Record the client’s vital signs on a flow sheet every 4 hours.This is because charting by exception (CBE) documentation is a system that only requires the nurse to document deviations from predefined norms or standards of care.

Therefore, the nurse only needs to record routine data such as vital signs on a flow sheet and does not need to write a narrative note for every nursing intervention performed (B), document the client’s response to antibiotics in the progress notes ©, or refer to the agency’s standards of care for routine procedures (D).These actions are unnecessary and time-consuming in CBE documentation, as they would duplicate information that is already available in the electronic health record (EHR) or the agency’s policies.CBE documentation is designed to decrease the amount of time required to document care and to improve the quality and accuracy of patient records.

The client’s medical history and current medications, and the results of the client’s electrocardiogram and cardiac enzymes are information that the nurse should expect to find in the EHR of a client who is admitted for chest pain.These are essential components of an EHR that provide comprehensive health information about the patient, such as their diagnosis, treatment, and progress.

Choice C is wrong because the discharge plan and teaching for the client and family are not part of the EHR until the client is ready to be discharged.They are not relevant for a client who is newly admitted for chest pain.

Choice D is wrong because the variances from the critical pathway for the client’s diagnosis are not part of the EHR, but rather a quality improvement tool that monitors the deviations from the expected outcomes and interventions for a specific diagnosis.

Choice E is wrong because the names and contact information of the case management team are not part of the EHR, but rather a communication tool that facilitates coordination of care among different providers and organizations.

Notify the surgeon and document the wound infection as a variance.A variance is a deviation from the expected course of care or outcome in a critical pathway.A wound infection is an example of a variance that can affect the patient’s recovery and length of stay after a total hip arthroplasty (THA).

The nurse should notify the surgeon to initiate appropriate treatment and document the infection as a variance in the patient’s record.

Choice B is wrong because changing the dressing alone is not sufficient to treat a wound infection.

The nurse should also notify the surgeon and document the infection as a variance.

Choice C is wrong because a wound infection is not an expected outcome of THA.It is a complication that can increase the risk of implant failure, sepsis, and revision surgery.

Choice D is wrong because discontinuing the critical pathway is not necessary or appropriate for a wound infection.The critical pathway is a guideline for optimal care that can be modified according to the patient’s condition and needs.

The nurse should follow the critical pathway as much as possible and document any variances.

Normal ranges for wound healing after THA are not well defined, but some signs of infection include increased pain, swelling, redness, drainage, fever, and elevated white blood cell count.

The nurse should monitor these signs and report any changes to the surgeon.

“Did you achieve your expected outcomes within the planned time frame?.”.

This statement is the best way to evaluate the effectiveness of the case management model of care, which is a plan that describes how to provide comprehensive and effective care to clients with different health needs and situations.It involves steps such as assessing, planning, implementing, coordinating, monitoring, and evaluating the care.By asking the client if they achieved their expected outcomes within the planned time frame, the nurse can measure the quality, satisfaction, and cost-efficiency of the care provided.

Choice A is wrong because it is too vague and subjective.

Asking the client if they received quality care during their stay does not specify what aspects of the care were satisfactory or not, or how they relate to the case management model.

Choice B is wrong because it is also too vague and subjective.

Asking the client how satisfied they are with their recovery process does not indicate what goals or outcomes were set or achieved, or how they were influenced by the case management model.

Choice D is wrong because it is too narrow and specific.

Asking the client how well they understood their discharge instructions does not reflect the whole process of the case management model, which involves more than just discharge planning.

It also does not measure the effectiveness of the care in terms of outcomes or cost-efficiency.