ATI PRACTICE CODES:
736710
736711
628038
628039
468162
627914
468163
736692
736693
736694
736716
736696
If a code does not work, it may be retired. To avoid error messages, enter the codes manually don’t copy/paste from this document electronically. Tape these codes to the inside of your ATI folder or books for easy retrieval.
THESE CODES ARE NOT TO BE REDISTRIBUTED OR HANDED DOWN.
Assessment
ID
Assessment
Password Name of Assessment
589270 21L6821F50 Focused Medical-Surgical 2007: Cardiovascular
593634
587943
593457
590978
588348
593952
588818
587850
468159
628041
21L5741F69
21L4831F66
21L6851F68
21L6881F50
21L5271F52
21L6761F52
21L5621F52
21L5311F70
21L4821R65
30L5431R48
Focused Medical-Surgical 2007: Endocrine
Focused Medical-Surgical 2007: Fluid, Electrolyte, and Acid-Base
Imbalances
Focused Medical-Surgical 2007: Gastrointestinal
Focused Medical-Surgical 2007: Immune
Focused Medical-Surgical 2007: Neurosensory and Musculoskeletal
Focused Medical-Surgical 2007: Perioperative
Focused Medical-Surgical 2007: Renal and Urinary
Focused Medical-Surgical 2007: Respiratory
RN Adult Medical-Surgical Online Practice 2007 A
RN Adult Medical-Surgical Online Practice 2007 B
18L5231R55
18L6641R70
30L5441R67
30L5751R66
21L6681R52
30L4891R50
21L5621R69
18L5431R65
18L5661R56
18L4871R50
18L5681R65
18L4991R68
RN Community Health Nursing Online Practice 2007 A
RN Community Health Nursing Online Practice 2007 B
RN Fundamentals Online Practice 2007 A
RN Fundamentals Online Practice 2007 B
RN Leadership Online Practice 2007 A
RN Leadership Online Practice 2007 B
RN Maternal Newborn Online Practice 2007 A
RN Maternal Newborn Online Practice 2007 B
RN Mental Health Online Practice 2007 A
RN Mental Health Online Practice 2007 B
RN Nursing Care of Children Online Practice 2007 A
RN Nursing Care of Children Online Practice 2007 B

628057
627919
736718
627910
368122
303109
468157
30L6741R54
30L5121R66
18L5501R57
30L7011R70
RN Nutrition Online Practice 2007 A
RN Nutrition Online Practice 2007 B
RN Pharmacology Online Practice 2007 A
RN Pharmacology Online Practice 2007 B
20L7051R66 RN Comprehensive Assessment: Online Practice
26L6641R65 RN Comprehensive Online Practice: No Rationales 2007B
21L6631R53 RN Comprehensive Online Practice: Rationales 2007A
627890
627891
587943
628045
627894
588348
30L6741F66 Focused Medical-Surgical 2007: Cardiovascular
30L5181F68 Focused Medical-Surgical 2007: Endocrine
21L4831F66 Focused Medical-Surgical 2007: Fluid, Electrolyte, and Acid-Base Imbalances
30L4901F53 Focused Medical-Surgical 2007: Gastrointestinal
30L4911F70 Focused Medical-Surgical 2007: Immune
21L5271F52 Focused Medical-Surgical 2007: Neurosensory and Musculoskeletal
593952 21L6761F52 Focused Medical-Surgical 2007: Perioperative REPLACED WITH CODE BELOW
419580 06L5561F50 Focused RN Medical Surgical: Perioperative
588818 21L5621F52 Focused Medical-Surgical 2007: Renal and Urinary
628056
468165
628054
627918
628058
468166
628060
468159
628041
468160
587850
468161
628039
468162
628062
627903
627904
468164
21L5311F70 Focused Medical-Surgical 2007: Respiratory
21L7041R54 RN Fundamentals Online Practice 2007 A
30L5751R66 RN Fundamentals Online Practice 2007 B
21L6681R52 RN Leadership Online Practice 2007 A
30L5391R53 RN Leadership Online Practice 2007 B
30L5121R55 RN Maternal Newborn Online Practice 2007 A
30L5731R69 RN Maternal Newborn Online Practice 2007 B
21L5561R66 RN Mental Health Online Practice 2007 A
30L6771R53 RN Mental Health Online Practice 2007 B
21L6781R51 RN Nursing Care of Children Online Practice 2007 A
30L6891R54 RN Nursing Care of Children Online Practice 2007 B
30L5641R54 RN Nutrition Online Practice 2007 A
30L5021R49 RN Nutrition Online Practice 2007 B
21L6501R49 RN Pharmacology Online Practice 2007 A
30L6811R52 RN Pharmacology Online Practice 2007 B
21L4821R65 RN Adult Medical-Surgical Online Practice 2007 A
30L5431R48 RN Adult Medical-Surgical Online Practice 2007 B
21L5331R66 RN Community Health Nursing Online Practice 2007 A
628064 30L7041R70 RN Community Health Nursing Online Practice 2007 B
For Senior Students:

184260
55561
419573
01L6961N54 NCLEX Alternate Item Test (NAIT)
14L6651R65 RN Comprehensive Assessment: Online Practice
06L5741R57 RN Comprehensive Online Practice: No Rationales 2007B
368123 20L5331R70 RN Comprehensive Online Practice: Rationales 2007A
214033 30L6871R68 RN Fundamentals for Nursing
55565 14L6991R52 RN Adult Medical-Surgical Nursing
214042 30L5231R49 RN Maternal-Newborn Nursing
175603 22L7071R55 RN Pharmacology 2.0: Online Practice
70474 23L5351R67 RN Nursing Care of Children
175600 22L5711R54 RN Mental Health Nursing
55565 14L6991R52 RN Adult Medical-Surgical
70489 23L4991R65 RN Community Health Nursing
175639 22L6611R70 RN Leadership 2.0
Additional unlimited practice codes for seniors:
303119 26L5521F50 Focused RN Medical Surgical: Cardiovascular
303111 26L5041F70 Focused RN Medical Surgical: Endocrine
303112 26L6731F51 Focused RN Medical Surgical:
Fluid-Elect-Acid-Base
303113 26L5551F49 Focused RN Medical Surgical: Gastrointestinal
303114 26L6781F51 Focused RN Medical Surgical: Immune
303115 26L5671F50 Focused RN Medical Surgical: Neuro &
Musculoskeletal
303116 26L4961F55 Focused RN Medical Surgical: Perioperative
303117 26L5321F50 Focused RN Medical Surgical: Renal and
Urinary
303118 26L6811F68 Focused RN Medical Surgical: Respiratory
Submit proof of practice (90% or above) for the No Rationales practice test:
303109 26L6641R65 RN Comprehensive Practice: No Rationales
2007B
303108 26L5131R68 RN Comprehensive Practice: Rationales 2007A
184324 01L5161N51 NCLEX Alternate Item Test (NAIT)
Assessment IDAssessment NamePassword
368094Focused RN Medical Surgical: Cardiovascular20L5121F67
368086Focused RN Medical Surgical: Endocrine20L5541F48
368087Focused RN Medical Surgical: Fluid, Electrolyte, and Acid-Base20L5331F51
368088Focused RN Medical Surgical: Gastrointestinal20L5051F50
368089Focused RN Medical Surgical: Immune20L5081F66
368090Focused RN Medical Surgical: Neurosensory and Musculoskeletal20L6671F52

368091Focused RN Medical Surgical: Perioperative20L6961F70
368092Focused RN Medical Surgical: Renal and Urinary20L5021F49
368093Focused RN Medical Surgical: Respiratory20L5511F48
368061RN Adult Medical-Surgical Nursing 1.0: Online Practice20L5071R57
368076RN Community Health Nursing 1.0: Online Practice20L6951R65
368082RN Comprehensive Assessment: Online Practice20L6651R52
368084RN Comprehensive Online Practice: No Rationales 2007B20L7041R53
368083RN Comprehensive Online Practice: Rationales 2007A20L6631R50
368058RN Fundamentals for Nursing 1.0: Online Practice20L4941R67
368079RN Leadership 1.0: Online Practice20L5031R50
368067RN Maternal-Newborn Nursing 1.0: Online Practice20L6521R70
368070RN Mental Health Nursing 1.0: Online Practice20L6841R67
368064RN Nursing Care of Children 1.0: Online Practice20L4851R69
368073RN Pharmacology 1.0: Online Practice20L6581R67
Important Study guide!
Pathophysiology/Pharmacology ATI
Unit 2
Cephalosporins (Cephalexin/Keflex): recognizing allergic rxn- urticaria, rash, hypotension, &/or dyspnea (stop & notify)
PCN: teaching client to recognize anaphylaxis- laryngeal edema, bronchoconstriction, hypotension
Antimybacterial (isoniaxid/INH): evaluating effectiveness of tx- improvement in TB symptoms (clear breath sounds, no night sweats, ↑ appetite, no afternoon rises of temp, 2 negative sputum cultures), usually 3-6 months to achieve
Sulfonamides (trimethoprim-sulfamethoxazole/TMP-SMZ, Bacterium): identify
contraindications- pts w/folic acid deficiency, avoid use in pregnancy
& lactation, w/renal dysfunction, do not use if creatinine clearance <15mL/min
Bacteriostatic inhibitors (erythromycin/E-Mycin): client ed regarding self adm- on empty stomach (1hr before meals & 2hrs after) w/full glass of water
Tetracyclines (tetracycline hydrochloride/Sumycin): med interactions- milk products, Ca
& iron supplements, Mg containing laxatives, most antacids, oral contraceptives
(↓ effectiveness of BC)
Unit 3
Chemo: formulating nursing dx-
Immunosuppressants (cyclosporine/Sandimmune): med therapy to prevent organ
rejection- lifelong therapy necessary
contraindications- cyclosporine: pregnancy, recent vaccines w/live virus, recent contact/active infection of chickenpox/herpes zoster; glucocorticoids: systemic fungal infections, recurring live virus vaccines
Unit 4
Ergot Alkaloids (ergotamine/Ergostat): client ed regarding adverse effects- GI, ergotism
(muscle pain, paresthesias in fingers/toes, cold pain extremities- stop, immediately notify), physical dependence (do not exceed prescribed dose, inform pt symptoms of withdrawal

