1
ATI RN Adult Medical Surgical Proctored Exam
Comprehensive Study Notes - Detailed Chapter Reviews &
Key Points (2025-2026 Updated)
ATI Med Surg
Ch 1 Health, Wellness, Illness
modifiable variables: smoking, nutrition, exercise, health education and awareness, sexual practices
nonmodifiable 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
1. activated charcoal
2. gastric lavage
3. 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
o 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
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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
o 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
o decerebrate: extension of your elbows and wrists out versus the flexing
• inter-cranial pressure and ICP monitoring: invasive, for scores 8 and below
o high risk of infection with devices monitoring ICP
o devices which are placed by neurosurgeon are interventricular catherer, subarachnoid screw or bolt, epidural or subdural sensor
o increased ICP: irritability, severe headache, decreased LOC, issues with pupil response, Cheyne-Stokes breathing, abnormal posturing
(decorticate, decerebrate)
o 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
X- rays: sometimes used with diagnosing neurological issues just bc fractures curvatures dislocations can damage neuro system
Ch 4 pain management
acute pain: temporary, protective and usually resolves with tissue healing
chronic pain: past 6 months & associated with depression, fatigue, and decreased level of functioning
nociceptive pain: damage or inflammation of tissue, throbbing, aching, LOCALIZED
1. somatic: bones, joints, muscles, skin, connective tissue
2. visceral: internal organs or viscera
3. cutaneous: skin or subcutaneous tissue
neuropathic pain: abnormal or damaged pain nerves ex. diabetic neuropathy or phantom limb pain; shooting, burning, pins and needles
• treat with muscle relaxants, antidepressants, or antispasmodic agents
PQRST
• pain location
• quality: dull, sharp, throbbing
• radiating
• severity or intensity: pain scale 1-10
• timing: when did pain start, frequency, duration of pain
• setting: how it affects daily life, what are they doing when symptoms occur
• aggravating v relieving symptoms
nonpharmacological methods:
• imagery acupunctures, relaxation techniques such as transcutaneous electrical nerve stimulation, the application of heat or cold can help with pain,
therapeutic touch or massage
pharmacological methods: pain level 1-3 is mild; 4-6 moderate; 7-10 severe – mild or moderate then NSAIDs, aspirin, salicylates
• NSAIDs: meloxicam, ibuprofen, aspirin, celecoxib, diclofenac, indomethacin, ketoprofen, piroxicam, naproxen
• NSAIDs S/E: gastric upset, bleeding
o aspirin S/E: tinnitus, vertigo, decreased hearing, acid reflux, gastric upset, monitor bleeding time
• acetaminophen: watch for >4g hepatotoxicity – do not give additional Tylenol if taking Vicodin/hydrocodone or/and Percocet/oxycodone
opioids: moderate to severe pain – morphine, hydromorphone (Dilaudid), fentanyl, hydrocodone (Vicodin), oxycodone (Percocet), tramadol, meloxicam
• fentanyl mostly cancer pain or end of life pain
• around the clock on schedule as opposed to PRN – get ahead of pain!
