ATI COMPREHENSIVE EXIT EXAM(
j j j j
NGN ATI) j
1. Treatjfirstjanyjimmediatejthreatsjtojajpatient'sjsurvivaljorjsafety.
Ex.jobstructedjairway,jlossjofjconsciousness,jpsychologicaljepisodejorjanxietyjattack.jAB
C's.
2. Next,jtreatjactualjproblems.jEx.jnausea,jfulljboweljorjbladder,jcomfortjmeasures.
3. Then,jtreatjrelativelyjurgentjactualjorjpotentialjproblemsjthatjthejpatientjorjfamilyjdoesjnotjrecogni
ze.jEx.jMonitoringjforjpost-
opjcomplications,janticipatingjteachingjneedsjofjajpatientjthatjmayjbejunawarejofjsidejeffectsjofjmeds.
4. Lastly,jtreatjactualjorjpotentialjproblemsjwherejhelpjmayjbejneededjinjthejfuture.
ExjTeachingjforjself-carejinjthejhome.
Herejarejsomejgreatjprinciplesjtojhelpjyoujasjyoujprioritize:
,Systemicjbeforejlocalj
AcutejbeforejchronicjA
ctualjbeforejpotentialjLi
stenjdon'tjassume
Recognizejfirstjthenjapplyjclinicaljknowledgej
Maslow'sjHierarchyjofjNeeds:
PrioritizejaccordingjtojMaslowjwithjphysiologicaljandjsafetyjissuesjbeforejpsychologicaljesteemjissu
es.
Variantjanginaj(Prinzmetal'sjangina)
Duejtojajcoronaryjarteryjspasm,jofteningjoccurringjduringjperiodsjofjrest.
Unstablejangina
Occursjwithjexercisejorjemotionaljstress,jbutjitjincreasesjinjoccurrence,jseverity,jandjdurationjover
jtime.
Stablejangina
Occursjwithjexercisejorjemotionaljstressjandjisjrelievedjbyjrestjorjnitroglycerinj(Nitrostat).
electrolytejimbalancejmanifestations:jh
ypocakelmia-->jflatjTjwavesjonjECG
hypercalcemia--
>jdecreasedjdeepjtendonjreflexesj(DTRs)jhypocalcemia--
>jtetany
hyperkalemia-->jtalljpeakedjTjwavesjonjECG
Addison'sjdisease
Decreasedjaldosteronejandjrenin
Hypothyroidism
Decreasedjtriiodothyroninej(T3)jandjthyroxine
,Cushing'sjdiseasej
Elevatedjcortisol
DiabetesjInsipidusj(DI)jDecrease
djurinejspecificjgravity
Diabetesjmelitus
Elevatedjglycosylatedjhemoglobinj(HbA1c)
SyndromejofjInappropriatejSecretionjofjAntidiureticjHormonejIn
creasedjurinejosmolality
Cataract
Progressivejandjpainlessjlossjofjvision
Angle-
closurejglaucomajRapidjons
etjofjelevatedjIOP
macularjdegenerationj
Centraljlossjofjvision
Open-
anglejgalucomajLossjofjp
eripheraljvision
Retinaljdetachment
Suddenjlossjofjvisionjwithoutjpain
Commonjdisease'sjmanifestationsj
Cholecystitis-->jMurphy'sjsign
Pancreatitis-->jTurner'sjsign
PepticjUlcerjDisease-->jUpperjepigastricjpainj1-
2jhoursjafterjmealsjAppendicits-->jPainjatjMcBurney'sjpoint
Decorticate
, Decerebrate
Hepatitisjdiseasejtransmissions
HepatitisjA--
>jIngestionsjojcontaminatedjfood/waterjHepatitisjB--
>jUnprotectedjsexualjcontact
NonviraljHepatits-->jDrugjtoxicity
HeartjFailure
Symptoms:jShortnessjofjbreath,jfatigue,jjugularjveinjdistention,jandjanjS3jarejsigns/symptomsjofjhear
tjfailurejresultingjfromjthejdecreasedjpumpingjabilityjofjthejheartjandjincreasedjfluidjvolume.
Hypovolemicjshock
position:jSupinejwithjlegsjelevatedj(shockjposition)
Below-the-kneejamputation
Position:jThejclientjshouldjbejplacedjinjthejpronejpositionjseveraljtimesjajdayjtojpreventjhipjflexi
onjcontractions.
Chestjtube
-
Continuousjbublingjinjthejwaterjsealjchampersjindicatesjanjairjleak.jIfjthisjisjobserved,jthejnursejsh
ouldjattemptjtojlocatedjthejsourcejofjthejairjleakjandjintervenejaccordinglyj(tightenjthejconnections,j
replacejdrainagejsystem)
Compartmentjsyndrome
Symptoms:jPulselessnessj(latejsign),jIncreasedjpainjunrelievedjwithjelevationjorjbyjpainjme
dication
Leftjhomonymousjhemianopsia
hasjlostjthejleftjvisualjfieldjofjbothjeyes.jTheyjarejunablejtojvisualizejanythingjtojthejleftjofjmidli
nejofjthejbody.
dialysisjfistula
clientjteaching:javoidjliftingjheavyjobjectsjwithjaccess-
sitejarm,javoidjcarryingjobjectsjthatjcompressjthejextremity,javoidjsleepingjonjtopjofjthejextremityj
withjthejaccessjdevice,jperform
j j j j
NGN ATI) j
1. Treatjfirstjanyjimmediatejthreatsjtojajpatient'sjsurvivaljorjsafety.
Ex.jobstructedjairway,jlossjofjconsciousness,jpsychologicaljepisodejorjanxietyjattack.jAB
C's.
