lOMoAR cPSD| 67756003
ATI Med Surg CMS Study Guide
Ch. 1 Health, Wellness, and Illness
Health & Wellness
- Modifiable (can be changed) v. Nonmodifiable (cannot be changed)
- Aspects; Physical, Emotional, Social, Intellectual, Spiritual, Occupational, Environmental
- Environment; Social (Crime vs. safety, poverty vs. prosperity, peace vs. social unrest, and presence vs.
absence of support from social networks ); Physical (access to health care, sanitation, availability of
clean water, and geographic location
Ch. 2 Emergency Nursing Principles and Management
Emergency Nursing Principles
• Triage
- Level 1; Resuscitation
- Level 2; Emergent
- Level 3; Urgent
- Level 4; Less Urgent - Level 5; Nonurgent
• Primary Survey; rapid assessment of life threatening conditions; completed systematically; standard
precautions; guided by ABCDE principle
ABCDE Principle
- Airway; maintain airway, head-tilt/chin-lift if unresponsive- DO NOT perform is potential cervical spine
injury; if trauma suspected use modified jaw thrust maneuver; bag valve mask w/ 100% O2 w/
nonrebreather for spontaneous breathers
- Breathing; if NOT breathing manual vent w. bag valve mask or mouth to mouth
- Circulation; HR, BP, pulses, cap refill;
To restore circulation; CPR, assess for internal bleed, hemorrhage control; IV access; Isotonic
fluids/blood
To alleviate shock; O2, pressure to bleed, elevate lower extremities, IV fluids & blood, VS, stay
w/ pt.
- Disability; assess LOC ; GCS; AVPU
- Exposure; complete physical assessment; clothing removed; hypothermia primary concern
• Poisoning; medical emergency; hx, type of poison,; resp support, circulation, restore fluids, BP/EKG,
ingested poison use activated charcoal, gastric lavage (done w/I 1hr) aspiration; diazepam if seizures occur
• Rapid response team; respond to emergency when pt. has indications of rapid decline; early recognition
before resp/cardiac arrest or stroke occurs;
• Cardiac emergency -
Cardiac arrest;
- Vfib/ Pulseless VT= defibrillate, CPR, admin IV antidysrhythmic (epi, amiodarone, lidocaine,
magnesium sulfate) - Ventricular asystole
, lOMoAR cPSD| 67756003
- Pulseless electrical activity (PEA) & Asystole; CPR, if shockable used Defib, IV access, Epi IVP
Q3-5 min
Emergency Meds;
• Epi; stimulate alpha 1 (vasoconstrict), beta 1 ( HR), beta 2 (bronchodilator); superficial bleeding, BP,
AV block, cardiac arrest, & asthma ; A/e; HTN crisis, dysrhythmias, angina
• Dopamine; renal blood vessel dilation, beta 1 ( HR) Shock, HF, AKI; A/E; dysrhythmias, angina
• Dobutamine; beta 1 ( HR) HF
NEUROLOGIC
Ch. 3 Neurologic Diagnostic Procedures
Cerebral Angiography; visualization of cerebral blood vessels, assess blood flow in brain, ID aneurysms
- Do NOT perform if pregnant, NPO for 4-6hrs prior, assess allergy to shellfish or iodine, assess bleeding
risk/ use of anticoag, assess BUN & Creat; monitor area for clotting after procedure; void immediately
after; may experience metallic taste or feeling of warmth ; movement restricted
CT; cross section image of cranial cavity
- Supine, no jewelry; if contrast dye used take precautions
EEG; ID brain wave abnormalities, seizure activity &sleep disorder
- Wash hair prior, be sleep deprived, expose to flashing lights or hyperventilate for 3-4 min; avoid
stimulants/sedatives 12-24 hr. prior; 45-120 min
ICP Monitoring; performed by neurosurgeon in operating room, used for ICP, GCS score of 8 or <,
complication of infection
• 3 Types ICP Monitoring
- Intraventricular Catheter; fluid filled cath connected to sterile drainage system inserted into burr hole,
allows simultaneous drainage & monitoring by transducer connected to monitor
- Subarachnoid screw or bolt; hollow threaded screw or bolt connected to transducer, placed thru burr
hole
- Epidural or subdural sensor; fiber optic sensor inserted thru burr hole
- S/S 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 prior, assume cannonball position, monitor puncture site, remain lying still on back after procedure
for several hours
Complications; headache from leaking CSF, give opioids/pain meds, fluid intake
MRI; NPO 4-8 hr. prior; remove jewelry, not claustrophobic, give earplugs; w/ contrast dyes: assess for
allergies for shellfish; no metal implants (IUD, aneurysm clip, ortho joint, artificial heart valve, pacemaker)
PET & SPECT Scan; Positron emission tomography and single-photon emission computed tomography scans;
