ATI MedSurg Comprehensive Review
Diabetic Ketoacidosis - ANS- assessment: dehydration, ketosis, metabolic acidosis,
hyperglycemia
- admin fast acting insulin that can be effective within 10 min, admin IV
- kussmaul resp
Beta blockers (Propanolol) - ANS- monitor: sore throat, vision changes, blurred vision, dry eyes,
dry mouth, abd cramping, colitis, acute pancreatitis
- notify provider: night cough
Factors that affect wound healing - ANS- dehydration (UO)
- infection
- BMI <18.5 or >25
- malnutrition (low protein, vita C)
- age
- decreased hgb, tissue perfusion
- wound stress
HIV/AIDS - ANS- positive response to treatment monitored by viral load
- risk for infection: do not drink fluids left out for longer than 60 min, clean toothbrush in
dishwasher weekly, avoid fresh produce, check temp daily
- dx test: ELISA confirmed by western blot/IFA, viral load
Fluid replacement - ANS- monitor BUN
Cerebrovascular accident - ANS- right sided: visual, spatial, proprioception; poor impulse
control/judgment; unilateral neglect
- left sided: language, math, analytical skills
Preventing UTIs - ANS- wipe from front to back
- void after intercourse
- avoid baths
- drink 2-3 L of fluid daily
- cotton underwear
- urinate Q2-4h
Radiation therapy - ANS- do not remove ink markings
- wash area gently with warm water and mild soap
- avoid sun esposure for 1 year
- dispose body fluids in lead container
- limit visits to 30 min a day
, - staff should wear dosimeter badge to monitor exposure
- keep all soiled linens in room until implant is removed
Kidney transplants - ANS- hemodialysis sometimes needed following surgery because kidneys
from deceased donors may not function immediately
- requires lifelong immunosuppressive therapy
- complications: cardiovascular disease
Hemodialysis - ANS- expected: weight loss, decrease BP, increase temp
- complications: hypocalcemia, bleeding, infection, hypovolemia, anemia
- disequilibrium syndrome: nausea, restlessness, dysrhythmias, seizures, headache
- notify: headache, nausea, dizziness during dialysis
- do not eat during dialysis
Inotropic medications - ANS- dopamine, digoxin, dobutamine, milirinone
- increase contractility and improve CO
- monitor HR (apical), hold if <60 min
Diabetes inspidus - ANS- deficiency in ADH
- inability to concentrate urine, 1.001-1.005
- assessment: hypotension, weak peripheral pulses, polydipsia, polyuria (4-30L/day), nocturia,
dehydration
- DILUTE urine chemistry, CONCENTRATED serum chemestry
- treatments: desmopressin, vasopressin (synthetic ADH)
- complications: CNS damage, serizures
Heart failure - ANS- monitor daily weight and i/o
- prevention/health promotion: exercise regularly, consume diet low in Na, fluid restrictions,
smokin cessation
- left sided HF r/t hypertension, CAD, angina, MI, valvular disease... decreased systemic
perfusion
- right sided HR r/t left sided HF, pulmonary problems, right ventricular MI
- **fluid will be backed up in the system behind the failure (Left in Lungs, right in body)
Esophageal varices - ANS- do not strain to have BM
- avoid using table salt to season food
Blood transfusion - ANS- prime line with NS
- verify with 2 nurses
- infuse over 2-4 h
- monitor for fluid overload
- hemolytic reaction: back/chest pain, apprehension/impending doom
- allergic reaction: within 24h, bronchospasm, urticaria, anaphylaxis
Diabetic Ketoacidosis - ANS- assessment: dehydration, ketosis, metabolic acidosis,
hyperglycemia
- admin fast acting insulin that can be effective within 10 min, admin IV
- kussmaul resp
Beta blockers (Propanolol) - ANS- monitor: sore throat, vision changes, blurred vision, dry eyes,
dry mouth, abd cramping, colitis, acute pancreatitis
- notify provider: night cough
Factors that affect wound healing - ANS- dehydration (UO)
- infection
- BMI <18.5 or >25
- malnutrition (low protein, vita C)
- age
- decreased hgb, tissue perfusion
- wound stress
HIV/AIDS - ANS- positive response to treatment monitored by viral load
- risk for infection: do not drink fluids left out for longer than 60 min, clean toothbrush in
dishwasher weekly, avoid fresh produce, check temp daily
- dx test: ELISA confirmed by western blot/IFA, viral load
Fluid replacement - ANS- monitor BUN
Cerebrovascular accident - ANS- right sided: visual, spatial, proprioception; poor impulse
control/judgment; unilateral neglect
- left sided: language, math, analytical skills
Preventing UTIs - ANS- wipe from front to back
- void after intercourse
- avoid baths
- drink 2-3 L of fluid daily
- cotton underwear
- urinate Q2-4h
Radiation therapy - ANS- do not remove ink markings
- wash area gently with warm water and mild soap
- avoid sun esposure for 1 year
- dispose body fluids in lead container
- limit visits to 30 min a day
, - staff should wear dosimeter badge to monitor exposure
- keep all soiled linens in room until implant is removed
Kidney transplants - ANS- hemodialysis sometimes needed following surgery because kidneys
from deceased donors may not function immediately
- requires lifelong immunosuppressive therapy
- complications: cardiovascular disease
Hemodialysis - ANS- expected: weight loss, decrease BP, increase temp
- complications: hypocalcemia, bleeding, infection, hypovolemia, anemia
- disequilibrium syndrome: nausea, restlessness, dysrhythmias, seizures, headache
- notify: headache, nausea, dizziness during dialysis
- do not eat during dialysis
Inotropic medications - ANS- dopamine, digoxin, dobutamine, milirinone
- increase contractility and improve CO
- monitor HR (apical), hold if <60 min
Diabetes inspidus - ANS- deficiency in ADH
- inability to concentrate urine, 1.001-1.005
- assessment: hypotension, weak peripheral pulses, polydipsia, polyuria (4-30L/day), nocturia,
dehydration
- DILUTE urine chemistry, CONCENTRATED serum chemestry
- treatments: desmopressin, vasopressin (synthetic ADH)
- complications: CNS damage, serizures
Heart failure - ANS- monitor daily weight and i/o
- prevention/health promotion: exercise regularly, consume diet low in Na, fluid restrictions,
smokin cessation
- left sided HF r/t hypertension, CAD, angina, MI, valvular disease... decreased systemic
perfusion
- right sided HR r/t left sided HF, pulmonary problems, right ventricular MI
- **fluid will be backed up in the system behind the failure (Left in Lungs, right in body)
Esophageal varices - ANS- do not strain to have BM
- avoid using table salt to season food
Blood transfusion - ANS- prime line with NS
- verify with 2 nurses
- infuse over 2-4 h
- monitor for fluid overload
- hemolytic reaction: back/chest pain, apprehension/impending doom
- allergic reaction: within 24h, bronchospasm, urticaria, anaphylaxis
