RNRS 396 ATI MED-SURG ATI STUDY GUIDE COMPLETE SOLUTION 100% CORRECT.

RNRS 396 ATI MED-SURG ATI STUDY GUIDE COMPLETE SOLUTION 100% CORRECT. ATI MED-SURG ATI STUDY GUIDE . I. NERVOUS SYSTEM: 1. Cerebral Angiogram: - Allows for visualization of cerebral blood vessels. A catheter is placed into an artery (usually in the groin) and threaded up the blood vessels in the brain, dye is injected, x-ray are taken. ▪ Pre-procedure: ▪ NPO 4-6 hrs prior. ▪ Assess for allergy to iodine or shellfish. ▪ Assess kidney function (BUN, creatinine) to determine if kidneys can excrete the dye. ▪ Post-procedure: ▪ Check insertion site for bleeding, check extremity distal to puncture site (pulses, capillary, refill, temperature, color) 2. EEG: - Analyzes electrical activity in the brain. It is used to identify seizure activity, sleep disorders, behavioral changes. 1 hrs. - Pre-procedure patient instructions: ▪ Wash hair prior to procedure ▪ Arrive sleep-deprived (as this increases chance of seizures) ▪ No NPO is needed. Avoid stimulates, sedative medications 12-24hrs before procedure. ▪ Flashing light, hyperventilate (to increase electrical activity) 3. Intracranial pressure (ICP) monitoring: RANGE 10-15 mmHg. - Inserted into cranial cavity in the OR to measure pressure. HUGE RISK OF INFECTION. ▪ GCS score of 8 or less or coma ▪ SYMTOMP: ▪ Irritability (early sign!), ▪ Restlessness, headache, decreased LOC ▪ Pupil abnormalities, abnormal breathing ( EX: Cheyne Stokes) ▪ Abnormal posturing. 4. Lumbar Puncture: Cerebral Spinal Fluid (CSF) - Used to diagnose multiple sclerosis, syphilis, meningitis, infection in CSF. ▪ Pre-procedure: ▪ VOID ▪ Position pt in cannonball position on their side, or have pt stretch over table while sitting. ▪ Post-procedure: ▪ Pt should lay flat for several hrs→ (bedrest) ▪ If the dura puncture site does not heal, CSF may leak, RESULTING IN HEADACHE (give pain meds, increased fluid intake). ▪ Epidural blood patch can be used to seal off the hole. ▪ Slightly elevated temp ▪ Difficulty VOIDING 5. MRI: ▪ Allergy shellfish/iodine ▪ Hx of claustrophobia ▪ Remove all jewelry ▪ No metal (pacemaker, orthopedic joints, artificial heart valves, IUDs, aneurysm clips). ▪ Earplugs can be provided, as MRIs are loud. 6. Pain Nociceptive pain Neuropathic pain ATI MED-SURG ATI STUDY GUIDE - Damage/inflammation of tissues ( NOT part of CNS). - Throbbing, aching, and localized. - 3 types: ▪ Somatic: ▪ Visceral: internal organs. ▪ Cutaneous: skin, subcutaneous tissue. - Damaged nerves. - Shooting, burning, “pins and needles” - MEDS: antidepressants, muscle relaxants. 7. Analgesics: Non-opioid Opioid (meperidine) - Mild → moderate pain - Acetaminophen NOT exceed 4g/day. - Monitor for salicylism w/aspirin (SX: tinnitus, vertigo) - WITH FOOD - RISK OF BLEEDING - Cause ringing of the ears - Moderate→ severe - S.E: constipation, hypotension, urinary retention, N/V, sedation, respiratory depression. - Naloxone is antidote. - Administer around the clock (vs PRN) - Instruct the client to void at least q4h to decrease the risk of urinary retention REPORT: - Oversedation (sleep through the day) ▪ Risk for respiratory depression. 8. Meningitis: - Prevention: ▪ MCV4 vaccine is given to students living in dorms - SX: ▪ Headache, nuchal (neck) rigidity, photophobia, N/V, positive Kerning’s and Brudzinski’s signs, fever, altered LOC, tachycardia, seizures. ▪ Weight loss - Diagnosis: ▪ CFS analysis ▪ Bacteria will have cloudy CSF, decrease glucose content. ▪ Viral will have clear CSF. ▪ Elevated WBC and protein for both types. - Nursing care: ▪ DROPLET precautions until antibiotics are administered for 24hrs. ▪ Quiet room, low light, HOB 30, monitor increased ICP. ▪ Avoid coughing/sneezing, seizure precaution. ▪ AVOID photophobia. - MEDS: ▪ Antibiotics, anticonvulsants (EX: phenytoin) 9. Seizures: - Uncontrolled electrical discharge of neurons in brain ▪ Epilepsy= chronic seizure (2 or more) - Risk factor: ▪ Fever, cerebral edema, infection, toxin, exposure, brain tumor, hypoxia, alcohol/drug withdrawal, fluid or electrolyte imbalances. - Triggering factors: ▪ Stress, fatigue, caffeine, flashing lights. - Types: ▪ Tonic Clonic: 3 phases ▪ Tonic: stiffening of muscles, LOC ▪ Clonic: 1-2 