Episode Notes: Prioritizing Critical Nursing Care & Assessment

1. Normal Aging: What Is Expected

Less subcutaneous fat

Presbycusis (age-related high-frequency hearing loss)

Reduced vital capacity → gets breathless more easily

Slower gait, unsteady movement

Slower cognitive processing

Mild recent-memory decline

Key nursing actions:

Monitor intake and output

Be cautious with medications cleared by kidneys

Give simple, step-by-step instructions

Assess social support and isolation risk

EN-klex trap:

“Increased gait speed” = NOT normal aging

“Intact recent memory” in older adults = distractor

2. Immediate Safety First: Environmental Fixes Before Anything Else

Scenario: Older adult climbing over raised bed rails
First action: Lower the entire bed

Why:

Fastest way to prevent injury

Environmental change beats calling for help or meds

Restraints require an order and take time

3. Maslow Priority: Physical Beats Psychosocial Every Time

Scenario: Client is sad and lonely but blood pressure is extremely high
First priority: Address the physical threat → recheck BP for accuracy

Reason: Physical instability always beats emotional distress.

4. Postpartum Priority Sequence (Non-Negotiable Order)

Check the fundus — must be firm, midline

Assess lochia — evaluate bleeding

Pain medication

Ambulation

Why: Hemorrhage is the most preventable cause of postpartum death.
Bleeding always comes before pain.

Fundus expectations immediately after birth:

Firm (grapefruit-like)

Midline

At the level of the umbilicus

Drops one finger-width per day

5. Pediatric Development Milestones

Erikson Examples:

Toddler: Autonomy vs. shame → “NO” stage

Middle adult: Generativity vs. stagnation

Language milestones:

12 months: 1–3 specific words (“mama,” “dada”)

15 months: Same range still acceptable

Preschool thinking:

Imaginary friends = normal

Centration = focuses on one aspect only

Square copying and fully clear speech → later stages

Moro reflex:

Should disappear by 3–4 months

Persistence → neurological red flag

6. Prevention Levels (Know These Cold)

Primary: Prevents disease (vaccines)

Secondary: Early detection (mammograms, colonoscopy, screening CT)

Tertiary: Manage complications (rehab, chronic care)

TDap pregnancy timing:

Give between 27–36 weeks for passive newborn protection

Lung cancer screening:

Ages 50–80

Twenty pack-year history

Current smoker OR quit within last 15 years

Annual low-dose CT

7. Physical Assessment Rules

Abdomen (Strict Order):

Inspect

Listen

Percuss

Palpate

Reason: Touching stimulates bowels → false readings.

Breath sounds:

Vesicular = heard best in lung periphery

Blood pressure cuff sizing:

Bladder should cover 80% of upper arm circumference

Too small → falsely high

Too large → falsely low

Capillary refill:

Slow if:

Cold

Dehydrated

Poor circulation
Not usually slowed by high blood pressure.

8. Delegation: What the UAP Can Do

UAP CAN:

Basic hygiene

Meals

Ambulation assistance

Newborn bath

UAP CANNOT:

Fundal assessment

Lochia assessment

Any evaluation

Any teaching

Anything requiring clinical judgment

RN always keeps assessment, evaluation, and teaching.

9. Orem’s Self-Care Theory

Scenario: Client has the skills + knowledge to change a colostomy bag but refuses to look at the stoma.
Deficit: Motivation deficit → needs emotional support, not more teaching.

10. Priority Themes Throughout the Episode

Safety before comfort

Environment adjustments before interventions

Physical danger beats psychosocial needs

Bleeding beats pain

Assessment before action

Rationale behind every step

Think like a nurse, not a task robot

Need to reach out? Send an email to Brooke at [email protected]