• S/E: constipation, orthostatic hypotension, urinary retention, nausea, vomiting, sedation, respiratory depression
• Narcan/naloxone: reversal agent - when respirations get too low
Ch 5 meningitis
Meningitis: inflammation of the meninges which are membranes that surround the brain or spinal cord – viral or bacterial – viral more common and self resolved –
bacteria is deadly and more dangerous and contagious, requires administration of antibiotics to resolve
• Hib vaccine, meningococcal MCV4 vaccine (when teens – crowded dorm rooms are risk factor)
• symptoms: excruciating headache, stiff neck, photophobia (no bright lights!), fever and chills, N/V, altered level of consciousness, positive turning sign
• positive turning sign and positive brooding skin
• tachycardia, seizures, red macular rash, increased intracranial pressure (keep head of bed elevated 30deg, discourage coughing/sneezing/straining),
irritability
• CSF will look different depending if viral (clear) or bacterial (cloudy)
• increased WBC, elevated protein for both bacterial and viral
• bacterial meningitis: cloudy, decreased glucose
• interventions: droplet antibiotics for 24h then standard, quiet room, HOB 30 degrees, avoid coughing and sneezing, seizure precautions
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• meds: antiseizure, steroids, pain meds
• complications:
o SIADH (inappropriate antidiuretic hormone) – monitor for conentrated urine, dilute blood
o septic emboli
Ch 6 seizures
seizures: abrupt and abnormal uncontrolled electrical charge, decrease LOC, motor and sensory changes
epilepsy: abnormal brain electrical activity and more chronic
causes:
• fever esp under 2y
• genetic
• head trauma, cerebral edema, meningitis, hyponatremia, hypoglycemia, exposure to toxins, brain tumor, hypoxia, drug or alcohol withdrawal, fluid or
electrolyte imbalance
triggering factors: excessive stress, overwhelming fatigue, excess caffeine, flashing lights
types:
• generalized or tonic-clonic
o tonic: maybe aura then stiffening of muscles and loss of consciousness
o clonic: 1-2min + jerk movements of extremities back and forth
o after: confusion, sleepiness
• absent: school-aged children, loss of consciousness lasting a few seconds, spacing out or not paying attention, blank stare, smacking of the lips, eye
fluttering
• myoclonic: brief jerking and stiffening or extremities
• atonic: no tone, usually falling down bc no muscle tone
seizure nursing interventions:
• gently lower them to ground,
• put them on side to prevent aspiration,
• move furniture,
• loosen restrictive clothing,
• do NOT restrain client,
• do NOT put anything in their mouth (no tongue blade, no airway)
- document onset, duration keep in sideline position, check vitals, reorient patient, put on seizure precautions
- meds: antiepileptic (ex. Phenytoin)
- Phenytoin: check lab work bc oral gum overgrowth/gingival hyperplasia, dec effectiveness of oral contraception, warfarin/coumadin
- vagal nerve stimulator inserted (avoid MRI and microwave ovens)
- surgical removal of brain tissue that is causing seizure
- status epilepticus: complications of seizures – prolonged seizure that occurs over 30 minutes so protect airway, establish IV access, EKG monitoring, pulse ox –
Valium, Diazepam, Lorazepam, Phenytoin
Ch 7 Parkinsons disease
affects motor function in your body – balance between dopamine and acetylcholine and in Parkinsons the Ach is too high and dopamine is too low bc substantia nigra
degenerates – Ach overstimulates basal ganglia
symptoms: tremor, muscle rigidity, bradykinesia, postural instability, slow and shufling type of gait, mask like facial expression, difficulty chewing and swallowing
(careful with aspiration of drool), difficulty with ADLs, mood swings, cognitive impairment
no definitive diagnostic procedure but based on symptoms
nursing care: monitor swallowing, suction available, maintain adequate nutrition, thicken foods, encourage exercise and ROM, yoga, slow walk to reduce risk of
injury, speak slowly, alternate forms of communication
meds: Levodopa (to increase dopamine), Benztropine (anticholinergics to decrease Ach)
complications: pneumonia, aspiration (eat upright, suction equipment, thickening foods)
Ch 8 Alzheimer’s
after age 65
memory loss, personality changes, problems with judgement
risk factors: old age, exposure to metal or toxic waste, herpes virus, previous head injury, genetic predisposition
7 stages – know key points
1. no impairment
