ATI comprehensive & Med Surg Review
(Answered)
Do not delegate
What you can EAT
E-evaluate A-assess T-teach
Better peripheral perfusion?
EleVate Veins, DAngle Arteries
APGAR
Appearance (all pink, pink and blue, blue (pale)
Pulse (>100, <100, absent)
Grimace (cough, grimace, no response)
Activity (flexed, flaccid, limp)
Respirations (strong cry, weak cry, absent)
Airborne precautions
My chicken hez tb (measles, chickenpox (varicella) Herpes zoster/shingles TB
Airborne precautions protective equip
private room, neg pressure with 6-12 air exchanges/hr mask N95 for TB
Droplet precautions
spiderman! sepsis, scarlet fever, streptococcal pharyngitis, parvovirus, pneumonia,
pertussis,
influenza,
diptheria,
epiglottitis,
rubella,
mumps, meningitis, mycoplasma or meningeal pneumonia, adeNovirus (Private room or
cohort mask!)
Contact precaution
MRS WEE
Multidrug resistant organism
Rresiratory infection
Skin infection
Wound infection
Enteric infection (C diff)
Eye infection (conjunctivitis)
Skin infection
VCHIPS
Varicella zoster
Cutaneous diptheria
Herpes simplez
Impetigo
Peduculosis
Scabies
Air or Pulmonary Embolism
,S/S chest pain, dyspnea, tachycardia, pale/cyanotic, sense of impending doom. (turn pt
to LEFT side and LOWER the head of bed.)
Woman in labor (un-reassuring FHR)
(late decels, decreased variability, fetal bradycardia, etc) Turn pt on Left side, give O2,
stop pitocin, Increase IV fluids!
Tube feeding with decreased LOC
Pt on Right side (promotes emptying of the stomach) Head of bed elevated (prevent
aspiration)
After lumbar puncture and oil based myelogram
pt is flat SUPINE (prevent headache and leaking of CSF)
Pt with heat stroke
flat with legs elevated
during Continuous Bladder Irrigation (CBI)
catheter is taped to the thigh. leg must be kept straight.
After Myringotomy
position on the side of AFFECTED ear, allows drainage.
After Cateract surgery
pt sleep on UNAFFECTED side with a night shield for 1-4 weeks
after Thyroidectomy
low or semi-fowler's position, support head, neck and shoulders.
Infant with Spina Bifida
Prone so that sac does not rupture
Buck's Traction (skin)
elevate foot of bed for counter traction
After total hip replacement
don't sleep on side of surgery, don't flex hip more than 45-60 degress, don't elevate
Head Of Bed more than 45 degrees. Maintain hip abduction by separating thighs with
pillows.
Prolapsed cord
Knee to chest or Trendelenburg
Cleft Lip
position on back or in infant seat to prevent trauma to the suture line. while feeding hold
in upright position.
To prevent dumping syndrome
(post operative ulcer/stomach surgeries) eat in reclining position. Lie down after meals
for 20-30 min. also restrict fluids during meals, low CHO and fiber diet. small, frequent
meals.
AKA (above knee amputation)
elevate for first 24 hours on pillow. position prone daily to maintain hip extension.
BKA (below knee amputation)
foot of bed elevated for first 24 hours. position prone to provide hip extension.
detached retina
area of detachment should be in the dependent position
administration of enema
pt should be left side lying (Sim's) with knee flexed.
After supratentorial surgery
,(incision behind hairline on forhead) elevate HOB 30-40 degrees
After infratentorial surgery
(incision at the nape of neck) position pt flat and lateral on either side.
During internal radiation
on bed rest while implant in place
Shock
bedrest with extremities elevated 20 degrees. knees straight, head slightly elevated
(modified Trendelenberg)
Head Injury
elevate HOB 30 degrees to decrease ICP
Peritoneal Dialysis (when outflow is inadequate)
turn pt from side to side BEFORE checking for kinks in tubing
Lumbar Puncture
After the procedure, the pt should be supine for 4-12 hours as prescribed.
Myesthenia Gravis
worsens with exercise and improves with rest
Myesthenia Gravis
a positive reaction to Tensilon---will improve symptoms
Cholinergic Crisis
Caused by excessive medication ---stop giving Tensilon...will make it worse.
Liver biopsy (prior)
must have lab results for prothrombin time
hypothyroidism
aka?
Myxedema
slowed physical and mental function, sensitivity to cold, dry skin and hair.
hyperthyroidism
aka?
Grave's Disease
accelerated physical and mental function. Sensitivity to heat. Fine/soft hair.
