ATI Remediation for Fundamentals

ATI REMEDIATION FOR FUNDAMENTALS 1. Management of Care a. Advocacy i. Cultural and Spiritual Nursing Care: Effective Communication When Caring for a Client Who Speaks a Different Language Than the Nurse (Chp 35)  It is important to utilize facility-approved interpreters if a client speaks a different language than the nurse. This will break down communication barriers and reassures that the client is receiving the appropriate information from the nurse or any healthcare professional. b. Continuity of Care i. Information Technology: Commonly Used Abbreviations (Chp 5)  Healthcare professionals are required to only use abbreviations and symbol that were approved by the Joint Commission and the by the facility. It is recommended to avoid unnecessary words and details. c. Establishing Priorities i. Client Education: Discharge Planning for a Client Who Has Diabetes Mellitus (Chp 17)  Some discharging goals are identifying mutually agreeable outcomes, prioritizing learning objectives with the client's needs, using methods that emphasize the learning style, speak and provide materials in the 6th-8th grade level, avoid medical jargon, and speak/write in second person. Provide the client with electronic educational resources and use reliable internet sources to access information and support services. The nurse should also incorporate active participation in the learning process and make sure to schedule some time for teaching sessions for learning. Have the client explain information in their own words and ask the client to evaluate their own progress. d. Informed Consent i. Legal Responsibilities: Informed Consent (Chp 4)  The nurse’s role is to witness the client’s signature on the informed consent form and to ensure that the provider has obtained the informed consent responsibly. A competent adult must sign the form for informed consent whom is capable of understanding the information from the HCP performing the service and is able to communicate with the HCP. If the client does not understand the information, the provider must be notified to provide clarification.  If there is a language barrier or a hearing impairment, then a trained medical interpreter must intervene. Individuals who may grant consent for another person include: parent of a minor, legal guardian, courtspecified representative, or an individual who has a durable power of attorney authority for health care. e. Information Technology i. Information Technology: Action to Take When Receiving a Telephone Prescription (Chp 5)  Telephone reports are useful when contacting the provider or other members of the interprofessional team. When dealing with telephone prescriptions, it is important to repeat the details of the prescription back to the provider including the med name/dosage/time/route, have another nurse listen to the telephone prescription, obtain the provider's signature on the prescription within 24 hr. All the data needs to be ready before contacting the professional and use professional demeanor. Make sure the name of the person who made the call is documented and who the information was given to. Include the time, the content of the message, and the instructions/information received during the report. 2. Safety and Infection Control a. Accident/Error/Injury Prevention i. Client Safety: Implementing Seizure Precautions (Chp 12)  Seizure precautions are especially needed for patients who have a history of seizures and the nurse needs to know what kind of seizures they have. Seizure precautions include padding the side rails, and rescue equipment like oxygen, an oral airway, and suction equipment available. If a patient is admitted with seizures, patient should have an IV access. Notify MD for order if not already ordered. Inspect the environment for items that could cause an injury to the patient and remove any items that are not needed for treatment. The side lying position is the best natural opening for the trachea and the bronchi. Keep the airway open by turning the head to the left during the seizure.  Do NOT put anything in the client's mouth! Do not restrain the client when they are having an episode. Lower the client’s head to the floor or the bed and make sure the head is protected. Remove any nearby furniture, loosen the clothing, and provide privacy. If the patient is in bed, raise and pad the side-rails with pillows or blankets wherever the patient may strike a hard surface. If all four side-rails are raised and padded, this is considered a restraint and appropriate interventions should be implemented. ii. Medical and Surgical Asepsis: Planning Care for a Client Who Has a Latex Allergy (Chp 10)  The healthcare team should check for latex allergies before starting any task or procedure. Prior to the admission of a latex allergic and latex alert patient to the operating theatres, staff should implement immediate latex