Chamberlain College of Nursing - ATI NURSING_VATI med surg remediation

Chamberlain College of Nursing - ATI NURSING_VATI med surg remediation VATI ADULT MEDICAL-SURGICAL ENHANCED REMEDIATION STUDY GUIDE Original, exam-focused remediation resource • Clinical judgment • Priority nursing care • NCLEX-style practice Source inspiration: the public Stuvia listing identifies a 2-page 2020/2021 study guide titled “ATI NURSING_VATI med surg remediation.” Because the paid portion is not publicly available, this guide does not reproduce or reconstruct the locked document. It expands the visible topic context into original study material. How to use this guide: Study the high-yield tables first, then work the practice questions without looking at the answers. For remediation, write down (1) what finding made the answer priority, (2) what intervention comes first, and (3) what finding would require escalation. VATI Adult Med-Surg Enhanced Remediation • Original Study Resource Page 2 1. Clinical Judgment & Priority Frameworks • ABCs: Airway → Breathing → Circulation. When a patient has an immediate threat to oxygenation or ventilation, that usually outranks a less urgent problem. • Acute vs. chronic: A new, rapidly worsening change is usually more urgent than a stable chronic finding. • Unstable vs. stable: Unexpected deterioration, altered mental status, severe respiratory distress, shock, or rapidly changing vital signs signal instability. • Safety first: Prevent immediate harm before completing routine teaching or comfort measures. • Maslow: Physiologic needs generally outrank psychosocial needs when the physiologic problem is acute. • Assess before acting—unless the emergency is obvious: If a patient is pulseless, severely hypoxic, actively hemorrhaging, or otherwise clearly unstable, immediate action takes priority. • Expected vs. unexpected: Know the normal disease trajectory. A finding can be abnormal but expected, while a new finding may indicate a complication. • Trend matters: A single value can mislead. Compare current status with baseline and prior measurements. 2. Respiratory Remediation • Hypoxemia clues: restlessness, confusion, tachycardia, low oxygen saturation, cyanosis (a late sign), and increased work of breathing. • COPD: Focus on prescribed oxygen, positioning, breathing techniques, secretion clearance, energy conservation, and monitoring for CO■-retention symptoms. Do not withhold oxygen from a hypoxemic patient; titrate according to the prescription and clinical target. • Asthma: Wheezing, chest tightness, cough, and prolonged expiration are common. A suddenly quiet chest in a severely distressed patient can be ominous because airflow may be critically reduced. • Pneumonia: fever, productive cough, crackles, pleuritic discomfort, and impaired gas exchange may occur. Prioritize oxygenation, airway clearance, hydration when appropriate, and ordered antimicrobials. • Pulmonary embolism: sudden dyspnea, pleuritic chest pain, tachycardia, anxiety, and hypoxemia. Treat suspected PE as urgent and prioritize oxygenation and rapid escalation. • Chest tubes: Keep the drainage system upright and below chest level. Assess tubing, connections, respiratory status, and drainage trends. Do not routinely clamp a chest tube. • Mechanical ventilation: Sudden deterioration requires assessment of the patient first, then equipment. Think DOPE: Displacement, Obstruction, Pneumothorax, Equipment failure. • Positioning: High-Fowler or semi-Fowler often improves ventilation; position according to the disease and provider orders. 