ATI RN Adult Medical Surgical Online Practice 2022 B.pdf, Exams of Nursing

Download ATI RN Adult Medical Surgical Online Practice 2022 B.pdf and more Exams Nursing in PDF only on Docsity! ATI RN Adult Medical Surgical Online Practice 2022 B.pdf 1. Parenting styles ATI pediatrics proctored exam Chapter 1: Family centered nursing care -Dictatorial or authoritarian: -Parents try to control the child’s behaviors and attitudes through unquestioned rules and expectations -Ex: The child is never allowed to watch television on school nights -Permissive: -Parents exert little or no control over the child’s behaviors, and consult the child when making decisions -Ex: The child assists with deciding whether he will watch television -Democratic or authoritative: -Parents direct the child’s behavior by setting rules and explaining the reason for each rule setting -Ex: The child can watch television for 1 hr on school nights after completing all of his homework and chores -Parents negatively reinforce deviations form the rules -Ex: The privilege is taken away but later reinstated based on new guidelines Chapter 2: Physical assessment findings 1. Vital signs -Usually vital signs are all high except for BP -Temperature: -3 – 6 months 99.5 -1 year 99.9 -3 year 99.0 -5 years 98.6 -7 years 98.2 -9 – 11 years 98.1 -13 years 97.9 -Pulse: -Newborn 80 – 180/min -1 weeks – 3 months 80 – 220/min -3 months – 2 years 70 – 150/min -2 – 10 years 60 – 110/min -10 years and older 50 – 90/min -Respirations: -Newborn – 1year 30 – 35/min -1 – 2 years 25 – 30/min -2 – 6 years 21 – 25/min ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -6 – 12 years 19 – 21/min -12 years and older 16 – 19/min ATI RN Adult Medical Surgical Online Practice 2022 B.pdf o Holds hand in open position | Grasp reflex fades ▪ 3 Months o Raises head and shoulders when prone | Slight head lag o No grasp reflex | Keeps hands loosely open ▪ 4 Months o Rolls from back to side o Grasp objects with both hands ▪ 5 Months o Rolls from front to back o Palmar grasp dominantly ▪ 6 Months o Rolls from back to front o Holds bottle ▪ 7 Months o Bears full weight on feet | Sits, leaning forward on both hands o Moves objects from hand to hand ▪ 8 Months o Sits unsupported o Pincer grasp ▪ 9 Months o Pulls to a standing position | Creeps on hands and knees instead of crawling o Crude pincer grasp | Dominant hand is evident ▪ 10 Months o Prone to sitting position o Grasps rattle by its handle ▪ 11 Months o Walks while holding onto something | Walks with one hand held o Places objects into a container | Neat pincer grasp ▪ 12 Months o Stands without support briefly | Sits from standing position without assistance o Tries to build a two-block tower w/o success | Can turn pages in a book 3. Cognitive development -Piaget: sensorimotor (birth to 24 months) -Object Permanence: objects still exists when it is out of view -Occurs at 9-10 months 4. Language development -3-5 words by the age of 1 year 5. Psychosocial development -Erikson: Trust vs. Mistrust: - Learn delayed gratification -Trust is developed by meeting comfort, feeding, simulation, and caring needs -Mistrust develops if needs are inadequately or inconsistently met or if needs ATI RN Adult Medical Surgical Online Practice 2022 B.pdf are continuously met before being vocalized by the infant ATI RN Adult Medical Surgical Online Practice 2022 B.pdf 6. Social development -Separation Anxiety: protest when separated from parents -Begins around 4-8 months -Stranger Fear: ability to discriminate between familiar and unfamiliar people -Begins 6-8 months 7. Age appropriate activities -Rattles -Playing pat-a cake -Brightly colored toys -Playing with blocks 8. Nutrition -Breastfeeding provides a complete diet for infants during the first 6 months -Solids are introduced around 4-6 months -Iron-fortified cereal is the first to be introduced -New foods should be introduced one at a time, over a 5-7 day period to observe for allergy reactions -Juice and water usually not needed for 1st year -Appropriate finger foods: -Ripe bananas -Toast strips -Graham crackers -Cheese cubes -Noodles -Firmly cooked vegetables -Raw pieces of fruit (except grapes) 9. Injury prevention -Avoid small objects (grapes, coins, and candy) -Handles of pots and pans should be kept turned to the back of the stove -Sunscreen should be used when infants are exposed to the sun -Infants and toddlers remain in a rear-facing car seat until age 2 -Crib slats should be no farther apart than 6 months -Pillows should be kept out of the crib -Infants should be placed on their backs for sleep Chapter 4: Health Promotion of Toddlers (1 to 3 years) 1. Physical development -Weight: -30 months: 4 times the birth weight -Height: -Toddlers grow 7.5 cm (3 in) per year -Head circumference and chest circumference: -Usually equal by 1 to 2 years of age 2. Cognitive development ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Peanut butter ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Raw carrots -Tough meats -Popcorn Chapter 5: Health Promotion of Preschoolers (3-6 years) 1. Physical development -Weight: -Gain 2-3 kg (4.5-6.5 lb) per year -Height: -Should grow 6.9-9 cm per year 2. Fine and gross motor skills ▪ 3 Years o Toe and heel walks o Tricycle o Jumps off bottom step o Stands on one foot for a few seconds ▪ 4 Years o Hops on one foot | Skips o Throws ball overhead o Catches ball reliably ▪ 5 Years o Jumps rope o Walks backward o Throws and catches a ball 