6/30 ATIs

Fluid Volume ATI: Expert Answer

- Ask provided about furosemide order - Check into kidney function (hasn't voided since he's been in the emergency room) - Compare against health history (atrial fibrillation and chronic kidney disease) - Discontinuing IV fluids - Check K levels for kidney function - Reduce oxygen since O2 stat has increased

Blood Administration ATI: Expert Answer

- Check barcode wristband to confirm the patient identity with the number on the order form and the unit of blood - Confirm blood band number? - The unit of blood should be cross identified with the unit of blood - The two nurses recite the blood type as compatible - If any of the information does not match exactly, notify the blood bank - Check the expiration date on the unit of blood - Check for any potential problems on the blood bag, such as discoloration, bubbles, or leaks - Hang blood bag on IV pole

Palliative ATI: Case Study Notes

- Hospice care provides holistic end of life care, maintain highest quality of life and facilitate a death that is peaceful and respects the clients wishes - Palliative Care: strives to alleviate pain and other manifestations of the client's illness or during the dying process; focuses on improving QUL for patients who have severe or life threatening illness by preventing, assessing, and treating physical manifestation and psychological and spiritual needs - Hospice Care: patients who have a prognosis of six months to live or less; client stops curative treatment and chooses palliative care - unique position to serve as the client's advocate - as the client nears death the needs of the family become more important, you need to inform them of the client's status and answer questions to provide teaching - allow families to participate in the clients care - arrange for grief counseling or coordinating respite care - make sure client receives pharmacological and nonpharmacological comfort measures (oxygen therapy, positioning, massage, music therapy, energy therapy, pain relief and opiates) - As the client nears death you may hear loud and wet respirations called "death rattle" > administering Scopolamine can help minimize wet secretions and promote ease of breathing - Other meds include Furosemide (fluid overload), Lorazepam (fear and anxiety), and Ondansetron (nausea and vomiting)

Depression ATI: Case Study Notes

- Introduce and HH - Confirm patient identification, name and DOB - Assess vital signs, encourage patient to walk, check if catheter can be removed - Patient concerned about end of life - Patient concerned about side effects of treatments (losing hair, being sick) - Patient concerned about how is taking care of them after treatment is done, and how she'll pay for treatment

Oxygenation ATI: Case Study Notes

- Oxygen therapy is a common treatment used in variety of settings, and for many conditions, such as pneumonia, emphysema, and COPD -- all of which cause impaired gas exchange and result in hypoxia if not treated - When a patient requires oxygen therapy, it is your responsibility to make sure that it is inflated immediately and that the oxygen is administered by correct flow rate and with the appropriate equipment. - Oxygen can have dangerous side effects, and should be considered a drug (administer rights and check against MAR) - Check blood oxy saturation and blood pressure -

Depression ATI: Expert Answer

- Therapeutic communication techniques help to establish rapport and trust with your clients - Develops and maintains effective nurse/client relationships - There are barriers to communication called "non-therapeutic techniques" Therapeutic Communication Techniques: - Active listening: verbal and nonverbal inconsistencies, conveys respect, trust, and promotes open honest expression - Silence - Providing leads - Focused questions: when you need more clarification about specific area of concern - Open ended questions: allow client to take the lead - Exploration: when client is vague or superficial - Clarifying - Paraphrasing/Restating - Reflection - Touch: to convey caring - Offering presence - Refocusing - Summarizing relevant points at the conclusion of the interaction SOLER S - sit facing the client to show you are genuinely interested O - observe an open, relaxed posture L - lean towards the client to indicate you're attentive and engaged E - establish and maintain eye contact R - relax, create sense of comfortableness with the client

Fluid Volume ATI: Case Study Notes

- introduce and HH - confirm patient name and dob - ask patient why they are here - listen to heart, lungs, and take vital signs - irregular heartbeat, crackles in lungs, oxygen saturation levels are down, should increase rate to 3L per doctors orders - review foot injury and change dressing - assess oxygen saturation level - retake vital sounds

Blood Administration ATI: Case Study Notes

- requires blood transfusion - privacy and hh - identify patient and confirm name/dob - confirm patient understands what the physician said and does not have any remaining questions - verify physicians order prior to transfusing blood or blood products - most facilities require a signed consent form

Blood Administration ATI: Video Challenge Question & Response

After checking the patient's identification and reviewing the orders for the blood transfusion, you need to start the blood. What are the steps in the blood verification process? Explain the rationale for this procedure. My response: >>> As blood and blood products are considered medical treatments, I would still complete the three medication checks and confirm the five rights prior to administering any blood or blood products. This is to ensure that I do not administer the wrong medication per the order. I would also assess the patient's vitals prior to administering any blood so that I have a baseline set of data to compare against and that there are no red flags with any of the vital levels before treatment. I would also confirm that the blood type of the order is appropriate for the blood type of the patient by comparing against the patient chart, or asking the provider to order a blood test if that information is not there. This is another safeguard to ensure the blood products being administered are not harmful to the patient.

