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ATI 4
th
Quarter Review
VIDEO 1 -
*Board of Nursing- Gives and revokes nursing licenses. *U need a nursing license for every state you will work in. *JCHAO- Develops accreditation standard for healthcare facilities, they go to hospitals every 2 years of so, they check documenting,talk to people etc. Medicare elegibility- 65 and older, have been receiving disability for 2 years, have ALS, have renal di sease and be on dialysis. Part A- Inpatient hospital, limited skilled nursing facility care and home health care. Part B- Outpatient care,Diagnostic services, outpatient care, outpatient occupational therapy and outpatient physical therapy. Part C- Combines part A and part B and is provided by private insurance, not required, it's something optional pt's can purchase. Part D - Drug coverage. Medicaid elegibility- Based on household size and income. VIDEO 2- Inter professional team: *Registered Dietitian- Helps Pt with nutritional needs. *Lab technician - Helps with lab draws. *Pharmacist- Review medication, put them on med record for administration. *Physical therapist - Helps pt with mobility *Occupational therapist- Helps patient regain their ability to perform activities of daily living (ADL's) such as putting on socks, brushing teeth, etc. Sometimes OT and PT work together. *Providers- Can be a Dr., Nurse practitioners, Physician assistants.
- Social workers - Identifies and coordinates community resources medical equipment needed and other resources in order to be discharged from acute care.( Case managers do this as well)
- Speech language pathologist - Help patients with speech, but super important to remember they are the ones that do SWALLOWING ASSESMENTS!! The 6 Nursing ethical principles
- Autonomy- Pt has right to make his own decision even if not on their best inte rest (such as a Jehovah's witness refusing a blood transfusion)
- Beneficence - Doing whats best for the patient, like giving meds, helping that patient, doing good.
- Fidelity- Keeping your promises ( if u tell a Pt you're gonna do something, you DO IT!) *Justice- Providing fairness in care and allocation of resources, not disproportioning resources or time against one segment of the population.
- Non Maleficence- Do no harm. ( If Dr. writes wrong/ too high dose/lethal prescription you would question it and call Dr. before administering it)
- Veracity - Telling the truth ( If pt. ask something about diagnosis or medical condition, then be honest and tell the truth) Video 3- Tortes *Unintentional tortes
Negligence- Pt is high risk for falls, u forgot to put bed alarm and they fell so that would be negligence. Mal practice- Medication error, u gave wrong med or dose, and it negatively impacted the patient. *Intentional tortes- Assault- to threaten the pt. (u tell the patient your gonna hit them if they don't take the meds)
Video 5- Delegation (pertains to RN - Do not delagte pt education or anything that erequires nursing judgement, or physical assessment. VIDEO 7-
- I dropping something above sterile field,Drop 6 in above sterile field.
- If sterile field becomes damp, it’s no sterile anymore. VIDEO 8- *Specific adaptive immunities- Producing antibodies against a specific antigen. *Non specific- our body’s mechanisms to protect us from all antigens.
- Active natural immunity- Get exposed to cold virus, u get sick but body produces antibodies so if u get same virus again body fights it off quickly.
- Active artificial immunity- body produces antibodies after receiving vaccines.
- Passive natural immunity- antibodies are passed from mom to baby from breast milk or placenta
- Passive artificial immunity -Pt get immunoglobulins administered after they have been exposed to a pathogen. ***Chain of infections
- Causative agent- Bacteria or Toxin
- Reservoir-where the causative agent lives (in a human or soil, it doesn’t have to be in a living being it could be in the environment)
- Portal of exit- how the pathogen leaves the host, can leave they blood stream, respiratory tract
- Mode of transmission- is it transmitted they contact or droplet, airborne.
- Portal of entry- almost same of portal of exit, it’s how the pathogen enters a host.
- Susceptible host - ***Risk factors for getting infections *Compromised immunity *Poor hand hygiene *Poor personal hygiene *Chronic or acute disease *Crowded living environments *IV drug use *Unprotected sex *Poor sanitation Virulence - Ability of a pathogen to produce disease. Highly virulent = easily produces disease. VIDEO 9 ***Stages of infections
- Incubation- the time from when the pathogen enters the body, til the first symptom appears.
