2022 NEW ATI PROCTORED MED/SURG COMPLETE STUDY
REVIEW
Anticholinergics - SE: Can't pee, can't see, can't spit, can't shit. (Drys everything)
ACE inhibitors - "-PRIL"
Assess BP before giving (hypotension)
SE: Angioedema, Cough[dry], Elevated potassium
Modifiable risk factors - Factors contributing to the development of a noncommunicable
disease that can be altered by modifying one's behavior or environment (Smoking, exercise,
etc.)
Non-modifiable risk factors - age, gender, race, family history
Triaging - Emergent - Must be seen immediately (life threatening)
Urgent - Teat soon but non-life threatening
Non-urgent - can wait w/o issues
Class 1 (Red Tag) - Immediate threat to life (Resp issues, MI etc.)
Class 2 (Yellow Tag) - Non-life threatening major injuries require immediate treatment (Major
fractures, etc)
Class 3 (Green Tag) - Minor injury; not requiring immediate attention (Abrasions, etc.)
Class 4 (Black Tag) - Expected to die
ABC's + DE - Airway, Breathing, Circulation
Disability (LOC), Exposure
Treat Poisoning - 1. Activated charcoal
2. Gastric Lavage
3. Whole bowel irrigation
Interventions for V-Fib or V-Tach - Initiate BLS, establish IV, epinephrine, (Give
Antiarrhythmic - Amiodarone)
Alpha 1 receptors - VasoCONSTRICTION of arterioles in skin, viscera, & mucous membranes
and in veins. (increase BP)
Beta 1 receptors - Increase heart rate (stimulate heart)
Beta 2 receptors - Bronchodilation, relax uterine smooth muscle (Heart and lungs)
Epinephrine - Alpha 1/Beta 1,2 Agonist
(SE: HTN crisis, dysrhthmias)
,Dopamine - Beta 1 receptors, alpha 1 (good for shock and HF)
SE: Dysryhthmias, angina
Debutamine - Beta 1 receptors (for HF)
Cerebral angiogram - X-ray of blood vessels in the brain after intracarotid injection of contrast
medium
(Contrast dye used: assess if pt is pregnant, allergies to iodine/shellfish, renal function, on
anticoagulant) No food 4-6 hrs prior, monitor bleeding/pulses after
EEG - Assesses electrical activity (for seizures)
Want pt. to have clean hair, no need to fast prior, sleep deprived is ok
Glasgow Coma Scale (GCS) - Scale used to assess Pt LOC (3-15)
Eye opening (1-4)
Verbal response (1-5)
Motor response (1-6)
Intercranial pressure (ICP) - Interventricular cath
Subarachnoid screw/bolt
Epidural/subdural sensor
Placed by neurosurgeon, very invasive(risk of infection), used in pts w/low GCS <8
S/s ^ICP: Irritablity, HA, dec LOC, dec pupil response, altered breathing (cheyne stokes),
posture (decortacate decerabrate)
Nl ICP = 10-15 mmhg
lumbar puncture - Fetal position. post-neuro assess q15-30 until stable. flat 2-3 hour.
encourage fluids, oral analgesics for headache.
MRI - Same contrast dye precautions
assess for claustraphobia, remove jewelry, assess for metal implants (pacemakers etc), give
earplugs
PET scan - Assesses tumor activity/response to treatment
Acute pain - Pain that is felt suddenly from injury, disease, trauma or surgery. Resolves w/
tissue healing
Chronic pain - Episode of pain that lasts for 6 months or longer; may be intermittent or
continuous (lead to depression)
Nociceptive Pain - Pain from a normal process that results in noxious stimuli being perceived
as painful
Damage/inflammation of tissue
Somatic (bones joints ct)
Visceral (internal organs)
Cutaneous (skin or sq)
,Neurpathic pain - Arises from direct injury to nerves and abnormal processing of sensory input
by PNS & CNS
includes phantom, diabetic neuropathy, spinal cord injury pain
tx usually includes muscle relax, anti spaz, etc
(shooting burning pins/needles)
Assessing pain - * Location
* Pain intensity (rating scales)
* Pain quality (description)
* Pattern (onset, duration, recurrence)
* Precipitating factors (precede pain)
* Alleviating factors (remedies)
* Associated symptoms
* Effect on ADLs
* Coping resources
* Affective responses
Non-pharmacologic pain management - Imagery, TENS, heat/cold, acupuncture, therapeutic
touch, massage, relaxation
Opiods SE - Constipation, orthostatic HypoTN, urinary retention, N/V, Resp depression (Have
Narcan/naloxone on hand)
Meningitis - Inflammation of the meninges of the brain and spinal cord
Viral (Self solves)
Bacterial (Deadly; need antibiotics)
Hib vaccine, MCB4 vaccine
S/s: Severe HA, neck stiffness, photophobia (pain associated w/lights), fever/chills, N/V,
altered LOC, positive kernig/brudzinski sign, tachycardia, seizures if severe
Diagnosis of meningitis - Diagnosed by lumbar puncture where the CSF is analyzed
Bacterial - Cloudy
Viral - Clear
see incr WBC, protien, decr glucose in baterial
Put pt. on droplet precautions (bacterial)
Complications of Meningitis - Hydrocephalus - irritablity
SIADH - concentrated urine, diluted blood
circulatory collapse
blindness, deafness
cerebral palsy
seizures
Seizure risk factors - Metabolic disorders
Acute alcohol/Substance abuse withdrawal
Electrolyte disturbances
Heart disease
High fever
, Stroke
Hypoxia
Stress/fatigue
Flashing lights
Generalized seizures - Seizures that involve the entire brain.