3. Cognitive development -Piaget: preoperational stage -Moves from totally egocentric thoughts to social awareness and the ability to consider the viewpoint of others -Magical thinking: -Thoughts are all-powerful and can cause events to occur -Animism: -Ascribing life-like qualities to inanimate objects 4. Psychosocial development -Erikson: Initiative vs. guilt: -Preschoolers become energetic learners, despite not having all of the physical abilities necessary to be successful at everything -Guilt can occur when preschoolers believe they have misbehaved or when they are unable to accomplish a task -During stress, insecurity, or illness, preschoolers can regress to previous immature behaviors or develop habits (nose picking, bed-wetting, thumb sucking) 5. Age appropriate activities -Preschooler’s transition to associative play -Play is not highly organized, but cooperation does exist between children ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Appropriate activities: ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Pubic hair growth -Axillary hair growth -Menstruation -In boys, sexual maturation occurs in the following order: -Testicular enlargement -Pubic hair growth -Penile enlargement -Growth of axillary hair -Facial hair growth -Vocal changes 2. Cognitive development -Piaget: Formal operations -Increasingly capable of using formal logic to make decisions 3. Psychosocial development -Erikson: Identity vs. role confusion -Adolescents develop a sense of personal identity and to come to view themselves as unique individuals 4. Age-appropriate activities -Nonviolent videogames -Nonviolent music -Sports -Caring for a pet -Reading Chapter 8: Safe Medication Administration 1. Oral -This route of medication administration is preferred for children -Avoid mixing medication with formula or putting it in a bottle of formula because the infant might not take the entire feeding, and the medication can alter the taste of the formula -Use the smallest measuring liquid medication for doses of liquid medication -Avoid measuring liquid medication in a tsp. or tbsp. -Administer the medication in the side of the mouth in small amounts -Stroke the infant under the chin to promote swallowing while holding the cheeks together 2. Otic -Children younger than years: -Pull the pinna downward and straight back -Children older than 3 years: -Pull the pinna upward and back 3. Intramuscular -Use a 22-25 gauge, 1/2-1 inch needle -Vastus lateralis is the recommended site in infants and small children ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Other sites: -Ventrogluteal and deltoid ATI RN Adult Medical Surgical Online Practice 2022 B.pdf 4. Intravenous -Avoid terminology such as “bee sting” or “stick” -Apply EMLA to the site for 60 minutes prior to attempt (helps numb) -Keep equipment out of site until procedure begins -Perform procedure in a treatment room (don’t do it in their room) -Allow parents to stay if they prefer -Swaddle infants -Offer nutritive sucking to infants before, during, and after the procedure Chapter 9: Pain management 1. Atraumatic measures -Use play therapy to explain procedures, allowing the child to perform the procedure on a doll or toy 2. Pharmacological measures -Give medications routinely, vs. PRN, to manage pain that is expected to last for an extended period of time 3. Pain assessment tool -Flacc: 2 months- 7 years -Faces: 3 years and older -Oucher: 3-13 years -Numeric scale: 5 years and older Chapter 10: Hospitalization, illness, and play 1. Infant -Experiences stranger anxiety between 6-18 months -Displays physical behaviors as expressions of discomfort due to inability to verbalize 2. Toddler -Limited ability to describe illness -Limited ability to follow directions -Experiences separation anxiety -Can exhibit an intense reaction to any type of procedure -Behavior can regress 3. Preschooler -Fears related to magical thinking -Can experience separation anxiety -Might believe illness and hospitalization are a punishment -Explain procedures using simple, clear language -Avoid medical jargon -Give choices when possible, such as, “Do you want your medicine in a cup or spoon?” 4. School-age child ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Offer to allow family to assist with preparation of the body ATI RN Adult Medical Surgical Online Practice 2022 B.pdf Chapter 12: Acute Neurological disorders 1. Meningitis -Viral (aseptic) Meningitis: supportive care for recovery -Bacterial (septic) Meningitis: contagious infection -Hib and PCV vaccines decrease the incidence -Newborns: -Poor Muscle Tone -Weak Cry -Poor Suck | Refuses Feedings -Vomiting/Diarrhea -Bulging Fontanels (late sign) -3 Months – 2 Years: -Seizures with a High-Pitched Cry -Bulging Fontanels -Poor Feedings | Vomiting -Possible nuchal rigidity -Brudzinki’s sign and Kernig’s sign not reliable for diagnosis -2 Years – Adolescence: -Seizures (often initial sign) -Nuchal rigidity -Fever/chills -Headache/vomiting -Irritability/restlessness that can progress to drowsiness/stupor -Petechiae or purpuric type rash (with meningococcal infection) -+ Brudzinski Sign: flexion of extremities with deliberate flexion of the neck -+ Kernig’s Sign: resistance to extension of the leg from a flexed position -Laboratory Tests -Blood Cultures | CBC | CSF Analysis -Viral CSF -Clear Color | Slightly Elevated WBC & Protein | Normal Glucose | - Gram -Bacterial CSF -Cloudy Color | Elevated WBC | Elevated Protein | Decreased