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lOMoARcPSD|28287070 215 Exam 1 study guide Theoretical Foundation In Nursing Practice (Arizona College of Nursing) Scan to open on Studocu Studocu is not sponsored or endorsed by a...

lOMoARcPSD|28287070 215 Exam 1 study guide Theoretical Foundation In Nursing Practice (Arizona College of Nursing) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 215 Exam 1 Study Guide (Modules 1-2 in NUR 215) 1) Be able to identify what patient or problem is the priority (what is most critical based on ABCs or who is most at risk) (Slide 24 on Module 1 PP AND Basic Nursing: Thinking, Doing, Caring pg 56/57) a) ABCs = Airway, Breathing, Circulation b) Nurses must decide which problems need to be addressed first and what problems can be addressed later i) *Reference question 5 also for prioritization c) Factors that influence prioritization: Problem urgency, future consequences, patient preference, computer-assisted diagnosing 2) What is within an RN’s scope of practice? (Basic Nursing: Thinking, Doing, and Caring pg 7) a) What types of things can a nurse do without a doctor’s order? (Slide 19 on Module 1 PP) i) Turning a patient ii) Providing comfort iii) Raising the head of the bed iv) Grooming/bathing v) Ice packs/heat pads (some exceptions) vi) Patient education vii) Assistance in ADLSs (activities of daily living) viii) Preventing falls ix) Promote hydration and nourishment (some exceptions) b) What can a nurse do if he/she is asked to do something out of their scope? Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 i) The policies and procedures of the facility at which you work are your guiding source. If your policies and procedures cover you, and you are following them, you are practicing within the scope. However, if there is no official policies and procedures, you may not be practicing within your scope ii) nurses should refuse to practice beyond their legal scope of practice and use the formal chain of command to verbalize concerns related to these assignments 3) Be able to identify examples of primary, secondary, and tertiary prevention levels (Slide 25 on Module 1 PP AND Basic Nursing: Thinking, Doing, and Care pg 370) a) Primary: Designed to prevent or slow the onset of disease i) Eating healthy foods, Exercising, Wearing sunscreen, Obeying seat belt laws, Car seats, Using condoms, and Keeping up with immunizations b) Secondary: Screening activities and education for detecting illnesses in the early stages i) Breast self-exams, Testicular exams, Regular physical exams, BP and diabetic screenings, Bone density screenings, and TB skin tests c) Tertiary: Focuses on stopping the disease from progressing and returning the individual to the pre-illness phase i) **Rehab is the MAIN intervention during this stage (1) Preventing pressure ulcers, Cardiac stent procedure, support groups, physical rehab, and speech therapy 4) Know the nursing process and what each step means (ADPIE) (Slide 18 on Module 1 PP AND Basic Nursing: Thinking, Doing, and Caring pgs 45, 51/52, 62, 69/74, and 79) a) **It’s important to note that the nursing process is NOT linear. It’s a cyclical process that follows a logical progression and going back and forth between steps is EXPECTED** b) Assessment: Involves gathering data about the patient and their health status; Info is related to the physiological, psychological, sociocultural, developmental, and spiritual status of the individual i) Primary data: Data obtained directly from the patient (1) Subjective data: What the patient SAYS/TELLS you (2) Objective data: What you can SEE for yourself ii) Secondary Data: Data obtained secondhand, from the medical record or another care provider Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 c) Diagnosis: Using critical-thinking skills, the nurse analyzes the Assessment to identify patterns in the data and draw conclusions about the client’s health status (strengths, problems, and factors contributing to the problem) i) *The purpose of diagnosing is to identify the patient’s health status; Accuracy is essential because the diagnosis is the basis for planning patient-centered goals/interventions ii) Nursing diagnosis: A statement of patient health status that nurses can identify, prevent, or treat independently iii) Medical diagnosis: Describes a disease, illness, or injury; Purpose is to identify a pathology so appropriate treatment can be given to cure the condition (1) A Medical diagnosis is a more narrowly focused than a Nursing diagnosis (2) Except for NPs, nurses CANNOT legally diagnose or treat medical problems (3) A Medical diagnosis can have any number of