Tonic/clonic
Postictal phase
Absent seizure - Brief; lasts seconds; pt may or may not lose consciousness
No loss of change in muscle tone
May occur several times during the day
Appears to be daydreaming
More common in children
Myoclonic seizure - Sudden jerk of the body or extremities
Atonic seizure - Sudden decrease in muscle tone > loss of postural control > patient may fall
("drop attack")
Seizure precautions - Nursing interventions:
Lower to ground/lay on side
Loosen restrictive clothing
Do not restrain client
Nothing placed into mouth
Clear surroundings
Pt. should have medical seizure ID tag/band
Antiepileptic drug: Phenytoin - Periodic blood checks, assess for gingival hyperplasia, decrease
effectiveness of birth control and warferin
Surgical seizure interventions - Vagal nerve stimulator - hold magnet over device; avoid MRIs
and use of microwaves
Surgical removal
Status epilepticus - A condition in which seizures recur every few minutes or last more than 30
minutes.
Parkinson's disease - Acetylcholine too high; Dopamine too low
S/s: Tremor, muscle instability, bradykinesia, slow shuffled gait, dysphagia (risk for aspiration)
Nursing care for Parkinson's disease - Thicken foods, encourage exercise ROM, speak slowly
Med: Carb/levo
Alzheimer's disease - a progressive and irreversible brain disorder characterized by gradual
deterioration of memory, reasoning, language, and, finally, physical functioning
Alzheimer's risk factors - Old age
Exposure to metal/toxic waste
REVIEW
Anticholinergics - SE: Can't pee, can't see, can't spit, can't shit. (Drys everything)
ACE inhibitors - "-PRIL"
Assess BP before giving (hypotension)
SE: Angioedema, Cough[dry], Elevated potassium
Modifiable risk factors - Factors contributing to the development of a noncommunicable
disease that can be altered by modifying one's behavior or environment (Smoking, exercise,
etc.)
Non-modifiable risk factors - age, gender, race, family history
Triaging - Emergent - Must be seen immediately (life threatening)
Urgent - Teat soon but non-life threatening
Non-urgent - can wait w/o issues
Class 1 (Red Tag) - Immediate threat to life (Resp issues, MI etc.)
Class 2 (Yellow Tag) - Non-life threatening major injuries require immediate treatment (Major
fractures, etc)
Class 3 (Green Tag) - Minor injury; not requiring immediate attention (Abrasions, etc.)
Class 4 (Black Tag) - Expected to die
ABC's + DE - Airway, Breathing, Circulation
Disability (LOC), Exposure
Treat Poisoning - 1. Activated charcoal
2. Gastric Lavage
3. Whole bowel irrigation
Interventions for V-Fib or V-Tach - Initiate BLS, establish IV, epinephrine, (Give
Antiarrhythmic - Amiodarone)
Alpha 1 receptors - VasoCONSTRICTION of arterioles in skin, viscera, & mucous membranes
and in veins. (increase BP)
Beta 1 receptors - Increase heart rate (stimulate heart)
Beta 2 receptors - Bronchodilation, relax uterine smooth muscle (Heart and lungs)
Epinephrine - Alpha 1/Beta 1,2 Agonist
(SE: HTN crisis, dysrhthmias)
,Dopamine - Beta 1 receptors, alpha 1 (good for shock and HF)
SE: Dysryhthmias, angina
Debutamine - Beta 1 receptors (for HF)
Cerebral angiogram - X-ray of blood vessels in the brain after intracarotid injection of contrast
medium
(Contrast dye used: assess if pt is pregnant, allergies to iodine/shellfish, renal function, on
anticoagulant) No food 4-6 hrs prior, monitor bleeding/pulses after
EEG - Assesses electrical activity (for seizures)
Want pt. to have clean hair, no need to fast prior, sleep deprived is ok
Glasgow Coma Scale (GCS) - Scale used to assess Pt LOC (3-15)
Eye opening (1-4)
Verbal response (1-5)
Motor response (1-6)
Intercranial pressure (ICP) - Interventricular cath
Subarachnoid screw/bolt
Epidural/subdural sensor
Placed by neurosurgeon, very invasive(risk of infection), used in pts w/low GCS <8
S/s ^ICP: Irritablity, HA, dec LOC, dec pupil response, altered breathing (cheyne stokes),
posture (decortacate decerabrate)
Nl ICP = 10-15 mmhg
lumbar puncture - Fetal position. post-neuro assess q15-30 until stable. flat 2-3 hour.
