ATI MEDSURG PROCTORED CRITICAL POINTS FOR STUDY(LATEST GUIDE)

ATI MEDSURG PROCTORED CRITICAL POINTS FOR STUDY(LATEST GUIDE) Topics to Review Safety and Infection Control (4 items) Accident/Error/Injury Prevention (1 item) Seizures and Epilepsy: Implementing Precautions (RN QSEN - Safety, Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 6) • Seizures are abrupt, normal, excessive, and uncontrolled electrical discharge of neurons within the brain that can cause alterations in the level of consciousness and changes in motor and sensory ability and/or behavior. Epilepsy is the term used to define chronic recurring abnormal brain electrical activity resulting in 2 or more seizures. • Precautions include knowing the risk factors related to seizures and epilepsy; genetic predisposition, acute febrile state, head trauma, cerebral edema, abrupt cessation of antiepileptic drugs. • There are triggering factors of seizures and epilepsy; increased physical activities, excessive stress, hyperventilation, alcohol, caffeine, flashing lights, substance abuse, aerosols, stress, and fatigue. It is important for nurses to know these factors in an order to implement precautions. Home Safety (1 item) Musculoskeletal Trauma: Discharge Teaching About an External Fixation Device (RN QSEN - Safety, Active Learning Template - Basic Concept, RM AMS RN 10.0 Chp 71) • External fixation involves fracture immobilization using percutaneous pins and wires that are attached to a rigid external frame. • For care of the device: clean the external fixation pins one to two times each day to remove exudate that can harbor bacteria, using a separate cotton swab on each pin will decrease the risk of cross‑contamination, which could cause pin site infection. • Advise the client that they should report redness, heat, and drainage at the pin sites, which can indicate an infection that can lead to osteomyelitis. Discuss clothing and other materials that can be used to cover the device. If activity is restricted, advise the client to perform deep breathing and leg exercises and other techniques to prevent complications to immobilization, such as pneumonia or thrombus formation. Standard Precautions/Transmission-Based Precautions/Surgical Asepsis (2 items) Infection Control: Teaching About Isolation Precautions (RN QSEN - Safety, Active Learning Template - Basic Concept, RM FUND RN 9.0 Ch 11) • Infection occurs when the presence of a pathogen leads to a chain of events, all components of chain must be present and intact for the infection to occur. Nurses use infection control practices to break the chain and thus stop the spread of infection. • Isolation guidelines are a group of actions that include hand hygiene and the use of barrier precautions which intend to reduce the transmission of infectious organisms. Precautions apply to every client, regardless of the dx and implementation of them must occur whenever there is anticipation of coming into contact with infectious material. • Clients in isolation are at high risk for depression and lonliness, assist client and their family to understand the reason for isolation and provide sensory simulation. Health Promotion and Maintenance (2 items) Health Promotion/Disease Prevention (1 item) Health, Wellness, and Illness: Identifying Risk Factors for Atherosclerosis (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 1) • Atherosclerosis is caused by gradual thickening of the intima and media of the arteries, it results in the progressive narrowing of the lumen. • Plaques may form on the walls of the arteries, making them rough and fragile. • Familial predisposition, High blood pressure, smoking, diabetes, obesity, unhealthy cholesterol levels are some major risk factors for atherosclerosis. Basic Care and Comfort (6 items) Elimination (4 items) Postoperative Nursing Care: Urinary Retention (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 96) • Monitor fluid and electrolyte balance following surgery. Monitoring can help determine if there is an issue of urinary retention. • Nursing care related to input and output should include: Palpate bladder for distention. Monitor urinary catheters for patency. Observe color, consistency, odor, and amount of urine. Urine output less than 30 mL/hr can indicate hypovolemia. • Urine output of at least 30 ml/hr is part of the criteria for discharge from PACU. Urinary Elimination: Teaching a Client to Manage Stress Incontinence (RN QSEN - Patient-centered Care, Active Learning Template - System Disorder, RM FUND RN 9.0 Ch 44) • Stress incontinence is loss of small amounts of urine from increased abdominal pressure without bladder muscle contraction with laughing, sneezing, or lifting. • A