3. Cardiovascular & Hemodynamic Remediation • Heart failure: Left-sided failure commonly causes pulmonary congestion (crackles, dyspnea, orthopnea). Right-sided failure more often causes systemic venous congestion (peripheral edema, JVD, hepatomegaly). • Acute pulmonary edema: Severe dyspnea, crackles, hypoxemia, and possibly pink/frothy sputum. Prioritize upright positioning, oxygenation, and rapid treatment. • Myocardial infarction: New chest pressure/discomfort with autonomic symptoms is an emergency. Follow the facility protocol for ECG, oxygen when indicated, medications, and rapid escalation. • Dysrhythmias: Assess the patient, not just the monitor. Determine whether perfusion is adequate: blood pressure, mental status, chest pain, pulses, and oxygenation. VATI Adult Med-Surg Enhanced Remediation • Original Study Resource Page 3 • Shock: Early findings can include tachycardia, anxiety/restlessness, cool skin, and delayed capillary refill. Hypotension can be a late sign. • Hypertension: Severe BP elevation with acute target-organ symptoms is more concerning than an isolated high reading without symptoms. Assess neurologic, cardiac, renal, and visual status. • Peripheral arterial disease: diminished pulses, cool skin, pain with activity, and dependent rubor. Protect the limb and avoid anything that further impairs arterial flow. • Venous insufficiency: edema, aching, warmth, and skin changes around the lower legs. Compression may be appropriate when arterial circulation is adequate. 4. Fluid, Electrolyte & Acid–Base Remediation • Dehydration: thirst, dry mucous membranes, tachycardia, orthostatic changes, concentrated urine, and reduced urine output. • Fluid overload: edema, weight gain, crackles, dyspnea, JVD, and hypertension can occur. Daily weight is a sensitive trend for fluid changes. • Hyponatremia: neurologic manifestations are especially important because sodium shifts can cause cerebral swelling—confusion, headache, seizures, and decreased level of consciousness. • Hyperkalemia: muscle weakness and potentially dangerous cardiac conduction changes. ECG monitoring and rapid treatment may be required depending on severity. • Hypokalemia: weakness, cramps, ileus, and dysrhythmias. Never give IV potassium by IV push. • ABG shortcut: Respiratory disorders move pH and PaCO■ in opposite directions; metabolic disorders move pH and HCO■■ in the same direction. • Respiratory acidosis: ↓pH + ↑PaCO■. Think hypoventilation. • Respiratory alkalosis: ↑pH + ↓PaCO■. Think hyperventilation. • Metabolic acidosis: ↓pH + ↓HCO■■. Think DKA, renal failure, or bicarbonate loss. • Metabolic alkalosis: ↑pH + ↑HCO■■. Think prolonged vomiting or gastric suction. 5. Neurologic Remediation • Stroke: sudden facial droop, arm weakness, speech difficulty, visual change, or balance problems require emergency response. Document last-known-well time when relevant. • Increased ICP: worsening headache, vomiting, altered level of consciousness, pupillary changes, and late Cushing response are concerning. Avoid unnecessary hip flexion and activities that increase intrathoracic pressure. • Seizure: protect from injury, maintain airway, turn to the side when possible, loosen restrictive clothing, and do not restrain or place objects in the mouth. • Meningitis: fever, headache, nuchal rigidity, photophobia, and altered mental status may occur. Use appropriate isolation precautions and obtain cultures/diagnostics as ordered without delaying urgent treatment. • Parkinson disease: bradykinesia, rigidity, tremor, and postural instability. Medication timing is important; aspiration and falls are major safety concerns. • Myasthenia gravis: fatigable weakness that worsens with activity. Respiratory muscle weakness can become life-threatening. • Multiple sclerosis: neurologic deficits can vary by lesion and may worsen with heat, infection, or fatigue. Conserve energy and monitor function. VATI Adult Med-Surg Enhanced Remediation • Original Study Resource Page 4 6. GI & Hepatic Remediation • GI bleeding: assess hemodynamic status first. Melena suggests upper GI bleeding; bright-red blood can occur with lower GI bleeding but may also occur with brisk upper bleeding. • Peptic ulcer disease: monitor for bleeding and perforation. Sudden severe abdominal pain with a rigid abdomen suggests perforation and requires urgent evaluation. • Pancreatitis: severe epigastric pain often radiating to the back, nausea/vomiting, and elevated pancreatic enzymes. Monitor fluids, pain, respiratory status, and complications. • Cirrhosis: portal hypertension, ascites, jaundice, coagulopathy, and he