A nurse manager is planning to teach staff about critical pathways. Which of the following information should the nurse plan to include?
Nurses notes are used to create the critical pathway
Critical pathways should reduce health care costs
Critical pathways have an unlimited timeframe for completion.
Nurses should discontinue the critical pathway if variances occur
The Correct Answer is B
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.
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Correct Answer is D
Explanation
Rationale:
A. Request a change in medication from the provider: Medication adjustments should be based on a full assessment of the child’s symptoms and patterns. Requesting a change prematurely may lead to ineffective or inappropriate treatment.
B. Refer the family to a chronic pain support group: Support groups are helpful for long-term coping and education, but they are not an immediate action. The nurse must first assess the current situation to guide any referrals.
C. Set up an appointment with the school nurse: While school involvement can support symptom management, especially for triggers or academic impact, it is not the initial step. The nurse must first gather complete data on the headaches.
D. Review the child's electronic pain diary: The pain diary provides detailed information about frequency, triggers, intensity, and patterns of the migraines. Reviewing it is the first step to making informed decisions about the child’s care plan.
Correct Answer is C
Explanation
Rationale:
A. Coarse lung sounds: Coarse lung sounds are typically associated with pulmonary issues such as fluid overload or pneumonia. They are not specific to cardiac tamponade and may appear later or not at all in this condition.
B. Widening pulse pressure: Cardiac tamponade causes narrowing of the pulse pressure due to decreased stroke volume, not widening. A narrowing pulse pressure is a more reliable hemodynamic sign of tamponade.
C. Muffled heart sounds: Muffled or distant heart sounds are a classic early sign of cardiac tamponade. They result from fluid accumulation in the pericardial sac, which insulates the heart and dampens the transmission of sound.
D. Decreased jugular vein distention: Cardiac tamponade typically causes increased jugular vein distention due to impaired venous return to the heart. A decrease in JVD would not be expected and may indicate a different process.
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