ATI Concept-Based Level 3 Practice A Remediation | Download To Score An A

ATI Concept-Based Level 3 Practice A Remediation ❖ Cognition ➢ Alzheimer's Disease ▪ Neurocognitive Disorders: Identifying the Earliest Possible Indicator of Alzheimer's Disease • Stage 1: Mild ◆ Memory lapses ◆ Lo ...

ATI Concept-Based Level 3 Practice A Remediation ❖ Cognition ➢ Alzheimer's Disease ▪ Neurocognitive Disorders: Identifying the Earliest Possible Indicator of Alzheimer's Disease • Stage 1: Mild ◆ Memory lapses ◆ Losing or misplacing items ◆ Difficulty concentrating and organizing ◆ Unable to remember material just read ◆ Still able to perform ADLs ◆ Short term memory loss noticeable to close relations • Stage 2: Moderate ◆ Forgetting events of one's own history ◆ Difficulty performing tasks that require planning and organizing (paying bills, managing money) ◆ Difficulty with complex mental arithmetic ◆ Personality and behavioral changes: appearing withdrawn or subdued, especially in social or mentally challenging situations; compulsive; repetitive actions ◆ Changes in sleep patterns ◆ Can wander and get lost ◆ Can be incontinent ◆ Clinical findings that are noticeable to others • Stage 3: Severe ◆ Losing ability to converse with others ◆ Assistance required for ADLs ◆ Incontinence ◆ Losing awareness of one's environment ◆ Progressing difficulty with physical abilities (walking, sitting, and eventually swallowing) ◆ Death frequently related to choking or infection ➢ Schizophrenia ▪ Psychotic Disorders: Identifying Cognitive Symptoms of Schizophrenia • Cognitive Symptoms: Problems with thinking making it very difficult for the client to live independently ◆ Disordered thinking ◆ Inability to make decisions ◆ Poor problem-solving ability ◆ Difficulty concentrating to perform tasks ❖ End of Life ◆ Memory deficits ◆ Long term memory ◆ Working memory, such as inability to follow directions to find an address ➢ Organ and Tissue Donation ▪ Grief, Loss, and Palliative Care: Evaluating Teaching About Organ and Tissue Donation • Provide support and education to family members as decisions are being made. News private areas for any family discussions concerning donation. • Be sensitive to cultural and religious influences. • In order to keep the organs viable, ventilatory and cardiovascular support must be maintained • Answer any of the questions the family has • Provide care with respect and compassion while attending to the desires of the client and family per their cultural, religious, and social practices. Check the client’s religion and make attempts to comply • The provider typically approaches the family about performing an autopsy • The law can require an autopsy to be performed if the death is due to homicide, suicide, or accidental death, or if death occurs within 24 hr of hospital admission ❖ Human Growth and Development ➢ Cerebral Palsy ▪ Chronic Neuromusculoskeletal Disorders: Planning Care for a Toddler Who Has Cerebral Palsy • Individualized care to meet client needs • monitor developmental milestones • evaluate the need for hearing and speech evaluations • assess the family’s awareness of available resources • communicate with the child directly, but include the parents as needed • encourage family to help verify the client's needs if communication is impaired • maintain an open airway by elevating the head of the child's bed (especially important if the child has increased oral secretions) • ensure suction equipment is available if required • monitor for pain using a developmentally appropriate pain tool • ensure adequate nutrition ◆ Assess for the possibility of aspiration for children who are severely disabled ◆ Determine the child’s ability to take oral nutrition ◆ Provide foods that are similar to food eaten at home when possible ◆ Maintain weight/height chart • Administer medication for pain and/or spasms as required • Provide skin care ◆ Assess skin under splints and braces if applicable ◆ Maintain skin integrity by turning child to keep pressure off bony prominences • Provide rest periods as needed • Educate the family about plan of care, medications, therapies, treatments • Coordinate care with other professionals such as speech, physical and recreational therapists, and education and/or medical specialists. ➢ Newborn Complications ▪ Chronic Neuromusculoskeletal Disorders: Planning Care for a Newborn Who Has a Myelomeningocele • Spina bifida cystica: protrusion of the sac is visible • Myelomeningocele: The sac contains spinal fluid, meninges, and nerves • Nursing Care: ◆ Assess for infant-parent attachment ◆ Assess the sac ◆ Perform routine newborn assessment ◆ Assess the level of neurologic involvement ◆ Obtain accurate output