nuclear medicine procedures produce 3D images of head; images can be static (depicting vessels) or functional
(depicting brain activity); captures reginal metabolic processes (tumor activity, dementia) - Radiation risks
X-ray; reveal fracture or curvature; no pregnant pts, no jewelry
, lOMoAR cPSD| 67756003
Ch. 4 Pain Management
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
- Nonopioid; mild-moderate pain, 4g Tylenol, monitor for salicylism (tinnitus, vertigo, decreased
hearing), gi upset, bleeding
- Opioid= moderate-severe pain, around clock admin, cause constipation, hypotension, urinary retention,
n/v, sedation, respiratory depression, have naloxone ready
Ch. 5 Meningitis
- Inflammation of meninges, viral most common and resolves w/o treatment, fungal common in AIDS pt.;
bacterial is contagious w/ high mortality
Prevention; Hib vaccine, PPSV & MCV4 vaccine (college students) s/s: 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), tachycardia, seizure, red macular rash, irritable
DX: CSF analysis (cloudy= bacterial, clear= viral; + = WBC, protein, GLU in bacterial);
CT scan/MRI to assess ICP
Meds
- Ceftriaxone or cefotaxime in combination with vancomycin: ABX given until culture &
sensitivity results available; Effective for bacterial infections
- Phenytoin: Anticonvulsants given if ICP increases or experiences a seizure.
, lOMoAR cPSD| 67756003
- Acetaminophen, ibuprofen: Analgesics for headache and/or fever. Non-opioid to avoid masking
changes in the level of consciousness.
- Ciprofloxacin, rifampin, or ceftriaxone: Prophylactic ABX given if in close contact w/ pt.
Complications; ICP; monitor loc, pupillary changes, impaired eom ; SIADH; monitor for dilute blood
and concentrated urine; Septic emboli
NURSING: isolation precautions, droplet precautions until 24 hrs. after antibiotics, environmental
stimuli, quiet environment, bright light, bed rest, HOB 30*, avoid coughing/ sneezing, seizure precautions
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; chronic recurring abnormal brain electrical activity w/ 2+ seizures; not caused by identifiable cause
Risks Factors; febrile state especially in children <2, head trauma, cerebral edema, infection, metabolic
disorder (hypoglycemia or hyponatremia), brain tumor, hypoxia, w/drawl, stroke, toxin exposure, heart
disease, brain tumor, hypoxia, w/drawl, fluid/electrolyte imbalances
Triggers; xs stress/fatigue/caffeine, flashing lights, hyperventilation, physical activity, substances
(cocaine, aerosols, inhaled glue) s/s:
Generalized (aura)
- Tonic clonic seizure; tonic episode (stiffening of muscles), clonic episode (rhythmic jerking)
postictal phase of confusion and sleepiness
- Tonic seizure; stiffening of muscle, increased muscle tone, LOC
- Clonic seizure; muscle contract and relax
- Myoclonic seizure; brief jerking or stiffening of extremities
- Atonic/akinetic seizure; muscle tone is lost; falling may occur
Partial or focal/local
- Complex partial seizure; automatisms (lip smacking, picking at clothes, zone out); may have LOC,
amnesia
- Simple partial seizure; remains consciousness unusual sensations (déjà vu, changes in HR, flushing,
unilateral limb movement, pain, odor)
Unclassified/Idiopathic; no know reason
DX: EEG, MRI, CT, CAT scan, PET scan, CSF analysis, skull Xray analysis
Meds; Antiepileptics;(phenytoin) take at same time daily- A/E; gingival hyperplasia; avoid oral BC (
effectiveness), avoid warfarin ( absorption)
TX: Vagal nerve stimulator (implanted in left chest wall, magnet over device at onset of seizure, avoid
MRI & ultrasound and microwaves); Surgical
Complications; Status Epilepticus; repeated seizure activity w/i 30 min; airway, O2, IV access, ECG
monitoring, pulse ox, admin diazepam or lorazepam push and IV phenytoin
NURSING: DURING; privacy, protect from injury, prepare suction, do not restrain do not insert anything
in mouth, document onset & duration; AFTER; maintain side lying, VS, assess neuro/injuries, reorient &
calm client, determine trigger; client should wear medical ID
Ch. 7 Parkinson’s Disease
ATI Med Surg CMS Study Guide
Ch. 1 Health, Wellness, and Illness
Health & Wellness
- Modifiable (can be changed) v. Nonmodifiable (cannot be changed)
- Aspects; Physical, Emotional, Social, Intellectual, Spiritual, Occupational, Environmental
- Environment; Social (Crime vs. safety, poverty vs. prosperity, peace vs. social unrest, and presence vs.
