times and has been coughing. What respiratory hygiene/cough etiquette education should you provide? • Instruct the wife that she must leave the facility. • Provide tissues to the wife and educate regarding covering nose/mouth with tissue, disposing of tissue and then performing hand hygiene. • Consider having the wife wear a mask if the coughing and/or sneezing become worse . • Both B and C.

4. As part of orienting Mr. James and his wife to the clinic and exam room, you educate them on clinic policies.

5. What key patient/family education should you share regarding hand hygiene? • Patient/family should only wash their hands when visibly soiled. • Family should perform hand hygiene using both soap and water as well as alcohol foam before entering patient room. • If patient is on contact isolation for C-Diff, family should perform hand hygiene only with alcohol foam when leaving the patient’s room. • Family should perform hand hygiene before any patient contact (e.g., before entering room, before/after assisting patient with ADLs, etc.).

6. *New Slide* You get Mr. James settled into his exam room, take his vital signs and review his allergies and current medications.

7. *New Slide* When taking Mr. James’ blood pressure, you know that it is important to a. Use any adult size blood pressure cuff b. Use a large size adult blood pressure cuff for increased accuracy c. Use a blood pressure cuff that covers 80% of the circumference of the upper arm d. Use a pediatric size blood pressure cuff if it is the only cuff available

8. *Revised Slide* Mr. James’ vital signs are as follows: • Temp – 39.5C • HR – 82 • RR – 18 • BP – 132/80 You assess the fever further and decide that he may need something to help bring the fever down. You give report to the provider, inform them about the fever and ask for an order.

9. Because the patient has difficulty swallowing tablets the provider enters an order for: Acetaminophen 650mg PO for fever x 1 now for temp > 38.5C You obtain a new bottle of Tylenol and label it appropriately after drawing up the dose.

10. Tylenol Picture – drop and drag

11. You are assessing Mr. James’ pain. Which pain scale should you use? (Click on the best response)

12. After assessment of Mr. James pain, the provider orders a dose of Morphine. How do you determine if this is a high alert medication? • You note the medication label which identifies the medication as high alert. • Your check the MAR which will indicate special process for high alert medication. • You recall that any medication given as an IV infusion is considered High Alert. • You refer to the list of medications in the Nursing Process Standard “High Alert Medications Protocol” and the high alert drug list from pharmacy.

13. If it was Influenza season and Mr. James had an order for the Influenza Vaccine while in clinic, you would administer the vaccine • Subcutaneous, using a 180 degree angle in the deltoid • Intramuscular, using a 90 degree angle in the vastuslateralis • Subcutaneous, using a 90 degree angle in the vastuslateralis • Intramuscular, using a 90 degree angle in the deltoid

14. The provider tells you that he has now ordered a CXR and that the patient must go to radiology. You now have orders for Mr. James to have completed before he goes down to radiology. Zofran 8 mg IV for nausea x 1 now

15. You prepare the Zofran in a syringe to give to Mr. James. What information must be included on the syringe that contains the medication?choose all that apply

16. One of the 6 Rights of Medication Administration is to verify the right patient. How do we verify Right Patient in the ambulatory setting? • Name and history number • Name and address • Name and room number • Name and date of birth

17. A Transporter has just arrived to take Mr. James down to X-ray. You have completed the “Ticket to Ride”.

18. Mr. James arrives for his procedure. The staff performs a time-out. Which of the following statements about time-out are correct? Choose all that apply • Only the transporter and the receiving nurse perform the time-out. • All members of the procedure team perform the time-out. • The right patient is verified. • The right procedure is verified. • The pre-procedure check-list is completed. • Documentation by the proceduralist that time-out occurred is included in the medical record. • Time-out is not required for this procedure.

19. *New Slide* Mr. James has returned to clinic after his X-ray. You need to reassess his fever now that it has been over an hour since he received the dose of Tylenol ordered in clinic. You are busy with another sick patient in clinic andthink about asking your co-worker to re-check Mr. James vital signs. Which of the following statements regarding delegation is true? • An unlicensed assistive personnel (i.e.. CMA, NCA) can delegate to another unlicensed assistive personnel. • A Registered Nurse can delegate any task to a CMA or NCA. • An RN can delegate to a CMA or NCA only if the task is consistent with the rules for delegation and the UAP is properly trained and competent. • A CMA or NCA can not refuse a task that is delegated by an RN.

20. *Revised Slide* Mr. James is seen by the provider and given all of his test results. His fever and nausea have resolved. You provide final patient education to Mr. James and his wife.

21. *New Slide* In providing patient education to Mr. James and his wife you review with him his new prescriptions and home care instructions the doctor has ordered. In assuring that Mr. James understands the patient education you have provided, you know to • Ask Mr. James to repeat back to you the instructions you have given him • Provide the number for the telephone triage line and on call physician • Ask Mr. James and his wife if they have any questions and provide them with written directions • All of the above

22. As you wrap up your day you are able to see how your actions throughout today reflect the DUHS Professional Practice Model. You advocated for your patient, collaborated with other disciplinesand provided safe care to your patients.