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ATI COMPREHENSIVE EXIT EXAM
(NGN ATI)
- Treat first any immediate threats to a patient's survival or safety. Ex. obstructed airway, loss of consciousness, psychological episode or anxiety attack. ABC's.
- Next, treat actual problems. Ex. nausea, full bowel or bladder, comfort measures.
- Then, treat relatively urgent actual or potential problems that the patient or family does not recognize. Ex. Monitoring for post-op complications, anticipating teaching needs of a patient that may be unaware of side effects of meds.
- Lastly, treat actual or potential problems where help may be needed in the future. Ex Teaching for self-care in the home. Here are some great principles to help you as you prioritize:
Systemic before local Acute before chronic Actual before potential Listen don't assume Recognize first then apply clinical knowledge Maslow's Hierarchy of Needs: Prioritize according to Maslow with physiological and safety issues before psychological esteem issues. Variant angina (Prinzmetal's angina) Due to a coronary artery spasm, oftening occurring during periods of rest. Unstable angina Occurs with exercise or emotional stress, but it increases in occurrence, severity, and duration over time. Stable angina Occurs with exercise or emotional stress and is relieved by rest or nitroglycerin (Nitrostat). electrolyte imbalance manifestations: hypocakelmia--> flat T waves on ECG hypercalcemia--> decreased deep tendon reflexes (DTRs) hypocalcemia--> tetany hyperkalemia--> tall peaked T waves on ECG Addison's disease Decreased aldosterone and renin Hypothyroidism Decreased triiodothyronine (T3) and thyroxine
Decerebrate Hepatitis disease transmissions Hepatitis A--> Ingestions o contaminated food/water Hepatitis B--> Unprotected sexual contact Nonviral Hepatits--> Drug toxicity Heart Failure Symptoms: Shortness of breath, fatigue, jugular vein distention, and an S3 are signs/symptoms of heart failure resulting from the decreased pumping ability of the heart and increased fluid volume. Hypovolemic shock position: Supine with legs elevated (shock position) Below-the-knee amputation Position: The client should be placed in the prone position several times a day to prevent hip flexion contractions. Chest tube
- Continuous bubling in the water seal champers indicates an air leak. If this is observed, the nurse should attempt to located the source of the air leak and intervene accordingly (tighten the connections, replace drainage system) Compartment syndrome Symptoms: Pulselessness (late sign), Increased pain unrelieved with elevation or by pain medication Left homonymous hemianopsia has lost the left visual field of both eyes. They are unable to visualize anything to the left of midline of the body. dialysis fistula client teaching: avoid lifting heavy objects with access-site arm, avoid carrying objects that compress the extremity, avoid sleeping on top of the extremity with the access device, perform
hand exercises that promote fistula maturation, check the access site at intervals following dialysis, apply light pressure if bleeding, notify the provider if the site continues to bleed after 30 min following dialysis. Chronic renal failure Diet: low-protein, low-potassium, and high-carbohydrate, as well as low-sodium and low-phosphate Synchronized cardioversion is the electrical management of choice for atrial fibrillation, supra ventricular tachycardia (SVT) and ventricular tachycardia with a pulse. Myoglobin is the earliest marker of injury to cardiac or skeletal muscle and levels no longer evident after 24 hr. Troponin I A positive Troponin I indicates damage to cardiac tissues and level are no longer evident in the blood after 7 days. Hyperglycemia
- Test urines for ketones and report if outside the expected reference range atropine blocks the cardiac muscarinic receptors and inhibits the parasympathetic nervous system. The blockage of parasympathetic activity results in an increased heart rate. When the heart rate increases, cardiac output will also increase. Constant bubbling in a water seal chamber (of a chest tube) is an indication of an air leak Cleft lip: nursing care plan (postoperative)—"CLEFT LIP" Crying, minimize Logan bow Elbow restraints Feed with Brecht feeder
Abdominal pain, dyspareunia Infection (abnormal vaginal discharge) Not feeling well, fever or chills String missing Newborn assessment components—"APGAR" Appearance Pulse Grimace Activity Respiratory effort Obstetric (maternity) history—"GTPAL" Gravida Term Preterm Abortions (SAB, TAB) Living children Oral contraceptives: Signs of potential problems—"ACHES" Abdominal pain (possible liver or gallbladder problem) Chest pain or shortness of breath (possible pulmonary embolus) Headache (possible hypertension, brain attack) Eye problems (possible hypertension or vascular accident)
Severe leg pain (possible thromboembolic process) Preterm infant: Anticipated problems—"TRIES" Temperature regulation (poor) Resistance to infections (poor) Immature liver Elimination problems (necrotizing enterocolitis [NEC]) Sensory-perceptual functions (retinopathy of prematurity [ROP]) VEAL CHOP-which relates to fetal heart rate. Variable decels => Cord compression (usually a change in mother's position helps) Early decels => Head compression (decels mirror the contractions; this is not a sign of fetal problems) Accelerations => O2 (baby is well oxygenated-this is good) Late decels => Placental utero insufficiency (this is bad and means there is decreased perfusion of blood/oxygen/nutrients to the baby). Nine-point Postpartum Assessment...BUBBLEHER B- Breasts U- Uterus B- Bladder B- Bowel function L- Lochia E- Episiotomy H- Hemorrhoids E- Emotional Status R- Respiratory System Considerations for the pregnant client Admittance of a pregnant client to a medical-surgical unit:
contractions are suspected, your diet for chronic renal failure low protein & potassium DM pt teaching change shoes, wash feet w/soap & water pulse pressure subtract systolic value from diastolic value lantus never mix, long lasting, no peak rhogam given @ 28 weeks & 72 hours post delivery when mom is negative & baby positive indication of baby dehydration improving smooth fontanel pt w/orthostatic hypotension put near nursing station cleaning a wound clean to dirty use bulb syringe peripheral arterial disease cramp in leg while walking intermittent claudication seizure precautions supine position 10 of 28
20 weeks gestation, having urinary frequency u/a & c/s report to new nurse @ shift change pt @ xray s/s of hemolytic blood transfusion flank pain ER rape victim priority acess anxiety nutrition carbs 45%, protein 10 - 15% latex allergy tape up cords first ingredient on a food label most content thoracentesis, & painful w/breathing put pt on UNAFFECTED side for 1 hour or longer pt w/IV sedation check LOC if not responsive help older brother get used to baby get a gift for big brother early decelerations head compressions methergine contraindication HTN delegate to AP I & O 11 of 28
total gastrectom y lack b 12 takes 30 - 60 meal to eat a meal stoma color pink or red is normal MAOI's diet no pepperoni, no tyramine, COTTAGE CHEESE OKJ give iron w/? OJ statins contraindication Grapefruit juice haldol lip smacking mag sulfate decreased urine output decreased respirations decreased pulmonary edema antidote for mag sulfate calcium gluconate clozaril interventions monitor WBC valproic acid liver function thyroid med effectiveness weight 13 of 28
loss diuretics don't skip doses
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