Get a Level 2 or Higher!
Med Surg ATI CMS
Comprehensive Review Study Guide
ABOUT THIS ATI
The BEST comprehensive Med Surg RN ATI CMS study
guide! Covers content from all the most important
chapters. Organized exactly like the latest ATI CMS book
for RNs! Get a level 2 or higher using this study guide! Over
60 pages of material organized in an easy-to-read and understand way!
,Ch. 1 Health, Wellness, and Illness
Health & Wellness
- Modifiable (can be changed) v. Nonmodifiable (cannot be changed)
- Aspects; Physical, Emotional, Social, Intellectual, Spiritual, Occupational, Environmental
- Environment; Social (Crime vs. safety, poverty vs. prosperity, peace vs. social unrest, and presence vs.
absence of support from social networks ); Physical (access to health care, sanitation, availability of
clean water, and geographic location
Ch. 2 Emergency Nursing Principles and Management
Emergency Nursing Principles
Triage
- Level 1; Resuscitation
- Level 2; Emergent
- Level 3; Urgent
- Level 4; Less Urgent
- Level 5; Nonurgent
Primary Survey; rapid assessment of life threatening conditions; completed systematically; standard
precautions; guided by ABCDE principle
ABCDE Principle
- Airway; maintain airway, head-tilt/chin-lift if unresponsive- DO NOT perform is potential cervical
spine injury; if trauma suspected use modified jaw thrust maneuver; bag valve mask w/ 100% O2 w/
nonrebreather for spontaneous breathers
- Breathing; if NOT breathing manual vent w. bag valve mask or mouth to mouth
- Circulation; HR, BP, pulses, cap refill;
To restore circulation; CPR, assess for internal bleed, hemorrhage control; IV access; Isotonic
fluids/blood
To alleviate shock; O2, pressure to bleed, elevate lower extremities, IV fluids & blood, VS,
stay w/ pt.
- Disability; assess LOC ; GCS; AVPU
- Exposure; complete physical assessment; clothing removed; hypothermia primary concern
Poisoning; medical emergency; hx, type of poison,; resp support, circulation, restore fluids, BP/EKG,
ingested poison use activated charcoal, gastric lavage (done w/I 1hr) aspiration; diazepam if seizures occur
Rapid response team; respond to emergency when pt. has indications of rapid decline; early recognition
before resp/cardiac arrest or stroke occurs;
Cardiac emergency
- Cardiac arrest;
- Vfib/ Pulseless VT= defibrillate, CPR, admin IV antidysrhythmic (epi, amiodarone, lidocaine,
magnesium sulfate)
- Ventricular asystole
- Pulseless electrical activity (PEA) & Asystole; CPR, if shockable used Defib, IV access, Epi IVP Q3-5
min
,Emergency Meds;
Epi; stimulate alpha 1 (vasoconstrict), beta 1 ( HR), beta 2 (bronchodilator); superficial bleeding,
BP, AV block, cardiac arrest, & asthma ; A/e; HTN crisis, dysrhythmias, angina
Dopamine; renal blood vessel dilation, beta 1 ( HR) Shock, HF, AKI; A/E; dysrhythmias, angina
Dobutamine; beta 1 ( HR) HF
NEUROLOGIC
Ch. 3 Neurologic Diagnostic Procedures
Cerebral Angiography; visualization of cerebral blood vessels, assess blood flow in brain, ID aneurysms
- Do NOT perform if pregnant, NPO for 4-6hrs prior, assess allergy to shellfish or iodine, assess
bleeding risk/ use of anticoag, assess BUN & Creat; monitor area for clotting after procedure; void
immediately after; may experience metallic taste or feeling of warmth ; movement restricted
CT; cross section image of cranial cavity
- Supine, no jewelry; if contrast dye used take precautions
EEG; ID brain wave abnormalities, seizure activity &sleep disorder