absence of support from social networks ); Physical (access to health care, sanitation, availability of
clean water, and geographic location
Ch. 2 Emergency Nursing Principles and Management
Emergency Nursing Principles
• Triage
- Level 1; Resuscitation
- Level 2; Emergent
- Level 3; Urgent
- Level 4; Less Urgent - Level 5; Nonurgent
• Primary Survey; rapid assessment of life threatening conditions; completed systematically; standard
precautions; guided by ABCDE principle
ABCDE Principle
- Airway; maintain airway, head-tilt/chin-lift if unresponsive- DO NOT perform is potential cervical spine
injury; if trauma suspected use modified jaw thrust maneuver; bag valve mask w/ 100% O2 w/
nonrebreather for spontaneous breathers
- Breathing; if NOT breathing manual vent w. bag valve mask or mouth to mouth
- Circulation; HR, BP, pulses, cap refill;
To restore circulation; CPR, assess for internal bleed, hemorrhage control; IV access; Isotonic
fluids/blood
To alleviate shock; O2, pressure to bleed, elevate lower extremities, IV fluids & blood, VS, stay
w/ pt.
- Disability; assess LOC ; GCS; AVPU
- Exposure; complete physical assessment; clothing removed; hypothermia primary concern
• Poisoning; medical emergency; hx, type of poison,; resp support, circulation, restore fluids, BP/EKG,
ingested poison use activated charcoal, gastric lavage (done w/I 1hr) aspiration; diazepam if seizures occur
• Rapid response team; respond to emergency when pt. has indications of rapid decline; early recognition
before resp/cardiac arrest or stroke occurs;
• Cardiac emergency -
Cardiac arrest;
- Vfib/ Pulseless VT= defibrillate, CPR, admin IV antidysrhythmic (epi, amiodarone, lidocaine,
magnesium sulfate) - Ventricular asystole
, lOMoAR cPSD| 67756003
- Pulseless electrical activity (PEA) & Asystole; CPR, if shockable used Defib, IV access, Epi IVP
Q3-5 min
Emergency Meds;
• Epi; stimulate alpha 1 (vasoconstrict), beta 1 ( HR), beta 2 (bronchodilator); superficial bleeding, BP,
AV block, cardiac arrest, & asthma ; A/e; HTN crisis, dysrhythmias, angina
• Dopamine; renal blood vessel dilation, beta 1 ( HR) Shock, HF, AKI; A/E; dysrhythmias, angina
• Dobutamine; beta 1 ( HR) HF
NEUROLOGIC
Ch. 3 Neurologic Diagnostic Procedures
Cerebral Angiography; visualization of cerebral blood vessels, assess blood flow in brain, ID aneurysms
- Do NOT perform if pregnant, NPO for 4-6hrs prior, assess allergy to shellfish or iodine, assess bleeding
risk/ use of anticoag, assess BUN & Creat; monitor area for clotting after procedure; void immediately
after; may experience metallic taste or feeling of warmth ; movement restricted
CT; cross section image of cranial cavity
- Supine, no jewelry; if contrast dye used take precautions
EEG; ID brain wave abnormalities, seizure activity &sleep disorder
- Wash hair prior, be sleep deprived, expose to flashing lights or hyperventilate for 3-4 min; avoid
stimulants/sedatives 12-24 hr. prior; 45-120 min
ICP Monitoring; performed by neurosurgeon in operating room, used for ICP, GCS score of 8 or <,
complication of infection
• 3 Types ICP Monitoring
- Intraventricular Catheter; fluid filled cath connected to sterile drainage system inserted into burr hole,
allows simultaneous drainage & monitoring by transducer connected to monitor
- Subarachnoid screw or bolt; hollow threaded screw or bolt connected to transducer, placed thru burr
hole
- Epidural or subdural sensor; fiber optic sensor inserted thru burr hole
- S/S 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 prior, assume cannonball position, monitor puncture site, remain lying still on back after procedure
for several hours
Complications; headache from leaking CSF, give opioids/pain meds, fluid intake
MRI; NPO 4-8 hr. prior; remove jewelry, not claustrophobic, give earplugs; w/ contrast dyes: assess for
allergies for shellfish; no metal implants (IUD, aneurysm clip, ortho joint, artificial heart valve, pacemaker)
PET & SPECT Scan; Positron emission tomography and single-photon emission computed tomography scans;