2. very mild cognitive decline – little forgetful
3. mild cognitive decline w/ short-term memory loss evident to loved ones
4. moderate cognitive decline w/ personality changes, obvious memory loss
5. moderately severe cognitive decline w/ ADLs help
6. severe cognitive decline w/ frequent episodes of fecal and urinary incontinence
7. very severe cognitive decline w/ loss of ability to speak and move, not able to eat w/o assistance, difficulty swallowing, speech unrecognizable – no
definitive diagnostic
nursing interventions: reorient client, simple calendar w/n clients view, simple short directions w/ consistency and repetition, avoid over stimulation and try to stick
to a routine including routine toilet schedule, you can change schedule but gradually
home safety: no scattered rugs, install door locks that cant be easily opened, good lighting, colored tape at the edge of stairs, remove clutter, mattress on floor
medicine: Donepezil (increases Ach by preventing breakdown, improve cognitive behavior and function)
Ch 9 Tumors
brain tumor: hypothalamus in brain damaged and pressure from tumor, will lead to SIADH or diabetes insipidus
Downloaded by Vin Campbell ()
ATI RN Adult Medical Surgical Proctored Exam
Comprehensive Study Notes - Detailed Chapter Reviews &
Key Points (2025-2026 Updated)
ATI Med Surg
Ch 1 Health, Wellness, Illness
modifiable variables: smoking, nutrition, exercise, health education and awareness, sexual practices
nonmodifiable 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
1. activated charcoal
2. gastric lavage
3. 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
o 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
Downloaded by Vin Campbell ()
,2
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
Downloaded by Vin Campbell ()
,3
• 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
o 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
o decerebrate: extension of your elbows and wrists out versus the flexing
• inter-cranial pressure and ICP monitoring: invasive, for scores 8 and below
o high risk of infection with devices monitoring ICP
o devices which are placed by neurosurgeon are interventricular catherer, subarachnoid screw or bolt, epidural or subdural sensor
o increased ICP: irritability, severe headache, decreased LOC, issues with pupil response, Cheyne-Stokes breathing, abnormal posturing
(decorticate, decerebrate)
o 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
X- rays: sometimes used with diagnosing neurological issues just bc fractures curvatures dislocations can damage neuro system
Ch 4 pain management
acute pain: temporary, protective and usually resolves with tissue healing
chronic pain: past 6 months & associated with depression, fatigue, and decreased level of functioning
nociceptive pain: damage or inflammation of tissue, throbbing, aching, LOCALIZED
1. somatic: bones, joints, muscles, skin, connective tissue
2. visceral: internal organs or viscera
3. cutaneous: skin or subcutaneous tissue
neuropathic pain: abnormal or damaged pain nerves ex. diabetic neuropathy or phantom limb pain; shooting, burning, pins and needles
• treat with muscle relaxants, antidepressants, or antispasmodic agents
PQRST
• pain location
• quality: dull, sharp, throbbing
• radiating
• severity or intensity: pain scale 1-10
• timing: when did pain start, frequency, duration of pain
• setting: how it affects daily life, what are they doing when symptoms occur
• aggravating v relieving symptoms
nonpharmacological methods:
• imagery acupunctures, relaxation techniques such as transcutaneous electrical nerve stimulation, the application of heat or cold can help with pain,
therapeutic touch or massage
pharmacological methods: pain level 1-3 is mild; 4-6 moderate; 7-10 severe – mild or moderate then NSAIDs, aspirin, salicylates
• NSAIDs: meloxicam, ibuprofen, aspirin, celecoxib, diclofenac, indomethacin, ketoprofen, piroxicam, naproxen
• NSAIDs S/E: gastric upset, bleeding
o aspirin S/E: tinnitus, vertigo, decreased hearing, acid reflux, gastric upset, monitor bleeding time
• acetaminophen: watch for >4g hepatotoxicity – do not give additional Tylenol if taking Vicodin/hydrocodone or/and Percocet/oxycodone
opioids: moderate to severe pain – morphine, hydromorphone (Dilaudid), fentanyl, hydrocodone (Vicodin), oxycodone (Percocet), tramadol, meloxicam
• fentanyl mostly cancer pain or end of life pain
• around the clock on schedule as opposed to PRN – get ahead of pain!
