recent lab values or other diagnostics tests
Recognising signs and symptoms of patient
Downloaded from https://journals.lww.com/nursingmadeincrediblyeasy by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3K8IvHCABgh8kcl0W4j+iPnatBCwbiq3a2s9nkszY3Ek= on 02/24/2019
Felton M.
completed.
To the rescue
The ability to quickly and accurately detect
subtle changes in your patient’s condition
aids in early identification of deterioration,
leading to improved patient outcomes. As
discussed, using a systems approach to as-
sessment can help you determine the com-
mon signs and symptoms experienced by
deteriorating patients. Through communi-
cation of your findings using the SBAR
technique, you’ll be able to intervene and
provide timely care to your patients. ■
REFERENCES
Bell-Gordon C, Gigliotti E, Mitchell K. An evidence-based
practice project for recognition of clinical deterioration:
utilization of simulation-based education. J Nurs Educ
Pract. 2014;4(6):69-76.
Boling B, Hardin-Pierce M. The effect of high-fidelity
simulation on knowledge and confidence in critical
care training: an integrative review. Nurse Educ Pract.
2016;16(1):287-293.
For more than 118 additional continuing education articles related to
med-surg topics, go to NursingCenter.com/CE.
Something isn’t right: The subtle changes of early deterioration
TEST INSTRUCTIONS
• To take the test online, go to our secure
web site at www.nursingcenter.com/CE/nmie.
• On the print form, record your answers in the test
answer section of the CE enrollment form on page 56.
Each question has only one correct answer. You may
make copies of these forms.
• Complete the registration information and course
evaluation. Mail the completed form and registration
fee of $12.95 to: Lippincott Williams & Wilkins, CE Group,
74 Brick Blvd., Bldg. 4, Suite 206, Brick, NJ 08723.
We will mail your certificate in 4 to 6 weeks. For faster
service, include a fax number and we will fax your
certificate within 2 business days of receiving your
enrollment form.
• You will receive your CE certificate of earned
contact hours and an answer key to review
your results.
• Registration deadline is February 28, 2019.
www.NursingMadeIncrediblyEasy.com
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
deterioration. Emerg Nurse. 2012;20(8):23-27.
Hallenbeck VJ. Use of high-fidelity simulation for staff
education/development: a systematic review of the litera-
ture. J Nurses Staff Dev. 2012;28(6):260-269.
Hommes T. Implementation of simulation to improve
staff nurse education. J Nurses Prof Dev. 2014;30(2):66-69.
Liaw SY, Rethans JJ, Scherpbier A, Piyanee KY. Rescuing a
patient in deteriorating situations (RAPIDS): a simulation-
based educational program on recognizing, responding
and reporting of physiological signs of deterioration.
Resuscitation. 2011;82(9):1224-1230.
National Patient Safety Agency. Recognising and
responding appropriately to early signs of deteriora-
tion in hospitalised patients. www.nrls.npsa.nhs.uk/
resources/?entryid45=59834.
Safer Healthcare. Why is SBAR communication so critical?
www.saferhealthcare.com/sbar/what-is-sbar/.
Schubert CR. Effect of simulation on nursing knowledge
and critical thinking in failure to rescue events. J Contin
Educ Nurs. 2012;43(10):467-471.
At Surrey Memorial Hospital, Fraser Health Authority, in Surrey, B.C.,
Canada, Sarah Crowe is a Critical Care Clinical Nurse Specialist,
Lisa Ewart is a Simulation Educator, and Sarah Derman is a Pain
Management Clinical Nurse Specialist.
The authors and planners have disclosed no potential conflicts of
interest, financial or otherwise.
DOI-10.1097/01.NME.0000508537.59047.b3
Earn CE credit online:
Go to www.nursingcenter.com/CE/nmie
and receive a certificate within minutes.
INSTRUCTIONS
DISCOUNTS and CUSTOMER SERVICE
• Send two or more tests in any nursing journal published by Lippincott
Williams & Wilkins together by mail and deduct $0.95 from the price
of each test.
• We also offer CE accounts for hospitals and other health care facilities on
nursingcenter.com. Call 1-800-787-8985 for details.
PROVIDER ACCREDITATION
Lippincott Williams & Wilkins, publisher of Nursing made Incredibly Easy!, will
award 1.0 contact hours for this continuing nursing education activity.
Lippincott Williams & Wilkins is accredited as a provider of continu-
ing nursing education by the American Nurses Credentialing Center’s
Commission on Accreditation.
This activity is also provider approved by the California Board of
Registered Nursing, Provider Number CEP 11749 for 1.0 contact hours.
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Broker #50-1223.
Your certificate is valid in all states.
January/February 2017 Nursing made Incredibly Easy! 41
 1.0
ANCC CONTACT HOURS

Something isn’t right: The subtle changes of early deterioration

GENERAL PURPOSE: To provide information about how to assess early signs of patient deterioration using a systems approach.
LEARNING OBJECTIVES/OUTCOMES: After completing this continuing-education activity, you should be able to: 1. Identify ways to
strengthen assessment skills and communicate findings effectively. 2. Recognize subtle signs of patient deterioration.

