ATI Comprehensive Predictor Remediation PDF

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Remediation for comprehensive predictor exam. Instructor requires main ideas, not 3 critical points, under each topic missed....

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Comprehensive Predictor Courtney Acquaotta Comprehensive Predictor Remediation

Management of Care Communicating With Clients Who Speak a Language Different Than the Nurse Nurses have the responsibility of ensuring clients are aware of their rights and protecting those rights while providing care. Regardless of a client’s age, needs, or care setting, the basic client rights remain the same. Clients have the right to be informed about all aspects of their care and participate in the decisions made, to accept, refuse, or change their plan of care, and to receive care that is delivered by competent caregivers who treat them with respect. As a patient advocate, we must ensure they understand what is happening with their care. As an advocate for our patients who speak a different language, we should seek the assistance of an interpreter if the client doesn’t speak the same language as us (the nurse) or another provider. Otherwise, these patients can’t be informed in respect to their care. Planning Care for a Client Following a Stroke Assess ability to swallow and assist with feeding on unaffected side. Assess movement/strength in extremities. Assess ability to perform ADLs and make any necessary referrals. Educating a Newly Licensed Nurse About Medication Administration Nursing responsibilities pertaining to medication administration:   

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Have knowledge of federal, state, and local laws as well as facility procedures and protocols related to prescribing, dispensing, and administering medications Preparing and administering medications and evaluating patient response to said medications Developing and maintaining up-to-date knowledge base of medications they administer, including uses, mechanism of action, routes of administration, safe dose range, adverse effects, precautions, contraindications, and interactions Maintain knowledge of acceptable practice and skills competency Determine accuracy of medication prescriptions Report any/all med errors Safeguarding and storing medications

The “Rights” of safe medication administration will reduce the occurrence of medication errors. These rights are:     

Right Client Right Medication Right Dose Right Time Right Route

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Right Documentation Right Client Education Right to Refuse Right Assessment Right Evaluation

Resources for Medication Information:      

Nursing drug handbooks Pharmacology textbooks Professional Journals Physicians’ Desk Reference (PDR) Professional Websites Pharmacists

Suspected Physical Abuse Priority Action Nurses are required by law to report all suspected cases of abuse or neglect for all vulnerable populations including children, the elderly, and disabled. Priority Action When Obtaining Signature on Informed Consent Form Informed consent is a legal process in which the client has given written consent for a procedure or treatment to be performed. Consent is considered informed when the client has been given and understands: the reason for the procedure/treatment, how it will help, risks associated if they have the procedure, risks posed if they choose not to have said procedure, and alternative treatments. The nurse’s role in the informed consent process is to witness the client’s signature on the form and that the above information has been explained to the patient prior to signing and the patient must be competent. Otherwise, a representative must sign for them. Safety and Infection Control Ergonomic Principles: Evaluating Teaching Ergonomics focuses on factors/qualities in an object’s design or use that contribute to comfort, safety, efficiency, and ease of use. Using good body mechanics when positioning and moving clients promotes safety for both clients and staff. Before moving a client, one should assess their mobility. Begin the assessment with easy movements and progress as client tolerates. Always ask for assistance if needed and communicate with clients and help to clarify their roles and how things will work. Burns: Priority Action to Reduce Risk of Infection       

Maintain a protective environment No plants/flowers (risk of pseudomonas) Check policy regarding fresh fruits and veggies. May be restricted Limit visitors. No sick people, small children, or other patients can visit Monitor for signs/symptoms of infection and report if they occur Use dedicated equipment Tetanus shot

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Antibiotics to treat infection. Monitor peaks/troughs Use strict asepsis with wound care

