ATI Fundamental Exam Review PDF

Preview

Summary

Download ATI Fundamental Exam Review PDF

Description

ATI Study Guide Topics include: I. End of Life/Cancer II. Blood Pressure III. Communication IV. Neurology V. Gastrointestinal System VI. Patient Teaching VII. Mobility VIII. Labs IX. Obesity & Diet X. Infection Control XI. Medication Administration

I: END OF LIFE/CANCER Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care: ● ● ● ● ● ● ●

provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten or postpone death; integrates the psychological and spiritual aspects of patient care; offers a support system to help patients live as actively as possible until death; offers a support system to help the family cope during the patients illness and in their own bereavement; uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated; ● will enhance quality of life, and may also positively influence the course of illness; ● is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications. #5

When providing palliative care to a patient with metastasis to the bone what should the nurse check first? First what is palliative care? Palliative car is health care provide to those who are terminally ill. This type of care provides emotional, physical, mental, spiritual and financial care, and can be given to the patient as soon as diagnosis or pretreatment is made. Opposed to hospice which is only given post treatment. This is very helpful because it a team of nurses that help to deal with pain and emotional suffering and lots of other factors . a good example would be if a patient is dying and is asked by a family how he or she is doing the response might be short and a lie opposed to talking with the nurse the patient can probably open up more and answer the question fully or express grief and panic to their current situation.

Hospice care is end of life care. A team of health care professionals and volunteers provides it. They give medical, psychological, and spiritual support. The goal of the care is to help people who are dying have peace, comfort, and dignity. The caregivers try to control pain and other symptoms so a person can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's family. Usually, a hospice patient is expected to live 6 months or less. Hospice care can take place ● ● ● ●

At home At a hospice center In a hospital In a skilled nursing facility

What is metastasis? Metastasis means that cancer spreads to a different body part from where it originally started. When this happens doctors call it or refer to it as “metasitsized” which is also called “Metastatic” “Bone Mets” occur when cancer cells from the primary tumor relocate to the bone. Prostate cancer, breast and lung cancer are most likely to spread to the bone. Bone metastasis does not begin from the bones but instead move from the primary tumor site into the bones. So, what should the nurse check first when providing palliative care to a patient with bone Mets? The nurse should check the diagnosis and explain to patient the help going to be provided and see if the patient wished to continue and then also ask if the patient would like the family to be involved and help with the care of patient. Get a verbal and written agreement for care being provided

Early detection of breast cancer 1. Monthly self examination 2.Yearly exam by MD 3. Blood work 4. Mammogram 5.Biopsy

Physical Manifestations of Death Loss of Appetite People experience difficulty swallowing and therefore will begin to refuse liquids and food Increased Physical Weakness Decreased food intake leads to less energy and simple activities like sitting on the edge of the bed, lifting one’s arms to change clothes and having a short conversation become difficult. Labored Breathing Deep rapid inhalations that slowly decrease, followed by a pause of not breathing. This is caused by unstable ventilatory control as the heart and/or brain fails. Changes in Urination Dehydration from decreased oral intake will lower blood pressure, leading to decreased renal function (decreased urine output) and eventually renal failure. Swelling to Feet, Ankles and Hands Fluid is not effectively pumped through the kidneys to be filtered and regulated. As a person ages, the kidney function decreases naturally. A very common cause of edema in a dying person is protein malnutrition. Acrocyanosis is blueness of the extremities (the hands and feet). Acrocyanosis is typically symmetrical. It is marked by a mottled blue or red discoloration of the skin on the fingers and wrists and the toes and ankles. Profuse sweating and coldness of the fingers and toes may also occur.

Mottling occurs when the heart is no longer able to pump blood effectively. The blood pressure slowly drops and blood flow throughout the body slows, causing one's extremities to begin to feel cold to the touch. Mottled skin before death presents as a red or purple marbled appearance A purplish or blotchy red-blue coloring on knees and/ or feet (mottling) is a sign that death is very near. Because the body no longer needs large amounts of energy and because the digestive system is slowing down, the need for and interest in food (and eventually fluids) gradually lessens. Mottling of skin occurs during the last week of life. Sometimes it may occur sooner or within just a few days of death.

