The complex adult client, building on Adult Health I. Organized exam → module (week). Everything for one week sits
together — the content, and the slots for your mind maps, infographics,
ATI templates and questions.
Your low-friction study launchpad
One module. One small win. Then the next.
You do not have to hold the whole course in your head. Choose one exam band, open one module, and let the visual chunks carry the load.
🧩 14 modules🗺️ 6 exam bands🧠 84 practice questions🎨 31 mind maps
1Choose a color bandUse the roadmap below. Each band is one exam-sized group.
2Open one moduleRead only the first open chunk. Stop before attention gets expensive.
3Use the pictures firstScan the mind map, comparison table or flow diagram before the details.
Modules you have opened0 of 14 opened
Six-color exam roadmap
Choose a band to jump directly to that part of the course.
🗺️
Visual atlas: see the pattern first
Use these three pictures before reading details. They show where the topics fit, what gets priority, and how nurses track change.
Four connected body-system stories
The modules are easier to remember when they live in four larger “neighborhoods.”
🛡️ DefenseM2–M4 and M9–M10 infection · immunity · burns · blood · cancer
🫁 Airway + breathingoxygenation and ventilation come first
The clinical-change loop
A single number matters less than its direction, the patient’s symptoms, and the response to what you did.
📍BaselineWhat is normal for this patient?
📈TrendWhich direction is it moving?
🚨ThresholdWhat finding makes it urgent?
🛠️ActionWhat is the safest first response?
🔁ReassessDid the patient improve?
🧩
New: study one bite—or only the high-yield facts.Open any module and use its purple study bar. “One bite” shows one small section at a time. “High yield” isolates the gold Exam Spotlight cards.
🆕 Open five current clinical safety updatesReviewed August 20, 2026 · authoritative sources
Why this shelf exists: the course is already unusually complete, but a few high-stakes recommendations have changed or gained important nuance. These cards show the newest safety anchors without replacing your instructor’s exam wording.
For eligible patients with a disabling deficit, either alteplase or tenecteplase may be used within the usual 4.5-hour IV thrombolysis window.
Select patients with unknown onset or onset 4.5–9 hours earlier may qualify using advanced imaging.
Endovascular thrombectomy eligibility is broader; for basilar artery occlusion, a strong recommendation covers selected patients arriving within 24 hours with NIHSS ≥10.
Recognize + evaluate→Antibiotics on time→Crystalloid if hypoperfused→Reassess perfusion
Sepsis and septic shock are emergencies: begin treatment and resuscitation immediately.
Give antimicrobials ideally within 1 hour for septic shock or probable/definite sepsis. Possible sepsis without shock gets rapid investigation and, if concern persists, antimicrobials within 3 hours.
For sepsis-induced hypoperfusion or septic shock, give at least 30 mL/kg IV crystalloid in the first 3 hours, then individualize using dynamic response and serial lactate. Balanced crystalloids are generally preferred.
Norepinephrine is first-line; initial MAP target is about 65 mm Hg.
Do not fuse every intervention into “one hour.” Antibiotic and fluid clocks are related—but not identical.
Take ART consistently→Viral load <200 copies/mL→Maintain suppression→No sexual transmission
A person who takes ART as prescribed and maintains viral suppression will not transmit HIV through sex. This is U=U.
U=U is not a cure and does not prevent other sexually transmitted infections.
Do not overgeneralize the message: CDC lists breastfeeding transmission as substantially reduced but not eliminated, and the effect for shared injection equipment remains uncertain.
Use accurate, stigma-free language: person with HIV—not “HIV patient” or “carrier.”
Study-safety note: These are guideline updates for learning. In clinical care, follow the prescriber, facility protocols, patient-specific contraindications and your scope of practice. For a course exam, note where an instructor’s expected answer differs from current guidance.
🔍 What the marks on this page mean
Red wavy underline — an absolute rule. Never, do not,
contraindicated, hold it. These are the lines that turn a right answer into a wrong one.
Gold bold — a number that decides a question: a dose, a lab
value, a time window, an age cutoff.
Mint italic — a priority or sequence cue. What comes first.
Bold is the term the question is really about. Same system as your NUR 198 pages.
🧠 Mega Quiz
Every question from every week, one at a time, on its own page — plain
background, big text, filter by exam or week. This page closes when it opens.
🔍 Where this came from Confirmed from your course calendar
This spine is copied straight off your Course Calendar — the week, the in-class topic, the Hinkle chapters and the exam windows are the instructor's own, not my reconstruction. Note the calendar's "Module N in Canvas" numbers run one ahead of the week numbers; the weeks below are the ones on the calendar's left column.
▸⚠️ Before you trust the recordings — 28 corrections
❌ Flat wrong in the recording — 12 of them
Repeat these and they cost you marks. Corrected here.
W9 — hemophilia
factor VII is deficient in hemophilia A.
Hemophilia A is factor VIII. Hemophilia B is factor IX. Factor VII deficiency is a separate rare disorder.
W5 — thyroid storm
do not choose acetaminophen for thyroid storm.
Backwards, and this one is dangerous. Acetaminophen is the antipyretic of choice in thyroid storm. The drug to avoid is aspirin — salicylates displace T4 from binding proteins and make the storm worse.
W8 — multiple sclerosis
relapsing-remitting MS means they "never go back to their previous functional level."
That is the definition of progressive MS. Relapsing-remitting is defined by recovery to or near baseline between relapses.
W7 — CT timing
the bleed will not show for 72 hours on CT.
A hemorrhage is visible on non-contrast CT immediately — that is the entire reason CT is done first. It is ischemia that may not appear for 6–24+ hours.
W10 — antiemetics
It calls aprepitant and its relatives "NK1 agonists."
They are NK1 antagonists. Calling them agonists inverts the mechanism.
W5 — pheochromocytoma
It lists alpha and beta blockers for BP and HR without ordering them.
Alpha blockade must come before beta blockade. A beta blocker given first causes unopposed alpha vasoconstriction and a hypertensive crisis. This is a classic test item and the recording omits it.
W7 — ICH blood pressure
It marks "vasopressors to keep systolic above 100" as totaly appropriate for an intracerebral bleed.
Acute ICH management is about lowering an elevated systolic (roughly toward 140) while protecting cerebral perfusion pressure. Vasopressors are only for genuine hypotension, not a routine ICH intervention.
W8 — meningitis
take all cultures including the LP before starting IV antibiotics.
Do not delay antibiotics for the LP. Give empiric antibiotics within an hour; draw blood cultures first if they are immediately available.
W7 — alteplase window
4 hours in one place and 4.5 in another.
4.5 hours from last known well. It contradicts itself; use 4.5.
W4 — arithmetic
"that's 1,112.5 mL/hr" mid-problem.
8,100 ÷ 8 = 1,012.5. Their stated final answer of 1,013 mL/hr is right — only the spoken intermediate is wrong. Do not memorize 1,112.
W4 — arithmetic
"198 pounds divided by 2.2 gives me my 98."
198 ÷ 2.2 = 90 kg, which is what they actually use two sentences later.
W10 — tumor lysis
encourage alkaline fluids to lower uric acid.
Urinary alkalinisation is no longer recommended — it risks calcium-phosphate precipitation. Aggressive isotonic hydration plus allopurinol or rasburicase.
⚖️ Your course vs current guidelines
Both defensible. Answer the way your course teaches it on the exam — the guideline is here so NCLEX or a preceptor does not blindside you.
Parkland formula
4 mL × kg × %TBSA
The American Burn Association moved to an initial 2 mL/kg/%TBSA for adult thermal burns (3 for children, 4 for electrical), titrated to urine output.
Metformin and contrast
Hold it 48 hours before contrast.
Current ACR guidance: no need to hold at all if eGFR ≥30 with no AKI. When it is held, it is held at the time of contrast and for 48 hours after, not before.
C. diff treatment
Vancomycin or metronidazole.
IDSA/SHEA now put fidaxomicin or oral vancomycin first-line, with metronidazole reserved for when neither is available. Also missing from the recording: soap and water, not alcohol gel — gel does not kill spores.
Penicillin allergy
Avoid cephalosporins and anything related to penicillin.
Cross-reactivity with modern cephalosporins is about 1–2%. Third- and fourth-generation cephalosporins are routinely used in penicillin-allergic patients.
HIV transmission
You would never tell someone with HIV that they cannot transmit it.
CDC has endorsed U=U since 2017 — a sustained undetectable viral load means effectively zero risk of sexual transmission. Blood, needle and breastfeeding caveats stand, so the blanket rule is defensible, but the counseling language is out of date.
The sepsis bundle
Lactate → cultures → antibiotics → fluids, on a 3-hour window, credited to "the American Critical Care Nurses Association."
The source is the Surviving Sepsis Campaign / SCCM. Its 2026 guidance says to start treatment immediately: antimicrobials are ideally given within 1 hour for septic shock or probable/definite sepsis, while at least 30 mL/kg crystalloid is given during the first 3 hours for sepsis-induced hypoperfusion or shock, followed by individualized reassessment. Dr. Gregg disagreed with the keyed order on the recording and said he would rewrite the question — expect the keyed order anyway.
The diabetes plate
50% fruits and vegetables.
The ADA plate is 50% non-starchy vegetables, 25% lean protein, 25% carbohydrate. Fruit sits inside the carbohydrate quarter, not the vegetable half.
Guillain-Barré recovery
95% recover within a year.
Commonly cited figures are roughly 70–80% with good recovery, a meaningful minority left with deficits, and 3–10% mortality.
🤷 Where the recordings argue with themselves
Sildenafil + sumatriptan (W8): the key marks "avoid sildenafil" correct, then Dr. Gregg immediately says the only real interactions are nitroglycerin and some antihypertensives. The nitrate interaction is the real one.
Hydroxychloroquine (W3): their matrix assigns it to lupus only, and the very next question opens with a rheumatoid arthritis client prescribed hydroxychloroquine. It is used in both.
TURP (W11): the keyed answer is to request a prescription to increase the irrigation rate, then the instructor says the nurse can adjust it. Pick the keyed answer.
Neurogenic shock (W13): one stem lists both "warm, dry skin" and "diaphoresis." Warm and dry is the correct teaching point.
Sexual assault ordering (W11): the two instructors audibly disagreed about consent vs emotional support before settling on consent. They flagged it as genuinely ambiguous.
Reference ranges drift between sessions — ANC normal given as 1,500–8,000 in W2 and 2,500–6,000 in W10; platelets 140,000–400,000 in one item and 150,000–450,000 on the next slide; hemoglobin 12–17.4 in W9 and 14–17.4 in the shock session. Do not memorize any single one of these as the normal.
Pyridostigmine (W8) is stated correctly as 30–60 minutes before meals, then later as after. Before.
Every session claims a wrong selection in a select-all cancels one of your correct selections. That is a course-specific scoring rule, not how NCLEX partial credit works — worth checking against your syllabus, because it drives all their "leave it unselected if unsure" advice.
🔍 Transcript decoder
The transcripts are auto-generated and mangle medical words, so Ctrl+F fails on the real spelling. Search the left column instead.
Every eye emergency is either pressure or detachment. Ask two questions and most
questions answer themselves: did it come on suddenly, and does it hurt.
Never give anticholinergics or atropine to a patient with closed-angle glaucoma.
They dilate the pupil, which jams the drainage angle shut and spikes the pressure.
Watch for this hidden inside antihistamines, TCAs, scopolamine and pre-op orders.
👁️ Retinal detachment
A painless curtain or shadow moving across vision, often after floaters and
flashes of light.
It is the one condition that gets face-down positioning after repair, so the gas
bubble presses the retina back.
👓 Cataract
A clouded lens, not a pressure problem. Painless, gradual, cloudy or yellowed vision,
glare at night.
Surgery is elective and done one eye at a time.
👂 Conductive vs sensorineural, in one line each
Conductive — sound cannot get in. Wax, fluid, perforation, otosclerosis. Often fixable.
Sensorineural — the hair cells or nerve are damaged. Noise, age, ototoxic drugs.
Usually permanent.
Vertigo + tinnitus + fluctuating hearing loss. Caused by too much endolymph in the inner ear.
Nursing priority is safety — the vertigo causes falls. Low-sodium diet and diuretics
reduce the fluid.
⭐ High-yield — what the exam actually asks
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Open-angle glaucoma is gradual and painless and takes peripheral vision first; lifelong beta-blocker drops. Closed-angle is sudden severe pain + halos + N/V and is a surgical emergency.
Cataract is a clouded lens, not a pressure problem. Surgery only, non-urgent, one eye at a time.
Retinal detachment = painless curtain across the vision. Emergency. The only one that gets face-down (prone) positioning post-op, about 2 weeks.
Macular degeneration takes central vision and spares peripheral. Amsler grid at home catches wavy lines; wet type gets anti-VEGF injections.
Diabetic retinopathy: annual dilated exam for every diabetic regardless of symptoms. Real prevention is tight A1C and BP control.
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Eye drops: 5–10 min between different drops; occlude the inner canthus 2 min to block systemic absorption.
Ménière's: low sodium, low caffeine and alcohol to cut inner-ear fluid (not for blood pressure). Meclizine + a diuretic, and fall precautions during vertigo.
External otitis hurts when you move the tragus or pinna — that is what separates it from otitis media.
Ruptured tympanic membrane: the pain suddenly relieves. Keep the ear dry, no swimming or flying, usually heals on its own.
Ototoxic drugs: furosemide, aspirin/NSAIDs, aminoglycosides (gentamicin), vancomycin, erythromycin. Worse at high dose over time.
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New hearing loss teaching: face her, cut background noise, get her attention first, and rephrase rather than repeat louder.
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
Show 5 moreHide these 5
Newly blind (diabetic retinopathy): the priority is keep frequently used items in consistent locations. The cue word is recently — someone blind twenty years can be left to ask for help, someone blind three weeks cannot.
Perimetry is just formal visual field testing. If she will not fixate, coach her to hold the center light — do not cancel the test and do not medicate her. Wanting to look at the moving thing is normal, not an inability to complete the test.
Hold the timolol the morning of tonometry so the pressure you measure is not already treated. And timolol is a beta blocker — the drops reach the bloodstream, so a client who says she feels dizzy on them gets a pulse and blood pressure check.
Their vocabulary warning: acute = closed = angle-closure, and chronic = open. Same two conditions, four names, and the exam may use any of them.
Prognosis ruling: vision already lost to chronic open-angle is gone for good — treatment only stops further loss. Vision lost in an acute closed-angle attack usually comes back if the pressure is relieved that day.
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Acute closed-angle presents as fixed dilated pupil + hazy cornea + severe pain with vomiting, coming on over minutes to an hour. The pupil is fixed because the pressure has paralyzed the nerve; the cornea is hazy because fluid is being forced into it.
Their glaucoma risk list: family history, over 60, diabetes, hypertension, corticosteroid use, thin central cornea, high myopia. They explicitly said not risks: corrective lenses, vitamin A, sunglasses — sunglasses actually prevent cataracts and retinal injury.
Anticholinergic and decongestant eye drops dilate the pupil → contraindicated specifically in closed-angle. The reverse is pilocarpine, a cholinergic that constricts the pupil and unbunches the iris off the canals of Schlemm.
Their matrix grid, cataract vs open-angle vs AMD: central vision loss = AMD; peripheral = open-angle; halos + glare + cloudy vision = cataract; raised IOP and a blocked drainage system = open-angle only; all three are commonest in old age.
Same grid, treatment row: cataract is surgical, glaucoma is pharmacologic (the drops), and wet AMD is pharmacologic too — intraocular bevacizumab or ranibizumab injections.
Cataract post-op yes-list: avoid bending and lifting, eye shield, antibiotic + anti-inflammatory drops, do not touch the eye.No warm compresses, and sleep on the NON-operative side. Do not tell her to resume normal activity — ask what her normal activity is.
Viral conjunctivitis: cool compresses, and no antibiotic drops. Do not promise it clears in 2–3 days — a week or two is normal. Telling the three apart: allergic itches, viral comes with a cold, bacterial pours purulent discharge.
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Weber louder in one ear tells you only that the two ears are unequal. The next step is the Rinne test — not charting a type of loss, not calling the provider.
Their tuning-fork positions: Weber on the forehead, heard equally in both ears when normal. Rinne on the mastoid, then in front of the ear — normal is air conduction outlasting bone conduction.
Swimming class + severe ear pain + purulent discharge = otitis externa, swimmer's ear. Otitis media is behind the eardrum, so it only drains once the tympanic membrane ruptures — far less likely.
The one mismatched pair they flagged: labyrinthitis is not "gradual hearing loss without vertigo" — the vertigo is severe enough that people arrive on a stretcher. Otosclerosis = conductive loss from abnormal bone growth; Ménière's = vertigo + tinnitus + fluctuating hearing loss.
Ménière's management: antihistamine + diuretic (the theory is too much endolymph), plus a low-sodium diet. Not high sodium, not more caffeine, not deliberate head movements.
The ototoxic pairing to memorize is aminoglycoside + loop diuretic (gentamicin + furosemide); vancomycin belongs on the list too. What is ototoxic is usually nephrotoxic as well. On gentamicin the priority is monitor for early hearing loss and report it so the dose can change — not fluids, not noise avoidance.
Labyrinthitis is viral and resolves over weeks; BPPV is brief, movement-triggered and caused by a loose otolith. Labyrinthitis + 4 vomits in 3 hours → the priority becomes fluid and electrolyte assessment, not the vestibular suppressant, which takes an hour to work anyway.
Vertigo is a fall risk: do not discharge until she can walk. Their line was that otherwise she gets as far as the parking lot and comes back with a fracture or a head injury.
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On a priority question, all four options can be correct actions — you cannot eliminate on accuracy, only on order. Their words: "I actually am going to do all four of these things."
Calc:2,500 mL over 12 h = 208.3 mL/hr — but the item asked in liters, so the answer is 2.5 L and there is no calculation at all. The faculty themselves went to mL/hr on the recording and had to back up. Read the units, and round only at the very end.
⚠️ Exam traps
Glaucoma is a pressure problem; cataract is a lens problem. Different answer every time.
Retinal detachment being painless does not make it less of an emergency.
Sensorineural loss is usually permanent; conductive loss is often fixable.
🧠 Mind maps 2
One per disorder, built from the structure of your ATI chapter.
Disorders of the Eye
🎯 Who gets it
AMD risk increases with smoking, hypertension, high cholesterol, and obesity.
AMD risk rises after age 60, with family history, or light-colored eyes.
Cataracts risk increases with advanced age, diabetes, heredity, and smoking.
Cataracts risk rises with eye trauma, heavy sun exposure, and steroid use.
👀 What you see
AMD: distorted objects, blurred vision, loss of central vision.
AMD: poor depth perception; can progress to blindness.
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
ATI Active Learning Template — System DisorderDisorders of the Eye
Filled from ATI chapter 13, row by row from that chapter’s own sections — 10 of 12 rows have content.
1 row below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
This chapter covers three major eye disorders: age-related macular degeneration (dry vs wet), cataracts (lens clouding from aging, trauma, or steroid use), and glaucoma (optic nerve damage from elevated pressure), including risk factors, diagnostics, medications, and surgical care.
Health Promotion & Disease Prevention
Wear sunglasses outdoors and protective eyewear for sports or hazardous work.
Get annual eye exams, especially after age 40.
Learn early glaucoma warning signs: reduced vision and mild eye pain.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
AMD risk increases with smoking, hypertension, high cholesterol, and obesity.
AMD risk rises after age 60, with family history, or light-colored eyes.
Cataracts risk increases with advanced age, diabetes, heredity, and smoking.
Cataracts risk rises with eye trauma, heavy sun exposure, and steroid use.
Glaucoma risk increases with age, race, genetic predisposition, and hypertension.
Glaucoma risk also rises with diabetes, severe myopia, and retinal detachment.
Glaucoma can also stem from eye trauma, tumors, or infection.
Assessment — Expected Findings
AMD: distorted objects, blurred vision, loss of central vision.
AMD: poor depth perception; can progress to blindness.
ATI Active Learning Template — System DisorderMiddle and Inner Ear Disorders
Filled from ATI chapter 14, row by row from that chapter’s own sections — 9 of 12 rows have content.
2 rows below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Covers middle ear conditions like otitis media and inner ear disorders like vertigo, Ménière's disease, and labyrinthitis — anatomy, hearing loss types, risk factors, diagnostics, nursing care, medications, procedures, and teaching.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from NIDCD, 2025.
Sound at or below about 70 A-weighted decibels is unlikely to damage hearing even with long exposure.
Repeated or prolonged exposure to sound at 85 dBA or higher can cause hearing damage, with louder sounds causing harm faster.
Wearing earplugs or other hearing protection during loud activities is a key way to prevent noise-induced hearing loss.
Noise-induced hearing loss is described as the only type of hearing loss that is completely preventable.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not a section in this chapter. Fill from lecture if your instructor covers it.
Diagnostic Procedures
Audiometry is a noninvasive hearing test measuring frequency, pitch, and intensity
Tympanogram measures TM and middle-ear mobility; useful for diagnosing middle ear disease
Weber and Rinne tuning-fork exams determine whether hearing loss is present
Otoscopy examines the external canal, tympanic membrane, and malleus
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Pull the auricle up/back in adults, down/back in children to straighten the ear canal
A normal TM is pearly gray and intact, with a visible anterior light reflex
Bulging TM with a diffuse or absent light reflex signals middle-ear fluid or infection
Avoid touching the ear canal lining — it is painful and sensitive
ENG: ask simple questions to keep client alert; keep NPO and on bedrest until vertigo resolves
Monitor ototoxic drug levels: gentamicin, furosemide, aspirin/NSAIDs, and cisplatin can damage hearing
Routine audiometry is needed when a client receives ototoxic IV antibiotics
Encourage slow position changes and assistive devices for clients with balance problems
Scopolamine is contraindicated in angle-closure glaucoma; monitor eye pressure in open-angle glaucoma
Medications
Meclizine (antihistamine/anticholinergic) treats vertigo from inner ear disorders
Ondansetron treats nausea and vomiting from vertigo; avoid in certain cardiac rhythm disorders
Diphenhydramine and dimenhydrinate (antihistamines) treat vertigo and nausea from inner ear disease
Therapeutic Procedures
Myringotomy incises the TM to drain middle-ear fluid and prevent perforation
A pressure-equalizing tube (grommet) replaces Eustachian tube function for 6-18 months
Stapedectomy removes the stapes and replaces it with a prosthesis, done via the ear canal
Stapedectomy treats otosclerosis, a cause of conductive hearing loss in older adults
💬 Around the patientClient Education · Interprofessional Care
Client Education
Fast immediately before ENG/caloric testing; avoid caffeine, alcohol, sedatives, antihistamines for several days prior
ENG is not performed on clients with a pacemaker — signals interfere with results
During vertigo, rest in a quiet, darkened room and move the head slowly
Avoid caffeine and alcohol; space fluid intake evenly and reduce salt to control vertigo
Take a diuretic, if prescribed, to reduce fluid in the semicircular canals
After ear surgery, avoid rapid movements and bending from the waist for weeks
After cochlear implant surgery, the device stays off until programmed 2-6 weeks later
Interprofessional Care
Vestibular rehab combines biofeedback, physical therapy, and stress management for frequent vertigo
Postural training teaches positions to avoid and exercises that can stop a vertigo attack
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2023.
