ATI Adult Med Surg Proctored Remed
Immunizations: Recommended Vaccinations for Older Adult Clients (Chp. 85) -
Pneumococcal: if 65 yrs.+ and not yet immunized, administer PCV13 first and then
PPSV23 6-12 months later.
- Influenza vaccine should be given yearly
- MPSV4 for adults who are 56 yrs.+ and have not had MenACWY previously.
- Zoster: one time dose for all adults older than 60 yrs.
- Tdap: if 19+ who did not receive dose of tetanus, diphtheria, pertussis previously.
Musculoskeletal Trauma: Maintaining Proper Traction (Chp. 71) - maintain body
alignment, avoid lifting and removing weights and ensure they hang freely
- ensure the pulley is free of knots, fraying and loosening every 8-12 hours.
- notify the provider if the. pt experiences severe pain from muscle spasms (unrelieved
with meds or repositioning)
- assess neurovascular every hour for 24 hours.
- provide pin care once a shift, 1-2x per day
Blood and Blood Product Transfusions: Indications of a Transfusion Reaction (Chp. 40)
Transfusion reactions can occur immediately or several hours after the transfusion.
--> can be acute hemolytic (immediate), febrile (within two hours), allergic (up to 24
hours), bacterial (several hours after), circulatory overload (can occur at any time).
Findings include chills, fever, low-back pain, tachycardia, flushing, hypotension, chest
tightening or pain, tachypnea, nausea, anxiety, hemoglobinuria, and an impending
sense of doom.
Blood and Blood Product Transfusions: Steps to Administer a Blood Transfusion (Chp.
40) - Explain the procedure to the client and assess vital signs and the client's
temperature prior to transfusion.
- Verify the prescription for a specific blood product and obtain consent for procedure if
required.
- Initiate large-bore IV access; an 18- or 20-gauge needle is standard for administering
blood products.
- Obtain blood products from the blood bank (inspect the blood for discoloration,
excessive bubbles, or cloudiness.
- Prior to transfusion, two RNs must identify the correct blood product and client (the
nurse completing the blood product verification must be one of the nurses who
administers the blood product.
- Prime the blood administration set with 0.9% sodium chloride only. Never add
medications to blood products. Y-tubing with a filter is used to transfuse blood.
, - Begin the transfusion, and use a blood warmer if indicated. Initiate the transfusion
within 30 min of obtaining the blood product to reduce the risk of bacterial growth (stay
with patient for first 15 - 30 min).
Cardiovascular Diagnostic and Therapeutic Procedures: Teaching About a Peripherally
Inserted Central Catheter (Chp. 27) - Instruct the client that he is awake and sedated
during procedure and a local anesthetic is used.
- A small incision is made, often in the groin, to insert the catheter (the client can feel
warmth and flushed when the dye is inserted)
- After the procedure, the client must keep the affected leg straight - pressure (a
sandbag) can be placed on the incision to prevent bleeding
Post-Procedure
- Leave the dressing in place for the first 24 hr following discharge and avoid strenuous
exercise for the prescribed period of time.
- Immediately report bleeding from the insertion site, chest pain, shortness of breath,
and changes in the color or temperature of the extremity
- Restrict lifting to less than 10 lbs for the prescribed period of time.
- Clients who have stent placement will receive anticoagulation therapy for 6 to 8 weeks.
Instruct the client to take the medication at the same time each day.
- Avoid activities that could cause bleeding. (Use soft toothbrush. Wear shoes when out
of bed.)
- Encourage the client to follow lifestyle guidelines. (Manage weight. Consume a
low-fat/low-sodium diet. Exercise regularly. Stop smoking. Decrease alcohol intake.
Arthroplasty: Pain Control (Chp. 68) - Analgesics: Opioids (epidural, PCA, IV, oral),
NSAIDs
- Peripheral nerve blockade: Inject the femoral or sciatic nerve with a local anesthetic, or
the client can receive a continuous infusion of local anesthetic directly into sciatic or
femoral nerve. (A continuous peripheral nerve block provides localized pain relief;
Monitor for systemic effects of local anesthetic, such as metallic taste in the mouth,
tinnitus, slurred speech, decreased respiratory rate, hypotension, bradycardia,
restlessness, or seizure.
- Antibiotics: Prophylaxis is generally administered 30 min before the surgical incision is
made and postoperatively to prevent infection.
- Anticoagulant: Warfarin, fondaparinux, rivaroxaban, or low-molecular-weight heparin,
such as enoxaparin.
- The client can have a prescription for sequential compression devices, foot pumps,
and/or antiembolism stockings to prevent venous thromboembolism formation that can
develop
into DVT.
- Apply ice or cold therapy to the incisional area to reduce postoperative swelling
Gastrointestinal Therapeutic Procedures: Total Parental Nutrition (Chp. 47) Ongoing
Care
- The flow rate is gradually increased and gradually decreased to allow body adjustment
(usually no more than a 10% hourly increase in rate)
Immunizations: Recommended Vaccinations for Older Adult Clients (Chp. 85) -
Pneumococcal: if 65 yrs.+ and not yet immunized, administer PCV13 first and then
PPSV23 6-12 months later.