Glucose | +Gram -Diagnostic Procedures -Lumbar Puncture (Definitive Diagnostic Test) -Empty Bladder -EMLA Cream 45min – 1-hour prior -Side-lying Position, Head Flexed, Knees Drawn up to Chest -Remain in Flat Position to prevent Leakage and Spinal HA -Nursing care: ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Droplet precautions -Maintain NPO status if the client has decreased LOC ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Violent jerking movements of the body -Postictal State (30 minutes) -Remains semiconscious but arouses with difficulty and confused -No recollection of the seizure -Absence seizure: petit mal or lapses -Onset between ages 5 – 8 years and ceases by the teenage years -Loss of Consciousness lasting 5 – 10 seconds -Minimal or no change in behavior -Resembles daydreaming or Inattentiveness -Can drop items being held, but the child seldom falls -Lip Smacking | Twitching of Eyelids or Face | Slight Hand Movements -Myoclonic seizure: -Brief contraction of muscle or groups of muscle -No postictal state -Atonic or akinetic seizure: -Muscle tone is lost for a few seconds 3. Diagnostic procedures -EEG: -Abstain from caffeine for several hours prior to the procedure -Wash hair (no oils or sprays) before and after the procedure to remove electrode gel 4. Nursing care -Initiate Seizure Precautions: -Pad side rails of Bed | Crib | Wheelchair -Keep bed free of objects that could cause Injury -Have Suction and Oxygen Equipment available -During a Seizure: -Protect from Injury (move furniture away, hold head in lap) -Maintain a position to provide a patent airway -Suction Oral Secretions -Side-lying Position (decreases risk of aspiration) -Loosen restrictive clothing -Do NOT restrain the child -Do NOT put anything in the child’s mouth -Do NOT open the jaw or insert an airway during seizure -This can damage teeth, lips, or tongue -Remain with the child -Note onset, time, and characteristics of seizure -Allow seizure to end spontaneously -Post-Seizure: -Side-lying position to prevent aspiration and facilitate drainage of secretions -Check for breathing, V/S and position of head -NPO until swallowing reflex has returned ATI RN Adult Medical Surgical Online Practice 2022 B.pdf 5. Medications -Antiepileptic Drugs (AEDs): ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Diazepam (Valium) | Phenytoin | Carbamazepine | Valporic Acid | 6. Therapeutic procedures -Focal Resection: of an area of the brain to remove epileptogenic zone -Corpus Callostomy: separation of two hemispheres in the brain -Vagal Nerve Stimulator 7. Complications -Status Epilepticus: -Prolonged Seizure Activity that Lasts >30 minutes or Continuous seizure activity in which the client does not enter a Postictal Phase -Maintain Airway, Administer oxygen, IV access Chapter 14: Head injury 1. Physical assessment findings -Minor injury: -Vomiting -Pallor -Irritability -Lethargy/drowsiness -Severe injury: Increased ICP -Infants: -Bulging fontanel -Irritability (usually 1st sign) -High-pitched cry -Poor feeding -Children: -Nausea/headache -Forceful vomiting -Blurred vision -Seizures -Late signs: -Alterations in pupillary response -Posturing (flexion and extension) -Decreased motor response -Decreased response to painful stimuli -Cheyne-stokes respirations -Seizures -Flexion: severe dysfunction of the cerebral cortex -Extension: Severe dysfunction at the level of the midbrain 2. Nursing care -Ensure the spine is stabilized until a spinal cord injury is ruled out -Implement actions to decrease ICP: -Keep the head midline with the bed elevated 30 degrees, which will also promote venous draining ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Helps facilitate proper inhalation -Take a deep breath and then exhale ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Tilt the head back slightly, and press the inhaler -While pressing the inhaler, begin a slow, deep breath that lasts for 3-5 seconds -Hold the breath for 5-10 seconds 2. Dry powder inhaler -DO NOT shake 3. Chest physiotherapy -Is a set of techniques that includes manual or mechanical percussion, vibration, cough, forceful expiration (or huffing), and breathing exercises -Helps loosen respiratory secretions -Schedule treatments before meals or at least 1 hr after meals and at bedtime -Administer bronchodilator medication or nebulizer treatment prior 4 4. Hypoxemia -Early signs: -Tachypnea -Tachycardia -Restlessness -Use of accessory muscles -Nasal flaring 5. Oxygen toxicity -Can result from high concentrations of oxygen, long duration of oxygen therapy, and the child’s degree of lung disease -Hypoventilation and increased PaCO2 levels allow for rapid progression into unconscious state Chapter 17: Acute and infectious respiratory illnesses 1. Tonsillitis -Physical assessment findings: -Report of sore throat with difficulty swallowing -Mouth odor/mouth breathing -Fever -Tonsil inflammation with redness and edema -Laboratory tests: -Throat culture: -For GABHS -Medications: -Antipyretics/analgesics: acetaminophen -Antibiotics: for Tx of GABHS -Tonsillectomy: for recurring tonsillitis -Side-lying position after then elevate HOB when child is awake -Assess for evidence of bleeding: -Frequent swallowing/clearing the throat -Avoid red-colored liquids, citrus juice, and milk-based foods -Discourage coughing, throat clearing, and nose blowing in order to ATI RN Adult Medical Surgical Online Practice 2022 B.pdf protect the surgical site -Avoid straws: can damage