Patient Assessment and Clinical Skills Flashcards

What is the DHA protocol for blood glucose monitoring in hospitalized patients?

Answer: Monitor before meals and at bedtime for diabetic patients, with additional checks for insulin drips or symptomatic patients

DHA protocols require blood glucose monitoring before meals and at bedtime for diabetic patients, with more frequent monitoring (every 1-2 hours) for patients on insulin infusions or experiencing glycemic instability.

How should a DHA nurse perform a pain assessment for a non-verbal patient?

Answer: Use behavioral pain assessment tools such as the FLACC scale or CPOT, observing facial expressions, body movements, and vital signs

For non-verbal patients, DHA nurses use validated behavioral pain assessment tools (FLACC, CPOT, BPS) that evaluate facial expressions, body movements, muscle tension, and physiological indicators.

What is the DHA standard for patient identification before medication administration?

Answer: Using at least two patient identifiers such as full name and medical record number, verified against the medication order and ID band

DHA patient safety standards require verification of at least two identifiers (typically full name and medical record number/date of birth) against the medication order and patient ID band before any medication administration.

What is the DHA nursing protocol for assessing a patient's fall risk?

Answer: Use a validated fall risk assessment tool on admission, after a fall, with any change in condition, and at regular intervals

DHA requires fall risk assessment using validated tools (such as the Morse Fall Scale) on admission, after any fall event, whenever the patient's condition changes, and at regular intervals throughout hospitalization.

How should a DHA nurse assess and document fluid balance?

Answer: Accurately measure and record all fluid intake and output including oral, IV, urine, drainage, and insensible losses

DHA standards require accurate measurement and documentation of all fluid intake (oral, IV, enteral) and output (urine, drainage, vomiting, wound output) to maintain an accurate fluid balance record.

What is the DHA protocol for monitoring patients receiving blood transfusions?

Answer: Monitor vital signs at baseline, 15 minutes, 30 minutes, hourly during transfusion, and post-transfusion, watching for transfusion reactions

DHA blood transfusion monitoring requires vital signs at baseline, 15 minutes after starting, then at 30-minute to hourly intervals during the transfusion, and after completion, with continuous observation for reactions.