encourage fluids, oral analgesics for headache.
MRI - Same contrast dye precautions
assess for claustraphobia, remove jewelry, assess for metal implants (pacemakers etc), give
earplugs
PET scan - Assesses tumor activity/response to treatment
Acute pain - Pain that is felt suddenly from injury, disease, trauma or surgery. Resolves w/
tissue healing
Chronic pain - Episode of pain that lasts for 6 months or longer; may be intermittent or
continuous (lead to depression)
Nociceptive Pain - Pain from a normal process that results in noxious stimuli being perceived
as painful
Damage/inflammation of tissue
Somatic (bones joints ct)
Visceral (internal organs)
Cutaneous (skin or sq)
,Neurpathic pain - Arises from direct injury to nerves and abnormal processing of sensory input
by PNS & CNS
includes phantom, diabetic neuropathy, spinal cord injury pain
tx usually includes muscle relax, anti spaz, etc
(shooting burning pins/needles)
Assessing pain - * Location
* Pain intensity (rating scales)
* Pain quality (description)
* Pattern (onset, duration, recurrence)
* Precipitating factors (precede pain)
* Alleviating factors (remedies)
* Associated symptoms
* Effect on ADLs
* Coping resources
* Affective responses
Non-pharmacologic pain management - Imagery, TENS, heat/cold, acupuncture, therapeutic
touch, massage, relaxation
Opiods SE - Constipation, orthostatic HypoTN, urinary retention, N/V, Resp depression (Have
Narcan/naloxone on hand)
Meningitis - Inflammation of the meninges of the brain and spinal cord
Viral (Self solves)
Bacterial (Deadly; need antibiotics)
Hib vaccine, MCB4 vaccine
S/s: Severe HA, neck stiffness, photophobia (pain associated w/lights), fever/chills, N/V,
altered LOC, positive kernig/brudzinski sign, tachycardia, seizures if severe
Diagnosis of meningitis - Diagnosed by lumbar puncture where the CSF is analyzed
Bacterial - Cloudy
Viral - Clear
see incr WBC, protien, decr glucose in baterial
Put pt. on droplet precautions (bacterial)
Complications of Meningitis - Hydrocephalus - irritablity
SIADH - concentrated urine, diluted blood
circulatory collapse
blindness, deafness
cerebral palsy
seizures
Seizure risk factors - Metabolic disorders
Acute alcohol/Substance abuse withdrawal
Electrolyte disturbances
Heart disease
High fever
, Stroke
Hypoxia
Stress/fatigue
Flashing lights
Generalized seizures - Seizures that involve the entire brain.
Tonic/clonic
Postictal phase
Absent seizure - Brief; lasts seconds; pt may or may not lose consciousness
No loss of change in muscle tone
May occur several times during the day
Appears to be daydreaming
More common in children
Myoclonic seizure - Sudden jerk of the body or extremities
Atonic seizure - Sudden decrease in muscle tone > loss of postural control > patient may fall
("drop attack")
Seizure precautions - Nursing interventions:
Lower to ground/lay on side
Loosen restrictive clothing
Do not restrain client
Nothing placed into mouth
Clear surroundings
Pt. should have medical seizure ID tag/band
Antiepileptic drug: Phenytoin - Periodic blood checks, assess for gingival hyperplasia, decrease
effectiveness of birth control and warferin
Surgical seizure interventions - Vagal nerve stimulator - hold magnet over device; avoid MRIs
and use of microwaves
Surgical removal
Status epilepticus - A condition in which seizures recur every few minutes or last more than 30
minutes.
Parkinson's disease - Acetylcholine too high; Dopamine too low
S/s: Tremor, muscle instability, bradykinesia, slow shuffled gait, dysphagia (risk for aspiration)
Nursing care for Parkinson's disease - Thicken foods, encourage exercise ROM, speak slowly
Med: Carb/levo
Alzheimer's disease - a progressive and irreversible brain disorder characterized by gradual
deterioration of memory, reasoning, language, and, finally, physical functioning
Alzheimer's risk factors - Old age
Exposure to metal/toxic waste