surgical site ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Repeat 3 more times -Record highest number 5. Complications -Status asthmaticus: -Airway obstruction that is often unresponsive to treatment -Prepare for emergency intubation Chapter 19: Cystic Fibrosis 1. Cystic fibrosis -Both biological parents carry the recessive trait for CF -Characterized by mucus glands that secrete an increase in the quantity of thick, tenacious mucus, which leads to mechanical obstruction of organs 2. Expected findings -Early manifestations: -Wheezing, rhonchi -Dry, nonproductive cough -Increased involvement: -Dyspnea -Paroxysmal cough -Obstructive emphysema and atelectasis on chest x-ray -Advanced involvement: -Cyanosis -Barrel-shaped chest -Clubbing of fingers and toes -GI findings: -Large, frothy, bulky, foul-smelling stools (steatorrhea) -Failure to gain weight or weight loss -Delayed growth patterns -Distended abdomen -Thin arms and legs -Deficiency of fat-soluble vitamins (Vitamin A,D,E,K) -Integumentary findings: -Sweat, tears, and saliva having high content of sodium and chloride 3. Diagnostic procedures -Sweat chloride test (most definitive) 4. Nursing care -Chest physiotherapy -High protein/calorie -Give pancreatic enzymes within 30 min of eating a meal or snack -Multivitamin A,D,E,and K 5. Medications -Bronchodilators: albuterol -Anticholinergics: ipratropium bromide ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Dornase alfa (pulmozyme): decreases viscosity of mucus and improves lung function ATI RN Adult Medical Surgical Online Practice 2022 B.pdf Chapter 20: Cardiovascular disorders 1. Defects that INCREASE pulmonary blood flow -Ventricular septal defect (VSD): -A hole in the septum between the right and left ventricle that results in increased pulmonary blood flow (left-to-right shunt) -Expected finding: -Loud, harsh murmur at the left sternal border -Atrial septal defect (ASD): -A hole in the septum between the right and left atria that results in increased pulmonary blood flow (left-to-right shunt) -Expected findings: -Loud, harsh murmur with a fixed split second heart sound -Patent ductus arteriosus (PDA): -Connection between pulmonary artery and aorta stays open after birth causing mixing of blood -Expected findings: -Murmur (machine hum) -Bounding pulses 2. Defects that DECREASE pulmonary blood flow -Tricuspid atresia: -A complete closure of the tricuspid valve that results in mixed blood flow -Tetralogy of Fallot: -Pulmonary stenosis, right ventricular hypertrophy, overriding aorta, and ventricular septal defect (PROV) 3. Obstructive defects -Pulmonary stenosis: -A narrowing of the pulmonary valve or pulmonary artery that results in obstruction of blood flow from the ventricles -Expected findings: -Systolic ejection murmur -Aortic stenosis: -A narrowing of the aortic valve -Coarctation of the aorta: -A narrowing of the lumen of the aorta -Expected findings: (BP/pulse elevated on top, but not on the bottom) -Elevated blood pressure in the arms -Bounding pulses in the upper extremities -Decreased blood pressure in the lower extremities -Cool skin of lower extremities -Weak or absent femoral pulses 4. Mixed defects -Transportation of the great arteries: ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Elevated or rising titer, most reliable diagnostic test -Jones Criteria: -The diagnosis of rheumatic fever is made on the basis of modified jones criteria -The child should demonstrate the presence of 2 major criteria or the presence of 1 major and 2 minor criterion following an acute infection with GABHS infection -Major criteria: -Carditis -Subcutaneous nodules -Polyarthritis -Rash (erythema marginatum) -Chorea: involuntary muscle movements -Minor criteria: -Fever -Arthralgia 10. Kawasaki disease -Acute systemic vasculitis (inflammation of the blood vessels in the body) -Expected findings: -Acute phase: -Fever greater than 102 F lasting 5 days to 2 weeks and unresponsive to antipyretics -Irritability -Red eyes without drainage -Bright red, chapped lips -Strawberry tongue with white coating or red bumps on the posterior aspect -Red oral mucous membranes with inflammation including the pharynx -Swelling of hand and feet with red palms and soles -Sub acute phase: -Peeling skin around the nails, on the palms/soles -Medication: -Gamma globulin: IVGG -Aspirin -Client education: -Avoid live immunizations for 11 months Chapter 21: Hematologic disorders 1. Epistaxis -Have the child sit up with the head tilted slightly forward to prevent aspiration of blood -Apply pressure to the lower nose with the thumb and forefinger for at least 10 min ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -If needed, pack cotton or tissue into the side of the nose that is bleeding -Apply ice across the bridge of the nose if bleeding continues ATI RN Adult Medical Surgical Online Practice 2022 B.pdf 2. Iron deficiency anemia -Adolescents are at risk due to poor diet, rapid growth, menses, strenuous activities, and obesity -Risk factors: -Excessive intake of cow’s milk in toddlers -Milk is not a good source of iron -Milk takes the place of iron-rich solid foods -Nursing care: -Modify the infants diet to include high iron and vitamin C -Iron supplements: -Give 1 hr before or 2 hr after milk or antacid to prevent decreased absorption -Give with Vitamin c to increase absorption -Use a straw to prevent staining of the teeth -Use a z-track method for injection -Do not massage the injection site -Tarry