ATI COMPREHENSIVE EXIT EXAM(
f f f f
NGN ATI) f
1. Treatffirstfanyfimmediatefthreatsftofafpatient'sfsurvivalforfsafety.
Ex.fobstructedfairway,flossfoffconsciousness,fpsychologicalfepisodeforfanxietyfattack.fA
BC's.
2. Next,ftreatfactualfproblems.fEx.fnausea,ffullfbowelforfbladder,fcomfortfmeasures.
3. Then,ftreatfrelativelyfurgentfactualforfpotentialfproblemsfthatfthefpatientforffamilyfdoesfnotfrecogn
ize.fEx.fMonitoringfforfpost-
opfcomplications,fanticipatingfteachingfneedsfoffafpatientfthatfmayfbefunawarefoffsidefeffectsfoffmeds
.
4. Lastly,ftreatfactualforfpotentialfproblemsfwherefhelpfmayfbefneededfinftheffuture.
ExfTeachingfforfself-carefinfthefhome.
Herefarefsomefgreatfprinciplesftofhelpfyoufasfyoufprioritize:
,Systemicfbeforeflocalf
AcutefbeforefchronicfA
ctualfbeforefpotentialfLi
stenfdon'tfassume
Recognizeffirstfthenfapplyfclinicalfknowledgef
Maslow'sfHierarchyfoffNeeds:
PrioritizefaccordingftofMaslowfwithfphysiologicalfandfsafetyfissuesfbeforefpsychologicalfesteemfiss
ues.
Variantfanginaf(Prinzmetal'sfangina)
Dueftofafcoronaryfarteryfspasm,fofteningfoccurringfduringfperiodsfoffrest.
Unstablefangina
Occursfwithfexerciseforfemotionalfstress,fbutfitfincreasesfinfoccurrence,fseverity,fandfdurationfove
rftime.
Stablefangina
Occursfwithfexerciseforfemotionalfstressfandfisfrelievedfbyfrestforfnitroglycerinf(Nitrostat).
electrolytefimbalancefmanifestations:fh
ypocakelmia-->fflatfTfwavesfonfECG
hypercalcemia--
>fdecreasedfdeepftendonfreflexesf(DTRs)fhypocalcemia--
>ftetany
hyperkalemia-->ftallfpeakedfTfwavesfonfECG
Addison'sfdisease
Decreasedfaldosteronefandfrenin
Hypothyroidism
Decreasedftriiodothyroninef(T3)fandfthyroxine
,Cushing'sfdiseasef
Elevatedfcortisol
DiabetesfInsipidusf(DI)fDecreas
edfurinefspecificfgravity
Diabetesfmelitus
Elevatedfglycosylatedfhemoglobinf(HbA1c)
SyndromefoffInappropriatefSecretionfoffAntidiureticfHormonefI
ncreasedfurinefosmolality
Cataract
Progressivefandfpainlessflossfoffvision
Angle-
closurefglaucomafRapidfons
etfoffelevatedfIOP
macularfdegenerationf
Centralflossfoffvision
Open-
anglefgalucomafLossfoffp
eripheralfvision
Retinalfdetachment
Suddenflossfoffvisionfwithoutfpain
Commonfdisease'sfmanifestationsf
Cholecystitis-->fMurphy'sfsign
Pancreatitis-->fTurner'sfsign
PepticfUlcerfDisease-->fUpperfepigastricfpainf1-
2fhoursfafterfmealsfAppendicits-->fPainfatfMcBurney'sfpoint
Decorticate
, Decerebrate
Hepatitisfdiseaseftransmissions
HepatitisfA--
>fIngestionsfofcontaminatedffood/waterfHepatitisfB--
>fUnprotectedfsexualfcontact
NonviralfHepatits-->fDrugftoxicity
HeartfFailure
Symptoms:fShortnessfoffbreath,ffatigue,fjugularfveinfdistention,fandfanfS3farefsigns/symptomsfoffhea
rtffailurefresultingffromfthefdecreasedfpumpingfabilityfoffthefheartfandfincreasedffluidfvolume.
Hypovolemicfshock
position:fSupinefwithflegsfelevatedf(shockfposition)
Below-the-kneefamputation
Position:fThefclientfshouldfbefplacedfinfthefpronefpositionfseveralftimesfafdayftofpreventfhipfflexi
onfcontractions.
Chestftube
-
Continuousfbublingfinfthefwaterfsealfchampersfindicatesfanfairfleak.fIffthisfisfobserved,fthefnursefsh
ouldfattemptftoflocatedfthefsourcefoffthefairfleakfandfintervenefaccordinglyf(tightenfthefconnections
,freplacefdrainagefsystem)
Compartmentfsyndrome
Symptoms:fPulselessnessf(latefsign),fIncreasedfpainfunrelievedfwithfelevationforfbyfpainfme
dication
Leftfhomonymousfhemianopsia
hasflostfthefleftfvisualffieldfoffbothfeyes.fTheyfarefunableftofvisualizefanythingftofthefleftfoffmidl
inefoffthefbody.
dialysisffistula
clientfteaching:favoidfliftingfheavyfobjectsfwithfaccess-
sitefarm,favoidfcarryingfobjectsfthatfcompressfthefextremity,favoidfsleepingfonftopfoffthefextremity
fwithfthefaccessfdevice,fperform
f f f f
NGN ATI) f
1. Treatffirstfanyfimmediatefthreatsftofafpatient'sfsurvivalforfsafety.
Ex.fobstructedfairway,flossfoffconsciousness,fpsychologicalfepisodeforfanxietyfattack.fA
BC's.