2. Next,jtreatjactualjproblems.jEx.jnausea,jfulljboweljorjbladder,jcomfortjmeasures.
3. Then,jtreatjrelativelyjurgentjactualjorjpotentialjproblemsjthatjthejpatientjorjfamilyjdoesjnotjrecogni
ze.jEx.jMonitoringjforjpost-
opjcomplications,janticipatingjteachingjneedsjofjajpatientjthatjmayjbejunawarejofjsidejeffectsjofjmeds.
4. Lastly,jtreatjactualjorjpotentialjproblemsjwherejhelpjmayjbejneededjinjthejfuture.
ExjTeachingjforjself-carejinjthejhome.
Herejarejsomejgreatjprinciplesjtojhelpjyoujasjyoujprioritize:
,Systemicjbeforejlocalj
AcutejbeforejchronicjA
ctualjbeforejpotentialjLi
stenjdon'tjassume
Recognizejfirstjthenjapplyjclinicaljknowledgej
Maslow'sjHierarchyjofjNeeds:
PrioritizejaccordingjtojMaslowjwithjphysiologicaljandjsafetyjissuesjbeforejpsychologicaljesteemjissu
es.
Variantjanginaj(Prinzmetal'sjangina)
Duejtojajcoronaryjarteryjspasm,jofteningjoccurringjduringjperiodsjofjrest.
Unstablejangina
Occursjwithjexercisejorjemotionaljstress,jbutjitjincreasesjinjoccurrence,jseverity,jandjdurationjover
jtime.
Stablejangina
Occursjwithjexercisejorjemotionaljstressjandjisjrelievedjbyjrestjorjnitroglycerinj(Nitrostat).
electrolytejimbalancejmanifestations:jh
ypocakelmia-->jflatjTjwavesjonjECG
hypercalcemia--
>jdecreasedjdeepjtendonjreflexesj(DTRs)jhypocalcemia--
>jtetany
hyperkalemia-->jtalljpeakedjTjwavesjonjECG
Addison'sjdisease
Decreasedjaldosteronejandjrenin
Hypothyroidism
Decreasedjtriiodothyroninej(T3)jandjthyroxine
,Cushing'sjdiseasej
Elevatedjcortisol
DiabetesjInsipidusj(DI)jDecrease
djurinejspecificjgravity
Diabetesjmelitus
Elevatedjglycosylatedjhemoglobinj(HbA1c)
SyndromejofjInappropriatejSecretionjofjAntidiureticjHormonejIn
creasedjurinejosmolality
Cataract
Progressivejandjpainlessjlossjofjvision
Angle-
closurejglaucomajRapidjons
etjofjelevatedjIOP
macularjdegenerationj
Centraljlossjofjvision
Open-
anglejgalucomajLossjofjp
eripheraljvision
Retinaljdetachment
Suddenjlossjofjvisionjwithoutjpain
Commonjdisease'sjmanifestationsj
Cholecystitis-->jMurphy'sjsign
Pancreatitis-->jTurner'sjsign
PepticjUlcerjDisease-->jUpperjepigastricjpainj1-
2jhoursjafterjmealsjAppendicits-->jPainjatjMcBurney'sjpoint
Decorticate
, Decerebrate
Hepatitisjdiseasejtransmissions
HepatitisjA--
>jIngestionsjojcontaminatedjfood/waterjHepatitisjB--
>jUnprotectedjsexualjcontact
NonviraljHepatits-->jDrugjtoxicity
HeartjFailure
Symptoms:jShortnessjofjbreath,jfatigue,jjugularjveinjdistention,jandjanjS3jarejsigns/symptomsjofjhear
tjfailurejresultingjfromjthejdecreasedjpumpingjabilityjofjthejheartjandjincreasedjfluidjvolume.
Hypovolemicjshock
position:jSupinejwithjlegsjelevatedj(shockjposition)
Below-the-kneejamputation
Position:jThejclientjshouldjbejplacedjinjthejpronejpositionjseveraljtimesjajdayjtojpreventjhipjflexi
onjcontractions.
Chestjtube
-
Continuousjbublingjinjthejwaterjsealjchampersjindicatesjanjairjleak.jIfjthisjisjobserved,jthejnursejsh
ouldjattemptjtojlocatedjthejsourcejofjthejairjleakjandjintervenejaccordinglyj(tightenjthejconnections,j
replacejdrainagejsystem)
Compartmentjsyndrome
Symptoms:jPulselessnessj(latejsign),jIncreasedjpainjunrelievedjwithjelevationjorjbyjpainjme
dication
Leftjhomonymousjhemianopsia
hasjlostjthejleftjvisualjfieldjofjbothjeyes.jTheyjarejunablejtojvisualizejanythingjtojthejleftjofjmidli
nejofjthejbody.
dialysisjfistula
clientjteaching:javoidjliftingjheavyjobjectsjwithjaccess-
sitejarm,javoidjcarryingjobjectsjthatjcompressjthejextremity,javoidjsleepingjonjtopjofjthejextremityj
withjthejaccessjdevice,jperform