Acute mastoiditis is most often a complication of an untreated or inadequately treated middle ear infection.
Infection erodes through the bony walls of the mastoid air cells, which can lead to pus collecting behind the ear.
Adults with mastoiditis typically present with severe ear pain, fever, and headache along with redness and swelling behind the ear.
Untreated mastoiditis can spread inward to cause meningitis, a brain abscess, or venous sinus thrombosis, complications seen in 6 to 23 percent of cases.
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Open-angle glaucoma is gradual and painless and takes peripheral vision first; lifelong beta-blocker drops. Closed-angle is sudden severe pain + halos + N/V and is a surgical emergency.
Retinal detachment = painless curtain across the vision. Emergency. The only one that gets face-down (prone) positioning post-op, about 2 weeks.
Diabetic retinopathy: annual dilated exam for every diabetic regardless of symptoms. Real prevention is tight A1C and BP control.
Eye drops: 5–10 min between different drops; occlude the inner canthus 2 min to block systemic absorption.
New hearing loss teaching: face her, cut background noise, get her attention first, and rephrase rather than repeat louder.
Perimetry is just formal visual field testing. If she will not fixate, coach her to hold the center light — do not cancel the test and do not medicate her.
Acute closed-angle presents as fixed dilated pupil + hazy cornea + pain with vomiting. Chronic open-angle eats peripheral vision first.
Their glaucoma risk list: family history, over 60, diabetes, hypertension, corticosteroid use, thin central cornea, high myopia. They explicitly said not risks: corrective lenses, vitamin A, sunglasses.
Anticholinergic and decongestant eye drops dilate the pupil → contraindicated specifically in closed-angle.
The ototoxic pairing to memorize is aminoglycoside + loop diuretic (gentamicin + furosemide). On gentamicin the priority action is monitor for early hearing loss and report so the dose can change — not fluids, not noise avoidance.
Labyrinthitis is viral and resolves over weeks; BPPV is brief and movement-triggered. Labyrinthitis + 4 vomits in 3 hours → the priority becomes fluid and electrolyte assessment, not the vestibular suppressant.
Cataract post-op yes-list: avoid bending and lifting, eye shield, antibiotic + anti-inflammatory drops, do not touch the eye. No warm compresses, no operative-side positioning.
Calc:2,500 mL over 12 h = 208.3 mL/hr — but if the item asks in liters the answer is 2.5 L. They flagged this as a units trap. Round only at the very end.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
HIV is a CD4 disease. The virus destroys helper T cells, and every complication follows
from how few are left. Learn the CD4 ladder and the opportunistic infections fall into place.
CD4 count — what it predictscells/mm³
<200 AIDS — PCP, toxo200–499 early symptoms500–1500 normal
🚨 The number that defines AIDS
CD4 < 200
That is the diagnostic threshold, regardless of how well the patient looks. Below it,
Pneumocystis jirovecii pneumonia (PCP) becomes the classic killer — and prophylaxis
with Bactrim starts at that same number.
C. diff needs soap.Alcohol gel does not kill C. diff spores.
Wash with soap and water, and use bleach to clean the room.
✅ Antiretroviral teaching, in one card
Adherence is the whole treatment. Missed doses breed resistance faster than any other
drug class.
Therapy is lifelong, continues in pregnancy (it prevents transmission to the baby),
and an undetectable viral load means untransmittable sexually.
⭐ High-yield — what the exam actually asks
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CD4 is the monitoring lab, not WBC. CD4 <200or an AIDS-defining condition = AIDS. Viral load tracks how well ART is working.
HIV testing sequence: antigen/antibody combination screen first, then a confirmatory differentiation assay.
PEP: start as soon as possible, ideally within hours, never beyond 72 hours. Continue 28 days.
Neutropenic precautions: private room, reverse isolation/positive pressure, no fresh flowers or plants, limited visitors, daily cleaning, dedicated equipment. The sign goes up at ANC ≤1,000 — but a client can be neutropenic above that.
Airborne (TB, measles, varicella) = negative pressure, door closed, N95. Droplet (flu, bacterial meningitis, pertussis) and contact (C. diff, MRSA, VRE) = door may stay open.
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Doff gown and gloves inside the room and do hand hygiene before you leave, not in the hall. One exception: an N95 comes off after you step out and close the door — then hand hygiene again.
C. diff: bleach cleaning, contact precautions. Priority problem is dehydration, then electrolytes.
HAI prevention: pull lines and catheters the moment they are not needed, scrub the hub 15 sec with friction, chlorhexidine 30 sec at dressing changes (2 min only on a moist site — groin or femoral) and let it dry, dressings q7 days.
Emerging infectious disease: isolate at the most protective level available until the route is confirmed, then report to public health.
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
Show 5 moreHide these 5
For both CLABSI and CAUTI the most effective action is do not place the device unless it is necessary. Sterile insertion is the runner-up — the question asks for most effective, and several options are effective. Femoral central lines infect far more than subclavian.
Prophylactic antibiotics are never the answer for a line or a catheter. Antibiotics are for a known infection.
Needlestick from an HIV-positive source: wash with soap and water first — express the blood if it was deep — then report, PEP, baseline draw. All four are correct actions; only the order is being tested.
VAP prevention is HOB at least 30°, semi-Fowler's, so stomach contents cannot be aspirated. Scheduled q2h suctioning is the wrong answer — suction on need, or you traumatize the trachea. Add chlorhexidine oral care and a PPI for stress-ulcer prophylaxis.
MRSA home teaching: keep the area covered with a clean, dry dressing. No petroleum jelly, no warm compresses, do not leave it open to air. MRSA spreads skin to skin — which is why it runs through wrestling and football teams.
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Their numbers: CD4 normal 500–1,200, CD4 under 200 = AIDS. WBC 5,000–10,000. ANC 1,500–8,000, with 500 = neutropenic. ART is typically 3–4 drugs daily.
ART goals, their SATA: it lowers viral load (target undetectable), raises CD4 — not lowers — and prevents opportunistic infections. It does not cure, and it does not prevent transmission — it reduces it. Their warning: never tell a client with HIV they cannot transmit it.
Poor ART adherence leads to drug resistance and treatment failure. Not "immediate" opportunistic infections, not "complete loss within days", not "rapid" progression — those take years. Watch the absolute words.
Their fewest-steps heuristic: when several options could eventually follow, count the steps. The option you can reach in one step is usually the answer. If you had to talk yourself through four links to get there, it is not it.
Acute HIV infection = flu-like illness with lymphadenopathy, then years of latency while CD4 falls silently. Kaposi's sarcoma, Pneumocystis pneumonia and wasting are late-stage opportunistic disease.
The bow-tie: CD4 180 is AIDS by definition — nothing else drops CD4 that far — and bilateral infiltrates mean pneumonia. Priorities: patent airway, medication adherence, nutrition. Complications: respiratory failure, sepsis, malnutrition. They ruled out TB (no night sweats, no hemoptysis) and asthma (no wheeze).
Be very careful ever choosing "promote fluid restriction." Their words — it is right in heart failure and chronic renal failure and almost nowhere else.
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Airborne is four things: TB, measles, varicella, disseminated herpes zoster. Their rule — learn those four, then essentially every other respiratory bug is droplet, and fecal-oral is contact.
Varicella is airborne, not contact. The virus causes respiratory symptoms too, not just the skin lesions.
From that same question: influenza is droplet; HIV and hepatitis B are standard precautions — you do not catch them by standing in front of someone.
The physical difference: a droplet is larger and falls faster; airborne particles are tiny and travel further. That is the whole distinction. Know the precautions themselves too — N95 fit, door closed — not just which condition gets which.
C. diff: about 80% follow antibiotic use in the past month, and the organism survives a long time on surfaces. Assess for dehydration before giving antibiotics — rehydrate first. Treatment is oral vancomycin first-line, metronidazole second.
Neutropenic vs isolation precautions, their decision rule: ask who is at greatest risk. Infected client → everyone else, so you cover up on the way out. Neutropenic client → the client, so you cover up on the way in.
Neutropenic precautions, their test: if you cannot disinfect it, it does not enter the room — no fresh flowers, plants or fruit, no stuffed animals. Nobody sick enters; the client masks to leave.
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Select-all-that-apply is plus/minus scored — a correct pick earns a point, a wrong pick loses one. Their strategy: pick only what you are confident about. Better to leave a point on the table than lose one. Same for every next-generation item where you may pick many.
Psychosocial items: throw out what is never therapeutic first — "avoid emotional concerns", "your feelings are irrational" — then choose between what is left. Their point: the diagnosis is usually not what is being tested, the feelings are.
Calc: acetaminophen 650 mg from 160 mg/5 mL → 650 ÷ 160 × 5 = 20.3 mL → 4 teaspoons at 5 mL each. The instructor stopped at 20 mL on the recording and had to catch herself. Convert to the unit they asked for, and round only at the end.
⚠️ Exam traps
Drawing blood from a central line does not itself cause CLABSI — bad technique does.
An incontinent VRE client transmits far more than one with a closed Foley system.
Viral infections get supportive care, not antibiotics.
🧠 Mind maps 1
One per disorder, built from the structure of your ATI chapter.
HIV/AIDS
🎯 Who gets it
Unprotected vaginal, anal, or oral sex raises HIV risk.
Multiple sex partners or another STI increase HIV risk.
Occupational exposure puts health care workers at risk.
Perinatal exposure can transmit HIV from mother to infant.
👀 What you see
Acute HIV: fever, chills, rash, night sweats, headache, sore throat.
Acute HIV: anorexia, nausea, weight loss, weakness, and fatigue.
CBC often shows anemia, thrombocytopenia, and leukopenia in HIV.
CD4 count measures T lymphocytes to gauge immune status and HIV stage.
🩺 What you do
Track fluid intake/output, daily weight, and nutritional status closely.
Monitor temperature, lung sounds, and neurologic status for changes.
Assess skin integrity often for rashes, bruising, or breakdown.
Alternate activity with rest; give supplemental oxygen as needed.
💊 Drugs
HAART combines 3 to 4 antiretrovirals to limit resistance and side effects.
Fusion inhibitors (enfuvirtide) block HIV from fusing with host cells.
Entry inhibitors (maraviroc) block the CCR5 receptor on CD4 cells.
NRTIs like zidovudine block the virus from converting RNA to DNA.
💬 What you teach
Take antiretrovirals exactly as prescribed and know their side effects.
Practice frequent hand hygiene to lower infection risk.
Avoid crowds and travel to areas with poor sanitation.
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🖼️ Infographics 4
Tap a card to open the matching graphics in your infographic library.
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
ATI Active Learning Template — System DisorderHIV/AIDS
Filled from ATI chapter 86, row by row from that chapter’s own sections — 8 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
This chapter reviews HIV as a retrovirus that destroys CD4 T-cells across three stages: acute infection, chronic asymptomatic infection, and AIDS, along with risk factors, testing, antiretroviral therapy, and care for related opportunistic infections.
Health Promotion & Disease Prevention
Prevent transmission with condoms, abstinence, and avoiding shared needles.
PrEP is taken orally daily or injected every 2 months to prevent HIV.
Confirm a client is HIV-negative with testing before starting PrEP.
Keep immunizations current, including yearly flu and pneumococcal vaccines.
Clinicians follow standard precautions whenever they treat clients with HIV.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Unprotected vaginal, anal, or oral sex raises HIV risk.
Multiple sex partners or another STI increase HIV risk.
Occupational exposure puts health care workers at risk.
Perinatal exposure can transmit HIV from mother to infant.
IV drug use with a shared, contaminated needle raises risk.
Blood transfusion is a rare HIV source in the U.S.
Older adult clients are also at increased risk.
Assessment — Expected Findings
Acute HIV: fever, chills, rash, night sweats, headache, sore throat.
Acute HIV: anorexia, nausea, weight loss, weakness, and fatigue.
CBC often shows anemia, thrombocytopenia, and leukopenia in HIV.
CD4 count measures T lymphocytes to gauge immune status and HIV stage.
CDC recommends HIV testing once for ages 13 to 64; yearly if high risk.
Antibody test detects HIV 23 to 90 days after exposure.
Rapid antigen/antibody test detects HIV 18 to 90 days after exposure.
Antigen/antibody lab test detects HIV 18 to 45 days after exposure.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not a section in this chapter. Fill from lecture if your instructor covers it.
Diagnostic Procedures
Not a section in this chapter. Fill from lecture if your instructor covers it.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Track fluid intake/output, daily weight, and nutritional status closely.
Monitor temperature, lung sounds, and neurologic status for changes.
Assess skin integrity often for rashes, bruising, or breakdown.
Alternate activity with rest; give supplemental oxygen as needed.
Normal CD4-to-CD8 ratio is 2:1; a ratio under 1 signals severe disease.
Falling CD4 counts suggest poor prognosis or medication resistance.
Give antiretrovirals, antineoplastics, antifungals, and antidiarrheals as prescribed.
Offer appetite stimulants and monitor for skin breakdown.
Wasting syndrome: maintain nutrition orally or via TPN; track weight and calories.
Medications
HAART combines 3 to 4 antiretrovirals to limit resistance and side effects.
Fusion inhibitors (enfuvirtide) block HIV from fusing with host cells.
Entry inhibitors (maraviroc) block the CCR5 receptor on CD4 cells.
NRTIs like zidovudine block the virus from converting RNA to DNA.
Protease inhibitors (atazanavir, nelfinavir, saquinavir, indinavir) block an enzyme HIV needs to replicate.
Integrase inhibitors (raltegravir, dolutegravir) stop HIV from inserting into host DNA.
Interleukin boosts immune response and lowers cancer cell growth in Kaposi's sarcoma.
Therapeutic Procedures
Not a section in this chapter. Fill from lecture if your instructor covers it.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Take antiretrovirals exactly as prescribed and know their side effects.
Practice frequent hand hygiene to lower infection risk.
Avoid crowds and travel to areas with poor sanitation.
Avoid raw or undercooked meat, fish, eggs, and produce.
Avoid tobacco and drink bottled or filtered water.
Avoid cleaning cat litter boxes to prevent toxoplasmosis exposure.
Stay away from family or friends who have colds or flu.
Interprofessional Care
Infectious disease specialists are consulted to manage HIV treatment.
Respiratory services support breathing and may provide portable oxygen.
Nutrition services help with dietary supplementation and meal planning.
Rehabilitation services build strength and improve energy levels.
Refer clients to local AIDS support groups for peer support.
⚠️ What goes wrongComplications
Complications
Not a section in this chapter. Fill from lecture if your instructor covers it.
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
CD4 is the monitoring lab, not WBC. CD4 <200or an AIDS-defining condition = AIDS. Viral load tracks how well ART is working.
HIV testing sequence: antigen/antibody combination screen first, then a confirmatory differentiation assay.
PEP: start as soon as possible, ideally within hours, never beyond 72 hours. Continue 28 days.
Neutropenic precautions: private room, reverse isolation/positive pressure, no fresh flowers or plants, limited visitors, daily cleaning, dedicated equipment. The sign goes up at ANC ≤1,000 — but a client can be neutropenic above that.
Airborne (TB, measles, varicella) = negative pressure, door closed, N95. Droplet (flu, bacterial meningitis, pertussis) and contact (C. diff, MRSA, VRE) = door may stay open.
C. diff: bleach cleaning, contact precautions. Priority problem is dehydration, then electrolytes.
HAI prevention: pull lines and catheters the moment they are not needed, scrub the hub 15 sec with friction, chlorhexidine 30 sec at dressing changes (2 min only on a moist site — groin or femoral) and let it dry, dressings q7 days.
For both CLABSI and CAUTI the most effective action is do not place the device unless it is necessary. Sterile insertion is the runner-up. Femoral central lines infect far more than subclavian.
Needlestick from an HIV-positive source: wash with soap and water first, then report, PEP, baseline draw.
Their numbers: CD4 normal 500–1,200, CD4 <200 = AIDS. WBC 5,000–10,000. ANC 1,500–8,000, with 500 = neutropenic. ART is typically 3–4 drugs daily, and it lowers viral load while raising CD4.
C. diff: about 80% follow antibiotic exposure; assess dehydration before antibiotics.
VAP prevention is HOB at least 30°. Scheduled q2h suctioning is the wrong answer — it traumatizes the trachea.
Calc: acetaminophen 650 mg from 160 mg/5 mL = 20.3 mL = 4 teaspoons. The instructor showed herself nearly stopping at "20 mL" and getting it wrong — 5 mL per teaspoon.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
Urticaria can be the opening act of anaphylaxis. Assess lips, tongue and airway before calling it minor.
Latex allergy cross-reacts with banana, avocado, kiwi, chestnut. Latex-free for the whole stay, not just procedures.
RA hits joints symmetrically with morning stiffness >1 hour. Lupus can hit any organ — kidneys most often, but heart, lung and brain involvement is the scary kind.
Both get NSAIDs, steroids, methotrexate. Methotrexate → pancytopenia. Steroids → immunosuppression. Never stop either abruptly.
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Lupus teaching is built around sun/UV protection. Exercise between flares is encouraged and does not trigger one.
Workup labs: CBC, ANA, ESR, CRP.
Gout: allopurinol is the long-term drug (monitor kidneys, push 2+ L fluid/day); colchicine treats the acute attack and causes diarrhea. Avoid organ meats, seafood, alcohol. Also caused by chemo, aspirin and diuretics — not just diet.
Raynaud's: cold triggers a white → blue → red vasospasm. Gloves in cold environments, including the freezer aisle.
Fibromyalgia is not inflammatory — ESR, CRP and ANA are normal. Low-impact exercise, sleep hygiene, duloxetine/pregabalin/milnacipran. Not opioids.
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
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Never start allopurinol during an acute gout flare — it can worsen it. Flare treatment is naproxen or colchicine, with corticosteroids if neither can be used. Infliximab is not a gout drug (a -mab, for autoimmune disease); apixaban is an anticoagulant.
Their conceptual hook: most flaring conditions — gout, asthma, COPD, migraine — split into PRN rescue drugs and daily preventive drugs. Allopurinol is the daily preventive and is taken flare or no flare; you simply do not start it mid-attack.
Colchicine hits the GI tract hard — expect horrendous diarrhea and cramping. NSAID no-go list: peptic ulcer disease, chronic renal failure or a rising creatinine, hypertension, heart failure.
Apixaban is an anticoagulant like warfarin but needs no INR monitoring. Bleeding precautions still apply.
Acute inflammatory condition, their SATA: give corticosteroids on schedule, monitor for GI bleeding on NSAIDs and steroids alike, give antipyretics for fever, and check renal function before high-dose NSAIDs. Do not delay anti-inflammatories until the diagnostics come back.
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The type I cue set they scored as relevant: onset 10 minutes after the infusion started, itching, dizziness, diarrhea, BP 86/52, HR 118, RR 24. Temp 37.3 °C and SpO₂ 96% were scored not indicative. About 90% of anaphylaxis has urticaria or rash.
Their five anaphylaxis systems, in order: skin (hives), respiratory (wheeze, SOB), cardiovascular (hypotension, tachycardia), GI (vomiting, diarrhea — the forgotten one), upper airway (lip and tongue swelling).
After epinephrine, monitor for cardiac dysrhythmias. Not respiratory depression, sedation or hypotension — those are the opposite of what a sympathomimetic does. Sinus tachycardia after a dose is expected, not an emergency.
Hypersensitivity with their examples: I allergy/anaphylaxis + allergic rhinitis, minutes · II antibody attacks a cell — hemolytic transfusion reaction · III antibody binds a molecule — serum sickness, lupus attacking DNA · IV delayed, days later — PPD read at 72 hours, poison ivy, nickel dermatitis.
Reported penicillin allergy: first clarify what actually happened. Rash, itching or swelling → notify the provider before giving. Do not document an allergy on a vague report — a false penicillin allergy also takes away the cephalosporins.
Their rule of thumb: always ask "what happens when you take it?" Most reported allergies are adverse effects. Itching and nausea on morphine is an adverse effect, and the provider may still give it with premedication.
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Salicylate toxicity: tinnitus is the red flag. The action is hold and notify, not treat the symptom. Acute overdose looks GI; chronic looks neuro (fatigue, confusion). Hyperventilation is the acid-base tell. Usually reversible if caught early.
RA is never diagnosed on one test — rheumatoid factor plus ESR, CRP and a CBC, to tell it apart from other joint disease. Morning stiffness lasting hours points at RA and away from osteoarthritis; so do symmetry and chronic progression.
SLE priority triad: rising BUN/creatinine, BP 160/98 with dark frothy urine (lupus nephritis), and SOB with pleuritic chest pain (lupus pneumonitis). The butterfly rash is expected, not a priority — famous, but it needs no intervention.
Their timing hook: NSAID relief within about 60 minutes; DMARDs take weeks to months. That is why the two are prescribed together — nobody waits months in pain for the DMARD to land.
Hydroxychloroquine: any visual change = possible irreversible retinal toxicity → stop the drug. Nausea and headache are ordinary side effects. Routine eye exams are required.
Their drug matrix: methotrexate → RA · duloxetine and pregabalin → fibromyalgia · hydroxychloroquine and azathioprine → SLE · physical therapy → all three. Resting a painful joint is the intuitive answer and the wrong one.
Fibromyalgia: the therapeutic answer validates — "your pain is real and valid" — and names why tests come back normal. It is muscle pain from central pain processing, not joint inflammation; expect fibro fog and sleep disturbance.
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"Requires immediate discontinuation" is asking for an adverse effect, not a side effect. A side effect is mild and can often be premedicated; an adverse effect changes the prescription.
Matrix and select-all items deduct for wrong picks — start from what you actually know and stop there.
Calc: diphenhydramine 25 mg from 12.5 mg/5 mL → 25 ÷ 12.5 × 5 = 10 mL → 2 teaspoons. Any of formula, ratio or dimensional analysis gets you there — do not round until the last step.