measurements ◆ Assess head circumference and fontanels • Preoperative ◆ Prepare the family for surgery ◆ Protect the sac from injury ◆ Place infant in a woman, without clothing ◆ Apply a sterile, moist, non-adhering dressing with 0.9% sodium chloride on the sac, changing it every two hours ◆ Assess for systemic indications of infection (fever, irritability, and lethargy) ◆ Administer IV antibiotics • Postoperative ◆ Monitor vital signs, I&O ◆ Assess for indications of infection ◆ Provide pain management ◆ Provide incision care ◆ Assess the CSF leakage ◆ Maintain prone position until other positions are prescribed ◆ Resume oral feedings ◆ Provide range of motion to extremities • Education ◆ Provide teaching for postoperative care at home ◆ Depending on disability, teach ROM techniques ❖ Immunity ➢ Rheumatoid Arthritis ▪ Connective Tissue Disorders: Client Teaching About Methotrexate • Purpose of Methotrexate ◆ Slows joint degeneration and progression of rheumatoid arthritis ◆ Slow/delay the worsening of the disease • Administration ◆ Advise clients that effects of DMARDs are delayed and can take 3 to 6 weeks, with full therapeutic effect taking several months • Complications: ◆ Increased risk of infection  Advise clients to notify the provider immediately for manifestations of infection (fever, sore throat) ◆ Hepatic fibrosis and toxicity  monitor liver function tests. Advise the clients to observe for anorexia, abdominal fullness, and jaundice, and to notify the provider if symptoms occur ◆ Bone marrow suppression  obtain baseline CBC, including platelet counts. Repeat every three to six months ◆ Ulcerative stomatitis/other GI ulcerations (early finding with toxicity) ▪ Inspect mouth, gums, and throat daily for ulcerations, bleeding, or color changes ▪ Advise clients to take the medication with food or 8 oz of water ▪ Stop the medication if symptoms occur ◆ Fetal death/congenital abnormalities  avoid use during pregnancy, advise clients to use adequate contraception if taking this medication • Contraindications ◆ This medication is pregnancy risk category X ◆ methotrexate is contraindicated in clients who have liver failure, alcohol use disorder, or blood disgrasias ◆ Use with caution in clients who have liver or kidney dysfunction, cancer and suppressed bone marrow function, peptic ulcer disease , ulcerative colitis , impaired nutritional status, or infections ◆ use cautiously with children, or woman who are breast feeding ❖ Intracranial Regulation/Neural Regulation ➢ Epilepsy ▪ Seizures and Epilepsy: Identifying the Preictal Phase • Triggering Factors: ◆ Increase physical activity ◆ Excessive stress ◆ Hyperventilation ◆ Overwhelming fatigue ◆ Acute alcohol ingestion ◆ Excessive caffeine intake ◆ Exposure to flashing lights ◆ Substances such as cocaine, aerosols, and inhaled glue products • Generalized seizures can begin with an aura (alteration in vision, smell, hearing, or emotional feeling ❖ Mood and Affect ➢ Personality Disorders ▪ Personality Disorders: Assessing for Characteristics of Schizoid Personality Disorder • Schizoid Personality Disorder: ◆ Characterized by emotional detachment, disinterest in close relationships, and indifference to praise or criticism; often uncooperative ❖ Perfusion ➢ Congenital Heart Defects ▪ Cardiovascular Disorders: Caring for an Infant Who Has Tetralogy of Fallot • Tetralogy of Fallot ◆ Four defects that result in mixed blood flow: Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy ◆ Cyanosis at birth; progressive cyanosis over the first year of life ◆ Systolic murmur ◆ Episodes of acute cyanosis and hypoxia (blue or “Tet” spells) ◆ Surgical procedures: ➢ Shunt placement until able to undergo primary repair ➢ Complete repair within the first year of life ➢ Gestational Hypertension ▪ Medical Conditions: Manifestations of Gestational Hypertension • Severe continuous headache • Nausea, vomiting, RUQ pain • blurring of vision, diminished breath sounds • flashes of light or dots before the eyes • hypertension, seizures, oliguria • proteinuria, hyperreflexia, scotoma, dyspnea, jaundice • periorbital, facial, hand, and abdominal edema • pitting edema of lower extremities ➢ HELLP Syndrome ▪ Medical Conditions: Recognizing Indications of HELLP Syndrome • HELLP syndrome: Is a variant of GH in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction. HELLP syndrome is diagnosed by laboratory tests, not clinically • H: Hemolysis resulting in anemia and jaundice • EL: Elevated Liver enzymes resulting in elevated alanine aminotransferase (ALT) or aspartate transaminase (AST), epigastric pain, and nausea and vomiting • LP: Low Platelets (< 100,000/mm3), Resulting in thrombocytopenia , abnormal bleeding