ATI Comprehensive Predictor Retake Review UPDATED 2023 graded A+

Comprehensive Predictor Retake Review UPDATED 2023 graded A+ Delegation to Assistive Personal - ANS - ADLs - Bathing - Grooming - Dressing - Tioleting - Ambulating - Feeding (without swallowing precautions) - Positioning - Rountine Tasks - Bed making - Specimen collection - I&O - Vital Signs ( for stable clients ) Planning Care for a Client Who Has Hypothyroidism - ANS - Monitor for low Bp & bradycardia - Monitor for chest pain & peripheral edema - Monitor clients weight - reorient the client if confusion occurs - provide frequent rest periods to avoid fatigue & decrease myocardial oxygen demands - Monitor respiratory status - encourage client to cough and breathe deeply to prevent pulmonary complications - low calorie, high fiber diet , & encourage fluids to prevent constipation and promote weight loss - Administer cathartics and stool softeners as needed. (Avoid fiber laxatives, interfere with absorption of levothyroxine) - Provide extra clothing and blankets for clients who have decreased cold intolerance - caution use of electric blankets - Encourage verbalization of feelings and fears about body changes - Reassure client that most physical manifestations are reversible - use caution with CNS depressants (barbiturates or sedatives) Signs of hypothyroidism - ANS - Fatigue/ lethargy - irritability - intolerance to cold - constipation - weight gain - pallor - think brittle fingernails - depression & apathy - joint or muscle pain - bradycardia, hypotension, dysrhythmias - slow thought process & speech - hypoventilation & pleural effusion - thickening of the skin - hair loss - thickening of hair on eyebrows - dry flaky skin - decreased acuity of taste - impotence - abnormal menstrual periods (menorrhagia/ amenorrhea) - delayed physical and mental growth in children Medication for hypothyroidism - ANS levothyroxin (synthetic thyroid hormone replacement) Risk factors for hypothyroidism - ANS - females 30 to 60 years of age - use of lithium & amiodarone medications - Inadequate intake of iodine - Radiation Therapy the head and neck What is hypothyroidism - ANS underactive thyroid Hyperthyroidism risk factors - ANS - Graves' disease - Thyroiditis - Toxic adenoma - Toxic nodular goiter - Exogenous hyperthyroidism What is hyperthyroidism? - ANS overactive thyroid Signs of hyperthyroidism - ANS - nervousness/ irritability - muscle weakness - heat intolerance - weight loss - insomnia - irregular menstrual flow - frequent stools and diarrhea - decreased libido - Tremor, hyperkinesia, hyperreflexia - Exophthalmos - blurry vision or changes - bloodshot appearance of eyes - Goiter - Tachycardia, palpitations, dysthymia - Elevated blood pressure - dyspnea Nursing care for hyperthyroidism - ANS - minimize clients energy - promote calm environment - monitor mental status - monitor nutritional status - monitor I&O / weight - provide eye protection (patches, eye lubricant, tape to close eyelids) - monitor vital signs and hemodynamic parameters - reduce room temp - provide cool shower/ sponge bath - Report a increased temp of 1*F immediately - Avoid excessive palpation of the thyroid Medication for hyperthyroidism - ANS - Methimazole Reinforcing Teaching About Ostomy Care - ANS stoma should be moist , shinny, and pink. The peristomal area should be intact - use mild soap and water to cleanse the skin, then dry it gently and completely ( moisturizing soaps interfere with adherence of the pouch) - Apply paste if necessary - measure and mark the desired size for the skin barrier - cut the opening 0.15 cm to 0.3 cm ( 1/18 to 1/8) in larger, allowing the stoma to appear through the opening - apply barrier paste to creases Developing a Improvement Plan for Assistive Personnel - ANS - performance should reflect the staff member's job and description - various sources of data should be collected - data should be collected over time and not just represent isolated incidents - actual observed behavior should be documented - peers can be a valuable source of data - the employee should be given the opportunity to provide input - the unit manager to host a private meeting with the staff member Monitoring the Performance of Assistive Personnel - ANS - have ap demonstrate the tasks before doing it Reinforcing Teaching About Client Privacy - ANS - only health care team members directly responsible for a clients care can access that client record. Nurses cannot share info with other clients or staff not caring for the client - Client have the right to read and obtain a copy of their medical record - Nurses cannot photocopy any part of a medical record - staff must keep medical records