Nursing diagnoses associated with it (4) Patients with the same Medical diagnosis may have different Nursing diagnoses d) Planning: encompasses identifying goals and outcomes, choosing interventions, and creating nursing care plans i) Initial Planning: Begins with the first patient contact; Refers to the development of the initial comprehensive care plan ii) Ongoing Planning: Changes made in the plan; Allows you to prioritize the problem(s) the patient has iii) Discharge Planning: Process of planning a self-care and continuity of care after the patient leaves the healthcare setting (1) Promotes patient’s progress towards health/disease management outside of facility care (2) Reduces chances of readmission to hospital care iv) Nursing Care Plan: The comprehensive central source of info needed to guide holistic, goal-oriented care to address each patient’s unique needs; It Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 specifies dependent, interdependent, and independent nursing actions necessary e) Implementation/Implement Interventions: Involves performing/delegating planned interventions; Carry out the care plan i) “It’s doing, documenting, and delegating” f) Evaluation: Last step of the nursing process; Involves making judgements about the patient’s progress towards desired health outcomes, the effectiveness of the nursing care plan, and the quality of nursing care in the healthcare setting i) Structure Evaluation: Focuses on the setting in which care is provided ii) Process Evaluation: Focuses on the activities performed. It does NOT describe the results of the activities performed (focuses on WHAT was done and HOW WELL it was done) iii) Outcomes Evaluation: Focuses on the observable/measurable changes in the patient’s health status resulting from the care given 5) Be able to identify the basics of Maslow’s Hierarchy of Needs (Slide 23 on Module 1 PP) 6) What is HIPAA and how can we protect patients’ privacy? (Slides 14/15 on Module 1 PP) a) HIPAA: Health Insurance Portability and Accountability Act Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 i) A federal law (passed in 1996) which established regulations of individually identifiable health information in verbal, electronic, or written form ii) Privacy relates to the client’s rights over the use/disclosure of his/her/their own personal health information iii) Identifiers for the info include a client’s name, address, phone number, driver’s license number, date of birth, etc. b) Ways to protect patient’s privacy i) Logging Off: log off the computer before you leave the area ii) Do Not Discuss: Do not discuss patient info with those who are not involved OR in public areas iii) Do Not Search: Do not search patient’s belongings without their permission (Unless they’re a danger to themselves/others) 7) What are examples of nursing attributes? (Slide 22 on Module 1 PP) a) Nursing Attributes: Qualities that make a nurse good and professional b) Honesty, Integrity, Assertive communication, Caring, Beneficent, Advocacy, Prioritization skills, Fair, Responsible, Trustworthy, Takes accountability for their own actions 8) How can a nurse therapeutically communicate with a patient during a sexual health exam? (Slide 52 on Module 2 PP AND Basic Nursing: Thinking, Doing, Caring pg 1261) a) Ways to make the patient feel more at ease during a sexual health exam i) Convey a non-judgemental attitude and unbiased approach ii) Provide privacy iii) Have others step out of the room b) Priorities when discussing sexual health with the patient i) Examine your own beliefs/values ii) Be aware of your nonverbal communication (1) Use a relaxed approach (2) Maintain eye contact iii) Watch for cues of discomfort/concerns c) A focused Sexual Health Assessment is needed for: Pregnancy/infertility work- up/request for birth control, menstrual cycle problems/irregularities, annual health visit or as part of a physical exam, unusual discharge from/change in genital organs, urination problems, a known sexual problem, illness/surgery/drugs d) determine risk factors, gauging the patient’s knowledge regarding sexuality, teach ways to make sexual activity safer, provide available resources and support groups 9) Differences between modifiable and nonmodifiable risk factors (Slide 40 on Module 2 PP) a) Modifiable Risk Factors: Risk factors that can be reduced by changes Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 i) Diet, lifestyle, stress b) Nonmodifiable Risk Factors: Risk factors that cannot be reduced by changes i) Family history ii) Genetics 10) For nursing to be considered a profession, what would be required? (Slides 6/7 on Module 1 PP AND Basic