2022 STUDY GUIDE WORKING EXAM SOLUTION FOR ATI ADULT MEDICAL SURGICAL PROCTOR COMPLETE SOLUTION

2022 STUDY GUIDE WORKING EXAM SOLUTION FOR ATI ADULT MEDICAL SURGICAL PROCTOR COMPLETE SOLUTION Seizures and Epilepsy: Seizure precautions During a seizure: Position client on the floor and provide a patent airway, turn client to side and loosen restrictive clothing Cancer treatment options: Protective Isolation (999) If WBC drops below 1,000, place the client in a private room and initiate neutropenic precautions. - Have client remain in his room unless be needs to leave for a diagnostic procedure, in case of transport place a mask on him - Protect from possible sources of infection (plants, change water in equipment daily) - Have client, staff and visitors perform frequent hand hygiene, restrict ill visitors - Avoid invasive procedures (rectal temps, injections) - Administer (neupogen, neulasta) to stimulate WBC production Infection control: Appropriate room assignment Standard Precautions: 1. applies to all patients 2. Hand washing a. alcohol based preferred unless hands visually soiled 3. Gloves - when touching anything that has the potential to contaminate. 4. Masks, eye protection & face shields when care may cause splashing or spraying of body fluids Droplet: 1. private room or with someone with same illness 2. masks Airborne: 1. private room 2. masks or respiratory protection devices a. use an N95 respirator for tuberculosis 3. Negative pressure airflow 4. full face protection if splashing or spraying is possible Contact: 1. private room or room with same illness 2. gloves & gowns 3. disposal of infections dressing materials into a single, nonporous bag without touching the outside of the bag TB: Priority action for a client in the emergency department (249) Wear an N95 or HEPA respirator -Place client in negative airflow room and implement airborne precautions -use barrier protection when the risk of hand or clothing contamination exists Immunizations: Recommended vaccinations for older adult clients (943) Adults age 50 or older: -Pneumococcal Vaccine (PPSV) - Influenza vaccine - Herpes Zoster Vaccine -Hepatitis A - Hepatitis B - Meningococcal Vaccine Pulmonary Embolism: Risk factors for DVT (258) Long term immobility - Oral contraceptives - Pregnancy - Tobacco use - Hypercoagulabilty - Obesity - Surgery - Heart failure or chronic A-Fib - Autoimmune hemolytic anemia (sickle cell) -Long bone fractures -Advanced age Disorders of the male reproductive system: Complications of continuous irrigation following Trans-urethral Resection (743) Urethral trauma -Urinary retention - Bleeding - Infection Stroke: Caring for a client who has left sided hemiplegia (155) Observe extremities for injury - Apply an arm sling if client is unable to care for the affected extremity - Ensure foot rest is on wheel chair and ankle brace is on the affected foot - Instruct client to dress the affected side first Fractures and immobilization devices: Prevent complications (787) Assess neurovascular status of the affected body part for every hour for 24 hours and Q4 hours after that - Maintain body alignment - avoid lifting or removing weights -Monitor pain level - Monitor for signs of infection - Support nutrition Pain Management: use of non pharmacological methods of pain relief Cutaneous (skin) stimulation- TENS, heat, cold, therapeutic touch and massage - Distraction (deep breathing, ambulation, visitors, TV and music) - Relaxation (meditation, yoga and progressive muscle relaxation -Imagery (focus on pleasant thoughts) - Elevation of extremities to promote venous return Acute Kidney injury and chronic kidney disease: Evaluating teaching about nutrition Restrict dietary intake of potassium, phosphate and magnesium during oliguric phase -K and Na is regulated according to stage of kidney injury - high protein diet to replace the high rate of protein breakdown due to the stress from the illness. Possible TPN Heart failure and pulmonary edema: Dietary teaching about sodium restriction Maintain fluid and sodium restriction Increase dietary intake of potassium Pulmonary Embolism: Planning care for a client who is receiving enoxaparin Assess for contraindications (active bleeding, peptic ulcer disease, history of stroke, recent trauma) -Monitor bleeding times (PT, aPTT and INR) -Monitor for side effects such as thrombocytopenia, anemia and hemmorhage Rheumatoid Arthritis: Reviewing Laboratory Values Positive Anti- cyclic citrullinated peptide -RF Antibody (Diagnostic level for RA is 1:40-1:60) expected reference range 1:20 - Elevated ESR 20-40 mild inflammation 40-70 moderate 70-150 severe - Positive C-reactive protein - Positive ANA titier - Elevated WBC's Medications affecting coagulation: Heparin Contraindications Avoid NSAIDS while on heparin Antibiotics affecting protein synthesis: Adverse effects of gentamicin Ototoxicity: cochlear damage (hearing loss) and vestibular damage (loss of balance). -Nephrotoxicity (proteinuria, elevated BUN, creatinine levels). -Hypersensitivity ( rash, pruritis, parathesia of hands and feet, and urticaria). Electrolyte imbalance: manifestations of hypokalemia Weak, irregular pulse, hypotension, respiratory distress Premature ventricular contractions, bradycardia, inverted T waves, ST depression Decreased GI motility, abdominal distension, constipation, n/v, anorexia, polyuria Decreased K (<3.5) ABG: Metabolic alkalosis (pH > 7.45) Electrolyte imbalance: Priority assessment for hypokalemia Assessing for a patent and open airway Blood and blood product transfusions: Administering Fresh Frozen Plasma Initiate a large bore IV access: 20 gauge needle Complete transfusion withing 2-4 hours time frame If reaction occurs: -Stop