⚠️ Exam traps
Allopurinol is prevention; colchicine is the acute attack. Reversing them is the classic miss.
Fibromyalgia's normal labs versus RA and lupus's abnormal ones is the fastest way to tell them apart.
🧠 Mind maps 2
One per disorder, built from the structure of your ATI chapter.
Lupus Erythematosus, Gout, and Fibromyalgia
🎯 Who gets it
Lupus risk rises with genetic predisposition and female sex aged 15-44.
Lupus is more common in African American, Asian, Hispanic, or Indigenous clients.
Lupus flares can be triggered by trauma, infection, UV light, or stress.
Gout risk rises with BMI over 30, heredity, and trauma.
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
ATI Active Learning Template — System DisorderLupus Erythematosus, Gout, and Fibromyalgia
Filled from ATI chapter 87, row by row from that chapter’s own sections — 9 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
This chapter covers three distinct conditions: lupus erythematosus, an autoimmune disease causing chronic inflammation across organs; gout, a hyperuricemia disorder that deposits uric acid crystals in joints; and fibromyalgia, a chronic widespread pain and fatigue syndrome.
Health Promotion & Disease Prevention
Not a section in this chapter. Fill from lecture if your instructor covers it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Lupus risk rises with genetic predisposition and female sex aged 15-44.
Lupus is more common in African American, Asian, Hispanic, or Indigenous clients.
Lupus flares can be triggered by trauma, infection, UV light, or stress.
Gout risk rises with BMI over 30, heredity, and trauma.
Gout risk also rises with alcohol use, diuretics, and chemo agents.
Gout risk increases with chronic kidney disease as well.
Fibromyalgia risk rises in females over age 40 with sleep deprivation.
Fibromyalgia risk rises with trauma, infection, or autoimmune disease history.
Pegloticase IV, given every other week, converts uric acid for excretion.
Therapeutic Procedures
Not a section in this chapter. Fill from lecture if your instructor covers it.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Lupus: taper steroids gradually; never stop corticosteroids abruptly.
Lupus: wear sunscreen, hats, and long sleeves to avoid UV flares.
Hydroxychloroquine needs frequent eye exams to monitor for visual changes.
Lupus: report peripheral or periorbital swelling and any infection signs.
Lupus: avoid crowds and sick contacts to prevent flares.
Lupus nephritis/pericarditis: report chest pain and take meds as prescribed.
Gout: follow a low-purine diet, avoiding organ meats and shellfish.
Interprofessional Care
Ophthalmologists monitor for visual deficits from hydroxychloroquine therapy.
Refer lupus clients to support groups as appropriate.
Physical therapy can help reduce pain from fibromyalgia symptoms.
Refer fibromyalgia clients to national foundations and local support groups.
⚠️ What goes wrongComplications
Complications
Not a section in this chapter. Fill from lecture if your instructor covers it.
ATI Active Learning Template — System DisorderRheumatoid Arthritis
Filled from ATI chapter 88, row by row from that chapter’s own sections — 11 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
This chapter explains rheumatoid arthritis, an autoimmune disease where white blood cells inflame joint synovium bilaterally, causing pain, deformity, and systemic effects on the lungs, heart, and eyes, alternating between flares and remission.
Health Promotion & Disease Prevention
Keep using affected joints and stay active to preserve range of motion.
Aim for 150 min of moderate activity weekly, or 30 min daily, 5 days a week.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
RA risk is higher in females aged 30 to 60 years.
Genetic predisposition and prior bacterial or viral infection raise RA risk.
Stress, smoking, and environmental factors also increase RA risk.
Older age is an added risk factor for RA.
Assessment — Expected Findings
Morning stiffness and pain after rest or long sitting are typical.
Joint swelling, warmth, and erythema are common RA findings.
Joint deformity is a late manifestation of RA.
RA commonly affects fingers, hands, wrists, knees, and feet.
Finger deformities include ulnar deviation, swan neck, and boutonniere changes.
Subcutaneous nodules can form over joints or pressure points.
Low-grade fever, fatigue, and muscle weakness are common.
Xerostomia, anorexia, and weight loss can also occur.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Anti-CCP antibodies are more sensitive for RA than RF antibody.
RF antibody normal range is under 20 U/mL; not RA-specific.
ESR rises with inflammation, infection, or tissue necrosis.
CRP normal range is under 1.0 mg/dL; tracks treatment response.
ANA titer is often positive in RA but not RA-specific.
Diagnostic Procedures
Arthrocentesis aspirates synovial fluid; RA shows raised WBCs and protein.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Encourage physical activity and safe mobility aids to protect joints.
Recommend assistive devices like grab bars and raised toilet seats.
Initiate fall precautions; refer to physical and occupational therapy.
Monitor for medication effectiveness: less pain, more mobility.
After arthrocentesis, check the joint site for bleeding, pain, fever, or swelling.
NSAID use: watch for fluid retention, hypertension, and renal dysfunction.
Corticosteroid use: monitor for Cushingoid changes, weight gain, and high BP.
DMARDs: monitor for allergic reaction, low WBCs, and rising liver enzymes.
Sjögren's syndrome: give eye drops, artificial saliva, and vaginal lubricants.
Medications
RA treatment typically starts with NSAID therapy first.
NSAIDs relieve pain, fever, and inflammation in RA.
NSAIDs can cause significant GI distress in some clients.
Therapeutic Procedures
Plasmapheresis removes circulating antibodies to reduce severe RA flares.
Total joint arthroplasty replaces joints unresponsive to medication therapy.
Synovectomy is surgical removal of the affected synovial membrane.
💬 Around the patientClient Education · Interprofessional Care
Client Education
After arthrocentesis: take acetaminophen for pain; avoid strenuous exercise a few days.
X-rays track joint damage progression; keep still during the scan.
Take NSAIDs with food, milk, or antacids to protect the stomach.
Watch for GI bleeding: coffee-ground emesis or dark, tarry stools.
Corticosteroids aren't for long-term RA use due to osteoporosis and hyperglycemia risk.
Corticosteroids can also cause immunosuppression and cataracts with prolonged use.
Report vision changes, high blood sugar, poor healing, or weight gain on steroids.
Interprofessional Care
Refer clients to RA support groups for peer support.
Occupational therapy provides adaptive devices to aid ADLs and prevent deformity.
⚠️ What goes wrongComplications
Complications
Not a section in this chapter. Fill from lecture if your instructor covers it.
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
RA hits joints symmetrically with morning stiffness >1 hour. Lupus can hit any organ — kidneys most often, but heart, lung and brain involvement is the scary kind.
Both get NSAIDs, steroids, methotrexate. Methotrexate → pancytopenia. Steroids → immunosuppression. Never stop either abruptly.
Gout: allopurinol is the long-term drug (monitor kidneys, push 2+ L fluid/day); colchicine treats the acute attack and causes diarrhea. Avoid organ meats, seafood, alcohol. Also caused by chemo, aspirin and diuretics — not just diet.
Never start allopurinol during an acute gout flare — it can worsen it. Flare treatment is naproxen or colchicine plus corticosteroids. Infliximab is not a gout drug. Colchicine hits the GI tract hard; NSAIDs are off-limits in renal impairment.
The type I cue set they scored as relevant: onset 10 minutes after the infusion started, itching, dizziness, diarrhea, BP 86/52, HR 118, RR 24. Temp 37.3 and SpO2 96% were scored as not indicative. About 90% of anaphylaxis has urticaria or rash.
Hypersensitivity with their examples: I allergy/anaphylaxis + allergic rhinitis · II hemolytic and transfusion · III serum sickness · IV delayed — PPD read at 72 hours, poison ivy, nickel dermatitis.
Reported penicillin allergy: first clarify what actually happened. Rash, itching or swelling → notify the provider before giving.
SLE priority triad: rising BUN/creatinine, BP 160/98 with dark frothy urine (lupus nephritis), and SOB with pleuritic chest pain (lupus pneumonitis). The butterfly rash is expected, not a priority.
Their timing hook: NSAID relief within about 60 minutes; DMARDs take weeks.
Hydroxychloroquine: any visual change = possible irreversible retinal toxicity → stop the drug. Routine eye exams required.
Calc: diphenhydramine 25 mg from 12.5 mg/5 mL = 10 mL = 2 teaspoons.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
A major burn is a fluid problem before it is a skin problem. Capillaries leak plasma
into the tissue, so the patient dies of hypovolemia, not of the wound.
First 24 hours = fluids. After 48 hours = infection.
Depth
Layers
Looks like
Pain
Superficial
Epidermis
Red, dry, blanches
Painful
Partial thickness
Into dermis
Blisters, moist, weeping
MOST painful
Full thickness
Through dermis
White, leathery, waxy, dry
Painless — nerves destroyed
Deep full thickness
Into muscle/bone
Charred, blackened
Painless
🚨 Painless is worse, not better
A patient who cannot feel the burn has destroyed nerve endings. Never read absent pain as a good sign.
⭐ Rule of Nines — adult
Head & neck — 9%
Each arm — 9% (front 4.5 + back 4.5)
Each leg — 18% (front 9 + back 9)
Front torso18% · Back torso18%
Perineum — 1%
Children have proportionally bigger heads, so pediatric charts shift percentage from
the legs to the head.
💧 Parkland formula — and the half that trips people
4 mL × kg × %TBSA
Lactated Ringer’s, over 24 hours — timed from the moment of the burn, not from
arrival at hospital.
Half in the first 8 hours. The other half over the next 16.
Worked example — 70 kg, 50% TBSA: 4 × 70 × 50 = 14,000 mL total →
7,000 mL in 8 h (~875 mL/h), then 7,000 mL over 16 h (~437 mL/h).
✅ The best indicator that fluids are working
Urine output — adults 30–50 mL/hr,
children 1 mL/kg/hr.
Not blood pressure, not heart rate. Urine output is the perfusion number the exam wants.
🔥 Airway comes before all of it
Suspect inhalation injury with: facial burns, singed nasal hair, soot in the mouth,
hoarseness, stridor, carbon in sputum, or any burn in an enclosed space.
Airway swelling worsens fast. Intubate early - waiting until distress is visible can be too late.
⭐ High-yield — what the exam actually asks
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Face, neck or chest burns → airway is the priority. Assess breathing before you estimate TBSA or start fluids. Waist-down burns → fluids are the priority.
Airway red flags: singed nasal hair or eyebrows, carbonaceous sputum, hoarseness, stridor, drooling or trouble swallowing, falling SpO2.
Rule of Nines: head/neck 9, each arm 9 (4.5 front / 4.5 back), anterior trunk 18, posterior trunk 18, each leg 18, perineum 1. Know the sub-fractions — the front of a forearm is ~2.25%, not 4.5%.
Her palm including fingers ≈ 1% TBSA, used for scattered irregular burns.
Parkland: 4 mL × kg × %TBSA of LR over 24 hr. First half in the first 8 hrtimed from the injury, not from arrival; second half over the next 16 hr. Count only 2nd- and 3rd-degree burns.
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Target urine output ≥30 mL/hr in adults — that is how you know resuscitation is working.
Depth: superficial = red, dry, no blisters. Superficial partial = blisters, moist, very painful. Deep partial = mottled/waxy, less painful. Full-thickness = white/leathery, painless. 4th degree = into muscle or bone.
Burn labs from cell death: sodium down, potassium up, uric acid up, H&H falsely high from hemoconcentration.
Escharotomy relieves circulation through eschar; fasciotomy goes deeper for compartment syndrome. Silver sulfadiazine topically; premedicate before every dressing change.
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Big burns (60–70%): infection, hypothermia, compartment syndrome, and fluid overload after the first 24 hours.
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
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Rule of nines as they drilled it: head/neck 4.5 front + 4.5 back · each arm 9 · each leg 18 · anterior trunk 18 · posterior trunk 18 · perineum 1. Their vocabulary trap: "torso" means chest AND abdomen = 18; "anterior chest" alone is 9.
First-degree burns are never counted in TBSA or in Parkland. You have to be at partial thickness or deeper.
Parkland as taught here: 4 mL × kg × %TBSA over 24 h, half in the first 8 h. Lactated Ringer's, always — they said burn centers are "very sensitive about this" and there will be a silence on the phone if normal saline is hanging.
Their worked problems: 63 kg / 58.5% → 921 mL/hr · 75 kg / 54% → 1,013 mL/hr (165 lb ÷ 2.2 = 75 kg first) · 100 kg / 47% → 1,175 mL/hr.
Calc: morphine 1 mcg/kg/min, 198 lb = 90 kg, supplied 50 mg/100 mL → 90 mcg/min → 0.09 mg/min → 5.4 mg/hr → 11 mL/hr. Their advice: once you know it is math, stop caring that it is morphine and carry your units through every line.
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Hourly urine output is the most reliable indicator of adequate resuscitation — not blood pressure (too variable), not daily weight (too slow), not the infusion rate (that only says what went in). An under-resuscitated kidney simply stops releasing fluid.
Urine output: 30 mL/hr is the floor, not the target — they want 50–60. Below 0.5 mL/kg/hr → fluid challenge and increase the rate. Parkland is only a starting rate; titrate to output. Their line: we treat people, not numbers.
Their trend SATA — urine 35 → 25 → 15 mL, BP 90/58 → 82/50, HR 118 → 132, alert → lethargic: notify the provider of hypovolemic shock, increase the fluid rate per protocol, prepare for a central line (peripheral lines cannot take the flow). No diuretics, no vasopressors, and do not "reassess in 2 hours."
Why not vasopressors: always ask what the underlying problem is. Here it is lost volume, so the answer is fluid. Vasopressors belong to septic shock.
In the emergent phase the priority is fluid resuscitation with crystalloids — not pain control, not antibiotic ointment, not debridement. In the emergent phase the answer is never infection or wound care; infection is days away. If the phase is not stated, derive it from context, because the priorities flip.
30% TBSA arriving in the ED: two large-bore IVs first, before analgesia or removing clothing. Crystalloid = water plus electrolytes (NS, LR — about 97% of what hangs in a hospital); colloid = protein (albumin, dextran), used to pull fluid into the vessels.
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Burn depth by description: first = erythema only, like sunburn · second = clear fluid blisters with surrounding redness, very painful · third = dry, leathery, painless · fourth = charred to muscle and bone. Painless is the frightening one — the nerves have burned through.
Triage among burn clients: face and airway beat a larger %TBSA. Inhalation cues — singed nasal hair, hoarseness, carbonaceous sputum, brassy cough → get intubation equipment now, because in 1–2 hours the airway swells shut. Even with no skin burns, an enclosed-space history still drives the priority.
Enclosed-space fire means more than the burn: carbon monoxide and cyanide from burning furniture. Check for both.
Circumferential chest burn → impaired ventilation is the immediate risk, not shock and not infection — the tight eschar is a belt around the chest. Around a limb it is ischemia instead. The fix is an escharotomy (through the burned skin) or a fasciotomy (deeper).
Systemic effects they scored correct: hyperkalemia (cells rupture and dump potassium), hyponatremia (sodium follows fluid into the third space), paralytic ileus, decreased cardiac output, hypothermia (skin regulates temperature), Curling's ulcer. Scored wrong: increased cardiac output, metabolic alkalosis, hypoglycemia — it is metabolic acidosis and hyperglycemia.
Home first aid: cool running water a full 20 minutes, no ice (it vasoconstricts), do not break blisters — the blister is the dressing — no petroleum jelly, no adhesive bandage, check tetanus, and remove rings and tight jewelry before the swelling makes them uncuttable.
Pressure garments: about 23 hours a day — the missing hour is for washing and drying a spare set, which also prevents fungal skin problems — for up to 24 months. They should not be painful. Pain means a poor fit or a problem, and is a report-it finding.
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ABC is not the only prioritization framework. Theirs: ABC, then Maslow, nursing process, unstable before stable, acute before chronic, least invasive first. And ABC has a D — disability, the neuro check — which comes after C.
Their two opposite mistakes: missing an ABC problem and answering the brain instead, or choosing an ABC answer when there is no ABC problem. Do not give oxygen to a client whose SpO₂ is 97%. If confusion sits next to a BP of 70/50, the blood pressure is the priority and probably the cause.
⚠️ Exam traps
Full-thickness burns are painless but the partial-thickness skin around them hurts intensely. "No pain" does not mean "not serious."
First-degree burns are excluded from the Parkland calculation.
🧠 Mind maps 1
Built from this page's own content — the same four questions every time, so the shape is familiar before the topic is.
Burns
🎯 Who gets it
Thermal — flame, scald, contact. The commonest kind, and scalds dominate in children.
Chemical — keeps burning until the agent is removed; brush powder off before irrigating.
Electrical — the visible wound understates the injury; the current damages everything on its path.
Radiation — sunburn through to radiotherapy injury.
Highest risk: the very young, the very old, and anyone with impaired mobility or sensation.
👀 What you see
Superficial — red, dry, blanches, painful.
Partial thickness — blisters, moist, weeping, and the most painful.
Full thickness — white, leathery, waxy, dry, and painless: the nerves are gone.
Inhalation clues: facial burns, singed nasal hair, soot in the mouth, hoarseness, stridor.
Fluid shift shows as tachycardia and falling urine output long before the blood pressure moves.
🧪 What confirms it
Rule of nines for the extent — head 9, each arm 9, each leg 18, front torso 18, back 18, perineum 1.
Children get a pediatric chart: proportionally bigger heads, so percentage shifts from legs to head.
Carboxyhemoglobin, because pulse oximetry reads normal in carbon monoxide poisoning.
Serial electrolytes: potassium rises early from cell destruction, then falls during diuresis.
🩺 What you do
Airway first — intubate early if inhalation is suspected; after the swelling you cannot.
Parkland: 4 mL × kg × %TBSA of lactated Ringer's over 24 h, half in the first 8 — timed from the burn, not from arrival.
Titrate to urine output: 30–50 mL/hr adults, 1 mL/kg/hr children.
Circumferential burns act as a tourniquet as edema builds — watch for the need for escharotomy.
After 48 hours the risk becomes infection: strict asepsis, and no prophylactic systemic antibiotics.
🖼️ Infographics & deep dives 7
Every burn page already on this site, in the order you would read them.
The ATI template layout, filled from this page. Print it, cover the right, rebuild it.
Active Learning Template — System DisorderBurns
Filled from this page's own content, row by row. No ATI chapter number is given, because that chapter was not opened.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
A burn destroys skin and, above roughly 20% TBSA, becomes a systemic injury: capillaries leak plasma into the tissue and the client becomes hypovolemic from a wound that has not bled.
Depth determines healing and pain; extent determines fluid need and survival.
Health Promotion & Disease Prevention
Water heater below 49 °C / 120 °F; turn pan handles inward; no tablecloths within a toddler's reach.
Working smoke alarms, a rehearsed exit plan, and no smoking in bed.
Sun protection, and eye and skin protection for chemical work.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Extremes of age, impaired mobility, sensory loss, cognitive impairment, and occupational exposure.
Assessment — Expected Findings
Superficial: red, dry, blanching, painful.
Partial thickness: blistered, moist, weeping, most painful.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Potassium rises early from cell lysis, then falls in the diuretic phase.
Hematocrit rises early from plasma loss — it looks like polycythemia and is really dehydration.
Carboxyhemoglobin where there was fire in an enclosed space.
Diagnostic Procedures
Rule of nines or a Lund–Browder chart for extent.
Bronchoscopy where inhalation injury is suspected.
🩺 What you doNursing Care · Medications
Nursing Care
Airway, then fluid, then the wound — in that order, every time.
Parkland formula from the time of the burn; titrate to urine output.
Keep the client warm: large burns lose heat fast and hypothermia worsens everything.
Strict asepsis; a burn wound is an open door.
Medications
Opioids intravenously — intramuscular absorption is unreliable while perfusion is poor.
Topical antimicrobials to the wound; tetanus prophylaxis.
💬 Around the patientClient Education
Client Education
Pressure garments and range-of-motion work prevent contractures; both are uncomfortable and both are essential.
Protect healed skin from the sun for at least a year.
Itching during healing is expected and is not infection.
⚠️ What goes wrongComplications
Complications
Airway obstruction from inhalation injury — the reason airway comes first.
Hypovolemic shock in the first 24–48 hours.
Infection and sepsis after 48 hours, and the leading cause of death.
Compartment syndrome under circumferential burns.
Curling ulcer — stress ulceration of the stomach after major burns.
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Face, neck or chest burns → airway is the priority. Assess breathing before you estimate TBSA or start fluids. Waist-down burns → fluids are the priority.
Airway red flags: singed nasal hair or eyebrows, carbonaceous sputum, hoarseness, stridor, drooling or trouble swallowing, falling SpO2.
Rule of Nines: head/neck 9, each arm 9 (4.5 front / 4.5 back), anterior trunk 18, posterior trunk 18, each leg 18, perineum 1. Know the sub-fractions — the front of a forearm is ~2.25%, not 4.5%.
Her palm including fingers ≈ 1% TBSA, used for scattered irregular burns.
Parkland: 4 mL × kg × %TBSA of LR over 24 hr. First half in the first 8 hrtimed from the injury, not from arrival; second half over the next 16 hr. Count only 2nd- and 3rd-degree burns.
Target urine output ≥30 mL/hr in adults — that is how you know resuscitation is working.
Depth: superficial = red, dry, no blisters. Superficial partial = blisters, moist, very painful. Deep partial = mottled/waxy, less painful. Full-thickness = white/leathery, painless. 4th degree = into muscle or bone.
Big burns (60–70%): infection, hypothermia, compartment syndrome, and fluid overload after the first 24 hours.
Rule of nines as they drilled it: head/neck 4.5 front + 4.5 back · each arm 9 · each leg 18 · anterior trunk 18 · posterior trunk 18 · perineum 1 · palm ≈ 1% for burns that do not fit the nines.
First-degree burns are never counted in TBSA or in Parkland.
Parkland as taught here: 4 mL × kg × %TBSA over 24 h, half in the first 8 h. Lactated Ringer's, always — they said burn centers are "very sensitive about this." Not NS, not D5W.
Their three worked problems: 63 kg / 58.5% → 921 mL/hr · 75 kg / 54% → 1,013 mL/hr · 100 kg / 47% → 1,175 mL/hr.
Urine output: 30 mL/hr is the floor, 50–60 is what they want. Below 0.5 mL/kg/hr → increase fluids. Parkland is a starting rate — titrate to output.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
Compare the gland hormone with its stimulating hormone and the diagnosis appears.
Low T4 + high TSH → the thyroid failed (primary). Low T4 + low TSH → the
pituitary failed (secondary). Both moving the same way means the problem is upstream.