- Wash hair prior, be sleep deprived, expose to flashing lights or hyperventilate for 3-4 min; avoid
stimulants/sedatives 12-24 hr. prior; 45-120 min
ICP Monitoring; performed by neurosurgeon in operating room, used for ICP, GCS score of 8 or <,
complication of infection
3 Types ICP Monitoring
- Intraventricular Catheter; fluid filled cath connected to sterile drainage system inserted into burr
hole, allows simultaneous drainage & monitoring by transducer connected to monitor
- Subarachnoid screw or bolt; hollow threaded screw or bolt connected to transducer, placed thru burr hole
- Epidural or subdural sensor; fiber optic sensor inserted thru burr hole
- S/S ICP (normal 10-15)= IRRITABILITY first sign, severe headache, decrease loc, dilated/ pinpoint
pupils, altered breathing pattern (Cheyne-stokes), hyperventilation, apnea, abnormal posturing
Lumbar Puncture; w/draw CSF to diagnose MS, syphilis, meningitis
- Void prior, assume cannonball position, monitor puncture site, remain lying still on back after
procedure for several hours
Complications; headache from leaking CSF, give opioids/pain meds, fluid intake
MRI; NPO 4-8 hr. prior; remove jewelry, not claustrophobic, give earplugs; w/ contrast dyes: assess for
allergies for shellfish; no metal implants (IUD, aneurysm clip, ortho joint, artificial heart valve, pacemaker)
PET & SPECT Scan; Positron emission tomography and single-photon emission computed tomography scans;
nuclear medicine procedures produce 3D images of head; images can be static (depicting vessels) or functional
(depicting brain activity); captures reginal metabolic processes (tumor activity, dementia)
- Radiation risks
X-ray; reveal fracture or curvature; no pregnant pts, no jewelry
, Ch. 4 Pain Management
Pain Assessment; location, quality, measures/intensity/severity, timing/onset/duration, setting/ how it affects
daily life, associated manifestations, aggravating/relieving factors
Nonpharm Pain Management; tens, heat, cold, massage, relaxation, imagery
Pharm management
- Nonopioid; mild-moderate pain, 4g Tylenol, monitor for salicylism (tinnitus, vertigo, decreased
hearing), gi upset, bleeding
- Opioid= moderate-severe pain, around clock admin, cause constipation, hypotension, urinary retention,
n/v, sedation, respiratory depression, have naloxone ready
Ch. 5 Meningitis
- Inflammation of meninges, viral most common and resolves w/o treatment, fungal common in AIDS pt.;
bacterial is contagious w/ high mortality
Prevention; Hib vaccine, PPSV & MCV4 vaccine (college students)
s/s: excruciating constant headache, stiff neck, photophobia, fever and chills, n/v, altered loc, positive
Kernig sign (resistance and pain w/ extension of pt. leg from flexed position), positive Brudzinski sign
(flexion of knee and hip w/ deliberate flexion of pt. neck), tachycardia, seizure, red macular rash,
irritable
DX: CSF analysis (cloudy= bacterial, clear= viral; + = WBC, protein, GLU in bacterial);
CT scan/MRI to assess ICP
Meds
- Ceftriaxone or cefotaxime in combination with vancomycin: ABX given until culture & sensitivity
results available; Effective for bacterial infections
- Phenytoin: Anticonvulsants given if ICP increases or experiences a seizure.
- Acetaminophen, ibuprofen: Analgesics for headache and/or fever. Non-opioid to avoid masking
changes in the level of consciousness.
- Ciprofloxacin, rifampin, or ceftriaxone: Prophylactic ABX given if in close contact w/ pt.
