ATI RN Comprehensive Predictor 2016 Remediation PDF

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ATI RN COMPREHENSIVE PREDICTOR 2016 REMEDIATION  Management of Care – (9)  Advance Directives/Self-Determination/Life Planning – (1)  Professional Responsibilities: Client Teaching About Do-Not-Resuscitate Orders (Active Learning Template – Basic Concept, RM Leadership 7.0 Chp. 3)  Unless a do not resuscitate (DNR) or allow natural death (AND) prescription is written, the nurse should initiate CPR when a client has no pulse or respirations. The written prescription for a DNR or AND must be placed in the client’s medical record. The provider consults the client and the family prior to administering a DNR or AND.  Client Rights – (1)  Coordinating Client Care: Appropriate Action When a Client Leaves Against Medical Advice (Active Learning Template – Basic Concept, RM Leadership 7.0 Chp. 2)  A client who leaves a facility without a prescription for discharge from the provider is considered leaving against medical advice (AMA). A client who is legally competent has the legal right to leave the facility at any time. The nurse should immediately notify the provider. If the client is at risk for harm, it is imperative that the nurse explain the risk involved in leaving the facility. The individual should sign a form relinquishing responsibility for any complications that arise from discontinuing prescribed care. The nurse should document all communication, as well as the specific advice that was provided for the client. A nurse who tries to prevent the client from leaving the facility can face legal charges of assault, battery, and false imprisonment.  Collaboration with Interdisciplinary Team – (1)  Coordinating Client Care: Information to Report to Occupational Therapist (Active Learning Template – Basic Concept, RM Leadership 7.0 Chp. 2)  Patient’s condition and current status; any medications the patient is on; patient’s tolerance level for pain; any assistive devices the patient uses  Confidentiality/Information Security – (1)  Professional Responsibilities: Protecting Confidential Client Information (Active Learning Template – Basic Concept, RM Leadership 7.0 Chp. 3)  It is essential for nurses to be aware of the rights of clients in regard to privacy and confidentiality. Facility policies and procedures are established in order to ensure compliance with HIPAA regulations. It is essential that nurses know and adhere to the policies and procedures. HIPAA regulations also provide for penalties in the event of noncompliance with the regulations.  Continuity of Care – (1)  Information Technology: Preparing a Change-of-Shift Report (Active Learning Template – Basic Concept, RM FUND 9.0 Ch 5)  Nurses give this report at the conclusion of each shift to the nurse assuming responsibility for the clients. Formats include face to face, audiotaping, or presentation during walking rounds in each client’s room (unless the client has a roommate or visitors are present). An effective report should: include significant

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objective information about the client’s health problems; proceed in a logical sequence; include no gossip or personal opinion; relate recent changes in medications, treatments, procedures, and the discharge plan  Legal Rights and Responsibilities – (1)  Professional Responsibilities: Understanding Regulations for Nursing Scope of Practice (Active Learning Template – Basic Concept, RM Leadership 7.0 Chp. 3)  Standards of care guide, define, and direct the level of care that should be given by practicing nurses. They also are used in malpractice lawsuits to determine if that level was maintained. Nurses should refuse to practice beyond the legal scope of practice and/or outside of their areas of competence regardless of reason (staffing shortage, lack of appropriate personnel). Nurses should use the formal chain of command to verbalize concerns related to assignment in light of current legal scope of practice, job description, and area of competence.  Performance Improvement (Quality Improvement) – (1)  Maintaining a Safe Environment: Demonstrating Quality and Safety Education for Nurses Competencies (Active Learning Template – Basic Concept, RM Leadership 7.0 Chp. 4)  Safe use of equipment refers to appropriate operation of health care-related equipment by trained staff. Equipment-related injuries can occur as a result of malfunction, disrepair, or mishandling of mechanical equipment. Nurses must ensure that they have the competence necessary to use equipment for tasks that fall within their scope of practice. Nurses should use equipment only after receiving sufficient instruction. Equipment should be regularly inspected by the engineering or maintenance department and by the user prior to use. Faulty equipment (frayed cords, disrepair) can start a fire or cause an electrical shock and should be removed from use and reported immediately per agency policy.  Referrals – (2)  Alzheimer’s Disease: Resources for Home Care (Active Learning Template – System Disorder, RM AMS RN 10.0 Chp 8)  Refer to social services and case managers for long-term/home management, Alzheimer’s Association, community outreach programs, and support groups  Nutrition and Oral Hydration: Priority Finding Following an Ischemic Stroke (Active Learning Template – System Disorder, RM FUND 9.0 Ch 39)  Identify if someone has dysphagia, this patient will need pureed foods; clear and full liquids plus pureed meats, fruits and scrambled eggs, low residue: low in fiber  Safety and Infection Control – (6)  Accident/Error/Injury Prevention – (2)  Adverse Effects, Interactions, and Contraindications: Priority Action to an Allergic Response (Active Learning Template – Medication, RM Pharm RN 7.0 Chp 5)  Treat with epinephrine, bronchodilators, and antihistamines. Provide respiratory support and inform the provider.  Health Promotion of Infants (2 Days to 1 Year): Car Seat Safety (Active Learning Template – Basic Concept, RM NCC RN 10.0 Chp 3)

