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Certified Practice: DST Update | Remote Nursing

Remote Nursing

Posted April 12, 2017

The CRNBC certified practice decision support tools (DSTs) undergo a regular review to ensure they reflect current evidence for the certified practice areas. The process includes a systematic review and update by clinical experts, feedback from nurses who use the DSTs, and approval by the CRNBC Certified Practices Approval Committee.

Revisions to the following Remote Nursing DSTs are effective immediately and are now posted on the CRNBC website. Be sure to replace previous versions of DSTs with the revised versions.

Please see below for a summary of the changes.

Email if you have questions.

Ear Nose and Throat Assessment—Adult

Medical History (Specific to ENT):

  • New bullet: chronic cough

Rationale: Chronic cough is noted to be a part of history taking and may be associated with ceruminosis, and ENT infections.

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Acute Otitis Media—Adult

Client Information and Discharge Education:

  • Expanded 4th bullet, include reference to scuba diving
    Rationale: Providing most common causes of barotrauma to include as relevant history for ENT
  • Added new bullet: counsel to stop smoking
    Rationale: Preventive education to decrease risk of ENT infections, specifically AOM.

Access the revised DST


Typical Findings of Ceruminosis, History:

  • Add 1. Reflex cough, 2. Dizziness.

Rationale: Significant history elements for ceruminosis, signs of impaction, neurogenic stimulation of the vagus nerve may cause both findings, therefore value add to History specific to ceruminosis.

Physical Assessment:

  • Add new bullet: partial/complete obstruction of ear canal by cerumen.

Rationale: Patients may be symptomatic with either partial or complete obstruction, therefore value add.

Client Information and Discharge Education:

  • Expand 3rd bullet, adding the extension 'for ear hygiene' adds to applicability and uptake of the information for reader; cotton swabs may be used for other types of hygiene, added language to focus comprehension
  • Add new bullet: weekly irrigation…alcohol…

Rationale: This has been reported as an effective method to prevent cerumen build up, alternative recommendation for health education.

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Ear Nose and Throat Assessment—Pediatric


  • Expanded 2nd bullet to add guidance to inspect tissue for local findings of infection or malignancy

Rationale: Added inspection detail may promote assessment of mastoid area changes associated with infection or malignancy- may be complications of acute otitis media

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Acute Otitis Media—Pediatric


  • Added new bullet: anorexia

Rationale: Significant history element in pediatric assessment for dental abscess; dental issues are associated with anorexia

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Acute Bronchitis—Adult


  • Added 'Dyspnea on exertion may be present'

Rationale: alerts nurse to assess for the additional characteristic of exertional dyspnea which is reported in some patients with acute bronchitis

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GI GU Assessment—Adult

Cardinal Signs and Symptoms, Nausea and Vomiting:

  • 3rd bullet expanded re: hematemesis to include "red or coffee ground".

Rationale: alerts nurse to assess for the additional characteristics of hematemesis; it may present as either fresh blood [upper GI] or digested blood [lower GI] and the descriptors (red or coffee ground) allow for improved identification of pertinent signs of GI bleeding.

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Lower UTI Infection—Adult

Diagnostic Tests:

  • Incorporation into considerations for urine C&S: this is suspected treatment failure
  • Using the term 'treatment failure' is a clinical descriptor for an unresolved infection where the client presents back with persistent symptoms, i.e. persistence of the UTI signs and symptoms related to the infection – it is not addressed by the criteria for Urine C&S currently in the DST content

Rationale: variable resistance and response patterns to standard therapy are noted in the literature. Given the scope of the DST a patient may return with treatment failure and require a C&S to receive appropriate subsequent antimicrobial therapy.

Client Education and Discharge Information:

  • Addition of information regarding behavioural measures –as per Society of Obstetrics and Gynecologists of Canada 'Advise alternative contraceptives, avoid spermicides'

Rationale: spermicide use has been linked with UTIs; the proposed understanding is that the spermicides have varying impact on the normal bacterial of the vagina, leading to an overgrowth of bacteria that lead to infections. As such, detailed information on alternative contraception is of benefit to the target group of young sexually active women.

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Pharyngitis Sore Throat—Pediatric

Potential Complications:

  • Added to current content: 1. Pneumonia, 2. Bacterial meningitis

Rationale: Significant complications of pharyngitis, cited in several sources

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Dental Abscess—Adult

Physical Assessment:

  • Added to current content: 1. Breath odour, 2. Fever

Rationale: Additional assessment elements for dental abscess, signs of dental infection, therefore value add. Note, repetition in Hx and Physical Assess. Section, but key finding.

Pharmacologic Interventions

Potential Complications:

  • Added new bullet: sepsis

Rationale: Significant complication of untreated dental abscess

Client Education and Discharge Information:

  • Expanded 2nd bullet, add the extension to limit sugary drinks

Rationale: Provides targeted guidance regarding the type of recommended dietary modifications that will impact the risk of developing a dental abscess

Access the revised DST

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