therapeutic procedure related to the treatment of stress incontinence is a bladder-retraining program. Urinary bladder retraining increases the bladders ability to hold urine and clients’ ability to suppress urination. • Nurses can teach the client how to perform Kegel exercises: tighten pelvic muscles for a count of 10, relax slowly for a count of 10 and repeat in sequences of 15 in the lying-down, sitting and standing positions. Mobility/Immobility (1 item) Mobility and Immobility: Climbing Stairs With Crutches (RN QSEN - Safety , Active Learning Template - Nursing Skill, RM FUND RN 9.0 Ch 40) • Maintain or regain body alignment and stability, decrease skin and musculoskeletal system changes, achieve full or optimal ROM, and prevent contractures. • Nurse should assist the client with ambulation. Use assistive devices such as gait belts, walkers, canes, or crutches as needed. • Crutch instructions: do not alter crutches after fitting, follow the prescribed crutch gait, support body weight at the hand grips with elbows flexed at 30 degrees, and position the crutches on the unaffected side when sitting or rising from a chair. Non-Pharmacological Comfort Interventions (1 item) Vitamins, Minerals, and Supplements: Medication Interaction With Feverfew (RN QSEN - Safety , Active Learning Template - Medication, RM Pharm RN 7.0 Chp 30) • Feverfew is used to decrease the frequency of migraine headaches, but it has not been proven to relieve an existing migraine headache. • Feverfew can cause increased risk of bleeding in clients taking NSAIDs, heparin, and warfarin. Discontinue 2 weeks before elective surgery. • Question clients about concurrent use of NSAIDs, heparin, and warfarin. Pharmacological and Parenteral Therapies (23 items) Adverse Effects/Contraindications/Side Effects/Interactions (6 items) Medications Affecting Blood Pressure: Adverse Effects of Enalapril (RN QSEN - Safety , Active Learning Template -Medication, RM Pharm RN 7.0 Chp 20) • Blood pressure is controlled in a variety of ways with many meds that are used alone or in combination. • Enalapril is a medication for hypertensive crisis. It is an ACE inhibitor. • Enalapril should be administered slowly because rapid administration will cause blood pressure to go down rapidly. Blood and Blood Products (2 items) Blood and Blood Product Transfusions: Steps in the Administration Process (RN QSEN - Safety , Active Learning Template - Nursing Skill, RM AMS RN 10.0 Chp 40) • Clients can receive transfusions of whole blood or components of whole blood for replacement due to blood loss or blood disease. • Explain the procedure to the client. Assess vital signs and the client’s temperature prior to transfusion. Remain with the client for the first 15-30 min of the infusion (reactions occur most often during the first 15min) and monitor vital signs and rate of infusion per facility policy. • Assess laboratory values (e.g., platelet count less than 20,000 and hemoglobin less than 6 g/dL). Verify the prescription for a specific blood product. Obtain consent for procedure if required. Obtain blood samples for compatibility determination, such as type and cross‑match. Rheumatoid Arthritis: Caring for a Client Receiving Plasmapheresis (RN QSEN - Safety , Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 88) • Rheumatoid arthritis is a chronic, progressive inflammatory disease that can affect tissues and organs but principally attacks the joints, producing an inflammatory synovitis. it involves joints bilaterally and symmetrically, and typically affects several joints at one time. Ra usually affects upper joints first. • Plasmapheresis removes circulating antibodies from plasma, decreasing attacks on the client’s tissues. This may be done for severe, life-threatening exacerbation. • Ra is an autoimmune disease that is precipitated by WBCs attacking synovial tissue. the WBCs cause the synovial tissue to become inflamed and thickened. Expected Actions/Outcomes (2 items) Chronic Obstructive Pulmonary Disease: Identifying Greatest Risk for Infection (RN QSEN - Safety , Active Learning Template - Basic Concept, RM AMS RN 10.0 Chp 22) • Copd encompasses two disease: emphysema and chronic bronchitis. Most clients who have emphysema also have chronic bronchitis. Copd is irreversible. • Use sputum cultures and WBC counts to dx acute respiratory infections. Encourage immunizations, such as influenza and pneumonia, to decrease the risk of infection. • Respiratory infections result from increased mucus production and poor oxygenation levels. Clients should advised to avoid people who have respiratory infections. Medication Administration (9 items) Antibiotics Affecting Protein Synthesis: Adverse