Medical Surgical Remediation Virtual ATI case study

ATI Medical Surgical Remediation Safety and Infection Control (4 items) Accident/Error/Injury Prevention (2 items) Meningitis: Clarify Prescription With Provider (RN QSEN - Safety, Active Learning Template - Basic Concept, RM AMS RN 10.0 Chp 5) • Repeat prescription back to the provider clearly Handling Hazardous and Infectious Materials (1 item) Cancer Treatment Options: Interventions for Internal Radiation Therapy (RN QSEN - Safety , Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 91) • Place the client in a private room. Keep door closed • Place a sign on the door warning of the radiation source • Wear a dosimeter film badge that records personal amount of radiation exposure • Limit visitors to 30-min and 6 feet • No visitors under 18yrs or who are pregnant • Have a lead apron Health Promotion and Maintenance (2 items) Health Promotion/Disease Prevention (1 item) Osteoporosis: Promoting Musculoskeletal Health (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 70) • Ensure the clients diet has calcium and vitamin D together • Limit carbonated beverages, which contain phosphates and can cause calcium loss • Encourage client to expose area of skin to sun 5-30 minutes twice a week. • Encourage female clients to discuss the pros and cons of hormone replacement therapy postmenopausal • Encourage weight-bearing exercises Basic Care and Comfort (6 items) Mobility/Immobility (2 items) Musculoskeletal Trauma: Caring for a Client in Continuous Buck’s Traction (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 71) • Assess neurovascular status of the affected part every hour for 24hr and every 4hr after that • Maintain body alignment and realign if the client seems uncomfortable or reports pain • Avoid lifting or removing weights Non-Pharmacological Comfort Interventions (1 item) Osteoarthritis and Low-Back Pain: Potential Contraindications to Chondroitin and Glucosamine (RN QSEN - Safety, Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 72) • Question concurrent use of chondroitin with NSAIDs, heparin, and warfarin Nutrition and Oral Hydration (3 items) Peptic Ulcer Disease: Complications of Dumping Syndrome (RN QSEN - Safety, Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 49) • Client can report full sensation, weakness, diaphoresis, palpitations, dizziness, and diarrhea • Late symps: rapid release of glucose, followed by an increase in insulin production resulting in hypoglycemia Pharmacological and Parenteral Therapies (23 items) Adverse Effects/Contraindications/Side Effects/Interactions (6 items) Blood and Blood Product Transfusions: Manifestation of Allergic Transfusion Reaction (RN QSEN – Safety, Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 40) • Itching, urticaria, and flushing • Anaphylactic transfusion resulting in bronchospasm, laryngeal edema, and shock Medications Affecting Coagulation: Medication Interactions With Warfarin (RN QSEN - Safety, Active Learning Template - Medication, RM Pharm RN 7.0 Chp 25) • Increases effects: heparin, aspirin, acetaminophen, glucocorticoids, sulfonamides, and parenteral cephalosporins • Decreases effects: phenobarbital, carbamazepine, phenytoin, oral contraceptives, and vitamin K Skin Disorders: Teaching About Adverse Effects of Topical Glucocorticoid Therapy (RN QSEN - Safety, Active Learning Template - Medication, RM AMS RN 10.0 Chp 74) • Avoid use if infection is present • Discontinue use when rash clears • Avoid direct sunlight and the use of tanning beds Blood and Blood Products (2 items) Blood and Blood Product Transfusions: Monitoring a Client Receiving a Blood Transfusion (RN QSEN - Safety, Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 40) • Explain the procedure • Assess vital signs and temp prior to transfusion • Remain with client in initial 15-30 min of the transfusion • An 18 or 20 gauge • Y-tubing with a filter Medication Administration (6 items) Antibiotics Affecting the Bacterial Cell Wall: Client Education About Cephalosporins (RN QSEN – Safety, Active Learning Template - Medication, RM Pharm RN 7.0 Chp 44) • Avoid if allergic to penicillin • Avoid alcohol • Oral cephalosporin with food Antilipemic Agents: Teaching About Colesevelam (Active Learning Template - Medication, RM Pharm RN 7.0 Chp 24) • Take other meds 4hr before taking bile sequestrants • Advise