and clotting time, bleeding gums, petechiae, and possibly disseminated intravascular coagulopathy ➢ Preeclampsia ▪ Medical Conditions: Nursing Action for Client During Administration of Magnesium Sulfate • Inform the client that she may initially feel flushed, hot, and sedated with the magnesium sulfate bolus • Monitor blood pressure, pulse, respiratory rate, deep tendon reflexes, level of consciousness, urinary output, presence of headache, visual disturbances, epigastric pain, uterine contractions, and fetal heart rate and activity • Place a client on fluid restriction of 100 to 125 mL/hr, and maintain a urinary output of 30 mL/hr or greater • Monitor for signs and symptoms of Magnesium Sulfate Toxicity: ◆ Absence of patellar DTRs ◆ Urine output less than 30 mL/hr ◆ Respirations less than 12/min ◆ Decreased level of consciousness ◆ Cardiac dysrhythmias • If magnesium toxicity is suspected: ◆ Immediately discontinue infusion ◆ Administer antidote calcium gluconate or calcium chloride ◆ Prepare for actions to prevent respiratory or cardiac arrest ➢ Sickle Cell Anemia ▪ Hematologic Disorders: Manifestations of a Vaso-Occlusive Crisis • Usually Lasts 4-6 days (Painful episode) • Acute ◆ Severe pain, usually in the bones, joints, and abdomen ◆ Swollen joints, hands, and feet ◆ Abdominal pain ◆ Hematuria ◆ Obstructive jaundice ◆ Visual disturbances • Chronic ◆ Increased risk of respiratory infections and osteomyelitis ◆ Retinal detachment and blindness ◆ Systolic murmurs ◆ Renal failure and enuresis ◆ Liver cirrhosis; hepatomegaly ◆ Seizures ◆ Skeletal deformities; shoulder or hip avascular necrosis ▪ Hematologic Disorders: Teaching About Sickle Cell Anemia • Teach child and family about manifestations of crisis and infection • Encourage the child and family to practice good hand hygiene and avoid individuals who have colds/infections/viruses • Give specific directions regarding fluid intake requirements, such as how many bottles or glasses of fluid should be consumed daily • Encourage maintenance of up-to-date immunizations • Provide emotional support, and refer to social services if appropriate • Advise the child to wear a medical identification wristband or medical identification tags • Provide information about genetic counseling • Advise the family of the importance of promoting rest and providing adequate nutrition for the child ❖ Reproduction ➢ Family planning and Preconception Counseling ▪ Contraception: Providing Client Teaching About Combined Oral Contraceptive Use • Combined Oral contraceptives: Model contraception containing estrogen and progestin, which acts by suppressing ovulation, thickening the cervical mucus to block semen, and altering the uterine decidua to prevent implantation • Client Education: ◆ Medication requires consistent and proper use to be effective ◆ Instruct the client to observe for adverse effects and danger signs of medication (chest pain, shortness of breath, leg pain from a possible clot, headache, I problems from a stroke, and hypertension) ◆ In the event of a client missing a dose, tell the client that if one pill is missed, take one as soon as possible; if two or three pills are missed, follow the manufacturer's instructions • Advantages: ◆ Highly effective if taken correctly and consistently ◆ Noncontraceptive benefits of combined hormonal contraception containing low dose estrogen include: decrease menstrual blood loss, decreased iron deficiency anemia, and reduced incidence of dysmenorrhea and premenstrual symptoms • Disadvantages: ◆ Does not protect against STIs ◆ Can increase the risk of thromboembolism, stroke, heart attack, hypertension, gallbladder disease, liver tumor ◆ Adverse effects include headache, nausea, breast tenderness, and breakthrough bleeding. (Common adverse effects of estrogen component include nausea, breast tenderness, fluid retention. Common adverse effects of progestin component include increased appetite, tiredness, depression, breast tenderness, oily skin and scalp, and hirsutism.) ▪ Contraception: Teaching a Client How to Use a Diaphragm • Diaphragm and Spermicide ◆ A dome-shaped cup with a flexible rim made of silicone that fits snugly over the cervix with spermicidal cream or gel placed into the dome and around the rim. Diaphragms are available in different sizes ◆ Client Education ➢ A client should be properly fitted with a diaphragm by a provider ➢ Replaced every 2 years and refitted for a 20% weight fluctuation, after abdominal or pelvic surgery, and after every pregnancy ➢ Requires proper insertion and removal. Prior to coitus, the diaphragm is inserted vaginally over the cervix with spermicidal jelly or cream that is applied to the cervical side of the