ATI Capstone Content Review: Leadership and Community Health - Tips of the Week

Whew! It has been a busy term but here we are close to the finish line.

To help you prepare for your comprehensive final assessment, please be sure to read back through your pre-assignment quizzes and post-assessment assignments. Also, if there are any of your focused reviews that you have not had a chance to complete yet, please do so now to give you a boost with the topics you missed on your assessments.

To create a focused review, just log into the www.atitesting.com site, click on the ‘my results’ tab, then the ‘practice assessments’ tab. You will see ‘create’ next to your assessments:

Once you click on ‘create’, select all topics to review and then click on ‘create focused review’.

One last look at prioritization:

When prioritizing, remember the four orders:

1. Any immediate threats to safety (ABCs, Maslow)

2. Actual problems for which the client is requesting help

3. Actual or potential problems of which the client may not be aware

4. Actual or potential future problems

Let’s look at some examples:

Scenario #1

You receive report in the morning and are assigned the following clients. Prioritize the order in which you will assess these clients:

A client needing assistance with feeding due to hemiparesis.

A client on a ventilator with a PRN order for tracheal suctioning.

A client going to OR for an appendectomy at 0900.

A client needing reinforcement of teaching regarding self-administration of insulin.

Scenario #1 Key

The order of care should be as follows:

1. A client on a ventilator with a PRN order for tracheal suctioning should be seen 1st—ABCs and Safety!

2. A client going to OR for an appendectomy at 0900 should be seen 2nd to ensure that the procedure is started on time.

3. A client needing assistance with feeding due to hemiparesis can be seen 3rd as hunger and thirst come before teaching according to Maslow’s Hierarchy of Needs.

4. A client needing reinforcement of teaching regarding self-administration of insulin can be seen last.

Scenario #2

You receive report in the morning and are assigned the following clients. Prioritize the order in which you will assess these clients:

A client requesting discharge instructions because his ride home is waiting.

A client requesting pain medication.

A client who had an episode of urinary incontinence, resulting in urine on the floor next to the bed.

A client needing a dressing change for an infected wound.

Scenario #2 Key

The order of care should be as follows:

1. A client who had an episode of urinary incontinence, resulting in urine on the floor next to the bed.

2. A client requesting pain medication.

3. A client needing a dressing change for an infected wound.

4. A client requesting discharge instructions because his ride home is waiting.

Think Safety first!! The urine spill needs to be cleaned first to prevent an injury from someone slipping and falling. The pain medication should be given before completing the dressing change because the pain is acute, but the wound is already established. Once client care needs are addressed, then teaching can take place.

Scenario #3

You are the nurse on the day shift and the following events are occurring. Prioritize the order in which you would address these issues:

The Emergency Department is full and wants to give you a report on a patient being transferred to your unit.

A client is experiencing pallor, a heart rate of 42, and has a change in level of consciousness.

Lunch trays need to be passed out to your clients.

A family member of one of your client’s has a question to ask you.

Scenario #3 Key

• The client experiencing pallor, a heart rate of 42, and changes in the level of consciousness needs to be seen 1st as these symptoms indicate an emergency situation! Remember—ABCs and Safety 1st!!

The remaining tasks can be managed by collaboration and delegation:

• Ask another nurse to take report on the client being transferred from the Emergency Department. This nurse can also speak with the family that has the question to see if she can be of assistance while you deal with an emergency situation.
• Delegate the passing of the lunch trays to an Assistive Personnel.

Scenario #4

A trash can in a client’s bathroom is smoldering from a lit cigarette being thrown away. Prioritize the following nursing Actions:

Pull the fire alarm.

Get the fire extinguisher, pull the pin, aim at the base of the fire, and spray in a sweeping motion at the base of the fire.

Remove the client and any visitors from the room.

Close the door to the client’s room.

Scenario #4 Key

1. Remove the client and any visitors from the room.

2. Pull the fire alarm.

3. Close the door to the client’s room.

4. Get the fire extinguisher, pull the pin, aim at the base of the fire, and spray in a sweeping motion at the base of the fire.

Remember RACE!