client to inform HCP of all meds currently taken • Is pregnancy risk Category B • Contraindicated in bowel obstruction or pancreatitis caused by high triglycerides Hypothyroidism: Client Education About Levothyroxine (RN QSEN - Safety, Active Learning Template - Medication, RM AMS RN 10.0 Chp 79) • Avoid fiber laxatives, which interfere with absorption • Increases the effects of warfarin and can increase the need for insulin and digoxin Medications Affecting Coagulation: Client Teaching About Self-Administration of Enoxaparin (RN QSEN - Safety, Active Learning Template - Medication, RM Pharm RN 7.0 Chp 25) • Advise to observe for bleeding, increased HR, decreased BP, bruising • Use a 20 to 22-gauge needle to withdraw med from the vial, then change to a small needle 25 or 26 gauge, ½ to 5/8 inches long. • Deep subq in the abdomen, ensuring a distance of 2 inches from the umbilicus. Do not aspirate Parenteral/Intravenous Therapies (2 items) Chronic Neurologic Disorders: Administering Phenytoin for Seizure Disorder (RN QSEN - Safety, Active Learning Template - Medication, RM Pharm RN 7.0 Chp 13) • Monitor for manifestation of CNS effects, and notify the HCP if they occur • Teratogenic: Cleft palate, heart defects, developmental deficiencies • For absence seizures and simple seizures too Total Parenteral Nutrition (TPN) (3 items) Gastrointestinal Therapeutic Procedures: Assessing for Fat Overload Syndrome (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 47) • Monitor for new onset of confusion or seizures • Assess for shallow respirations • Monitor for increased muscular weakness Reduction of Risk Potential (21 items) Changes/Abnormalities in Vital Signs (1 item) Esophageal Disorders: Priority Intervention for Esophageal Variceal Bleeding (RN QSEN - Safety, Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 48) • If suspected bleeding, establish IV access with a large bore needle, monitor vital signs and hematocrit, type and cross-match for possible blood transfusion, and monitor for overt and occult bleeding • Endoscopic variceal ligation for acute bleeding Laboratory Values (4 items) Cardiovascular Diagnostic and Therapeutic Procedures: Obtaining Blood Cultures from a Central Line (Active Learning Template - Diagnostic Procedure, RM AMS RN 10.0 Chp 27) • Use distal port because it has the biggest gauge so it has the greatest flow rate • Turn off the infusion and clamp the tubing for a few minutes before obtaining the blood sample Potential for Alterations in Body Systems (1 item) Respiratory Diagnostic Procedures: Client Teaching About Bronchoscopy (RN QSEN - Patient- centered Care, Active Learning Template - Diagnostic Procedure, RM AMS RN 10.0 Chp 17) • Permits visualization of the larynx, trachea, and the bronchi • Instruct clients that gargling with salt water or using throat lozenges can provide comfort for soreness of the throat • Report bronchospasm after bronchoscopy; blood tinged sputum is expected after Potential for Complications from Surgical Procedures and Health Alterations (4 items) Cancer Disorders: Postoperative Mastectomy Exercises (Active Learning Template - Diagnostic Procedure, RM AMS RN 10.0 Chp 92) • Affected arm elevated on pillow for 24hrs to allow fluid to drain • Flex and extend finger in recovery room • Exercise prevent contractures, muscle shortening, maintain muscle tone, and promote lymph drainage • Squeezing a rubber ball, elbow flexion and extension, and hand-wall climbing Diabetes Mellitus Management: Identifying Microvascular Complication (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 82) • Complications of insulin pump are accidental cessation of insulin administration, obstruction of the tubing/needle, pump failure, and infection • HTN, MI, and Stroke Esophageal Disorders: Preventing Further Complications (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 48) • Avoid alcohol or limit tobacco use • Eat a low-fat diet • Avoid tight-fitting clothing • Maintain a weight below BMI of 30 • Avoid large meals System Specific Assessments (6 items) Cancer Disorders: Description of Basal Cell Carcinoma (Active Learning Template - Basic Concept, RM AMS RN 10.0 Chp 92) • Small, waxy nodule with superficial blood vessels, well-defined borders • Erythema and ulcerations • Affects the lips and skin around the mouth Physiological Adaptation (34 items) Alterations in