- Prodromal stage- time of onset of general symptoms such as malaise,fatigue,fever, until the pt delivers specific symptoms to that particular infection.
- Illness stage- Specific symptoms occur that are particular to that illness.
- Convalescence - the time from when symptoms disappear to complete recovery occurs, can take several months. ***Systemic and Local infections Systemic infection-fever,chills, malaise, fatigue, ^ respiratory rate, ^ pulse, maybe enlarged lymph nodes. Local infection -edema, erythema, pain, warmth in just ONE part of the body. Inflammation stages
- Erythema, warmth edema and pain at the site of injury.
- WBC’s kill the microorganisms and exudate containing those white blood cells as well as dead tissue cells accumulate at the site of the injury. The exudate can take different forms: Serous- clear Sanguenous- bloody Serosanguinus - pink, clear and a little bloody Purulent - pus (contains leukocytes and bacteria)
- Damaged tissue is replaced by scar tissue ***Labs ordered when infection is suspected
- WBC count - normal 5,000- 10,000 (If over 10,000 indicative of infection) *Left shift in WBC count-immature WBC count *ESR - Erythrocyte sedimentation rate *CRP - C reactive protein , positive means there’s infection. Obtain culture before starting any antibiotics. Gallion Scan Xrays, CT scans and Byopsies are also used to diagnose infections. VIDEO 10- *** Precautions Standard precautions - para todos, whether they have an infection or not, HAND HYGIENE!!! Alcohol based antiseptic is preferred VS soap and water unless hands are visibly soiled. Mask and face shield are used when splashing of bodily fluids is possible, cleans gloves when touching anything that might contaminate us (anything in the room). Airborne- Measles, Varicella (Chiken pox) and TB- Provate room, room needs to have negative air flow, wear N95 mask. Droplet precautions- Influenza, Pneumonia, Pertussis, Rubella ,Mumps, Sepsis, Vacterial Meningitis. Pt needs private room or room with pt with exact same infection, visitor will need to wear mask!! Contact precaution- Impetigo, Scabies , MRSA,VRE (Vancomicyn Resistant Enterococcus) C Diff, RSV (Respiratory syncytial virus) Video 12- Remind pt's with orthostatic hypotension to get up slowly and sit for a few mins. **** Provide regular toileting schedule so they wont try to get up on their own!! Place in room near nurses station Round on pt hourly!! Place stuff close by to patient Lock bed brakes Put beds in lowest position ****DO NOT put all 4 bed rails up!! Seizures- Lower pt to floor Turn pt to side Loosen restrictive clothing Do NOT restrain pt Do NOT place anything in mouth Note onset and duration After Seizure- Check vitals Check neurological checks Reorient pt
Implement seizure precautions (padding bed rails) Restraints- Physical-vest , belt, mittens. Chemical - sedative, psychotic. Before restraining pt: Reorient , supervise, try to divert In emergency u can restrain pt but need a signed order from Dr ASAP, within 1 hr. Remove restrain Q2 hrs, one at a time to check on skn integrity, to do neurovascular checks and to provide ROM. Orders can be written for up to 4 hrs at a time Use the least restrictive restrain first (mittens) Apply restrains so 2 finger can fit between restrain and pt. ALWAYS use a quick release knot!!! Video 12 Fire safety R- Rescue first horizontal evacuation then lateral or vertical A- Alarm, activate alrm system C- Contain fire, close doors and windows E - Extinsguis fire with fire extinguisher. P- Pull pin A- Aim at base of fire S- Squeeze the handle S- Sweep side to side **Injury prevention Infants and toddler- Be careful with hard foods, choking hazards (grapes, raisins, hor dogs, popcorn, celery, peanuts, peanut butter, tough meats) Cribs slats have to be not more than 2 3/8 inches apart, if 3 in apart then its hazardous. To reduce SIDS always put baby to sleep on her back, NO BLANKETS, PILLOWS OR STUFFED ANIMALS in crib or around baby. Use rear facin car seat until 2 years old, use 5 point ha rness, place in back seat. Close bathroom doors, keep toilet lid down. Turn pot handles away from edge of stove. School age children Use car booster if below 40 lbs and beloe 4ft 9'! Parent need to make kids wear helmets and protective gear ****Water temp should be less than 120 farenheit to prevent burns Fence around pools, lock fence, always supervise pool or water activities. Lock firearms and bullets separately Adolecents Pt teaching on risks or drugs, alcohol and unprotected sex Wear seat belt, don't text and drive. Monitor for mental health issues such as depression and anxiety. Older adults- **** TRIP HAZARDS- Scatter rugs around home and loose carpets are dangerus! Home should have grab bars in bathroom and non skid shower mat. Electrical cords behind furniture and fastened to floor. Add colorful tape to edge of steps in stairs to prevent falls down stairs.
