ATI Medical Surgical Adult Nursing Chapters

1 Health, Wellness, and Illness

2 Emergency Nursing Principles and Management

Unit 2 Nursing Care of Clients with Neurosensory

Disorders

3 Neurologic Diagnostic Procedures

4 Pain Management

5 Meningitis

6 Seizures and Epilepsy

7 Parkinson’s Disease

8 Alzheimer’s Disease

9 Brain Tumors

10 Multiple Sclerosis, Amyotrophic Lateral Sclerosis,

and Myasthenia Gravis

11 Headaches

12 Disorders of the Eye

13 Middle and Inner Ear Disorders

14 Head Injury

15 Stroke

16 Spinal Cord Injury

17 Respiratory Diagnostic Procedures

18 Chest Tube Insertion and Monitoring

19 Respiratory Management and Mechanical Ventilation

20 Acute Respiratory Disorders

21 Asthma

22 Chronic Obstructive Pulmonary Disease

23 Tuberculosis

24 Pulmonary Embolism

25 Pneumothorax and Hemothorax

26 Respiratory Failure

27 Cardiovascular Diagnostic and Therapeutic

Procedures

28 Electrocardiography and Dysrhythmia Monitoring

29 Pacemakers

30 Invasive Cardiovascular Procedures

31 Angina and Myocardial Infarction

32 Heart Failure and Pulmonary Edema

33 Valvular Heart Disease

34 Inflammatory Disorders

35 Peripheral Vascular Diseases

36 Hypertension

37 Hemodynamic Shock

38 Aneurysms

39 Hematologic Diagnostic Procedures

40 Blood and Blood Product Transfusions

41 Anemias

42 Coagulation Disorders

43 Fluid Imbalances

44 Electrolyte Imbalances

45 Acid-Base Imbalances

46 Gastrointestinal Diagnostic Procedures

47 Gastrointestinal Therapeutic Procedures

48 Esophageal Disorders

49 Peptic Ulcer Disease

50 Acute and Chronic Gastritis

51 Noninflammatory Bowel Disorders

52 Inflammatory Bowel Disease

53 Cholecystitis and Cholelithiasis

54 Pancreatitis

55 Hepatitis and Cirrhosis

56 Renal Diagnostic Procedures

57 Hemodialysis and Peritoneal Dialysis

58 Kidney Transplant

59 Acute and Chronic Glomerulonephritis

60 Acute Kidney Injury and Chronic Kidney Disease

61 Infections of the Renal and Urinary System

62 Renal Calculi

63 Diagnostic and Therapeutic Procedures for Female

Reproductive Disorders

64 Menstrual Disorders and Menopause

65 Disorders of Female Reproductive Tissue

66 Diagnostic Procedures for Male Reproductive

Disorders

67 Disorders of the Male Reproductive System

68 Musculoskeletal Diagnostic Procedures

69 Arthroplasty

70 Amputations

71 Osteoporosis

72 Fractures and Immobilization Devices

73 Osteoarthritis

74 Integumentary Diagnostic Procedures

75 Chronic Skin Conditions

76 Burns

77 Endocrine Diagnostic Procedures

78 Posterior Pituitary Disorders

79 Hyperthyroidism

80 Hypothyroidism

81 Cushing’s Disease/Syndrome

82 Addison’s Disease and Acute Adrenal Insufficiency

(Addisonian Crisis

83 Diabetes Mellitus Management

84 Complications of Diabetes Mellitus

85 Immune and Infectious Disorders Diagnostic

Procedures

86 Immunizations

87 HIV/AIDS

88 Systemic Lupus Erythematosus

89 Rheumatoid Arthritis

90 General Principles of Cancer

91 Cancer Screening and Diagnostic Procedures

92 Cancer Treatment Options

93 Cancer Disorders

94 Pain Management for Clients with Cancer

95 Anesthesia and Moderate Sedation

96 Preoperative Nursing Care

97 Postoperative Nursing Care

Chapter 1- Health, Wellness, and Illness

 Aspects of health and wellness

o Physical – able to perform activities of daily living

o Emotional – adapts to stress; expresses and identifies emotions

o Social – interacts successfully with others

o Intellectual – effectively learns and disseminates information

o Spiritual – adopts a belief that provides meaning to life

o Occupational – balances occupational activities with leisure time

o Environmental – creates measures to improve standards of living and quality of life