Complications; ICP; monitor loc, pupillary changes, impaired eom ; SIADH; monitor for dilute blood
and concentrated urine; Septic emboli
NURSING: isolation precautions, droplet precautions until 24 hrs. after antibiotics, environmental
stimuli, quiet environment, bright light, bed rest, HOB 30*, avoid coughing/ sneezing, seizure precautions
Med Surg ATI CMS
Comprehensive Review Study Guide
ABOUT THIS ATI
The BEST comprehensive Med Surg RN ATI CMS study
guide! Covers content from all the most important
chapters. Organized exactly like the latest ATI CMS book
for RNs! Get a level 2 or higher using this study guide! Over
60 pages of material organized in an easy-to-read and understand way!
,Ch. 1 Health, Wellness, and Illness
Health & Wellness
- Modifiable (can be changed) v. Nonmodifiable (cannot be changed)
- Aspects; Physical, Emotional, Social, Intellectual, Spiritual, Occupational, Environmental
- Environment; Social (Crime vs. safety, poverty vs. prosperity, peace vs. social unrest, and presence vs.
absence of support from social networks ); Physical (access to health care, sanitation, availability of
clean water, and geographic location
Ch. 2 Emergency Nursing Principles and Management
Emergency Nursing Principles
Triage
- Level 1; Resuscitation
- Level 2; Emergent
- Level 3; Urgent
- Level 4; Less Urgent
- Level 5; Nonurgent
Primary Survey; rapid assessment of life threatening conditions; completed systematically; standard
precautions; guided by ABCDE principle
ABCDE Principle
- Airway; maintain airway, head-tilt/chin-lift if unresponsive- DO NOT perform is potential cervical
spine injury; if trauma suspected use modified jaw thrust maneuver; bag valve mask w/ 100% O2 w/
nonrebreather for spontaneous breathers
- Breathing; if NOT breathing manual vent w. bag valve mask or mouth to mouth
- Circulation; HR, BP, pulses, cap refill;
To restore circulation; CPR, assess for internal bleed, hemorrhage control; IV access; Isotonic
fluids/blood
To alleviate shock; O2, pressure to bleed, elevate lower extremities, IV fluids & blood, VS,
stay w/ pt.
- Disability; assess LOC ; GCS; AVPU
- Exposure; complete physical assessment; clothing removed; hypothermia primary concern
Poisoning; medical emergency; hx, type of poison,; resp support, circulation, restore fluids, BP/EKG,
ingested poison use activated charcoal, gastric lavage (done w/I 1hr) aspiration; diazepam if seizures occur
Rapid response team; respond to emergency when pt. has indications of rapid decline; early recognition
before resp/cardiac arrest or stroke occurs;
Cardiac emergency
- Cardiac arrest;
- Vfib/ Pulseless VT= defibrillate, CPR, admin IV antidysrhythmic (epi, amiodarone, lidocaine,
magnesium sulfate)
- Ventricular asystole
- Pulseless electrical activity (PEA) & Asystole; CPR, if shockable used Defib, IV access, Epi IVP Q3-5
min
,Emergency Meds;
Epi; stimulate alpha 1 (vasoconstrict), beta 1 ( HR), beta 2 (bronchodilator); superficial bleeding,
BP, AV block, cardiac arrest, & asthma ; A/e; HTN crisis, dysrhythmias, angina
Dopamine; renal blood vessel dilation, beta 1 ( HR) Shock, HF, AKI; A/E; dysrhythmias, angina
Dobutamine; beta 1 ( HR) HF
NEUROLOGIC
Ch. 3 Neurologic Diagnostic Procedures
Cerebral Angiography; visualization of cerebral blood vessels, assess blood flow in brain, ID aneurysms
- Do NOT perform if pregnant, NPO for 4-6hrs prior, assess allergy to shellfish or iodine, assess
bleeding risk/ use of anticoag, assess BUN & Creat; monitor area for clotting after procedure; void
immediately after; may experience metallic taste or feeling of warmth ; movement restricted
CT; cross section image of cranial cavity
- Supine, no jewelry; if contrast dye used take precautions
EEG; ID brain wave abnormalities, seizure activity &sleep disorder
