ATI Proctored Med Surg Focused Review ALL ANSWERS 100% CORRECT FALL-2021/2022 SOLUTION AID GRADE A+

Safety & Infection Control: Care of client with Halo device for spinal injury: • Clients who have cervical fractures may be placed in a halo fixation device or cervical tongs. • The purpose is to provide traction and/or immobilize the spinal column. • Screws are placed through a halo-type bar that encircles the head into the outer table of the bone of the skull. This halo is attached to rods that are secured to a vest worn by the client. Ensure that the wrench to release the rods is attached to the vest when using halo traction in the event CPR is necessary. • Maintain body alignment and ensure cervical tong weights hang freely. • Monitor skin integrity by providing pin care and assessing the skin under the halo fixation vest as appropriate. • Do not use the halo device to turn or move a client. • If the client goes home with a halo fixation device on, provide instruction on pin and vest care. • Teach the client signs of infection and skin breakdown. Basic Care & Comfort: Fractures & Immobilization devices: Maintaining proper traction: Types of Immobilization Devices: • Casts • Splints/immobilizers • Traction • External fixation • Internal fixation *Traction uses a pulling force to promote and maintain alignment of the injured area. Goals of traction include: • Prevent soft tissue injury. • Realign of bone fragments. • Decrease muscle spasms and pain. • Correct or prevent further deformities. *Traction prescriptions should include the type of traction, amount of weight, and whether traction can be removed for nursing care. Classification of Traction: Straight or running: The counter traction is provided by the client’s body by applying a pulling force in a straight line. *Movement of the client’s body can alter the traction provided. Balanced suspension: The counter traction is produced by devices such as slings or splints to support the fractured extremity while pulling with ropes and weights. *The client’s body can be moved without altering the traction. Types of Traction: • Manual: A pulling force is applied by the hands of the provider for temporary immobilization, usually with sedation or anesthesia, in conjunction with the application of an immobilizing device. • Skin: Primary purpose is to decrease muscle spasms and immobilize the extremity prior to surgery. The pulling force is applied by weights that are attached by rope to the client’s skin with tape, straps, boots, or cuffs. Examples include Bryant’s traction (used for congenital hip dislocation in children) and Buck’s traction (used preoperatively for hip fractures for immobilization in adult clients). • Buck's traction/skeletal: The pulling force is applied directly to the bone by weights awtatsadocwhneloaddebd byy 1r0o0p00e081d9i1r9e82c2t8lfyromtoCoaursreHoedro/.scocmreonw12-p09l-a20c2e1 d12:t0h3:0r4oGuMgTh-0t6h:00e bone to promote bone alignment. Examples include skeletal tongs (Gardner-Wells) and femoral or tibial pins (Steinmann pin). Weights 15 to 30 lb. can be applied as needed. Prevention of skin breakdown: • Keep skin clean, dry, and intact. Provide a firm, wrinkle-free foundation with wrinkle- free linens. • Use pressure-reducing surfaces and devices. • Inspect the client’s skin frequently and document the client’s risk using a tool such as the Braden scale. • Clean the skin with a mild cleansing agent and pat it dry immediately following urine or stool incontinence. • Bathe with tepid water (not hot) and minimal scrubbing. • Apply dimethicone-based moisture barrier creams or alcohol-free barrier films to the skin of clients who are incontinent. • Do not use powder or cornstarch to prevent friction or repel moisture due to their abrasive grit and aspiration potential. • Reposition the client in bed at least every 2 hr. and every 1 hr. in a chair. Document position changes. • Keep the head of the bed at or below a 30° angle (or flat), unless contraindicated, to relieve pressure on the sacrum, buttocks, and heels. • Use pressure-reducing devices (overlays; replacement mattresses; specialty beds; kinetic therapy; foam, gel, or air cushions). • Keep clients from sliding down in bed, as this increases shearing forces that pull tissue layers apart and cause damage. • Lift, rather than pull, clients up in bed or in a chair, because pulling creates friction that can damage the outer layer of skin (epidermis). • Raise heels off of the bed to prevent pressure. • Ambulate clients as soon as possible and as often as possible. • Instruct clients who are mobile to shift their weight every 15 min when sitting. • Implement active and passive exercises for clients who are immobile. • Do not massage bony prominences. • Provide adequate hydration (2,000 to 3,000 mL/day) and meet protein and calorie needs. • Note if serum albumin levels are low (below 3.5 g/dL), because a lack of protein puts the client at greater risk for skin breakdown, slowed healing, and infection. • Provide nutritional support as indicated, such as vitamin and mineral supplements (especially A, C, zinc, copper), nutritional supplements, and enteral and parenteral nutrition. Assessing implanted port: • Use a noncoring, non-barbed (Huber) needle. Noncoring needles have a deflected point that helps avoid septal injury by slicing through the septum without coring out a tiny piece of it each time the port is accessed. Most facilities policies allow access to the implanted port with the same needle for 7 days.Hemodynamic status is assessed with several parameters. • The most common site for implanted port placement is the anterior chest, just below the clavicle. Other less common sites for implanted port placement include the upper arm, the abdomen, and the back. Total parental nutrition: Iwsasadohwynlpoaederdtboyn1i0c000in08t1r9a19v82e2n8 foroumsCo(uIVrse)Hsons1o2l-u09t-2io02n1 .12T:0h3:e04 pGMuTrp-0o6:s00e of TPN ad