 A client’s state of health and wellness is constantly changing and adapting to a continually fluctuating external

and internal environment.

o The external environment

 Social – crime versus safety, poverty versus prosperity, and peace versus social unrest

 Physical – access to health care, sanitation, availability of clean water, and geographic isolation

o The internal environment includes cumulative life experiences, cultural and spiritual beliefs, age,

developmental stage, gender, and other support systems.

Chapter 2- Emergency Nursing Principles and Management

 Emergency nursing principles are the guidelines that nurses follow to assess and manage emergency situations

for a client or multiple clients.

 7 Emergency nursing principles

1) Triage- ensures that clients with the highest acuity needs receive the quickest treatment 3

Categories:

 Emergent- indicates a life- or limb-threatening situation.

 Urgent- indicates that the client should be treated soon, but that the risk posed is not

life-threatening.

 Non-urgent- generally can wait for an extended length of time without serious

deterioration.

o Triage Under Mass Casualty Conditions a military form of triage that is implemented with a

focus of achieving the greatest good for the greatest number of people 4 Classifications:

 Emergent or Class I- identified with a red tag indicating an immediate threat to

life

 Urgent or Class II- identified with a yellow tag indicating major injuries that

require immediate treatment

 Non-urgent or Class III- identified with a green tag indicating minor injuries that

do not require immediate treatment

 Expectant or Class IV- identified with a black tag indicating one who is expected

and allowed to die

2) Primary survey- a rapid assessment of life-threatening conditions. It should take no longer than 60

seconds to perform with use of ABCDE as a guideline wear standard PPE

3) Airway/cervical spine, breathing, circulation, disability, and exposure/environmental control

(ABCDE)

o Airway/Cervical Spine- the most important step in performing the primary survey. If a patent

airway is not established, subsequent steps of the primary survey are futile.

 Inspect for blood, broken teeth, vomit, or foreign materialsobstruction clear with

finger sweep

 If unresponsive without suspicion of trauma, open airway with a head-tilt/chin-lift

maneuver.

 Do NOT perform this technique on clients who have a potential cervical spine

injury.

 If the client is unresponsive with suspicion of trauma, open airway with a modified jaw

thrust maneuver.

o Breathing- Auscultation of breath sounds, observation of chest expansion and respiratory

effort, notation of rate and depth of respirations, identification of chest trauma, note position of

trachea, assess for jugular vein distention

o Circulation- Nurses should assess heart rate, blood pressure, and perfusion.

 CPR, assess for external bleeding, hemorrhage control, obtain IV access using

large-bore IV catheters inserted into the antecubital fossa of both arms, infuse

IV fluids (lactated Ringer’s and 0.9% normal saline and/or blood).

o Disability quick assessment to determine the client’s level of consciousness (AVPU and

Glasgow Coma Scale)

 A- alert, V- responsive to voice, P- responsive to pain, U- unresponsive

o Exposureremoves the client’s clothing for a complete physical assessment

 Hypothermia (RISK)to preventRemove wet clothing from the client, cover the client

with blankets or use a heat lamp to provide additional warmth, increase the

temperature of the room, infuse warmed IV fluids as prescribed.