Body Systems (13 items) Benign Prostatic Hyperplasia: Care Following a Transurethral Resection of the Prostate (Active Learning Template - Basic Concept, RM AMS RN 10.0 Chp 66) • Monitor vital signs and urinary output • Administer/provide increased fluids • Monitor for bleeding and report to the provider • Assist the client to ambulate as soon as possible to reduce the risk of DVT Burns: Performing Hydrotherapy (Active Learning Template - Nursing Skill, RM AMS RN 10.0 Chp 75) • Assist the client into a warm tub of water or use warm running water, as if to shower, to cleanse the wound o Use the mild soap or detergent to wash burns gently, and then rinse with room- temperature water o Encourage the client to exercise his joints during treatment Gastrointestinal Therapeutic Procedures: Providing Client Teaching About an Ileostomy (RN QSEN - Patient-centered Care, Active Learning Template - Basic Concept, RM AMS RN 10.0 Chp 47) • Assess for fluid and electrolyte imbalances, particularly with a new ileostomy • More than 1000ml/day • Can be bile-colored and liquid Hemodialysis and Peritoneal Dialysis: Planning Care for a Peritoneal Dialysis Catheter Site (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 57) • Monitor weight, serum electrolytes, creatinine, BUN, and blood glucose • Teach to follow instructions carefully and to take all meds • Instruct the client to take essential minerals, and vitamins with supplements of phosphorus, calcium, sodium, and potassium Fluid and Electrolyte Imbalances (4 items) Electrolyte Imbalances: Expected Laboratory Findings of Hyponatremia (Active Learning Template - Basic Concept, RM AMS RN 10.0 Chp 44) • Normal to high BP • Hypothermia, tachycardia, rapid thread pulse, hypotension, ortho hypotension, diminished peripheral pulses • Increased motility, hyperactive bowel sounds, ab cramping Emergency Nursing Principles and Management: Priority Intervention for Heat Stroke (RN QSEN – Safety, Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 2) • ABCs • LOC • VS’s • Resuscitation Hemodynamics (2 items) Electrocardiography and Dysrhythmia Monitoring: Rhythm Interpretation (Active Learning Template - Diagnostic Procedure, RM AMS RN 10.0 Chp 28) • Atrial fib, supraventricular tachycardia, ventricular tachycardia with pulse all treated with amiodarone, adenosine, and verapamil Pacemakers: Client Teaching About a Newly Inserted Permanent Pacemaker (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 29) • Carry a pacemaker identification card at all time • Prevent wire dislodgement • Take pulse daily at same time • Report signs of dizziness, fainting, fatigue, weakness, chest pain, hiccupping, palpitations, difficulty breathing Illness Management (4 items) Esophageal Disorders: Teaching About Gastroesophageal Reflux Disease (RN QSEN - Patient- centered Care, Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 48) • Symps: dyspepsia and regurgitation, radiating pain (neck, jaw, or back) • Report of a feeling of having a heart attack • Pyrosis (burning sensation in the esophagus) • Pain that worsens with position (bending, straining, laying down) Respiratory Management and Mechanical Ventilation: Verifying Placement of Endotracheal Tube (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 19) • Chest X-ray Medical Emergencies (2 items) Head Injury: Identifying Cerebrospinal Fluid Leak (Active Learning Template - Basic Concept, RM AMS RN 10.0 Chp 14) • Clear drainage from the nose • Glucose monitoring Pathophysiology (7 items) Infections of the Renal and Urinary System: Causes of Edema in Nephrotic Syndrome (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 60) • Glomerular damage Inflammatory Bowel Disease: Recognizing Clinical Manifestations of Appendicitis (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 52) • Right lower quadrant pain; begins at peri-umbilical area • Fecaliths, or hard pieces of stool, can be the initial cause of obstruction • Pain increases with movement • Tachycardia, fever Multiple Sclerosis: Clinical Manifestations (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 10) • Pain or paresthesia • Diplopia decreased visual acuity Uhthoff’s sign (a temporary worsening of vision and other neurological function) Tinnitus, vertigo, decreased hearing acuity • Dysphagia • Ataxia, Nystagmus Pulmonary Embolism: Client Findings (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 24) • Anxiety • Feelings of Impending Doom • Pressure in chest • Pain upon inspiration and chest wall tenderness • Dyspnea and air hunger • Cough, adventitious breath sound and cough, diaphoresis, syncope, cyanosis • Hemoptysis, tachycardia, pleural friction rub, hypotension, tachypnea Unexpected Response to Therapies (2 items) Spinal Cord Injury: Monitoring for Complication Following a Lumbar Laminectomy (Active Learning Template - Diagnostic Procedure, RM AMS RN 10.0 Chp 16) • Cervical: pneumonia, thoracic: pneumonia & Paralytic ileus, Lumbar: urinary retention 4 Concepts In nursing safety and infection control is essential. I have learned that when it comes to treating chemo patients, there are certain things that must be adhered to. For example, since most chemo patients are diagnosed with neutropenia due to condition or administered chemotherapy, they must be placed in a private room with the door closed. Place a sign on the door warning of the radiation source. When visitors come over, their time is limited to 30 minutes and must be 6 feet away from the patient. Also, no kids under 18 or pregnant should be present. It is essential to ensure that certain procedures are carried out in a specific order for the safety of the patient and of the nurse as well. When it comes to administering blood, steps such as explaining the procedure, getting consent, assessing vital signs and temp prior to transfusion are important. Also remaining with the client in initial 15-30 minutes of the transfusion. There are more steps to take, but all of these are important to avoid any complications from occurring with the patient. When it comes to client education and teaching it is vital for the patient to understand the steps, to avoid them hurting themselves. For example, when it comes to teaching clients to self- administer Enoxaparin, one must advise them to observe for bleeding, increased heart rate, decreased BP, and bruising, because these could all be signs of complications. Make sure they know to do a deep Subq in the abdomen, specifically 2 inches from the umbilicus, while not aspirating. Also let them know to always use a 20 to 22 gauge needle to withdraw med from vial, then change to 25 or 26 gauge needle, ½ to 5/8 inches long. Health promotion and maintenance is important for the nurse to encourage towards the patient. For example, every diagnosis consists of interventions to help the patient better. For example, in a patient with osteoporosis, ensure the diet has calcium and vitamin D, and make sure they are consumed concurrently. Also encourage weight-bearing exercises to help the patient get stronger. In addition, limit carbonated beverages, which contain phosphate and can cause calcium loss. Questions A nurse is caring for a client receiving a blood transfusion. What manifestations would indicate a possible allergic reaction to the transfusion? • Symps: flushing, dyspnea, itching, and a generalized rash A client has been prescribed warfarin. What are some common medication interactions for this medication? • SSRIs increase bleeding risk and so do antiplatelets, antibiotics (GI bleeding), and NSAIDs, as well as herbal supplements such as garlic and ginkgo biloba. A client has been prescribed prednisone for treatment of a chronic skin condition. Identify five (5) potential adverse effects of glucocorticoid therapy and associated nursing interventions to discuss with the client. • Hyperglycemia- Increase Insulin • Infection- Assess status for signs of infection (sore throat, weakness, malaise) • Osteoporosis- Provide calcium and Vitamin D in diet; weight bearing exercises • Peptic Ulcer Disease- Avoid Ibuprofen to not worsen condition; administer with food or meals • Myopathy- Report sign of muscle weakness A nurse is administering packed red blood cells to a client. What should the nurse do if a transfusion reaction is suspected? • Stop the transfusion; replace tubing with new tubing and administer 0.9% NS A nurse is caring for a client with a central venous pressure (CVP) line. What are potential complications of hemodynamic monitoring? • Pneumothorax, infection, and air embolism A client is prescribed a cephalosporin. Identify potential adverse effects of cephalosporins and list interventions/client teaching points the nurse should discuss with the client regarding