1. A reason for delayed recognition of patient deterioration 12. Which breath sound is caused by fluid or mucus in a
is a lack of larger airway?
a. confidence in assessment skills. a. coarse crackles
b. staffing. b. rhonchi
c. time. c. stridor
2. Understanding which patient is at greater risk for dete- 13. When assessing a patient’s work of breathing, the nurse
rioration will help the nurse anticipate potential problems should take note of
and a. the patient’s positioning.
a. plan care. b. coughing effectiveness.
b. prioritize care. c. abdominal guarding.
c. provide care.
14. All of the following are signs of respiratory distress
3. Which assessment strategy centers on the body system except
related to the admitting problem or diagnosis? a. unproductive cough.
a. focused b. nasal flaring.
b. head-to-toe c. pursed-lip breathing.
c. systems
15. Hypoactive bowel sounds may indicate an
4. Subtle clues of deterioration may go unnoticed when the a. abdominal mass.
nurse uses which assessment strategy? b. infectious process.
a. focused c. inflammatory process.
b. head-to-toe
c. systems 16. An important part of communicating patient findings is to
a. communicate quickly.
5. Recognizing when a patient’s status has changed can be b. keep it brief.
assisted by having a clear understanding of his or her c. use specific language.
a. baseline status.
b. comorbidities. 17. The “S” in the SBAR communication tool stands for
c. past medical history. a. signs and symptoms.
b. situation.
6. A change in which of the following is one of the earliest c. surgeries.
signs that a patient’s condition may be deteriorating?
a. BP 18. The “R” in the SBAR communication tool stands for
b. LOC a. recent vital signs.
c. respiratory rate b. recommendation.
c. what’s happening right now.
7. Which is a characteristic of delirium?
a. clear LOC
b. impaired attention span
c. normal psychomotor skills
8. Which can be an early sign of hypoxia?
a. depression
b. fatigue
c. restlessness
9. Which can be a sign of severe hypoxia?
a. dilated pupils
b. pinpoint pupils
c. unequal pupils
10. Which pupillary response is most indicative of signifi-
cant brain injury and poor outcomes?
a. inequality in size
b. pinpoint size
c. unreactive to light
11. When evaluating vital signs, which of the following best
signals early deterioration?
a. vital signs outside normal values
b. abnormal baseline values
c. trends over time

Go
Goto
topage
page54
56for
forthe
theCE
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enrollmentform.
form.

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CE ENROLLMENT FORM Nursing made Incredibly Easy! January/February 2017
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Help for patients with borderline personality disorder (page 26)

B. Test Answers: Darken one circle for your answer to each question.

a b c a b c a b c a b c a b c Registration deadline:
1. ❍ ❍ ❍ 5. ❍ ❍ ❍ 9. ❍ ❍ ❍ 13. ❍ ❍ ❍ 17. ❍ ❍ ❍ February 28, 2019
2. ❍ ❍ ❍ 6. ❍ ❍ ❍ 10. ❍ ❍ ❍ 14. ❍ ❍ ❍ 18. ❍ ❍ ❍ Contact hours: 1.0
3. ❍ ❍ ❍ 7. ❍ ❍ ❍ 11. ❍ ❍ ❍ 15. ❍ ❍ ❍ Fee: $12.95
4. ❍ ❍ ❍ 8. ❍ ❍ ❍ 12. ❍ ❍ ❍ 16. ❍ ❍ ❍ Test code: NMIE0117B
C. Course Evaluation*
1. Did this CE activity’s learning objectives relate to its general purpose? ❑ Yes ❑ No 4. How long in minutes did it take you to read the article ______ , study the material ______ ,
2. Was the journal home study format an effective way to present the material? ❑ Yes ❑ No and take the test ______?
3. Was the content relevant to your nursing practice? ❑ Yes ❑ No 5. Suggestion for future topics _________________________________________________________
___________________________

Something isn’t right: The subtle changes of early deterioration (page 34)
B. Test Answers: Darken one circle for your answer to each question.

a b c a b c a b c a b c a b c Registration deadline:
1. ❍ ❍ ❍ 5. ❍ ❍ ❍ 9. ❍ ❍ ❍ 13. ❍ ❍ ❍ 17. ❍ ❍ ❍ February 28, 2019
2. ❍ ❍ ❍ 6. ❍ ❍ ❍ 10. ❍ ❍ ❍ 14. ❍ ❍ ❍ 18. ❍ ❍ ❍ Contact hours: 1.0
3. ❍ ❍ ❍ 7. ❍ ❍ ❍ 11. ❍ ❍ ❍ 15. ❍ ❍ ❍ Fee: $12.95
4. ❍ ❍ ❍ 8. ❍ ❍ ❍ 12. ❍ ❍ ❍ 16. ❍ ❍ ❍ Test code: NMIE0117A
C. Course Evaluation*
1. Did this CE activity’s learning objectives relate to its general purpose? ❑ Yes ❑ No 4. How long in minutes did it take you to read the article ______ , study the material ______ ,
2. Was the journal home study format an effective way to present the material? ❑ Yes ❑ No and take the test ______?
3. Was the content relevant to your nursing practice? ❑ Yes ❑ No 5. Suggestion for future topics _________________________________________________________
___________________________

D. Two Easy Ways to Pay: Mail completed test with registration fee to: Lippincott Williams & Wilkins,
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❑ Charge my ❑ Mastercard ❑ Visa ❑ American Express
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