Exam (elaborations)

ATI COMPREHENSIVE PREDICTOR 2019

ATI COMPREHENSIVE PREDICTOR 2019 MED-SURG: 38 Questions  MS Priority Referral for a ALS • OT, PT, Speech Therapy • Home care • Hospice when needed  Lupus, Gout, Fibro Identifying a Client Requires a Referral to Dietitian • Gout  Keep diary of food triggers  Low-purine diet NO!!! organ meats or shellfish, yeast, sardines, spinach  Avoid/Limit alcohol intake  Avoid starvation diets, aspirin, diuretics  Increase fluid intake 3L/day • Lupus  Limit salt intake for fluid retention secondary to steroid therapy  High-vitamin, high iron diet  If anorexia, • provide small, freq. meals…offer between-meal supplements • take folic acid  High-protein diet, if no evidence of kidney disease • Fibro  Limit intake of caffeine, alcohol, & other substances interfere w/ sleep  Parkinson’s DiseaseAssessing Client’s Need for Physical Therapy • If unable to,  Walking and balance difficult  Physical movements slow down affecting moving  Unilateral shaking or tremor of one lime  Stand or walk, dependent for  Do exercise, yoga, ROM  Use of assistive devices, as disease progresses  Walking to slow down (can reduce injury)  Renal Disorder Dietary Teaching for Chronic Kidney Disease • LOW protein, LOW-potassium, HIGH-carb, vitamins & calcium supplements, LOW sodium, LOW phosphorous • Restrict magnesium • Strict I&O; fluid replacement –500 to 600 mL more than previous 24hr urine output • Limit alcohol intake • Don’t give antacids w/ Mg or enemas w/ phosphorous • Use diet & exercise to manage weight & prevent or control diabetes & HTN • Test albumin yearly  Dietary Teaching About Heme Iron for pt w/ Anemia • Nutritional deficiencies  iron, B12, folic acid, intrinsic factor • Encourage increase intake of deficient nutrient  iron (meats, poultry, fish), vitamin B12, folic acid • iron-fortified cereal & breads, fish, poultry, & dried peas and beans (NOT red meat or organ meats) • should reg. consume high folate (spinach, lentils, bananas) &folic acid fortified grains & juices  Stroke Assisting pt w/ Dysphagia • Monitor for aspiration, assess swallowing and gag reflexes before eating • Liquid consistencies  Thinwater, juice  Nectar-likecream soups, nectars  Honey-likehoney, yogurt  Spoon-thickpudding, cooked cereals • Food levels:  Pureed  Mechanically altered  Advanced/mechanically soft  Regular  Use appropriate consistency & food type as recommended by SLP to minimize choking • Position pt sitting in chair or sitting up in bed, w/ the head & neck positioned slightly forward & flexed • Feed pt slowly, placing food in the back of the mouth and to unaffected side • Provide sips of fluids & slowly advance diet foods easy to chew & swallow • Have suction on standby • Maintain a distraction-free environment during meals • Weight loss is common collaborate w/ dietitian for caloric intake • COMPLICATIONS NI:  if gag reflexes are present, give sip of water to determine if choking occurs  keep NPO until evaluated by SLP  Begin w/ prescribed liquid-consistency regimen from NDD & closely observe for choking  Have suction equipment available, feed w/ care bc nasotracheal suctioning increases ICP  RN should initial feeding  Nursing Actions Before Infusion Blood • Verify client ID, name, & blood type by two nurse • Prior to administration, assess baseline VS, **temp** • Establish iv assess, 18 to 20gauge catheter • Once obtained blood product from blood bank…inspect for discoloration, excessive bubbles, or cloudiness • Must have 0.9% sodium chloride primed tubing, Y-tubing w/ filter • First 15mins, stay w/ client & infuse slowly, monitoring for any reaction…If reaction occrs…  Stop blood immediately & take vitals  Infuse 0.9 sodium chloride  Notify the provider  Follow facility policy  send urine sample, CBC, & bag & tubing to lab for analysis  Complete infusion of product w/in 4hr