green stools are expected -Instruct the child to brush teeth after oral dose to minimize or prevent staining -Dietary sources of iron: -Infants: Iron-fortified cereals and formula -Older children: Dried beans, lentils, peanut butter, green leafy veggies, iron- fortified breads and flour, and red meat 3. Sickle cell anemia -SCD is an autosomal recessive genetic disorder -Primarily affects African Americans -Causes cell to be sickled shape causing increased blood viscosity, obstruction of blood flow, and tissue hypoxia -Expected findings: -Reports of pain: due to tissue ischemia -Shortness of breath/fatigue -Pallor -Jaundice -Vaso-occlusive crisis (painful episode): -Severe pain, usually in bones, joints, and abdomen -Nursing care: -Keep patient hydrated -Schedule administration of analgesics to prevent pain -Complications: -CVA 4. Hemophilia -Bleeding time is extended due to lack of a factor required for blood to clot -Hemophilia A: deficient of factor VIII -Hemophilia B: deficient of factor IX ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Possible thirst and irritability -Severe: ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Capillary refill >4 -Tachycardia -Extreme thirst -Very dry mucous membranes and tented skin -No tearing with sunken eyeballs -Sunken anterior fontanel -Oliguria and anuria Chapter 23: Gastrointestinal structural and inflammatory disorders 1. Cleft lip and cleft palate -Cleft lip: -Results from incomplete fusion of the oral cavity during intrauterine life -Apply elbow restraints -Cleft palate: -Results from the incomplete fusion of the palates during intrauterine life -Infant may be placed on the abdomen (prone) -For isolated cleft lip: -Use a wide-based nipple for bottle-feeding -For CP or CL and CP: -Use a specialized bottle with a one-way valve and a specially cut nipple -Avoid having the infant suck on a nipple or pacifier -Complications: -Ear infections and hearing loss -Speech and language impairment -Dental problems 2. GERD -Expected findings: -Infants: -Sitting up or forceful vomiting -Irritability -Arching of back -Children: -Difficulty swallowing -Chronic cough -Non-cardiac chest pain -Nursing care: -Small, Frequent Meals -Thicken infant’s formula with 1 tsp. to 1 tbsp. rice cereal per 1oz formula -Avoid: Caffeine | Citrus | Peppermint | Spicy or Fried Foods -Assist with weight control -HOB elevated during and after meals (at least 30 degrees) -Therapeutic procedures: ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Nissen fundoplication: wraps the fundus of the stomach around the distal esophagus to decrease reflux ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Pre-op: -Give IV fluid replacement/IV antibiotic -Post-op: -Place NG tube for decompression Chapter 24: Enuresis and Urinary tract infections 1. Enuresis -Must be at least 5 years of age before there’s consideration about diagnosing enuresis -Primary enuresis: -A child has never been free of bed-wetting for any extended periods of time -Secondary enuresis: -A child who started bed-wetting after development of urinary control -Nursing care: -Have the child empty their bladder before bedtime -Encourage fluids during the day and restrict fluids in the evening -Avoid fruit and fruit drink, caffeinated or carbonated drinks after 1600 -Use positive reinforcement -Avoid punishing, scolding, or teaching the child following an incident 2. UTI -Physical assessment findings: -Infants: -Poor feeding, vomiting, or failure to gain weight -Increase in thirst -Frequent urination -Foul-smelling urine -Fever -Seizure -Pallor -Laboratory tests: -Urinalysis and urine culture and sensitivity: -Nitrates and leukocytes will be increased -Client education: -Teach females to wipe the perineal area from front to back -Suggest the use of cotton underwear -Instruct avoidance of bubble baths -Encourage frequent voiding -Empty complete bladder Chapter 25: Structural Disorders of the genitourinary tract and Reproductive system ATI RN Adult Medical Surgical Online Practice 2022 B.pdf 1. Defects of the genitourinary tract -Bladder exstrophy: ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Eversion of the posterior bladder through the anterior bladder wall and lower abdominal wall -Cover the exposed bladder with sterile, nonadherent dressing -Prepare the child for immediate surgery -Hypospadias: -Urethral opening located just below the glans penis, behind the glans penis, or on the ventral surface of the penile shaft -Meatus opening below the glans penis -Epispadias: -Urethra opened on dorsal surface of the penis -Phimosis: -Inability to retract foreskin of penis -Testicular torsion: -Pain is either acute or insidious in onset and radiates to the groin area Chapter 26: Renal disorders 1. Acute glomerulonephritis -Associated with GABHS -Physical assessment findings: -Cloudy, tea-colored urine -Decreased urine output -Periorbital edema -Facial edema that is worse in the morning but then spreads to extremities and abdomen with progression of the day -Mild to severe HTN -Laboratory: -Urinalysis: -Proteinuria, smoke or tea-colored urine, hematuria, increased specific gravity -Renal function: -Elevated BUN and creatinine -Antistreptolysin O (ASO) titer: -Positive indicator for the presence of streptococcal antibodies -Nursing care: -Possible restriction of sodium and fluid -Monitor for skin break down (at risk due to edema) -Encourage frequent turning and repositioning -Medications: -Diuretics and antipyretics 