Effects of Aminoglycosides (RN QSEN - Safety , Active Learning Template - Medication, RM Pharm RN 7.0 Chp 45) • Antibiotics affecting protein synthesis are bacteriostatic, such as tetracyclines and macrolides, or bactericidal, such as aminoglycosides. • Aminoglycosides are bactericidal antibiotics that destroy micro‑organisms by disrupting protein synthesis. Clients who have kidney impairment should receive lower doses of aminoglycosides. • Most aminoglycosides, such as gentamicin and streptomycin (IM only), are parenteral. Neomycin also has oral and topical formulations; tobramycin also has an inhalation formulation Diabetes Mellitus Management: Client Teaching About Insulin Lispro (RN QSEN - Safety, Active Learning Template - Medication, RM AMS RN 10.0 Chp 82) • Diabetes mellitus is a metabolic disorder resulting from either an inadequate production of insulin (type 1) or an inability of the body’s cells to respond to insulin that is present (type 2). • Insulin regimens are established for clients who have type 1 dm. More than 1 type of insulin: rapid, short, intermed, and long acting. Given one or more times a day based on blood glucose results. • Insulin lispro is a rapid acting insulin, onset is rapid (10-30 min). Should be administered before meals to control postprandial rise in blood glucose. Administer in conjunction with intermediate- or long acting insulin to provide glycemic control between meals and at night. Diabetes Mellitus: Teaching About Metformin (RN QSEN - Patient-centered Care, Active Learning Template - Medication, RM Pharm RN 7.0 Chp 39) • Exenatide is prescribed along with an oral antidiabetic medication, such as metformin or a sulfonylurea medication, for clients who have type 2 diabetes mellitus to improve diabetes control. • Metformin is contraindicated for clients who have severe infection, shock, and any hypoxic condition. The medication should not be used by clients who have alcohol use disorder. • Instruct clients to take immediate release tablets two times per day with breakfast and dinner and to take sustained‑release tablets once daily with dinner. Seizures and Epilepsy: Client Teaching About Phenytoin (RN QSEN - Safety , Active Learning Template - Medication, RM AMS RN 10.0 Chp 6) • Administer prescribed antiepileptic drugs (AEDs), such as phenytoin. Administer diazepam or lorazepam IV push followed by IV phenytoin or fosphenytoin. • When using phenytoin, specific instructions should include avoidance of oral contraceptives, as this medication decreases their effectiveness. Warfarin should also not be given with this medication, as phenytoin can decrease absorption and increase metabolism of oral anticoagulants. • The nurse should not instruct the client to take oral contraceptives, because contraceptive effectiveness is decreased when taking phenytoin. The nurse should instruct the client that phenytoin causes overgrowth of the gums. The nurse should instruct the client to take phenytoin at the same time every day to enhance effectiveness. Urinary Tract Infections: Teaching About Ciprofloxacin (RN QSEN - Patient-centered Care, Active Learning Template - Medication, RM Pharm RN 7.0 Chp 46) • Instruct clients to observe for and report pain, swelling, and redness at the Achilles tendon site. Tell clients to stop taking ciprofloxacin and avoid exercise until the inflammation subsides. • Pain and swelling of the achilles tendon indicate an adverse effect of ciprofloxacin to report to the provider. Vaginal yeast infection is an overgrowth of Candida albicans, which commonly occurs when taking ciprofloxacin. • Cottage cheese‑like lesions in the mouth indicate an overgrowth of Candida albicans, a common adverse effect when taking ciprofloxacin. Milk and other dairy products contain calcium ions that reduce the effect of ciprofloxacin. The client should take the medication 6 hr before or 2 hr after ingesting dairy products. Parenteral/Intravenous Therapies (1 item) Medications Affecting Coagulation: Nursing Actions for Enoxaparin Administration (RN QSEN - Safety , Active Learning Template - Medication, RM Pharm RN 7.0 Chp 25) • Pharmaceutical agents that modify coagulation are used to prevent clot formation or break apart an existing clot. These meds work in the blood to alter the clotting cascade, prevent platelet aggregation, or dissolve a clot. They all carry a significant risk of bleeding. • Monitor vital signs. Advise clients to observe for bleeding: increased heart rate, decreased blood pressure, bruising, petechiae, hematomas, black tarry stools. Monitor platelet count. Instruct client to avoid aspirin. • Monitor platelets. Discontinue medication for platelet count less than 100,000/mm3. In clients