ATI Fundamentals Review of Concepts

What is the role of spiritual support staff?

Pastors, rabbis, and priests provide SPIRITUAL care such as if a family asks for a prayer prior to a procedure.

What is the role of RDs?

They assess, plan, and educate the patient regarding NUTRITION needs. They design special diets and supervise meal prep. An example of this is if a client has a low albumin level and recently had an unexplained weight loss.

What is the role of lab technicians?

They obtain SPECIMENS of body fluids and perform diagnostic TESTS. An example is if a provider needs to see a client's CBC.

What is the role of OTs?

They assess and plan for clients to REGAIN ADL skills, especially MOTOR skills of the UPPER extremities such as using an eating utensil following a stroke.

What is the role of pharmacists?

They provide, monitor, and evaluate MEDICATION such as if a client is concerned about a new medication's INTERACTIONS with any of their others.

What is the role of PTs?

They assess and plan for clients to increase MUSCULOSKELETAL function, especially of the LOWER extremities. An example of this is a client post-hip arthroplasty that requires assistance learning to AMBULATE and regain STRENGTH.

What is the role of providers?

They assess, diagnose, and treat diseases and injuries. This includes MDs, DOs, and PAs.

What is the role of radiologic technologists?

They position clients and perform X-RAYS and other IMAGING procedures for providers to review for diagnosis of various disorders such as after a fall.

What is the role of RTs?

They evaluate respiratory status and provide respiratory treatments including O2 therapy, chest physiotherapy, inhalation therapy, and mechanical ventilation.

What is the role of SWs?

They work with clients and families to coordinate inpatient and COMMUNITY resources to meet psychosocial and environmental needs that are necessary for recovery and discharge such as medical equipment in the home.

What is the role of SLPs?

They evaluate and make recommendations regarding the impact of disorders or injuries on SPEECH, LANGUAGE, and SWALLOWING. They teach techniques and exercises to improve function.

What is the nurse's role for a client's informed consent?

To WITNESS the client signature on the form and to ensure that the PROVIDER has obtained the informed consent responsibly and the provider EXPLAINS the treatment with its risks and benefits as well as other options.

What are examples of problem-oriented medical records for documentation?

SOAP (Subjective data, objective data, assessment, plan), PIE (Problem, intervention, evaluation), and DAR (Data, action, response) or focus charting

What are the 5 rights of delegation?

Right TASK

Right CIRCUMSTANCES (setting and resources)

Right PERSON

Right INFORMATION (direction and communication)

Right SUPERVISION and EVALUATION (oversee)

What is Maslow's Hierarchy of Basic Needs?

Physiological, safety and security, love and belonging, self-esteem, self-actualization

What are seizure precautions?

Rescue equipment such as O2, suction, padded side rails, and saline lock for IV access

Remove items in the environment that could cause injury during.

Do not put anything in the airway.

Do not restrain the client but LOWER to the floor or bed and protect their head.

Place client on SIDE with head flexed slightly forward if possible.

Loosen their clothing.

What are barriers to learning?

Fear, anxiety, depression

Physical discomfort, pain, fatigue

Environmental distractions

Sensory and perceptual deficits

Psychomotor deficits

What are some expected integumentary changes in the older adult?

Decreased SKIN turgor, subcutaneous fat, and connective tissue (dermis) which leads to wrinkles and dry transparent skin

Loss of subcutaneous fat which makes it more difficult to adjust to COLD temperatures

Thinning and graying of HAIR as well as sparser distribution

Thickening of fingernails and toenails

What are some expected cardiovascular/pulmonary changes in the older adult?

Decreased chest wall movement, vital capacity, and cilia which increases the risk for RESPIRATORY INFECTIONS

Reduced CO

Decreased peripheral CIRCULATION

Increased BP

What are some expected neurologic changes in the older adult?

Slower reaction time

Decreased senses such as touch, smell, and taste

Decline in visual acuity

Decreased ability for eyes to adjust from light to dark leading to NIGHT BLINDNESS (dangerous when driving)

Inability to hear High-pitched sounds or PRESBYCUSIS

Reduced spatial awareness

What are some expected GI changes in the older adult?

Decreased production of saliva

Decreased digestive enzymes

Decreased intestinal motility which can lead to increased risk of CONSTIPATION

Increased dental problems

What are some expected musculoskeletal changes in the older adult?

Decreased HEIGHT due to intervertebral disk changes

Decreased MUSCLE strength and tone

Decalcification of BONES

Degeneration of JOINTS

What are some expected GU changes in the older adult?

