Daily Journal Melissa Santos

NUR2811C

Journal entry #1 ATI 3-day review

Day one of the review session was very engaging and informative. The presenter, Mrs. Connie
Lindmeier, reviewed many topics which included, delegation, communication, client education, and
rescue medications among other topics. The review was very interactive as the presenter had us answer
many NCLEX style questions such as select all that apply, multiple choice, and drag and drop questions
which require higher order thinking. Throughout the review I was challenged to recall prior knowledge
and to apply test taking strategies. Personally, I benefited from practicing the select all that apply
questions as those have been the most challenging for me. As Mrs. Lindmeier reviewed, I used The
Comprehensive NCLEX-RN Review book to guide my learning and highlight the most important points of
the presentation. Additionally, I filled out the answers to the handouts provided, to serve as a
recollection guide while studying for the NCLEX exam. Day one concluded with an information session
regarding the next step in my preparation for the NCLEX, this was regarding Virtual ATI. This preparation
tool provides me with a coach and a personalized study plan to successfully pass the NCLEX.

Journal entry #2 ATI 3-day review

Day two of the review session focused on organ systems. One of the areas I had most difficulty
with was gastrointestinal disorders. The focused review really helped me to understand and remember
the medications that are administered if a patient has GERD, peptic ulcers, irritable bowel syndrome,
inflammatory bowel, or diverticular disease. As some medications are used in the treatment of more
than one disorder, I previously did not correctly identify all the medications in the treatment of Peptic
ulcers for example, antibiotics, prokinetic agents and antacids. Although I did identify that PPI’s
histamine blockers and mucosal protectants were used. The review was very helpful in helping me
categorize the medications with the diseases and create a chart which I could use to help me study more
effectively. Additionally, the presenter once again engaged the participants in polling questions and
NCLEX style questions, as well as challenging the class to properly complete skills. One example of an
ordered skill I reviewed was the proper steps to blood administration. This procedure requires the nurse
to keep safety as a top priority, proper administration is of utmost importance for all nurses to master
the skill. Overall, the review session today covered many of the more complex topics presented in the
NCLEX exam.

Journal Entry # 3 ATI Real Life Scenario-Myocardial Infarction (improvement needed)

The ATI Real Life scenario was a bit challenging but very educational. The case was based on a
54-year-old client, R.D. who experienced a myocardial infarction at home. Although I did demonstrate
evidence-based practice in many instances such as, identifying 911 should be called if the client’s chest
pain is not relieved within 5 minutes after nitroglycerin is administered, my overall score was
improvement needed. I worked through the scenario which began with the client demonstrating signs
and symptoms of myocardial infarction, then upon arrival at the emergency room, an ECG reviled ST-
segment elevation, thus confirming a STEMI had occurred. Consequently, the client had a left cardiac
catheterization done. Unfortunately, it was not identified prior, that the patient had a shellfish allergy
and developed an allergic reaction to the contrast dye used in the catheterization. At this point, I
demonstrated good clinical reasoning by contacting the HCP for an antihistamine prescription and to
report the possible allergic reaction. It was evident that the patient was not improving and anaphylaxis
was occurring, at this point another good clinical decision and intervention I decided for was to
administer epinephrine IV to promote bronchodilation, vasoconstriction, and maintenance of the blood
 Daily Journal Melissa Santos
NUR2811C

pressure and heart rate. Moreover, the content area that was my weakness was identifying
manifestations of cardiogenic shock. However, I was able to identify that the patient should be monitored
for decreased urine output as this is an adverse effect of norepinephrine which was administered for
unstable systolic blood pressure less than 90 mm Hg. My strength in the scenario was client education
regarding sodium restriction and the best dietary choices the client should make.

Journal entry #4 ATI Nurse Touch – The Leader case 1

The Leader case 1 followed Cynthia a newly licensed nurse. Throughout the scenario I had to
select the most appropriate actions and delegations. Delegation to members of the team is one of my
weakest areas. For instance, in the scenario I assigned a task to the AP that actually required making
nursing decisions and therefore it was not appropriate for the AP. Additionally the scenario had me make
selections regarding what the charge nurse should keep in mind when making assignments and I selected
that The National Council of State Boards of Nursing determines the scope of practice for RNs and LPNs,
however that is incorrect. Each state has a governing body that determines the scope of practice for RNs
and LPNs. I learned a lot from the scenario on the actions required by the Rn when being a leader vs a
follower. Additionally, I used good communication skills when interacting with other team members, and
correct actions when providing feedback. Lastly, my strongest point was estimating the time needed to
complete tasks and prioritizing care.