Nursing Care of Newborns: Teaching About Abduction An ID band is placed on the newborn’s ankle and wrist immediately after birth. These will match the parent’s bands, and all must be cut off to remove them. Each time the newborn is given to the parents ID should be verified against parent’s bands. All staff who assist and care for baby will have ID badge with photo. Many hospitals have locked units that one must be permitted to enter and exit. Some have alarm systems like wonder guard that alert staff when a baby is taken off the unit. Health Promotion & Maintenance Teaching a Client Who is Postpartum about Contraception Client should have a birth control method ordered prior to discharge. If they are not using birth control it is possible to get pregnant very soon after giving birth. Ovulation occurs within a few weeks if they are not breastfeeding and around 6 months postpartum if they are EBF. Discuss which options are best for you with your provider. Evaluating Client Understanding of Infant Care Provide education about infant care with each parent/caregiver and encourage a hands-on approach. Assist to co-parent to transition to parental role by providing guidance and encouraging equal participation in infant care. Encourage parents to verbalize concerns and expectations related to infant care. Provide and encourage community resources when possible. Psychosocial Integrity Expected Finding in an Adolescent Who Has Anorexia Nervosa Anorexia Nervosa:       

Persistent energy intake restriction that leads to a low body weight for their demographic Fear of gaining weight or being fat Disturbance in their self-perceived weight or shape Clients are preoccupied with food, rituals of eating, along with a voluntary refusal to eat Occurs most often in females from adolescence to young adulthood Onset can be associated with stressful life event such as college Compared to those with restricting type, those with binging/purging type have higher rates of impulsivity and are more likely to abuse drugs/alcohol

Assessment & Findings:      

Client’s perception of issue? Eating habits History of dieting Methods of weight control Value attached to specific size/shape/weight Interpersonal and social functioning

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Difficulty with impulsivity and compulsivity Family and interpersonal relationships Cognitive distortions including overgeneralizations, all-or-nothing thinking, catastrophizing, personalization, and emotional reasoning. Client demonstrates high interest in preparing food but not eating it Can exhibit the need for intense physical regimen May experience guilt or shame associated with binge eating OCD features may or may not be related to food Low BP with possible orthostatic hypotension Decreased pulse and body temp Languo Dysrhythmias, HF, Cardiomyopathy Peripheral edema Acrocyanosis Amenorrhea or other menstrual irregularities

Responding to a Client with MDD        

Minimize distractions Provide privacy Identify mutually agreed-upon client goals/outcomes Set priorities according to the client’s needs Plan adequate time for interventions Establish a rapport with client so they feel at ease during treatment Be empathetic in your responses and explanations by using observations, providing hope, humor, and information Show acceptance and recognition

Basic Care & Comfort Assisting a client to Urinate After Birth           

Urinary retention secondary to loss of bladder elasticity and tone &/or loss of sensation related to trauma, medications, or anesthesia. A distended bladder because of urinary retention can cause infection, uterine atony, and displacement to one side. the ability of the uterus to contract is also compromised Postpartum diuresis with increased urinary output starts within 12 hours of delivery Assess client’s ability to void – perineal edema can cause pain/difficulty in first 24-48 hours Assess elimination pattern. Excessive diuresis (>3000 mL/day) is normal for 2-3 days Assess for evidence of distended bladder – displaced uterine fundus, fundal height above umbilicus, bladder bulging or tenderness, excessive lochia Frequent voiding of less than 150 mL indicates retention with overflow Assist to void within 6-8 hours of delivery. If they can’t void a catheter may be necessary Encourage them to void often Measure first few voids to assess for bladder emptying Encourage patient to increase oral fluids

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Comprehensive Predictor Home Recommendations for Client Who is Postoperative When a client demonstrates factors that increase risk for injury (such as recent surgery), a home hazard evaluation should be conducted by a nurse, PT, &/or OT. The client is made aware of environmental factors that could pose a risk and modifications should be suggested. These modifications might include:         

Removing items that can lead to falls (throw rugs) Put electrical cords against walls and behind furniture Monitor gait/balance, provide aids as needed Make sure steps and sidewalks are in good repair Install grab bars near toilets, tub/shower, and install a stool raiser Nonskid mat in tub/shower Use a shower chair and bedside commode if needed Remove clutter Ensure lighting (inside and out) are adequate