Oxygenation ATI: Video Challenge Question & Response

How does the respiratory system provide oxygen to the body? My Response: >> Through diffusion at the alveoli capillary junction, oxygen is inspired and CO2 is expired. The oxygen molecules enter the arterial blood stream and connect to the hemoglobin in the blood (pulled by the iron in the hemoglobin). The oxygen molecules flow through the blood stream bound to the hemoglobin, and once oxygen saturation is reached, the molecules can disassociate and enter the tissue for cellular metabolism.

Oxygenation ATI: Reflection

My response was fairly aligned with the expert answer, although I did not specify the respiratory anatomy prior to reaching the alveoli. I also did not note how the chest can expand or decrease during inhalation/exhalation. Nor did I describe the auditory signs of respiration. I also included more information about what is happening to the oxygen molecules and how they are bound to the hemoglobin, which the Expert Answer did not expand on.

Depression ATI: Reflection

My response was strong as I identified three communication techniques to employ. I could have employed a few more techniques such as providing leads, asking open ended questions, providing touch to convey care, rephrasing or restating what I heard to clarify, and summarizing what the patient said at the close of our conversation.

Palliative ATI: Reflection

My response was very aligned with the Expert Answer, though I did miss some keywords such as "Coordinator of Care" which I think is an important distinction and title for the Nursing lead in this kind of care environment. This title allows the Nurse to expand their reach to not only the patient and their family, but to other members of the nursing and AP team. The expert answer also reiterated the need to be an educator for the patient and their family, explaining what will happen and what their options are. The expert answer also expanded the responsibility of the Social Worker to also coordinate transfers to hospice facilities or clients home, and coordinating the appropriate equipment to each of those locations.

Blood Administration ATI: Reflection

Take notes here to describe the strengths and weaknesses of your own submission based on your review of the expert answer. My response: >>> My answer was relatively strong when compared to the expert answer, although I did overlook some of the final reviews of the actual blood unit. I did suggest that we needed a way to confirm that the right blood product was being administered to the right patient. I was not aware specifically of a "blood band number" which I'm assuming will be on the patient's wrist band based on the video. I also did not know that two nurses were required to review and administer, but this makes sense given the review and confirmations needed. It my answer, I also forgot to review the blood for expiration date, check for any issues with the bag and blood itself (leaks, bubbles, etc), and hang the blood bag on the IV pole. Although not show in the video, I do still assume that the three checks against the MAR were performed along with the medication administration rights prior to administering. I also learned that the "Blood Bank" is specifically responsible for providing the blood unit.

Fluid Volume ATI: Reflection

The initial video did not mention any intake of fluids or that the patient hasn't voided. So I did not consider that in my assessment of nursing priorities. However, as the patient had increased, labored breathing, we could have assumed they were in respiratory acidosis and the kidneys were not functioning properly to compensate for homeostasis. However, I think the expert answer showed that we should always review the patient's health history and labs which would revealed some of the underlying issues, such as the chronic kidney disease. It also would have provided a more well rounded picture to present back to the physician when checking in on the other items.

Fluid Volume ATI: Video Challenge Question & Response

What are the priority nursing actions you would anticipate implementing when caring for Mr. Jones and why? My Response: Mr Jones is showing an irregular, tachycardic heart beat, hypertension, low oxygen saturation levels, and is expressing trouble breathing. While all of these are vital signs are important, we should consider any considerations to the ABCs (airway, breathing, circulation) the most important. Given that, the priority nursing action would be to report the low oxygen saturation level to the doctor and assess an increased or alternate treatment option with them. The doctor may want to increase their oxygen Ls or change up the type of oxygen mask used to ensure enough oxygen is being inspired and adequate gas exchange and oxygen transport is happening. Additionally you may position him in a posture that better helps with respiration.

Depression ATI: Video Challenge Question & Response

What are three therapeutic communication techniques the nurse could use when interacting with Mrs. Fisher? My response: 1) Active Listening, by remaining neutral and quiet, and letting the patient vent their frustrations and worries without judgement or interruption 2) Acknowledging the patient's fears about end of life, side effects of the treatment, and the logistics and financial realities of care 3) Ask specific follow-up questions to help them elaborate more on a certain concern that you may need clarification on

Palliative ATI: Video Challenge Question & Response

What members of the interprofessional health care team provide palliative/hospice care, and what roles do they play? - Nursing staff - Medical care providers - Social service specialists - Spiritual support personnel Can also include volunteers, massage therapists, and pet therapy providers My Response: The interprofessional care team in palliative/hospice care includes: - Nursing Staff: To advocate for the client and their families, to help clients achieve comfort and alleviate pain through pharmacological and non-pharmacological interventions, to assess and attend to the physical, psychological and spiritual needs of the client, and to arrange for respite care and grief counseling for the family. - Medical Care Providers: To assess the client's physical and psychological needs, and to prescribe treatments to help alleviate pain and improve quality of life - Social Service Specialists: Interacts with the nursing team to assess client and family's needs with regards to grief counseling, financial support, etc. - Spiritual Support Personnel: Interacts with the nursing team to assess client and family's needs with regards to spiritual and religious needs and considerations - Volunteers: To support the Nursing team and Family by providing companionship and outlet for emotions - Massage Therapists: To employ non-pharmacological massage treatments to help alleviate pain and increase quality of life - Pet Therapy Providers: To employ non-pharmacological treatments to help alleviate pain and increase quality of life