- Influenza vaccine should be given yearly
- MPSV4 for adults who are 56 yrs.+ and have not had MenACWY previously.
- Zoster: one time dose for all adults older than 60 yrs.
- Tdap: if 19+ who did not receive dose of tetanus, diphtheria, pertussis previously.
Musculoskeletal Trauma: Maintaining Proper Traction (Chp. 71) - maintain body
alignment, avoid lifting and removing weights and ensure they hang freely
- ensure the pulley is free of knots, fraying and loosening every 8-12 hours.
- notify the provider if the. pt experiences severe pain from muscle spasms (unrelieved
with meds or repositioning)
- assess neurovascular every hour for 24 hours.
- provide pin care once a shift, 1-2x per day
Blood and Blood Product Transfusions: Indications of a Transfusion Reaction (Chp. 40)
Transfusion reactions can occur immediately or several hours after the transfusion.
--> can be acute hemolytic (immediate), febrile (within two hours), allergic (up to 24
hours), bacterial (several hours after), circulatory overload (can occur at any time).
Findings include chills, fever, low-back pain, tachycardia, flushing, hypotension, chest
tightening or pain, tachypnea, nausea, anxiety, hemoglobinuria, and an impending
sense of doom.
Blood and Blood Product Transfusions: Steps to Administer a Blood Transfusion (Chp.
40) - Explain the procedure to the client and assess vital signs and the client's
temperature prior to transfusion.
- Verify the prescription for a specific blood product and obtain consent for procedure if
required.
- Initiate large-bore IV access; an 18- or 20-gauge needle is standard for administering
blood products.
- Obtain blood products from the blood bank (inspect the blood for discoloration,
excessive bubbles, or cloudiness.
- Prior to transfusion, two RNs must identify the correct blood product and client (the
nurse completing the blood product verification must be one of the nurses who
administers the blood product.
- Prime the blood administration set with 0.9% sodium chloride only. Never add
medications to blood products. Y-tubing with a filter is used to transfuse blood.
, - Begin the transfusion, and use a blood warmer if indicated. Initiate the transfusion
within 30 min of obtaining the blood product to reduce the risk of bacterial growth (stay
with patient for first 15 - 30 min).
Cardiovascular Diagnostic and Therapeutic Procedures: Teaching About a Peripherally
Inserted Central Catheter (Chp. 27) - Instruct the client that he is awake and sedated
during procedure and a local anesthetic is used.
- A small incision is made, often in the groin, to insert the catheter (the client can feel
warmth and flushed when the dye is inserted)
- After the procedure, the client must keep the affected leg straight - pressure (a
sandbag) can be placed on the incision to prevent bleeding
Post-Procedure
- Leave the dressing in place for the first 24 hr following discharge and avoid strenuous
exercise for the prescribed period of time.
- Immediately report bleeding from the insertion site, chest pain, shortness of breath,
and changes in the color or temperature of the extremity
- Restrict lifting to less than 10 lbs for the prescribed period of time.
- Clients who have stent placement will receive anticoagulation therapy for 6 to 8 weeks.
Instruct the client to take the medication at the same time each day.
- Avoid activities that could cause bleeding. (Use soft toothbrush. Wear shoes when out
of bed.)
- Encourage the client to follow lifestyle guidelines. (Manage weight. Consume a
low-fat/low-sodium diet. Exercise regularly. Stop smoking. Decrease alcohol intake.
Arthroplasty: Pain Control (Chp. 68) - Analgesics: Opioids (epidural, PCA, IV, oral),
NSAIDs
- Peripheral nerve blockade: Inject the femoral or sciatic nerve with a local anesthetic, or
the client can receive a continuous infusion of local anesthetic directly into sciatic or
femoral nerve. (A continuous peripheral nerve block provides localized pain relief;
Monitor for systemic effects of local anesthetic, such as metallic taste in the mouth,
tinnitus, slurred speech, decreased respiratory rate, hypotension, bradycardia,
restlessness, or seizure.
- Antibiotics: Prophylaxis is generally administered 30 min before the surgical incision is
made and postoperatively to prevent infection.
- Anticoagulant: Warfarin, fondaparinux, rivaroxaban, or low-molecular-weight heparin,
such as enoxaparin.
- The client can have a prescription for sequential compression devices, foot pumps,
and/or antiembolism stockings to prevent venous thromboembolism formation that can
develop
into DVT.
- Apply ice or cold therapy to the incisional area to reduce postoperative swelling
Gastrointestinal Therapeutic Procedures: Total Parental Nutrition (Chp. 47) Ongoing
Care
- The flow rate is gradually increased and gradually decreased to allow body adjustment
(usually no more than a 10% hourly increase in rate)