4) Poisoningassess for toxin originReverse heroin and other opiate toxicity with naloxone (Narcan)

Administer IV diazepam (Valium) if seizures occurAssess for tissue edema every 15 to 30 min if bitten

by a snake or spider

5) Rapid response teamA group of critical care experts (ICU nurse, respiratory therapist, a critical care

provider, hospitalist)

6) Cardiac emergencyCardiac arrest (sudden cessation of cardiac function) Ventricular fibrillation

(VF) Pulseless ventricular tachycardia (VT)(Irritable firing of ectopic ventricular beats at a rate of 140-

180/min) Ventricular asystole (complete absence of electrical activity and ventricular movement of the

heart) Pulseless electrical activity (PEA)

o AHA ACLS Protocols

 VF or pulseless ventricular tachycardia (VT)Initiate the CPR components of

BLSDefibrillate according to BLS guidelinesEstablish IV accessAdminister IV

antidysrhythmic medications according to ACLS guidelinesEpinephrine 1 mg IV push

every 3 to 5 min or vasopressin 40 units IV x 1 only (switch to epinephrine if no

response)

 Consider the following medicationsAmiodarone hydrochloride (Cordarone),

Lidocaine hydrochloride (Xylocaine), Magnesium sulfate, Procainamide (Procan

SR), Vasopressin

 Pulseless electrical activity (PEA)Initiate the CPR components of BLSDefibrillate

according to BLS guidelinesEstablish IV accessConsider the most common causes.

 5 H’sHypovolemia, Hypoxia, Hydrogen ion accumulationacidosis,

Hyper-/hypo-kalemia, Hypothermia

 5 T’sToxins (drugs), Tamponade (cardiac), Tension pneumothorax, Thrombosis

(coronary or pulmonary)

o Administer epinephrine 1 mg IV push every 3 to 5 min.

 Asystole Initiate the CPR components of BLSDefibrillate according to BLS

guidelinesEstablish IV accessBegin immediate transcutaneous pacingGive

epinephrine 1 mg push every 3 to 5 min

7) Postresuscitation Medicate after resuscitationepinephrine, dopamine, and dobutamine

Chapter 3- Neurologic Diagnostic Procedures

**For all procedures if pregnant, determine if benefits outweigh risks**

 Cerebral Angiogram- assesses the blood flow to and within the brain, identifies aneurysms, and defines the

vascularity of tumors. Detects defects, narrowing, or obstruction of arteries or blood vessels in brainiodinebased contrast dye is injected into an artery during the procedure.

o NPO 4-6 hours prior Assess allergies to shellfish or iodine Assess BUN and creatinine no jewelryDo

not move during the procedurevoid before the test metallic taste in the mouth, a warm sensation

over the face, jaw, tongue, lips, and behind the eyes from the dye injected during procedure

o IntraprocedureA catheter is placed into an artery (groin or the neck), dye is injected, and x-ray

pictures are taken

o Postprocedurearea is closely monitored to ensure that clotting occurs movement is restricted

o Complications Bleeding or hematoma formation at entry siteCheck the insertion site frequently,

Check the affected extremity distal to the puncture site for adequate circulation (e.g., color,

temperature, pulses, and capillary refill)

 Cerebral Computed Tomography (CT) Scan- used to identify tumors and infarctions, detect abnormalities,

monitor response to treatment, and guide needles used for biopsies.

o NPO at least 4 hours prior Assess allergies to shellfish or iodine Assess BUN and creatinine no

jewelryClient must lie supine with the head stabilized during the procedurepainlesssedate if needed

 Electroencephalography (EEG)- most commonly performed to identify and determine seizure activity, but

they are also useful for detecting sleep disorders and behavioral changes.

o Preprocedure wash his hair prior to the procedure and eliminate all oils, gels, and sprays instruct

the client to be sleep-deprived because this provides cranial stress, increasing the possibility of

abnormal electrical activity, such as seizure potentials, occurring during the procedure.

o Intraprocedure procedure takes 1 hr Electrical signals produced by the brain are recorded by the

machine or computer in the form of wavy linesclient may resume normal activities after

 Glasgow Coma Scale (GCS)- GCS scores are helpful in determining changes in the level of consciousness for

clients with head injuries, space occupying lesions or cerebral infarctions, and encephalitis.