• S/E: constipation, orthostatic hypotension, urinary retention, nausea, vomiting, sedation, respiratory depression
• Narcan/naloxone: reversal agent - when respirations get too low
Ch 5 meningitis
Meningitis: inflammation of the meninges which are membranes that surround the brain or spinal cord – viral or bacterial – viral more common and self resolved –
bacteria is deadly and more dangerous and contagious, requires administration of antibiotics to resolve
• Hib vaccine, meningococcal MCV4 vaccine (when teens – crowded dorm rooms are risk factor)
• symptoms: excruciating headache, stiff neck, photophobia (no bright lights!), fever and chills, N/V, altered level of consciousness, positive turning sign
• positive turning sign and positive brooding skin
• tachycardia, seizures, red macular rash, increased intracranial pressure (keep head of bed elevated 30deg, discourage coughing/sneezing/straining),
irritability
• CSF will look different depending if viral (clear) or bacterial (cloudy)
• increased WBC, elevated protein for both bacterial and viral
• bacterial meningitis: cloudy, decreased glucose
• interventions: droplet antibiotics for 24h then standard, quiet room, HOB 30 degrees, avoid coughing and sneezing, seizure precautions
Downloaded by Vin Campbell ()
, 4
• meds: antiseizure, steroids, pain meds
• complications:
o SIADH (inappropriate antidiuretic hormone) – monitor for conentrated urine, dilute blood
o septic emboli
Ch 6 seizures
seizures: abrupt and abnormal uncontrolled electrical charge, decrease LOC, motor and sensory changes
epilepsy: abnormal brain electrical activity and more chronic
causes:
• fever esp under 2y
• genetic
• head trauma, cerebral edema, meningitis, hyponatremia, hypoglycemia, exposure to toxins, brain tumor, hypoxia, drug or alcohol withdrawal, fluid or
electrolyte imbalance
triggering factors: excessive stress, overwhelming fatigue, excess caffeine, flashing lights
types:
• generalized or tonic-clonic
o tonic: maybe aura then stiffening of muscles and loss of consciousness
o clonic: 1-2min + jerk movements of extremities back and forth
o after: confusion, sleepiness
• absent: school-aged children, loss of consciousness lasting a few seconds, spacing out or not paying attention, blank stare, smacking of the lips, eye
fluttering
• myoclonic: brief jerking and stiffening or extremities
• atonic: no tone, usually falling down bc no muscle tone
seizure nursing interventions:
• gently lower them to ground,
• put them on side to prevent aspiration,
• move furniture,
• loosen restrictive clothing,
• do NOT restrain client,
• do NOT put anything in their mouth (no tongue blade, no airway)
- document onset, duration keep in sideline position, check vitals, reorient patient, put on seizure precautions
- meds: antiepileptic (ex. Phenytoin)
- Phenytoin: check lab work bc oral gum overgrowth/gingival hyperplasia, dec effectiveness of oral contraception, warfarin/coumadin
- vagal nerve stimulator inserted (avoid MRI and microwave ovens)
- surgical removal of brain tissue that is causing seizure
- status epilepticus: complications of seizures – prolonged seizure that occurs over 30 minutes so protect airway, establish IV access, EKG monitoring, pulse ox –
Valium, Diazepam, Lorazepam, Phenytoin
Ch 7 Parkinsons disease
affects motor function in your body – balance between dopamine and acetylcholine and in Parkinsons the Ach is too high and dopamine is too low bc substantia nigra
degenerates – Ach overstimulates basal ganglia
symptoms: tremor, muscle rigidity, bradykinesia, postural instability, slow and shufling type of gait, mask like facial expression, difficulty chewing and swallowing
(careful with aspiration of drool), difficulty with ADLs, mood swings, cognitive impairment
no definitive diagnostic procedure but based on symptoms
nursing care: monitor swallowing, suction available, maintain adequate nutrition, thicken foods, encourage exercise and ROM, yoga, slow walk to reduce risk of
injury, speak slowly, alternate forms of communication
meds: Levodopa (to increase dopamine), Benztropine (anticholinergics to decrease Ach)
complications: pneumonia, aspiration (eat upright, suction equipment, thickening foods)
Ch 8 Alzheimer’s
after age 65
memory loss, personality changes, problems with judgement
risk factors: old age, exposure to metal or toxic waste, herpes virus, previous head injury, genetic predisposition
7 stages – know key points
1. no impairment
2. very mild cognitive decline – little forgetful
3. mild cognitive decline w/ short-term memory loss evident to loved ones
4. moderate cognitive decline w/ personality changes, obvious memory loss
5. moderately severe cognitive decline w/ ADLs help
6. severe cognitive decline w/ frequent episodes of fecal and urinary incontinence
7. very severe cognitive decline w/ loss of ability to speak and move, not able to eat w/o assistance, difficulty swallowing, speech unrecognizable – no
definitive diagnostic
nursing interventions: reorient client, simple calendar w/n clients view, simple short directions w/ consistency and repetition, avoid over stimulation and try to stick
to a routine including routine toilet schedule, you can change schedule but gradually
home safety: no scattered rugs, install door locks that cant be easily opened, good lighting, colored tape at the edge of stairs, remove clutter, mattress on floor
medicine: Donepezil (increases Ach by preventing breakdown, improve cognitive behavior and function)
Ch 9 Tumors
brain tumor: hypothalamus in brain damaged and pressure from tumor, will lead to SIADH or diabetes insipidus
Downloaded by Vin Campbell ()