(headache, nausea, vomiting, restlessness), notify), abortion (avoid using during pregnancy, use adequate contraception during therapy)
Antigout med (cholchicine): contraindications- during pregnancy (C if PO, D if IV), cautiously in older adults, debilitated pts, & pts w/renal, cardiac, GI dysfunction
Nonsteroidal anti inflammatory drugs (aspirin, celecoxib/Celebrex): ID
contraindications- aspirin (peptic ulcer disease, bleeding d/o, hypersensitivity, pregnancy D, children w/chickenpox/influenza), NSAIDs (older adults, smokers, pts w/H. pylori infection, hypovolemia, hay fever, chronic urticaria, &/or hx of alcoholism)
Opioid agonist (Morphine sulfate): interventions for pain management- assess level of pain, baseline vitals, check dose w/another nurse, IV slowly (4-5min), pts w/cancer on fixed schedule around the clock & supplemental dose PRN
Transdermal fentanyl- w/1 st adm will take numerous hrs to achieve desired therapeutic effects, adm short-acting opioids prior to onset & for breakthrough pain
Evaluating PCA use- monitor dose, lockout, interval, & 4hr limit; reassure pt of safety measures protecting against excessive dose; encourage use prophylactically prior to activities likely to augment pain levels; make sure pt receives adequate PCA dosing until onset of
PO med takes place if switching
Documenting assessment findings- document pain level on regular basis
Adverse effects of codeine- resp. depression (stop if <12), sedation (avoid hazardous activities- driving), overdose (coma, resp. depression, pinpoint pupils); (constipation, orthostatic hypotension, urinary retention, cough suppression, biliary colic, emesis)
Morphine adm-
Risk for resp. depression- pts w/asthma, emphysema, &/or head injuries, infants/premature infants & older adults; CNS depressants (barbituates, benxos, alcohol)
Recognizing side effects- above
Agonists-antagonists opioids (pentazocine/Talwin): eval med order- use cautiously in pts w/hx of MI (↑ cardiac workload) & pts who are physically dependent on opioids; for mild to moderate pain
Unit 5
Anti-Parkinsons med dopamine-levadopa/Dopar: adverse rxns- nausea & vomiting, drowsiness (adm in small doses @ start & w/food), dyskinesias (head bobbing, tics, grimacing, tremors- ↓ dose, but may result in resumption of PD symptoms), orthostatic hypotension
(monitor BP, educate pt of signs & ways to reduce)
Antidepressants: Tricyclic (TCA) (amitriptyline/Elavil)- blocks reuptake of NE & serotonin & intensifies their effects; for depression & bipolar d/o; side effects- orthostatic hypotension, anticholinergic effects, cardiac toxicity; interactions- MAOIs = hypertension, antihystamines = added anticholinergic effects, ephedrine & amphetamines = ↓ med response
Antipsychotics (chlorpromazine/Thorazine, haloperidol/Haldol): recognizing side effects
to report- neuroendocrine effects (gynecomastia- breast enlargement, galatorrhea, menstrual irregularities), seizures, agranulocytosis (signs of infection), inflammation of heart muscle
(dyspnea, ↑rr, lethargy, chest pain, palpitations), loss of glucose/new onset of diabetes
(polyuria, polyphagia, polydipsia)
Atypical: (clozapine/Clozaril) recognizing contraindications- pregnancy B, pts w/hx of agranulocytosis & bone marrow depression, on anticancer meds, pts w/seizure d/o & diabetes
SSRI (fluoxetine/Prozac): recognizing adverse effects- sexual dysfunction (no orgasm,

impotence, ↓ libido), weight gain, serotonin syndrome (2-72hr after starting tx; mental confusion, agitation, anxiety, hallucinations, hyperreflexia, tremors), withdrawal syndrome
(headache, nausea, visual disturbances, anxiety), hyponatremia, rash, sleepiness, faintness, lightheadedness
Mood stabilizer (lithium carbonate): analyzing data- Lithium carbonate: check Q2-3 days then Q1-3 months; norms are 0.4-1.0; during manic phase levels can be between 0.8-1.4; >1.5 = toxic; maintain adequate Na levels
Atypical antidepressants (bupropion HCl/Wellbutrin): recognizing contraindications- pregnancy B, pts w/seizure d/o, pts taking MAOIs
MAOI (phenelzine/Nardil): dietary teaching- avoid tyramine (aged cheese, salami, avocados, bananas, protein, dietary supplement, red wine)
Antiepileptics (AEDs): interventions for adverse rxns- p.178-180
Cholinesterase inhibitors (neostigmine/Prostigmin): cholinergic crisis- excessive muscarinic stimulation & resp. depression from neuromuscular blockade; tx w/atropine, provide resp. support through mechanical ventilation & O2
Unit 6
Cardiac glycosides (digoxin/Lanoxin:) recognizing side effects- dysryhthmias, cardiotoxicity leading to bradycardia (monitor serum K levels, hypokalemia = nausea, vomiting, general weakness; monitor digoxin levels & maintain 0.5-0.8)
Beta blockers (metroprolol/Lopressor, propranolol/Inderal): documenting adverse effects- p.250-251
Antipsychotics- atypical (clozapine/Clozaril): evaluating therapeutic effects- improvement of symptoms (prevention of acute psychotic symptoms, absence of hallucinations, delusions, anxiety, hostility), improvement in ability to perform ADLs, interact socially w/peers, sleeping & eating habits
Ca Channel blockers (nifedipine/Procardia): monitoring med effects- p.259-262
Recognizing pharm action- vasodilation, ↓ force of contraction, heart rate, & slowing of rate through AV node
Organic nitrates (nitroglycerine/Nitrol): self adm- don’t swallow, let dissolve under tongue (if mouth dry, nitrospray instead), can take up to 3 doses @ 5min apart
Adrenergic agonist (epinephrine/Adrenaline): titrating dose- continuous IV infusion, titrated based on blood pressure response
Antilipemics (ezetimibe/Zetia, cholestyramine/Questran): monitoring side effects- hepatotoxicity (liver function tests after 12wks then @6months), myopathy (baseline CK & monitor, symptoms of muscle aches, pain & tenderness), peripheral neuropathy (weakness, numbness, tingling, & pain in hand/feet)
Client teaching- lovastatin w/evening meal (other statins can be taken w/out food); obtain baseline cholesterol levels, HDL, LDL, & triglycerides & monitor periodically; obtain baseline liver, renal function tests & monitor
Unit 7
Hemopoietic growth factor: side effects of erythropoietin- hypertension (due to ↑ Hct), ↑ risk for cardiovascular event (MI, stoke, cardiac arrest) w/↑ in Hgb
evaluating pt response- Hgb levels of 10-12g/dL, Hct of 40%, ↑ reticulocyte ct
Antiplatelets: client education- prevention of strokes, MI, & reinfarction can be accomplished w/low dose aspirin (81mg); aspirin 325mg should be taken during initial acute episode of MI; notify provider regarding aspirin use; use EC tablets

& take aspirin w/food; observe for signs of weakness, dizziness, & headache, & notify provider if occur; avoid concurrent use of NSAIDs, heparin, warfarin
(enhance bleeding)
adverse effects- GI (bleeding- use EC & take w/food, proton pump inhibitor may be used- omeprazole/Prilosec)
Thrombolytics (streptokinase/Streptase): minimizing adverse affects- risk of bleeding from different sites (limit venipunctures & injections, apply pressure to recent wounds), hypotension (infuse slowly), allergic rxn
Similar to Mental Health ATI
Study Guide
1) SchizophreniaPower pointtypical onset late teens to early 20’s. Early age is 18-25 and more often males but late onset of 25-35 is often females with better outcomes too. The prevent on relapse is more important than the risk of side effects because it is reversible and relapses aren’t. Each relapse has an increase of dysfunction/deterioration.
Phases-Acute-positive and negative symptoms.Maintanence-acute symptoms decrease in severity but last up to 6 months or more. Stable- symptoms in remission. People who have it tend to have abused substances(males), nicotine dependence, depression, anxiety, polydipsia, and drink 4-10 liters of h20 and day. therories. combo-genetic/life style, Biochemical-serotonin, nore,gaba, cause it.genetic-if both parents have it 46% child chance of having it 12% if only 1 parent has it,40-50% chance twins having it. People who have it have lower brain volume/more cerebral spinal fluid too.
Non-genetic risk factors-born with hx of pregnance/history or complications, hx of stress or d/o’s.
4A’s-Affect-flat,blunted. Associative looseness-confused thinking (jumbled). Autismnot bound to reality (delusions, hallucinations).Ambivalence-2 or emotions, attitudes, ideas, wishes.
Subtypes- Paranoid- irrational suspicions, later age onset, sarcastic or hostile, patiens are usually guarded or reserved. Catatonic- abnormal motor behaviors, abrupt onset, acutely aware of environment around them, waxy flexible. Catatonic excited phase-talks/shout continually, increased activity, needs fluids and calories, waxy flexible. Disorganize- most regressed subtype, grossly inappropriate affect, bizarre mannerisms, incoherent, early age of onset, good portion of homeless ppl. Undifferentiated- early onset, does not meet criteria of paranoid, catatonic, or disorganized. Residual- no longer active phase present but has 2 or more symptoms of lack of energy, initiative, social withdraw, impaired role function, speech deficit, odd beliefs.
Positive symptoms-grandiose- belief that one has powers of wealth or skill. Nihilistic- belief that one is dead or soon to be. Presecutory-belief that one is being watching or plotted against. Somatic- belief of abnormalities in bodily functions. Jealousy, ideas of reference(misconstruing trivial events).
Negative symptoms- develop over time, interfere with survival needs, relationships, conversations, holding a job.
2) Echolalia - repetition of words or phrases spoken by others.
3) Flight of ideas - the topic of conversation changes repeatedly and rapidly, generally after one sentence or phrase.
4) neologism words that are made up that have no common meaning and are not recognized.

5) Concrete vs Abstract thinking Concrete is understanding math, laws, and objects. Abstract is ability to realize logic or reason. Loss of abstract thinking would be no longer to understand analogies, punch lines, metaphors.
6) Echopraxia involuntary imitation of another person’s movements and gestures
7) waxy flexibilityposture held in odd or unusual fixed positions for extended periods of time.
8) Alterations in perception- Hallucincations- 90% will experience this, auditory is most common, commanding voices may signal emergency. Personal boundaries- often lack sense of their body in relationship to the rest of the world. Depersonalization-Loss of identity think the self is different or unreal (fingers are snakes). Derealization-false perception that the environment has changed.
9) Alterations in Thinking- refer to positive symptoms.
10) Thought broad casting- ones’ thoughts can be heard.
11) Thought withdrawal thoughts are being removed from your head.
12) Thought insertion- thoughts are being inserted into your head.
13) EPSStands for extra pyramidal symptoms, includes acute dystonia, akathesia, pseudoparkinosim(stiffening of muscular activity in face, body, arms, legs, and relieved by antiparkinson drugs(artane, cogentin)).
14) Tardive dyskinesiamost troubling, involves irregular, repetitive involunatary movements of the mouth, face, tounge, and rapid eye blinking,
15) Neuroleptic malignant syndromefatal in 10% cases, occurs in early course of treatment.
Invloves decreased level of consciousness, increase muscle tone, hyperpyrexia, tachycardia, diaphoresis, and drooling. Treatment means discontinue antipsychotic drugs, manage fluid balance, reduce temperature, and monitor for further complications.
16) Medications- Haldol-risk of EPS, a typical. Prolixin- risk for EPS, typical. Thorazine- lower risk of EPS but all can cause Tardive dyskinesia. Newer atypical have no risk of TD. Atypicals-
Clozaril-is first line drug but has a high incidence of agranulocytosis and seizures. Risperdone, zyprexia, and seroquel can cause wt. gain. Geodon- prolongs QT, and has no wt. gain.
17) Cogentin- is used to treat the effects of EPS.
18) ADHDa common disorder, inattention, hyperactivity, impulsiveness, restless, these are the three core symptoms. Medications is Ritalin, education for patient and parents, and monitoring wt, and height.
19) Autism- impairments in communication affecting both verbal and nonverbal, interprets language in a concrete manner, stereotypic behavior includes repetitive rocking, hand flapping.
Medication include haldol, risperdal, Ritalin, and naltrexone for hyperactivity. No medication has proved effective at changing the core social and language deficits of autism.
20) Tourettes syndrome No diagnostic tests are use, average age onset is 7yrs. usually permanent, can be periods of remission. Symptoms often diminish during adolescence or early adulthood. Symptoms include obsessions, compulsions, hyperactivity, distractibility, and impulsivity. Medications are haldol, geodon, risperdone, clonidine, and tenex.
21) Aspergers and difference from autism sever. sustained impairment in social interaction, repetitive patterns of behavior unlike autism. Instead of acting out concretely concrete language is used for interpretation. no significant delays in self-help skills, or language development unlike autism. Treatment is same for depression and anxiety.
22) Children risk for depression-

