3Crits Medsurg B - MED SURG INFO
APPENDIX H
THREE CRITICAL AREAS
ATI PRACTICE ASSESSMENT
NAME Bernard Quijada DATE: 1/26/2021
1. Stroke nursing care includes maintaining a safe environment to reduce the risk of falls.
Assistive devices (transfer belts and sliding boards) should be used during transfers. Sit-to-stand
lifts can also facilitate transfers and reduce strain on the care provider’s body. If the client has
homonymous hemianopsia (loss of the same visual field in both eyes), instruct them to use a
scanning technique (turning head from the direction of the unaffected side to the affected side)
when eating and ambulating. Clients who have experienced strokes have decreased endurance
and impaired balance due to paralysis on one side of the body. Provide frequent rest periods
from sitting in the wheelchair by returning the client to bed after therapies and meals. When
sitting the client up in bed or in the wheelchair, leaning to the affected side typically occurs and
should be countered with some manner of support.
2 DKA is an acute, life-threatening condition characterized by uncontrolled hyperglycemia
(greater than 300 mg/dL), metabolic acidosis, and an accumulation of ketones in the blood and
urine. The onset is rapid, and the mortality rate is up to 10%. Expected findings for DKA include
polyuria, polydipsia, polyphagia, weight loss, nausea, vomiting, abdominal pain, blurred vision,
headache, weakness, orthostatic hypotension, fruity odor of breath, Kussmaul respirations,
metabolic acidosis, and mental status change. Insulin is administered IV rather than
subcutaneously to provide immediate treatment. The client who has DKA will absorb
subcutaneous insulin slowly and erratically, making it difficult to adjust dosages of insulin
appropriately. Monitor blood glucose hourly. Blood glucose of less than 200 mg/dL is the goal for
resolution, with a pH greater than 7.3, blood bicarbonate level greater than 18 mEq/L, and
calculated anion gap less than 12 mEq/L. In DKA, IV administration of insulin and dextrose
must continue even when glucose is less than 200 mg/dL until the acidosis resolves and the client
is able to take subcutaneous insulin.
3. Verapamil is a calcium channel blocker. It blocks the calcium channels in blood vessels which
leads to vasodilation of peripheral arterioles and arteries/arterioles of the heart. Blocking of
calcium channels in the myocardium, SA node, and AV node leads to a decreased force of
contraction, decreased heart rate, and slowing of the rate of conduction through the AV node. It
is used for Angina pectoris, hypertension and cardiac dysrhythmias. Complications can include
orthostatic hypotension, peripheral edema, constipation, suppression of cardiac function
(bradycardia, heart failure), dysrhythmias, acute toxicity (hypotension, bradycardia, AV block,
ventricular tachydysrhythmias.
APPENDIX H
THREE CRITICAL AREAS
ATI PRACTICE ASSESSMENT
NAME Bernard Quijada DATE: 1/26/2021
1. Stroke nursing care includes maintaining a safe environment to reduce the risk of falls.
Assistive devices (transfer belts and sliding boards) should be used during transfers. Sit-to-stand
lifts can also facilitate transfers and reduce strain on the care provider’s body. If the client has
homonymous hemianopsia (loss of the same visual field in both eyes), instruct them to use a
scanning technique (turning head from the direction of the unaffected side to the affected side)
when eating and ambulating. Clients who have experienced strokes have decreased endurance
and impaired balance due to paralysis on one side of the body. Provide frequent rest periods
from sitting in the wheelchair by returning the client to bed after therapies and meals. When
sitting the client up in bed or in the wheelchair, leaning to the affected side typically occurs and
should be countered with some manner of support.
2 DKA is an acute, life-threatening condition characterized by uncontrolled hyperglycemia
(greater than 300 mg/dL), metabolic acidosis, and an accumulation of ketones in the blood and
urine. The onset is rapid, and the mortality rate is up to 10%. Expected findings for DKA include
polyuria, polydipsia, polyphagia, weight loss, nausea, vomiting, abdominal pain, blurred vision,
headache, weakness, orthostatic hypotension, fruity odor of breath, Kussmaul respirations,
metabolic acidosis, and mental status change. Insulin is administered IV rather than
subcutaneously to provide immediate treatment. The client who has DKA will absorb
subcutaneous insulin slowly and erratically, making it difficult to adjust dosages of insulin
appropriately. Monitor blood glucose hourly. Blood glucose of less than 200 mg/dL is the goal for
resolution, with a pH greater than 7.3, blood bicarbonate level greater than 18 mEq/L, and
calculated anion gap less than 12 mEq/L. In DKA, IV administration of insulin and dextrose
must continue even when glucose is less than 200 mg/dL until the acidosis resolves and the client
is able to take subcutaneous insulin.
3. Verapamil is a calcium channel blocker. It blocks the calcium channels in blood vessels which
leads to vasodilation of peripheral arterioles and arteries/arterioles of the heart. Blocking of
calcium channels in the myocardium, SA node, and AV node leads to a decreased force of
contraction, decreased heart rate, and slowing of the rate of conduction through the AV node. It
is used for Angina pectoris, hypertension and cardiac dysrhythmias. Complications can include
orthostatic hypotension, peripheral edema, constipation, suppression of cardiac function
(bradycardia, heart failure), dysrhythmias, acute toxicity (hypotension, bradycardia, AV block,
ventricular tachydysrhythmias.