prevention/management precautions. It is preferable for latex allergic patients to be scheduled first on the operating list. Children with a strong or confirmed allergy to bananas should be considered to be allergic to latex. If unable to obtain IV tubing without latex ports, cover latex ports with tape. iii. Safe Medication Administration and Error Reduction: Client Identifiers (Chp 47)  The Joint Commission requires that a client is verified by two identifiers before each administration. These identifiers can be the client’s name, assigned ID number, phone number, birth date, or a photo ID. Check for allergies by asking the client and check for an allergy bracelet/medal and check the MAR. Bar code scanners may be used to identify clients. b. Handling Hazardous and Infectious Materials i. Intravenous Therapy: Action to Take After Administering an Injection (Chp 49)  After administering the injection, dispose of the syringe and needle in a sharps container. Position the holder so that it is cradling the syringe. Unscrew the plunger rod from the plunger of the syringe. Rotate the blue lock a half turn. Maintaining the same position, bring the holder over to a sharps container and carefully invert the holder over the opening, letÝng the syringe and needle drop into the container. c. Safe Use of Equipment i. Client Safety: Priority Action for Handling Defective Equipment (Chp 12)  Use equipment only after a safety inspection and instruction of its use. Faulty equipment is a hazard because it can cause it can start a fire and cause a shock. The defected equipment should be unplugged by the plug and not by the cord. This needs to be done first to avoid causing a fire. d. Standard Precautions/Transmission-Based Precautions/Surgical Asepsis i. Infection Control: Teaching for a Client Who is Scheduled for an Allogeneic Stem Cell Transplant (Chp 11)  Clients who have an allogenic hematopoietic stem cell transport are immunocompromised and require protective precautions. The client must wear a mask when they leave the room, needs a private room, positive airflow, and a HEPA filtration for incoming air. ii. Medical and Surgical Asepsis: Preparing a Sterile Field (Chp 10)  Prepare by performing hand hygiene. A sterile object remains sterile only when touched by another sterile object. Only sterile objects may be placed on a sterile field. A sterile object or field out of range of vision or an object held below a persons waist is contaminated. A sterile object or field becomes contaminated by prolonged to exposure to air. When a sterile surface comes in contact with a wet contaminated surface, the sterile object or field becomes contaminated by capillary action. Fluid flows in the direction of gravity. The edges of a sterile field or container are considered contaminated and there is a 1-inch border.  When opening the sterile pack, the flap furthest from your body, open the side flaps, and then open the flap closest to your body. The package needs to be slipped onto the center of the workspace.  A nurse preparing a sterile field knows that the field has been contaminated when they turn to address the patient's question concerning the procedure, cotton ball dampened with sterile normal saline is placed on the field, or when the procedure is postponed for 30 minutes to accommodate the patient. 3. Health Promotion and Maintenance a. Health Promotion/Disease Prevention i. Health Promotion and Disease Prevention: Stages of Health Behavior Change (Chp 16)  The Stages of Health Behavior Change explains the readiness of the client’s readiness to change their behavior. First, precontemplation stage. In this stage, there is no intention of taking an action towards changing the behavior. Clients in this stage tend to avoid reading, thinking, or talking about their high-risk behaviors. The second stage is contemplation, which shows intentions to take action and provides a plan to do so in the future. Third, the preparation stage; there is intention to take action and the client has taken some steps like buying a self-help book. The client makes the final specific plans to accomplish this change. Fourth, the action stage; the client's behavior has been changed for a short period of time. The client is actively implementing behavioral and cognitive strategies of the action plan to interrupt previous health risk behaviors and adopt new ones. The maintenance stage is the final stage, the client’s behavior has been changed and continues to be maintained for the long-term. The person strives to prevent lapse by integrating newly adopted behaviors into their lifestyle. Last stage is the termination stage, where the client has no desire to return to prior negative behaviors. This is the ultimate goal where the client has complete confidence that the problem is no longer a temptation/threat. 