dome and around the rim. The diaphragm can be inserted up to 6 hr before intercourse and must stay in place 6 hr after intercourse but for no more than 24 hr ➢ Spermicide must be reapplied with each act of coitus ➢ A client should empty her bladder prior to insertion of the diaphragm ➢ Diaphragm should be washed with mild soap and warm water after each use ➢ Infertility ▪ Infertility: Client Teaching About Tests to Determine Fertility • Female ◆ Pelvic examination: Assesses for uterine or vaginal anomalies. ◆ Hormone analysis: Evaluates hypothalamic-pituitary-ovarian axis to include serum prolactin, FSH, LH, estradiol, progesterone, and thyroid hormones. ◆ Postcoital test: evaluates coital technique and mucus secretions. ◆ Ultrasonography: A transvaginal or abdominal ultrasound procedure performed to visualize female reproductive organs. ◆ Hysterosalpingography: Outpatient radiological procedure in which dye is used to assess the patency of the fallopian tubes. Assess for history of allergies to iodine and seafood prior to beginning the procedure. ◆ Hysteroscopy: A radiographic procedure in which the uterus is examined for signs of defect, distortion, or scar tissue that can impair successful impregnation. ◆ Laparoscopy: A procedure in which gas insufflation under general anesthesia is used to observe internal organs • Male ◆ Semen analysis: In 40% of couples who are infertile, inability to conceive is due to male infertility. This test is the first in an infertility workup because it is less expensive and less invasive compared with female infertility testing. It can need to be repeated. ◆ Ultrasonography: An ultrasound procedure is performed to visualize testes and abnormalities in the scrotum. A transrectal ultrasound procedure is performed to assess the ejaculatory ducts, seminal vesicles, and vas deferens. ➢ Newborn Care ▪ Nursing Care of Newborns: Identifying Client Understanding of Newborn Care Instructions • Provide family education while performing all nursing care. Encourage family involvement, allowing the mother and family to perform newborn care with direct supervision and support by the nurse • encourage mothers and family to hold the newborn so that they can experience eye-to- eye contact and interaction • foster sibling interaction in newborn care • Umbilical cord clamp stays in place for 24 to 48 hours • It is recommended to clean the cord with water, using cleanser sparingly if needed to remove debris • The newborn's diaper should be pulled it down and away from the umbilical stump • Bathing infant by submerging in water should not occur until the cord has fallen off • Advise parents to monitor elimination habits. baby should voice 6 to 8 times per 24 hours after day 4. The stools of newborns who are breast fed can appear yellow and seedy. They should have at least three stools per day for the first month • Newborns sleep approximately 16 to 19 hours per day. They should be positioned supine. no bumper pads, loose linens, or toys should be placed in the bassinet. ➢ Postpartum Hemorrhage ▪ Postpartum Disorders: Priority Action for a Client Experiencing Hemorrhage ▪ Firmly massage the uterine fundus ▪ Monitor vital signs ▪ Assess for source of bleeding • Assess fundus for height, firmness, and position. If uterus is boggy, massage fundus to increase muscle contraction • Assess lochia for color, quantity, and clots • Assess for clinical findings of bleeding from lacerations, episiotomy site, or hematomas ▪ Assess bladder for distention. insert an indwelling catheter to assess kidney function and obtain an accurate measurement of urinary output ▪ Maintain or initiate IV fluids to replace fluid volume loss with IV isotonic solutions, such as lactated ringer's or 0.9% sodium chloride; colloid volume expanders, such as albumin; and blood products (packed RBC's and fresh frozen plasma) ▪ Provide oxygen at 2 to 3 L/min per nasal cannula, and monitor oxygen saturation ▪ Elevate the client's legs to a 20 degree to 30 degree angle to increase venous return ▪ Administer prescribed uterine stimulant such as oxytocin, methylergonovine, misoprostol, or carboprost tromethamine ❖ Sexuality ➢ Sexually Transmitted Infections ▪ Infections: Caring for a Client Who Has Human Papillomavirus • Medications: ◆ For genital warts and Condyloma acuminata, options include a client-applied cream, such as imiquimod, or a provider-administered therapy, such as trichloroacetic acid application • Therapeutic Procedures: ◆ For precancerous changes on the cervix ➢ The provider can perform treatments including laser therapy or cone biopsy ◆ For a pregnant woman with an abnormal Pap that requires further follow-up ➢ Further evaluation and treatment