Thyroid storm
increased temp, pulse and HTN
Post-Thyroidectomy
semi-fowler's. Prevent neck flexion/hyperextension. Trach at bedside
Hypo-parathyroid
CATS---Convulsions, Arrhythmias, Tetany, Spasms, Stridor. (decreased calcium) give
high calcium, low phosphorus diet
Hyper-parathyroid
fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium) give a
low calcium high phosphorous diet
Hypovolemia
increased temp, rapid/weak pulse, increase respiration, hypotension, anxiety. Urine
specific gravity >1.030
Hypervolemia
bounding pulse, SOB, dyspnea, rales/crackles, peripheral edema, HTN, urine specific
gravity <1.010. semi fowler's
, Diabetes insipidus (decreased ADH)
excessive urine output and thirst, dehydration, weakness, administer Pitressin
SIADH (increased ADH)
change in LOC, decreased deep tendon reflexes, tachycardia. N/V HA administer
Declomycin, diuretics
hypokalemia
muscle weakness, dysrhythmias, increase K (rasins bananas apricots, oranges, beans,
potatoes, carrots, celery)
Hyperkalemia
MURDER Muscle weakness, Urine (olig, anuria) Resp depression, decreased cardiac
contractility, ECG changes, reflexes
Hyponatremia
nausea, muscle cramps, increased ICP, muscular twitching, convulsions. give osmotic
diuretics (Mannitol) and fluids
Hypernatremia
increased temp, weakness, disorientation, dilusions, hypotension, tachycardia. give
hypotonic solution.
Hypocalcemia
CATS Convulsions, Arrythmias, Tetany, spasms and stridor
+Trosseaus
+Chovasteks
Hypercalcemia
muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon
reflexes, shallow respirations, emergency!
Hypo Mg
Tremors, tetany, seizures, dysthythmias, depression, confusion, dysphagia, (dig toxicity)
Hyper Mg
depresses the CNS. Hypotension, facial flushing, muscle weakness, absent deep
tendon reflexes, shallow respirations. EMERGENCY
Addison's
can it cause shock? why?
s/s
NOT ENOUGH STEROID
(low aldosterone > fluid & sodium loss > K+ retention)
S/S: sever hypotension
Hypo Na, Hyper K, Hypoglycemia, decreased resistance to stress, allopecia, weight
loss., lethargy, bronze like skin pigmentation
Cushings
TOO MUCH STEROID Hyper Na, Hypo K, hyperglycemia, prone to infection, muscle
wasting, weakness, edema, HTN, hirsutism, moonface/buffalo hump
Addesonian crisis
(Answered)
Do not delegate
What you can EAT
E-evaluate A-assess T-teach
Better peripheral perfusion?
EleVate Veins, DAngle Arteries
APGAR
Appearance (all pink, pink and blue, blue (pale)
Pulse (>100, <100, absent)
Grimace (cough, grimace, no response)
Activity (flexed, flaccid, limp)
Respirations (strong cry, weak cry, absent)
Airborne precautions
My chicken hez tb (measles, chickenpox (varicella) Herpes zoster/shingles TB
Airborne precautions protective equip
private room, neg pressure with 6-12 air exchanges/hr mask N95 for TB
Droplet precautions
spiderman! sepsis, scarlet fever, streptococcal pharyngitis, parvovirus, pneumonia,
pertussis,
influenza,
diptheria,
epiglottitis,
rubella,
mumps, meningitis, mycoplasma or meningeal pneumonia, adeNovirus (Private room or
cohort mask!)
Contact precaution
MRS WEE
Multidrug resistant organism
Rresiratory infection
Skin infection
Wound infection
Enteric infection (C diff)
Eye infection (conjunctivitis)
Skin infection
VCHIPS
Varicella zoster
Cutaneous diptheria
Herpes simplez
Impetigo
Peduculosis
Scabies
Air or Pulmonary Embolism
,S/S chest pain, dyspnea, tachycardia, pale/cyanotic, sense of impending doom. (turn pt
to LEFT side and LOWER the head of bed.)
Woman in labor (un-reassuring FHR)
(late decels, decreased variability, fetal bradycardia, etc) Turn pt on Left side, give O2,
stop pitocin, Increase IV fluids!
Tube feeding with decreased LOC
Pt on Right side (promotes emptying of the stomach) Head of bed elevated (prevent
aspiration)
After lumbar puncture and oil based myelogram
pt is flat SUPINE (prevent headache and leaking of CSF)
Pt with heat stroke
flat with legs elevated
during Continuous Bladder Irrigation (CBI)
catheter is taped to the thigh. leg must be kept straight.
After Myringotomy
position on the side of AFFECTED ear, allows drainage.
After Cateract surgery
pt sleep on UNAFFECTED side with a night shield for 1-4 weeks
after Thyroidectomy
low or semi-fowler's position, support head, neck and shoulders.