HYPOthyroid
HYPERthyroid
Metabolism
Everything slows
Everything speeds up
Weight
Gains, despite poor appetite
Loses, despite eating more
Temperature
Cold intolerance
Heat intolerance, sweating
Heart rate
Brady
Tachy, atrial fibrillation
Bowels / mood
Constipation, depression, fatigue
Diarrhea, anxiety, insomnia
Distinctive
Dry skin, hair loss, myxedema
Exophthalmos (Graves), goitre
Crisis
Myxedema coma — hypothermia, ↓LOC
Thyroid storm — fever, HR >140
⭐ Levothyroxine teaching — four points, all testable
Take in the morning, on an empty stomach, 30–60 min before food
Lifelong — do not stop when feeling better
Report chest pain or palpitations — the dose is too high
Separate from calcium, iron and antacids by 4 hours — they block absorption
Steroids are always tapered, never stopped abruptly - the adrenals have atrophied.
⭐ High-yield — what the exam actually asks
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Addison's = low cortisol and aldosterone → low BP, low glucose, low sodium, high potassium, hyperpigmentation, weight loss. Cushing's is the mirror image plus moon face, buffalo hump, central obesity, thin limbs.
Addisonian crisis order: fluids + dextrose first, then IV hydrocortisone. Fix the hyperkalemia with insulin + D50.
Cushing's: taper steroids, never stop abruptly — exogenous steroids suppress the body's own cortisol. Sodium restriction, K-sparing diuretics.
Pheochromocytoma: catecholamine-secreting adrenal tumor → severe HTN, headache, diaphoresis, tachycardia. Alpha blockers before surgery.
DI = "Dry Inside." Too little ADH → massive dilute urine, low specific gravity, dehydration, low BP, high sodium. Fluids + desmopressin.
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SIADH = "Soaked Inside." Too much ADH → scant concentrated urine, high specific gravity, overload, high BP, low sodium. Fluid restriction + diuretics + sodium. Low sodium means seizure precautions.
Graves'/hyperthyroid: weight loss with a big appetite, heat intolerance, tachycardia, tremor, diarrhea. Methimazole (immunosuppression) or PTU (hepatotoxicity), or radioactive iodine.
Thyroid storm: high fever, severe tachycardia, delirium → fluids + dextrose first, then beta blockers for the cardiac symptoms plus PTU/methimazole, plus cooling.
Hashimoto's/hypothyroid: fatigue, bradycardia, constipation, cold intolerance, depression. Airway is the priority — lethargic with poor respiratory effort. Myxedema coma: fluids + dextrose first, then IV levothyroxine plus warming.
Overtreated hypothyroidism looks exactly like hyperthyroidism — agitation, insomnia, sweating.
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
Show 7 moreHide these 7
Their thyroid model: a dial from 0 to 10, normal sits at 5. Hypo = dial down, every organ slows. Hyper = dial up. They want pattern-matching, not memorized symptom lists — "find the pattern and do not deviate from it."
The hypothyroid highlight, cues they scored: tired for weeks, +10 lb without a diet change, dry skin and brittle hair, feels cold most of the time, HR 56, temp 97.2 °F. Constipation would count too. "Denies heat intolerance" was NOT scored — absence of a hyper sign only means normal.
Hypo and hyper are opposites in everything except three: fatigue, insomnia and hair loss appear in both. Learn one list and invert it.
Primary hypothyroidism = high TSH with low T3/T4 (the gland has failed). Secondary = low TSH with low T3/T4 (the pituitary has). Hashimoto's is roughly 18 of every 20 primary cases, and overwhelmingly female.
Hypothyroid symptoms + high TSH + low T4 → levothyroxine. Methimazole would drive them further down; vasopressin is ADH; hydrocortisone is for Addison's.
Levothyroxine overdose is iatrogenic hyperthyroidism. Scored findings: temp 104.9 °F, HR 125, RR 42, restlessness, tremor, heat intolerance, weight loss. Not cold intolerance, not constipation — it would be diarrhea.
Interventions for that overdose: beta blocker, cooling blanket, low-stimulation room, hold the next dose and notify.Antithyroid drugs are useless here — the excess T4 is already circulating, not being made. Levothyroxine is started low and titrated slowly, especially in older adults.
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"DI = dry inside, SIADH = soaked inside." Their other hook: ADH is the anti-pee hormone — no anti-pee means a lot of pee.
"Diabetes" is just Latin for a lot of urine. Diabetes insipidus has nothing to do with glucose. On the fluid deprivation test the DI finding is dilute urine continuing despite the restriction; a normal person concentrates it.
In DI the serum sodium climbs — you are losing water, not salt. DI is genuinely rare and usually follows brain injury. Stop a fluid deprivation test for hypotension, tachycardia, dizziness or severe dehydration; you have your answer already.
SIADH plan of care, their SATA: seizure precautions, daily weights, urine specific gravity, regular neuro assessments.Not a low-potassium diet — potassium is not part of this picture, and they said to leave it rather than guess. Their case sodium was 120.
The SIADH story to recognize: cough, weight loss, hemoptysis and a sodium of 120 = a lung cancer secreting ADH. Brain injury and meningitis can do it too.
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Cushing's is three hormones, not one: cortisol (breaks down muscle and fat, releases liver sugar → hyperglycemia), aldosterone (holds sodium, dumps potassium → hypertension and hypokalemia) and androgens (hirsutism in women).
Cushing's diet: potassium-rich, sodium-restricted, high protein.Not high calorie — steroids stimulate appetite and they are already gaining. Not protein-restricted — cortisol is already breaking down muscle.
Addison's diet is the exact mirror: high sodium, low potassium. No aldosterone means salt and water are lost and potassium is retained.
Their point about frequency: Cushing's is usually something we cause with prednisone and dexamethasone, so it is common and worth knowing cold — moon face, central obesity, purple striae, thin bruising skin, osteoporosis, new diabetes. Addison's is far rarer.
Dexamethasone suppression test: cortisol that stays elevated confirms Cushing's. It is confirmatory because a plain serum cortisol swings high in the morning and low at night.
Adrenal crisis: hypotension, confusion, hyperkalemia, plus severe abdominal pain, vomiting and diarrhea (which is why every oral option is wrong). The keyed answer was IV hydrocortisone, but both instructors said fluids first, steroids second — steroids take days to raise a pressure. Do not take orthostatics on a client who is already hypotensive, and do not default to high-flow oxygen when nothing respiratory is described.
Pheochromocytoma releases catecholamines — epinephrine and norepinephrine — in bursts: episodic severe hypertension, palpitations, sweating, flushing, then it settles. Treatment is an alpha blocker, the "-osin" drugs (doxazosin, terazosin), because the problem is vasoconstriction. Beta blockers work on the heart, not the vessels. Watch first-dose severe hypotension; the same class treats BPH. Cure is adrenalectomy — one gland is plenty.
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Post-thyroidectomy priority is voice change (recurrent laryngeal nerve). But if neck swelling is on the list, it wins — that is an airway. Then hypocalcemia from the parathyroids sitting behind the gland — Chvostek, Trousseau, carpopedal spasm. Never encourage neck extension — that is how you dehisce the wound.
Two test-taking rules they gave here: if two options say essentially the same thing, both are wrong (they cannot both be right). If two options are exact opposites, one of them is usually the answer.
Calc:5 mcg/kg/min, 132 lb, supplied 100 mg/100 mL → 18 mL/hr. Their mantra: "2.2 always goes with the pounds." Dimensional analysis, formula or ratio — pick one and get the same answer every time.
⚠️ Exam traps
Addison's low / Cushing's high on nearly every parameter except potassium, which inverts. That one flip is the whole question.
DI vs SIADH: sort it by urine concentration and serum sodium and it falls out immediately.
Both thyroid crises start with fluids + dextrose before the definitive drug.
🧠 Mind maps 4
One per disorder, built from the structure of your ATI chapter.
Pituitary Disorders
🎯 Who gets it
Acromegaly risk: genetics, onset in the 30s-40s, and pituitary adenomas.
Central DI (AVP deficiency) risk: head injury, brain tumor, CNS infection, or autoimmune disease.
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
ATI Active Learning Template — System DisorderPituitary Disorders
Filled from ATI chapter 77, row by row from that chapter’s own sections — 11 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Covers pituitary gland anatomy, anterior/posterior hormones, and three disorders: acromegaly (excess GH), arginine vasopressin disorder (ADH deficiency), and SIADH (excess ADH) with their fluid/electrolyte effects.
Health Promotion & Disease Prevention
Not a section in this chapter. Fill from lecture if your instructor covers it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Acromegaly risk: genetics, onset in the 30s-40s, and pituitary adenomas.
Central DI (AVP deficiency) risk: head injury, brain tumor, CNS infection, or autoimmune disease.
Carbamazepine can stimulate ADH release, reducing urine output in DI.
Thiazide diuretics are sometimes used to lower urine output in central DI.
Indomethacin (an NSAID) can increase urine concentration in DI.
Therapeutic Procedures
Hypophysectomy removes the pituitary via a minimally invasive transnasal transsphenoidal approach; craniotomy if needed.
Postop: monitor neurologic status, vision, and vital signs closely (watch for hypotension).
Postop: watch the nasal drip pad for epistaxis.
Postop: report clear watery nasal drainage - may signal a CSF leak.
Postop: encourage deep breathing but limit coughing to avoid raising ICP or a CSF leak.
Postop: assess for sinusitis and meningitis; nasal packing is removed on postop day 1.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Acromegaly: hormone replacement therapy may be lifelong; report vision or mental status changes.
Acromegaly: avoid lifting or straining postop; report nasal bleeding or watery discharge.
Clients with sleep apnea should skip CPAP use right after hypophysectomy.
Report any increase in urine output after pituitary surgery.
DI: drink fluids based on thirst, matching urine output volume; weigh daily.
DI: reduce protein and sodium intake to help lower urine output.
SIADH: avoid taking demeclocycline with calcium, iron, magnesium, aluminum antacids, or milk.
Interprofessional Care
DI and SIADH may need home health support for fluids, meds, and diet management.
⚠️ What goes wrongComplications
Complications
Untreated SIADH can cause water intoxication, cerebral or pulmonary edema, and severe hyponatremia.
Without prompt treatment, these SIADH complications can progress to coma and death.
Watch for lung crackles, distended neck veins, and neuro changes signaling complications.
Maintain seizure precautions and monitor blood sodium closely in SIADH.
Teach clients to follow fluid restriction strictly to prevent worsening SIADH.
ATI Active Learning Template — System DisorderHypothyroidism
Filled from ATI chapter 79, row by row from that chapter’s own sections — 9 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Explains hypothyroidism's primary, iatrogenic, and central (pituitary or hypothalamic) causes, why older adults are often underdiagnosed, and covers its risk factors, findings, labs, levothyroxine therapy, and the emergency of myxedema coma.
Health Promotion & Disease Prevention
Not a section in this chapter. Fill from lecture if your instructor covers it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Women develop hypothyroidism about 7 times more often than men.
Risk rises with older age and history of thyroid surgery.
Amiodarone, lithium, immune modulators, and chemotherapy can trigger hypothyroidism.
Inadequate iodine intake and autoimmune disease raise hypothyroidism risk.
Prior radiation therapy to the head or neck is a risk factor.
Assessment — Expected Findings
Classic signs: fatigue, cold intolerance, constipation, and weight gain.
Mood/cognitive changes: depression, anxiety, psychosis, and trouble concentrating.
Joint stiffness, muscle pain, and carpal tunnel syndrome can occur.
Cushing syndrome treatment: taper glucocorticoids gradually and manage symptoms.
Ketoconazole (an antifungal) inhibits adrenal corticosteroid synthesis at high doses.
Mitotane selectively destroys adrenocortical cells to treat inoperable adrenal carcinoma; watch for shock.
Hydrocortisone replaces cortisol after Cushing treatment and is often paired with ketoconazole.
Therapeutic Procedures
Chemotherapy with cytotoxic agents can treat tumor-driven Cushing disease.
Hypophysectomy (pituitary removal) or adrenalectomy (one or both adrenal glands) may be needed.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Report weight gain over 2 lb in 24 hr or 3 lb in a week.
Eat foods high in calcium and vitamin D; avoid high-risk activities to prevent fractures.
Ketoconazole relief is temporary; take with food to reduce GI upset.
Mitotane: report visual changes or blood in urine; use caution driving.
Hydrocortisone: never skip a dose; carry emergency corticosteroid ID.
Hydrocortisone: report abdominal pain, black tarry stools, or infection signs to the provider.
Post-hypophysectomy: breathe through the mouth, avoid coughing, nose-blowing, or sneezing.
Interprofessional Care
Arrange frequent endocrinologist follow-up and home care for mobility and fall prevention.
⚠️ What goes wrongComplications
Complications
Not a section in this chapter. Fill from lecture if your instructor covers it.
ATI Active Learning Template — System DisorderAddison Disease and Acute Adrenal Insufficiency (Addisonian Crisis)
Filled from ATI chapter 81, row by row from that chapter’s own sections — 9 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Addison disease is chronic adrenocortical insufficiency from adrenal cortex damage, causing low aldosterone and cortisol; acute adrenal insufficiency (Addisonian crisis) is a rapid, life-threatening emergency requiring immediate treatment, especially in older adults.
Health Promotion & Disease Prevention
Not a section in this chapter. Fill from lecture if your instructor covers it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Primary Addison disease: autoimmune adrenal destruction is the most common cause
Primary causes also include TB, histoplasmosis, adrenalectomy, or abdominal radiation
Metastatic cancer (breast, lung, colon, melanoma) can destroy adrenal tissue
Secondary Addison disease follows steroid withdrawal, hypophysectomy, or pituitary tumors
High-dose radiation to the pituitary or whole brain causes secondary disease
Acute adrenal insufficiency occurs when cortisol need exceeds the body's supply
Untreated acute adrenal insufficiency can be rapidly fatal
Triggers include infection, trauma, and intense physical exertion
Fludrocortisone (mineralocorticoid replacement) can cause hypertension as a side effect
Mild peripheral edema is expected with fludrocortisone; report sudden weight gain
Vasopressors treat persistent low blood pressure; antibiotics treat active infections
Avoid alcohol and caffeine; watch for GI bleeding signs like black tarry stool
Interprofessional Care
Home health can help manage fluids, medications, and diet after discharge
⚠️ What goes wrongComplications
Complications
Not a section in this chapter. Fill from lecture if your instructor covers it.
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Addisonian crisis order: fluids + dextrose first, then IV hydrocortisone. Fix the hyperkalemia with insulin + D50.
Cushing's: taper steroids, never stop abruptly — exogenous steroids suppress the body's own cortisol. Sodium restriction, K-sparing diuretics.
Thyroid storm: high fever, severe tachycardia, delirium → fluids + dextrose first, then beta blockers for the cardiac symptoms plus PTU/methimazole, plus cooling.
Hashimoto's/hypothyroid: fatigue, bradycardia, constipation, cold intolerance, depression. Airway is the priority — lethargic with poor respiratory effort. Myxedema coma: fluids + dextrose first, then IV levothyroxine plus warming.
Their thyroid model: a dial from 0 to 10, normal sits at 5. Hypo = dial down, everything slows. Hyper = dial up. They want pattern-matching, not memorized symptom lists.
Primary hypothyroidism = high TSH with low T3/T4. Secondary = low TSH with low T3/T4. Hashimoto's is roughly 18 of every 20 primary cases.
Levothyroxine overdose is iatrogenic hyperthyroidism: temp 104.9°F, HR 125, RR 42, restless, heat intolerant. Antithyroid drugs are useless here — the excess T4 is already circulating, not being made. Beta blocker, cooling, low-stimulation room, hold the next dose, notify.
Levothyroxine is started low and titrated slowly, especially in older adults. Judge the dose on symptoms plus T4.
"DI = dry inside, SIADH = soaked inside." Their SIADH case sodium was 120: fluid restriction, urine specific gravity, seizure precautions and neuro checks — low sodium is a neuro problem. Classic cause is lung cancer secreting ADH.
Adrenal crisis: hypotension, confusion, hyperkalemia, plus severe abdominal pain, vomiting and diarrhea (which is why every oral option is wrong). The keyed answer was IV hydrocortisone, but both instructors said what they wanted was a 0.9% NS bolus.
Pheochromocytoma: alpha-1 blockers, the "-osin" drugs (doxazosin, terazosin). Watch first-dose severe hypotension. Same class treats BPH.
Post-thyroidectomy priority is voice changes (recurrent laryngeal nerve). Then hypocalcemia — Chvostek, Trousseau, carpopedal spasm — then neck swelling. Avoid neck extension.
Hypoglycemia kills in minutes. Hyperglycemia kills over hours. When a diabetic patient
changes behavior, confusion or shakiness, check the glucose first — treat low before high.
15 g of fast carbohydrate → wait 15 minutes → recheck. Repeat until above 70,
then give a snack with protein.
15 g looks like: 4 oz juice3 glucose tabs1 tbsp honey
If the patient is unconscious or cannot swallow, nothing goes in the mouth. IM glucagon or IV dextrose.
DKA
HHS / HHNS
Diabetes type
Usually type 1
Usually type 2
Onset
Hours to a day — fast
Days to weeks — slow
Glucose
>250
>600, often far higher
Ketones
Present — large
Absent / minimal
pH
<7.35 acidotic
Normal
Breathing
Kussmaul, fruity breath
Normal
Mental state
Alert → drowsy
Profound confusion, seizures
Mortality
Lower
Higher
💧 Treatment order — identical for both
1 · FluidsIV normal saline — always first
2 · InsulinRegular insulin IV infusion
3 · PotassiumReplace as it falls into cells
4 · WatchGlucose, K⁺, pH, urine output
Fluids come before insulin. Insulin drives potassium into cells and can drop it dangerously.
Add dextrose once glucose reaches ~250 so the drip can continue
clearing ketones without going hypoglycemic.
Insulin
Onset
Peak
Duration
Lispro / aspart (rapid)
15 min
1 h
3–4 h
Regular (short)
30 min
2–3 h
5–8 h
NPH (intermediate)
1–2 h
4–12 h
12–18 h
Glargine (long)
1–2 h
No peak
~24 h
Peak time is when hypoglycemia happens. That is the only reason the
exam asks you to memorize these. Glargine is never mixed with another insulin.
When mixing NPH and regular: clear before cloudy.
⭐ High-yield — what the exam actually asks
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Type 1: autoimmune beta-cell destruction, absolute deficiency, thinner, younger, prone to DKA. Type 2: insulin resistance, obesity-associated, prone to HHS.
Insulin: rapid (lispro, aspart) 15 min before meals, onset ~15 min, peak 1–3 hr — watch for hypoglycemia at the peak. Regular is the only IV insulin. Long-acting (glargine, detemir) has no peak and is never mixed.
Rapid-acting may be mixed with intermediate (NPH). Nothing mixes with glargine.
Metformin cuts hepatic glucose production; GI upset, rare lactic acidosis. Sulfonylureas (glipizide) cause hypoglycemia.
Hypoglycemia, conscious: 15 g fast carb, recheck in 15 min. Unconscious: glucagon or IV dextrose. Signs: shaky, sweaty, tachycardic, confused, headache.
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DKA (Type 1): ketones positive, fruity breath, Kussmaul respirations, acidotic pH, N/V, faster onset, glucose lower than HHS. HHS (Type 2): no ketones, normal pH, no N/V, much higher glucose, slow insidious onset.
Both crises: IV fluids first, then a regular insulin drip. Never subQ insulin in a crisis. Replace potassium.
Sick day rules: keep taking insulin even if not eating, glucose q2–4 hr, ketones if Type 1, hydrate, call if glucose >250 and not falling or if ill more than 2 days.
Complications: microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (CAD, stroke, PAD).
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
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DKA vs HHS as they framed it: DKA is type 1, presents within ~24 h because they are so sick, with Kussmaul breathing, fruity breath, metabolic acidosis, abdominal pain and vomiting. HHS is type 2, sits at home for days, glucose 500–800, profound dehydration, and much more prominent mental-status change — up to paralysis — with no acidosis.
Why DKA gets the GI symptoms: no insulin → the body burns fat → the pH falls, and the gut hates a low pH. Fruity breath, Kussmaul and the acidosis all come from the same place, which is why HHS has none of them.
In severe hyperglycemia the first assessment is dehydration — that is circulation. Ahead of a fingerstick, ahead of level of consciousness. Glucose is not part of A-B-C-D, and confusion is D.
Complications split two ways: microvascular = eyes, kidneys, nerves (retinopathy, nephropathy, neuropathy); macrovascular = brain, heart, limbs (stroke, MI, peripheral arterial disease). Their warning: nerve damage is permanent — good control from here does not bring it back.
Type 1 vs type 2 vs DI, their matrix: the three Ps belong to both diabetes types. DI has polyuria and polydipsia but no polyphagia — it is an ADH problem, nothing to do with glucose. Autoimmune beta-cell destruction + lifelong insulin + DKA risk = type 1. Obesity, insulin resistance, oral agents and HHS = type 2.
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NPH is the only intermediate insulin: onset 1–2 h, peak 6–8 h → snack at 8 hours, when the hypoglycemia risk is highest. Cloudy is normal — it looks like skim milk. Roll it, never shake; insulin is a protein and briskly shaking it foams.
Their rule for every insulin: the onset tells you when she should eat, the peak tells you when she is most likely to go low.
Lispro and aspart work in 15 minutes → give immediately before the meal.Not 30 minutes ahead — she will be hypoglycemic before the tray arrives — and do not hold it until after she eats, and do not wait to mix it with the NPH.
The common regimen to recognize: rapid-acting before every meal + a long-acting basal for 24-hour background insulin, because a failed pancreas makes none.
Hypoglycemia at 58 mg/dL: awake → 4–6 oz of juice. Unconscious → 50 mL of D50 IV, or IM glucagon when there is no line, which is what EMS gives. Not water, not skim milk, not oral carbohydrate in an unconscious client.
Their mnemonic for reading it without a glucose value: "Cool and clammy, give them candy. Dry and hot, insulin shot."
Sliding scale is ACHS — before each of the three meals plus bedtime, four checks — and it is always regular insulin, never a long-acting one. Under 150 usually means no coverage. If a type 1 client says a dose will tank her, you may document "given 4, refused 4" — do not override her knowledge of her own body.
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Metformin, their SATA: take it with meals (notorious for GI upset), watch for lactic acidosis — the nasty one, and the slide that called it "rare but not serious" is wrong, it is rare and serious — hold it 48 h before IV contrast, and report a persistent metallic taste. It does not drop glucose in 2–3 hours (it works on insulin resistance) and it does not cause weight gain — it tends to cause weight loss.