23) Bulima goals of treatmentrefrain from binge-purge behaviors, demonstrate new skills for managing stress/anxiety.Be free of self-directed harm, express feelings in a non-food related way, state she feels good about herself and about who she is as a person.
24) appropriate DX for bulima/anorexia- Bulimia-decreased cardiac output, disturbed body image, chronic low self esteem. Anorexia- Imbalanced nutrition: less than body requirements, decreased cardiac output, risk for imbalanced fluid volume, disturbed body image, chronic low self-esteem.
25) Paraphilias- sexual instinct is expressed in ways that are socially prohibited or unacceptabale. They do not consider their sexual activities a disorder and do not seek treatment.
Treatment is cognitive-behavioral methods, and antiandrogen meds to lower sexual desires and
SSRIS.
26) Borderline PD overwhelming needs of both internal and external, seek to have these needs met in relationships. Splitting is when the person sees themselves as all good or all bad and are unable to intergrate the positive and negative qualities of the self or others into an integrated whole. Little tolerance of being alone. Self-mutilation is more coming and be used as a selfsoothing behavior.
27) Anisocialalso called sociopath, has a long history of illegal activity. Intend to deceive, impulsive action, and reckless disregard for others and themselves. Presumed to be right to hold themselves above others.
28) NarcissisticFear that they are “bad” and never tolerate mistakes of others. require admiration of other in greater and greater quantity, mostly males are diagnosed. Lack of sensitivity, envy, and demanding.
ATI REVIEW STUDY GUIDE PHARMOCOLOGY!!
• CCB’s: super ventricular tachycardia
Verapamil (CALAN)
Diltiazem (Cardizem)
-s/s- edem, constipation, bradycardia
-teach- increase fiber, monitor bp and weigh daily, monitor ECG, dysrhythmias.
• Bile acid sequestriant: monitor effects (cholesterol medication)
- Cholestyramine (Questran) or colestid
- Lowers LDL levels
-don’t take digoxin, warfarin, thiazides, and tetracyclines.
- monitor normal cholesterol levels and a Decrease in LDL levels.
- Takes up Serum cholesterol .
• Digitalis glycosides: monitor effects
- digoxin ( lanoxin, digitek)
-T/x: HF, Dysrhythmias

-monitor digoxin levels should be .5-2.0 ng/ml
- watch for hypokalemia or muscle weakness, or anorexia.
-monitor K levels <3.5 mEQ/L
• Hypertension: major goals for therapy
- Decrease BP
-ARBS (Cozaar)
- change lifestyle , weight loss NA restrict
• Organic nitrates: planning for safety
- Nitroglycerin (nitrol, nitrostat)
- don’t take if head injury, on anti-HTN, renal or liver prob.
-Use transmucosal, spray, or tab at first sign of pain. Prior to activity should be used.
-IV, caps, transdermal, ointment for long term.
-ANginal attack- take rapid acting. If pain still in 5min call 911. Two more doses at 5min intervals are ok.
Medications that affect the blood
• Antiplatelet medication: client monitoring
-Aspirin (ecotrin)(plavix)
-monitior signs of dizzy, or headache, bleeding
-prevents platelet clump
• Anticoagulant: monitoring lab studies
-Warfarin (Coumadin)
-Monitor PT levels should be 18-24 secs and INR levels should 2-3.
-alos CBC platelet count, and hematocrit levels.
Heparin
-monitor aPTT levels 60-80.
• Thromboyltic therapy: nursing diagnosis

-Streptokinase
- Pt’s will say they have constricted chest, pain down arms, 20-30min.
ECG- ST enlogated.
- elevation in cardiactroponins and creatine kinase.
• Blood products: proper administration
- first obtain vitals. then monitor every 5min for 15min
- Whole blood- verify w/ primary’s orders, clients blood typing, consent for transfusion, check clients history, second person check ID of donor and recipient its compatibility and date, asses client, asses infusion site, patency of IV line and Prime IV with saline, use 19 guage or larger, finish w/in 2-4hr.
• Biologic response modifiers: Erythropoietin effects
-glycoprotein stimulates RBC production in response to hypoxia
-epoetin alfa (epogen, procrit)
-for anemia of CRF.
-S/S- HTN from Increased hematocrit.
Medications that affect the respiratory system
• Mucolytics: Teaching about side effects
-Acetylcysteine (mucomyst)
-advise client it has an odor that smells like rotten eggs, to dilute it with fruit juice, will make nose watery for coughing.
-3 doses- loading, next 4hr, then infuse over 16hr.
• Bronchodilators: client education
Albuterol (proventil, ventolin,) terbutaline (brethine)
-teach mouth piece at bottom, shake it, 2inches in front of mouth, tilt head back, slow deep 3sec breath, hold 10 sec, wait 1 full min for next dose,
-inhale beta2 first
• Bronchodilators: evaluating client’s use
-long term control of asthma, prevents exercise induced asthma, no shortness of breath or wheezing.

• Corticosteroids: client education
QVAR-prednisone(deltasone)flovent
-use on regular, fixed schedule for long term therapy, not for acne. Use a
MDI, DPI, or nebulizer, use a spacer, oral glucocorticoids are short term (3-
10days).
• Antitussives: adverse effects codeine (hydrocodon)
-CNS effects (dizzy, lighthead, drowsy, resp. depression) GI (nausea, vomit, constipation), Abuse.
Medications that affect the nervous system
• Meds to teat psych disorders: dopamine antagonist effect
• Antimetics: monitor effects
-control of emesis and absence of nausea and vomiting
- anticholinergic effects
• Histamine 2 receptor antagonist: drug- drug interactions
-Ranitidine (zantac), cimetidine (tegamet) (pepcid)
-Warfarin and phenytoin- monitor signs of bleeding. Increase these drug levels
-Anatacids- decrease absorption of H2-receptor antagonists.
• PPI’s precautions
Omeprazole (prilosec)(prevacid)
-Preggo C and women who breast feed.
-Clients who are on ant-HTN meds
-Increase risk of pneumonia and decrease gastric PH making bacteria colonize

• Antacid therapy: client education
Aluminum hydroxide (amphojel)
-using aluminum and calcium can offset diarrhea or constipation
- Client with HTN should avoid NA containing antacids or magnesium for renal.
- take warfarin and tetracycline 1hr apart.
- chew tab the 8 oz milk or water and shake liquid forms
- 1hr b4 any antacid and 1hr b4 and 3hr after meals and b4 bed. 7times a day.
Medications used to treat infection
• Tetracyclines: client teaching
-Sumycin-vibramycin
-watch for diarrhea
- don’t take w/ food
- complete course even if no symptoms.
• Antiviral medications: evaluating effects acyclovir (zovirax)(rebetol)(symmetrel)
-improved vision, healed genital lesions, decrease inflammation and pain.
• Penicillin g:proper administration
-Bicillin LA
-take with full glass of water 1hr b4 meals or 2hr after
- don’t mix in same IV solution.
- First interview for allergy, observe client 30 min after admin, monitor kidney and I&O. and Cardiac status and electrolytes.
- admin IM
• Antiviral medications: anticipating use zovirax, cytovene, rebetol, symmetrel, ganciclovir.
-Herpes, zoster virus (zovirax) acyclovir

-cytomegalovirus(ganiciclovir-vitrasert or cytovene)
-symmetrel if anticipating influenza
-rebetol-hepatitis
• Antitubercular medications: interpreting effects
-isoniazid(INH),strepto,ethambutol,pyrazinamide
-therapeutic if 3 negative cultures
-peripheral neuropathy if tingling sensations
-hepatotoxicity if yellowish skin, nausea, anoxrexia or malaise.
Medications that affect the immune system
• Immunostimulants: nursing diagnosis
-aldesleukin (interleukin-2)
-hariy cell leukemia and cancers
-store in fridge and give at room temp, don’t shake.
-no antihypertensives will cause hypotensive effect
• Immunosuppressants: managing effects
-cyclosporine, neural, prednisone
-osteoporosis take Vit D
-admin over 2-6hr and stay with client for 30min
-mix with milk or oj
-monitor liver function and adjust dosage.
• Immunosuppressants: organ rejecting prevention
-increased dosages of immunosuppressants are indicated.
-So avoid phenytoin, phenobarb,rifam,, carbam, trimethoprin. All will decrease level of cyclosporine and reject organ.
• Passive immunity agent: adverse effect
-local reaction (erythema, swelling),
-urticaria or anaphylaxis
• Active immunity agent: educational goals

-teach adverse effects so they notify doctor if it happens.
-no aspirin to children to treat fever with varicella immunization
Meds for pain and inflammation
• Opioid agonist: monitoring effects
-Morphine sulfate (oxycodone,Demerol, fentanyl, codeine)
-monitor resp. I&O, vitals,
-monitor PCA setting for doses,
-monitor for coma or pinpoint pupils of overdose.
• Anti-migraine medications: client educations
-Only use aspirin w/o drugs
-ergot-teach withdrawal symptoms , avoid pregnancy, use adequate contraception. avoid trigger factors that cause stress.
sumtriptan (imitrex)-teach chest symptoms are common
Elavil-teach about anticholinergic effect.
• Antirheumatic medications: monitoring electrolytes
Prednisone (deltasone)
-prevent adrenal suppression with administering fluids such as normal saline, salt and hydrocortisone
• Anti-gout medications: avoiding adverse effects
-Indocin, allopurinol, probenecid
-take meds w/ food
-provide antidiahrreals
-drink more water
Meds that affect the renal system
• Osmotic diuretics: monitoring client
-monitors client’s serum osmolarity and electrolytes.

• Potassium sparing diuretics: effects
- Spironolactone (aldactone)
-K retention and the secretion of NA and water
-block aldersterone
-hyperkalemia and dysrhythmias and tumors. Impotence to males.
• Loop diuretics: evaluating effectiveness
-if K level below 3.5 add K supplement.
- weight loss is good, decrease bp, increase urine, decreased pulmonary or peripheral edema.
• Potassium sparing diuretics: aldosterone antagonist effects
-IN treatment for Heart failure
-combined with other k-sparring diuretics for greater effect
-in Primary hyperaldosteronsim it block aldosterone
• Thiazide: drug0srug interactions
-digoxin-hypokalemia
-anti-HTN-hypotensive effect
-NSAIDS
Meds that affect reproduction
• Ovualtion suppressant: client education
Necon,ortho-novum
-don’t smoke, record bleeding of menstruation (length)
-take pills same time each day
-if missed dose take 2 next time and take for 21 days with 7 days no meds.
• Androgens: risk of inappropriate use
-halotestin,danocrine (testosterone)
-not for athletic training
-clients with prostate cancer.