4. Psychosocial Integrity a. Coping Mechanisms i. Coping: Priority Intervention for a Client Who Has a Terminal Illness (Chp 33)  Some things that the nurse can do with a client who has a terminal illness is by helping to coordinate care that is acceptable for the patient. Actively listen to patient and patient's family. Administer meds as prescribed and assist as needed with palliative care. Helping patients understand what to expect in terms of the progression of their illness. Continually assess patient’s needs and answer all their questions as truthfully as possible, yet with compassion. Be emphatic in communication and encourage the client to verbalize feeling. Be able to identify grief over a terminal diagnosis and symptoms of clinical depression. Encourage client’s autonomy with decision-making and discuss the client’s and family’s abilities to deal with the current situation. b. Stress Management i. Coping: Manifestations of the Alarm Stage of General Adaptation Syndrome (Chp 33)  In the Alarm stage, the body’s responses are heightened to respond to stressors. It is also called the fight-or-flight response. Hormones are released which then causes the blood pressure and heart rate to elevate, along with heightened mental alertness, pupil dilation, increased secretion of epinephrine and norepinephrine and increased blood flow to the muscles. 5. Basic Care and Comfort a. Nutrition and Oral Hydration i. Fluid Imbalances: Calculating a Client's Net Fluid Intake (Chp 57)  When planning a diet with the client to increase or decrease their body weight, the client's weight and body mass index should be monitored on a regular basis. The calculations for both of these variables were discussed above. In addition to these calculations, the nurse must also be knowledgeable about what is and what is not a good body mass index or BMI. The body mass index is calculated using the client's bodily weight in kg and the height of the client in terms of meters. If the intake is less than output or if the output is more than the intake, then it might be dehydration. The patient is losing too much fluids compared to what they are taking in. If the intake is more than output or if the output is less than the intake, then the patient may be retaining fluid and is in fluid overload. ii. Nasogastric Intubation and Enteral Feedings: Unexpected Findings (Chp 54)  The patient can experience many complications with NG tubes and enteral feedings. Some complications include aspiration, discomfort, and trauma. The NG tube can cause some discomfort since it is passing through the nostril and into the stomach. The patient could possibly gag or vomit, which is why suction should be present and ready just in case it occurs. The tube can injure the tissue in the sinus, throat, esophagus, or stomach if it is not inserted correctly. Another complication is wrong placement or dislodge; if the tube goes into the lung, food and medicine can pass through it and cause a fatal injury to the patient.  Other compilations can include abdominal cramping, swelling, tube obstruction or blockage, tube perforation or tear, diarrhea, nausea and vomiting, and tubes coming out of place and causing additional complications. Since NG tubes are only meant to be used for a short period of time, the nurse should make sure that it is not prolonged to prevent sinusitis, infections, and ulcerations of the tissues of the sinuses, throat, esophagus, or the stomach. Refeeding syndrome can occur if the patient is severely malnourished and can trigger arrhythmias and multisystem dysfunction. Fluid imbalances can happen depending on the concentration of the feeding formula. iii. Nutrition and Oral Hydration: Advancing to a Full Liquid Diet (Chp 39)  Full liquid diets include any clear liquids, also can include liquid dairy all juices and sometimes it can include vegetable puree. The nurse needs to keep record of all intake and be sure to communicate with the shift change the amount taken in on that shift. The full liquid diet can provide many of the nutrients your body needs, but it may not give enough vitamins, minerals, and fiber. This diet should only be used briefly as you recover until it is safe for you to eat regular foods. The dietitian can help create a balanced full liquid meal plan to give the client the nutrients they need. 6. Pharmacological and Parenteral Therapies a. Dosage Calculation i. Dosage Calculation: Calculating a Dose of Gentamicin IV (Chp 48)  Gentamicin can also be given intravenously over 30 minutes. The nurse should set the IV pump in mL/hr. The nurse needs to determine whether the IV flow rate make sense and set at the right rate. b. Medication Administration i. Diabetes Mellitus: Mixing Two Insulins in the Same Syringe (Chp 39)  Draw the short-acting insulin (regular) into the syringe first, followed by the long-acting insulin (NPH). The amount of air that should be injected into the short-acting insulin bottle should be the same amount that will be drawn