II: BLOOD PRESSURE Orthostatic hypotension, A drop of 20-25 mm Hg in systolic pressure or 10mm Hg diastolic pressure when moving from lying to sitting or standing position. Prevention: ● Keep hydrated by drinking plenty of fluids ● Use more sodium on the diet (Consult a Doctor before increasing sodium) ● Avoid strenuous activity during hot water ● When getting out of bed sit on the edge of the bed for a minute before standing ● Sleep with the head of the bed slightly elevated can help fight the effects of gravity. ● Compression stockings can promote circulation and help prevent fluid from pooling in the legs ● Avoid alcohol

● Regular cardiovascular and strengthening exercises may help reduce symptoms of orthostatic hypotension. ● Eat small, low-carbohydrate meals if blood pressure drops after eating. ● Take vitamin supplements as needed. Both anemia and vitamin B-12 deficiency can affect blood flow and worsen symptoms of orthostatic hypotension, so iron and vitamin supplements might be helpful. Symptoms: ● Lightheadedness or dizziness upon standing ● Blurry vision ● Weakness ● Fainting (syncope) ● Confusion ● Nausea Causes: ● Dehydration ● Heart problems ● Endocrine problems ● Nervous systems disorders ● Eating some meals (Postprandial Hypotension) Risk factors: ● Age ● Medication ● Certain diseases ● Heat exposure ● Bed rest ● Pregnancy ● Alcohol Complications ● Falls ● Stroke ● Cardiovascular diseases

III: COMMUNICATION Question #1 A nurse is caring for a client who does not speak the same language as the nurse and is 6 hours post-operative. ● Cultural awareness communication Example: ● The nurse would find an interpreter that speak the same language as the patient ● The nurse would ask open ended questions and try to understand the patient culture ● The nurse can use pictures and facial expressions to communicate with the patient Rationale: Consider your actions and strive for cultural awareness every time you communicate with the patient. Question #2 Which of the following instructions should the nurse include, Caring for a patient with hearing loss?

● Speech therapist ● Minimize background noise to decrease distractions ● Speak facing the patient Rationale: Speech therapeutic treatment of impairments and disorders of speech, communication and swallowing can help the patient with heating loss. Minimizing noises can decrease distractions and minimize patient anxiety, facing the patient when you speak can help the patient to understand you are trying to communicate. Question 3 “All of you nurses think you are better than me”. Which approach is appropriate for the nurse to take when communicating to this patient? ● Verbal communication / Active listening Example: ● What makes you feel that way? ● Do you like to talk about it? ● What makes you think that? Rationale: Communicating and asking questions to the patients, will help us to understand what, why, or how are they feeling. Showing empathy. Question # 4 Major depression disorder patient previously agreed to electroconvulsive therapy, the client does not want to have it. What es the appropriate response by the nurse? ● Verbal communication/Active listening Example: ● What make you change your mind about the therapy? ● Do you have concerns about the outcome of therapy? ● Would you like to talk to the provider about procedure of the therapy? Rationale: Listen to understand is one of the best principles for active listening, knowing the needs and questions of the patients can help us to give the appropriate care the patient needs.

NEUROLOGY Aphasia- Deficient or absent language function that results from ischemic. Aphasia often arises as a result of damage to Broca's area or Wernicke's area. Aphasia is a language disorder that results from damage to portions of the brain that are responsible for language. main treatment for aphasia is speech and language therapy. The person with aphasia relearns and practices language skills and learns to use other ways to communicate.

What is a stroke? A stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes.A stroke is a medical emergency, and prompt treatment is crucial. Early action can reduce brain damage and other complications. Effective treatments can also help prevent disability from stroke. What causes stroke? There are two main causes of stroke: a blocked artery (ischemic stroke) or leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn't cause lasting symptoms. What are the complications of stroke? ● Paralysis or loss of muscle movement. You may become paralyzed on one side of your body, or lose control of certain muscles, such as those on one side of your face or one arm.