-Liver, heart, or renal failure
-Pregnancy
• Estrogen therapy: client instruction
-Estrace,Premarin.
-take at same time everyday
-apply patch to skin of the trunk
-inject IM deep in large muscles and report menstral changes
-perform monthly breast exam.
• Ovulation stimulant: safety measure
Oxytocin
-don’t give to clients with HTN
-use an infusion Pump to administer slowly
-risk factors are multiple deliveries so assess for that
-have magnesium sulfate on stand by
• Progestins: client education
-Provera
-don’t smoke and report large vaginal bleeding amounts.
-anticapte withdrawal bleeding 3-7 days after stopping.
-Immediately stop taking med if suspecting pregnancy
Meds that affect the endocrine system
• Hyperglycemic hormones: sever hyopoglycemia
-hyperglycemic caused by to little insulin
-severe hypoglycemia
- Tachycardia, palpitations, sweating, shakiness.
-administer glucose fast acting (tablet, orange juice, soda) IV glucose may be needed
-no BB’s, alcohol, cimetidine, or sulfon anti-biotics, or nsaids. BG should be 90-130

• Cushing’s syndrome: suppression testing
-too much ACTH
-Suppression test with Dexamethasone and urine samples. treat with spironalactone
-2mg dose of dex every 6hr for 2 days.
• Thyroid agents: client education synthroid or levothroid
-teach signs of overdosing (anxiety, wt. loss, tachy)
-teach for signs of bruising or bleeding
-methimazol(tapazole)
-treats graves
-take w/meals
• Antidiabetics: preventing hypoglycemia
-<50 bg
-prevent by eating carbs or glucagon
• Sulfonylureas: client education
-wear medical bracelet
-take fast acting source ofsugar if hypo
-talk about alcohol risks and closely monitor bg
-exercise and maintain a glucose log or refer to dietician
OB ATI Exact Sections on Exam
Discharge teaching: care seat safety (chapter 24, pg 463)
Always use an approved car seat when traveling. Parents should be instructed about the proper installation of an approved car safety seat.
The infant should always be in a rear-facing car seat from birth to 9.1kg (20lb) or 1 year of age, after which, a toddler seat should be used.
The infant car seat should be secured in the rear seat of the car.
The shoulder straps should be strong enough so they do not fall off the infant’s shoulders.
Nursing care NB: # safety , security and ID

Provide community resource to clients who may need additional and ongoing assessment and instruction on infant care.
Never leave the infant unattended with pets or other small children.
Keep small objects (coin) out of reach of infants (choking hazard).
Never leave the infant alone on a bed, couch or table. Infants move enough to reach the edge and fall off.
Never provide an infant a soft surface to sleep on. The infant’s mattress should be firm. Never put pillows, large floppy toys, or loose plastic sheeting in a crib. The infant can suffocate.
Never place the infant on its stomach to sleep during the first few months of life. The back-lying position is the position of choice.
When using an infant carrier, always be within arm’s reach when the carrier is on a high place such as a table. If possible, place the carrier on the floor near you.
Do not tie anything around the infant’s neck. Check the infant’s crib for safety. Slats should be no more than 2.5 inches apart. The space between the mattress and sides should be less than 2 fingers widths.
Keep a crib or playpen away from window blinds and drapery cords. Infants can become strangled in them.
The bassinet or crib should be placed on an inner wall, not next to a window, to prevent cold stress by radiation.
Eliminate potential fire hazards. Keep a crib and playpen away from heaters, radiators, and heat vents.
Linens could catch fire if in contact with heat sources.
Smoke detectors should be on every floor of a home and should be checked monthly to assure they are working. Batteries should be changed yearly. (change batteries when daylight savings time occurs).
Provide adequate ventilation. Control the temperature and humidity of the infant’s environment.
Avoid exposure to cigarette or cigar smoke in a home or elsewhere. Passive exposure increases the infant’s risk of developing respiratory symptoms and illness.
Be gentle with the infant. Do not swing the infant by his arms or throw the infant up in the air.
All visitors should wash their hands before touching the newborn.
Any individual with an infection should be kept away from the newborn.
Leopolds maneuvers/ labor
Homecare of pregnancy induced hypertension
Maintaining bed rest and encouraging side-lying position.
Promoting diversional activities.
Avoiding foods high in sodium.
Avoiding alcohol and limiting caffeine.
Increasing fluid intake to 8 glasses/day.
Putting up side rails for safety and seizure precautions.
Maintaining a dark quiet environment to avoid stimuli that may precipitate a seizure.
Maintaining patent airway in the event of a seizure.
Administering antihypertensive medications as prescribed.
Interventions for thrombophlebitis 317
Providing client education and encouragement pertaining to measures for prevention of thrombophlebitis.
Initiating early and frequent ambulation postpartum.
Avoiding prolonged periods of standing, sitting, or immobility.
Elevating legs when sitting.
Avoiding crossing lets, which will reduce the circulation and exacerbate venous stasis.
Maintaining fluid intake of 2500 mL per day to prevent dehydration, which causes circulation to be sluggish.

Discontinuing smoking, which is known to be a risk factor.
Measuring lower extremities for fitted elastic support hose/TED (thromboembolic disorder) hose to lower extremities.
Physiologic changes of pregnancy/documentation/ & recognizing presumptive signs and nagele’s rule.
(Chapter 3, page 33)
Presumptive signs-changes experienced by the women that make her think that she might be pregnant.
These changes may be subjective symptoms or objective signs.
Amenorrhea, nausea vomiting, fatigue, urinary frequency, breast changes, quickening - slight fluttering movements of the fetus by a women, usually between 16 and 20 weeks gestation, uterine enlargement, linea negra, chloasma (mask of pregnancy), Striae gravidarum, darkened areola.
Nagele’s Rule: Take the first day of last menstrual cycle, subtract 3 months, and add 7 days and 1 year.
Remember to take into account how many days there are in each particular month when adding 7 days.
Amenorrhea, nausea vomiting, fatigue, urinary frequency, breast changes, quickening - slight fluttering movements of the fetus by a women, usually between 16 and 20 weeks gestation, uterine enlargement, linea negra, chloasma (mask of pregnancy), Striae gravidarum, darkened areola.
TORCH infection cytomegalovirus (Chapter 8, page 124)
Cytomegalovirus (member of herpes virus family)- NO treatment for infection exists. Prevent exposure by frequent hand washing before eating and avoiding crowds of young children.
Nursing Interventions-
Monitor fetal well-being.
Emphasize to the client the important of compliance with prescribed treatment.
Provide client education and emotional support.
Administer antibiotics as prescribed.
Nonstress test (Chapter 7, page 85)
For a NST, the nurse should:
Seat the client in a reclining chair or place in a semi-fowler’s or left-lateral position.
Apply conduction get to the client’s abdomen.
Apply two belts to the client’s abdomen and attach the FHR and uterine contraction monitors.
Instruct the client to press the button on the handheld event marker each time she feels the fetus move.

If there are no fetal movements (fetus sleeping), vibroacoustic stimulation (sound source, usually laryngeal stimulator) may be activated for 3 sec on the maternal abdomen over the fetal head to awaken a sleeping fetus.
If NST is sill nonreactive, anticipate a CST and/or BPP.
Antepartum Dx interventions: group B strep
Assess meconium amniotic fluid: (Chapter 14, Page 245)
Nursing Assessment:
The presense of meconium in the amniotic fluid can be determined by visual inspection of the amniotic fluid.
The fluid will have a greenish black color and a thick fresh consistency.
Criteria for evaluation of meconium-stained amniotic fluid.
Consistency- Thick, fresh consistency indicative of fetal stress.
Timing- Thick, fresh meconium first passed in late labor with variable, or late FHR decelerations
(Ominous sign)
Presence of other indicators. The existence of meconium alone in the amniotic fluid is not a sign of fetal distress. It must be accompanied by variable or late FHR decelerations with or without acidosis, which is confirmed by scalp blood sampling to be considered ominous.
At the time of birth, the nurse should be prepared to suction the nasopharynx of the neonate.
Suctioning reduces the incidence and severity of meconium aspiration syndrome in the neonate.
1. Suctioning is by mouth and nasal passages with a bulb syringe are done to remove excess mucus in the respiratory tract.
Gentle percussion may be performed over the chest wall using a percussions cup to loosen secretions prior to suctioning.
Support the infant by holding the head slightly lower than the body. Turn the infant’s head to the side if the infant is coughing or choking on secretions to allow gravity to aid in drainage of secretions.
Suction the infant’s mouth first (prevents the infant form gasping as the nares are touched and inhaling pharyngeal secretions)
Compress the bulb before insertion into the mouth and release bulb after insertion

Insert the bulb into one side of the infant’s mouth, which could stimulate the gag reflex.
Nasal passages are suctioned one nostril at a time.
If these measures are unsuccessful, mechanical suction and or back blows and chest thrusts may need to be used as well as the institution of emergency procedures.
The bulb syringe should be kept with the infant, and the infant’s family should be instructed on how to use it. Family members should be asked to perform a demonstration to show they understand bulb syringe techniques. (372)
2. Interventions for respitory distress syndrome include assessment for:
Retractions of the chest wall during inspiration
Nasal flaring on inspiration
Expiratory grunting
Changes in the respiratory and heart rates
Nursing interventions include administering glucocorticoids for 24-hour period prior to delivery to promote fetal lung development in an attempt to prevent respitory distress syndrome.
(Pg237)
3. Ectopic pregnancy is the abnormal implantation of the fertilized ovum outside of the uterine cavity. The implantation is usually in the fallopian tube, which can result in a tubal rupture, which can result in a tubal rupture causing a fatal hemorrhage.
Signs and symptoms of ectopic pregnancy which include:
One or two missed menses
Unilateral stabbing pain and tenderness in the lower abdominal quadrant
Scant, dark red, or brown vaginal spotting if tube ruptures (bleeding may be into intraperitoneal area)
Referred shoulder pain from blood irritation of the diaphragm or phrenic nerve (common symptom).
Nausea and vomiting frequently after tube rupture.
Symptoms of hemorrhage and shock (e.g. hypotension, tachycardia, pallor)
Nursing assessment for ectopic pregnancy includes:
Abdomen for unilateral pain, vaginal bleeding, vital signs and temperature, skin color, respirations, urine output.
Nursing Interventions for clients with an ectopic pregnancy include:
Replacement of fluids loss and maintenance of electrolyte balance
Provide client education and psychological support
Prepare the client for surgery and postoperative nursing care. (pg 103)
4. Augmentation of labor is the stimulation of hypotonic contractions once labor has spontaneously begun, but progress is inadequate. Certain primary care providers favor active management of labor to establish effective labor with aggressive use of amniotomy, oxytocin, or rupture of membranes. This ensures that the client delivers within 12 hr of admission to the labor unit so that the risk of cesarean birth will be decreased.
Key nursing assessment and nursing interventions:
Risk factors requiring augmentation of labor, administration procedures, nursing assessments and interventions, and possible procedure complications are the same for labor induction. (211)

5. Priority nursing assessment during fourth stage of labor includes :
Maternal vital signs, uterine tone, lochia, urinary output, maternal newborn bonding activities
Nursing interventions during the fourth stage of labor include:
Massaging the uterine fundus and or administering oxytocis as prescribed to maintain uterine tone to prevent hemorrhage.
Encourage voiding to prevent bladder distention. (Pg 195)
6. Prenatal care cultural awareness include the eliminating acultural nursing care (care that avoids concern for cultural differences), which is the traditional tendency to treat all clients as though no cultural differences exists.
Cultural competent nursing is care that respects and is compatible with each client’s culture and shows respect for the values and beliefs of others. A nurse who is culturally sensitive incorporates client’s cultural preferences into the prenatal care situation as much as possible.
There are four major subcultures in the United States. An awareness of general communication patterns among these subcultures can assist a nurse in providing quality nursing care. A nurse should keep in mind that there are variations among individuals and not stereotypes. (Page 56)
7. Prenatal education encompasses a great deal of information provided to the client who is pregnant. Major areas of focus include assisting the client in self-care of the discomforts of pregnancy, promoting a sage outcome to pregnancy, and fostering positive feelings by the pregnant woman and her family regarding the childbearing experience.
Nursing play an integral role in assessing the client’s current knowledge, previous pregnancies, and birthing experiences. Nurses provide anticipatory teaching to the pregnant woman and her family about:
Physical and emotional changes during pregnancy and interventions that can be implemented to provide relief
Danger signs and symptoms to report to the primary to report to the primary care provider.
Various birthing options available to enhance the birthing process.
8. The greatest period of danger to the developing fetus for incurring structural anomalies from intrauterine environmental hazards occurs between day 15 to 18 weeks from conception.
Preconception and prenatal education should stress healthy behaviors that promote the health of the pregnant woman and her fetus.
Clients should be instructed to avoid all over the counter medications supplements and prescriptive medications unless the obstetricians who is supervising their care has knowledge of this practice.
Alcohol (birth defects) and tobacco (low birth weight) are contradicted in pregnancy.
Substance abuse of any kind is to be avoided during pregnancy and during lactation
Components of childbirth education may include early prenatal care, preparation for birth, pain management, complications of pregnancy and delivery, sibling and grandparent classes, breastfeeding, and newborn care.
Birth plans can be verbal or written agreements that describe what the pregnant woman wishes to occur during labor and delivery.
9. Evaluating home teaching for preterm labor includes focusing on stopping uterine contractions by restricting activity, ensuring hydration, identifying and treating any infection.