Metformin carries no hypoglycemia risk — it does not make the pancreas secrete insulin. Sulfonylureas do, so they can.
Sulfonylureas (glyburide, glipizide): hypoglycemia, weight gain, increased appetite, photosensitivity, allergic reaction — and a sulfa cross-allergy. Not hyponatremia, not constipation, not bradycardia. Their explicit advice on that item: if you cannot name the mechanism, do not pick it.
Why sulfonylureas and insulin both cause weight gain: they drive sugar into cells, blood glucose falls, and the body answers by making her hungry.
The diabetic plate method: 50% non-starchy vegetables and fruit, 25% lean protein, 25% grains, plus a glass of dairy. Their best meal was black bean chili with brown rice and spinach — protein, fiber, low glycemic index, no saturated fat. The cheeseburger's whole-wheat bun was bait.
Nutrition teaching: consistent amounts of carbohydrate at regular times. Not "avoid all carbohydrates", not "only sugar-free foods", not "skip meals as long as I take my insulin." Type 1 clients can eat sugar — they cover it with insulin.
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Sick-day rule they guarantee will be tested: keep taking your insulin and monitor frequently.Never skip it, never halve it, never take "only rapid-acting." If she cannot keep anything down at all, she comes to hospital — she is heading for DKA.
Exercise: hold it if glucose is over 250 with ketones — exercising then pushes a near-DKA into a real one. Check before and after, carry fast-acting carbohydrate, and never skip insulin before a run.
DKA drip set: hourly glucose · replace potassium as soon as it is normal and falling · swap to a D5-containing fluid at glucose 250 so the drop is not fast enough to cause cerebral edema · bicarbonate only if pH under 7.0. Their trend case ran K 5.8 → 4.2 → 3.5 with bicarb 12 → 16 → 20, and the answer was give potassium.
Why the potassium moves: acidosis drives H⁺ into the cells and kicks potassium out, so they arrive hyperkalemic. Insulin then drives potassium back in — which is why a normal-and-falling K is the moment to replace it, not later.
Diabetic neuropathy findings only: burning feet, reduced light touch, lost vibration sense in the toes, and gastroparesis (peristalsis needs nerves). Blurred vision and floaters are retinopathy; proteinuria is nephropathy.
Calc: insulin 0.1 units/kg/hr, 165 lb = 75 kg, supplied 100 units/100 mL → 7.5, rounded to 8 mL/hr.
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Two stem-reading rules they drilled: "indicates an understanding" means you are hunting a TRUE statement; "needs further teaching" means you are hunting a FALSE one. Write which one at the top of the whiteboard, because by option 4 your brain has flipped.
Watch only, always, never. Medicine is rarely that absolute, so those options usually lose. And two options that say almost the same thing are usually both wrong — they cannot both be right.
⚠️ Exam traps
Hypoglycemia outranks a very high glucose in acuity — she can lose consciousness fast.
Ketones are the single cleanest DKA/HHS discriminator.
🧠 Mind maps 1
One per disorder, built from the structure of your ATI chapter.
Complications of Diabetes Mellitus (DKA and HHS)
🎯 Who gets it
DKA risk: undiagnosed or untreated type 1 diabetes, or skipping insulin doses.
A missed or too-low insulin dose can trigger DKA.
Illness or emotional stress raises insulin demand through faster carbohydrate metabolism.
Infection is the most common trigger of DKA.
👀 What you see
Polyuria: osmotic diuresis from hyperglycemia leads to excess urine output.
Polydipsia: fluid loss from diuresis triggers excessive thirst and dehydration.
Polyphagia: cells can't use glucose, so hunger increases despite eating.
Weight loss occurs as the body breaks down fat cells can't use.
🧪 What confirms it
DKA blood glucose typically exceeds 250 mg/dL, sometimes reaching 800 mg/dL or higher.
HHS blood glucose exceeds 600 mg/dL.
DKA sodium can run low or normal, shifting with hyperglycemia, dehydration, and fluid changes.
DKA potassium starts high as it leaves cells, then drops after fluids and insulin.
🩺 What you do
Recheck vital signs at 15-min intervals initially, tapering to every 4 hr once the client stabilizes.
Always treat the underlying cause, most often infection.
Give isotonic fluids; the client may need 6 to 9 L in 24 hr to replace half the deficit.
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
ATI Active Learning Template — System DisorderComplications of Diabetes Mellitus (DKA and HHS)
Filled from ATI chapter 83, row by row from that chapter’s own sections — 6 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
DKA is a rapid, life-threatening emergency in type 1 (sometimes type 2) diabetes marked by hyperglycemia above 250 mg/dL, ketosis, and acidosis; HHS is a slower-onset crisis with glucose above 600 mg/dL, severe dehydration, and no ketosis.
Health Promotion & Disease Prevention
Not a section in this chapter. Fill from lecture if your instructor covers it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
DKA risk: undiagnosed or untreated type 1 diabetes, or skipping insulin doses.
A missed or too-low insulin dose can trigger DKA.
Illness or emotional stress raises insulin demand through faster carbohydrate metabolism.
Infection is the most common trigger of DKA.
High cortisol, glucagon, and epinephrine boost glucose production and blunt insulin's effect.
HHS risk: severe hyperglycemia causes sustained osmotic diuresis from too little insulin.
In HHS, enough insulin remains to block ketosis but not to control glucose.
Poor fluid intake or kidney function worsens hyperosmolarity and dehydration in HHS.
Assessment — Expected Findings
Polyuria: osmotic diuresis from hyperglycemia leads to excess urine output.
Polydipsia: fluid loss from diuresis triggers excessive thirst and dehydration.
Polyphagia: cells can't use glucose, so hunger increases despite eating.
Weight loss occurs as the body breaks down fat cells can't use.
GI symptoms (nausea, vomiting, abdominal pain) stem from ketosis and acidosis.
Blurred vision, headache, and weakness result from fluid volume depletion.
Hypotension results from dehydration caused by osmotic diuresis.
A fruity breath odor comes from ketone buildup in the blood.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
DKA blood glucose typically exceeds 250 mg/dL, sometimes reaching 800 mg/dL or higher.
HHS blood glucose exceeds 600 mg/dL.
DKA sodium can run low or normal, shifting with hyperglycemia, dehydration, and fluid changes.
DKA potassium starts high as it leaves cells, then drops after fluids and insulin.
HHS sodium is usually normal or low, shifting with dehydration and osmotic fluid changes.
Diagnostic Procedures
Not a section in this chapter. Fill from lecture if your instructor covers it.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Recheck vital signs at 15-min intervals initially, tapering to every 4 hr once the client stabilizes.
Always treat the underlying cause, most often infection.
Give isotonic fluids; the client may need 6 to 9 L in 24 hr to replace half the deficit.
Start rapid 0.9% sodium chloride for 1 to 3 hr, switching to 0.45% if sodium is elevated.
Add dextrose to IV fluids when glucose falls to 200 mg/dL in DKA or 250 mg/dL in HHS.
Use IV insulin, not subcutaneous, for moderate to severe DKA.
Give regular insulin 0.1 unit/kg IV bolus, then infuse at 0.05 unit/kg/hr.
Check glucose hourly; target glucose under 200 mg/dL, pH over 7.3, bicarbonate over 15 mEq/L.
Medications
Not a section in this chapter. Fill from lecture if your instructor covers it.
Therapeutic Procedures
Not a section in this chapter. Fill from lecture if your instructor covers it.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Wear a medical alert bracelet identifying your diabetes diagnosis.
Take steps to prevent dehydration and future hyperglycemic crises.
Drink 2 to 3 L/day of fluids from food, beverages, and water unless restricted.
If glucose runs low, drink liquids that contain sugar.
Check glucose every 2 to 4 hr during illness, and keep taking insulin.
Check urine for ketones whenever glucose exceeds 240 mg/dL.
Drink carbohydrate- and electrolyte-containing fluids, like sports drinks, if solid food isn't tolerated.
Interprofessional Care
Not a section in this chapter. Fill from lecture if your instructor covers it.
⚠️ What goes wrongComplications
Complications
Not a section in this chapter. Fill from lecture if your instructor covers it.
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Type 1: autoimmune beta-cell destruction, absolute deficiency, thinner, younger, prone to DKA. Type 2: insulin resistance, obesity-associated, prone to HHS.
Insulin: rapid (lispro, aspart) 15 min before meals, onset ~15 min, peak 1–3 hr — watch for hypoglycemia at the peak. Regular is the only IV insulin. Long-acting (glargine, detemir) has no peak and is never mixed.
Hypoglycemia, conscious: 15 g fast carb, recheck in 15 min. Unconscious: glucagon or IV dextrose. Signs: shaky, sweaty, tachycardic, confused, headache.
DKA (Type 1): ketones positive, fruity breath, Kussmaul respirations, acidotic pH, N/V, faster onset, glucose lower than HHS. HHS (Type 2): no ketones, normal pH, no N/V, much higher glucose, slow insidious onset.
Both crises: IV fluids first, then a regular insulin drip. Never subQ insulin in a crisis. Replace potassium.
Sick day rules: keep taking insulin even if not eating, glucose q2–4 hr, ketones if Type 1, hydrate, call if glucose >250 and not falling or if ill more than 2 days.
DKA vs HHS as they framed it: DKA is type 1, presents within ~24 h, Kussmaul, fruity odor, acidosis, abdominal pain and vomiting. HHS is type 2, sits at home for days, glucose 500–800, profound dehydration, much more prominent neuro and mental status change (up to paralysis), no acidosis.
In severe hyperglycemia the first assessment is dehydration — circulation. Ahead of a fingerstick, ahead of LOC, because glucose is not A-B-C-D.
NPH is the only intermediate insulin: onset 1–2 h, peak 6–8 h → snack at 8 hours. Cloudy is normal. Roll it, never shake — protein foams.
Lispro and aspart work in 15 minutes → give immediately before the meal, never 30 minutes ahead.
Hypoglycemia at 58 mg/dL: awake → 4–6 oz juice. Unconscious → 50 mL of D50 IV.
Sick-day rule they guarantee will be tested: keep taking insulin. Monitor frequently. Never skip it, never halve it.
Exercise: hold it if glucose >250with ketones, carry fast-acting carbohydrate, never skip insulin before a run.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
The skull cannot expand. Brain, blood and CSF share a fixed box, so anything that
swells or bleeds pushes something else out. Every neuro emergency is that competition.
The earliest sign of rising ICP is a change in level of consciousness — always.
Rising ICP
What you see
EARLIEST
Change in LOC — restless, confused, harder to rouse
By the time the triad appears, herniation is close. It is never the answer to "earliest sign".
Positioning: head of bed 30°, head midline,
no neck flexion, no hip flexion. Avoid coughing, straining and suctioning longer than 10 seconds.
Ischemic stroke
Hemorrhagic stroke
Cause
Clot blocks a vessel (~87%)
Vessel ruptures and bleeds
Onset
Sudden deficits, often on waking
Sudden “worst headache of my life”
First test
Non-contrast CT — before any treatment decision
tPA
Yes, within 3–4.5 h of onset
ABSOLUTELY NOT
🧠 Why the CT comes first
Ischemic and hemorrhagic strokes look identical at the bedside, and the treatment for
one is fatal in the other. CT exists to rule out bleeding before giving tPA.
BE-FAST:Balance · Eyes · Face droop ·
Arm drift · Speech · Time — note the last known well time.
⬅️ LEFT brain stroke
Right-sided weakness. Aphasia — language is on the left.
Slow, cautious, anxious. Aware of the deficit, so depression is common.
➡️ RIGHT brain stroke
Left-sided weakness. Left-sided neglect — ignores that half of the world.
Impulsive, poor judgment, unaware of the deficit — so a major fall risk.
⭐ The one intervention that prevents the common killer
Swallow screen before anything by mouth. Aspiration pneumonia is the leading cause of
death after stroke.
Nothing by mouth - not even water or medications - until swallowing is formally assessed.
⭐ High-yield — what the exam actually asks
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Normal ICP 10–15 mmHg; normal CPP >50 mmHg; CPP = MAP − ICP. Rising ICP drops CPP and starves the brain.
A change in LOC is the earliest sign of rising ICP. Cushing's triad — rising systolic with widened pulse pressure, bradycardia, irregular/Cheyne-Stokes respirations — is a late herniation sign.
Mannitol and 3% saline pull fluid off the brain; confirm mannitol is working by increased urine output. Never Trendelenburg with raised ICP.
GCS: eye 1–4, verbal 1–5, motor 1–6. Max 15, min 3. GCS ≤8 → intubate.
Decorticate = arms in toward the core, better prognosis. Decerebrate = arms out/extended, brainstem damage, worse.
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Non-contrast CT within 25 minutes of arrival decides ischemic vs hemorrhagic and t-PA candidacy. CT first acutely; MRI is better detail but too slow for the emergency.
Ischemic stroke ~87%, hemorrhagic ~13%. t-PA window 3–4.5 hr from symptom onset. Contraindicated with anticoagulants, SBP >180, recent bleed or surgery, age under 18, or abnormal glucose. Not a candidate → heparin drip.
Hemorrhagic: "worst headache of my life." No t-PA ever. Lower the BP, check and reverse coags, then surgical evacuation. Always ask when the symptoms started.
Left-brain stroke → right-sided weakness plus language and swallowing deficits (airway risk), slow cautious behavior. Right-brain stroke → left-sided weakness, homonymous hemianopsia and neglect, impulsive behavior, big fall risk.
Carotid endarterectomy removes plaque (>70% blockage, or >50% with TIAs). Post-op watch for HTN, neck swelling, hoarseness. Stroke care: VS q1–2 hr, notify for SBP >180 or DBP >110, keep SpO2 >92%.
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Seizures: protect the airway, turn her to the side, time it, pad the head. Never restrain, never put anything in the mouth. Status epilepticus (>5 min, or repeated without recovery) → IV lorazepam first, then fosphenytoin or levetiracetam.
A TIA resolves fully with no infarct on imaging — but it gets the same urgency of workup as a stroke.
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
Show 7 moreHide these 7
Posturing scores on the GCS motor scale: decorticate = 3, decerebrate = 2. The scale runs 3–15 — "you get 3 points just for showing up." Eye 4, verbal 5, motor 6. 8 or less: sedate and intubate. Posturing means the brainstem is being compressed.
With posturing and high ICP, elevate the HOB to 30° first. It takes seconds and gravity does the work; mannitol has to be fetched and mixed. That is the whole reason it beats the drug.
Their ICP mechanism table, worth learning as cause → effect: head elevation → venous outflow · sedation → less metabolic demand · mannitol or 3% saline → osmotic diuresis pulling free water out of brain tissue · hyperventilation → CO₂ washout → cerebral vasoconstriction · CSF drainage → less volume.
Mannitol and 3% saline are either/or, never both — together they pull too much fluid. Treat them as interchangeable when you see them as options.
ICP hyperventilation target: PaCO₂ 30–35 (normal 35–45) → cerebral vasoconstriction → less volume in the skull.
Reducing ICP, their SATA: HOB 30°, mannitol, quiet and dimly lit room.Not coughing and deep breathing — that is a Valsalva and it raises ICP. Not fluid restriction to 500 mL — very few conditions justify restricting fluid at all.
Cushing's triad: bradycardia, irregular respirations, widened pulse pressure. Once ICP exceeds the MAP the brain stops being perfused — a true emergency.
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Hematoma pattern recognition — Epidural: arterial, a blow to the temple (the thinnest bone), brief LOC → lucid interval → decline, needs burr holes urgently. Subdural: venous, crescent-shaped, elderly / alcohol / anticoagulated, confusion and unsteadiness over 3–5 days, may recall a bump a week ago. Subarachnoid: berry aneurysm (~1% of people), thunderclap "worst headache of my life", photophobia, no trauma; calcium channel blockers for vasospasm. Intracerebral: elderly, chronic hypertension, sudden severe headache.
Their anatomy note: three of the four are arterial; only the subdural is venous — which is why it is the one that unfolds over days instead of an hour.
Why the elderly get subdurals: the brain shrinks with age, the skull does not, so it rattles on a minor knock and tears the bridging veins.
Subarachnoid vs intracerebral sound almost identical. Only the CT tells them apart.
Worst-headache workup: non-contrast CT first. MRI takes 45–60 minutes; an LP needs a needle, a lab and a wait. Analgesia is given, but it is not the priority.
Elderly + chronic alcohol + minor fall + days of confusion → non-contrast CT for a subdural. Not thiamine (no gait or memory picture, so no Wernicke's), not a withdrawal protocol (they are not withdrawing), not dementia screening. The alcohol matters because a damaged liver makes fewer clotting factors.
Basilar skull fracture: raccoon eyes + Battle sign + clear rhinorrhoea. Confirm CSF with the halo sign or a glucose test strip — nasal mucus has no glucose, CSF does. No NG tube — it can pass through the fracture into the brain. This is the one head injury laid flat.
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Seizure priority is protect the client from injury — turn them side-lying so vomit does not go into the lungs. The benzodiazepine and the documentation both come after. Never restrain a seizing client — it injures muscle and can stop their breathing — and never put anything in the mouth.
Post-ictal: do very little. The brain is exhausted. Raise the head slightly, monitor vitals, and let them wake on their own — do not overstimulate them to rouse them.
Head-injury room setup, their SATA: bed in the lowest position, seizure precautions, quiet dim room, suction at the bedside, HOB 30°.No coughing and deep breathing, no NG tube, no soft restraints.
Hemorrhagic stroke, indicated vs contraindicated: indicated — HOB 30°, mannitol, normal glucose, frequent neuro checks. Contraindicated — alteplase (any bleed is absolute) and "encourage frequent suctioning"; gagging spikes ICP, so suction only when it is needed. Watch that wording.
Intracerebral hemorrhage SATA: HOB 30°, normothermia (fever raises metabolic demand), PaCO₂ 30–35, vasopressors to keep systolic above 100 so the brain is still perfused, frequent neuro checks. Not frequent suctioning, not restricting nutrition for 72 hours, not alteplase.
Epidural picture (temple blow, LOC then awake): emergent CT, monitor for rising ICP, frequent neuro checks, 3% saline or mannitol. Not alteplase, and not flat in bed — flat is only for the basilar skull fracture.
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Their stroke matrix — TIA: resolves within 24 h, usually within an hour; painless; antiplatelets or anticoagulants; the only one that may get a carotid endarterectomy to prevent a future stroke. Ischemic: a clot; painless; CT before thrombolytics; rapid neuro assessment for eligibility; alteplase within 4.5 h. Hemorrhagic: sudden severe headache, nausea, photophobia; may need surgical evacuation.
Ischemic strokes and TIAs do not hurt. A severe headache means a rupture. Their shorthand: a stroke is either a blocked artery or a broken one.
Stroke screening is BEFAST — balance, eyes, face, arms, speech, time. NIHSS runs 0–42: 0 is no damage, 42 is severe.
Suspected stroke with airway and breathing already confirmed: next is a rapid neuro assessment — GCS, pupils, grip, feet, speech, about 20 seconds — then the CT. You cannot give aspirin before the CT, because you do not yet know whether it is a bleed.
Their explicit priority ruling: hypotension 82/50 with HR 130 outranks a new unilateral dilated sluggish pupil. "If we don't fix #4, #3 won't matter." ABC before D, every time — and the full order is A-B-C-D-E, ending in exposure.
Calc: esmolol 50 mcg/kg/min, 67 kg, supplied 2,500 mg/250 mL → 20.1 mL/hr, rounded to the nearest tenth with no trailing zero.
⚠️ Exam traps
t-PA dissolves the clot, endovascular therapy removes it, a stent opens the artery, endarterectomy removes plaque. Four different answers.
The early ICP change is a subtle LOC change, not Cushing's triad. If the triad is there, you are late.
🧠 Mind maps 6
One per disorder, built from the structure of your ATI chapter.
Neurologic Diagnostic Procedures
🩺 What you do
Have the client avoid food and fluids for at least 6 hr before angiography.
Assess allergy history; a contrast allergy may need pretreatment with a steroid or antihistamine.
Bleeding disorders or anticoagulant use call for extra monitoring for post-procedure clotting.
Check BUN and creatinine to confirm the kidneys can clear the contrast dye.
💬 What you teach
The head will be immobilized; the client must stay still throughout the procedure.
Void immediately before the cerebral angiography procedure begins.
Expect a metallic taste and a warm sensation right after dye injection.
⚠️ What goes wrong
Cerebral angiography risks bleeding or hematoma at the arterial entry site.
After angiography, check the site and distal pulses, color, and refill; apply pressure and notify the provider for bleeding.
Before contrast or sedated CT, hold food and fluids 4 hr; shellfish allergy alone doesn't rule out iodine contrast.
Remove all metal objects before CT or MRI; the client wears a hospital gown.
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
Pain Management
🎯 Who gets it
Undertreatment risk factors: cultural attitudes, lack of knowledge, fear of addiction, and exaggerated fear of respiratory depression.
Infants, children, older adults, and clients with substance use disorder face the highest risk of undertreated pain.
Common pain causes include trauma, surgery, cancer, arthritis, fibromyalgia, and neuropathy.
Cancer pain can stem from tumor invasion, nerve compression, bone metastases, infection, or immobility.
👀 What you see
Nonverbal cues can supplement self-report: facial grimacing, restlessness, pacing, or guarding.
Moaning, crying, and a shortened attention span can signal pain in nonverbal clients.
Vital signs may rise briefly with acute pain but normalize even as pain continues.
Because vital signs stabilize over time, they aren't a reliable long-term pain measure.
Protect the head, time it, turn her on her side. Nothing goes in her mouth and she is never restrained. — tap it to open full size.
A CT scan comes before anything else — thrombolytics into a bleed are fatal. Last known well is the number the whole plan hangs on. — tap it to open full size.
A change in level of consciousness is the earliest sign, every time. By the time the pupils change you are already late. — tap it to open full size.
📋 Active Learning Templates 6
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
ATI Active Learning Template — System DisorderNeurologic Diagnostic Procedures
Filled from ATI chapter 4, row by row from that chapter’s own sections — 4 of 12 rows have content.
5 rows below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
This chapter reviews neuro diagnostics: cerebral angiography, CT, EEG, the Glasgow Coma Scale, ICP monitoring, lumbar puncture, MRI, PET/SPECT, and x-ray, covering purpose, informed consent, prep, and nursing care before, during, and after each test.
Health Promotion & Disease Prevention
Not a section in this chapter. Fill from lecture if your instructor covers it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not in your ATI chapter — filled from StatPearls, 2025.
About 10 to 40 percent of patients get a headache after a lumbar puncture, usually within two to three days.