who have spinal or epidural anesthesia: Assess insertion site for indications of hematoma formation, such as redness or swelling. Monitor sensation and movement of lower extremities. Notify provider of abnormal findings. Pharmacological Pain Management (1 item) Pain Management: Opioid Education for an Older Adult Client (Active Learning Template - Medication, RM AMS RN 10.0 Chp 4) • Opioid analgesics, such as morphine, fentanyl, and oxycodone, are appropriate for treating moderate to severe pain. Nociceptive pain typically responds to opioids and nonopioid medications. • Older adults, especially those with cognitive impairment are at risk for undertreatment of pain. It is a serious complication and can lead to increased anxiety with acute pain and depression with chronic pain. • It is important to educate clients about the adverse effects of taking opioids. Urinary retention, respiratory depression, dizziness, nausea, vomiting, and lightheadedness are some common adverse effects of opioid analgesia. Total Parenteral Nutrition (TPN) (2 items) Dosage Calculation: Calculating an Infusion Rate (Active Learning Template - Basic Concept, RM FUND RN 9.0 Ch 48) • It is extremely important for nurses to have knowledge of dosage calculations. Proper dosage calculations for med administration can serious affect med errors. Iv infusion rates is one of the many calculations it is important for nurses to know. • If an electronic infusion pump is not available, regulate the IV flow rate using the roller clamp on the IV tubing. When setting the flow rate, count the number of drops that fall into the drip chamber over 1 min. • Then calculate the flow rate using the drop factor on the manufacturer’s package containing the administration set. The drop factor is the number of drops per milliliter of solution. Gastrointestinal Therapeutic Procedures: Administering Total Parenteral Nutrition (RN QSEN - Safety , Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 47) • Gastrointestinal therapeutic procedures are performed for maintenance of nutritional intake, and treatment of gastrointestinal obstructions, obesity, and other disorders. • Gastrointestinal therapeutic procedures nurses should be knowledgeable about include TPN. • TPN admin is usually through a central line, such as a tunneled triple lumen or a single or double lumen peripherally inserted central picc line. You should first determine the clients’ readiness for TPN. Obtain laboratory values, including electrolytes. Solutions are customized for each client according to daily lab results. Reduction of Risk Potential (21 items) Diagnostic Tests (1 item) Musculoskeletal Trauma: Monitoring Laboratory Values (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 71) • Monitoring for manifestations of infection include: monitoring laboratory values (WBC, ESR). • A fracture is a break in a bone secondary to trauma or a pathological condition. Fractures cause by trauma are the most common type of bone fracture. Pathological fractures can be caused by metastatic cancer, osteoporosis, or Paget’s disease. • Osteomyelitis is an infection of the bone that begins as an inflammation within the bone secondary to penetration by infectious organisms (virus, bacteria, or fungi) following trauma or surgical repair of a fracture. Laboratory Values (4 items) Anemias: Laboratory Findings for a Client Who Has Aplastic Anemia (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 41) • Anemia is an abnormally low amount of circulating RBCs, Hgb concentration, or both. It is an indicator of an underlying disease or disorder. Anemia results in diminished oxygen-carrying capacity and delivery to the tissues and organs. The goal of treatment is to restore and maintain adequate tissue oxygenation. • Aplastic anemia results in a decreased number of red blood cells as well as decreased platelets and white blood cells. • Bone-marrow aspiration/biopsy is used to diagnose aplastic anemia. Chronic Obstructive Pulmonary Disease: Interpreting ABG Results (Active Learning Template - Diagnostic Procedure, RM AMS RN 10.0 Chp 22) • COPD encompasses two diseases: emphysema and chronic bronchitis. Most clients who have emphysema also have chronic bronchitis. Copd is irreversible. • Expected findings of laboratory tests of patients of copd include ABGs: hypoxemia (decreased Pa02 less than 80 mm Hg) and hypercarbia (increased PaC02 greated than 45 mm Hg). • The nurse should observe for hypokalemia, fluid retention, and black tarry stools these ar ,..................................................................................................................................................DOWNLOAD FOR MORE REVISION TO THAT 'A' GRADE