Activity restrictions include modified breast with bathroom privileges, encouraging clients to rest in the left lateral position to increase blood flow to the uterus and decrease uterine activity, avoidance of sexual intercourse.
Encouraging hydration because preventing dehydration will prevent the release of oxytocin, which stimulate uterine contractions
Identifying and treating any infection by having the client report any vaginal discharge, noting color, consistency and odor. Monitor maternal vital signs, amniotic fluid infection should be suspected with the occurrence of elevated maternal temperature. (pg 232-233)
Contraction Stress Test p. 86
An assessment performed to stimulate contractions (which decrease placental blood flow) and analyze how the fetal heart rate in conjunction with tohe contractions to determine how the fetus will tolerate the stress of labor.
Use nipple stimulation or oxytocitn can stimulate contractions.
Positive CST=abnormal (w/in 10 min, no late decels)
Negative CST=normal (late decels on more than half contractions)=uteroplacental deficiency
Newborn Assessment: Behavioral Characteristics p. 371
1 st 6-8 hours, infants go through periods of reactivity as systems stabilize
First period of reactivity: alert and exhibits exploring activity, makes sucking sounds, has a rapid heartbeat and respiratory rate. Lasts 15-30 min after birth.
Period of relative inactivity: infant will become quiet and begin rest and sleep. Heart and respirations will decrease. Lasts from 30-100 min after birth.
Second period of reactivity: infant reawakens, becomes responsive again, and often gags and chokes on mucus that has accumulated in mouth. Occurs 4-8 hours after birth—may last 10 minutes or several hours.
Discharge Teaching: Circumcision p. 405
Teach to keep area clean (Change diaper at least q 4 hrs, and clean penis with warm water. Apply petroleum jelly with each diaper change and fanfold diaper)
Avoid wrapping penis in tight gauze.
NO tub bath until completely healed.
Notify doc if signs of infection.
Yellowish mucous may form by day 2—Don't wash it off!
Use premoistened towlettes to clean circ, because they contain alcohol.
May be fussy or sleep several hours after circumcision.
Should heal completely in a couple of weeks.
Complication of Pregnancy: Care for Placenta Previa p. 109
Occurs when the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of to the lower fundus. Results in bleeding during third trimester of pregnancies as cervix begins to dilate and efface.
Nursing Interventions:
Bed rest

Nothing inserted vaginally
IV fluids as prescribed
Corticosteroids for fetal lung maturation if delivery is anticipated
Blood replacement as prescribed
Estimated Date of Birth p. 351 (I think they're talking about Gestational Age Assessment)
Gestational Age Assessment is performed within 2 to 12 hrs of birth. Neonatal morbidity and mortality are related to gestational age and birth weight. This involves measeurments of the newborn and the use of the New Ballard Scale which provides an estimation of gestational age and a baseline to assess growth and development
Calculation of Delivery Date p 34
Nagele's Rule-take the first day of the last menstrual cycle, subtract 3 months, and add 7 days and 1 year.
Remember to take into account how many days there are in each particular month when adding 7 days.
McDonald's Method-measure uterine fundal hight in centimenters from the symphisis pubis to the top of the uterine fundus (between 18 and 30 weeks gestation age).
The gestational age is estimated to be equal to the fundal height.
Fetal Heart Rate Patterns p. 173
Reassuring: heart rate of 110-160 bpm with beat to beat variablity of 15 bpm, lasting at least 15 seconds, with a return to baseline in less than 2 min with no decelerations
Nonreassuring: fetal hypoxia due to fetal bradycardia fetal tachycardia absence of FHR variablity late decelerations variable decelerations
Assess Fetal Heart Rate p.169-176See above
Postpartum Care: Cultural Awareness p.
311 (The only remotely cultural thing I could find...)
Postpartum Complications
Hematoma/Lacerations
Light Skinned Women, especially with reddish hair, have less distnesible tissue than darker skinned women
Pitocin:
-administered via IV
-monitor BP, P, R every 30 minutes
-before giving, nurse needs to confirm fetus is engaged in birth canal at a minimum of station 0
-increase until desired contractions
Episiotomy care:

-inform provider of foul-smell drainage, redness, swelling
-encourage of cleansing area with water bottles filled with warm tap water after voiding and defecation
-avoid sexual intercourse until healed up
-apply ice packs if needed
-perform kegel exercises
D/C to adolescent who is breastfeeding:
-make sure baby is getting enough milk
-monitor amount of feedings and voids
-feed every 3-4 hours
-wake infant up every three hours to make sure they are eating enough and gaining enough weight
-place in supine position
-be clean (wash hands, bottles,)
-page 391
Preg/adequate weight gain:
-normal pregnancy:
-gain 25-35 pounds
-3-4 lbs during first trimester
-last 2 trimesters, a pound a week
Abnormal NB assessment:
-preterm=born after 20 weeks and before 37
-Respiratory distress syndrome
-post term infant=born after 42 weeks
-hyperbilirubinemia=elevated bilirubin levels
Newborn bathing:
-infant's face and perineal area cleaned daily
-occur before feeding
-do not leave unattended
-water not hot. Don't let infant get cold
-sponge bath til cord falls off
-clean eye from inner to outer
-don't use lotions, oils, or powders
Gestational hypertension:
-begins after 20 weeks of pregnancy
-BP is 140/90 mmHg or systolic increase of 30 and diastolic of 15 or more
-no proteinuria or edema
-BP returns to baseline by 6 weeks postpartum
-interventions:
-maintain bedrest
-avoid foods high in sodium
-increase fluids each day
-put up side rails for safety
-maintain dark environment to avoid stimuli to prevent seizure
-give antihypertensives
-administer magnesium sulfate if needed
Priority in postpartum hemmorhage:
-STOP BLOOD LOSS!
-Maintain IV fluids

-give oxygen
-insert indwelling catheter
-elevate patient's legs to 20-30 degree angle
True labor:
-contractions at regular intervals
-intervals between shorten
-progressive dilation and effacement of the cervix
-contractions don't decrease with rest or warmth
-discomfort begins in the back and radiates to abdomen
D/C Teaching-NB Chapter 24
Instruct parents that they will learn the cries of their baby, do not feed baby every time it cries, its okay for infant to cry for short periods of time
Quieting techniques: carrying in a front or back pack, swaddling, preheating sheets with a hot water bottle or heating pad, providing rhythmic monotonous noises to stimulate utero sounds, providing movement, place infant on its stomach across a holder’s lap while bouncing legs, close skin contact with infant, stimulate infant if bored
Sleep Wake cycle: infant must sleep in supine position, will sleep for 16 out of 14 hours in cycles of 2-3 hours each, do not add cereal to formula until 4-6 months of age, most infant sleep through night by 4-5 months of age, keep things quiet and dark at night, never let infant sleep in parents bed, develop a predicable routine so infant doesn’t get days and nights so mixed up, keep a small night light for nighttime feedings and diaper changes and speak softly
Oral and Nasal Suctioning: teach parents to use bulb syringe, suction mouth first then nose one nostril at a time, compress bulb before inserting, insert syringe in sides of mouth not middle to avoid hitting gag reflex
Positioning and Holding: head must be supported, cradle hold, upright position, football hold, colic hold
Bathing: cleanse face and perineal area daily, completely bathe newborn 2-3 times a week using mild soap, bathe before feeding to prevent spitting up, test water on inner wrist should, use sponge baths until the cord falls off, don’t use lotions, oils or powders
Feeding/Elimination: breastfeeding on demand or every 2-3 hours 20-30min per breast, formula on demand or ever 3-4 hours, 6-8 wet diapers and 3-4 stools/day
Cord Care: cleansed 2-3 times daily, keep dry w/ diaper folded underneath cord, any foul smelling, purulent drainage or redness should be reported to doc
Circ Care: petroleum jelly for 24 hours on penis to promote healing
Diapering: keep area dry and clean
Clothing: soft and cotton best material, washed w/ mild detergent and hot water, dress infant as parent would dress
Safety: never provide soft surface to sleep on b/c risk of suffocation, never place infant on stomach first few months of life,
Car Seat: rear facing until 20lbs or age 1, placed in rear seat
Infant Well-check ups: 2-6 weeks of age then every 2 months until 6 months old
Signs of illness: fever above 100.4, below 97.9, poor feeding, frequent vomiting, decreased BM or diarrhea, deceased urination, nostril flaring, cyanosis, jaundice, lethargy, difficulty waking, inconsolable crying, drainage around eyes---for all listed call doc!
Give instructions on CPR and relieving airway obstruction
Comfort Measures- L&D Chapter

Nonpharmacologic: childbirth preparation education-Lamaze, Bradley, Dick-Read breathing methods, Sensory stimulation strategies-aroma therapy, breathing techniques, imagery, music, focal points, Cutaneous strategies-back rubs, effleurage, sacral counterpressure, heat/cold therapy, hydrotherapy, intradermal water block, acupressure, transcutaneous electrical nerve stimulation (TENS),
Positioning changes
Pharmacologic: Analgesia- sedatives, opiods, Stadol & Nubain, Ataractics-to control nausea and anxiety, epidural and spinal regional analgesia, anesthesia, regional blocks, continuous infusions or intermittent injections, spinal block\
Babinski’s Reflex- Chapter 19
When the sole of the foot on the side of the newborns’s small toe is stroked upward, the toes will fan upward and out
1 st stage priority assessment/4 th stage- Chapter 12
1 st : Leopold’s maneuvers, vaginal examination, bladder palpation, Vitals, contraction monitoring,
FHR monitoring
2 nd : Vitals, Contractions, pushing effort, increase in bloody show, cervical dilation, FHR, perineal lacerations
3 rd : Vitals, signs of placental separation from uterus (fundusm gushing blood, vaginal fullness, umbilical cord appears to lengthen as placenta descends), Apgar scores
4 th : Maternal VS, uterine tone, lochia, urinary output, maternal newborn bonding activities
Nutrition & Pregnancy/ assess needs adolescents- Chapter 4
Recommended weight gain 11-14 lbs, 300 calories diet increase, protein intake, high folic acid intake (leafy vegetable, dried peas, seeds, orange juice, breads, cereals, other fortified grains), iron supplements (give with Vitamin C for good absorption), Calcium intake, limit caffeine to 300mg daily, urine output no less than 30ml/hr
Prevention of neural tube defects- Chapter 4
Folic Acid supplements!
Postpartum urinary complications assessment- Chapter
UTIs common infection secondary to bladder trauma-complication of UTI  pyelonephritis with permanent damage leading to acute or chronic renal failure- Monitor urgency, frequency, dysuria, retention, hematuria, pyuria, pain in suprbuic region, pain at costovertebral angle, elevated temp and chills, malaise, cloudy urine
Rh isoimmunization/ postpartum- Chapter 15
All Rh-negative mothers with Rh-positive infants must be given Rh immune globulin (RhoGAM)
IM within 72 hrs of the infant being born to suppress antibody formation in mother-test client who receives both the rubella vaccine and RhoGAM after 3 months to determine if immunity to rubella has been developed
NB vitamin K injection- Chapter
Administered to prevent hemorrhagic disorders, 0.5-1mg IM into vastus lateralis within 2 hr after birth