Nursing: Thinking, Doing, Caring pg 9) a) Nursing Profession i) Technical and scientific knowledge ii) Be evaluated by a community of peers iii) Have a service orientation and a code of ethics b) Improving recognition as a profession i) Standardizing educational requirements ii) Uniform continuing education requirements iii) Increased participation of nurses in professional organizations iv) Educating the public about the true nature of nursing practice 11) Therapeutic communication technique examples (From Therapeutic Communication pdf) a) Active Listening: Being attentive to what the patient is saying (verbally and nonverbally) i) Sit facing the patient, open posture, lean in, eye contact, relax b) Sharing Observations: Commenting on how the patient looks, sounds, or acts c) Sharing Empathy: The ability to understand and accept another person’s reality; To accurately perceive feelings and communicate understanding d) Sharing Hope: Communicating a “Sense of possibility” to others; Encouragement when appropriate and positive feedback e) Sharing Humor: Contributes to feelings of togetherness, closeness, and friendliness; Promotes positive communication in prevention, perception, and perspective Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 f) Sharing Feelings: Help patient’s express emotions by making observations, acknowledging feelings, encouraging communication, and giving permission to express “negative” feelings and modeling healthy anger g) Using Touch: **Most potent form of communication** Comforting touches are especially important for vulnerable patients who are experiencing severe illness/stress h) Silence: Time for nurses and patients to observe one another, sort out feelings, think about how to say things, and reflect i) Nurse should allow patient to break the silence i) Providing Information: Relevant info is vital to decision making, reducing anxiety, and feeling safe/secure j) Clarifying: To check whether understanding is accurate or to better understand k) Focusing: Taking notice of a single idea/word expressed l) Paraphrasing: Restating another’s own message, briefly, in one’s own words; conveys the essential idea m) Asking Relevant Questions: To seek further information for decision making; Asking only one question at a time and fully exploring one topic before moving on to another i) Open-ended questions allows for taking the conversational lead and introducing pertinent info about a topic n) Summarizing: Pulls together information for documentation; A concise review of key aspects of an interaction; Brings a sense of closure and full understanding o) Self-Disclosure: Subjectively true personal experiences about self are intentionally revealed to another for the purpose of emphasizing similarities/differences of experiences; Offered as an expression of genuineness and honesty p) Confrontation: Helping the patient become more aware of inconsistencies in his/her/their feelings, attitudes, beliefs, and behaviors; Should be done with sensitivity and ONLY AFTER trust has been established 12) Non-Therapeutic communication examples (From Therapeutic Communication pdf) a) Asking Personal Questions: Questions that are NOT relevant to the situation are not appropriate/professional i) Do NOT ask questions to justify your own curiosity b) Giving Personal Opinions: Takes away decision-making for the patient i) Remember the problem; the solution belongs to the patient, NOT the nurse c) Changing the Subject: Changing the subject when someone is trying to communicate is rude/shows a lack of empathy; Blocks further communication d) Automatic Responses: These are generalizations/stereotypes that reflect poor nursing judgements and threaten nurse-patient and team relationships e) False Reassurance: The nurse is trying to be kind/helpful but these comments tend to block conversation and discourage further expression of feelings; Statements not based on fact/reality can do more harm than good Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 f) Sympathy: Focuses on the nurse’s feelings rather than the patient’s; Sympathy is a subjective look at another person’s world that prevents clear perspective of the issues confronting that person g) Asking for Explanations: “Why” questions can cause resentment, insecurity, and mistrust; Patients frequently interpret “Why” questions as accusations h) Approval or Disapproval: Nurses must NOT impose their own beliefs, values, attitudes, or moral standards on others while in a professional helping role; Agreeing/disagreeing send the subtle message that nurses have the right to make value judgements on a patient’s decisions i) Do not use words