- Wash hair prior, be sleep deprived, expose to flashing lights or hyperventilate for 3-4 min; avoid
stimulants/sedatives 12-24 hr. prior; 45-120 min
ICP Monitoring; performed by neurosurgeon in operating room, used for ICP, GCS score of 8 or <,
complication of infection
3 Types ICP Monitoring
- Intraventricular Catheter; fluid filled cath connected to sterile drainage system inserted into burr
hole, allows simultaneous drainage & monitoring by transducer connected to monitor
- Subarachnoid screw or bolt; hollow threaded screw or bolt connected to transducer, placed thru burr hole
- Epidural or subdural sensor; fiber optic sensor inserted thru burr hole
- S/S ICP (normal 10-15)= IRRITABILITY first sign, severe headache, decrease loc, dilated/ pinpoint
pupils, altered breathing pattern (Cheyne-stokes), hyperventilation, apnea, abnormal posturing
Lumbar Puncture; w/draw CSF to diagnose MS, syphilis, meningitis
- Void prior, assume cannonball position, monitor puncture site, remain lying still on back after
procedure for several hours
Complications; headache from leaking CSF, give opioids/pain meds, fluid intake
MRI; NPO 4-8 hr. prior; remove jewelry, not claustrophobic, give earplugs; w/ contrast dyes: assess for
allergies for shellfish; no metal implants (IUD, aneurysm clip, ortho joint, artificial heart valve, pacemaker)
PET & SPECT Scan; Positron emission tomography and single-photon emission computed tomography scans;
nuclear medicine procedures produce 3D images of head; images can be static (depicting vessels) or functional
(depicting brain activity); captures reginal metabolic processes (tumor activity, dementia)
- Radiation risks
X-ray; reveal fracture or curvature; no pregnant pts, no jewelry
, Ch. 4 Pain Management
Pain Assessment; location, quality, measures/intensity/severity, timing/onset/duration, setting/ how it affects
daily life, associated manifestations, aggravating/relieving factors
Nonpharm Pain Management; tens, heat, cold, massage, relaxation, imagery
Pharm management
- Nonopioid; mild-moderate pain, 4g Tylenol, monitor for salicylism (tinnitus, vertigo, decreased
hearing), gi upset, bleeding
- Opioid= moderate-severe pain, around clock admin, cause constipation, hypotension, urinary retention,
n/v, sedation, respiratory depression, have naloxone ready
Ch. 5 Meningitis
- Inflammation of meninges, viral most common and resolves w/o treatment, fungal common in AIDS pt.;
bacterial is contagious w/ high mortality
Prevention; Hib vaccine, PPSV & MCV4 vaccine (college students)
s/s: excruciating constant headache, stiff neck, photophobia, fever and chills, n/v, altered loc, positive
Kernig sign (resistance and pain w/ extension of pt. leg from flexed position), positive Brudzinski sign
(flexion of knee and hip w/ deliberate flexion of pt. neck), tachycardia, seizure, red macular rash,
irritable
DX: CSF analysis (cloudy= bacterial, clear= viral; + = WBC, protein, GLU in bacterial);
CT scan/MRI to assess ICP
Meds
- Ceftriaxone or cefotaxime in combination with vancomycin: ABX given until culture & sensitivity
results available; Effective for bacterial infections
- Phenytoin: Anticonvulsants given if ICP increases or experiences a seizure.
- Acetaminophen, ibuprofen: Analgesics for headache and/or fever. Non-opioid to avoid masking
changes in the level of consciousness.
- Ciprofloxacin, rifampin, or ceftriaxone: Prophylactic ABX given if in close contact w/ pt.
Complications; ICP; monitor loc, pupillary changes, impaired eom ; SIADH; monitor for dilute blood
and concentrated urine; Septic emboli
NURSING: isolation precautions, droplet precautions until 24 hrs. after antibiotics, environmental
stimuli, quiet environment, bright light, bed rest, HOB 30*, avoid coughing/ sneezing, seizure precautions
