Reduction of Risk Potential
Reduction of Risk Potential
This domain tests recognition of deterioration, prevention of complications, preoperative and postoperative care, laboratory monitoring, specimen collection, and safe transitions. The exam asks which finding is most concerning and what action prevents harm.
Risk assessment and monitoring
- Screen for falls, pressure injury, VTE, malnutrition, and delirium on admission and when condition changes.
- Use an early warning score; a rising respiratory rate, heart rate, or falling blood pressure and urine output signal deterioration.
- Postoperative fever timing: days 1-2 atelectasis; days 3-5 urinary tract infection; days 5-7 wound infection; after day 7 consider deep vein thrombosis.
- Know common values: potassium 3.5-5.0 mmol/L, sodium 135-145 mmol/L, fasting glucose about 4-7 mmol/L, and hemoglobin trends.
Procedures and transitions
- Preoperative: verify consent, allergies, NPO status, marking, and baseline vital signs.
- Postoperative: deep breathing and coughing every 1-2 hours, incentive spirometry 10 breaths per hour, early ambulation, pain control, and wound assessment.
- Collect specimens using sterile technique; label at the bedside; send promptly.
- Discharge: medication reconciliation, teach-back, follow-up appointments, and warning signs to report.
Worked example
On postoperative day 2, a client has a heart rate of 112, respiratory rate of 28, temperature of 37.9 C, and decreased breath sounds at the bases. The PN suspects atelectasis rather than wound infection. The PN assists the client to sit up, coaches deep breathing and coughing, uses the incentive spirometer, encourages ambulation, and notifies the provider. The PN documents the findings and interventions.
Traps that cost marks
- Assuming every postoperative fever is a wound infection.
- Ignoring a rising respiratory rate because the oxygen saturation is still acceptable.
- Discharging a client without confirming medication understanding.
- Sending an unlabelled specimen or delaying transport.
- Ambulating a client before assessing orthostatic vital signs when indicated.