ATI Med Surg notes
Ch 1 Health, Wellness, Illness
modifiable variables: smoking, nutrition, exercise, health education and awareness, sexual practices no... [Show More] nmodifiable variables: cant change = age, gender, developmental level, genetics
Ch 2: Emergency nursing principles and management emergency nursing – triage: based on acuity
emergent: life threatening
urgent: not life threatening
non urgent: can wait for extended time w/o issues
In mass casualty event, tag diff patients – class 1 red tag, class 2 yellow tag, class 3 green tag, class 4 black tag
class 1: red tag immediate threat to life ex. respiratory issues, cardiovascular issues like chest pain like a heart attack coming on
class 2: yellow tag are major injuries that require immediate treatment but maybe aren't life-threatening ex. major fracture
class 3: green tag is indicates a minor injury that does not require immediate attention ex. abrasion, minor laceration so they need to be seen they're taken care of at some point but it's definitely not a priority in a mass casualty event
class 4: black tag when theyre expected to die ex. penetrating head wound - you know you're you're allowing them to die because then unfortunately if you provide your attention to them they are still likely to die so you're going to divert your attention to those red tag and then to the yellow tag pts patient is not really going to come back
PRIORITIES aka ABCDE:
Airway: secure airway! head-tilt chin-lift maneuver unless fracture in cervical spine
Breathing
Circulation
Disability: level of consciousness ex. using Glascow Coma Scale
Exposure: ex. hypothermia then removes wet clothing, give blanket, increase room temp, warm the IV fluids Poisoning: if accidental or purposeful poisoning, then activated charcoal gastric lavage whole bowel irrigation DO NOT induce vomiting DO NOT give syrup of ipecac which produces vomiting Call rapid response team when patient is rapidly declining
Cardiac emergencies: V-fib or V-tach then initiate BLS or CPR and establish IV access. epinephrine to tx. other meds given p15 (Amiodarone, Lidocaine, Magnesium, Procainamide, Vasopressin – most are antiarrhythmics) p 16 other meds (alpha 1 receptors, beta 1, beta 2, dopamine receptors)
alpha 1: skin, mucous membranes, veins vasoconstrict
meds help congestion, superficial bleeding, raise bp
beta 1: stimulate heart – activation causes increase HR to treat AV block and cardiac arrest
beta 2: heart and lungs – activation causes bronchodilation (use for asthma) and relaxation of uterine smooth muscle Dopamine: activation causes renal blood vessels to dilate – use for shock and HF
if given more triggers beta 1
if given more triggers beta 1 and alpha 1
S/E: dysrhythmias, angina Epinephrine: triggers alpha 1, beta 1, beta 2; vasoconstriction so increases bp, HR, bronchodilation S/E: hypertensive crisis, dysrhythmias, angina Dobutamine: triggers beta 1 so inc HR – use for HF
Ch 3 Neurologic Diagnostic Procedures
Cerebral angiogram: allows the doctor to visualize the blood vessels up in the brain usually insert the catheter either in the groin or the neck then thread your way up there
use contrast dye (with contrast dye, always check if pt is pregnant bc toxic; allergies to iodine or shellfish; renal function, BUN, creatinine to see if elevated bc if elevated and renal fxn compromised then dye wont be excreted well and can build to toxic levels; pt on anticoagulant bc bleeding risk can increase so
refrain from eating or drinking 4-6hrs prior to procedure and after procedure monitor for bleeding; check insertion site frequently; check pulses distally from insertion site and make sure circulation is good)
CT scan: contrast dye
EEG: detect seizures or test for sleep disorders and behavioral changes –
do not have to fast prior
tell pts to wash hair prior
be sleep deprived bc the stress can actually trigger seizures or other abnormal brain activity.
might also expose pts to bright flashing lights or ask them to hyperventilate in order to create activity in brain
1 hour
Glascow Coma Scale: determine LOC
highest score 15 anything less than 8 is associated with severe head injury and coma
eye opening (1-4), verbal response, motor response
4 is your best score eyes open spontaneously; 3 if your eyes open to voice commands and you get a 2 if it opens to pain and you get a 1 if you don't open your eyes at all
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verbal response highest level is 5 conversation is coherent and oriented you get a 4 if conversation is incoherent and disoriented you get a 3 if words are spoken but inappropriately so they're kind of like garbage and then you get a 2 if sounds are made but there are no words at all and then you get a 1 if they don't have any vocalization at all
motor response highest score 6 if they follow your commands they get a 5 if they have a local reaction to pain and they get a 4 if there is a general kind of withdrawal from pain 3 is for decorticate posturing and then 2 is for decerebrate posturing and then 1 is for like no motor response at all
decorticate: you're gonna have adduction of the arms and then flexion of the elbows and wrist - flexing those elbows and wrist kind of towards your core which is how I remember that as decorticate
decerebrate: extension of your elbows and wrists out versus the flexing
inter-cranial pressure and ICP monitoring: invasive, for scores 8 and below
high risk of infection with devices monitoring ICP
devices which are placed by neurosurgeon are interventricular catherer, subarachnoid screw or bolt, epidural or subdural sensor
increased ICP: irritability, severe headache, decreased LOC, issues with pupil response, Cheyne-Stokes breathing, abnormal posturing (decorticate, decerebrate)
NORMAL ICP 10-15mmHg
lumbar puncture: withdraw a small amount of cerebral spinal fluid to test for certain infections and diseases like meningitis and syphilis
empty bladder
lay on side like a cannonball
apply local anesthetic then insert needle - monitor puncture site
after procedure, have pt lay flat for several hours
if no clotting occurs to seal the dura puncture site then cerebral spinal fluid may leak and pt may get spinal headache and need epidural blood patch to seal hole
give opioids/pain meds increase fluid intake
MRI: may use contrast dye but assess for shellfish allergy; remove jewelry; check for claustrophobia (may need sedation); check for implants containing metal such as pacemaker orthopedic joints artificial heart valves inner uterine devices or aneurism clips; give ear plugs
PET: nuclear medicine procedure that checks for tumor activity
rays: sometimes used with diagnosing neurological issues just bc fractures curvatures dislocations can damage neuro system
Ch 4 pain management [Show Less]