Choosing a small, non-cutting spinal needle of 24 gauge or smaller lowers that headache risk to roughly 2 percent.
The headache is positional, easing when the patient lies flat and returning within minutes of sitting up.
Most cases resolve on their own within one to two weeks with rest, fluids, and caffeine.
StatPearls (NCBI Bookshelf) · Postdural Puncture Headache · open the source →
Assessment — Expected Findings
Not in your ATI chapter — filled from MedlinePlus, 2025.
Normal cerebrospinal fluid is clear and essentially free of cells, protein, and toxins.
Cloudy or abnormal fluid can point to an infection, an autoimmune condition, or another disease of the brain or spinal cord.
MedlinePlus (National Library of Medicine) · Cerebrospinal Fluid (CSF) Analysis · open the source →
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not in your ATI chapter — filled from MedlinePlus, 2025.
CSF analysis checks fluid drawn by spinal tap for infections such as meningitis and encephalitis, plus autoimmune disease, bleeding, or tumors.
Collecting the sample during the lumbar puncture takes about five minutes, and the patient needs to stay still throughout.
Providers usually order more tests to confirm a diagnosis rather than relying on the CSF result alone.
MedlinePlus (National Library of Medicine) · Cerebrospinal Fluid (CSF) Analysis · open the source →
Diagnostic Procedures
Not in your ATI chapter — filled from NINDS, 2026.
EEG records the brain's electrical activity through scalp electrodes and usually takes about an hour to complete.
A longer, sleep-based EEG of about four hours may be needed to capture a seizure that a routine study misses.
Cerebral angiography injects dye into blood vessels to show aneurysms, malformations, and areas of narrowing or blockage in the brain.
NINDS (NIH) · Neurological Diagnostic Tests and Procedures · open the source →
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Have the client avoid food and fluids for at least 6 hr before angiography.
Assess allergy history; a contrast allergy may need pretreatment with a steroid or antihistamine.
Bleeding disorders or anticoagulant use call for extra monitoring for post-procedure clotting.
Check BUN and creatinine to confirm the kidneys can clear the contrast dye.
A mild sedative may be given; monitor vital signs continuously during the procedure.
After the procedure, closely watch the insertion site to confirm clotting occurs.
Restrict movement per the arterial closure method used to prevent rebleeding.
Perform frequent neuro checks and vital sign monitoring after the procedure.
Apply an ice pack to the insertion site.
Medications
Not a section in this chapter. Fill from lecture if your instructor covers it.
Therapeutic Procedures
Not in your ATI chapter — filled from NINDS, 2026.
For a lumbar puncture the patient lies curled on one side or leans forward so a needle can pass between two vertebrae.
A local anesthetic numbs the lower back before the needle is inserted to withdraw roughly three teaspoons of spinal fluid.
The sample can help detect brain bleeding, infection, multiple sclerosis, metabolic disease, or other neurologic conditions.
NINDS (NIH) · Neurological Diagnostic Tests and Procedures · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
The head will be immobilized; the client must stay still throughout the procedure.
Void immediately before the cerebral angiography procedure begins.
Expect a metallic taste and a warm sensation right after dye injection.
A catheter goes into a groin or neck artery to inject dye and take x-rays.
After imaging, the catheter is removed and pressure or a closure device seals the artery.
Interprofessional Care
Not a section in this chapter. Fill from lecture if your instructor covers it.
⚠️ What goes wrongComplications
Complications
Cerebral angiography risks bleeding or hematoma at the arterial entry site.
After angiography, check the site and distal pulses, color, and refill; apply pressure and notify the provider for bleeding.
Before contrast or sedated CT, hold food and fluids 4 hr; shellfish allergy alone doesn't rule out iodine contrast.
Remove all metal objects before CT or MRI; the client wears a hospital gown.
EEG recording runs 45 to 120 min; wash hair first and skip caffeine, stimulants, or sedatives as directed.
Total GCS score equals eye plus verbal plus motor points; the highest possible score, 15, means full consciousness.
A GCS score under 8 signals severe head injury and coma.
ATI Active Learning Template — System DisorderPain Management
Filled from ATI chapter 5, row by row from that chapter’s own sections — 5 of 12 rows have content.
2 rows below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Chapter covers holistic pain management: nurses' duty to assess and treat pain using self-report as the gold standard, nociceptive versus neuropathic physiology, acute versus chronic patterns, and a focused assessment covering location, quality, intensity, timing, and aggravating or relieving factors.
Health Promotion & Disease Prevention
Not a section in this chapter. Fill from lecture if your instructor covers it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Undertreatment risk factors: cultural attitudes, lack of knowledge, fear of addiction, and exaggerated fear of respiratory depression.
Infants, children, older adults, and clients with substance use disorder face the highest risk of undertreated pain.
Common pain causes include trauma, surgery, cancer, arthritis, fibromyalgia, and neuropathy.
Cancer pain can stem from tumor invasion, nerve compression, bone metastases, infection, or immobility.
Diagnostic or treatment procedures, such as injections, intubation, or radiation, can also cause pain.
Infants cannot verbalize pain; older adults often have several pain-causing conditions at once.
Fatigue can heighten a client's sensitivity to pain.
Genetic differences can raise or lower a person's pain tolerance.
Assessment — Expected Findings
Nonverbal cues can supplement self-report: facial grimacing, restlessness, pacing, or guarding.
Moaning, crying, and a shortened attention span can signal pain in nonverbal clients.
Vital signs may rise briefly with acute pain but normalize even as pain continues.
Because vital signs stabilize over time, they aren't a reliable long-term pain measure.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not a section in this chapter. Fill from lecture if your instructor covers it.
Diagnostic Procedures
Not a section in this chapter. Fill from lecture if your instructor covers it.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nonpharmacologic options, such as yoga, meditation, distraction, heat or cold, and TENS, can lower medication needs.
The WHO analgesic ladder starts with nonopioids and progresses through weak to strong opioids as needed.
Oral opioid dosing needs a higher dose than IV because less medication reaches the bloodstream.
Acetaminophen must not exceed 4 g per day for clients 50 kg (110 lb) or more.
Acetaminophen can be safely combined with NSAIDs since the two act by different mechanisms.
"Narcotic" is not the same as "opioid"; severe-pain opioid effects are compared against morphine.
Watch for and manage opioid adverse effects: constipation, orthostatic hypotension, urinary retention, nausea, and sedation.
Sedation always precedes respiratory depression, so monitor level of consciousness closely.
Medications
Not in your ATI chapter — filled from StatPearls, 2023.
Mild pain is treated first with a non-opioid such as an NSAID or acetaminophen, with or without an adjuvant drug.
Moderate pain adds a weaker opioid like hydrocodone, codeine, or tramadol, often paired with a non-opioid agent.
Severe pain calls for a stronger opioid such as morphine, oxycodone, fentanyl, or methadone.
Adjuvant drugs such as antidepressants, anticonvulsants, topical anesthetics, and corticosteroids can boost pain control alongside the primary analgesic.
The stepwise approach favors dosing on a fixed schedule and by the oral route whenever possible, moving up a step only as needed.
StatPearls (NCBI Bookshelf) · WHO Analgesic Ladder · open the source →
Therapeutic Procedures
Not in your ATI chapter — filled from StatPearls, 2023.
Patient-controlled analgesia lets the patient self-dose IV pain medication within limits set by the prescriber.
A lockout interval blocks another dose for a set time after each button press, even if the patient tries again sooner.
One- and four-hour dose caps alert staff when a patient's pain is not being controlled within the ordered limits.
Nurses should reassess pain and sedation level every one to two hours for the first day or two of therapy.
Only the patient should press the button; having a family member dose the pump for the patient raises the risk of overdose.
StatPearls (NCBI Bookshelf) · Patient-Controlled Analgesia · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
Not a section in this chapter. Fill from lecture if your instructor covers it.
Interprofessional Care
Not a section in this chapter. Fill from lecture if your instructor covers it.
⚠️ What goes wrongComplications
Complications
Undertreated pain can worsen anxiety with acute cases or fuel depression with chronic pain.
Opioid overdose can cause sedation, respiratory depression, and coma.
Identify clients at high risk for over-sedation, such as older adults.
Titrate opioid doses carefully while closely monitoring respiratory status.
Hold the opioid and give naloxone if breathing drops under 8/min, is shallow, or the client won't wake.
Monitor closely after giving naloxone; the opioid can outlast it, requiring repeat doses.
Always determine the underlying cause whenever sedation occurs.
ATI Active Learning Template — System DisorderMeningitis
Filled from ATI chapter 6, row by row from that chapter’s own sections — 8 of 12 rows have content.
4 rows below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Meningitis inflames the meninges protecting the brain and spinal cord. Viral meningitis is common and self-limiting; fungal affects immunocompromised clients; bacterial meningitis is highly contagious with high mortality, requiring rapid diagnosis and vaccination-based prevention.
Health Promotion & Disease Prevention
Hib vaccine: 4-dose series starting at 2 months, final dose at 12-15 months
PPSV targets respiratory infection but also lowers CNS infection risk
Vaccinate immunocompromised adults, those with chronic disease, smokers, and LTC residents
Give one PPSV dose to unvaccinated adults over 65 with no prior disease
MCV4 covers Neisseria meningitidis; give it before college dorm living
Immunize other communal-living groups too, such as military recruits
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Viral meningitis follows viral illness (mumps, measles, herpes, West Nile); no vaccine exists
Fungal meningitis (Cryptococcus neoformans) is a severe sinus-based infection
Bacterial meningitis often follows infections like otitis media, pneumonia, or sinusitis
Phenytoin is given for rising ICP or an active seizure
Acetaminophen or ibuprofen treat headache and fever; avoid opioids that mask consciousness
Ciprofloxacin, rifampin, or ceftriaxone are given prophylactically to close contacts
Dexamethasone or prednisone corticosteroids are given to reduce inflammation
Therapeutic Procedures
Not in your ATI chapter — filled from StatPearls, 2023.
Anyone suspected of having bacterial meningitis should get a lumbar puncture to collect CSF for gram stain, culture, cell count, glucose, and protein.
Bacterial meningitis typically shows low glucose, high protein, and a high neutrophil count on the CSF sample.
A gram stain or positive culture from the CSF confirms the diagnosis and guides antibiotic choice.
StatPearls (NCBI Bookshelf) · Bacterial Meningitis · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
Not in your ATI chapter — filled from CDC, 2026.
Routine meningococcal conjugate vaccination is recommended for all preteens and teens as part of the standard immunization schedule.
A meningococcal B vaccine series is also available and may be recommended for certain higher-risk patients.
Vaccination greatly lowers risk but cannot prevent every case, so patients should still seek care promptly for fever, headache, or stiff neck.
Mild, temporary side effects such as soreness lasting one to five days are common after vaccination.
Centers for Disease Control and Prevention · Meningococcal Vaccination · open the source →
Interprofessional Care
Not in your ATI chapter — filled from CDC, 2024.
Patients with known or suspected meningococcal meningitis are placed on droplet precautions until they have had 24 hours of effective antibiotics.
Staff who were within about three feet of the patient for more than eight hours need preventive antibiotics regardless of vaccination status.
Preventive antibiotics such as rifampin, ciprofloxacin, or ceftriaxone are most effective when started within 24 hours of exposure.
Infectious disease specialists, emergency physicians, laboratory staff, and nursing work together so antibiotics start without waiting on culture results.
Centers for Disease Control and Prevention · Meningococcal Disease | Infection Control · open the source →
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2023.
Roughly one in four people with meningococcal disease develops a lasting complication.
Documented after-effects include seizures, hearing loss, vision loss, and problems with memory, balance, coordination, or speech.
Bacterial meningitis carries a mortality rate of about 10 to 15 percent.
Delayed treatment can let intracranial pressure rise and reduce blood flow to the brain, which can be fatal.
StatPearls (NCBI Bookshelf) · Bacterial Meningitis · open the source →
ATI Active Learning Template — System DisorderSeizures and Epilepsy
Filled from ATI chapter 7, row by row from that chapter’s own sections — 10 of 12 rows have content.
2 rows below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Seizures are sudden abnormal brain electrical discharges causing altered consciousness or motor/sensory changes; epilepsy means recurrent unprovoked seizures. This chapter covers seizure types, triggers, safety care, medications, surgical options, and status epilepticus.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from CDC, 2024.
Preventing head injury lowers epilepsy risk — using seat belts, car seats, helmets, and fall precautions all help.
Managing stroke risk through a healthy diet, activity, not smoking, and limiting alcohol also lowers epilepsy risk since stroke can trigger it.
Cysticercosis, a preventable parasitic infection, is the leading cause of epilepsy worldwide and is avoided through handwashing and safe food and water.
Staying current on recommended vaccines helps prevent infections that can lead to seizures and epilepsy.
Following a prenatal care plan helps prevent epilepsy linked to pregnancy or birth complications.
Centers for Disease Control and Prevention · Preventing Epilepsy · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Genetic predisposition raises absence-seizure risk, especially in children
Acute fever, head trauma, cerebral edema, and stroke (first 24 hr) can trigger seizures
Abrupt AED discontinuation can cause rebound seizure activity
Infection, metabolic imbalance, toxin exposure, and hypoxia are common causes
Brain tumors and fluid or electrolyte imbalances can also trigger seizures
In older adults, cerebrovascular disease raises seizure risk considerably
Hormonal shifts with menses or pregnancy can change seizure patterns
Common triggers: intense activity, stress, hyperventilation, fatigue, alcohol, and excess caffeine
Assessment — Expected Findings
Generalized seizures affect both cerebral hemispheres; some start with an aura
Tonic-clonic: brief muscle stiffening and loss of consciousness, then 1-2 min of rhythmic jerking
Breathing can stop in the tonic phase and turn irregular, causing cyanosis
A postictal period of confusion and sleepiness follows tonic-clonic seizures
Tonic seizures: sudden loss of consciousness with increased muscle tone only
Myoclonic seizures: brief, symmetric or asymmetric jerking or stiffening of limbs
Atonic/akinetic seizures: seconds of lost muscle tone, often causing falls
Absence seizures: 5-10 second lapses in consciousness, minimal motor activity, often clustered
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Check alcohol and illicit substance levels, HIV status, and toxin screening if indicated
CBC, electrolytes, BUN, and glucose help rule out other causes
Diagnostic Procedures
EEG records brain electrical activity to pinpoint seizure origin
MRI, CT/CAT, PET, CSF analysis, or skull x-ray can identify the cause
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Shield the client from onlookers while a seizure runs; dignity is part of seizure care.
Position for a patent airway; suction secretions and turn the client onto their side
Loosen tight clothing; never restrain the client or force the jaw open
Never insert padded tongue blades or any object into the mouth
Document seizure onset, duration, consciousness, apnea, cyanosis, motor activity, and incontinence
Postictal: keep the client side-lying, check vitals, assess injuries, do neuro checks
Ask about an aura afterward — it can hint at seizure origin
In status epilepticus: secure the airway, give oxygen, get IV access and an ECG
Give IV diazepam or lorazepam, then IV phenytoin or fosphenytoin
Medications
AEDs like phenytoin aim to control seizures using one medication first
If one AED fails, the dose is raised or another drug added
Routine blood tests confirm therapeutic AED levels and medication adherence
Therapeutic Procedures
Vagal nerve stimulation treats focal seizures unresponsive to medication therapy
The device implants in the left chest wall, wired to the left vagus nerve
It delivers programmed intermittent brain stimulation tailored to the client's needs
💬 Around the patientClient Education · Interprofessional Care
Client Education
Take AEDs at the same time daily to boost their effectiveness
Tolerance or age-related sensitivity may need more frequent level checks and dose changes
Watch for drug-specific side effects and food or drug interactions
Some AEDs cause gum overgrowth — stress routine oral hygiene and dental visits
Phenytoin lowers oral contraceptive effectiveness — advise backup birth control
Several AEDs reduce warfarin absorption and speed its metabolism, weakening anticoagulation
Antiseizure drugs raise birth-defect risk — pregnant clients should consult their provider
Interprofessional Care
Refer clients to community resources like the Epilepsy Foundation
For school-age children, involve the disability office to arrange an IEP
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from CDC, 2024.
Sudden unexpected death in epilepsy (SUDEP) affects about 1 in 1,000 adults with epilepsy each year, and about 1 in 4,500 children.
The strongest risk factors are generalized seizures and seizures that are frequent or poorly controlled.
SUDEP most often occurs during sleep, from a combination of breathing pauses and dangerous heart rhythm changes during a seizure.
Taking antiseizure medication consistently is described as the most important step a patient can take to lower SUDEP risk.
Centers for Disease Control and Prevention · Sudden Unexpected Death in Epilepsy · open the source →
ATI Active Learning Template — System DisorderHeadaches
Filled from ATI chapter 12, row by row from that chapter’s own sections — 9 of 12 rows have content.
1 row below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Headaches range from primary (migraine, tension, cluster — no organic cause) to secondary (tumor, aneurysm — needs workup). This chapter details migraine and cluster headache patterns, triggers, diagnostics, pain management, medications, and prevention.
Health Promotion & Disease Prevention
Teach stress-management strategies and how to recognize headache triggers
A headache diary helps track type and response to treatment
Hand hygiene helps prevent viral illness that mimics cold symptoms
Review OTC medications and herbal remedy options for pain control
Common triggers: alcohol, allergies, strong odors, bright light, medication overuse
Other triggers: fatigue, sleep loss, depression, stress, anxiety, hormone shifts
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Cluster headaches tend to peak during spring and fall
Cluster headaches are more common in males aged 20-50
Assessment — Expected Findings
Migraines bring photophobia, phonophobia, nausea or vomiting, and unilateral pain behind the eye
Migraine symptoms usually stay consistent and disrupt ADLs for 4-72 hr
Classic migraine (with aura): prodrome of irritability, cravings, or GI change beforehand
Aura stage brings numbness, tingling, confusion, and visual flashes over minutes to an hour
Second stage: severe throbbing pain with nausea, vomiting, drowsiness, and vertigo over hours
Common migraine (no aura): unilateral pulsating pain worsened by activity for 4-72 hr
Older adults may get a visual aura with no pain, called a visual migraine
Status migrainosus is a headache lasting more than 72 hr
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not a section in this chapter. Fill from lecture if your instructor covers it.
Diagnostic Procedures
Neuroimaging is warranted for neuro findings or new headaches after age 50
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Pain management is the main focus of care during a headache episode
Keep the environment cool, dark, and quiet; raise the head of bed to 30°
Give prescribed analgesics and antiemetics as ordered by the provider
Medications
Abortive therapy works best during the aura or right after headache onset
For mild migraine: NSAIDs, acetaminophen, or OTC migraine-formula anti-inflammatories
Metoclopramide, an antiemetic, relieves migraine-related nausea and vomiting
For severe migraine: triptans like zolmitriptan, sumatriptan, or eletriptan cause vasoconstriction
Ergotamine combined with caffeine narrows blood vessels and reduces inflammation
Isometheptene combination drugs are used when other options fail
Preventive therapy: NSAID plus a beta-blocker, calcium channel blocker, or AED
Check pulse when taking beta-blockers or calcium channel blockers for prevention
Therapeutic Procedures
Home oxygen at 12 L/min for 15-20 min can relieve cluster pain within 15 min
💬 Around the patientClient Education · Interprofessional Care
Client Education
Keep a headache diary of patterns and triggers; report new neuro changes
Stay in a cool, dark, quiet room and elevate the head of bed
Women over age 50 face higher cardiovascular and stroke risk
Estrogen, nitroglycerin, and nifedipine are medications that can trigger migraines
Manage anger and conflict, get enough sleep, and avoid light glare
Track your menstrual cycle — hormone shifts around menses can trigger migraines
Interprofessional Care
Not a section in this chapter. Fill from lecture if your instructor covers it.
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2025.
Using simple pain relievers or NSAIDs on 15 or more days a month can itself trigger medication overuse headache.
Using combination analgesics, triptans, ergots, or opioids on just 10 or more days a month carries the same risk.
The pattern is diagnosed when headaches occur 15 or more days a month for over three months in someone with an existing headache disorder.
Complete withdrawal of the overused medication gives the best outcome, though about half of patients relapse within five years.
Withdrawal can bring on nausea, anxiety, irritability, restlessness, and trouble concentrating for a time.
StatPearls (NCBI Bookshelf) · Medication Overuse Headache · open the source →
ATI Active Learning Template — System DisorderStroke
Filled from ATI chapter 16, row by row from that chapter’s own sections — 9 of 12 rows have content.
3 rows below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Covers stroke pathophysiology, hemorrhagic vs. ischemic types, risk factors, and FAST recognition, plus emergency nursing priorities, thrombolytic and anticoagulant therapy, surgical options, and rehabilitation needs for post-stroke deficits like aphasia and neglect.
Health Promotion & Disease Prevention
Hypertension, diabetes, and smoking raise stroke risk — treat early to reduce it.
Control blood pressure, keep glucose in target range, and quit smoking to lower risk.
Maintain a healthy weight and exercise regularly to reduce stroke risk.
Use FAST to screen for stroke: face drooping, arm drift, slurred speech, time to call 911.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Cerebral aneurysm or AV malformation increases hemorrhagic stroke risk.
Higher stroke risk in Black American, Hispanic, Indigenous, and Alaska Native populations.
A family history of stroke raises a person's overall risk.
Age over 65 years raises ischemic stroke risk.
Diabetes mellitus and obesity are both modifiable risk factors.
Untreated sleep apnea also contributes to stroke risk.
Hypertension, atherosclerosis, and hyperlipidemia are major vascular risk factors.
Hypercoagulable states such as sickle cell disease raise clot risk.
Assessment — Expected Findings
Sudden stroke signs: severe headache, dizziness, gait or vision changes, confusion, slurred speech, unilateral numbness.
TIA causes brief neuro deficits from focal ischemia without permanent damage.
TIA symptoms resolve within 1-24 hours with no lasting deficits.
Deficits are contralateral to the damaged hemisphere — left damage causes right-sided weakness.
Aphasia types: expressive (cannot speak) and receptive (cannot understand language).
Agnosia is failure to recognize familiar objects; alexia is trouble reading.
Agraphia is difficulty writing; apraxia is inability to follow simple commands.
Ataxia causes poor coordination and balance loss after stroke.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not in your ATI chapter — filled from AHA/ASA, 2023.
Stroke workup includes blood tests along with the medical history and neurologic exam, though the page does not name a specific required panel.
Results from laboratory testing are combined with imaging findings rather than used alone to confirm a stroke diagnosis.