Breastfeeding & frequency
This is the optimal source of nutrition for newborns; it is recommended exclusively for the first 6 months of age by the American Academy of Pediatrics; beginning of one feeding to the beginning of the next is every 2-3 hours; parents should awaken the infant atleast every 3 hours during the day and 4 hours during the night until the infant is feeding well and gaining weight adequatley
Lactation suppression/D/C teaching
Suppression is necessary for woman not breastfeeding; avoid stimulation and running warm water over the breast for prolonged periods until no longer lactating; for breast engorgement apply cold compress 15 mins on and 45 mins off; fresh cabbage leaves can be placed inside the bra; mild analgesics may be taken for pain and discomfort of breast engorgement
Labs for large for gestational age infant
Large for gestational age is a neonate whose weight is about the 90 th percentile/ weighing more than 4000g or 8lbs 12oz; macrosomic infants are at risk for birth injuries; uncontrolled hyperglycemia during pregnancy can lead to congentital defects; chest x-ray to rule out meconium aspiration, blood glucose levels to monitor for hyperglycemia, CBC for polycythemia, hyperbilirubinemia, and hypocalcemia
Coagulopathies/assess postpartum complication
Monitor for signs/symptoms of postpartum hemorrhage such as: uterine atony, blood clots larger than a quarter, perineal pad saturation in 15mins or less, return of lochia rubra once lochia has progressed to serosa or alba, constant oozing trickling or frank flow of bright red blood from the vagina, a rising pulse rate/decrease in blood pressure, skin that’s pale cool and clammy with poor turgor and pale mucous, oliguria + assess the client for the source of bleeding
Postpartum care
Fourth stage of labor is maternal recovery period, it takes approximately six weeks for a return to normal, watch for physiological changes/adjustments, hemorrhage, shock, infection, assist clients recovery and return to prepregnant state, assess fundal height, uterine placement, and uterine consistency, bleeding assessment, v/s, breasts, bowel/GI, bladder, comfort level, teaching needs
Bonding/maternal adjustment
Bonding/maternal adjustment depends a lot on the family situation/how family felt about the pregnancy; 3 phases:
Taking-in phase-immediately after birth last anywhere from a few hours to a couple of days, the client is concerned about her own needs and overall health of the newborn;
Taking-hold phase:2 nd
-3 rd
postpartum day and lasts 10 days to several weeks, focus of mother is on asserting her independence in competently caring for the newborn;
Letting-go phase: when patient assumes her role at home and focuses on moving forward of the family unit
Contraception/ tubal ligation/ appropriate choices/ emergency assess/ contraindications hormonal contraceptives use
Contraception is the prevention of conception or impregnation/ tubal ligation- cutting, burning, or blocking of fallopian tubes to prevent ovum from being fertilized by sperm/ appropriate choices- decision must be made according to the clients preferences and expected outcomes for now and in the future/

emergency assess- I could not find anything for this / contraindications hormonal contraceptives use- women with history of blood clots, stroke, cardiac problems, breasts or estrogen-related cancers, pregnancy, smoking are not advised to take, effectiveness decreases with use of medications that affect liver enzymes such as anticonvulsants and some antibiotics, increases the risk of multiple births by more than 25%
Amniocentesis procedural care/ & complications & diagnostic interventions/ interpret AFP
Procedural care- explain procedure and get informed consent, empty bladder, supine position, baseline v/s and FHR throughout and 30 mins post, use aseptic solution on abdomen, advice client of pressure of needle, administer RhoGAM if necessary, drink plenty of fluids and rest for next 24 horus / complications- amniotic fluid emboli, maternal or fetal hemorrhage, fetomaternal hemorrhage with Rh isoimmunization, infection, fetal damage or anomalies involving limbs, fetal death, bladder damage, miscarriage or preterm labor, PROM, leakage of amniotic fluid + diagnostic interventions- chromosomal anomalies, neural tube defects, alpha fetoprotein level, pulmonary maturity assessment, meconium in amniotic fluid, fetal hemolytic disease, fetal fibronectin levels/ interpret AFP- high levels: neural tube defects ex spina bifida, anencephaly, omphalocele low levels: chromosomal disorders, gestational trophoblastic disease
Diagnostic Interventions/chorionic villus sampling (pg. 92)
(There are a lot of diagnostic interventions, might want to read through them)
First trimester alternative to amniocentesis with one of its advantages being an earlier diagnosis of abnormalities.
Can be performed at 10-12 weeks gestation
A portion of the placenta is aspirated through a catheter through the abdomen or vagina/cervix under ultrasound guidance
Indications: women at risk for giving birth to a baby with a genetic deformity
The nurse should instruct the client to drink enough to fill the bladder prior to the procedure to assist in positioning the uterus for catheter insertion
Assist the client to the lithotomy position
Risks: spontaneous abortion
Identification of rupture of membranes (pg.191)
The nurse should first assess the fetal heart rate to assure there is no fetal distress
Nitrazine paper- turns blue in the presence of alkaline amniotic fluid
Ferning test- exhibits a frond-like ferning pattern when a small amount of amniotic fluid is viewed on a slide under a microscope
Should assess for odor, should be free of foul odor and clear straw color abnormal findings include the presence of meconium, foul odor or abnormal color (yellow or port-wine)
Education/Lamaze (pg. 71)
Focuses on partner coached breathing techniques and relazation with the woman panting and using outside focal points during labor

Pain management epidural infusion/epi blood patch and hypnosis (Pg.153)
I couldn’t find anything on epi blood patch and hypnosis
Epidural
Consists of using short acting opiod analgesics administered as a motor block without anesthesia, provide rapid pain relief while still allowing the patient to sense contractions and bear down
Adverse effects: decreased gastric emptying resulting in N&V, inhibition of bowel and bladder sensation, bradycardia or tachycardia, hypotension, respiratory depression, allergic reaction and pruritis
Monitor maternal and fetal heart rate, N&V, and allergic reaction
Preterm labor/Magnesium Sulfate (Pg. 235)
A uterine tocolytic that relaxes the smooth muscle of the uterus
Most commonly used tocolytic because it causes fewer maternal and fetal side effects
Adverse effects: lethargy, weakness, visual blurring, headache, N&V, decreased respiratory rate, depressed deep tendon reflexes, decrease in urinary output, cardiac arrest
Monitor for toxicity and discontinue if loss of deep tendon reflexes occurs, urinary output is less than
25mL/hr, respiratory depression, pulmonary edema or chest pain
Calcium gluconate is the antidote for toxicity
Nonpharmocological Pain management during labor (Pg. 150)
Childbirth preparation education (breathing techniques, monitor for hyperventilation, sensory and cutaneous strategies (back rubs, massage, effleurage: light gental circular stoking of the abdomen with fingertips in rhythm with breathing patterns, sacral counterpressure, heat or cold therapy, hydrotherapy, intradermal water blck, acupressure, transcutaneous electrical nerve stimulation) frequent maternal position changes (semi sitting, squatting, kneeling, rocking back and forth, supine with wedge uner hips to tilt the uterus and avoid supine hypotension syndrome
Assess hyperemesis gravidarum (Pg. 113) excessive nausea and vomiting that is prolonged past 12 weeks gestation and results in a 5% weight loss from prepregnancy weight may be accompanied by liver dysfunction risk for intrauterine growth restriction or preterm birth
Monitor for: excessive vomiting for prolonged periods, dehydration with possible electrolyte imbalance, weight loss, decreased BP, increased HR, poor skin turgor, I and O, mucous membranes, weight
Hyperbilirubin/Phototherapy/Home therapy (Pg. 428)
Elevation of serum bilirubin levels resulting in jaundice
Physiologic: benign, only after first 24 hrs of age
Pathologic: appears before 24hrs of age or is persistent after day 7 with bili levels greater than 12mg/dL

Kernicterus: bili levels higher than 25
Phototherapy
Put eye mask over baby’s eyes to protect corneas and retinas, keep newborn undressed except males
(surgical mask over genitalia to prevent testicular damage), don’t apply lotions or ointments, remove from phototherapy every 4hr, reposition every 2 hr to expose all body surfaces
Side effects: bronze discoloration, maculopapular skin rash, development or pressure areas, dehydration, elevated temperature
Monitor: elimination, daily weights, signs of dehydration, check azillary temp every 4 hrs during phototherapy d/t elevated temp
Home care: Feed early and frequently, maintain adequate fluid intake
Bishops Score (Pg. 206)
Used to determine the maternal readiness for labor by evaluating if the cervix is favorable by rating: cervical dilation, effacement, consistency, position, presenting part station
Five factors are assigned a numeral value of 0-3, total score of 9 for nulliparas and 5 for multiparas indicates readiness for labor induction
Fetal distress/decelerations
There is a whole chapter on this… Chapter 11, Page 169
1) Contraction patterns in labor
1 st stage-Latent Phase or early: contraction frequency every 5-10 minutes and last for 30-45. contraction intensity is mild to palpation.
Active phase- Contractions from 2-5 min, for 45-60 seconds. intensity is moderate to palpation.
Transition- Contraction frequency is 1-2mins for 60-90 seconds w/ strong intensity with palpation.
2 nd stage- Perineal phase-Contractions 2-3 minutes or less for frequency. Last for 60-90 seconds strong
3 rd intensity with urge to push.
stage- Placental expulsion- Uterine contractions cause placenta to expel within 20-30minutes.
2) How does the fetus maneuver down the birth canal?
By cardial movements. !In this order! the babies movements are concurrent.
Engagement-descent-flexion-internal rotation-extension-external rotation-expulsion
Descent, flexion, internal rotation, extension, restitution, external rotation and expulsion.
3) What helps the removal of membranes and placenta after delivery
- Continued uterine contractions
- Manual extraction
-Breast feeding immediately (Oxytocin)
- Uterine muscle fibers shorten or retract
- uterus changes its shape to globular
- Umbilical cord lengthens
- Endorphins (block out pain)
- Administer oxytocin
4) Know all stages of labor
1 st stage- 0-10cms, 100% effaced.
Early- 0-3 cms
Active- 4-7 cms

Transition- 8-10 cms
2 nd Stage- Delivery of the baby.
Crowing- entire top of fetus’ head can be seen.
3 rd
Pushing & Premature urge to push- Valsalva maneuver and Open Glottis technique.
Stage- Delivery of Placenta
Usually occurs within 5-10 minutes of delivery of baby.
Retained Placenta- If the third stage is taking a while, you could try breastfeeding your baby or rubbing your nipples, as this can cause the uterus to contract and may help to expel the placenta. If you're sitting or lying down, try changing to a more upright position so that gravity can help.
If you choose a managed third stage, you'll be given an injection of an oxytoxic drug to make your uterus contract and your doctor will use controlled cord traction to gently deliver the placenta.
If the placenta still can't be removed, it may need to be removed manually. You'll be given a regional anaesthetic such as a spinal or epidural , or you can ask for a general anaesthetic if you prefer.
Before the placenta is removed manually your doctor will insert a catheter in to empty your bladder and you'll be given intravenous (IV) antibiotics to prevent infection. After manual extraction, you may need more drugs which are given intravenously to help the uterus contract down.
Pediatrics ATI Study Guide Form B
Basic Care and Comfort:
Acute Gastrointestinal disorders: providing appropriate dietary choices for gastroenteritis-
Avoid: fruit juices, carbonated sodas, gelatin because they are high in carbs and low in electrolytes.
Avoid caffeine because its diuretic effect. Avoid chicken or beef broth because it has too much sodium and not enough carbs. Avoid bananas, rice, applesauce, and toast (BRAT diet). This diet carries low nutritional value, high carb, low electrolytes.
Health Promotion and Maintenance:
Health promotion and the school-age child: cognitive development- Concrete thought: weight and volume seen as unchanging, is able to understand simple analogies, is able to understand time
(days, seasons), can define many words and understand rules of grammar, classifies more complex information, is able to understand various emotions people experience.
?Health promotion and the toddler: anticipatory guidance-
Health promotion and the toddler: nurse/parent communication-
Health promotion and the toddler: toilet training- can begin when its recognized that the child has the sensation of needing to urinate or defecate. Parents should demonstrate patience and consistency in toilet training their child. Nighttime control may develop last of all.
Nutrition: age appropriate guidelines-

