ATI Medical Surgical Adult Nursing Chapters

ATI Medical Surgical Adult Nursing Chapters
1 Health, Wellness, and Illness 50 Acute and Chronic Gastritis
2 Emergency Nursing Principles and Management 51 Noninflammatory Bowel Disorders
Unit 2 Nursing Care of Clients with Neurosensory 52 Inflammatory Bowel Disease
Disorders 53 Cholecystitis and Cholelithiasis
3 Neurologic Diagnostic Procedures 54 Pancreatitis
4 Pain Management 55 Hepatitis and Cirrhosis
5 Meningitis 56 Renal Diagnostic Procedures
6 Seizures and Epilepsy 57 Hemodialysis and Peritoneal Dialysis
7 Parkinson’s Disease 58 Kidney Transplant
8 Alzheimer’s Disease 59 Acute and Chronic Glomerulonephritis
9 Brain Tumors 60 Acute Kidney Injury and Chronic Kidney Disease
10 Multiple Sclerosis, Amyotrophic Lateral Sclerosis, 61 Infections of the Renal and Urinary System
and Myasthenia Gravis 62 Renal Calculi
11 Headaches 63 Diagnostic and Therapeutic Procedures for Female
12 Disorders of the Eye Reproductive Disorders
13 Middle and Inner Ear 64 Menstrual Disorders and Menopause
Disorders 14 Head Injury 65 Disorders of Female Reproductive Tissue
15 Stroke 66 Diagnostic Procedures for Male Reproductive
16 Spinal Cord Injury Disorders
17 Respiratory Diagnostic Procedures 67 Disorders of the Male Reproductive System
18 Chest Tube Insertion and Monitoring 68 Musculoskeletal Diagnostic Procedures
19 Respiratory Management and Mechanical Ventilation 69 Arthroplasty
20 Acute Respiratory Disorders 70 Amputations
21 Asthma 71 Osteoporosis
22 Chronic Obstructive Pulmonary Disease 72 Fractures and Immobilization Devices
23 Tuberculosis 73 Osteoarthritis
24 Pulmonary Embolism 74 Integumentary Diagnostic Procedures
25 Pneumothorax and Hemothorax 75 Chronic Skin Conditions
26 Respiratory Failure 76 Burns
27 Cardiovascular Diagnostic and Therapeutic 77 Endocrine Diagnostic Procedures
Procedures 78 Posterior Pituitary Disorders
28 Electrocardiography and Dysrhythmia Monitoring 79 Hyperthyroidism
29 Pacemakers 80 Hypothyroidism
30 Invasive Cardiovascular Procedures 81 Cushing’s Disease/Syndrome
31 Angina and Myocardial Infarction 82 Addison’s Disease and Acute Adrenal Insufficiency
32 Heart Failure and Pulmonary Edema (Addisonian Crisis
33 Valvular Heart Disease 83 Diabetes Mellitus Management
34 Inflammatory Disorders 84 Complications of Diabetes Mellitus
35 Peripheral Vascular Diseases 85 Immune and Infectious Disorders Diagnostic
36 Hypertension Procedures
37 Hemodynamic Shock 86 Immunizations
38 Aneurysms 87 HIV/AIDS
39 Hematologic Diagnostic Procedures 88 Systemic Lupus Erythematosus
40 Blood and Blood Product 89 Rheumatoid Arthritis
Transfusions 41 Anemias 90 General Principles of Cancer
42 Coagulation Disorders 91 Cancer Screening and Diagnostic Procedures
43 Fluid Imbalances 92 Cancer Treatment Options
44 Electrolyte Imbalances 93 Cancer Disorders
45 Acid-Base Imbalances 94 Pain Management for Clients with Cancer
46 Gastrointestinal Diagnostic Procedures 95 Anesthesia and Moderate Sedation
47 Gastrointestinal Therapeutic Procedures 96 Preoperative Nursing Care
48 Esophageal Disorders 97 Postoperative Nursing Care
49 Peptic Ulcer Disease

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,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 brainiodine-

based 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.