Pharmacological & Parenteral Therapies Preparing Client for Insertion of Non-tunneled Percutaneous Central Venous Access Device A non-tunneled central line is used for short term IV therapy – less than 6 weeks. Position client in a head-low position as this dilates vessels and prevents air embolism. During insertion of a non-tunneled percutaneous device the client should turn their head away from the site during the procedure and perform Valsalva maneuver. The position is confirmed with Xray. And it should be flushed after insertion, after infusions, after specimen withdrawal, and when it is disconnected. Notify the provider if there is resistance when flushing. Medications for Pain Relief While Taking Enoxaparin  

Avoid epidurals, LPs while taking Lovenox because of the increased risk of hematoma Avoid antiplatelet agents - aspirin, NSAIDs – increased bleeding risk

Contraindications for Aspirin     

Pregnancy Risk Category D in 3rd trimester Bleeding disorders and thrombocytopenia Use caution in those with peptic ulcer disease and severe kidney or hepatic disorders Never give to children or adolescents who have a fever to recent viral infection Use caution in older adults

Selecting a long-acting Insulin Long-acting insulin is Insulin Glargine U-100 and Insulin detemir. Ultra-long insulins are U-300 insulin glargine and insulin degludec. Reduction of Risk Potential Obtaining a Temperature of a Newborn

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Comprehensive Predictor Temperature should be taken with axillary thermometer. Rectal temps are avoided because they can injure rectal mucosa. Occasionally an initial rectal temperature can be obtained to evaluate for anal abnormalities. Assess temp hourly until stable and under radiant warmer or during skin to skin contact with parent. RA Findings to Report Patient should continue to follow routine health screenings. They should immediately report manifestations that indicate early or late exacerbation of RA such as fever, infection, pain upon inspiration, or pain in the substernal area of the chest. Nursing Interventions for Hypocalcemia 

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Tetany is the most common manifestation seen in hypocalcemia. It is caused by neural excitability or the spontaneous discharges from both the sensory and motor fibers (peripheral nerves). Paresthesia of fingers and lips – early Muscle twitches and it progresses Seizure activity Frequent, painful muscle spasms at rest in foot or calf (Charley Horse) Hyperactive DTRs Positive Chvostek’s and/or Trousseau’s Sign Hx of thyroid surgery

Interventions:       

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Implement seizure and fall precautions Administer oral or IV calcium supplements Administer Vitamin D supplements to enhance absorption Avoid overstimulation by keeping client’s room quiet, using soft lighting, and limiting visitors Have emergency equipment ready Encourage foods high in calcium like dairy, canned salmon, sardines, fresh oysters, and dark leafy greens Clients exhibiting life-threatening manifestations will need immediate/rapid treatment with calcium gluconate or calcium chloride. Calcium chloride isn’t used as often due to possible tissue damage if infiltrated. IV administration should be diluted in dextrose 5% and water and given as a bolus infusion using an infusion pump. If given too quickly, cardiac arrest could occur.

Kidney Transplant: Lab Results to Report to Provider Conduct daily urinalysis to check for presence of Protein, WBCs, RBCs, Ketones, glucose, specific gravity, and ph. Monitor for hypervolemia, hypovolemia, hypokalemia, and hyponatremia. But the labs we will check, and monitor are BGL, BUN, Creatinine, Potassium, Calcium, Phosphorus, Magnesium, Amylase, Lipase, WBCs, H&H. Bacterial, Viral, Fungal, and Parasitic Infections: Reportable Laboratory Results of a School-Age Child 

Diphtheria

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Mumps TB Pertussis E. coli Salmonella Campylobacter Shigella Giardia Hepatitis A Hib Streptococcus pneumoniae Meningococcal infection Viral meningitis Chickenpox German measles Measles

Physiological Adaptation Postoperative Finding to Report: 

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Patient reports subjective data o Chills o Sore throat o Fatigue o Malaise o Change in level of consciousness o Nuchal rigidity o Photophobia o Headache o GI symptoms o Localized pain or discomfort Fever Increased heart and/or respiratory rate Decreased BP Enlarged lymph nodes Dyspnea, Cough, purulent sputum, and/or crackles in lung fields Dysuria, urinary frequency, pyuria, hematuria Rash, skin lesions, purulent wound drainage, and erythema Dysphagia, enlarged tonsils Elevated WBCs Increased ESR