● Difficulty talking or swallowing. A stroke might affect control of the muscles in your mouth and throat, making it difficult for you to talk clearly, swallow or eat. You also may have difficulty with language, including speaking or understanding speech, reading, or writing. ● Memory loss or thinking difficulties. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, reasoning, making judgments and understanding concepts. ● Emotional problems. People who have had strokes may have more difficulty controlling their emotions, or they may develop depression. ● Pain. Pain, numbness or other unusual sensations may occur in the parts of the body affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you may develop an uncomfortable tingling sensation in that arm. ● Changes in behavior and self-care ability. People who have had strokes may become more withdrawn. They may need help with grooming and daily chores. Prevention? ● Controlling high blood pressure (hypertension), Lowering the amount of cholesterol and saturated fat in your diet, Quitting tobacco use, Managing diabetes, Maintaining a healthy weight, Eating a diet rich in fruits and vegetables, Exercising regularly, Drinking alcohol in moderation, if at all, Treating obstructive sleep apnea (OSA), and avoiding illegal drugs

3.Expressive Aphasia- Inability of the patient to send the desired verbal message. What is Expressive Aphasia? It is known as Broca’s Aphasia and it is known as the most common syndrome of the frontal lobe language disorder. The characteristics of this syndrome includes nonfluent, effortful speech production, semantic and phonemic paraphasias, articulatory errors, and agrammatism. What Causes Expressive Aphasia? The cause of expressive aphasia is a lesion to the left posterior and lower frontal lobe and subjacent white matter, often extending back through the lower precentral and postcentral gyri. A lesion causing Broca’s aphasia typically extends downward to the periventricular white matter because the purely cortical/shallow lesions produce a transient disorder. A middle cerebral artery stroke is also associated with expressive aphasia in which affects the third frontal convolution of the frontal lobe and it also affects the upper right extremity.

4.Receptive Aphasia- Inability to recognize or interpret the verbal message being received฀. What part of the brain is affected? Left posterior, temporal regions of the brain which are part of what is known as Wernike’s.

5. Dementia Dementia is a syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities. IT IS NOT NORMAL AGING. It isn’t a specific disease but different diseases may cause dementia, For example Alzheimer’s Disease. Symptoms may include Amnesia; Personality behavior changes

6. Hypoglossal Cranial Nerve - The twelfth cranial nerve, and innervates all the extrinsic and intrinsic muscles of the tongue, except for the palatoglossus which is innervated by the vagus nerve. It is a nerve with a solely motor function. The 12th (hypoglossal) cranial nerve is evaluated by asking the patient to extend the tongue and inspecting it for atrophy, fasciculations, and weakness (deviation is toward the side of a lesion). https://youtu.be/e6X8vMYTSHs

GASTROINTESTINAL 1. Nurse is reinforcing discharge teaching about fecal occult blood testing with a client. Which of the following actions should the nurse take? ● The test is a noninvasive procedure that the patient can do at home. The nurse should reinforce teaching of how to properly perform the test at home to ensure accurate results. ● If a patient is over 50 the nurse should stress the importance of performing the test regularly. ● Certain foods and drugs also may alter the result of the test such as: Nonsteroidal, anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin for seven days prior to

your test. If you take aspirin for heart problems, talk to your health care provider before stopping your medicine. Acetaminophen may be safe to use during this time, but check with your health care provider before taking it. ● Avoid more than 250 mg of vitamin c daily from supplements, fruit juices, or fruit for seven days prior to your test. Vitamin C can affect the chemicals in the test and cause a negative result even if there is blood present. Avoid red meat, such as beef, lamb, and pork, for three days prior to the test. Traces of blood in these meats may cause a false-positive result. 2. Nurse is caring for an older adult client who has fecal incontinence which of the following actions should the nurse take? ● Determine causes (medications, infections, or impaction) ● Provide perineal care after each stool, apply a moisture barrier ● Provider can prescribe a fecal incontinence pouch or other bowel management system to collect stool and prevent it from coming into contact with the skin 3.