2. Nephrotic syndrome -Alterations in the glomerular membrane allow proteins (especially albumin) to pass into the urine, resulting in decreased serum osmotic pressure -Expected findings: ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Move Fingers or Toes 3. Casting ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Elevate the cast above the level of the heart during the first 24 -Apply ice for the first 24 hours to prevent swelling -Turn and position every 2 hours (cast dries faster | prevents cast from changing shape) -Assess for increased warmth or hot spots on the cast surface (infection) -Plaster Casts: Use Palms of Hands to avoid Denting | Expose the Cast to Air -Instruct the client not to place any foreign objects inside the cast to avoid trauma to the skin 4. Traction care -Maintain body alignment -Pharmacological and Nonpharmacologic Interventions for Pain and Muscle Spasms -Assess and monitor neurovascular status -Assess pin sites for pain, redness, swelling, drainage, or odor -Weights should hang freely -Halo device: -Ensure that the wrench to release the rod is readily available when using halo traction in the event that CPR is necessary 5. Complications -Compartment syndrome: -Compression of nerves, blood vessels, and muscle inside a confined place, resulting in neuromuscular ischemia -Findings: 5 P’s: -Pain: unrelieved with elevation or analgesics, increases with passive movement -Paresthesia: numbness (early finding) -Pulselessness: distal to fracture -Paralysis: inability to move digits (nerve damage) -Pale: cold skin and cyanosis to nail beds -Osteomyelitis: -Expected findings: -Fever -Tachycardia -Edema -Pain is constant but increases with movement -Nursing actions: -Administer IV and oral ABX therapy Chapter 28: Musculoskeletal congenital disorders 1. Clubfoot -A complex deformity of the foot and ankle -Therapeutic procedures: -Series of castings 2. Legg-calve-Perthes disease ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Aseptic necrosis of the femoral head can be unilateral or bilateral -Expected findings: ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -An inherited condition that results in bone fractures and deformity along with restricted growth -Expected findings: -Multiple bone fractures -Blue sclera -Early hearing loss -Small, discolored teeth -Medications: -Pamidronate: Increase bone density -SE: decreases electrolytes -Nursing care: -Teach the family and client low-impact exercises 5. Scoliosis -Characterized by a lateral curvature of the spine and spinal rotation that causes rib asymmetry -Have the child bend over at the waist with arms hanging down and observe for asymmetry of ribs and flank -Bracing: -Customized braces slow the progression of the curve -Spinal fusion with rod placement: -Used for curvatures >45 degrees Chapter 29: Chronic Neuromusculoskeletal disorders 1. Cerebral palsy -Is a non-progressive impairment of motor function, especially that of muscle control, coordination, and posture -Abnormal perception and sensation; visual, hearing, and speech impairment; seizures; and cognitive disabilities -Risk factors: -Exact cause is unknown -Prenatal, perinatal, and postnatal risk factors -Expected findings: -Spastic CP (pyramidal): -Hypertonicity, increased deep tendon reflex; clonus; and poor control of motion, balance and posture -Dyskinetic CP (nonspastic, extrapyramidal): -Involuntary jerking movements that appear slow, writhing, and wormlike -Ataxic CP (nonspastic, extrapyramidal): -Poor ability to do repetitive movements -Lack of coordination with purposeful movements (ex: reaching for an object) -Medications: ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Baclofen/Diazepam -Complications: ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Aspiration 2. Spina Bifida -Is failure of the osseous spine to close -Meningocele: -The sac contains spinal fluid and meninges -Myelomeningocele: -The sac contains spinal fluid, meninges, and nerves -Risk factors: -Medications/substances taken during pregnancy -Insufficient folic acid intake during pregnancy -Physical assessment findings: -Protruding sac midline of the osseous spine (cystica) -Dimpling in the lumbosacral area (occulta) -Therapeutic procedures: -Closure of myelomeningocele sac is done as soon as possible to prevent complications of injury and infection -Apply a sterile, moist, nonadherent dressing with 0.9% sodium chloride on the sac, changing it every 2 hr -Place in the infant in prone position with hips flexed, legs abducted -Complications: -Skin ulceration -Latex allergy: -Also bananas, avocados, kiwi, and chestnuts -Increased intracranial pressure: -Infants: -High-pitched cry, lethargy, vomiting, bulging fontanels, and increased head circumference -Bladder issues -Orthopedic issues 3. Juvenile idiopathic arthritis -Chronic autoimmune inflammatory disease affecting joints and other tissues -Expected findings: -Joint swelling/stiffness/redness/warmth that tends to be worse in the morning or after inactivity -Nursing care: -Apply heat or warm moist packs to the child’s affected joints prior to exercise -Encourage warm baths -Medications: -NSAIDs: control pain and inflammation -Ibuprofen, naproxen, diclofenac, indomethacin, and tolmetin -DMARD: slows joint degeneration and progression of rheumatoid arthritis when NSAIDs do not work alone -Methotrexate ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Tinea corporis (Ringworm of the body): -Round erythematous