Journal entry #5 ATI Nurse Touch Leader case 2

The Leader case 2 detailed the unexpected fall of a postoperative patient, and the nurse’s actions
and responsibility. Mr. Adams was 3 days post total hip arthroplasty when he called for assistance out of
bed but, but no one attended to him in a timely manner, so he got up from bed and fell after becoming
dizzy. My role was to identify the characteristics of an emotionally intelligent leader, identify what
information is needed to complete an incident report, and how to identify sentinel events. I was able to
select appropriate actions throughout the scenario as well as answer all questions correctly. The case was
also helpful in reviewing the role of the UAP and RN to better understand the responsibilities of each
when delegating tasks. The patient was okay and the UAP received a verbal warning as the first step in
progressive discipline to prevent further incidents regarding fall prevention and safety. Overall, my
takeaway was the importance of responding in a timely manner when patient’s request assistance,
especially when they’ve been instructed to do so, and the process of completing an incident report. In
addition to working through the case study, I met with my clinical instructor and he clarified several
questions regarding ATI testing and our remediation plans. I am working daily on my remediation so that
I can be successful in my exit exam.

Journal entry #6 November 15 ATI 3 Day Review

Day three of the review was very informative. Today’s session covered several topics including
mental health, labor and delivery, and pediatrics. Personally, I benefited from the mental health review
the most. I now have a better understanding of the differences between clinical manifestations of
intoxication vs withdrawal for clients on opioids, alcohol, or stimulants. Additionally, we were provided
with additional resources to prepare for exams including the Leadership exam I will be taking tomorrow.
In preparation, I will make sure to do the practice questions and use all the resources I’ve been provided
with. I’m feeling anxious due to the pressure to perform well in the ATI exams as well as the NCLEX.
However, I also feel confident because of the effort I am putting in, as well as the educational tools and
resources my professors and the school of nursing has provided me with. In summary, the 3-day ATI
 Daily Journal Melissa Santos
NUR2811C

review was very concise yet detailed. It was extremely helpful in jogging my memory regarding concepts I
learned earlier in the program, and in reviewing test taking skills and strategies.

Journal entry #7 ATI Real Life Scenario COPD

The case began with the admission of a client with exacerbation of COPD. At first, I was able to
properly identify the components of SBAR report, correct order of administering IV bolus, and correct
medication dose calculation. The patient received an infusion of ceftriaxone and shortly after, the
patient’s daughter reported the patient had dry itchy skin. Unfortunately, at this point I did not realize this
could be an allergic reaction to the medication so I replied that I would go see the patient in a few
minutes. Because of my decision the case closed out deeming I had made a detrimental decision. I was
able to reconsider my actions and start the case over. This time, I made good clinical decisions that
helped improve the patient’s outcome. These actions included, attending to the patient right away,
stopping the infusion, assessed the chest tube and drainage system, identified risk factors for skin
breakdown and lastly included pulmonary rehabilitation in the patient’s discharge. The case was
challenging at first but once I was able to identify my weak areas, and correct my actions, I felt more
confident in my clinical decision making. Moreover, today during the preconference class meeting, several
of my classmates presented on various topics. The presentation that stood out to me most was on
communication. Particularly the acceptable forms of expressing and communicating ideas online,
referred to as “netiquette”. As a future nurse it is part of my role to be professional and communicate in
the most effective and proper form. Therefore, this presentation was very relevant and informative.

Journal entry #8 ATI Real Life Scenario Kidney Disease

Today’s case was focused in a 60 y/o male with renal failure who also had complication of atrial
fibrillation and a stage 3 diabetic ulcer. As I have completed a few Real-Life scenario cases, I am starting to
feel more confident with my decision making and clinical reasoning skills. My performance with this case
shows that I have substantial understanding of kidney disease including identifying manifestations,
monitoring, and incorporating proper care. The most challenging part of the case was determining which
was the most appropriate nursing intervention for the client with low urine output. Initially I was going to
select “obtain an order for urinary catheterization”, but then I realized that performing a bladder scan
first, is less invasive and the most suitable initial action. Lastly, this case required that I constantly check
the EMR to read lab values, diagnostic results, and physician orders. There was quiet a bit of detailed
information that required a thorough analysis before implementing nursing interventions. I am really
learning a lot from the scenarios especially proper delegation and communication using SBAR.

