ATI Proctored Med/Surg 2023 A+

Anticholinergics - ANS-SE: Can't pee, can't see, can't spit, can't shit. (Drys everything) ACE inhibitors - ANS-"-PRIL" Assess BP before giving (hypotension) SE: Angioedema, Cough[dry], Elevated potassium Modifiable risk factors - ANS-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 - ANS-age, gender, race, family history Triaging - ANS-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) - ANS-Immediate threat to life (Resp issues, MI etc.) Class 2 (Yellow Tag) - ANS-Non-life threatening major injuries require immediate treatment (Major fractures, etc) Class 3 (Green Tag) - ANS-Minor injury; not requiring immediate attention (Abrasions, etc.) Class 4 (Black Tag) - ANS-Expected to die ABC's + DE - ANS-Airway, Breathing, Circulation Disability (LOC), Exposure Treat Poisoning - ANS-1. Activated charcoal 2. Gastric Lavage 3. Whole bowel irrigation Interventions for V-Fib or V-Tach - ANS-Initiate BLS, establish IV, epinephrine, (Give Antiarrhythmic - Amiodarone) Alpha 1 receptors - ANS-VasoCONSTRICTION of arterioles in skin, viscera, & mucous membranes and in veins. (increase BP) Beta 1 receptors - ANS-Increase heart rate (stimulate heart) Beta 2 receptors - ANS-Bronchodilation, relax uterine smooth muscle (Heart and lungs) Epinephrine - ANS-Alpha 1/Beta 1,2 Agonist (SE: HTN crisis, dysrhthmias) Dopamine - ANS-Beta 1 receptors, alpha 1 (good for shock and HF) SE: Dysryhthmias, angina Debutamine - ANS-Beta 1 receptors (for HF) Cerebral angiogram - ANS-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 - ANS-Assesses electrical activity (for seizures) Want pt. to have clean hair, no need to fast prior, sleep deprived is ok Glasgow Coma Scale (GCS) - ANS-Scale used to assess Pt LOC (3-15) Eye opening (1-4) Verbal response (1-5) Motor response (1-6) Intercranial pressure (ICP) - ANS-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 - ANS-Fetal position. post-neuro assess q15-30 until stable. flat 2-3 hour. encourage fluids, oral analgesics for headache. MRI - ANS-Same contrast dye precautions assess for claustraphobia, remove jewelry, assess for metal implants (pacemakers etc), give earplugs PET scan - ANS-Assesses tumor activity/response to treatment Acute pain - ANS-Pain that is felt suddenly from injury, disease, trauma or surgery. Resolves w/ tissue healing Chronic pain - ANS-Episode of pain that lasts for 6 months or longer; may be intermittent or continuous (lead to depression) Nociceptive Pain - ANS-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 - ANS-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 - ANS-* 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 - ANS-Imagery, TENS, heat/cold, acupuncture, therapeutic touch, massage, relaxation Opiods SE - ANS-Constipation, orthostatic HypoTN, urinary retention, N/V, Resp depression (Have Narcan/naloxone on hand) Meningitis - ANS-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 - ANS-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 - ANS-Hydrocephalus - irritablity SIADH - concentrated urine, diluted blood circulatory collapse blindness, deafness cerebral palsy Continues...