up. Then, do the same for the long-acting insulin bottle. Return to the first bottle and draw the first insulin dose into the syringe. Hold the syringe at eye level to make sure it is the ordered dosage. Then, do the same for the next bottle. The total solution should meet the insulin needs of the patient. ii. Pharmacokinetics and Routes of Administration: Enteral Administration of Medications (Chp 46)  Tablets, capsules liquids suspensions, elixirs and lozenges are the most common route, least expensive, and most convent. Follow dilution instructions for the liquids, suspensions and elixirs. Make sure to listen before administering, flush after each medication-each med is given separately and then flush again after last medication. Do not force the patient to take their medications if they do not want to take it. They have the autonomy to reduce treatment if they so choose to. iii. Pharmacokinetics and Routes of Administration: Preparing an Injectable Medication From a Vial (Chp 46)  When a nurse is preparing an injectable medication from a vial, she should first scrub the self-sealing tops on both the diluent and powdered medication vials with the antimicrobial swab and allow to dry. Draw up the appropriate amount of diluent into the syringe, then insert the needle or blunt cannula through the center of the self-sealing stopper on the powdered medication vial. The nurse should then inject the diluent into the powdered medication vial, remove the needle or  blunt cannula from the vial, and replace cap. Gently agitate the vial to mix the powdered medication and the diluent completely, while remembering not to shake the vial. Draw up the prescribed amount of medication while holding the syringe vertically and at eye level. After the correct dose is withdrawn, remove the needle from the vial and carefully replace the cap over the needle. Some facilities require changing the needle, if one was used to withdraw the medication, before administering the medication. 7. Reduction of Risk Potential a. Therapeutic Procedures i. Nasogastric Intubation and Enteral Feedings: Administering an Enteral Feeding Through a Gastrostomy Tube (Chp 54)  Gastrostomy tube is placed through the abdomen straight into the stomach. This kind of therapy lasts longer than six weeks and is inserted surgically. Reasons for getÝng enteral feedings is to administer medication, gastric aspiration, or for gastric decompression. These feedings provide nutrition to clients who cannot consume foods orally, but their GI tract is still functioning.   When preparing the formula and tubing, check for expiration dates and the content of the formula. Make sure the formula is at room temperature and set up the feeding system by gravity or the pump. The nurse should mix or shake the formula, fill the container, prime the tubing, and then clamp it. By the client by positioning them in Fowler’s position or elevating the HOB by 30 degrees. Auscultate the client for bowel sounds, monitor tube placement, then flush the tubing with 30mL of water and administer the formula. If it is an intermittent gravity drip, administer the set volume over 30-60 minutes several times a day. If it is a continuous-drip feeding, administer the full feeding solution over a period of 8-24 hours, using a pump set to a prescribed rate. 8. Physiological Adaptation a. Alterations in Body Systems i. Airway Management: Performing Chest Physiotherapy (Chp 53)  The purpose of this therapy is to loosen respiratory secretions and move them into the central airways where they can be removed by coughing or suctioning. Removing secretions from the airway and not allowing them to accumulate reduces the risk for respiratory infections and atelectasis. Chest physiotherapy is a method of mobilizing pulmonary secretions by positioning the patient's head downward to incline the trachea below the affected area and then applying percussion and vibration techniques; often used synonymously with postural drainage, although that term technically refers to drainage by gravity without percussion and vibration. ii. Vital Signs: Caring for a Client Who Has a High Fever (Chp 27)  Take note of the patient’s age and health. Things that can influence temp- hormonal changes, exercise/activity/dehydration, illness, injury, food/fluid intake, smoking, circadian rhythm, stress and environmental conditions. Excess ear wax can alter the reading. Stool in the rectum can cause inaccurate reading. Do not obtain oral temp to patients that breathe through their mouth or have trauma to face or mouth. Provide fluids, antipyretics, and rest to the client. Offer blankets when the client is feeling chilly and remove them when they feel warm. Also, keep the room temperature between 70-80 degrees Fahrenheit. Assess and monitor their WBCs, sedimentation rates, and electrolytes. If antibiotics are needed, ensure cultures are taken before administering them.