Journal #9 ATI Nurse Touch Leader case 3

Coincidentally, I mentioned in my previous journal how the scenarios had helped me improve my
SBAR communication; this case was primarily based on SBAR and how to effectively use the
communication tool. The case demonstrated a physician upset regarding the report he received from a
nurse. I had to select the appropriate actions and skills needed to de-escalate and deal with conflict.
Active listening and collaboration played a key role in solving the conflict. I made correct decisions, such
as identifying that SBAR communication contributes to client safety. Additionally, the case highlighted
different types of leadership styles which included bureaucratic, autocratic, and Laissez-fair. My task was
to differentiate between the characteristics of each. I was able to answer all the questions in the case
correctly and scored 100%. From the first case to now I feel that I have improved in my decision making
 Daily Journal Melissa Santos
NUR2811C

and analyzing. I have also learned to be thorough when reading the questions and take my time to
answer.

Journal #10 ATI Nurse Touch Leader case 4

The Leader case four focused on quality improvement. The unit in the scenario is experiencing an
increased rate of falls. Using the quality improvement process and nursing-sensitive indicators, I was able
to successfully navigate through the case. In addition, I identified the root-cause analysis as being useful
in the investigation of the increase in falls. I was able to answer all the questions correctly and navigate
through the case successfully. I attribute this to prior knowledge I had in addition to the information
discussed in the videos. Because Baptist Hospital is magnet recognized, I had learned in my student nurse
partner role, a bit about quality improvement and the role the nurses play in collecting data. I feel that I
am acquiring a lot of knew knowledge regarding leadership and management through these interactive
scenarios. Prior to the ATI cases I had minimal understanding of the case manager’s role and leadership
responsibilities in general.

Journal #11 ATI Real Life scenario Urinary Tract Infection

Today I worked on the urinary tract infection case. By far, this was the most complex case I have
worked on. The 78 y/o female presented with symptoms of a urinary tract infection but experienced
several complications which included, fluid overload, adverse reaction to a medication, a fall which
caused a fracture, a pressure ulcer, and septicemia. It was challenging to navigate successfully through
the case but I took my time to analyze the questions and applied the prior knowledge I had learned about
focused assessments, signs and symptoms of allergic reactions, bucks traction, ulcer staging, and cardiac
symptoms of fluid overload. After completing this case I feel that I have learned a lot and gained
confidence in clinical decision making, but I need more practice with complex cases that include
unexpected complications that arise. Moreover, during pre-conference this morning, my professor spoke
about the important information to include on a resume to stand out and be more marketable. The
recommendations were very useful as I am currently updating my resume to align with my goal of being
hired soon as a registered nurse.

Journal #12 ATI Real Life Scenario Gastrointestinal Bleed

Today’s case followed a 36 y/o female with Chron’s disease, gastritis, and new ileostomy. I
reviewed and practiced the actions to take with adverse reactions to blood administration, medication
dosage calculation, and patient teaching. What I took from this scenario was the importance of nutrition
and stress management as it relates to improving or worsening the client’s condition. Additionally, the
case included thorough patient education and open communication which I believe is of up most
importance. Listening to the patient’s concerns can help the nurse support the patient and work together
to come up with solutions or a treatment plan. Overall, I performed well in the case although
gastrointestinal cases have been challenging in the past. The ATI exercises and videos have helped me
make the connection with my lectures and studies on various topics including ostomies and their proper
care.
 Daily Journal Melissa Santos
NUR2811C

Journal #13 ATI Nurse Touch Leader case 5

The Leader case 5 focused on clinical pathways, case management, and decision-making styles. I was not
familiar with the term “clinical pathways” prior to completing the case but the videos helped me
understand the concept. For example, I learned one-way nurses use clinical pathways is to help decrease
length of stay. Another term I did not know prior to this case was the “integrative” decision making style,
which involves analyzing large amounts of data to come up with different options. Once again, I achieved
a 100% score for following the correct steps and identifying the correct answers. I am proud to have
completed almost all of the cases with complete accuracy because I have put a lot of effort in reviewing
my leadership ATI practice book and have read about the concepts presented in the cases. I feel confident
that I have gained the skills and knowledge that will prepare me to be a safe and competent nurse who
uses clinical judgment and communication skills to collaborate with the interdisciplinary health team in
order to provide excellent care.