the associated adverse effects? (Review the Pharmacology Review Module) • N/V, Diarrhea, hypersensitivity rxns, superinfection, nephrotoxicity, headache, Stevens- Johnsons syndrome o Advise patient to avoid alcoholic beverages when taking meds and for 3 days after completing the course of therapy because severe rxns can occur. A nurse is caring for a client newly prescribed Colesevelam. In what classification is this medication found? What is the expected pharmacological action of this medication? What are possible medication interactions for this medication? • Antilipemic agent; decreases LDL; take other meds 1 hr before/4 hrs after due to interactions The nurse is providing discharge education for a client who will be self-administering enoxaparin. Identify three (3) things to teach this client about self-administering enoxaparin. • Advise to observe for bleeding, increased HR, decreased BP, bruising • Use a 20 to 22-gauge needle to withdraw med from the vial, then change to a small needle 25 or 26 gauge, ½ to 5/8 inches long. • Deep subq in the abdomen, ensuring a distance of 2 inches from the umbilicus. Do not aspirate A nurse is caring for a client with a history of esophageal varices. Identify three (3) priority actions the nurse should take if bleeding is suspected. • Airway patency • If suspected bleeding, establish IV access with a large bore needle • Monitor vital signs and hematocrit, type and cross-match for possible blood transfusion, and monitor for overt and occult bleeding • Endoscopic variceal ligation for acute bleeding List five (5) teaching points to be included when educating a client newly diagnosed with diabetes about foot care. • Inspect feet daily • Pat dry gently, especially between toes, avoid lotions between toes to decrease excess moisture • Use mild powder on sweaty feet • Avoid open-toe, open- heel shoes • Trim nails straight across 3. Complete the pre-test, tutorial and post-test for the following skills module: Blood Administration Module Activity Last Date Accessed Time Spent Individual Score Lesson 12/11/2018 33:14 N/A Posttest 12/11/2018 04:45 Passed *ATI didn’t let me retake pretest* 4. RN Adult Medical Surgical 2016 B Remediation Pharmacological and Parenteral Therapies (23 items) Adverse Effects/Contraindications/Side Effects/Interactions (9 items) Hepatitis and Cirrhosis: Effects of Lactulose (Active Learning Template - Medication, RM AMS RN 10.0 Chp 55) • Stimulates the production of excess stool to rid the body of excess ammonia • Adverse effects are hypokalemia and dehydration • Decreases confusion • Can result in hyponatremia Expected Actions/Outcomes (2 items) Heart Failure and Pulmonary Edema: Assessing for Digoxin Toxicity (RN QSEN - Safety , Active Learning Template - Medication, RM AMS RN 10.0 Chp 32) • Bradycardia, anorexia, N/V, and visual disturbances • Drowsiness and change in LOC • Hypotension Hematologic Diagnostic Procedures: Efficacy of Warfarin Therapy (RN QSEN - Safety, Active Learning Template - Medication, RM AMS RN 10.0 Chp 39) • INR 2.5 is within therapeutic range of 2 to 3 for a client who has Atrial Fib Physiological Adaptation (34 items) Alterations in Body Systems (10 items) Lupus Erythematosus, Gout, and Fibromyalgia: Planning Teaching for a Client Who Has Gout (RN QSEN – Patient-centered Care, Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 87) • Should follow a low-purine diet and avoid food, such as organ meats and shellfish. • Avoid aspirin and diuretics • Should eat citrus fruits and juices, milk and other dairy products that increase the urinary pH Pathophysiology (4 items) Musculoskeletal Trauma: Early Manifestation of a Fat Embolism (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 71) • Dyspnea, tachypnea, and a decreased arterial oxygen level • Petechiae is the last manifestation of a fat embolism • Fever can develop later on 5. 15 Board Vitals Questions Name Roosevelt Santana Email Exam NCLEX-RN Exam 12/11/2018 Date December 11, 2018 Total Questions 15 Student Score 80% Subjects Performance Subject Response Overview Total Questions Student Score Median Score Percentile Rank ALTERNATE FORMAT Physiological Integrity - 1 0% 57% 0th Reduction of Risk Potential Med-Surg 13 85% 74% 65th Physiological 3 100% 71% 100th Integrity - Physiological Adaptation Physiological 3 100% 73% 100th Integrity - Reduction of Risk Potential