transfusion immediately - Initiate 0.9% NaCl in a separate line - Save blood bag and blood tubing Cardiovascular Diagnostic and Therapeutic Procedures: Caring for a client who has a PICC ----- Assessing site every 8 hours. Note redness, swelling, drainage, tenderness and condition of dressing -Change tube and positive pressure cap per facility protocol -Using 10mL or larger syringe to flush the line -Cleanse with alcohol for 3 seconds before accessing it -Use transparent dressing Cardiovascular Diagnostic and Therapeutic Procedures: Teaching about a PICC Advise client not to immerse arm in water, to cover dressing site to avoid water exposure -Avoid BP in the arm with PICC Cardiovascular Diagnostic and Therapeutic Procedures: PICC care Apply an initial dressing of gauze and replace with transparent dressing within 24 hours - An initial x-ray should be taken to ensure proper placement Cardiovascular and Hematologic Disorders: teaching client about food interaction with Warfarin -----Kale, spinach -Brussels sprouts -collard greens, mustard greens -green tea -grapefruit juice, alcohol Angina and MI: Client teaching about nitroglycerin Nitrogylcerin prevents coronary artery vasospasm and reduces preload and afterload. Used to treat angina and help with BP. - Place nitro under tongue to dissolve - Take up to two more doses of nitro at 5-min intervals - Stop activity and rest Headache is a common side effect Orthostatic hypotension Osteoporosis: Teaching about self administration of Alendronate Take with 8oz water in the early morning before eating Remain upright for 30 minutes after taking medication Diabetes Mellitus Management: teaching about self administration of insulin Rotate injection sites - Inject at a 90 degree angle. Aspiration is not necessary - Advise client to eat at regular intervals, avoid alcohol intake and adjust insulin to exercise and diet to avoid hypoglycemia - When mixing insulin's, draw up the shorter acting insulin into the syringe first and then the longer acting insulin. IV therapy: Performing Venipuncture on an older adult client a 22-24 gauge catheter is best to use on older adults Tie the tourniquet sparingly and try to avoid veins in the hand Dosage calculations: Calculating IV infusion rate Ex: nurse is preparing to administer dextrose 5% in water 500 mL IV to infuse over 4 hours. The nurse should set the IV infusion pump to deliver how many mL/hr> -Volume (mL)/Time (hr) = X -500 mL/5hr = 125 mL/hr IV therapy: Medication administration Know -Right Patient -Right drug -Right Dose -Right Time -Right Route Arthoplasty: Pain control Analgesics - opiods (epidural, PCA, IV, Oral) NSAIDS Continuous peripheral nerve block Ice or cold therapy to reduce swelling Head of bed slightly elevated and the affected leg in a neutral position. place a pillow or abduction device between the legs when turning to the unaffectedNe side Pain management: PCA Small frequent dosing ensure consistent plasma levels Morphine and Dilaudid Let nurse know if the pump doesn't control the pain Client is the only person to push the button Pain management: Interventions to promote postoperative recovery Managing acute severe pain with short term around the clock administration of opiods parental route is best for immediate short term relief GI therapeutic procedures: D/C TPN therapy Never abruptly stop TPN, gradually decrease (10%) to allow body adjustment. Monitor vital signs q 4-8 hours GI therapeutic procedures: Shortage of TPN Solution Clients receiving TPN frequently need supplemental regular insulin. Keep dextrose 10% in water at the bedside in case the solution runs out. this minimizes the risk of hypoglycemia Nutrition Assessment: Caring for a client with pancreatitis increased serum glucose -reduce pancreatic stimulation through NPO; NG tube is inserted to suction gastric contents -snacks high in calories in order to maintain weight ECG and Dysrthymia monitoring: Analyzing ECG Watch for manifestations of dysrhythmias (chest pain, decreased LOC, SOB) and hypoxia. Remove leads, print ECG report and notify the provider ECG and Dysrthymia monitoring: Performing 12 lead ECG Prepare client for 12 lead if prescribed - Position client in supine position with chest exposed - wash skin to remove oils - Attach one electrode to each of the clients extremities by applying electrodes to flat surfaces above the wrist and ankles and the other 6 electrodes to the chest, avoiding chest hair. Instruct client to remain still Neurologic Diagnostic Procedures: Preparing for a lumbar puncture Instruct client to void before procedure and have them stretch over an overbed table if sitting is preferred - Monitor the puncture site for several hours to ensure the site clots and to decrease the risk of post lumbar puncture headaches COPD: Expected ABG results Hypoxemia (decreased PaO2, less than 80) Hypercarbia (increased PaO2, greater than 45) Respiratory acidosis, metabolic alkalosis compensation Hematologic Diagnostic Procedures: Laboratory findings to report ----RBC: 4.2-5.4 and 4.7-6.1 WBC: 5-10,000 Platelets: 150-400,000 Hgb: 12-16 and 14-18 Hct: 37-47% and 42-52% PT: 11-12.5 sec aPPT: 1.5-2 times normal range of 30-40 INR: 2-3 on warfarin Acid base imbalance: Interpreting ABG results 1) Look at pH <7.35 acidosis >7.45 Alkalosis 2) PaCo2 and HCO3 <35 or >45 PaCO2 is respiratory <22 or >26 is metabolic Diabetes Mellitus Management: Evaluating Glycemic Control Monitor with HbA1c expected reference range is 4-6% acceptable target for clients with diabetes 6.5-8% indicator of average blood glucose for the past 120 days Electrolyte Imabalances: Increasing the risk for digoxin toxicity Hypokalemia and client receiving digoxin increases the risk for digoxin toxicity