ATI Fundamentals
Pharm Meds
o Allopurinol – Tx gout & kidney stones by reducing uric acid
o Plasma volume expanders
Help correct hypovolemia (hemorrhage or burns)
Dextran
Albumin
o Skeletal muscle relaxant
Cyclobenzaprine
Metaxalone
o Beta-adrenergic blockers
Lower HR
Propranolol
Atenolol
Carvedilol
o Broad-spectrum anti-infective agents
Ampicillin
Cefixime
o
Pharmacology (med – adverse effect)
o Acetaminophen – liver toxic, < 3-4 g/day
o Aspirin & NSAIDS – gastric ulcer, stomach problems
o Opioid analgesics – constipation, respiratory depression
Medication
o Medication wasting
Record the amount of med wasted on the controlled substance inventory record
Must have another RN witness wasting (not AP)
Do not return unused portion
o Documentation
Be specific. Document med name, the dose, and the time
If pt refuse, doc med name, date, time pt refused and if any action occurs (pt
throws med to floor) doc the action that took place
Only quote what pt says, not what pt implies
Do not doc “pt seems upset and hostile” as this is an opinion, not a fact
o Med admin steps
Check pt pain level with pain scale
Discuss adverse effects of med
Check allergies
Check VS
o Multi-use bottle
Hold label against palm of hand when pouring
Fill cup until med is even w/ surface or meniscus base of dosage
Discard any excess med in sink, do not pour back in
,Medication administration
o Eyes
Instill in conjunctival sac
Apply pressure to puncta for 1-2 min to prevent systemic absorption of med
Apply pressure to nasolacrimal duct for 30-60 sec to prevent systemic
absorption
Hold eye dropper 1-2 cm from conjunctival sac
Close eye gently, avoid blinking after instillation
Look up toward ceiling during instillation
Irrigation
Hold upper lid against eyebrow and lower lid against cheekbone
Hold irrigator 1 inch above eye
Direct onto lower conjunctival sec
Direct from inner canthus to outer
o Ear (optic)
Hold dropper 1 cm (0.5 inch) above ear canal
Adult: straighten ear canal by pulling auricle up and out
Child (younger than 3y/o): straighten ear canal by pulling auricle down and back
Apply cotton ball into outermost part of ear canal, remove after 15 min
o Inhaler
Shake vigorously for 3-5 sec before use
Place inhaler in mouth, tightly close lips to create seal, depress canister, take
deep breath, hold for at least 10 secs
Wait 20-30 sec btw inhalations
Rinse mouth after use
Steps:
Hold mouthpiece 1-2 inch from mouth
Tilt head back slightly, then open mouth
Depress medication while taking a deep breath
Hold breath for 10 sec, then breathe normally
o Hearing aids
If hearing aids whistle then:
Poor seal with the ear mold
Ear infection
Excessive wax in ear canal
Improper fit
Malfunction
Volume too high
Low battery
Will not whistle, just not work effectively
o Remove battery at night
Crack in ear tube of an in-the-canal hearing aid
Impairs amplification of sound
,Injections
o IM
Ventrogluteal
Safest injection site for adult
Does not contain major nerves/blood vessels
Safe for pt older than 7 months
Side hip between iliac crest and anterior iliac spine
Hand on greater trochanter w/ first 2 fingers touching the iliac crest and
anterior superior iliac spine, forming a V shape
Vastus lateralis
Safe for adults
Best for infants and children
Thick and away from major nerves/blood vessels
Middle portion of thigh
Hand below greater trochanter, hand above knee = middle of thigh
where injection should be
Deltoid
Easy access but not the safest
Small muscle and poorly developed
Dorsolateral
Not recommended due to closeness to nerves & arteries
o SC
Deltoid muscle
Posterior tissue of the upper arm
<1 mL
4 fingers on deltoid muscle, top finger on acromion process
Injection site = 3 fingers below acromion process (2in)
Sympathetic system
o Flight-or-fight
o Increase arterial BP, HR, RR, cardiac output
o Dilated pupils
o Bronchiolar dilation
Communication
o Feedback (whether nonverbal or verbal) = successful communication
o Use multiple channels (visual, auditory, facial expressions) to improve effectiveness of
communication
Healthcare team
o Speech-language pathologist
Help w/ dysphagia, learn how to eat safely
o Social worker
Assist w/ finding & accessing community services (meal delivery, financial
services) once pt is at home
o Physical therapist
Musculoskeletal problems
, o Occupational therapist
Help w/ ADLs
Hand position
o Supination
Palm up
o Pronation
Palm down
o Flexion
Fingers pointing towards floor
o Extension
Fingers pointing towards ceiling
Body position
o Prone
Laying on stomach
o Supine
Laying on back
Good for abdominal exam
o Lateral recumbent
Laying on side
Good for auscultating heart to detect murmurs
o Fowler’s
Laying/sitting at a degree 40-90
o Trendelenburg
Laying feet above head
o Lithotomy position
Good for gynecological examination
o Sims’ position
Laying on side w/ left leg over and bent
Good for rectal and vaginal examinations
Peripheral pulses
o “bilaterally symmetric, equal, and strong in all 4 extremities”
Radial
Brachial
Groove btw bicep & triceps, antecubital fossa
Ulnar
Femoral
Popliteal
Behind the knee
Posterior tibial
Medial malleolus, inner ankle
Dorsalis pedal
Dorsum of foot
o Used if indications of circulatory impairment or comprehensive physical exam (not vital
