ATI COMPREHENSIVE PREDICTOR 2019
MED-SURG
MS Priority Referral for a ALS
• OT, PT, Speech Therapy
• Home care
• Hospice when
... [Show More] needed
Lupus, Gout, Fibro Identifying a Client Requires a Referral to Dietitian
• Gout
Keep diary of food triggers
Low-purine diet NO!!! organ meats or shellfish, yeast, sardines, spinach
Avoid/Limit alcohol intake
Avoid starvation diets, aspirin, diuretics
Increase fluid intake 3L/day
• Lupus
Limit salt intake for fluid retention secondary to steroid therapy
High-vitamin, high iron diet
If anorexia,
• provide small, freq. meals…offer between-meal supplements
• take folic acid
High-protein diet, if no evidence of kidney disease
• Fibro
Limit intake of caffeine, alcohol, & other substances interfere w/ sleep
Parkinson’s DiseaseAssessing Client’s Need for Physical Therapy
• If unable to,
Walking and balance difficult
Physical movements slow down affecting moving
Unilateral shaking or tremor of one lime
Stand or walk, dependent for
Do exercise, yoga, ROM
Use of assistive devices, as disease progresses
Walking to slow down (can reduce injury)
Renal Disorder Dietary Teaching for Chronic Kidney Disease
• LOW protein, LOW-potassium, HIGH-carb, vitamins & calcium supplements, LOW sodium, LOW phosphorous
• Restrict magnesium
• Strict I&O; fluid replacement –500 to 600 mL more than previous 24hr urine output
• Limit alcohol intake
• Don’t give antacids w/ Mg or enemas w/ phosphorous
• Use diet & exercise to manage weight & prevent or control diabetes & HTN
• Test albumin yearly
Dietary Teaching About Heme Iron for pt w/ Anemia
• Nutritional deficiencies iron, B12, folic acid, intrinsic factor
• Encourage increase intake of deficient nutrient iron (meats, poultry, fish), vitamin B12, folic acid
• iron-fortified cereal & breads, fish, poultry, & dried peas and beans (NOT red meat or organ meats)
• should reg. consume high folate (spinach, lentils, bananas) &folic acid fortified grains & juices
Stroke Assisting pt w/ Dysphagia
• Monitor for aspiration, assess swallowing and gag reflexes before eating
• Liquid consistencies
Thinwater, juice
Nectar-likecream soups, nectars
Honey-likehoney, yogurt
Spoon-thickpudding, cooked cereals
• Food levels:
Pureed
Mechanically altered
Advanced/mechanically soft
Regular
Use appropriate consistency & food type as recommended by SLP to minimize choking
• Position pt sitting in chair or sitting up in bed, w/ the head & neck positioned slightly forward & flexed
• Feed pt slowly, placing food in the back of the mouth and to unaffected side
• Provide sips of fluids & slowly advance diet foods easy to chew & swallow
• Have suction on standby
• Maintain a distraction-free environment during meals
• Weight loss is common collaborate w/ dietitian for caloric intake
• COMPLICATIONS NI:
if gag reflexes are present, give sip of water to determine if choking occurs
keep NPO until evaluated by SLP
Begin w/ prescribed liquid-consistency regimen from NDD & closely observe for choking
Have suction equipment available, feed w/ care bc nasotracheal suctioning increases ICP
RN should initial feeding
Nursing Actions Before Infusion Blood
• Verify client ID, name, & blood type by two nurse
• Prior to administration, assess baseline VS, **temp**
• Establish iv assess, 18 to 20gauge catheter
• Once obtained blood product from blood bank…inspect for discoloration, excessive bubbles, or cloudiness
• Must have 0.9% sodium chloride primed tubing, Y-tubing w/ filter
• First 15mins, stay w/ client & infuse slowly, monitoring for any reaction…If reaction occrs…
Stop blood immediately & take vitals
Infuse 0.9 sodium chloride
Notify the provider
Follow facility policy send urine sample, CBC, & bag & tubing to lab for analysis
Complete infusion of product w/in 4hr
• Assess for hx of blood –transfusion reactions
MSAnticipated Prescription for provider to Prescribe
• Cyclosporineimmunosuppressive agents
• Prednisonereduce inflammation
• Dantrolene & Baclofenantispasmodics (muscle spasticity)
GI ProceduresLab Findings to Report to Provider TPN
• Metabolic complications
Hyperglycemia restlessness, confusion, elevated blood glucose >200
Hypoglycemia anxiety, low blood glucose <70
Vitamin deficiencies
• Air Embolism
Pressure change during tubing changes
CMsudden onset of dyspnea, chest pain, anxiety, hypoxia
• Infection
Concentrated glucose a medium for bacteria
Observe central line insertion site for local erythema, tenderness, exudate
Observe CM of systemic infectionfever, increased WBC, chills, malaise
• Fluid Imbalance
Lungs Crackles, resp. distress
Heart Bounding pulse, JVD
Identifying Complications of IV Fluid Therapy
• Fluid Volume Deficits
Hypovolemic Shock
• CM Mean arterial pressure decrease (slows blood flow & perfusion to tissues), Cells no longer able to carry oxygen to the blood (loss of RBCs)
• Fluid Volume Excesses
Pulmonary Edema
• CM Anxiety, Tachycardia, Increased vein distention, Premature ventricular contractions (PVC), Dyspnea at rest, Change in LOC, restlessness, lethargy, ascending crackles, cough productive of frothy pink-tinged sputum
Stoke Manifestation of Left Hemisphere Stoke
• Expressive & receptive aphasia inability to speak & understand language
• Agnosia unable to recognize familiar objects
• Alexia reading difficulty
• Agraphia writing difficulty
• Right extremity hemiplegia paralysis or hemiparesisweakness
AmputationsEvaluation Teaching
Anesthesia & Moderate SedationPriority Finding to Report for a Post OP pt
• General Anesthesia
Malignant Hyperthermia: 44C (111.2 F)
Overdose of Anesthetic
• Pt: older w/ pre-existing conditions or poor liver or kidney function
Unrecognized Hypoventilation
• CM cardiac arrest, hypoxia, brain damage, & death
Intubation problems
• Injury to teeth, lips, & vocal cord due to too small mouth, inability to open mouth wide, mouth tumors
• Sore throat
• Local Anesthesia
• Moderate Sedation
Airway obstruction, cardiac dysrhythmias, hypotension, anaphylaxis
Resp. depression
Cardiac arrhythmias
Hypotension
Anaphylaxis
DMCaring for Client w/ Hypoglycemic
• Give pt 15g of fast-acting simple carbs recheck blood glucose in 15min
3 or 4 glucose tablets for equivalent to of 15g or carb
4 to 6oz of juice or reg soda
6 to 10 hard candies
2 to 3 teaspoons of sugar or honey 1 tbsp
• If unconscious, or unable to swallow, administer glucagon IM or subcutaneous,Repeat in 10 min if client is still unconscious and notify provider
• Follow the 15/15/15 rule
Administer 15g of fast act carbs
Wait 15min & recheck blood glucose
Administer 15 more grams of carbs if blood glucose remains >70
Give 7g of protein when blood glucose is w/in normal limits
• 2tbps of peanut butter
• 1oz of cheese
• 8oz milk
FUNDAMENTALS: 25 Questions
LEADERSHIP: 19 Questions
MENTAL HEALTH 15 Questions
MATERNAL NEWBORN: 15 Questions
CHILDREN: 15 Questions
PHARMACOLOGY: 12 Questions
COMMUNITY: 6 Questions [Show Less]