NURSING ATI CLASS NOTES

NURSING ATI CLASS NOTES Aging Process Newborn Assessment: Expected Findings ● Normal Assessment Findings for Head: Should be 2-3 cm larger than chest. ● Anterior fontanel should be palpated and approximately 5 ...

NURSING ATI CLASS NOTES Aging Process Newborn Assessment: Expected Findings ● Normal Assessment Findings for Head: Should be 2-3 cm larger than chest. ● Anterior fontanel should be palpated and approximately 5 cm on average and diamond shaped. ● Posterior fontanel is smaller and triangle-shaped. Should be soft and flat. Molding of sutures is normal. Psychosocial Integrity Crisis Intervention Sexual Assault: Priority Intervention ● Provide a private environment and limit personnel who examine the client. ● Assess client emotions and provide support ● Assess, treat, and document all injuries ● Use a non judgemental and empathetic approach Abuse/Neglect Psychosocial Issues of Infants, Children, and Adolescents: Caring for a Child Who Reports Sexual Abuse ● Remove the child from the situation ● Mandatory reporting for all health care workers; there are civil and criminal penalties for not reporting ● Assess for unusual bruising on ABD, back and buttocks Sensory/Perceptual Alterations Effective Communication: Responding to a Client Who Is Obese and Is Crying Psychotic Disorders: Caring For a Client Who Is Experiencing Delusions ● Ask the client directly about hallucinations. The nurse should not argue or or agree with the client’s view of the situation. ● Do not argue with a client’s delusions, but focus on the client’s feelings and possibly offer reasonable explanations. ● Assess the client for paranoid delusions, which can increase the risk for violence against others. Basic Care and Comfort Elimination Postpartum Physiological Adaptations: Interventions to Promote Voiding ● Assist with frequent urination ● Provide noninvasive measures to promote urination ● Perform bladder scan Nutrition and Oral Hydration Burns: Supporting Nutritional Re