American Stroke Association · Common Diagnosis Methods · open the source →
Diagnostic Procedures
Not in your ATI chapter — filled from AHA/ASA, 2023.
CT and MRI scans are the primary imaging tools used to diagnose stroke.
MRI gives a sharper, more detailed picture of brain injury than CT.
Electrical tests such as EEG and evoked response testing, plus blood-flow tests like ultrasound and angiography, may add further diagnostic detail.
American Stroke Association · Common Diagnosis Methods · open the source →
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Priority: assess LOC, airway patency, vital signs, and circulation first.
Check VS every 15 min to 2 hr; report BP over 185/110 mm Hg.
Give oxygen to keep saturation above 94% or if LOC drops.
Place on a cardiac monitor and obtain a 12-lead ECG for dysrhythmias.
Watch for rising ICP signs like decreasing level of consciousness.
Check glucose; hyperglycemia is linked to worse neurologic outcomes.
Elevate head of bed to 30° and keep neck midline to lower ICP.
Start seizure precautions and perform frequent neurologic status checks.
NIHSS score of 10 or higher suggests a severe stroke.
Medications
Alteplase (tPA) dissolves clots; give within 3 to 4.5 hr of symptom onset.
Alteplase goal: administer within 45 minutes of ED arrival.
Alteplase is contraindicated with active bleeding; hold antiplatelets or anticoagulants 24 hrs.
Watch for alteplase adverse effects: hypotension, intracranial bleeding, bruising.
Warfarin targets INR 2 to 3 for atrial fibrillation-related stroke prevention.
Anticoagulant therapy is avoided for clients with hemorrhagic stroke.
DOACs (dabigatran, apixaban, rivaroxaban) are alternatives to warfarin for afib.
Low-dose aspirin given within 24 to 48 hr after ischemic stroke prevents further clots.
Therapeutic Procedures
Thrombolytic therapy must start within 6 hr of symptom onset.
Thrombolytics are contraindicated in hemorrhagic stroke or high bleeding risk.
MRI rules out hemorrhage before starting thrombolytic therapy.
Thrombectomy to remove the clot can be mechanical, endovascular, or intra-arterial.
Carotid angioplasty with stenting places a stent via femoral catheter access.
Stenting causes less blood loss and a shorter hospital stay than endarterectomy.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Follow prescribed liquid and food consistency levels to reduce choking risk.
Sit upright and tuck chin forward when swallowing to lower aspiration risk.
Unilateral neglect means the client can't see, feel, or move the affected side.
Neglect raises injury risk and creates a self-care deficit on that side.
Dress and care for the affected side of the body first each time.
Pull the affected limb to midline to protect it from the wheelchair.
Periodically look toward the affected side to stay aware of it.
Interprofessional Care
Stroke team includes neurologist, social worker, rehab coordinators, psychologist, PT/OT, SLP, dietitian, pharmacist.
SLP provides language therapy and helps manage swallowing difficulties.
PT rebuilds ambulation using canes, walkers, or wheelchair adaptations.
OT restores hand and arm function; recommends massage or gloves if it doesn't return.
Social services arrange rehab placement and evaluate home safety needs before discharge.
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from AHA/ASA, 2023.
Reduced mobility and swallowing trouble after stroke can let material enter the lungs and cause pneumonia.
Immobility after stroke raises the risk of deep vein thrombosis from blood pooling in the leg veins.
Seizures are described as common after larger strokes because of abnormal electrical activity in the injured brain tissue.
Post-stroke depression is a treatable complication that can be more severe in patients with a prior history of depression.
Prolonged pressure from immobility after a stroke can lead to skin breakdown and pressure injuries.
American Stroke Association · Let's Talk About Complications After Stroke · open the source →
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Normal ICP 10–15 mmHg; normal CPP >50 mmHg; CPP = MAP − ICP. Rising ICP drops CPP and starves the brain.
Mannitol and 3% saline pull fluid off the brain; confirm mannitol is working by increased urine output. Never Trendelenburg with raised ICP.
GCS: eye 1–4, verbal 1–5, motor 1–6. Max 15, min 3. GCS ≤8 → intubate.
Non-contrast CT within 25 minutes of arrival decides ischemic vs hemorrhagic and t-PA candidacy. CT first acutely; MRI is better detail but too slow for the emergency.
Ischemic stroke ~87%, hemorrhagic ~13%. t-PA window 3–4.5 hr from symptom onset. Contraindicated with anticoagulants, SBP >180, recent bleed or surgery, age under 18, or abnormal glucose. Not a candidate → heparin drip.
Hemorrhagic: "worst headache of my life." No t-PA ever. Lower the BP, check and reverse coags, then surgical evacuation. Always ask when the symptoms started.
Carotid endarterectomy removes plaque (>70% blockage, or >50% with TIAs). Post-op watch for HTN, neck swelling, hoarseness. Stroke care: VS q1–2 hr, notify for SBP >180 or DBP >110, keep SpO2 >92%.
Seizures: protect the airway, turn her to the side, time it, pad the head. Never restrain, never put anything in the mouth. Status epilepticus (>5 min, or repeated without recovery) → IV lorazepam first, then fosphenytoin or levetiracetam.
Posturing scores on GCS motor: decorticate = 3, decerebrate = 2. Scale runs 3–15 — "an object gets 3." Eye 4, verbal 5, motor 6. ≤8: sedate and intubate. A drop from 14 to 10 is the reportable event.
With posturing and high ICP, elevate the HOB to 30° first — it takes seconds, and mannitol has to be fetched and mixed.
Mannitol and 3% saline are interchangeable as osmotic options on their items.
Hematoma pattern recognition — Epidural: arterial, temple blow, brief LOC then lucid then decline, burr holes. Subdural: crescent-shaped, elderly / alcohol / anticoagulated, confusion and unsteadiness over 3–5 days, may recall a bump a week ago. Subarachnoid: berry aneurysm (~1% of people), thunderclap "worst headache of my life," photophobia; calcium channel blockers for vasospasm.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
Guillain–Barré ascends — when it reaches the diaphragm, ventilation fails.
Monitor vital capacity, not just pulse oximetry; oxygen saturation falls late.
Myasthenic crisis is the same emergency from a different mechanism.
Respiratory failure is the priority in both. Airway before everything else.
Myasthenic crisis
Cholinergic crisis
Cause
Too little medication / stress, infection
Too much anticholinesterase
Pupils
Normal or dilated
Pinpoint
Secretions
Normal
SLUDGE — drooling, tearing, diarrhea
Treatment
More medication
Hold the drug; atropine
🧠 Meningitis — recognize it in three signs
Nuchal rigidity (stiff neck) + fever + severe headache, often with
photophobia and altered mental state.
Kernig’s — pain on straightening the knee when hip is flexed
Brudzinski’s — flexing the neck makes the hips and knees flex
Droplet precautions immediately, before the organism is known. Definitive diagnosis is
a lumbar puncture: bacterial shows cloudy CSF, high protein, low glucose.
⭐ Dementia vs delirium — the distinguishing word is onset
Delirium — sudden, hours to days, fluctuates, attention impaired,
and it is reversible. Always look for a cause: infection (especially UTI in elders),
drugs, hypoxia, electrolytes.
Dementia — gradual over months to years, steadily progressive, memory first,
irreversible.
Sudden confusion in an older adult is delirium until proven otherwise — and it is a medical emergency.
⭐ High-yield — what the exam actually asks
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Epidural hematoma = arterial, fast, lucid interval (out → awake and fine → out again), major trauma. Subdural = venous, slow over 24–48 hr to 2 weeks, older adults on anticoagulants or with alcohol use; expect elevated PT/PTT/INR. Both get coags and surgical evacuation.
Basilar skull fracture: Battle's sign (bruising behind the ear), raccoon eyes, halo sign (CSF ring around blood on the dressing).
Diffuse axonal injury is severe — roughly 25% do not survive.
Suspected SCI: ABCs → cervical collar → log roll → backboard → imaging. If she stops breathing use a jaw thrust, not head-tilt chin-lift. Keep MAP ≥85 mmHg.
Spinal shock = temporary loss of all reflexes, sensation and motor below the injury; a cord "shutdown" that resolves over days to weeks. Neurogenic shock = loss of sympathetic tone (usually T6 and above) causing true hypotension + bradycardia.
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Autonomic dysreflexia (T6 and above): severe hypertension, bradycardia, pounding headache, flushed and sweaty above the injury, pale and cool below. Sit her up first, then find and remove the cause — check the bladder before the bowel — then call for medication.
Halo device: never lift or reposition by the vest bars. Keep a wrench taped to the vest for emergency CPR access. Pin site care.
Pressure injury prevention in SCI: reposition q2 hr in bed, q1 hr in a wheelchair. Injuries can form within 6 hours.
Meningitis (bacterial) = droplet precautions, agitated/anxious mental status, positive Kernig's and Brudzinski's. Encephalitis is viral and mosquito-borne, not person-to-person, so no respiratory isolation; mental status is flat and confused.
LP results: bacterial CSF is cloudy with LOW glucose, high WBC, high protein, high pressure. Viral is clear with normal glucose. Post-LP: lie flat and hydrate.
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Parkinson's TRAP: Tremor (pill-rolling, at rest), Rigidity, Akinesia/bradykinesia, Postural instability. Swallowing and airway always outrank mobility.
Huntington's: autosomal dominant, chorea, cognitive decline to psychosis. MS: young women, relapsing-remitting demyelination, optic neuritis, heat worsens symptoms (Uhthoff's).
Myasthenia gravis: weakness worsens with activity, improves with rest; ptosis and diplopia; myasthenic crisis is an airway emergency; pyridostigmine.
Guillain-Barré: ascending symmetric paralysis after an infection. Monitor respiratory status continuously. ~70% recover fully.
Bell's palsy takes the whole side of the face including the forehead (a stroke spares the forehead). Protect the eye with lubricant and a night patch. ~95% recover in months.
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ALS: progressive motor neuron loss with cognition intact; priorities shift to airway, nutrition and advance care planning. Alzheimer's: memory loss first, then safety and wandering.
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
Show 5 moreHide these 5
Post-spinal-surgery bundle: patent airway, hourly neuro checks and vitals, log roll and maintain alignment, watch for CSF leak, inspect the incision. No high Fowler's, no ambulation in the first 4 hours. Always assess distal to the surgical site — motor, sensory, reflexes, bowel and bladder.
Their trend item: BP drifting 122→110 and pain oscillating 4–5 are noise. Progressive left-leg weakness to inability to move is the concerning trend.
Myasthenia gravis: pyridostigmine 30–60 minutes BEFORE meals, lasting 3–4 hours — clients plan activity around the peak. Never stop it because she feels better. Thickened liquids sitting upright. Eye patch for diplopia. Avoid heat and emotional stress. Thymectomy often improves function.
ALS: no cure · enteral feeding when swallowing fails · ventilation as respiratory muscles weaken · screen for depression and suicidal ideation, because cognition is intact · ROM exercises are required to prevent contractures.
Autonomic dysreflexia: injury T6 or above, trigger always below the injury — full bladder, constipation, tight wrap, pressure ulcer. Vasodilation above, vasoconstriction below. Priority is find and remove the trigger; antihypertensives are adjunct, not first.
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Halo traction: priority is neurovascular checks of all extremities. Never remove the device.Pin care with sterile applicators, one per pin, never re-dipped, and no alcohol-based cleaner on non-intact skin.
Sumatriptan: abortive only, take at symptom onset, not daily prophylaxis, avoid caffeine, stimulants and sildenafil (both are vasoactive), report chest pain — it is a potent vasoconstrictor. Recognize the "-triptan" ending. DHE is IV only.
Meningitis: nuchal rigidity + photophobia + positive Brudzinski. Droplet precautions for meningococcal. The follow-up findings are a petechial rash on trunk and extremities and a falling LOC. HOB 30°.
Guillain-Barré: paresthesias start distally in hands and feet and ascend within about a day, not weeks. Recovery takes months. Treatment is plasma exchange or IVIG. The danger is complications — DVT, pneumonia — while you wait.
Pin-site solutions: chlorhexidine and alcohol are for intact skin. An open wound gets sterile saline — harsh antiseptics poured into broken tissue kill the cells that are trying to heal it.
Mild cognitive impairment in Alzheimer’s: a calendar and family photographs. Not antipsychotics (no disruptive behavior at this stage), not a writing board (hearing and comprehension are intact), not bed alarms (nothing to contain). Short-term memory goes first.
Delirium vs dementia: delirium is sudden, has a cause and is reversible — a UTI, pneumonia, hypoxemia, or too much opioid in an older adult. Dementia is gradual and progressive. Treat the cause and the delirium lifts.
Parkinson’s, what to expect: bradykinesia, a pill-rolling resting tremor, masked facies, low quiet speech, rigidity, shuffling gait, stooped posture, postural instability, and orthostatic/autonomic BP swings that make her a major fall risk. Not hyperreflexia, not hypertension. Personality change and dementia come late.
Why Parkinson’s clients fall: autonomic dysfunction swings the blood pressure from normal to profoundly low and back within minutes. It is not only the gait — it is syncope. They arrive with fractures.
Show 4 moreHide these 4
Autonomic dysreflexia, the end point: the severe hypertension can cause a hemorrhagic stroke. That is why it is an emergency and why antihypertensives are given alongside removing the trigger, never instead of it.
Myasthenia gravis, the wrong answers: “take corticosteroids only when symptoms are gone” and “delay meals until after physical therapy” are both wrong. She eats when the drug is at peak, not when she is exhausted.
Their test-taking rule: any option that says “I will stop this once I feel better” is wrong for a daily maintenance drug — she feels better because she is taking it. It is only correct for a rescue or PRN medication.
Myasthenia gravis mechanism: the body destroys acetylcholine receptors, so the nerve signals and the muscle ignores it. Pyridostigmine stops acetylcholine being broken down, so more of it reaches the muscle — temporarily, until the dose wears off.
⚠️ Exam traps
Parkinson's movement is slow and rigid; Huntington's is jerky and excessive.
MG worsens through the day; MS waxes and wanes with relapses; GBS ascends.
Bell's palsy vs stroke hinges entirely on the forehead.
🧠 Mind maps 6
One per disorder, built from the structure of your ATI chapter.
Parkinson's Disease
🎯 Who gets it
Onset usually starts around age 60; early onset can occur before age 50.
More common in clients assigned male at birth.
Having a genetic predisposition to Parkinson's disease increases the risk of onset.
Exposure to environmental toxins and chemical solvents is a risk factor.
👀 What you see
Bradykinesia is slowed movement; akinesia means no movement at all.
Posture is stooped with a slow, shuffling, propulsive gait pattern.
Speech often becomes slow, monotonous, and hard to understand.
A classic pill-rolling tremor appears in the fingers.
🧪 What confirms it
No definitive lab test exists; diagnosis is clinical, based on symptoms and ruling out other diseases.
Stage I: tremor limited to only one limb (unilateral).
Stage II: both sides get involved; walking and balance become harder.
Stage II also shows a masklike face and shuffling gait.
🩺 What you do
Give PD medications at exact prescribed times to maintain steady symptom control.
Consult SLP for swallowing risk; dietitian may order semisolid foods and thickened liquids.
Weigh client weekly and offer smaller, more frequent meals sitting upright.
Encourage exercise like yoga and regular ROM to preserve mobility.
💊 Drugs
PD medications can take several weeks before symptoms improve.
Maintaining steady therapeutic levels of combination drug regimens is essential.
Levodopa converts to dopamine in the brain to raise basal ganglia dopamine levels.
Combining levodopa with carbidopa lowers peripheral breakdown, allowing a smaller effective dose.
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
Delirium and Dementia
🎯 Who gets it
Delirium risk rises in critical care settings and with acute or chronic illness.
Anticholinergics, opioids, and antipsychotic drugs can all trigger delirium.
Infections, alcohol toxicity, and head trauma are common delirium triggers.
Insomnia, sudden environment changes, and sensory extremes can raise delirium risk.
👀 What you see
No apparent symptoms stage shows normal function with no memory problems.
Stage 2 forgetfulness means misplacing everyday items like glasses or keys.
Stage 3 mild cognitive decline shows up as testing-detected memory or focus problems.
Stage 4 brings obvious memory loss and trouble managing finances or planning.
🧪 What confirms it
No single lab test can confirm an Alzheimer's disease diagnosis.
Labs mainly rule out other causes: CBC, chemistry panel, B12, thyroid, CSF studies.
Apolipoprotein genetic testing shows increased AD risk but isn't diagnostic alone.
No definitive test exists except a brain tissue exam after death.
🩺 What you do
Remove contributing causes of delirium and reorient the client frequently.
Use a calm voice and calming music to ease delirium agitation.
Mild Alzheimer's brings memory lapses, misplaced items, and trouble concentrating while still managing ADLs.
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
ATI Active Learning Template — System DisorderParkinson's Disease
Filled from ATI chapter 8, row by row from that chapter’s own sections — 8 of 12 rows have content.
4 rows below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Parkinson's disease is a progressive movement disorder from dopamine loss in the basal ganglia, causing tremor, rigidity, slow movement, and postural instability; care focuses on boosting dopamine or blocking acetylcholine.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from NINDS, 2026.
There is no known way to prevent Parkinson's disease, and its exact cause is still unclear.
Exposure to certain pesticides and other pollutants has been linked to a greater risk of developing the disease.
Regular exercise is associated with better flexibility, balance, and strength and may help slow symptom progression once diagnosed.
A healthy diet is described as helpful for easing some Parkinson's symptoms, though it does not prevent the disease itself.
ATI Active Learning Template — System DisorderDelirium and Dementia
Filled from ATI chapter 9, row by row from that chapter’s own sections — 11 of 12 rows have content.
1 row below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Chapter covers delirium (acute, reversible confusion) and Alzheimer's disease (progressive dementia), including risk factors, staged progression, diagnostic workup, medications, safety-focused nursing care, and home safety teaching for caregivers.
Health Promotion & Disease Prevention
An active lifestyle and Mediterranean diet may support brain health.
Managing chronic illnesses well may help reduce dementia risk long-term.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Delirium risk rises in critical care settings and with acute or chronic illness.
Anticholinergics, opioids, and antipsychotic drugs can all trigger delirium.
Infections, alcohol toxicity, and head trauma are common delirium triggers.
Insomnia, sudden environment changes, and sensory extremes can raise delirium risk.
Advanced age is a leading risk factor for Alzheimer's disease.
Family history of AD or Down syndrome raises Alzheimer's risk.
Genetic predisposition, including the apolipoprotein E gene, increases AD risk.
Environmental exposures like herpes virus, metals, or toxic waste are linked to AD.
Assessment — Expected Findings
No apparent symptoms stage shows normal function with no memory problems.
Stage 2 forgetfulness means misplacing everyday items like glasses or keys.
Stage 3 mild cognitive decline shows up as testing-detected memory or focus problems.
Stage 4 brings obvious memory loss and trouble managing finances or planning.
Stage 4 also causes social withdrawal and difficulty with complex mental math.
Stage 5 brings decreased planning ability and memory loss relatives notice.
Stage 5 includes a shorter attention span and trouble recalling names or words.
In stage 5, clients can get lost while driving and struggle socially.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
No single lab test can confirm an Alzheimer's disease diagnosis.
Labs mainly rule out other causes: CBC, chemistry panel, B12, thyroid, CSF studies.
Apolipoprotein genetic testing shows increased AD risk but isn't diagnostic alone.
Diagnostic Procedures
No definitive test exists except a brain tissue exam after death.
MRI, CT, PET, and EEG help rule out other causes of symptoms.
Lumbar puncture checking low CSF soluble beta protein precursor supports an AD diagnosis.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Remove contributing causes of delirium and reorient the client frequently.
Use a calm voice and calming music to ease delirium agitation.
Mild Alzheimer's brings memory lapses, misplaced items, and trouble concentrating while still managing ADLs.
Keep the environment safe: monitor closely, block stairs, elevators, and exits, remove hazards.
Provide frequent walks to help reduce wandering behavior.
Keep a structured routine and introduce changes gradually to reduce confusion.
Use short directions, repetition, and a calendar to support orientation.
In later stages, use validation therapy: acknowledge feelings, don't argue with the client.
Medications
Dementia medications mainly target behavioral symptoms like anxiety, agitation, and depression.
Options include antipsychotics, antidepressants, and anxiolytics, monitored closely for adverse effects.
AD-specific medications only slow progression temporarily and don't work for everyone.
If one medication fails to help, providers try switching to another agent.
Donepezil blocks acetylcholine breakdown, increasing available acetylcholine for nerve signaling.
Memantine blocks nerve damage from excess glutamate and may pair with donepezil.
Cholinesterase inhibitors help slow the disease's progression over time.
Pimavanserin is an antipsychotic used for dementia-related psychosis.
Therapeutic Procedures
Estrogen therapy may lower AD risk but doesn't help existing dementia.
Ginkgo biloba may boost memory or circulation but carries interaction risks; report use to providers.
Bedtime massage can ease stress and improve sleep.
Lavender or bergamot essential oils can promote relaxation and better sleep.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Connect families to social services, the Alzheimer's Association, and support groups.
Teach caregivers about the disease course, care methods, medications, and home changes.
Explain that late-stage disease can bring new seizure activity.
Offer strategies to help reduce caregiver stress and burnout.
Remove scatter rugs and clear clutter to help prevent falls.
Install door locks and alarms the client can't easily open.
Lock the water heater and thermostat to keep water temperature safe.
Interprofessional Care
Encourage early legal planning for advance directives and power of attorney.
Refer families to social services for day care or long-term care options.
Involve physical therapy to build an individualized exercise plan.
Connect families with the Alzheimer's Association for support and respite care.
Review available home care and community resources as the disease progresses.
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from NIA, 2024.
In late-stage dementia, loss of the ability to chew and swallow safely raises the risk of food entering the lungs and causing pneumonia.
Staying in one position too long in advanced dementia commonly leads to skin breakdown and pressure sores.
Reduced appetite and interest in food in late-stage dementia can lead to significant weight loss and malnutrition.
National Institute on Aging (NIH) · Care in the Last Stages of Alzheimer's Disease · open the source →
ATI Active Learning Template — System DisorderBrain Tumors
Filled from ATI chapter 10, row by row from that chapter’s own sections — 9 of 12 rows have content.
3 rows below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Covers brain tumor classification (benign vs. malignant, supratentorial vs. infratentorial), risk factors, location-specific findings, diagnostic workup, medication management, surgical care, and pituitary-related complications like SIADH and diabetes insipidus.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from ACS, 2026.
There is no known way to prevent most brain and spinal cord tumors.
The only established environmental risk factor is exposure to ionizing radiation, most often from prior radiation therapy to the head.