for pt using O *** Use Cotton bedding and clothes,less flamable as opposed to nylon or wool.
****Prone- Flat on stomach - If pt had lower extremity amputation , if prone for about 30 min at a time then it helps prevent hip flexion contractions!!
*****Orthopneic- sitting on top of bed with arms around over bed table , good for pt's with COP helps expand lungs, position for thoracentesis as well!! Sims position- Laying on left side with left hip and lower leg straight and right hip and leg bent, good for enemas and rectal examination. Trendelenburg- when bed is tilted and HOB is lower than foot of bed, good for promoting venous return from extremities to the heart. Reverse Trendelenburg - when HOB is higher, good for GERD , prevents reflux, promotes gastric emptying. Modified Trendelenburg- pt lies flat with legs elevated, good for hypovolemia or hypovolemic shock. VIDEO 15 Triaging Class 1- RED pts that have immediate threat to life, breathing issues,burn, hemorrhaging, needs care ASAP or they'll die. Class 2 - YELLOW pts who have major injuries but are not threaths to life, like a bone fracture. Class 3 - GREEN pts who have cuts, scrapes, abrasions etc, need care but after class 1 or class 2. Class 4- BLACK pts who are expected and allowed to die, such as pt who has penetrating head wound sor chest crush injury that u know they cant survive. Tornados
- Close shades from windows.
- Move pts away from windows, place in hallway.
- For bed bound pts place blankets over them. For chemical exposure- Undress pt and irrigate extensively with water. If exposed to dry chemicals then brush chemicals off pts clothing and skin For hazardous material- Locate Safety data sheet Water is usually the antidote Bomb threat- Keep caller on phone as long as possible, listen to background noise to help give authorities clues. Screening- Colonoscopy
starting at 50 pt can get fecal occult test annualy, sigmoidoscopy every 5 years or colonoscopy every 10 years. Pap smears- Every 3 yrs starting at 21. Mammograms- Every year starting at age 40. Testicular exams - Done at every health screening starting at 20. Prostate specific antigen test (PSA) and Digital rectal exam (DRE) Done annually starting at age 50. Primary prevention- Prevents initial occurrence of a disease such as immunization, prenatal classes, pt teaching, etc. Secondary prevention- Focus on early detection of disease or limiting severity of disease such as screening and measures to prevent outbreaks. Tertiary prevention- Maximize recovery AFTER an injury or illness, such as rehab, support groups, physical or occupational therapy. Learning domains Cognitive- thinking, knowledge and comprehension. Affective - feelings, ideas,
Pt education 4 phases.
- Assessment- Identify pt's needs, identify pts learning stile (auditory, visual or kinesthetic), then you evaluate their abilities and available resources they have.
- Planning- Develop mutually agreeable goals and outcomes with the pt.
- Implementation- Avoid use of medical jargon if u provide material make sure they are at a 6th grade level or lower so it can be easily understood.