scaling patch ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Use topical antifungal (tolnaftate, Clotrimazole) -Tinea pedis (athletes foot): -Between toes or on the plantar surface of the feet 3. Skin infestations -Scabies mite (Sarcoptes scabiei): -Manifestations: -Itchy, especially at night -Rash, especially between the fingers -Thin, pencil-like marks on the skin -Infants: -Pimples on the trunk -Blisters on the palms of the hands and soles of the feet -Interventions: -Scabicide such as 5% permethrin all over body -Treat entire family and persons that have been in contact with infected person during and 60 days after infection -Wash underwear, towels, clothing, and sleepwear in hot water -Pediculosis capitis (Head lice): -Intense itching -Nits (white specs) on the hair shaft -1% permethrin shampoo -Remove nits with a nit comb; repeat in 7 days after shampoo TX -Washing clothing, bedding in hot water with detergent -Client education: -Teach the parent to bag items that cannot be laundered into tightly sealed bag for 14 days -Teach the parents to boil combs, brushes and hair accessories for 10 min or soak in lice-killing products for 1 hr -Discourage sharing of personal items Chapter 31: Dermatitis and Acne 1. Dermatitis -Diaper dermatitis -Nursing interventions: -Clean urine in the perineal area with a nonirritating cleanser -Expose the affected area to air -Use superabsorbent disposable diapers to reduce skin exposure (no cloth) -Apply a skin barrier (zinc oxide) -Poisonous plant exposure: -Cleanse exposed area as soon as possible with cold running water, then soap and water shower -Apply calamine lotion; burrow solution compresses, or natural ATI RN Adult Medical Surgical Online Practice 2022 B.pdf colloidal oatmeal baths -Use topical corticosteroid gel ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Damage to the entire epidermis -Dermal elements are intact -Painful, moist, red in color with blisters -Blanches with pressure -Sensitive to temperature changes, exposure to air, and light touch -Deep partial thickness: -Damage to the entire epidermis and some parts of the dermis -Sweat glands and hair follicles remain intact -Red to white in color, with blisters -Blanches with pressure -Painful -Sensitive to temperature changes and light touch -Third degree: -Full thickness: -Damage to the entire epidermis and dermis and possible damage to the subcutaneous tissue -Red to tan, black, brown, or waxy white in color -Dry, leathery appearance -Fourth-degree: -Deep full thickness: -Damage to all layers of the skin that extends to muscle, bone, and fascia -No pain is present 2. Nursing care -Check immunization status, and determine the need for immunization -Administer tetanus vaccine if it has been more than 5 years -Educate the family to avoid using greasy lotions or butter on burns -Maintain airway and ventilation -Initiate IV access with large-bore catheter -Multiple access points may be necessary -Fluid replacement is important during the first 24 hours -Isotonic crystalloid solutions, such as 0.9% sodium chloride or lactated ringer’s are used during the early stage of burn recovery -Maintain urine output of 0.5 to 1 ml/kg/hr is <30 kg -Maintain urine output of 30 ml/hr for >30 kg -Manage pain: -Use IV opioid -Provide nutritional support: -Increase caloric intake/protein -Vitamin A, C, and zinc for wound healing -Maintain active and passive range of motion 3. Medications -Topical agents: -Silver sulfadiazine/ Mafenide acetate ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Use with 2nd and 3rd degree burns -Apply to cleansed, debrided area ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Wear sterile gloves for applications -Bacitracin: -Use for prevention of secondary infection 4. Skin coverings -Biologic skin coverings: -Allograft (homograft): -Skin from human cadavers that is used for partial and full thickness burn wounds -Xenograft: -Obtained from animals: pigs (partial thickness burns) -Permanent skin coverings: -Autografts: -Client’s skin Chapter 33: Diabetes Mellitus 1. Risk factors -Genetics -Toxins/viruses: can destroy the beta cells ->type 1 DM -Obesity/physical inactivity/HTN -> type 2 DM 2. Expected findings -Hypoglycemia: blood glucose <60 -Hunger, lightheadedness, and shakiness -Pale, cool skin/diaphoresis -Decreasing LOC -Slurred speech -Headache and blurred vision -Seizures leading to coma -Hyperglycemia: blood glucose >250 -Thirst -Polyuria (early sign)/oliguria (late sign) -Nausea, vomiting, and abdominal pain -Skin that is warm, dry, and flushed with poor turgor -Dry mucous membranes -Confusion -Weakness -Lethargy -Weak pulse -Diminished reflexes -Rapid, deep respirations with acetone/fruit odor due to ketones (Kussmaul respirations) 3. Laboratory tests -Diagnostic criteria for diabetes: -An 8-hr fasting blood glucose level of 126 or more ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Expected findings: -Ketone levels in the blood and urine ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Fruity scent to the breath -Mental confusion -Dyspnea -Nausea and vomiting -Electrolyte imbalances: Metabolic acidosis/hyperkalemia -Nursing actions: -Monitor serum potassium levels -Administer sodium bicarbonate by slow IV infusion for severe acidosis (pH <7) -Have a cardiac monitor -Kidney disease -Eye disease -Neurologic complications Chapter 34: Growth Hormone deficiency 1. Expected findings -Short stature but proportional height and weight -Delayed