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Infants and toddlers remain in a rear-facing car seat until the age of 2 years or the height recommended by the manufacturer. The safest area for infants and children is the backseat of the car. Do not place rear-facing car seats in the front seat of vehicles with passenger airbags. Infants should not be left in parked cars. Emergency Response Plan – (1)  Facility Protocols: Nursing Role During Mass Casualty Incident (Active Learning Template – Basic Concept, RM Leadership 7.0 Chp. 5)  Principles of mass casualty triage should be followed in health care institutions involved in a mass casualty event. These differ from the principles of triage typically following during provision of day-to-day services in an emergency or urgent care setting. During mass casualty events, casualties are separated related to their potential for survival, and treatment is allocated accordingly. This type of triage is based on doing the greatest good for the greatest number of people. Nurses can find this situation very stressful because clients who are not expected to survive are cared for last. Home Safety – (1)  Nursing Care and Discharge Teaching: Teaching About Newborn Safety (Active Learning Template – Basic Concept, RM MN RN 10.0 Chp 26)  Never leave the newborn unattended with pets or other small children. Keep small objects (coins) out of the reach of newborns due to choking hazard. Never leave the newborn alone on a bed, couch, or table. Newborns move enough to reach the edge and fall off. Never place the newborn on his stomach to sleep during the first few months of life. The back-lying position is the position of choice. The newborn can be placed on his abdomen when awake and being supervised. Standard Precautions/Transmission-Based Precautions/Surgical Asepsis – (1)  Medical and Surgical Asepsis: Setting Up a Sterile Field (Active Learning Template – Nursing Skill, RM FUND 9.0 Ch 10)  Open the covering of the package per the manufacturer’s directions, slipping the package onto the center of the workspace with the top flap of the wrapper opening away from the body.  Grasp the tip of the top flap of the package, and with arm positioned away from the sterile field, unfold the top flap away from the body.  Next, open the side flaps, using the right hand for the right flap and the left hand for the left flap  Grasp the last flap and turn it down toward the body. Use of Restraints/Safety Devices – (1)  Complications of Infants: Treatment of Positional Plagiocephaly (Active Learning Template – Therapeutic Procedure, RM NCC RN 10.0 Chp 42)  Educate parents about the importance of daily “tummy time” when infant is awake. Educate parents of the importance of alternating the infant’s head position during sleep. Refer parents to physical therapy for neck exercises. Assist parents in the proper use of the skull-molding helmet. Educate parents that the helmet

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needs to be worn 23 hr/day, usually for 3 months. Educate parents to continue to place infant in the supine position for sleep.  Health Promotion and Maintenance – (8)  Aging Process – (1)  Chronic Neurologic Disorders: Teaching About Phenytoin (Active Learning Template – Medication, RM Pharm RN 7.0 Chp 13)  Monitor for manifestations of CNS effects, and notify the provider if they occur  Advise clients to maintain good oral hygiene (dental flossing, massaging gums). Folic acid supplements can decrease the occurrence.  Stop medication if rash develops.  Administer at slow IV rate (no faster than 50 mg/min) and in dilute solution to prevent adverse cardiovascular effects. Avoid administering to a client who has sinus bradycardia, sinoatrial block, or Stokes-Adams syndrome  Instruct client to report changes. Encourage the client to consume adequate amounts of calcium and vitamin D.  Administer prophylactic vitamin K to the mother for 1 month before the infant is delivered.  Ante/Intra/Postpartum and Newborn Care – (2)  Complications Related to the Labor Process: Findings to Report to the Provider (Active Learning Template – Basic Concept, RM MN RN 10.0 Chp 16)  Prolapsed umbilical cord and Meconium-stained amniotic fluid  Nursing Care and Discharge Teaching: Circumcision (Active Learning Template – Therapeutic Procedure, RM MN RN 10.0 Chp 26)  Circumcision is the surgical removal of the foreskin of the penis. It is a personal choice made by the newborn’s family for reasons of health and hygiene, religious conviction (Jewish male on eighth day after birth), tradition, culture, or social norms. Parents should make a well-informed decision in consultation with the provider. Circumcision should not be done immediately following birth because the newborn’s level of vitamin K is at a low point, and the newborn would be at risk for hemorrhage.  Health Promotion/Disease Prevention – (2)  Pediatric Emergencies: Planning Education About Sudden Infant Death Syndrome (Active Learning Template – Basic Concept, RM NCC RN 10.0 Chp 43)  Teach the family how to reduce the risk of SIDS: place the infant on the back for sleep; avoid exposure to tobacco smoke; prevent overheating; use a firm, tightfitting mattress in the infant’s crib; remove pillows, quilts, and stuffed animals from the crib during sleep; ensure that the infant’s head is kept uncovered during sleep; offer pacifier at naps and night; encourage breastfeeding; avoid cosleeping; maintain immunizations up to date.  Practice Settings and Aggregates: Recommended Health Screenings for Young Adult Male Clients (Active Learning Template – Basic Concept, RM CH RN 7.0 Chp 4)  Height/weight; blood pressure; dental health; digital rectal exam; fecal occult blood test/sigmoidoscopy (50 years and older); immunization status: check the