Fecal incontinence- Inability to control bowel movements Causing stool (feces) to leak unexpectedly from the rectum. It is also known as "bowel incontinence", fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control. The causes of bowel/fecal incontinence is a variety of things such as: 1. 2. 3. 4.

Diarrhea (often due to an infection or irritable bowel syndrome) Impacted stool (due to severe constipation, often in older adults) Inflammatory bowel disease (Crohn's disease or ulcerative colitis) Nerve damage (due to diabetes, spinal cord injury, multiple sclerosis, or other conditions

COLOSTOMY- is a surgery in which the colon is brought through the opening in the abdominal wall, and stools are collected in a bag on the outside of the abdomen. Doctors may recommend this surgery as a last resort for the treatment of fecal incontinence because of the colostomy's effect on quality of life. OTHER SURGERIES- doctors may perform other surgeries to treat the causes of fecal incontinence, such as : 1. Hemorrhoids 2. Rectal prolapse 3. Rectocele DISCOMFORT--- Fecal incontinence can cause anal discomfort such as irritation, pain or itching. You can help relief anal comfort by: 1. 2. 3. 4. 5. 6. 7.

Washing the anal area after a bowel movement. Changing soiled underwear as soon a s possible. Keeping the anal area dry. Using a moisture-barrier cream in the area around your anus. Using non medicated powders. Using wicking pads or disposable underwear. Wearing clothes or underwear that let air pass through easily.

10. Borborygmi- a rumbling or gurgling noise made by the movement of fluid and gas in the intestines DEFINITION ● A rumbling or gurgling noise made by the movement of fluid and gas in the intestines WHY DOES IT OCCUR? ● Can be associated with hunger, slow or incomplete digestion, or the consumption of certain foods ● Normal part of digestion ● Signals hunger ● Helps digestion ● Can indicate underlying issues ISSUES THAT CAN CAUSE BORBORYGMI ● Food allergies ● Food intolerances ● Gastrointestinal infections ● Intestinal blockage ● Irritable bowel syndrome (IBS) HOW TO STOP BORBORYGMI ● Drink water ● Eat ● Chew slowly ● Limit sugar, alcohol, acidic foods ● Avoid food and drink that can cause gas ● Discover food intolerances ● Practice portion control ● Stay active ● Address gastrointestinal issues FOOD AND DRINK THAT MAY CAUSE GAS ● Beans ● Beer ● Broccoli ● Brussels sprouts ● Cabbage ● Cauliflower ● Lentils ● Mushrooms ● Onions ● Peas ● Sodas ● Whole grains 11. Inflammatory Bowel Disease- A group of inflammatory conditions of the colon and small intestine Also known as "IBD". It is a term for two conditions (Crohn's disease and ulcerative colitis) that are characterized by chronic information of the gastrointestinal (GI) tract. Prolonged inflammation results in damage to the GI tract. Some of the differences between Crohn's disease and ulcerative colitis are as follows:

CROHN'S DISEASE-Can affect any part of the GI tract ( from the mouth to the anus)--- Most often it affects the portion of the small intestine before the large intestine/colon. DAMAGED AREAS: Damaged areas appear in patches that are next to areas of healthy tissue INFLAMMATORY: Inflammatory may reach through the multiple layers of the walls of the GI tract. ULCERATIVE COLITIS-Occurs in the large intestine (colon) and the rectum. DAMAGED AREAS: Damaged areas are continuous (not patchy)- Usually starting at the rectum and spreading further into the colon. INFLAMMATION: Inflammation is present only in the innermost layer of the lining of the colon. SYMPTOMS: ● Persistent diarrhea ● Abdominal pain ● Rectal bleeding/bloody stools ● Weight loss ● Fatigue What causes IBD? ● The exact cause of inflammatory bowel disease remains unknown. Previously, diet and stress were suspected but now doctors know these factors may aggravate but don't cause IBD. ● One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacteria, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too. Hereditary also seems to play a role in that IBD is more common in people who have family mem...