RNRS 396 Med Surg ATI Study Guide- Azusa Pacific University

Med-surge ATI:
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
- Damage/inflammation of tissues ( NOT part of CNS). - Damaged nerves.
- Throbbing, aching, and localized. - Shooting, burning, “pins and
- 3 types: needles”
 Somatic: - MEDS: antidepressants, muscle
 Visceral: internal organs. relaxants.
 Cutaneous: skin, subcutaneous tissue.

, 7. Analgesics:
Non-opioid Opioid (meperidine)
- Mild → moderate pain - Moderate→ severe
- Acetaminophen NOT exceed 4g/day. - S.E: constipation, hypotension, urinary
- Monitor for salicylism w/aspirin (SX: retention, N/V, sedation, respiratory
tinnitus, vertigo) depression.
- WITH FOOD - Naloxone is antidote.
- RISK OF BLEEDING - Administer around the clock (vs PRN)
- Cause ringing of the ears - 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)
 MEDS:
 Anticholinesterase agents (pyridostigmine or neostigmine)
→ 45-60 mins before meal (prevent aspiration)
 Immunosuppressants.
 Procedures/surgeries:
 Plasmapheresis→ removes antibodies from plasma.
 Thymectomy→ removal of thymus.
15. Headache:
Migraine headaches Cluster headaches