Preterm infants <37 weeks gestation: require 50-60kcal/kg per day or 75kcal/kg per day if fed orally, breast milk is recommended and needs are increased with illness.
Infants- birth to a year: Birth to a year needs breast milk or formula. 4-6 months need iron fortified cereal such as rice cereal. 6-8 months need yellow vegetables, fruits. 8-10 months need meat. Usually delayed until after 12 months are whole milk, eggs, strawberries, wheat, corn, fish and nut products.
Toddlers- 1 to 3 years: toddlers do well with finger foods. They may temporarily become a picky eater and will require three meals and two snacks per day. Give the toddler small portions that are health. Limit fruit juice to 4-6 oz/day due to sugar content.
Preschool children- 3 to 5 years: a preschool child may eat only certain foods for a period of time. A preschool child requires three meals and two to three snacks per day from all areas of the food pyramid.
School age children- 5 to 12: nutritional needs of the school-age child are dependent on activity level. A school-age child requires a balanced diet. A school-age child also likes to be included in meal planning and preparation.
Adolescents- 12 to 20: growth spurts are associated with adolescents. Fast foods make maintaining healthy nutrition difficult. The adolescent requires 2,000-3,000 kcal/day.
Health promotion and the infant: assessment findings- Posterior fontanel closes at 2-3 months.
Gains 0.7kg per month for first 6 months. And 0.3 kg per month the last 6 months. Grows 2.5 cm per month the first 6 months. Grows 1.25 cm per month the last 6 months. Want bilirubin <8. Will have 6-8 teeth by the end of the first year.
Hospitalization and illness: adolescent- Level of understanding is they continue to develop the ability to understand cause and effect and the severity of illness perceptions based on the degree of body-image changes. The impact of hospitalization is development of body-image disturbance, attempt to maintain composure and embarrassed about losing control, experience feelings of isolation from peers, worries about outcome and impact on school activities, may not be compliant with treatments and medication regimen if it makes the adolescent appear different from his peer group. Some interventions are provide factual information, include the adolescent in the planning of care to relieve feelings of powerlessness and lack of control, encourage contact with peer group.
Play: infant development- Birth to 3 months: visual and auditory stimuli, 3-6 months: noise making objects and soft toys, 6-9 months: teething toys and social interaction, 9-12 months: large blocks, toys that pop apart, and push and pull toys.
Immunizations: side effects of influenza- Guillain-Barre syndrome (ascending paralysis, weakness of lower extremities, difficulty breathing) local reaction and fever.
Pharmacological and parenteral therapies:

Acne: Providing client teaching- eat a balanced diet, healthy diet. Encourage sleep and rest and daily exercise, teach to wash the affected area with a mild cleanser once or twice daily and not to pick or squeeze comedones. Encourage frequent shampooing. Encourage family support of the child and encourage the family members to assist the child in coping with body image changes. Instruct the child to wear protective clothing and sunscreen when outside. Teach the child to avoid using tanning beds.
Teach the child and family about medications prescribed, especially side effects.
Congenital heart disease: reporting adverse effects of digoxin (lanoxin)- Administer it at an hour before or 2 hours after feedings. Give to the back and side of mouth. Give water following administration to prevent tooth decay if the child has teeth. If a dose is missed more than 4 hrs, withhold the dose and do not double the next dose. If the child vomits do not re-administer the dose.
Observe for signs of dgoxin toxicity (monitor pulse prior to medication administration for a slow pulse rate and/or irregular heartbeat. Observe for decreased appetite, nausea, and/or vomiting.
Asthma: evaluating medication use- Beta2-adrenergic agonists are bronchodilators that can be used for short term or long term control. Bronchospasms are relieved, histamine released is inhibited, ciliary motility is increased.
Physiological adaptation:
Cleft palate: post op care- keep child pain free to decrease crying and stress on repair. Keep repair sites clean. Allowed to be positioned on the abdomen in the immediate post op period. Maintain iv fluids until the child is able to eat and drink. Monitor packing, which is usually removed in 2-3 days.
Assist the child to breathe by facilitating upright position. Avoid using objects for feeding that could harm cleft palate repair, such as forks. Avoid placing objects such as tongue depressor or pacifier in the childs mouth after cleft palate repair. The child be discharged on a soft diet. Child may require restraints for 4-6 weeks.
Dermatitis: maintaining skin integrity- diaper dermatitis- promptly remove diaper. Clean urine off infant with nonsoap cleanser. Clean feces off with warm water and mild soap. Expose affected area to air. Use superabsorbent diapers. Apply a skin barrier such as zinc oxide. Do not wash off with each diaper change. Use of cornstarch may reduce friction between diaper and skin. Contact dermatitis- rinse area exposed to poisonous plants with cold water. If outdoors the child can go into a body of water with his clothes still on. Remove all clothing that has come into contact with the plant and wash in hot water and detergent. Encourage the child not to scratch skin and to prevent secondary infection.
?Gastrointestinal structural disorders: post op colostomy care-
Oxygen and inhalation therapy: suctioning- catheters should be one half size in the diameter of the childs trach tube, advance the catheter to the end of the trach tube, or no more than 0.5 cm beyond the end, suction pressure for infants and child ranges from 60-100 mm hg, and 40-60 mm hg for infants who are premature. Suction should take no longer than 5 sec. it is no longer the standard of practice to instill sterile saline into the trach tube prior to suctioning.

Seizures: emergency treatment- Diazepam(valium) may be given rectally, or lorazepam(ativan) may be given during seizure activity. Perform suctioning if needed and give oxygen if necessary, reorient and calm the child.
Strabismus: evaluating client understanding of management-
Acute gastrointestinal disorders: diarrhea- may be mild to severe, acute or chronic and may result mild to severe dehydration. Acute diarrhea may follow secondary to an upper respiratory or urinary tract infection or antibiotic use. Acute infectious diarrhea is a result of various bacterial, viral, and/or parasitic infections. The onset of gastroenteritis is often abrupt with rapid loss of fluids and electrolytes from persistent vomiting and diarrhea. Chronic diarrhea is related to chronic conditions
(malabsorption syndrome, lactose intolerance, food allergies, and inflammatory bowel disease).
I&O’s.
Congenital heart disease: nutritional management- perform daily weights and keep track of
Diabetes mellitus: emergency treatment-
Juvenile idiopathic arthritis: pain management- regularly evaluate the child’s pain. Splint knees, wrists and hands for sleep to decrease pain and prevent flexion deformities. Provide a firm mattress and discourage use of pillows under the knees. NSAIDs is the pain med of choice to control pain and inflammation and take with food. Use aspirin frequently. Methotrexate is used when NSAID’s don’t work.
HIV/AIDS: candidiasis- its an oral bacterial infection.
Infectious mononucleosis: expected findings- headache, malaise, fatigue, loss of appetite, puffy eyes, fever, sore throat, cervical adenopathy, splenomegaly, tender upper abdomen, palatne petechiae, pharyngitis/tonsillitis exudate, diagnostic blood tests to include: mono spot blood smear for heterophile antibodies, which are specific for disease;antibodies present within 1 week of symptoms, will peak in 2-5 weeks, and may be present for 1 year. WBC often elevated, atypical lymphocytes detected, possible liver enzymes elevation (AST,ALT).
Skin infections: tinea corporis (fungal)-ringworm- circular red patches, clearing beginning in the middle of the patches, then proceeding to the edges, usually not bilateral. Child may need to be on oral griseofulvin for several months. May use topicaly antifungal meds that are appropriate for the affected area. Apply 1 inch past the edge of the lesion and continue treatment for 1-2 weeks after resolution.
Burns: emergency interventions- stop the burning process. Remove clothing and jewelry that might conduct heat. Position the child horizontally to prevent flames from rising to the head. Flush chemical burns with large amounts of water. Assess and maintain ABC’s. Cover the burn with clean cloth to prevent contamination and hypothermia. Provide warmth. If necessary bring child to the healthcare facility for medical care.

Head injury: priority actions- maintain patent airway. Prepare for mechanical ventilation. Keep suction and oxygen at bedside for emergency use. Maintain stability of neck and spine until radiologic evidence indicates that neck and spine are not injured. Elevate head of bed for 30 degrees to avoid extreme flexion or extension. Maintain head in midline neutral position to reduce ICP and to promote venous drainage. Frequently assess and report changes as frequently as 15 minutes. Assess: vital signs and pulse ox, neuro status, papillary response, motor activity, verbal responses, and sensory perception.
Pediatric emergencies: anaphylaxis-
Burns: identifying degree of injury-
Gastrointestinal structural disorders: intussusception- is the telescoping of the intestine over itself. This usually occurs in infants and young children up to age 3, but is most common between 5-9 months of age. Is more common in boys and in children with cystic fibrosis. The etiology of intussusception is usually unknown; however, it sometimes occurs after a viral infection.
Head injury: assessing intracranial pressure- assess resp with breath sounds and o2 sat. assess
LOC, change in LOC are the earliest indications of neuro detioration. Assess site of injury for bleeding.
Identify alcohol or drugs use at time of injury. Assess amnesia before and after injury. Observe for CSF leakage from the nose and ears (halo sign- yellow stain surrounded by blood, test positive for glucose).
Changes in behavior- irritability, restlessness, agitation. Cushings reflex (severe hypertension with a widened pulse pressure and bradycardia)-late sign of increased ICP. Assess papillary changes, seizures.
Assess for signs of infection. Perform Glasgow coma scale rating 15 normal and 3 deep coma.
Mental Health ATI unknown Form
1.
Utilize the nursing process in the delivery of nursing care to individuals, families and groups.
a.
Identify two strategies for changing the caregiver’s behavior toward the elderly client.
To help prevent the caregiver looking like he or she may not care they can express warmth and concern towards the patients welfare. So I walked around, I asked how they felt. I said great job as one gentleman was using his fork to eat which was obviously a task for him. Before I took their vitals I would also ask how they felt today or if they wanted anything to drink too.
It’s also important for the caregiver to keep their health status good. I am allergic to cats and I get itchy skin and red eyes. I asked my instructor what to do about it and he said take
Benadryl. By doing so I was able to perform my duties and fully participate in the activities with less worry about sneezing on my patients. b.
Identify methodology used in diagnosis of mental problems of the aged individual.