min for rhythmic jerking of extremities. ▪ Postictal: confusion, sleepiness. ▪ Absence: ▪ LOC for a few seconds. ▪ Blank staring, eye fluttering, lip smacking, picking at clothes. ▪ Myoclonic: ▪ Brief stiffening of extremities. ▪ Atonic: ▪ Loss of muscle tone, results in FALLING. ▪ Status epilepticus: ▪ Repeated seizure activity within 30 min, or a single seizure more than 5 min. - Diagnosis: EEG - Nursing care: ▪ DURING: ▪ Turn the pt to the side (priority) • Greatest risk for hypoxia from impaired airway. • Prevent aspiration. ▪ Loosen restrictive clothing ▪ DO NOT insert airway or restrain pt ▪ Document/onset/duration of seizure ▪ POST: ▪ Check vital, neurological, reorient. ▪ Seizure precaution, determine possible trigger. - MEDS: ▪ Anti-seizure = phenytoin - Surgeries: ▪ Vagal nerve stimulator, craniotomy to remove brain tissue causing seizures. 10. Parkinson’s Dz - Too little dopamine and too much acetylcholine. - Sx: ▪ Tremor, muscle rigidity, slow/shuffling gait, bradykinesia (slow movement) ▪ Masklike expression, drooling, difficulty swallowing. - Nursing care: ▪ Monitor swallowing/food intake ▪ Thicken food, sit upright to eat. ▪ Suction available, ROM, and exercise, assist w/ADLs - MEDS: ▪ Levodopa/carbidopa (increases dopamine levels) → sudden onset of sleep, drowsiness and dizziness. → AVOID driving. → amantadine (increasing the release of dopamine) ▪ Benztropine (decreases acetylcholine levels) 11. Alzheimer’s Dz: ▪ NON-REVERSIBLE dementia. ▪ Memory loss, problem with judgment, and changes in personality. ▪ difficulty with recent memory, swallowing and walking, impaired learning, and depression. ▪ Nursing care: ▪ Maintain structured environment. ▪ Easy to read clocks with plain background (minimize confusion) ▪ Explain how to complete a task before. ▪ Place completed outfits on hangers and allow the client to select which one to wear each day. ▪ Short directions, repetition. ▪ Avoid overstimulation, use single-day calendar (with days). ▪ Frequent reorientation, maintain routine toileting schedule. ▪ Home safety: ▪ Remove scatter rugs ▪ Door locks, good lighting (stairs) ▪ Mark step edges w/colored tape, remove clutter. ▪ MEDS: ▪ Donepezil (prevents breakdown of Ach, improves ADLs) ▪ Manage sx (antipsychotics, antidepressants, anti-anxiety) 12. Multiple sclerosis: ▪ Autoimmune disorder where plaque develops in white matter of the CNS. ▪ Onset 20-40 yrso. More in WOMEN. ▪ Characterized by periods of relapsing and remitting. ▪ Triggers: ▪ Temperature extremes, stress/injury, pregnancy, fatigue. ▪ Vitamin D deficiency. ▪ Sx: ▪ Eye problems (diplopia/nystagmus). ▪ Muscle spasticity and weakness, bowel/bladder dysfunction ▪ Cognitive changes, ear problems (tinnitus/hearing issues) ▪ Dysphagia, fatigue. ▪ N.C: ▪ Speech pathologist will be performing a swallowing study (prevent aspiration) ▪ Encourage pt rest before meal (weakness and fatigue) ▪ Adequate vitamin D ▪ Increased dietary fiber (constipation) ▪ Liquids should be thickened to reduce aspiration. 13. Amyotrophic lateral sclerosis: (ALS) ▪ Degenerative neurological disorder of upper and lower motor neurons, resulting on progressive paralysis. ▪ Eventually causes respiratory paralysis within 3-5 years. Cognitive function not impacted. ▪ NO CURE ▪ SX: ▪ Muscle weakness, atrophy ▪ Nursing care: ▪ Maintain patent airway ▪ Suction/intubates ▪ Monitor for pneumonia, respiratory failure. ▪ MEDS: ▪ Riluzole→ slows deterioration of motor neurons, extend pt’s life 2-3 months. 14. Myasthenia Gravis (MG): ▪ Autoimmune disorder = severe muscle weakness= antibodies that interfere with Ach at neuromuscular junction (NMJ). ▪ Characterized by periods of exacerbation and remission. ▪ Associated with thymus hyperplasia. ▪ Symptoms: ▪ Muscle weakness (worse w/activity) ▪ Diplopia, dysphagia, impaired respiration ▪ Drooping eyelids (Ptosis) ▪ Incontinence ▪ Diagnosis: ▪ Administer edrophonium= increased Ach at NMJ ▪ Symptom improve= it is MG ▪ IF NOT= cholinergic crisis (Atropine is antidote). ▪ Nursing care: ▪ Maintain air way, REST ▪ Provide small/frequent/high-calorie meals ▪ Sit upright while eating, thicken liquids ▪ Administer lubricating eye drops ▪ Tape eyes shut at night (prevent damage to cornea) .