epiphyseal closure -Delayed sexual development 2. Medications -Somatropin: -Given until epiphyseal plate closes -Administer SC 1. Contraindications -DTaP: Chapter 35: Immunizations -IPV: -MMR: -Occurrence of encephalopathy within 7 days following prior doses of the vaccine -Anaphylactic reaction to neomycin, streptomycin or polymyxin B -Anaphylactic reaction to eggs, gelatin, and neomycin -Influenza vaccine: -Hypersensitivity to eggs -Varicella: -If taking corticosteroids -The common cold and other minor illnesses are not contraindications to immunizations -Severe febrile illness is a contraindication to all immunizations -Do not administer live virus vaccines, such as varicella or MMR, to a child who is severely Immunocompromised ATI RN Adult Medical Surgical Online Practice 2022 B.pdf 2. Nursing administration ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Complications: -Birth defects (deafness; heart defects; mental, liver, and spleen damage) in fetus of women infected during pregnancy 7. Rubeola (measles)/rubeola virus -Spread: droplet -Expected findings: -Cough, runny nose, red eyes, and sore throat -Rash: -Koplik spots (tiny white spots) appear in mouth 2 days before rash 8. Varicella (chicken pox)/varicella-zoster virus -Spread: droplet (airborne) -Expected findings: -Manifestations 1-2 days prior to rash: -Fever/fatigue -Rash: -Macules start in center of trunk, spreading to the face and proximal extremities -Progresses from macules, to papules, to vesicles, and crust formations follow 9. Nursing care -Do not administer aspirin, due to the risk of Reye Syndrome -Provide calamine lotion for topical relief -Keep the child’s fingernails clean and short 10. Medications -Antihistamine -Antiviral therapy: -Acyclovir for high-risk clients who have varicella Chapter 37: Otitis Media 1. Risk factors -Most common in the first 24 months of life and again when children enter school ages (5-6) 2. Medications -Acetaminophen/ibuprofen: -For analgesia and reduce fever -Antibiotics 3. Therapeutic procedures -Myringotomy and placement of tympanoplasty tubes -A small incision is made in the tympanic membrane -The tubes come out spontaneously (usually in 6-12 months) -Instruct parents to notify the provider when tubes come out -This is usually does not require replacement of tubes ATI RN Adult Medical Surgical Online Practice 2022 B.pdf Chapter 38: HIV/AIDS ATI RN Adult Medical Surgical Online Practice 2022 B.pdf 1. HIV/AIDS -HIV infection is a viral infection in which the virus primarily infects a specific subset of T-lymphocytes, the CD4 T cell causing immune dysfunction -This leads to organ dysfunction and a variety of opportunistic illnesses in a weakened host 2. Expected findings -Mild: -Lymphadenopathy -Hepatomegaly -Splenomegaly -Dermatitis -Parotitis -Severe: -Multiple serious bacterial infections -Kaposi’s sarcoma: skin infection -Pneumocystis carinii pneumonia -Wasting syndrome 3. Laboratory findings -Ages >6: -CD4 T-lymphocyte count= lower than 500=some immunosuppression -CD4 T-lymphocyte count=lower than 200=severe immunosuppression 4. Nursing care -Diet high in calories and protein -Provide good oral care -Prevent infection using standard precautions -Does not need special precautions -Teach the child and parents to avoid individuals who have colds/infections/viruses -Encourage immunizations: -Pneumococcal vaccine and yearly influenza vaccine 5. Medications -Antiretroviral -Antibiotics -IV gamma globulin Chapter 39: Organ neoplasms 1. Wilms’ tumor (Nephroblastoma) -Is a malignancy that occurs in the kidneys or abdomen -Tumor is usually unilateral -Most cases diagnosed between 2-3 years of age -Metastasis is rare -Expected findings: -Painless, firm, nontender abdominal swelling or mass -Fatigue, malaise, and weight loss ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Given SC daily -Administer epoetin alfa: ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Given SC 2-3 times per week -Stimulate RBC production -Administer Oprelvekin -Given SC daily -For PLT formation -Encourage the use of soft toothbrush -Mucositis and dry mouth: -Lubricate the child’s lips -Avoid hydrogen peroxide and lemon glycerin swabs Chapter 40: Blood Neoplasms 1. Leukemia -Is the term of a group of malignancies that affect the bone marrow and lymphatic system -Diagnostic procedures: -Bone marrow aspiration or biopsy analysis: -Topical anesthetic such as EMLA cream 45 min-1 hr prior -CSF analysis: -Have the child empty their bladder -EMLA cream 45 min-1 hr prior -Side-lying position with the head flexed and knees drawn up toward the chest, and assist in maintaining the position (during procedure) -Remain in bed 4-8 hr in a flat position to prevent leakage and a resulting spinal headache (after) Chapter 43: Pediatric Emergencies 1. Obstructed airway -Children/adolescents: -Use abdominal thrusts -Infants: -Combination of back blows and chest thrusts -Remove any visual obstruction or large debris from the mouth, but do not perform a blind finger sweep 2. Drowning -Encourage parents of toddlers to lock toilet seats when their child is at home -Instruct parents to not leave the child unattended in the bathtub -Inform parents not to leave the child unattended in a swimming pool, even if the child can swim -Encourage parents to provide life jackets when boating 3. SIDS -Risk factors: ATI RN Adult Medical Surgical Online Practice 2022 B.pdf -Maternal smoking during pregnancy -Co-sleeping with parent or adult