Med -Surg ATI Review study guide
Ch. 1 Health, Wellness, and Illness
• Variables
o Modifiable= can be changed, smoking, nutrition, health edu, sex
... [Show More] practices, exercise
o Non modifiable= sex, age, developmental level, genetics
Ch. 2 Emergency Nursing Principles and Management
• Triage
o Resuscitation= level one
o Emergent= level two
o Urgent= level 3
o Less urgent= level four
o Nonurgent= level five, non life threatening condition require simple eval and care management
• ABCDE
o Airway= maintain airway, head tilt/chin lift (do NOT perform if pt has spine injury do modified jaw
thrust maneuver), bag valve mask w/ 100% O2, nonrebreather w/ 100% O2 use for spontaneous
breathers
o Breathing
o Circulation
o Disability= loc
o Exposure= clothing
• Poisoning= use activated charcoal, gastric lavage (done w/I 1hr) aspiration
• Rapid response team= respond to emergency when pt has indications of rapid decline
• Cardiac emergency
o Vfib= defibrillate, CPR, admin IV antidysrhythmic (epi, amiodarone, lidocaine, magnesium sulfate)
o Vtach
• Epi= stimulate alpha 1 (vasoconstrict), beta 1 (increase hr), beta 2 (bronchodilate), good for superficial bleeding, increase bp, AV block and cardiac arrest and asthma
o s/e= htn crisis, dysrhythmias, angina
• Dopamine= renal blood vessel dilation, beta 1 increase hr, good for shock, hf
o s/e= dysrhythmias, angina
• Dobutamine= beta 1 increase hr, good for hr Ch. 3 Neurologic Diagnostic Procedures
• Cerebral angiography= visualization of cerebral blood vessels, assess blood flow within brain, id aneurysms
o Do NOT perform if pregnant, don’t eat food or fluids for 4-6hrs prior to procedure, assess for allergy
to shellfish or iodine b/c require use of contrast media, ask about anticoag, assess BUN and creatinine; monitor area for clotting after procedure
• CT= cross section image
• EEG= id seizure activity and sleep disorder
o Wash hair b/f procedure, be sleep deprived, expose to flashing lights, hyperventilate for 3-4 min
• Glasgow coma scale= determine loc, best score is 15, score less than 8 is associate w/ severe head injury and coma
o Eye open (E)
▪ 4= eye open spontaneously
▪ 3= eye open to sound
▪ 2= eye open to pain
▪ 1= eye does not open
o Verbal (V)
▪ 5= conversation is coherent and oriented
▪ 4= conversation is incoherent and disoriented
▪ 3= words are spoken but inappropriate
▪ 2= sound made
▪ 1= no sound
o Motor (M)
▪ 6= commands followed
▪ 5= local reaction to pain
▪ 4= general w/drawal to pain
▪ 3= decorticate posture (adduction of arms, flexion of elbows and wrists)
▪ 2= decerebrate posture (extension of elbows and wrists)
▪ 1= no motor response
• ICP monitoring= performed by neurosurgeon in operating room, used for GCS score of 8, complication of infection
o Intraventricular catheter
o Subarachnoid screw/bolt
o Epidural or subdural sensor
• Increased ICP (normal 10-15)= IRRITABILITY first sign, severe headache, decrease loc, dilated/ pinpoint pupils, altered breathing pattern (Cheyne-stokes), hyperventilation, apnea, abnormal posturing
• Lumbar puncture= w/draw CSF to diagnose MS, syphilis, meningitis, void b/f procedure, assume cannonball position, monitor puncture site, remain lying still on back after procedure
o Complication= headache from leaking csf, give opioids/pain meds, increase fluid intake
• MRI= remove jewelry, not claustrophobic, give earplugs
o w/ contrast dyes: assess for allergies for shellfish
o no jewelry, no metal implants (IUD, aneurysm clip, ortho joint, artificial heart valve, pacemaker)
• PET= brain injury, determine tumor activity or response to treatment
• X-ray= can reveal fracture or curvature Ch. 4 Pain Management
• Acute pain= protective, temporary, self limiting, resolves with tissue healing
• Chronic= last longer than 3 months, depression, fatigue, decreased level of function, disability
• Nociceptive= damage to or inflame of tissue, throbbing, aching, localized
o Somatic= bones, joints, muscles, skin, connective tissue
o Visceral= internal organs
• Neuropathic= abnormal or damaged pain nerves, phantom limb pain, diabetic neuropathy, shooting, burning, pins and needles; responds to antidepressants, antispasmodic, muscle relaxants
• Pain assessment= location, quality, measures/intensity/severity, timing/onset/duration, setting/ how it affects daily life, associated manifestations, aggravating/relieving factors
• Nonpharm pain management= tens, heat, cold, massage, relaxation, imagery
