A nurse is caring for a client being transferred from an acute care setting to a long-term care facility. Which information should the nurse include in the transfer report? Select All That Apply.

Suspected drug diversion is a critical regulatory and safety concern where a healthcare professional misappropriates controlled substances intended for patient use. The nurse manager must balance due process with the immediate need to protect patients from untreated pain and potential harm. Initial management focuses on the objective collection of corroborative evidence to substantiate claims of impairment or theft before initiating formal confrontation or disciplinary reporting procedures.

Rationale:

A. Educating the staff about addiction is a proactive preventative measure but does not address the acute suspicion of active drug theft. The manager must first determine if a specific violation has occurred before implementing broad educational interventions for the unit. Addressing the immediate safety risk to patients takes precedence over general staff development during an active investigation.

B. Approaching the nurse without sufficient evidence can lead to the concealment of further proof or defensive behavior that compromises the investigation. A formal meeting should only occur after the manager has reviewed objective data, such as medication administration records and witness statements. Premature confrontation may alert an impaired individual, allowing them to bypass safety controls.

C. Referring a nurse to a diversion program is a rehabilitative step that occurs only after the suspicion of substance abuse has been confirmed through an internal audit. The manager lacks the authority or evidence to mandate such a program based solely on hearsay from an unlicensed staff member. Proper investigative protocols must be satisfied before involving external regulatory bodies or boards.

D. The manager’s first priority is to conduct a comprehensive audit of the nurse’s narcotic records, patient pain assessments, and patterns of absenteeism. This data collection phase provides the factual foundation necessary to identify discrepancies between documented care and actual patient experiences. Gathering evidence ensures that subsequent actions are legally sound and clinically justified to protect patient welfare.

Thrombocytopenia is characterized by reduced platelet count <150000/mm3 causing impaired primary hemostasis. Bone marrow suppression, petechiae, mucosal bleeding, and prolonged bleeding time occur, increasing hemorrhage risk with minor trauma including invasive procedures like rectal instrumentation.

Rationale:

A. Rectal temperature is not specifically contraindicated after an ileostomy because the rectum is typically bypassed but not traumatized. Risk is lower unless active inflammation or surgical complications exist. Focus is on stoma care and preventing infection and skin breakdown.

B. Rectal temperature is contraindicated in thrombocytopenia due to high risk of mucosal trauma and bleeding. Fragile rectal mucosa can easily hemorrhage with minor insertion. Avoid all rectal procedures to prevent hemorrhage and worsening platelet deficiency complications.

C. A productive cough with oxygen therapy does not contraindicate rectal temperature measurement. There is no direct bleeding or mucosal integrity issue. Priority is maintaining airway clearance and adequate oxygenation while monitoring respiratory status, not avoiding rectal routes.

D. Hypothermia does not inherently contraindicate rectal temperature measurement; in fact, rectal temperature may provide accurate core readings. Care focuses on gradual rewarming and preventing complications like arrhythmias and metabolic acidosis, not bleeding risk.