Rescue the client and any visitors

Activate alarm

Confine the fire

Extinguish the fire

Scenario #5

The following clients arrive at the Emergency Department at the same time. Which order should be used when attending to these clients?

An elderly client who fell at home and is reporting hip pain.

An elderly client requesting a flu shot.

A middle-aged client who is unable to stop the bleeding after cutting her finger while cleaning up broken glass.

A young adult who was splashed in the face and chest with a chemical agent.

Scenario #5 Key

The clients should be attended to in the following order:

1. The young adult who was splashed in the face and chest with a chemical agent should be seen 1st due to the risk for serious injury related to the chemical agent.

2. The elderly client who fell at home and is reporting hip pain should be seen 2nd because of the potential for severe internal bleeding if the femur is fractured.

3. The middle-aged client with the bleeding finger should be seen 3rd because the severity of bleeding is not as serious as the potential bleeding secondary to a fractured hip.

4. The elderly client requesting a flu shot should be seen last.

Delegation Tips

• Nurses need to delegate fittingly and review that clients receive safe, quality care by the assigned personnel.
• The delegating nurse reviews the following factors when assigning tasks and nursing activities:  Individual client needs, facility policies, job descriptions, the specific state nurse practice act, and professional standards.
• RNs are responsible for the supervision of client care tasks delegated to licensed practical nurses (LPNs) and to assistive personnel (APs).
• The RN must be knowledgeable about the applicable state nurse practice act and regulations
• LPNs may delegate to other LPNs and AP.

Disaster Management Tips

Disaster is an event that causes human distress and anguish and demands resources that strain demand. 

Disasters can be man-made, naturally occurring and/or a combination of both.

Role of the Community Health Nurse in Disaster Management includes risk assessments.

• Risk assessment questions:

¨    What are the populations at risk within the community?

¨    Have there been previous disasters, natural or man-made?

¨    What size of an area or population is likely to be affected in a worst-case scenario?

¨    What is the community disaster plan?

¨    What kind of warning systems is in place?

¨    What types of disaster response teams are in place?

¨    What kinds of resource facilities are available in the event of a disaster?

¨    What types of evacuation measures will be needed?

¨    What types of environmental dangers may be involved?

Some final test taking tips for you too:

Use the Nursing Process

Use of the nursing process can be helpful. Always remember to “assess” first. Even if your knowledge of the topic is gray, you can still recognize that an answer choice is an “assessment” rather than an “intervention.”

Look for the layers

It would seem that life and death issues would be very easy to recognize in the text of a question. Unfortunately, they are usually not obvious. Instead, they are buried beneath words that, at first glance, seem to bear no clinical significance.

To prevent glancing over these words and missing the most critical or impending symptom, you will need to ask yourself, “What could be the possible clinical significance of each answer choice?”

Go with your First Instinct

Your first response to a question is usually correct. DO NOT change your answers unless you have a compelling reason for doing so.

Cause no Harm

When in doubt, always choose a nursing action that could result in harm to the client if not recognized. Even if you don’t know whether it is related to the stem, it is still a life-saving maneuver that, in all likelihood, is correct.

Use Your Presence

Seldom will a correct answer have the nurse physically leave the client. Choose an answer that keeps the nurse with the client.

Rule out an Answer Associated with Something Else

In some instances, rule out an option if you know it is associated with something else. For example, you may not know about the labs for Coumadin therapy, but you do know the labs for heparin and aspirin. Those labs can be eliminated because you are “using what you know.”

Pay attention to Communication Skills

Graduate Nurses have a tendency to use the same communication skills regardless of whether the client has anxiety, depression, schizophrenia, bipolar disorder, or obsessive-compulsive disorder. Everyone wants to use empathetic listening and everyone wants to be caring. Unfortunately, these are not therapeutic responses for all disorders and every situation. Keep it very simple and apply it correctly. Use what you know.

· Responses that are open-ended acknowledge the client’s feelings and seek more information. This approach is appropriate for the client with anxiety, a knowledge deficit, or depression.

· Reality orientation is important for the client with paranoia and delusions.

· Distraction is more appropriate for the client with obsessive-compulsive disorder.

Eighty percent of success is showing up.... Woody Allen.