A community health nurse is planning to offer community programs that benefit as many clients as possible. Which of the following ethical principles should the nurse use to guide their planning?

Rationale for correct choices:

• DTR 2+ bilaterally: This is within the normal range and shows recovery from previous central nervous system depression caused by magnesium sulfate toxicity, which earlier caused a drop to 1+.
• Urine output 40 mL in the last hour: Output is improving from the prior 20 mL/hr, suggesting better renal perfusion and clearance of magnesium. Adequate urine output is critical to prevent accumulation and toxicity.
• Oxygen saturation 95% on 2 L nasal cannula: This value meets the prescribed goal and reflects stabilized respiratory function after earlier shallow breathing. It indicates successful oxygenation support.

Rationale for incorrect choices:

• Temperature 38.3° C (101° F): This is an elevated temperature and may indicate systemic infection or inflammation. It does not support an improvement in condition and warrants monitoring.
• Heart rate 58/min: This is bradycardia and could indicate lingering effects of magnesium toxicity or a vagal response. It does not reflect improvement and needs further assessment.
• Blood pressure 146/96 mm Hg: Although slightly lower than the earlier reading of 170/112 mm Hg, it is still in the hypertensive range and does not signify resolution of preeclampsia or stabilization.

Rationale:

A. Nurses notes are used to create the critical pathway: Critical pathways are developed from evidence-based clinical guidelines and best practices, not directly from nurses’ notes. While documentation may help track progress, it is not the foundation for pathway creation.

B. Critical pathways should reduce health care costs: Critical pathways standardize care for specific diagnoses, promoting timely interventions and reducing unnecessary treatments or delays. This efficiency helps lower healthcare costs while improving patient outcomes.

C. Critical pathways have an unlimited timeframe for completion: Each critical pathway includes a defined timeline with expected outcomes for each phase of care. This structure ensures care is efficient and progress is monitored closely to prevent delays or complications.

D. Nurses should discontinue the critical pathway if variances occur: Variances are deviations from the expected outcomes and are used to evaluate and adjust care. They do not justify discontinuing the entire pathway but rather indicate a need for reassessment or individualized modifications.