When a person is placed in a nursing home they are screened for several problems such as depression, anxiety, or panic disorders. What I noticed about the methodology of assessing and diagnosing through the nurse was to first make treatment around main problem no matter what encounter it was that brought him/her there. The nurse at Circle of Friends had an ongoing diagnosis process with certain patients because their mental disorders wear always fluctuating.
The lady who was in the manic stage that one day is a good example. Her main concern was to make sure she didn’t get hurt by other people by bugging them. When she is not manic, she told me she is quiet and does not participate in activities. That causes a change in implementation to ensure a healthy cognitive state. This is because we evaluated her in a different mental status. c.
List general biophysiologic changes in aging.
Generally, with aging the body’s systems and ability to function will decrease. This increases adverse drug effects either due to pharmacodynamics or pharmacokinetics. At Circle of
Friends, I was taking the pulse of an elderly African-American female who was very thin and had some sort of Dementia.
The nurse said they were not sure what caused it either and explained to me that she had what was called psuedodementia since it mimicked dementia or they weren’t sure of its origin. It was interesting to me but that’s beside the point. She had a radial pulse of 42! We later found out that she was on some new medication that could cause bradycardia and the nurse called it in to the doctor. d.
Identify personality characteristics in aged individuals and their family.
Personality characteristics that I saw in the elderly included, depression, fatigue, and withdrawal. In the dining hall many people were asleep at their table or sitting silently to themselves. The woman, who told me that she felt like nuisance because she has to ask for food, is sort displaying an inappropriate guilt feel. I Think this personality characteristic hovers around depression and I know this is at large with the elderly
Although, one particular nice lady who I sat down with while she ate breakfast was a talker! As soon as she found out that I was a nursing student she went on and on how her sisters and relatives are nurses too. We had many stories to trade and it was an enjoyable time. e.
Express the importance of nursing diagnoses in planning care of the elderly individual and their family.
Nursing diagnoses are important because interventions are designed around them so there can be a plan of action written for all to follow focused on problems of the elderly and their family. When a patient is admitted to a nursing home there are care plans written that focuses on

the problems of that particular person and family. I did not see this in clinical but I did learn this in class.
At Circle of Friends there wear many patients with some form of dementia. So it was important that we stimulated their minds and engaged them in active games. I read out loud and asked for their opinions, and worked on a simple puzzle with another person.
2.
Demonstrate the development of specific behaviors related to professional roles and specifics of care in the delivery of safe and comprehensive nursing care: a.
Discuss how the caregiver’s value system will impact caring for the elderly client.
During my clinical stay at Circle of Friends, the head nurse said we value to the importance of education for families and the patients themselves. One man at the facility needed his medications twenty minutes after breakfast, so I watched the clock and made sure the assistants knew what time that was. I personally value the priority of proper medication administration because that is a simple task with great benefits to their health and increase the therapeutic effects of the drug. Not completely sure which drug it was, but was needed shortly after breakfast. He did not want to eat his food unless I kept reminding him to take bites and sips of his water. Another example relating to this is the caregiver valuing the patients? nutrition
.
b.
Discuss how attitudes towards one own aging will affect attitudes toward the elderly peers.
A Stereotypical attitude towards aging is very prevalent around the world. At Prairie Winds we played cards with a few of the residents there. A CNA was helping an elderly man with which card he should lay down. He didn’t want to play this particular card because he wanted to use his strategy but the CNA persisted him to play that card because she thought it was the best option for him. He played it and lost that round but that is beside the point.
I perceive that her attitude towards aging and her own is that when you get older you become dumber and when you are younger you are smarter than the elderly. Since she felt that she was younger and wittier she wanted to decide for him. From an observers point of view it was making him look a little incompetent and older than he really was. c.
Develop a plan of care to promote change in an older individual?s health status.
To change the health status of an elderly patient we can lower the blood pressure, help in range of motion, and neurocognitive function, by promoting exercise and mental activities. The patient can walk around the facility for exercise or perform stretching movements helping in balancing and maintain joint flexibility. At the Circle of Friends, I was asked to assist an elderly lady while she walked around on her own. No one asked her to so I was sort of confused why,

but now I get it. If she is already performing that aspect on her own we don’t need to tell her to stop. Encouraging her to walk around is promoting that behavior, and by this weight bearing exercise it helps prevent osteoporosis. The specific ADL I assisted her was with transferring her from the recliner to standing. d.
Discuss differences and similarities between acute and long-term models of health care delivery.
Acute care is when the person is in the hospital and long term is the nursing home or assistive living like the Prairie Winds, which is their home. I guess Circle of Friends would be acute care too even though not much medical interventions and planning happen but a nurse had me take vitals and assist with eating.
3.
Analyze current research findings for application to nursing practice: a.
Describe biological and psychosocial theories of aging.
Biologic theories of aging suggest problems in cell division, mutations, free radicals or they just wear out and quit reproducing. During my clinical time at Prairie Winds, there was a man with perhaps advanced lung cancer which could be from smoking or free radicals.
Psychosocial theories are formed around human development such as Maslow’s Hierarchy were you have to complete one level before going to the next level. Since I really don’t know anything about him, I just observed him for a while and Eric Erikson’s Integrity v.s. Despair makes sense here. Same with this particular man and at several of my clinicals there are people sitting around just starring at the floor, which I would consider despair. b.
Discuss families in later life and the relationship to theories of aging.
In class we discussed the sandwich generation where the adult children were having to take care of their parents and their children or grandchildren.
What I heard at clinical though from an elderly woman, is that her family visits once a month. Visits tend become less frequent and seem to only pertain to holidays. When I was at clinicals I saw some kids and couple other visitors. My guess is that it was for Easter. c.
Discuss the importance of research related to the older client.
Research in elderly pathophysiology is developing medications and finding therapeutic ranges that will help them maintain their health and better treat their disease. As I sat down with an elderly male as he ate, we talked about his medications. Well he only told me how much he hates taking so many pills throughout the day. I told him that it has to be taken at certain times to avoid certain reactions or side effects.

d.
Review current research related to the older adult.
Same as 3c e.
Identify problem areas nurses need to study to improve the quality of life for the elderly person.
One problem that we learned in class that could improve the elderly quality of life is spirituality. Personally I’m a Catholic and always pray before eating but when I’m in public places I don’t. I thought it was a little embarrassing when this elderly woman who asked me to bow my head while she prayed. Maybe if nurses learn more about this subject we may feel less hesitant about religion and faith and express it better as we work. f.
Define aging generally and in terms of social, psychological, functional and biological aspects.
One of the psychological theories is the disengagement theory where the elderly step back and the younger people take over. Sociologic aging theories are based on what the elderly is expected to do according to their chronologic age. Functional aging is how well the person is able to do their activities of daily living not just by their age and biologic aging is predetermined or changed by damaging a cell.
One client that I was taking vitals on had two jackets on. Her hypothalamus, which conducts temperature control, shows a decline in function. I asked her are you cold and she said no but insisted to have her coat put back on after I took the blood pressure cuff off. Her skin was tough and had poor tugor so it may be partly to that too. g.
Reply to questions frequently asked about aging. h.
Discuss problems associated with functional versus chronological definitions of aging.
Chronological aging is based on age. To retire you have to be 65 years old but many are not retiring because they are still functioning well. With functional aging is based on how well you can still perform activities of daily living. Some of the older people are still high functioning and could live at home or in assistive living but I noticed a client at Circle of Friends who was around 60 and he had a lot of trouble grasping his cup. An elderly woman there, who had to be at least 80, was walking around all over the place and grabbing everything, singing, and shaking random people’s hands. She was in a manic like state at that time and the nurse said most of the time she is quiet and withdrawn but this happens.

4.
Participate in the provision and coordination of health care through collaborative relationships with other health professionals.
a.
Describe the collaborative approach of a multidisciplinary team effort in meeting the needs of the elderly individual and their family.
I sat in on a care plan meeting where the nurse, director of the nursing home, and a CNA were discussing the current health of the woman who was having an adverse reaction to her medication. They discussed if the patient was safe enough to stay here or needed to go to the hospital. They nurse called this into the doctor and I believe he told her to administer something to treat the symptom because the woman took a pill. The final decision was that she was stable enough to stay there for the day. b.
Discuss different programs or services that are available for the elderly individuals, families and groups.
In a nursing home there are social services, dietary, physical therapy and activities that are available to the patient and families. There are also support groups for Alzhiemers, and care givers. In this area there is an agency of aging, Cumberland Associates, screen the elderly in this area to get help they need. There are meals on wheels for those that live at home and home health care with visiting nurses, bath aids, and transportation services.
I saw a physical therapy service that was given by a physical therapist at Prairie Winds.
Everybody sat in a chair and made a circle around him. The clients had this giant rubber band that was pink and it wrapped around their feet and over their thighs. I wanted to stay and watch but breakfast was over and we headed upstairs. c.
Discuss methods by which the nurse can act as an advocate for the elderly individual and family.
On the video with the nurse advocated and her patient that dies and the doctor wanted to keep her alive because she was in a research group. She wanted to be DNR and told the nurse and when she died to nurse had to fight for her wishes. d.
Describe the characteristics of an ideal health care delivery system.
Individualized physical therapy that is tapered specifically for the patient’s sickness. In
Loyd’s room I noticed a packet of ROM exercises to do on his free time. I asked him how often he does the stretches and he said he never really does.
Ideal health care would have timely medication administration. After assisting Loyd back up into his room he remembers that he needs to take his pills and asked me to help administer them. He took a Ca chewable tablet, and two other ones, but I still don’t know why it seems to be

within 20 min of breakfast. Gloria who took care of medication didn’t start giving meds until they were back in their rooms too. Timeliness, food interactions, and patient adherence to regime is very important with drugs.
5.
Utilize professional values with ethical, moral, and legal aspects into nursing practice.
a.
Identify two (2) strategies for changing the caregiver’s behavior toward the elderly client. b.
Identify attributes of elderly people that may elicit negative responses from nursing personnel.
During my clinical time at Windsor Court I work with an elderly man named Loyd. He is known to be grumpy all hours of the day. I was told to make sure he brushes his teeth, wear his hearing aid, and shave. Bonnie, who was one of the nurses there, told me I have to be stern with him and stand in front of him as he does it. They weren’t joking he refused to shower and shave and I in turn had to become a little more strict on my verbal commands.
Another example I saw that same day involves the loss of hearing in the elderly. As the local residents walked into the dining hall for breakfast, I said good morning to the majority of them. The majority response was….no response. This made me feel ignored or disliked as they gave me the blank stares. That could result in negative responses because now we feel hurt inside.
6.
Demonstrate caring through behaviors reflecting commitment to well-being of individuals, families and groups.
a.
Demonstrate caring through a willing nature toward the well-being of the elderly client, families and groups
The CNAs and I demonstrated caring through a willing nature by getting a group of elderly patients together to play cards instead of sitting in their room. This will help ease them form thinking of sad things or feeling depressed. Also when family visitors were eating with their loved ones, they were shown a caring attitude by being offered coffee and food while they talked.
Also, an older gentleman left his medication dispenser at his table after breakfast. The
CNAs asked around who he was and consulted among themselves where he lived. They immediately took the pills up to his room after the frenzy was over and continued to monitor the other people. b.
Discuss losses of aging and their impact on holistic nursing care of the elderly individual and their family.

Losses that follow aging besides the physiology aspect are the losses of loved ones. An elderly woman was telling me how her husband died two years ago leaving her alone and feeling like there is no more purpose in life. So her children try their best to visit a few times a month but they live three hours away. The person who took her food orders did a good job asking caring questions. The worker asked her if she would like anything else even if it’s not on the menu. This shows a great deal of compassion.
This affects nursing care in the terms of non-drug treatment for depression. The woman who lost her husband can get companionship through intrapersonal relationships with sympathetic nurses or workers, who express kindness and understanding. That’s very therapeutic for helping depression. Communication and relationships are very important in holistic nursing. c.
Describe how sensory deprivation (environment) could result in feelings of paranoia in the elderly individual.
Sensory deprivation such as hearing loss, lead this elderly woman to say no thanks when the worker asked her what she wanted to eat. The elderly lady then told me that she was fed up with this place because she feels like she can’t eat since it is such a big problem. In all actuality it’s not, just poor communication led her to feel that way.
She didn’t go hungry though; I repeated what the worker said out loud for her and made sure my lips really pronounced the words. Even having to be spoken to in that way may make someone feel different too. d.
Identify coping methods utilized by the elderly individuals and their families in dealing with stress.
Betty, an elderly client I met at Prairie Winds, dealt with her stress by whistling to her birds that she owns. She said she likes to talk with them when she is feeling alone or wants to get away from the day. Owning pets or something that can be interacted with is a good way to manage stress. Playing cards with us would be another way they deal with stress too.
Coping methods that are used in families are by placing their elder loved ones into care facilities due to emotional stress with the person’s declining health. I saw this at Circle of
Friends and at Prairie Winds. Except at Circle of Friends, their visit only last for a portion of the day instead of living at the facility.