are usually deferred until after birth • Client Education: ◆ Vaccines are recommended to protect against low-risk types of HPV that cause genital warts and high-risk types of HPV that cause cancer. The vaccine is indicated for clients 9 to 26 years of age, though ideally given at age 11 to 12 years ◆ Educate clients regarding safe sex practices (e.g., mutual monogamy and correct, consistent condom use) ▪ Infections: Teaching About Genital Herpes Simplex Virus • Herpes simplex Infection ◆ Symptoms consisting of painful blisters and tender lymph nodes ◆ A cesarean section is recommended for all women in labor who have active genital herpes lesions or early symptoms of impending outbreak, such as vulvar pain and itching (due to the risk of transferring the disease/infection to the newborn) ◆ Emphasize to the client the importance of compliance with prescribed treatment ◆ Discuss safe sexual relations with client ◆ Provide client with emotional support ❖ Stress and Coping ➢ Eating Disorders ▪ Eating Disorders: Developing a Plan of Care for a Client Who Has Bulimia Nervosa • Monitor the client’s vital signs, intake and output, and weight (2 to 3 lb/week is medically acceptable) • Establish realistic goals for weight loss or gain • Develop and maintain a trusting nurse/client relationship through consistency and therapeutic communication • Promote cognitive behavioral therapies ◆ Cognitive reframing ◆ Relaxation Techniques ◆ Journal Writing ◆ Desensitization exercises • Teach and encourage self-care activities • Reward the client for positive behaviors • Use a positive approach and support to promote client self-esteem and self-image • Incorporate the family when appropriate in client education and discharge planning • Work with a dietitian to provide nutrition education to include correcting misinformation regarding food, meal planning, and food selection ◆ Consider the client’s preferences and ability to consume food when developing the initial eating plan ◆ A structured and inflexible eating schedule at the start of therapy, only permitting food during scheduled times, promotes new eating habits and discourages binge or binge-purge behavior ◆ Provide small, frequent meals, which are better tolerated and will help prevent the client from feeling overwhelmed ◆ Provide liquid supplement as prescribed ◆ Provide a diet high in fiber to prevent constipation ◆ Provide a diet low in sodium to prevent fluid retention ◆ Limit high-fat and gassy foods during the start of treatment ◆ Administer a multivitamin and mineral supplement ◆ Instruct the client to avoid caffeine to reduce the risk for increased energy, resulting in difficulty controlling eating disorder behaviors. Caffeine also can be used by clients as a substitute for healthy eating. ➢ Post-Traumatic Stress Disorder ▪ Trauma- and Stressor-Related Disorders: Expected Findings for a Client Who Has Post- Traumatic Stress Disorder • Intrusive findings (presence of memories, flashbacks, dreams about the traumatic event) • Memories of the event recur involuntarily and are distressing to the client • Flashbacks (dissociative reactions where the client feels the traumatic event is recurring in the present), such as a military veteran feeling that he is reliving a combat situation after hearing a harmless loud noise • Night-time dreams related to the traumatic event • Avoidance of people, places, events, or situations that bring back reminders of the traumatic event • Trying to avoid thinking of the event • Sleep disturbances like insomnia • Aggression, irritability, and angry responses towards others • Destructive behavior such as suicidal thoughts • Hypervigilance with heightened startle responses • Decreased interest in current activities • Detachment from others, including friends and family members • Inability to experience positive emotional experiences, such as love and tenderness ➢ Substance Use Disorders ▪ Substance Use and Addictive Disorders: Screening for Indications of Alcohol Use Disorder • A laboratory blood alcohol concentration (BAC) of 0.08% (80 g/dL) is considered legally intoxicated for adults operating automobiles in most U.S. states. Death could occur from acute toxicity in levels greater than about 0.4% (400 g/dL) • BAC depends on many factors, including body weight, gender, concentration of alcohol in drinks, number of drinks, gastric absorption rate, and the individual’s tolerance level. • Standardized Screening Tools: ◆ Michigan Alcohol Screening Test (MAST) ◆ CAGE Questionnaire: Asks questions of clients to determine how they perceive their current alcohol use ◆ Alcohol Use Disorders Identification Test (AUDIT) ◆ Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)