Teaching About Management of Juvenile Idiopathic Arthritis 

JIA is a chronic autoimmune inflammatory disease affecting joints and other tissues

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Chronic inflammation of the synovium leads to wearing down and damage to articular cartilage JIA is rarely life-threatening It can resolve over time, but can result in residual joint deformities and altered function of said joints Care is primarily in outpatient setting Goals are to control pain, minimize damage from inflammation, preserve joint function, and promote normal growth and development Assist client with development of exercise program Encourage support group Encourage PT to increase mobility and prevent deformities Encourage activity as tolerated, especially full ROM exercises Apply heat or warm, moist packs to joints prior to exercise Encourage warm baths Identify alternative ways to child to meet developmental needs, especially during periods of exacerbation Encourage self-care by allowing plenty of time for them to complete tasks Well-balanced diet with adequate fluid intake Encourage participation in school and contact with peers Collaborate with the school nurse and teachers to arrange for care during the school day (medication administration, in school PT, extra books, split days, virtual learning, etc.) Instruct clients about relaxation techniques and nonpharmacological pain management Exacerbation worsens with illness Schedule and keep all follow-up appointments including regular eye exams Educate patient on medications they are ordered. These may include: o NSAIDs o Methotrexate o Corticosteroids o Etanercept

Caring for a Client Who Has Cerebral Edema Implement actions that will decrease ICP:          

Elevate head of bed 30°-45° to decrease ICP and promote venous drainage Keep head in neutral position and midline with body Maintain patent airway. Provide mechanical ventilation if necessary Administer oxygen if needed to maintain O2 saturation above 92% Hyperventilate clients on mechanical ventilation to keep PaCO2 between 35-38 mmHg to reduce cerebral blood flow Maintain C-spine stability until cleared by Xray Report presence of CSF from nose or ears to provider Provide calm, restful environment (minimize noise, limit visitors) Monitor fluid and electrolytes Provide adequate fluids to maintain cerebral perfusion and minimize cerebral edema.

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When high volume IV fluids are ordered, monitor for fluid volume overload which can increase ICP Maintain safety and seizure precautions Even if level of consciousness is decreased, communicate with client. Hearing is the last sense affected.

Wound Care for an Abdominal Incision             

Principles of wound care include assessment, cleaning, and protection. An incision should be closed, and the skin edges should be well approximated If there is any drainage present note any/all characteristics Note integrity of surrounding skin Note/document number of dressings and frequency of which they are changed Provide adequate hydration (>2500 mL/day), protein, and calorie needs. Note if albumin levels fall below 3.5 g/dL For clean wounds (i.e., abdominal incision) cleanse from least contaminated (incision) to most contaminated (surrounding skin) Use gentle friction/pressure when cleansing to avoid further injury/bleeding Isotonic solutions are the preferred cleanser Never use same gauze to clean across the incision/wound more than once Don’t use cotton balls or other things that can shed fibers If irrigating, a 30-60mL syringe with 19g needle provides adequate pressure. Use NS, LR, or ordered antimicrobial agent. Hold tip 1 inch above the incision and use continuous pressure to flush wound. Repeat until irrigate runs clear

Effectiveness of Endotracheal Suctioning           

Suctioning is the use of negative pressure to clear airways with collection tubes. Can be for upper (oropharynx) or lower (trachea and bronchi) Suctioning is performed to remove secretions, maintain artificial airway, obtain sputum samples, and stimulate the cough reflex Assess patient for indications for need of suctioning (abnormal breath sounds) Gather all equipment Hyperoxygenate patient for 30-60 seconds Insert catheter Apply suction for no longer than 15 seconds Reoxygenate patient Reassess Document color, amount, odor, consistency of sputum

PVD: Interventions for DVT     

Client may be asymptomatic Calf or groin pain, tenderness, and sudden onset of edema in extremity Warmth, edema, and induration, and hardness over involved vessel Changes in circumference of calf/thing over time d/t localized edema over affected area !!! Shortness of breath and chest pain indicate PE!!!

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Encourage ambulation ONLY AFTER...