ATI MS Proctor

ATI MS Proctor • Accident/Error/Injury Prevention - (1) o Spinal Cord Injury: Care of a Client who has a Halo Device (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 16) o The purpose is to provide traction and/or immobilize the spinal column  Do not use the halo device to turn or move a client  If the client goes home with a halo fixation device on, provide instruction on pin and vest care.  Teach the client signs of infection and skin breakdown.  Maintain body alignment and ensure cervical tong weights hang freely.  Monitor skin integrity by providing pin care and assessing the skin under the halo fixation vest as appropriate. • Standard Precautions/Transmission-Based Precautions/Surgical Asepsis - (1) o Bacterial, Viral, Fungal, and Parasitic Infections: Isolation Precautions for Client Who Has Influenza (Active Learning Template - Basic Concept, RM FUND RN 9.0 Ch 56)  Contact: Clostridium difficile, herpes simplex virus, impetigo, methicillin‑resistant Staphylococcus aureus (MRSA), vancomycin‑resistant Staphylococcus aureus (VRSA)  Airborne: Measles, varicella, tuberculosis  Droplet (3-6 ft): Haemophilus influenzae type B (Hib), pertussis, mumps, rubella, plague, streptococcal pneumonia, meningococcal pneumonia • Tuberculosis: Priority Action for a Client in the Emergency Department (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 23)  Administer heated and humidified oxygen therapy as prescribed  The client should be transported using the shortest and least busy route  cough and expectorate sputum into tissues that are disposed of by the client into provided plastic bags or no‑touch receptacles  Clients are no longer considered infectious after three consecutive negative sputum cultures • Adverse Effects/Contraindications/Side Effects/Interactions - (1) o Electrolyte Imbalances: Manifestations of Hypokalemia (Active Learning Template - Medication, RM AMS RN 10.0 Chp 44)  VITAL SIGNS:  Decreased blood pressure, thready weak pulse, orthostatic hypotension  NEUROLOGIC:  Altered mental status, anxiety, and lethargy that progresses to acute confusion and coma  ECG:  Flattened T wave, prominent U waves, ST depression, prolonged PR interval  GASTROINTESTINAL:  Hypoactive bowel sounds, nausea, vomiting, constipation, abdominal distention. Paralytic ileus can develop.  MUSCULAR:  Weakness. Deep‑tendon reflexes can be reduced.  RESPIRATORY: Shallow breathing • Blood and Blood Products - (1) o Blood and Blood Product Transfusions: Steps to Administer a Blood Transfusion (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 40) ● Verify the prescription for a specific blood product. ● Obtain consent for procedure if required. ………………………………….CONTINUED…………………………………..