2. Next,ftreatfactualfproblems.fEx.fnausea,ffullfbowelforfbladder,fcomfortfmeasures.
3. Then,ftreatfrelativelyfurgentfactualforfpotentialfproblemsfthatfthefpatientforffamilyfdoesfnotfrecogn
ize.fEx.fMonitoringfforfpost-
opfcomplications,fanticipatingfteachingfneedsfoffafpatientfthatfmayfbefunawarefoffsidefeffectsfoffmeds
.
4. Lastly,ftreatfactualforfpotentialfproblemsfwherefhelpfmayfbefneededfinftheffuture.
ExfTeachingfforfself-carefinfthefhome.
Herefarefsomefgreatfprinciplesftofhelpfyoufasfyoufprioritize:
,Systemicfbeforeflocalf
AcutefbeforefchronicfA
ctualfbeforefpotentialfLi
stenfdon'tfassume
Recognizeffirstfthenfapplyfclinicalfknowledgef
Maslow'sfHierarchyfoffNeeds:
PrioritizefaccordingftofMaslowfwithfphysiologicalfandfsafetyfissuesfbeforefpsychologicalfesteemfiss
ues.
Variantfanginaf(Prinzmetal'sfangina)
Dueftofafcoronaryfarteryfspasm,fofteningfoccurringfduringfperiodsfoffrest.
Unstablefangina
Occursfwithfexerciseforfemotionalfstress,fbutfitfincreasesfinfoccurrence,fseverity,fandfdurationfove
rftime.
Stablefangina
Occursfwithfexerciseforfemotionalfstressfandfisfrelievedfbyfrestforfnitroglycerinf(Nitrostat).
electrolytefimbalancefmanifestations:fh
ypocakelmia-->fflatfTfwavesfonfECG
hypercalcemia--
>fdecreasedfdeepftendonfreflexesf(DTRs)fhypocalcemia--
>ftetany
hyperkalemia-->ftallfpeakedfTfwavesfonfECG
Addison'sfdisease
Decreasedfaldosteronefandfrenin
Hypothyroidism
Decreasedftriiodothyroninef(T3)fandfthyroxine
,Cushing'sfdiseasef
Elevatedfcortisol
DiabetesfInsipidusf(DI)fDecreas
edfurinefspecificfgravity
Diabetesfmelitus
Elevatedfglycosylatedfhemoglobinf(HbA1c)
SyndromefoffInappropriatefSecretionfoffAntidiureticfHormonefI
ncreasedfurinefosmolality
Cataract
Progressivefandfpainlessflossfoffvision
Angle-
closurefglaucomafRapidfons
etfoffelevatedfIOP
macularfdegenerationf
Centralflossfoffvision
Open-
anglefgalucomafLossfoffp
eripheralfvision
Retinalfdetachment
Suddenflossfoffvisionfwithoutfpain
Commonfdisease'sfmanifestationsf
Cholecystitis-->fMurphy'sfsign
Pancreatitis-->fTurner'sfsign
PepticfUlcerfDisease-->fUpperfepigastricfpainf1-
2fhoursfafterfmealsfAppendicits-->fPainfatfMcBurney'sfpoint
Decorticate
, Decerebrate
Hepatitisfdiseaseftransmissions
HepatitisfA--
>fIngestionsfofcontaminatedffood/waterfHepatitisfB--
>fUnprotectedfsexualfcontact
NonviralfHepatits-->fDrugftoxicity
HeartfFailure
Symptoms:fShortnessfoffbreath,ffatigue,fjugularfveinfdistention,fandfanfS3farefsigns/symptomsfoffhea
rtffailurefresultingffromfthefdecreasedfpumpingfabilityfoffthefheartfandfincreasedffluidfvolume.
Hypovolemicfshock
position:fSupinefwithflegsfelevatedf(shockfposition)
Below-the-kneefamputation
Position:fThefclientfshouldfbefplacedfinfthefpronefpositionfseveralftimesfafdayftofpreventfhipfflexi
onfcontractions.
Chestftube
-
Continuousfbublingfinfthefwaterfsealfchampersfindicatesfanfairfleak.fIffthisfisfobserved,fthefnursefsh
ouldfattemptftoflocatedfthefsourcefoffthefairfleakfandfintervenefaccordinglyf(tightenfthefconnections
,freplacefdrainagefsystem)
Compartmentfsyndrome
Symptoms:fPulselessnessf(latefsign),fIncreasedfpainfunrelievedfwithfelevationforfbyfpainfme
dication
Leftfhomonymousfhemianopsia
hasflostfthefleftfvisualffieldfoffbothfeyes.fTheyfarefunableftofvisualizefanythingftofthefleftfoffmidl
inefoffthefbody.
dialysisffistula
clientfteaching:favoidfliftingfheavyfobjectsfwithfaccess-
sitefarm,favoidfcarryingfobjectsfthatfcompressfthefextremity,favoidfsleepingfonftopfoffthefextremity
fwithfthefaccessfdevice,fperform