Infant with Spina Bifida
Prone so that sac does not rupture
Buck's Traction (skin)
elevate foot of bed for counter traction
After total hip replacement
don't sleep on side of surgery, don't flex hip more than 45-60 degress, don't elevate
Head Of Bed more than 45 degrees. Maintain hip abduction by separating thighs with
pillows.
Prolapsed cord
Knee to chest or Trendelenburg
Cleft Lip
position on back or in infant seat to prevent trauma to the suture line. while feeding hold
in upright position.
To prevent dumping syndrome
(post operative ulcer/stomach surgeries) eat in reclining position. Lie down after meals
for 20-30 min. also restrict fluids during meals, low CHO and fiber diet. small, frequent
meals.
AKA (above knee amputation)
elevate for first 24 hours on pillow. position prone daily to maintain hip extension.
BKA (below knee amputation)
foot of bed elevated for first 24 hours. position prone to provide hip extension.
detached retina
area of detachment should be in the dependent position
administration of enema
pt should be left side lying (Sim's) with knee flexed.
After supratentorial surgery
,(incision behind hairline on forhead) elevate HOB 30-40 degrees
After infratentorial surgery
(incision at the nape of neck) position pt flat and lateral on either side.
During internal radiation
on bed rest while implant in place
Shock
bedrest with extremities elevated 20 degrees. knees straight, head slightly elevated
(modified Trendelenberg)
Head Injury
elevate HOB 30 degrees to decrease ICP
Peritoneal Dialysis (when outflow is inadequate)
turn pt from side to side BEFORE checking for kinks in tubing
Lumbar Puncture
After the procedure, the pt should be supine for 4-12 hours as prescribed.
Myesthenia Gravis
worsens with exercise and improves with rest
Myesthenia Gravis
a positive reaction to Tensilon---will improve symptoms
Cholinergic Crisis
Caused by excessive medication ---stop giving Tensilon...will make it worse.
Liver biopsy (prior)
must have lab results for prothrombin time
hypothyroidism
aka?
Myxedema
slowed physical and mental function, sensitivity to cold, dry skin and hair.
hyperthyroidism
aka?
Grave's Disease
accelerated physical and mental function. Sensitivity to heat. Fine/soft hair.
Thyroid storm
increased temp, pulse and HTN
Post-Thyroidectomy
semi-fowler's. Prevent neck flexion/hyperextension. Trach at bedside
Hypo-parathyroid
CATS---Convulsions, Arrhythmias, Tetany, Spasms, Stridor. (decreased calcium) give
high calcium, low phosphorus diet
Hyper-parathyroid
fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium) give a
low calcium high phosphorous diet
Hypovolemia
increased temp, rapid/weak pulse, increase respiration, hypotension, anxiety. Urine
specific gravity >1.030
Hypervolemia
bounding pulse, SOB, dyspnea, rales/crackles, peripheral edema, HTN, urine specific
gravity <1.010. semi fowler's
, Diabetes insipidus (decreased ADH)
excessive urine output and thirst, dehydration, weakness, administer Pitressin
SIADH (increased ADH)
change in LOC, decreased deep tendon reflexes, tachycardia. N/V HA administer
Declomycin, diuretics
hypokalemia
muscle weakness, dysrhythmias, increase K (rasins bananas apricots, oranges, beans,
potatoes, carrots, celery)
Hyperkalemia
MURDER Muscle weakness, Urine (olig, anuria) Resp depression, decreased cardiac
contractility, ECG changes, reflexes
Hyponatremia
nausea, muscle cramps, increased ICP, muscular twitching, convulsions. give osmotic
diuretics (Mannitol) and fluids
Hypernatremia
increased temp, weakness, disorientation, dilusions, hypotension, tachycardia. give
hypotonic solution.
Hypocalcemia
CATS Convulsions, Arrythmias, Tetany, spasms and stridor
+Trosseaus
+Chovasteks
Hypercalcemia
muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon
reflexes, shallow respirations, emergency!
Hypo Mg
Tremors, tetany, seizures, dysthythmias, depression, confusion, dysphagia, (dig toxicity)
Hyper Mg
depresses the CNS. Hypotension, facial flushing, muscle weakness, absent deep
tendon reflexes, shallow respirations. EMERGENCY
Addison's
can it cause shock? why?
s/s
NOT ENOUGH STEROID
(low aldosterone > fluid & sodium loss > K+ retention)
S/S: sever hypotension
Hypo Na, Hyper K, Hypoglycemia, decreased resistance to stress, allopecia, weight
loss., lethargy, bronze like skin pigmentation
Cushings
TOO MUCH STEROID Hyper Na, Hypo K, hyperglycemia, prone to infection, muscle
wasting, weakness, edema, HTN, hirsutism, moonface/buffalo hump
Addesonian crisis