such as ought, should, good, bad, right, or wrong i) Defensive Responses: When patient’s express criticism, nurses should listen to what they are saying; Listening does not imply agreement j) Passive or Aggressive Responses: i) Passive: Serve to avoid conflict/sidestep issues; Reflect sadness, anxiety, depression, hopelessness, and powerlessness ii) Aggressive: Provoke confrontation at the other’s expense; Reflect stress, anger, frustration, and resentment k) Arguing: Implies that the other person is lying, uneducated, or misinformed 13) Be able to identify the ethical principles of nursing (autonomy, fidelity, etc.) (Slide 20 on Module 1 PP AND Basic Nursing: Thinking, Doing Caring Chapter 41) a) Nonmaleficence: 1) do not harm and 2) prevent harm b) Autonomy: A person’s rights to choose and ability to act on that choice; Based on the respect for human dignity c) Justice: The obligation to be fair; Implies equal treatment for all patients d) Beneficence: The duty to do and promote good; This coincides with Nonmaleficence; The duty to bring about positive good → duty to do no harm e) Veracity: The duty to tell the truth f) Fidelity: The duty to keep promises g) **Nurses actions are to be at the level expected by the profession h) **Nurses are professionally bound to give correct info to the patient i) **Not a law, but rather standards of professional responsibilities 14) What does the State Board of Nursing do? (Slide 16 on Module 1 PP AND Basic Nursing: Thinking, Doing, Caring pg 12) a) Directly responsible for regulating the practice of nursing in each state b) Evaluate nursing license applications, renew licenses, decides the scope of practice for nurses in their jurisdiction, and handle any disciplinary actions for nursing practice violations 15) What is the Nurse Practice Act? (Slide 16 on Module 1 PP AND Basic Nursing: Thinking, Doing, Caring pg 12) Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 a) A compilation of laws that govern the practice of nursing and empower a state board of nursing to oversee and regulate nursing practice i) Regulated by each State Board of Nursing 16) What is cultural awareness? (Slides 33/34/35 on Module 2 PP AND Basic Nursing: Thinking, Doing, Caring pg 299/300) a) Definition: Perceiving cultural beliefs, values, and customs to understand how they shape a person’s decisions/behavior b) Responding to a client’s cultural health practices i) Cultural Awareness: An appreciation of the external signs of diversity ii) Cultural Sensitivity: An awareness/knowledge of the uniqueness of other cultures iii) Cultural Competence: The ability to effectively incorporate culture into the provision of care; shows respect/accepts differences/empower decision making iv) Negotiation: The patient’s perspective may differ from yours about the effects of a particular practice; Negotiation acknowledges that gap v) Repatterning/Restructuring: When you attempt to change your actions or your patient’s lifestyle while still respecting their cultural values/beliefs 17) What are body mass index ranges (underweight, healthy, overweight, obese) (Slide 14 on Module 2 PP IN NUR216) a) BMI: A measure of body fat based on height and weight that applies to adult women and men 18) What is the wellness-illness continuum (Slide 7/8 on Module 2 PP AND Basic Nursing: Thinking, Doing, Caring pg 185) a) Wellness-illness continuum: A gradient that helps describe the varied and dynamic nature of human health i) Components that influence the wellness-illness continuum: Biological factors, nutrition, physical activity, meaningful work, sleep/rest, culture, Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 family relationships, lifestyle choices (smoking and alcohol), finances, environment, and religion/spirituality ii) *Nurse should encourage health promotion/health restoring characteristics within the limits of the patient’s specific illness 19) What immunizations are recommended for older adults? (Fundamentals of Nursing, CH. 24) a) Middle adults (35-65): Annual influenza, tetanus, diphtheria, zoster, pneumococcal, and pertussis b) **FOR THE TEST: Prof Leach said we ONLY need to memorize flu and pneumonia vaccines!