Decreased bladder capacity

PROSTATE hypertrophy in males

Decline in ESTROGEN or TESTOSTERONE production

Atrophy of breast tissue in females

What are some expected endocrine changes in the older adult?

Decline in triiodothyronine (T3) production yet overall function remains effective

Decreased sensitivity of tissue cells to INSULIN

What are some expected immunity changes in the older adult?

Decreased production of antibodies by B cells

Increased production of autoantibodies with increased autoimmune response

Decreased core body temperature

Decreased T-cell function

Decreased stress response

Decrease response to immunizations

What is the expected oral temperature range for an adult?

36 - 38 C or 96.8 to 100.4 F

What are the different classifications of BP?

Normal = < 120/80

Elevated = 120-129/ >80

Stage 1 HTN = 130-139/80-89

Stage 2 HTN = > or equal to 140 / > or equal to 90

List the name and function of the cranial nerves.

I = Olfactory for SMELL (Sensory)

II = Optic for VISUAL acuity and fields (Sensory)

III / IV / VI = Oculomotor, trochlear, and abducens for PERRLA and the 6 cardinal positions of GAZE (Motor)

V = Trigeminal for light SENSATION to the face (Sensory) and JAW opening/clenching/chewing (Motor)

VII = Facial for TASTE on the anterior tongue (Sensory) and FACIAL MOVEMENTS (Motor)

VIII = Auditory for HEARING and BALANCE (Sensory)

IX = Glossopharyngeal for TASTE on the posterior tongue (Sensory) and SWALLOWING/SPEECH/GAG REFLEX (Motor)

X = Vagus for GAG REFLEX (Sensory) and SWALLOWING/SPEECH quality (Motor)

XI = Spinal accessory for TURNING of the head and SHRUGGING of the shoulders (Motor)

XII (Hypoglossal) = TONGUE movement (Motor)

What is the Kubler-Ross Model?

Denial

Anger

Bargaining

Depression

Acceptance

How much energy is in a carbohydrate?

4 kcal/g

How much energy is in fat?

9 kcal/g

How much energy is in protein?

4 kcal/g

What are the fat-soluble vitamins?

A, D, E, K

What are the water-soluble vitamins?

C and B Complex (8)

When can infants have solid food?

6 months

What should the stoma of an ostomy look like upon inspection?

Moist, shiny, and pink

How much larger should the opening be than the stoma for ostomy care?

0.15 cm to 0.3 cm or 1/18 to 1/8 in

What are different types of urinary incontinence?

Stress: Weak pelvic floor muscles after childbirth or menopause

Urge: Bladder irritation from UTI

Overflow: Neurogenic bladder or enlarged prostate

Reflex: Impaired CNS

Functional: Cognitive, mobility, and environmental barriers

Transient: UTI, medications

What are the rights of safe medication administration?

Right client: 2 identifiers

Right medication: Prescription

Right dose: Calculation and confirm

Right time: Within 30 min if time-critical

Right route: PO, topical, subcutaneous, IM, IV, SL, buccal, ID, TD, epidural, INH, nasal, ophthalmic, otic, rectal, vaginal, IO, enteral tube

Right documentation: Client response

Right education

Right to refuse: Document

Right assessment: Prior to administration

Right evaluation: F/U

How many mL are in 1 oz?

30

How many mL are in 1 tsp?

5

How many mL are in 1 tbsp?

15

What are low-flow O2 delivery systems?

Nasal Cannula: 1-6 L/min; skin breakdown

Simple face mask: FiO2 of 35-50%; Skin breakdown and aspiration and impaired eating/drinking/talking

Partial rebreather mask: FiO2 of 60-75%; Varies with client's breathing; keep reservoir bag from deflating

Non-rebreather mask: FiO2 of 80-95%; Highest O2 possible; valve and flap on mask

What are high-flow O2 delivery systems?

Venturi mask: FiO2 or 24-50%; most precise O2 concentration; skin breakdown

Aerosol mask (Face tent or tracheostomy collar): FiO2 of 24-100%; high humidification

What is the primary drug of choice according to the American Pain Society for treating OA?

Acetaminophen

How is pitting edema documented?

1+ = < 2 mm

2+ = 2-4 mm

3+ = 5-7 mm

4+ = > 7 mm

What are the different stages of pressure ulcers?

Stage 1: ERYTHEMA (non-blanching) but INTACT skin with blood-filled blisters

Stage 2: PARTIAL thickness skin loss with superficial ulcer

Stage 3: FULL thickness skin loss with NECROTIC SUBCUTANEOUS tissue

Stage 4: FULL thickness skin loss with exposed or palpable BONE or MUSCLE