nuclear medicine procedures produce 3D images of head; images can be static (depicting vessels) or functional
(depicting brain activity); captures reginal metabolic processes (tumor activity, dementia) - Radiation risks
X-ray; reveal fracture or curvature; no pregnant pts, no jewelry
, lOMoAR cPSD| 67756003
Ch. 4 Pain Management
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
- Nonopioid; mild-moderate pain, 4g Tylenol, monitor for salicylism (tinnitus, vertigo, decreased
hearing), gi upset, bleeding
- Opioid= moderate-severe pain, around clock admin, cause constipation, hypotension, urinary retention,
n/v, sedation, respiratory depression, have naloxone ready
Ch. 5 Meningitis
- Inflammation of meninges, viral most common and resolves w/o treatment, fungal common in AIDS pt.;
bacterial is contagious w/ high mortality
Prevention; Hib vaccine, PPSV & MCV4 vaccine (college students) s/s: 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), tachycardia, seizure, red macular rash, irritable
DX: CSF analysis (cloudy= bacterial, clear= viral; + = WBC, protein, GLU in bacterial);
CT scan/MRI to assess ICP
Meds
- Ceftriaxone or cefotaxime in combination with vancomycin: ABX given until culture &
sensitivity results available; Effective for bacterial infections
- Phenytoin: Anticonvulsants given if ICP increases or experiences a seizure.
, lOMoAR cPSD| 67756003
- Acetaminophen, ibuprofen: Analgesics for headache and/or fever. Non-opioid to avoid masking
changes in the level of consciousness.
- Ciprofloxacin, rifampin, or ceftriaxone: Prophylactic ABX given if in close contact w/ pt.
Complications; ICP; monitor loc, pupillary changes, impaired eom ; SIADH; monitor for dilute blood
and concentrated urine; Septic emboli
NURSING: isolation precautions, droplet precautions until 24 hrs. after antibiotics, environmental
stimuli, quiet environment, bright light, bed rest, HOB 30*, avoid coughing/ sneezing, seizure precautions
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; chronic recurring abnormal brain electrical activity w/ 2+ seizures; not caused by identifiable cause
Risks Factors; febrile state especially in children <2, head trauma, cerebral edema, infection, metabolic
disorder (hypoglycemia or hyponatremia), brain tumor, hypoxia, w/drawl, stroke, toxin exposure, heart
disease, brain tumor, hypoxia, w/drawl, fluid/electrolyte imbalances
Triggers; xs stress/fatigue/caffeine, flashing lights, hyperventilation, physical activity, substances
(cocaine, aerosols, inhaled glue) s/s:
Generalized (aura)
- Tonic clonic seizure; tonic episode (stiffening of muscles), clonic episode (rhythmic jerking)
postictal phase of confusion and sleepiness
- Tonic seizure; stiffening of muscle, increased muscle tone, LOC
- Clonic seizure; muscle contract and relax
- Myoclonic seizure; brief jerking or stiffening of extremities
- Atonic/akinetic seizure; muscle tone is lost; falling may occur
Partial or focal/local
- Complex partial seizure; automatisms (lip smacking, picking at clothes, zone out); may have LOC,
amnesia
- Simple partial seizure; remains consciousness unusual sensations (déjà vu, changes in HR, flushing,
unilateral limb movement, pain, odor)
Unclassified/Idiopathic; no know reason
DX: EEG, MRI, CT, CAT scan, PET scan, CSF analysis, skull Xray analysis
Meds; Antiepileptics;(phenytoin) take at same time daily- A/E; gingival hyperplasia; avoid oral BC (
effectiveness), avoid warfarin ( absorption)
TX: Vagal nerve stimulator (implanted in left chest wall, magnet over device at onset of seizure, avoid
MRI & ultrasound and microwaves); Surgical
Complications; Status Epilepticus; repeated seizure activity w/i 30 min; airway, O2, IV access, ECG
monitoring, pulse ox, admin diazepam or lorazepam push and IV phenytoin
NURSING: DURING; privacy, protect from injury, prepare suction, do not restrain do not insert anything
in mouth, document onset & duration; AFTER; maintain side lying, VS, assess neuro/injuries, reorient &
calm client, determine trigger; client should wear medical ID
Ch. 7 Parkinson’s Disease