- Evaluation stage- Evaluate by asking pt to explain teaching in their own words or demonstrate to show education was successful
II. Video 46
Electrolyte imbalances
Sodium , Potassium, Calcium and Magenisum imbalance.
Sodium levels should be between 136-145.
Sodium function-Helps maintain fluid balance in the body, very important for nerve and muscle
function.
Hyponatremia- Sodium under 136!!!
Causes: GI losses, diuretic, sweating, edema, hyperglycemia.
Symptoms: Tachycardia, hypotension, confusion (common in older patients),fatuigue, nausea
and vomiting and headache.
*** She says if ATI asks about confused older pt it could be hyponatremia OR UTI!!!
Hypernatremia -Levels over 145!!
Causes- Water deprivation, excess sodium, kidney failure, Cushins syndrome
Symptoms: Muscle twitching, edema, tachycardia, GI upset
Potassium normal levels- 3.5-
Function of potassium, maintains intracellular fluid balance, important for nerve function,
regulates muscle and heart contractions.
Hypokalemia (lower than 3.5!!!) causes - GI losses (vomiting and diarrhea), diuretics, sweating,
and metabolic alkalosis.
Symptoms- Dysrhythmias, muscle weakness and cramps, constipations, hypotension.
(Note to self ... HYPO natremia and HYPO kalemia both have HYPO tension as a symptom!!!)
Hyperkalemia ( potassium level over 5) causes: Uncontrolled diabetes, diabetes ketoacidosis,
metabolic acidosis, slat substitutes and kidney failures
**Remember Hyperkalemia associated with metabolic acidosis which is associated with
diabetes ketoacidosis.
Symptoms- Dysrhythmias (happen whether potassium is low or high!!) , muscle weakness,
numbness and weakness, diarrhea and confusion.
CALCIUM normal levels 9-10.
Function- important for bone and teeth formation, nerves and muscle function and
clotting. HYPOCALCEMIA- Diarrhea, vitamin D deficiency and hypoparathyroidism.
Symptoms- Positive Chvostek's or trousseau's sign, muscle spams, numbness on lips and fingers
GI upset.
Hypercalcemia (over 10.5)
Causes- Hyperparathyroidism, long term steroid use, bone cancer.
Symptoms- Constipation, lethargy, kidney stones and decreased tendon reflexes.
Magnesium levels 1.3- 2.
Function-nerve and muscle function, bone formation, critical for many biochemical reaction in
the body
Hypomagnesemia (less than 1.3) causes- Diuretics, GI losses , malnutrition, alcohol abuse.
Symptoms-dysrhythmias, tachycardia, hypertension, tremors, seizures, deep tendon reflexes
(everything is amplified)
Hypermagnesemia (more than 2.1) causes- Kidney disease, taking too many laxatives that
contain magnesium.
Symptoms- Hyportension, muscle weakness, lethargy , respiratory and cardiac arrest.
(everything gets depressed)
Menstruation , ovulation and menopause increases temp.
Exercise, dehydration and certain illneses will also
increase temps.
If pt just ate, drank or smoked give it 20-30 min after to obtain accurate
oral temp as eating, drinkin and smoking alters actual temp.
How to take temp-
Rectal- Sims position, use lubrication and insert thermomether 1-1 1/
inches inside rectum for adult ONLY, never take rectal temp on a baby
under 3 months old since it might perforate or for ANYONE at risk or
bleeding.
Tempatic-
Adults , pull ear up and back.
Children under 3 yrs old, pull ear back and
down. Excess earwax impacts temp!
Temporal -slide thermomether across forehead to hairline and stop at soft
depression behind ear.
Nursing interventions-
For Hyperthermia- temp over 39 degrees celcius
Obtain blood cultures and other specimens, is it n
infection? Start antibiotics BUT...Obtain cutures first
Give antipyretics-
Tylenol Give fluids
Prevent shivering-provide blankets
Hypothermia- under
35 Give warm
blankets.
Might give warm IV
fluids. Raise room
temperature. Keep pt's
head covered.
