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Certified Practice: DST Update | RN First Call

RN First Call

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 RN First Call 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 certifiedpractice@crnbc.ca if you have questions.

Eye assessment—Adult

Medical History (Specific to eyes):

  • “Defects” added between Eye diseases or injuries

Rationale: adding ‘defects’ alerts nurse to assess for the specifics of eye anomalies that are most pertinent. Inclusion of defects promotes identification of individuals that present with corneal defects, who are predisposed to recurrent erosions and issues with the surface of the eye.
Symptoms Requiring Urgent Referral:

  • “or bilateral eye pain” added to first bullet
  • “Ocular pain” added as second bullet

Rationale: expand to provide better descriptor, as patients may present with either unilateral or bilateral eye pain that prompts referral as they may indicate pathology.

  • “recent onset” added to sixth bullet to describe floaters

Rationale: alerts nurse to assess for the specific chronicity of floaters: floaters of new onset may indicate acute pathology versus the presence of floaters.

Access the revised DST 

Conjunctivitis—Adult

Common Findings:

  • Streamlined description of pupillary reaction
  • “Papillary reaction normal” deleted

Rationale: applicability. Papillary reaction may be an indicator of viral conjunctivitis, but was misaligned with this DST; term describes conjunctival surface finding and is not described as ‘normal’.

  • Wording added to include ‘known’ and ‘environmental’

Rationale: alerts nurse to consider common allergens when performing history related to conjunctiva

Access the revised DST​

Eye Assessment—Pediatric

Cardinal Signs and Symptoms (Other Associated Symptoms):

  • “squinting or keeping one eye closed in younger children” added as a descriptor for diplopia
  • “observed” added at beginning of above statement

Rationale: addition of content provides age appropriated symptom cues.
Medical History (Specific to eyes):

  • “Defects” added between Eye diseases or injuries

Rationale: alerts nurse to assess for the specific of eye anomalies that are pertinent. Inclusion of defects promotes identification of individuals that present with corneal defects, whom are predisposed to recurrent erosions and issues with the surface of the eye.
Symptoms Requiring Urgent Referral:

  • “or bilateral eye [pain]” added to second bullet
  • “Ocular pain” added
  • “recent onset” added to sixth bullet to describe floaters

Rationale: alerts nurse to assess for the specific chronicity of floaters: floaters of new onset may indicate acute pathology versus the presence of floaters.

Access the revised DST

Conjunctivitis—Pediatric

History (Bacterial and Viral):

  • Revised to include timing of red eye/unilateral or bilateral presentation

Rationale: Improved recognition of the sequencing of presentation for history taking.
Common Findings:

  • Streamlined description of pupillary reaction
  • “Papillary reaction normal” deleted

Rationale: applicability. Papillary reaction may be an indicator of viral conjunctivitis, but seems misaligned with this DST; term describes conjunctival surface finding and is not described as ‘normal’.
Allergic, History:

  • Alternate wording added to include ‘known’ and ‘environmental’

Rationale: alerts nurse to consider common allergens when performing history related to conjunctiva

Access the revised DST
Corneal Abrasion—Pediatric

Potential Causes:

  • “contact lens use” added to bracketed content

Rationale: alerts nurse to consider the most pertinent causes for corneal abrasion. Improper contact lens use may include incorrectly fitting or soiled contact lenses – that introduce sources of trauma, infection or small foreign bodies.
Non-pharmacologic Intervention:

  • “to promote removal” added to first bullet

Rationale: intent of irrigation is the removal of the foreign body – not explicit as an intervention related to corneal abrasion – for clarification of direction, rationale
Client/Caregiver Education and Discharge Information:

  • “Or participating in contact sports” added to fifth bullet

Rationale: provides health teaching relevant to corneal abrasion prevention
Consultation and/or Referral:

  • “There is significant worsening of vision” added

Rationale: vision that worsens is a sign of potentially serious complications and requires referral to a physician or nurse practitioner.

Access the revised DST

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.

Access the revised DST

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

Ear Nose and Throat Assessment—Pediatric

Inspection:

  • 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

Access the revised DST

Acute Otitis Media—Pediatric

​​History:

  • Added new bullet: anorexia

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

Access the revised DST

Pharyngitis Sore Throat—Pediatric

Potential Complications:

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

Rationale: Significant complications of pharyngitis, cited in several sources

Access the revised DST

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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