• Pharm management
o Nonopioid= mild-moderate pain, 4g apap, monitor for salicylism (tinnitus, vertigo, decreased hearing),
gi upset, bleeding
o Opioid= moderate-severe pain, around clock admin, cause constipation, hypotension, urinary retention, n/v, sedation, respiratory depression, have naloxone ready
Ch. 5 Meningitis
• Inflam of meninges, viral most common and resolves w/o treatment, bacterial is contagious w/ high mortality
• Hib vaccine and MCV4 vaccine, especially in college students
• Findings= excruciating constant headache, stiff neck, photophobia, fever and chills, n/v, altered loc, positive kernig sign (resistance and pain w/ extension of pt leg from flexed position) positive Brudzinski sign (flexion
of knee and hip w/ deliberate flexion of pt neck), tachy, seizure, red macular rash, irritable
• Diagnostics= csf analysis (cloudybacterial, clearviral, increased wbc, increased protein, decreased glucose in bacterial)
• Care= isolation precautions, droplet precautions until 24 hrs after antibiotics, decrease environmental stimuli, quiet environment, decrease bright light, bed rest hob 30 degrees, avoid coughing and sneezing, seizure precautions
• Meds= antibiotics, anticonvulsant, analgesics
• Complications
o Increased icp= monitor loc, pupillary changes, impaired eom
o Siadh= monitor for dilute blood and concentrated urine
o Septic emboli
Ch. 6 Seizures and Epilepsy
• Seizures= abrupt, abnormal, excessive uncontrolled electrical discharge of neurons w/I brain, altered loc, change in motor and sensory ability/ behavior
• Epilepsy= abnormal brain electrical activity w/ 2+ seizures, fever
• Risks= febrile state especially in children <2, head trauma, cerebral edema, infection, metabolic disorder (hypoglycemia or hyponatremia), brain tumor, hypoxia, w/drawal, fluid and electrolyte imbalances
• Triggers= excess stress, fatigue, excess caffeine, flashing lights
• Findings
o Generalized seizures= aura
o Tonic clonic seizure= tonic episode (stiffening of muscles), clonic episode (rhythmic jerking) postictal phase of confusion and sleepiness
o Tonic seizure= stiffening of muscle, increased muscle tone, loc
o Clonic seizure= muscle contract and relax
o Myoclonic seizure= brief jerking or stiffening of extremities
o Atonic= muscle tone is lost
o Complex partial seizure= lip smacking, picking at clothes, zone out
• Diagnostics= eeg id origin of seizure, mri, cat, csf analysis
• Care= provide privacy, move furniture away, patent airway, turn pt on side to decrease risk of aspiration, loosen restrictive clothing, don’t restrain, don’t open jaw, don’t use padded tongue blade, document onset and
duration of seizure, after seizure maintain in side lying position, check vitals, perform neuro check, allow rest, reorient and calm pt
• Meds= phenytoin, needs blood tests, cause gingival hyperplasia, avoid ocp b/c decreased effectiveness, avoid warfarin b/c decreased absorption
• Vagal nerve stimulator= device implanted in left chest wall, magnet over device at onset of seizure, avoid mri and ultrasound and microwaves
• Wear medical id
• Complications= status epilepticus which is repeated seizure activity w/I 30 min, airway, o2, est IV, ECG monitoring, pulse ox, admin diazepam or lorazepam push and IV phenytoin
Ch. 7 Parkinson’s Disease
• Characterized by tremor, muscle rigidity, bradykinesia, postural instability
• Caused by overstimulation of basal ganglia by Ach which occurs b/c degeneration of substantia nigra which results in decreased dopamine
• Manifestations= slow, shuffling gait, masklike expression, difficulty chewing and swallowing, drooling, difficulty w/ ADLs, mood swings, cognitive impairment
• Diagnostics= no definitive diagnostic procedure, based on manifestations
• Care= monitor swallowing and maintain adequate nutrition, thickened liquids, encourage exercise like yoga, ROM, slow down speed and reduce risk of injury, speak slow pause frequently and use alternate form of
communication
• Meds
o Levodopa= increase dopamine levels in basal ganglia, carbidopa combo
▪ Monitor for wearing offneed for medication holiday
o Anticholinergics (bromocriptine)= control tremor and rigidity
▪ Monitor for anticholinergic effects (dry mouth, constipation, urinary retention, confusion)
• Complications= aspiration pneumonia (always have nurse watch eating, sit in upright position and have suction ready) [Show Less]