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CDC, www.cdc.gov, for current administration schedules; diabetes mellitus; HIV; skin cancer; cholesterol (ages 45 to 65 years)  Health Screening – (2)  Health Promotion of Infants (2 Days to 1 Year): Finding to Report (Active Learning Template – Basic Concept, RM NCC RN 10.0 Chp 3)  If the baby does not cry because this is the first form of verbal communication, or if the amount of crying does not decrease by 12 weeks of age. Also, if any of the stages of development are either not met or are delayed at any moment. If there is any suspicion that there is injury to the baby or delayed development.  Osteoporosis: Dietary Recommendations for Health Promotion (Active Learning Template – Basic Concept, RM AMS RN 10.0 Chp 70)  Instruct the client and family regarding dietary calcium food sources; Instruct the client to limit excess caffeine, alcohol, and carbonated beverages, which increase bone loss; Provide information regarding calcium and vitamin D supplementation. (Take with food); Instruct the client on the need for adequate amounts of protein, magnesium, vitamin K, and other trace minerals needed for bone formation  Techniques of Physical Assessment – (1)  Electrolyte Imbalances: Priority Assessment for Suspected Hypocalcemia (Active Learning Template – System Disorder, RM AMS RN 10.0 Chp 44)  Laboratory tests – calcium level less than 9.0 mg/dL  Diagnostic procedures – electrocardiogram changes: Prolonged QT and ST interval  Tetany is the most common manifestation seen in clients in a hypocalcemic state. It is caused by neural excitability-spontaneous discharges from both the sensory and motor fibers (peripheral nerves).  Psychosocial Integrity – (4)  Behavioral Interventions – (1)  Personality Disorders: Caring for a Client Who Has Antisocial Personality Disorder (Active Learning Template – System Disorder, RM MH RN 10.0 Chp 15)  Promote therapeutic communication to lower anxiety, decrease defensive patterns, and encourage participation in the milleu.  Establish a trusting relationship with the client and encourage the development of social skills and friendships, as well as, encourage participation in group work and psychoeducation  Cultural Awareness/Cultural Influences on Health – (1)  Cultural, Ethnic, and Religious Influences: Food Selections for a Client Who Follows a Kosher Diet (Active Learning Template – Basic Concept, RM Nutrition 6.0 Chp. 6)  Kosher meat – bulls, cows, sheep, lambs, goats, veal, and springbok  Some birds – goose, duck, chicken, and turkey  Dairy products that contain only kosher animals  Eggs of kosher birds only  Only fish with fins and scales  All products that grow in the soil or on plants, bushes, or trees are kosher