signs)
Pharm Meds
o Allopurinol – Tx gout & kidney stones by reducing uric acid
o Plasma volume expanders
Help correct hypovolemia (hemorrhage or burns)
Dextran
Albumin
o Skeletal muscle relaxant
Cyclobenzaprine
Metaxalone
o Beta-adrenergic blockers
Lower HR
Propranolol
Atenolol
Carvedilol
o Broad-spectrum anti-infective agents
Ampicillin
Cefixime
o
Pharmacology (med – adverse effect)
o Acetaminophen – liver toxic, < 3-4 g/day
o Aspirin & NSAIDS – gastric ulcer, stomach problems
o Opioid analgesics – constipation, respiratory depression
Medication
o Medication wasting
Record the amount of med wasted on the controlled substance inventory record
Must have another RN witness wasting (not AP)
Do not return unused portion
o Documentation
Be specific. Document med name, the dose, and the time
If pt refuse, doc med name, date, time pt refused and if any action occurs (pt
throws med to floor) doc the action that took place
Only quote what pt says, not what pt implies
Do not doc “pt seems upset and hostile” as this is an opinion, not a fact
o Med admin steps
Check pt pain level with pain scale
Discuss adverse effects of med
Check allergies
Check VS
o Multi-use bottle
Hold label against palm of hand when pouring
Fill cup until med is even w/ surface or meniscus base of dosage
Discard any excess med in sink, do not pour back in
,Medication administration
o Eyes
Instill in conjunctival sac
Apply pressure to puncta for 1-2 min to prevent systemic absorption of med
Apply pressure to nasolacrimal duct for 30-60 sec to prevent systemic
absorption
Hold eye dropper 1-2 cm from conjunctival sac
Close eye gently, avoid blinking after instillation
Look up toward ceiling during instillation
Irrigation
Hold upper lid against eyebrow and lower lid against cheekbone
Hold irrigator 1 inch above eye
Direct onto lower conjunctival sec
Direct from inner canthus to outer
o Ear (optic)
Hold dropper 1 cm (0.5 inch) above ear canal
Adult: straighten ear canal by pulling auricle up and out
Child (younger than 3y/o): straighten ear canal by pulling auricle down and back
Apply cotton ball into outermost part of ear canal, remove after 15 min
o Inhaler
Shake vigorously for 3-5 sec before use
Place inhaler in mouth, tightly close lips to create seal, depress canister, take
deep breath, hold for at least 10 secs
Wait 20-30 sec btw inhalations
Rinse mouth after use
Steps:
Hold mouthpiece 1-2 inch from mouth
Tilt head back slightly, then open mouth
Depress medication while taking a deep breath
Hold breath for 10 sec, then breathe normally
o Hearing aids
If hearing aids whistle then:
Poor seal with the ear mold
Ear infection
Excessive wax in ear canal
Improper fit
Malfunction
Volume too high
Low battery
Will not whistle, just not work effectively
o Remove battery at night
Crack in ear tube of an in-the-canal hearing aid
Impairs amplification of sound
,Injections
o IM
Ventrogluteal
Safest injection site for adult
Does not contain major nerves/blood vessels
Safe for pt older than 7 months
Side hip between iliac crest and anterior iliac spine
Hand on greater trochanter w/ first 2 fingers touching the iliac crest and
anterior superior iliac spine, forming a V shape
Vastus lateralis
Safe for adults
Best for infants and children
Thick and away from major nerves/blood vessels
Middle portion of thigh
Hand below greater trochanter, hand above knee = middle of thigh
where injection should be
Deltoid
Easy access but not the safest
Small muscle and poorly developed
Dorsolateral
Not recommended due to closeness to nerves & arteries
o SC
Deltoid muscle
Posterior tissue of the upper arm
<1 mL
4 fingers on deltoid muscle, top finger on acromion process
Injection site = 3 fingers below acromion process (2in)
Sympathetic system
o Flight-or-fight
o Increase arterial BP, HR, RR, cardiac output
o Dilated pupils
o Bronchiolar dilation
Communication
o Feedback (whether nonverbal or verbal) = successful communication
o Use multiple channels (visual, auditory, facial expressions) to improve effectiveness of
communication
Healthcare team
o Speech-language pathologist
Help w/ dysphagia, learn how to eat safely
o Social worker
Assist w/ finding & accessing community services (meal delivery, financial
services) once pt is at home
o Physical therapist
Musculoskeletal problems
, o Occupational therapist
Help w/ ADLs
Hand position
o Supination
Palm up
o Pronation
Palm down
o Flexion
Fingers pointing towards floor
o Extension
Fingers pointing towards ceiling
Body position
o Prone
Laying on stomach
o Supine
Laying on back
Good for abdominal exam
o Lateral recumbent
Laying on side
Good for auscultating heart to detect murmurs
o Fowler’s
Laying/sitting at a degree 40-90
o Trendelenburg
Laying feet above head
o Lithotomy position
Good for gynecological examination
o Sims’ position
Laying on side w/ left leg over and bent
Good for rectal and vaginal examinations
Peripheral pulses
o “bilaterally symmetric, equal, and strong in all 4 extremities”
Radial
Brachial
Groove btw bicep & triceps, antecubital fossa
Ulnar
Femoral
Popliteal
Behind the knee
Posterior tibial
Medial malleolus, inner ankle
Dorsalis pedal
Dorsum of foot
o Used if indications of circulatory impairment or comprehensive physical exam (not vital
signs)