** 20) What is Healthy People 2030? (Slide 39 on Module 2 PP) a) It’s a national initiative that establishes goals to reduce preventable health risks; It addresses the effect of lifestyle on health and eliminates health disparities; Creates health improvement goals 21) What are the differences in interventions that are least restrictive or invasive vs most restrictive or invasive (Slide 21 on Module 1 PP) a) Least Restrictive/Invasive: Always used first; Ensures safety of the patient i) Use toileting schedule VS putting in an indwelling catheter ii) Get a sitter VS applying restraints iii) Use non-pharmacological measures VS giving opiates for mild pain iv) Healthy diet VS weight loss surgery 22) What is delegation? (Slide 12 on Module 1 PP AND Basic Nursing: Thinking, Doing Caring 77 pg) Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 a) When the RN, who holds the authority for nursing care delivery, transfers responsibility for the performance of a task to a nursing assistive personnel while still retaining accountability for a safe outcome i) Delegating is NOT the same as assigning 23) What are the 5 rights of delegation? (Slide 13 on Module 1 PP AND Basic Nursing: Thinking, Doing, Caring pg 77) a) Right Task: Can I delegate that? b) Right Circumstance: Should I delegate that? c) Right Direction and Communication: What does the UAP (Unlicensed Assistive Personnel) need to know? d) Right Person: Who is best prepared to do that? e) Right Supervision: How will I follow up? 24) What types of things can you delegate to assistive personnel? (Slide 12 on Module 1 PP) a) Vital signs on a stable patient b) Feeding/grooming/bathing/toileting a patient c) Turning a patient d) Ambulating a patient e) Stocking supplies f) Secretarial tasks g) *Other types of tasks can be delegated depending on the UAP, facility, and facility policies 25) What does being a client advocate mean? (Basic Nursing: Thinking, Doing, Caring pg 7) a) A function of a nurse; supporting patients’ right to make healthcare decisions when they are able to voice their opinions and protecting patients from harm when they are unable to make decisions 26) Why should we attempt to develop a definition of nursing? (Slide 5 on Module 1 PP) a) Helps the public understand the value of nursing b) Helps differentiate the activities of nursing from those of medicine c) Helps students understand what is expected of them 27) Examples of direct vs indirect care (Basic Nursing: Thinking, Doing, Caring pg 69/74) a) Direct Interventions: Performed through interactions with the patient i) Physical care, Emotional support, Patient teaching b) Indirect Interventions: Performed away from the patient but on behalf of the patient i) Advocacy, Making referrals, Getting second opinions, Managing the environment surrounding the patient Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 28) What is self-concept? (Slides 17/18/19 on Module 2 PP AND Basic Nursing: Thinking, Doing, Caring pg 240) a) Self-concept: Overall view of self; forms out of a person’s evaluation of his/her/their characteristics i) Physical appearance, sexual performance, intellectual abilities, success in the workplace, friendships, unique talents, and problem-solving/coping abilities ii) Components of self-concept: Body image, self-esteem, role performance, and personal identity b) Examples of issues with self-concept i) Factors that affect self-concept: gender, family, developmental level, socioeconomic status, locus of control, and peer relationships 29) What is the ANA Code of Ethics? (Basic Nursing: Thinking, Doing, and Caring pg 12) a) ANA provides guidelines of acceptable and unacceptable behaviors for how nurses should conduct themselves in their day-to-day practice b) **Also reference questions 4 and 13** 30) What is the purpose of health screenings? (Slide 39 on Module 2 PP) a) Motivated by the desire to increase well-being (health promotion); meant to detect disease at an early stage 31) How do people typically define illness? (Slide 4 on Module 2 PP) a) Illness: A change in the way they feel/a disruption of their typical life i) Usually described in terms of how it makes a person feel ii) Health and illness are influenced by a patient’s attitude and lifestyle choices 32) Assessment of a non-English-speaking patient (Basic Nursing: Thinking, Doing, Caring pg 300) a) How to communicate with a non-English-speaking patient i) Facility interpreter ii) Internet/computer translation software iii) Translator iv) **DO NOT USE: patient’s family member or hospital staff not formally trained as an interpreter 33) What are the characteristics of vulnerable populations? (Slide 28 on Module 2 PP AND Basic Nursing: Thinking, Doing, Caring pg 294) a) Vulnerable Populations: Groups that are more likely to develop health problems and experience poorer outcomes due to limited access to care, high-risk behaviors, and/or multiple and cumulative stressors (experiencing homelessness, mental illness, economic instability, etc.) Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 b) Characteristics (subgroups): Homeless, poor, mentally ill, young, elderly, people with physical disabilities, some ethnic and racial minorities 34) Fall risk education (Slide 46 on Module 2 PP AND Basic Nursing: Thinking, Doing, Caring pg 710) a) Morse Fall Scale: A rapid and simple method of assessing a patient’s likelihood of falling i) https://networkofcare.org/library/Morse%20Fall%20Scale.pdf b) Ways to reduce fall risk: remove throw rugs/cords/trip hazards, using a shower chair, grab bars, non-skid bathroom mats, mobility aids (canes), non-slip socks, “fall risk” band, sign on door, and bed/chair alarm 35) When to do a fall risk assessment (Slide 46 on Module 2 PP AND Basic Nursing: Thinking, Doing, Caring pg 19) a) For all clients at admission and at regular intervals 36) Who are interprofessional team members? (Slide 27 on Module 1 PP AND Basic Nursing: Think, Doing, Caring pg 16) a) Nurses: Asses patients, administer meds/treatments, provide education, and modify care plans based on patient’s response to treatment i) **Licensed Practical Nurse: Work under RN supervision to provide non- complex care, administer certain meds, and communicate patient’s responses b) Nurse Practitioners: Independent practitioners with advanced education/training and are licensed to provide a broad range of medical/nursing care based on their specialty area i) Nursing Assistive Personnel: Unlicensed assistive personnel (nursing assistants, aides, and techs) provide custodial care under the direction of nurses/providers in a variety of settings c) Physicians: Licensed medical doctors (MD) or doctors of osteopathy (DO); primary role is to diagnose/treat a disease/illness through medical and surgical services i) Physician Assistant: Practice under a Physician to diagnose and prescribe treatments/meds to treat certain illnesses/diseases d) PT/OT/Speech Therapy: Focus on a variety of rehab needs to the patient; goal is to treat and maximize functioning and/or help the patient adapt to limitations and achieve optimal outcomes i) Respiratory Therapy: Provide prescribed treatments for effective respiration and ventilation e) Lab: Run diagnostic tests ordered by doctors in a variety of healthcare settings i) Radiology Techs: Run diagnostic testing/activities related to chemotherapy Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 f) Case Managers/Social Workers: Provide psychosocial support, patient services, and coordinate continuity of care for patients after discharge g) **Pharmacists: Prepare/dispense meds and therapeutic solutions in various healthcare settings h) **Registered Dieticians/Licensed Nutritionists: Apply specialized knowledge of nutrition science to plan food treatments/goals to promote patient health or treat illness i) **Spiritual Care Providers: Organized religious services, patient visits, and family/staff support; particularly in serious illness and end-of-life care j) **Alternative Care Providers: Chiropractors, Herbalists, and Naturopaths offer health services that are primarily outside of the traditional healthcare system 37) Home safety measures (fire, fall hazard, etc.) (Slide 44 on Module 2 PP AND Basic Nursing: Thinking, Doing, Caring pgs 702/703) a) Common safety hazards in the home: Poisoning, carbon monoxide exposure, scalds/burns, fires (smoking, heating equipment, home oxygen administration equipment, unsupervised children, unmonitored candles, faulty wiring), falls, firearm injuries, suffocation/asphyxiation, take-home toxins (bugs, dust, dirty clothes) b) Home Safety Teaching: Smoke alarms/carbon monoxide detectors, safe medication/poison storage, wear a seatbelt, wear a helmet, secure firearms, and label faucets hot/cold 38) Hospital safety measures (RACE, seizure precautions, fall precautions) (Slides 45/46 on Module 2 PP AND Basic Nursing: Thinking, Doing, Caring pg 705) a) RACE: i) Rescue: move clients to a safe area ii) Alarm: Call EMS, pull fire alarm, alert others iii) Contain: Closing doors, turning off Oxygen iv) Extinguish: Using fire Extinguishers b) Seizure Precautions: i) Make sure rescue equipment is available (padding, Oxygen, suction) ii) Stay with the patient and call for help iii) Lower to the floor/bed and protect the head iv) Do NOT restraint v) Do NOT place anything into the mouth c) Fall Precautions: **Same as question 34** i) Remove throw rugs/cords/trip hazards ii) Using a shower chair and grab bars and non-skid bathroom mats iii) Use mobility aids (canes) iv) Use non-slip socks v) Patient wear “fall risk” band vi) Place sign on door Downloaded by angel agramont ([email protected]) lOMoARcPSD|28287070 vii) Have bed/chair alarm Downloaded by angel agramont ([email protected])

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