VIDEO
PULSES
When obtaining a pulse -Asses for rate:
Adults rate between 60 -
Infant rate 120-
Rhythm- regular or irregular.
Quality- how is the right compared
to left. Strength of pulse:
Number on top- Systolic Number on bottom_ Dyastolic Normal under 120/ under 80 Pre hypertension between 120-139 / 80- 89 Stage 1 hypertension 140-159/90- Stage 2 hypertension over 160/over 100
Hypotention systolic (top) under 90
Diagnosing with hypertension, take BP in 3 separate occasions (between
a couple weeks not 3 different times on the same day!!)
Orthostatic hypotension - When a pt sits up or stands up and BP plummets,
super high risk for fall
Take pt BP when layin flat, then have them sit up and wait 3-4 min and
retake BP and have then them stand up and wait 3-4 min again and retake
BP, IF systolic (top number) decreases 20 or more or if diastolic decrease 10
or more with a 10 -20 percent increase in heart rate then this indicates pt
has Orthostatic hypotension. (asking myself if is this for RN's??...Ana G)
If positive- Assist with ambulation and ask them to change positions slowly
and get up slowly.
Again is this for RN's, she talks about it so here it is:
Pulse pressure is systolic BP minus diastolic BP
If elevated- increased risk of cardiovascular
disease She says ATI will ask about this:
****** Proper sizing of BP cuff :
*Cup width should be 40% of the arm circumference.
*Inflation bladder (pump) should surround 80% of the arm cicumference
*If cuff its too large you will get a false low reading.
* If u have a small cuff u will get a false high reading
* Never take BP on arm where or has IV, or side where pt had mastectomy
or on side where pt has shunt or fistula.
Also Remember the way Ms. V showed us in first quarter how to estimate
systolic BP (how much to inflate BP cuff!! ) While palpating radial
pulse,inflate cuff until u feel pulse disappear and then inflate the cuff another
30mmhg to use the least pressure needs to obtain BP.
VIdeo 20
Cranial
nerves
List of the Cranial Nerves
1. I Olfactory (Smell)
2. II Optic (Sight)
3. III Oculomotor (Moves eyelid and eyeball and adjusts the pupil and lens of the eye)
4. IV Trochlear (Moves eyeballs)
5. V Trigeminal (Facial muscles incl. chewing; Facial sensations)
6. VI Abducens (Moves eyeballs)
7. VII Facial (Taste, tears, saliva, facial expressions)
8. VIII Vestibulocochlear (Auditory)
9. IX Glossopharyngeal (Swallowing, saliva, taste)
10. X Vagus (Control of PNS e.g. smooth muscles of GI tract)
11. XI Accessory (Moving head & shoulders, swallowing)
12. XII Hypoglossal (Tongue muscles - speech & swallowing)
Cranial Nerves Summary Table
Number
of the
Cranial
Nerve
Name of the
Cranial Nerve Modality^ Origin^ Exit^ Route^
Function of
the Cranial
Nerve
1: CN-I Olfactory Nerve Sensory
Olfactory
Lobe Cribriform^ Plate^ Smell
2: CN-II Optic Nerve Sensory Optic Lobe Optic Canal Vision
3: CN-III Occulmotor Nerve Motor
Floor of
the
Midbrain
Superior Orbital Fissure
Helps in moving
the eyelid &
eyeball and
adjusts the pupil
and lens of the
eye
4: CN-IV Trochlear Nerve Motor
From the
junction
between
the optic
lobe and
cerebellum
Superior Orbital Fissure
Moves the
eyeballs
5: CN-V
Trigeminal
Nerve (Branches:
Ophthalmic,
Maxillary, and
Mandibular)
Both
Side of the
Medulla
Oblongata
i.Ophthalmic: Superior
orbital f issure
ii.Maxillary: Foramen
Rotundum
iii.Mandibular: Foramen
Ovale
Controls facial
muscles and
actions including
chewing and
facial sensations
6: CN-VI Abducens Nerve Motor
Ventral
side of the
Medulla
Superior Orbital Fissure
Moves the
eyeballs