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 Support Systems – (1)  Neurocognitive Disorders: Teaching Family Members of a Client Who Has Dementia (Active Learning Template – System Disorder, RM MH RN 10.0 Chp 17)  Educate family/caregivers about the client’s illness, methods of care, and adaptation of the home environment  Ensure a safe environment in the home  Home safety measures – remove scatter rugs; install door locks that cannot be easily opened; lock water heater thermostat and turn water temperature down to a safe level; provide good lighting, especially on stairs; install a handrail on stairs, and mark step edges with colored tape; place mattresses on the floor; remove clutter, keeping clear, wide pathways for walking through a room; secure electrical cords to baseboards; store cleaning supplies in locked cupboards; install handrails in bathrooms  Therapeutic Environment – (1)  Anger Management: De-escalation Techniques (Active Learning Template – Basic Concept, RM MH RN 10.0 Chp 29)  Develop a therapeutic nurse-client relationship; remain with the client; listen and observe; make eye contact; ask questions related to the client’s feelings and the event; demonstrate genuineness and caring; communication clearly and, if needed, with clear directives; avoid false reassurance and other nontherapeutic responses; teach relaxation techniques; identify and teach coping skills (assertiveness training and parenting skills); assist the client with the development of the following type of action plan (short-term, no longer than 24 to 72 hr; focused on the crisis; realistic and manageable)  Basic Care and Comfort – (7)  Elimination – (1)  Postpartum Physiological Adaptations: Interventions to Promote Voiding (Active Learning Template – Basic Concept, RM MN RN 10.0 Chp 17)  Encourage the client to empty her bladder frequently (every 2-3 hr) to prevent possible displacement of the uterus and atony  Measure the client’s first few voidings after delivery to assess for bladder emptying  Encourage the client to increase her oral fluid intake to replace fluids lost at delivery and to prevent or correct dehydration  Catheterize if necessary for bladder distention if the client is unable to void to ensure complete emptying of the bladder and allow uterine involution  Mobility/Immobility – (1)  Mobility and Immobility: Complications of Immobility (Active Learning Template – Basic Concept, RM FUND 9.0 Ch 40)  Increased pressure on skin, which is aggravated by metabolic changes; decreased respiratory movement resulting in decreased oxygenation and carbon dioxide exchange; orthostatic hypotension; altered endocrine system; urinary stasis;

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decreased peristalsis; decreased muscle endurance, strength, and mass; altered sensory perception  Non-Pharmacological Comfort Interventions – (2)  Hematologic Disorders: Interventions for a Child Who Is Experiencing a Vasoocclusive Crisis (Active Learning Template – System Disorder, RM NCC RN 10.0 Chp 21)  Promote rest to decrease oxygen consumption; administer oxygen as prescribed if hypoxia is present; maintain fluid and electrolyte balance; administer blood products, usually packed RBCs, and exchange transfusions per facility protocol (observe for manifestations of hypervolemia and transfusion reaction); treat and prevent infection; monitor and report laboratory studies  Use an interprofessional approach; treat mild to moderate pain with acetaminophen or ibuprofen. Manage severe pain with opioid analgesics; apply comfort measures, such as warm packs to painful joints; schedule administration of analgesics to prevent pain  Pain Management: Nonpharmacological Pain Management Strategies (Active Learning Template – Basic Concept, RM MN RN 10.0 Chp 12)  Cognitive strategies – biofeedback, hypnosis, childbirth education  Sensory stimulation strategies – aromatherapy, breathing techniques, imagery  Cutaneous stimulation strategies – therapeutic touch and massage, back rubs and massage; walking; rocking  Nutrition and Oral Hydration – (3)  Cardiovascular and Hematologic Disorders: Teaching About a Low-Cholesterol Diet (Active Learning Template – Basic Concept, RM MN RN 10.0 Chp 12)  Daily cholesterol intake should be less than 200 mg/day. Saturated fat should be limited to less than 7% of daily caloric intake.  To lower cholesterol and saturated fats, instruct the client to do the following: trim visible fat from meats; limit red meats and choose lean meats (turkey, chicken); remove the skin from meats; broil, bake, grill, or steam foods (avoid frying foods); use low-fat or nonfat milk, cheese and yogurt; use spices in place of butter or salt to season foods; use liquid oils such as olive or canola in place of oils that contain saturated fat; avoid trans fat, which increases LDL (partially hydrogenated products contain trans fat); increase consumption of oily fish (tuna, salmon, herring); read labels  Medications for Depressive Disorders: Food and Medication Interaction (Active Learning Template – Medication, RM MH RN 10.0 Chp 22)  Concurrent use with MAOIs can cause severe hypertension; concurrent use with antihistamines and other anticholinergic agents can result in additive anticholinergic effects; concurrent use with direct-acting sympathomimetics can result in increased effects of these medications, because uptake is blocked by TCAs; concurrent use with indirect-acting sympathomimetics can result in decreased effect of these medications; concurrent use with alcohol,

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benzodiazepines, opioids, and antihistamines can result in additive CNS depression  Sources of Nutrition: Best Sources of Vitamin C (Active Learning Template – Basic Concept, RM Nutrition 6....