Radiation-related tumors typically appear 10 to 15 years after the original exposure.
Inherited conditions such as neurofibromatosis, tuberous sclerosis, and Li-Fraumeni syndrome raise risk but are not preventable.
American Cancer Society · Adult Brain Tumor Causes, Risk Factors, and Prevention · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Genetics and environmental agents may contribute to brain tumor risk.
Exposure to ionizing radiation or electromagnetic fields raises risk.
Previous head injury is a possible risk factor.
A history of neurofibromatosis or being immunocompromised raises tumor risk.
Assessment — Expected Findings
Dysarthria, dysphagia, and vertigo are common tumor-related findings.
Positive Romberg and Babinski signs can occur with brain tumors.
Hemiparesis and cranial nerve dysfunction, like impaired gag or blink reflex, may appear.
Papilledema is a sign of rising intracranial pressure.
Supratentorial tumors cause headache worse on waking that eases through the day.
Supratentorial tumors bring visual field changes, seizures, and loss of voluntary movement.
Supratentorial tumors can alter memory, language, and personality, and cause nausea or paralysis.
Infratentorial tumors bring hearing loss, tinnitus, and visual changes.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
CBC and differential rule out anemia or malnutrition.
Blood alcohol and toxicology screening rules out other causes of symptoms.
TB and HIV screening are done when social history warrants.
Diagnostic Procedures
X-ray, CT, MRI, brain scan, PET, and cerebral angiography define tumor size and location.
Lumbar puncture and EEG add data but risk harm if ICP is already high.
Cerebral biopsy identifies tumor cell type via CT- or MRI-guided tissue sampling.
Biopsy recovers faster than open surgery but can't debulk the tumor and may misdiagnose it.
Continue antiepileptic medications before biopsy to help prevent seizures.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Maintain airway with oxygen and lung sound monitoring as needed.
Watch closely for LOC changes, new deficits, or seizure activity.
Support safe mobility with transfer help and assistive devices.
Implement seizure precautions for all clients with brain tumors.
Administer prescribed medications as ordered to manage symptoms and prevent complications.
Medications
Non-opioid analgesics treat headache; opioids are avoided since they blunt LOC.
Corticosteroids quickly reduce cerebral edema and improve headache or LOC changes.
Chronic corticosteroids control edema from ongoing tumor presence or treatment.
Osmotic diuretics lower brain fluid content to reduce intracranial pressure.
Anticonvulsants suppress neuronal activity to prevent or control seizures.
Different antiepileptic classes each target specific seizure types.
H2-antagonists reduce stomach acid to prevent stress ulcers during acute treatment.
Antiemetics treat nausea from raised ICP, tumor site, or treatment effects.
Therapeutic Procedures
Craniotomy removes all or part of the tumor through a skull opening.
Preop: answer written questions and encourage the partner's presence at discussions.
Stop aspirin at least 72 hr before surgery.
Stop alcohol, tobacco, anticoagulant, and NSAID use for 5 days before the operation.
Complete a living will and health care power of attorney before surgery.
Postop: monitor vitals and neuro status closely, including Glasgow Coma Scale checks.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Not in your ATI chapter — filled from ACS, 2024.
Family should be taught to protect the airway during a seizure by loosening tight clothing and turning the person onto their side.
Restraining a person during a seizure should be avoided; the priority is clearing the area of hazards.
Getting enough sleep and taking antiseizure medication exactly as prescribed are stressed as key ways to prevent breakthrough seizures at home.
Missed doses of antiseizure medication are named as one of the most common seizure triggers.
American Cancer Society · Seizures (Cancer-related Side Effects) · open the source →
Interprofessional Care
Referrals include social services, support groups, and PT/speech/OT therapy.
Treatment options: steroids, surgery, chemo, radiation, radiosurgery, or clinical trials.
Chemo or radiation can shrink a tumor before surgery or prevent recurrence after.
Benign tumor surgery is often curative, though regrowth is possible.
Some benign tumors carry high mortality risk due to their location alone.
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from ACS, 2026.
A tumor can raise pressure inside the skull through its own growth, surrounding swelling, or blocked CSF flow.
Headaches that steadily worsen over time occur in about half of people with a brain tumor.
Rising intracranial pressure can cause nausea, vomiting, drowsiness, and in severe cases coma.
Balance problems, seizures, and personality or behavior changes are also linked to increased pressure from a tumor.
American Cancer Society · Signs and Symptoms of Brain Tumors in Adults · open the source →
ATI Active Learning Template — System DisorderMultiple Sclerosis
Filled from ATI chapter 11, row by row from that chapter’s own sections — 10 of 12 rows have content.
2 rows below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
MS is a chronic autoimmune disease that demyelinates CNS nerve fibers, causing irreversible plaques and progressive motor, sensory, and cognitive decline. Four subtypes vary in relapse and remission patterns; no cure exists.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from NINDS, 2025.
People who get more sun exposure and have higher vitamin D levels appear less likely to develop MS.
Smoking raises MS risk and is linked to a more aggressive disease course with more brain lesions and greater brain shrinkage.
Epstein-Barr virus infection is the virus most consistently linked to later development of MS, though most infected people never develop it.
Being infected with Epstein-Barr virus in childhood is associated with lower MS risk than infection during the teen or adult years.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Report new weakness or jaundice to the provider right away.
Never stop baclofen abruptly; taper it as directed.
Carbamazepine, an anticonvulsant, is used to manage paresthesia.
Docusate sodium, a stool softener, helps prevent constipation.
Oxybutynin, an anticholinergic, is used for bladder dysfunction.
Amantadine combats fatigue that interferes with daily activities.
Dalfampridine is used to improve a client's walking speed.
Interprofessional Care
Care team spans neurology, ophthalmology, speech, PT, OT, mental health, case management, and social work.
Connect clients to local MS support groups and the National MS Society.
OT/PT can assess home safety and recommend adaptive mobility devices.
Speech therapy referral supports clients with dysarthria and dysphagia.
Teach clients to avoid overexertion, stress, temperature extremes, and sick contacts.
⚠️ What goes wrongComplications
Complications
Watch for complications such as urinary tract infection, constipation, and pneumonia.
ATI Active Learning Template — System DisorderHead Injury
Filled from ATI chapter 15, row by row from that chapter’s own sections — 11 of 12 rows have content.
1 row below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Head injuries are classified as open or closed and rated mild to severe by Glasgow Coma Scale score. Types include concussion, contusion, diffuse axonal injury, and intracranial hemorrhage, with skull fracture and cervical spine injury as key concerns.
Health Promotion & Disease Prevention
Wear helmets for skateboarding, biking, motorcycling, skiing, and contact sports.
Always wear a seatbelt when driving or riding in a vehicle.
Avoid speeding and never drive under the influence.
Firearm owners should always keep all firearms securely locked.
Avoid riding unrestrained in the open bed of a pickup truck.
Fall-prevention programs matter most for adults over age 65.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Motor vehicle or motorcycle crashes are a leading cause.
Alcohol or illicit substance use raises injury risk.
Sports-related trauma is a common cause of head injury.
Assault is another possible cause of head injury.
Gunshot wounds are a cause of head injury.
Falls are a common cause, especially in older adults.
Assessment — Expected Findings
Amnesia about events before or after the injury is common.
The length of unconsciousness helps indicate how severe the injury is.
CSF leaking from the nose or ears suggests a basilar skull fracture.
Check for a halo sign: a clear ring around bloody drainage on gauze.
Increased ICP: severe headache, nausea, vomiting, restlessness, or irritability.
Increased ICP: worsening level of consciousness and cranial nerve dysfunction.
Increased ICP: dilated or pinpoint pupils that do not react.
Increased ICP: abnormal breathing patterns such as Cheyne-Stokes or apnea.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Head injury labs include ABGs, CBC with differential, and blood glucose.
Electrolytes, plus blood and urine osmolarity, are also monitored.
A toxicology screen is part of the diagnostic workup.
Anti-seizure medication blood levels are monitored during treatment.
Diagnostic Procedures
Cervical spine films rule out a cervical spine injury.
CT or MRI of the head or neck assesses injury extent.
Skull x-ray can help identify any skull fractures present.
ICP monitor readings allow calculation of cerebral perfusion pressure.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Respiratory status is the priority; injury from hypoxia can begin in 3 to 5 min.
GCS: 13 to 15 = mild, 9 to 12 = moderate, less than 8 = severe.
ICP is normally 10 to 15 mm Hg.
Elevate the head of bed at least 30° to lower ICP.
Avoid extreme neck flexion, extension, or rotation; keep the head midline.
Give oxygen to keep PaO2 above 60 mm Hg; maintain a patent airway.
Give stool softeners and avoid the Valsalva maneuver to prevent ICP spikes.
Maintain cervical spine stability until an x-ray clears the spine.
Report any CSF drainage from the nose or ears immediately.
Medications
Mannitol, an osmotic diuretic, pulls fluid from the brain into the blood to treat cerebral edema.
Give mannitol IV; insert an indwelling catheter to track fluid and renal status.
Monitor electrolytes and osmolality closely during mannitol therapy.
Barbiturate coma (pentobarbital, thiopental) lowers cellular metabolic demand to control ICP.
Barbiturate coma requires mechanical ventilation plus cardiac and ICP monitoring.
Phenytoin prevents seizures prophylactically; dosing is based on therapeutic blood levels.
Morphine or fentanyl treat pain and restlessness but risk respiratory depression if unventilated.
Give naloxone as the reversal agent if opioid overmedication occurs.
Therapeutic Procedures
Craniotomy removes nonviable tissue, hematomas, or tumors via a burr hole or bone flap.
Surgical approaches include supratentorial, infratentorial, and transsphenoidal routes.
Burr holes help assess cerebral swelling and ventricle size or position.
Risks include severe neurologic impairment, infection, seizures, and death.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Brain herniation surgery decisions are made emergently during a crisis.
Social work and pastoral care can support families during a crisis.
Watch for severe headache, rapid decline in consciousness, and signs of rising ICP.
Subdural and epidural hematomas typically require surgical removal to treat.
Mannitol can trigger pulmonary edema that mimics cardiac edema without heart involvement.
This mannitol-related pulmonary edema is a life-threatening emergency; survival is rare.
Arginine vasopressin deficiency, formerly called central diabetes insipidus, is a possible complication.
Interprofessional Care
Refer to PT, OT, recreational, and speech therapy for deficits from brain injury.
Involve social services or case management for community and school resources.
Rehab facilities help speed recovery and reintegration into daily life.
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2023.
About 90 percent of concussion symptoms resolve within 10 to 14 days.
Roughly 15 percent of patients with a mild traumatic brain injury go on to develop postconcussive syndrome.
About 10 to 15 percent of patients still have symptoms a year later, though this figure may be overestimated due to reporting bias.
Being female, having had prior concussions, an intracranial abnormality on imaging, or older age are linked to a higher chance of prolonged symptoms.
StatPearls (NCBI Bookshelf) · Postconcussive Syndrome · open the source →
ATI Active Learning Template — System DisorderSpinal Cord Injury
Filled from ATI chapter 17, row by row from that chapter’s own sections — 11 of 12 rows have content.
1 row below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Spinal cord injury causes loss of motor, sensory, reflex, and elimination control below the injury level. Cervical injuries cause quadriplegia; injuries below T1 cause paraplegia. About 17,000 new U.S. cases occur yearly, average age 43.
Health Promotion & Disease Prevention
Wear helmets and protective gear for skating, biking, skiing, and football.
Always wear a seatbelt when driving or riding in a car.
Avoid speeding and never drive under the influence.
Secure windows and use safety gates around hazardous areas.
Never dive into water of unknown or shallow depth; mark pool depth clearly.
Help prevent falls in older adults with handrails and clear walkways.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
High-risk or extreme sports raise the chance of spinal cord injury.
Motor vehicle accidents are a leading cause of spinal cord injury.
Impact sports such as football or diving increase risk.
Violence, including gunshot or knife wounds, can cause spinal cord injury.
Substance use is also a notable risk factor.
Metastatic cancer or spinal arthritis can raise injury risk.
Falls are a common cause, especially in older adults.
Assessment — Expected Findings
Loss of sensation follows a dermatome pattern below the injury level.
Neck or back pain is a commonly reported finding.
Client cannot feel light touch, sharp versus dull, or hot versus cold.
Deep tendon reflexes are absent below the level of injury.
Muscles below the level of injury often become flaccid.
Hypotension can worsen when the client sits upright.
Shallow respirations can occur, especially with high-level lesions.
Spinal shock causes temporary loss of reflex and autonomic function for days to weeks.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Urinalysis, hemoglobin, ABGs, and CBC screen for hidden internal bleeding.
These labs also flag respiratory compromise linked to phrenic nerve involvement.
Diagnostic Procedures
X-ray, MRI, and CT scans locate the extent of damage, blood, and bone fragments.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Respiratory status is the top priority; injury at or above C4 threatens spontaneous breathing.
Neurogenic shock can start within 24 hr of injury, causing severe hypotension.
Upper motor neuron injury, above L1-L2, causes spastic tone once shock resolves.
Lower motor neuron injury, below L1-L2, causes flaccid paralysis instead.
Move clients to a wheelchair gradually; watch for postural-hypotension dizziness.
Reposition every 2 hr in bed, every 1 hr in a wheelchair, to protect skin.
Spastic bladder: manage with a condom catheter or by stimulating the voiding reflex.
Flaccid bladder: manage with intermittent catheterization or the Credé method.
For autonomic dysreflexia, sit the client upright immediately to lower blood pressure.
Medications
Norepinephrine or dopamine treat hypotension during neurogenic shock.
Atropine is used to treat bradycardia linked to neurogenic shock.
Dextran, a plasma expander, treats spinal-shock hypotension; watch for fluid overload.
Baclofen or dantrolene manage severe spasticity; watch for drowsiness and weakness.
Intrathecal baclofen lessens sedative side effects for severe spasticity cases.
Bethanechol lowers bladder spasticity; monitor for urinary retention.
Opioids, non-opioids, and NSAIDs are used for pain control.
Heparin or low-molecular-weight heparin prevent DVT; monitor INR, PT, and aPTT.
Therapeutic Procedures
A halo device or cervical tongs immobilize a cervical fracture through traction.
Ensure cervical tong weights hang freely; never use the halo to move the client.
Provide pin care and check skin under the halo vest for breakdown.
Spinal fusion stabilizes an area of instability from a spinal fracture.
Cervical fusion is typically done through an approach at the front of the neck.
Thoracic or lumbar fusion uses a posterior approach, often with a decompressive laminectomy.
💬 Around the patientClient Education · Interprofessional Care
Client Education
If discharged with a halo device, follow the pin and vest care routine.
Report any sign of pin-site infection or skin breakdown.
Range of motion stays permanently reduced at the fusion site.
Paravertebral rods remain in place unless they cause pain.
Quadriplegia needs lengthy, extensive rehab; paraplegia needs less, but still many accommodations.
Family or support persons should learn ADLs, transfers, and medication routines.
The home may need changes to allow wheelchair access.
Interprofessional Care
OT/PT teach ADLs and mobility using wheelchairs, braces, or crutches.
Splints help prevent contractures; wrist supports assist eating and wheelchair use.
Social services assess finances, home-care needs, and needed home modifications.
SCI support groups help clients adapt to changes in body image and role.
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2025.
Autonomic dysreflexia risk is highest with injury at or above T6, affecting up to 90 percent of people with cervical or high thoracic injury.
Injuries below T10 rarely cause autonomic dysreflexia.
About 85 percent of episodes are triggered by a full bladder, making bladder distension the most common cause.
A sudden, severe headache with a systolic blood pressure over 150 mm Hg, or a rise of more than 40 mm Hg above baseline, signals an episode needing immediate treatment.
First-line management is sitting the patient upright, loosening tight clothing, and checking for a full bladder or blocked catheter.
StatPearls (NCBI Bookshelf) · Autonomic Dysreflexia · open the source →
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Epidural hematoma = arterial, fast, lucid interval (out → awake and fine → out again), major trauma. Subdural = venous, slow over 24–48 hr to 2 weeks, older adults on anticoagulants or with alcohol use; expect elevated PT/PTT/INR. Both get coags and surgical evacuation.
Diffuse axonal injury is severe — roughly 25% do not survive.
Suspected SCI: ABCs → cervical collar → log roll → backboard → imaging. If she stops breathing use a jaw thrust, not head-tilt chin-lift. Keep MAP ≥85 mmHg.
Spinal shock = temporary loss of all reflexes, sensation and motor below the injury; a cord "shutdown" that resolves over days to weeks. Neurogenic shock = loss of sympathetic tone (usually T6 and above) causing true hypotension + bradycardia.
Autonomic dysreflexia (T6 and above): severe hypertension, bradycardia, pounding headache, flushed and sweaty above the injury, pale and cool below. Sit her up first, then find and remove the cause — check the bladder before the bowel — then call for medication.
Halo device: never lift or reposition by the vest bars. Keep a wrench taped to the vest for emergency CPR access. Pin site care.
Pressure injury prevention in SCI: reposition q2 hr in bed, q1 hr in a wheelchair. Injuries can form within 6 hours.
Parkinson's TRAP: Tremor (pill-rolling, at rest), Rigidity, Akinesia/bradykinesia, Postural instability. Swallowing and airway always outrank mobility.
Guillain-Barré: ascending symmetric paralysis after an infection. Monitor respiratory status continuously. ~70% recover fully.
Bell's palsy takes the whole side of the face including the forehead (a stroke spares the forehead). Protect the eye with lubricant and a night patch. ~95% recover in months.
ALS: progressive motor neuron loss with cognition intact; priorities shift to airway, nutrition and advance care planning. Alzheimer's: memory loss first, then safety and wandering.
Post-spinal-surgery bundle: patent airway, hourly neuro checks and vitals, log roll and maintain alignment, watch for CSF leak, inspect the incision. No high Fowler's, no ambulation in the first 4 hours. Always assess distal to the surgical site — motor, sensory, reflexes, bowel and bladder.
Their trend item: BP drifting 122→110 and pain oscillating 4–5 are noise. Progressive left-leg weakness to inability to move is the concerning trend.
Myasthenia gravis: pyridostigmine 30–60 minutes BEFORE meals, lasting 3–4 hours — clients plan activity around the peak. Never stop it because she feels better. Thickened liquids sitting upright. Eye patch for diplopia. Avoid heat and emotional stress. Thymectomy often improves function.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
Anemia is not one disease — it is three different failures. Not making cells,
losing cells, or destroying cells. The cell size tells you which.
Anemia
Cell size
Cause
Signature
Iron deficiency
Microcytic, small
Blood loss, poor intake
Most common; pica, spoon nails
B12 deficiency
Macrocytic, large
No intrinsic factor
Neuro signs — numbness, gait
Folate deficiency
Macrocytic
Poor diet, alcohol
Same but no neuro signs
Aplastic
Normocytic
Marrow fails
All three lines low
Sickle cell
Normocytic
Genetic Hgb S
Pain crises, triggered by hypoxia and dehydration
⭐ The distinction they test
B12 and folate look identical on a blood count. The difference is neurological:
B12 deficiency causes numbness, tingling and gait problems. Folate does not.
Pernicious anemia is a lack of intrinsic factor, so oral B12 will not absorb —
it needs lifelong IM injections.
💊 Iron teaching, four points
Take with vitamin C (orange juice) — it doubles absorption
Best on an empty stomach; with food if it upsets the gut
Stools turn black and tarry — this is expected, not bleeding
Liquid iron through a straw — it stains teeth. Z-track for IM
🚨 Transfusion reactions — first action is always the same
1 · STOPStop the transfusion immediately
2 · LineNormal saline with new tubing
3 · AssessVital signs, stay with patient
4 · NotifyProvider and blood bank
5 · ReturnBlood bag and tubing to lab
Never restart a transfusion after a reaction, and never flush the existing line - that pushes more blood in.
Stay with the patient for the first 15 minutes; that is when most severe reactions begin.
Blood must infuse within 4 hours, and only normal saline may share the line.
🩸 DIC — clotting and bleeding at once
Widespread clotting consumes the clotting factors and platelets, so the patient then
bleeds everywhere. Labs: low platelets, low fibrinogen,
prolonged PT/aPTT, high D-dimer.
Treatment is treat the cause — usually sepsis, obstetric emergency, or major trauma.
⭐ High-yield — what the exam actually asks
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MCV sorts the anemias: microcytic = iron deficiency; normocytic = chronic disease or kidney; macrocytic = B12, folate or alcohol. Ferritin low + TIBC high = iron deficiency. Hgb electrophoresis confirms sickle cell. Bone marrow biopsy (posterior iliac crest) diagnoses aplastic anemia and leukemia.
Fatigue is the #1 anemia sign. Transfuse chronic anemia around Hgb <7 g/dL; long-term management is subQ epoetin alfa.
Polycythemia vera is the opposite — marrow overproduces RBCs → thick blood, ruddy face, itching after a warm shower, splenomegaly, high clot risk. Therapeutic phlebotomy is the mainstay; nursing priority is clot prevention.
Sickle cell crisis: IV fluids, IV opioids (PCA/morphine, not PO Tylenol — do not withhold opioids), oxygen, transfusion PRN.Ice is contraindicated. Prevention: avoid high altitude and temperature extremes.
Leukemia crowds out normal marrow → the pancytopenia triad: infection, bleeding/bruising, fatigue.
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Hodgkin lymphoma has Reed-Sternberg cells, painless cervical/supraclavicular nodes, B symptoms (fever, night sweats, weight loss), orderly contiguous spread, better prognosis. Non-Hodgkin has no Reed-Sternberg cells and spreads unpredictably.
Multiple myeloma CRAB: Calcium elevated, Renal failure, Anemia, Bone lesions and pathologic fractures. Push fluids to protect the kidneys; fall and fracture precautions.
Platelets normal 150,000–450,000/mm³; fibrinogen 170–340 mg/dL. Neutropenic precautions start at ANC <1,000/mm³.
Thrombocytopenia precautions: electric razor, soft toothbrush, no NSAIDs/aspirin/heparin, stool softeners to prevent straining, minimize IV sticks, check stool for occult blood.
Hemophilia: give clotting factor before and after any procedure. Priority labs are coags, not CBC (platelets are normal). Compression beats a factor injection if she is bleeding right now. Ice, not heat. No aspirin. Deep joint bleeds are ~75% of bleeds.
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Von Willebrand is the most common inherited bleeding disorder — heavy menses is often the presenting complaint. DDAVP for mild disease.
DIC: bleeding and clotting at once from an underlying cause. Labs: PT/PTT/INR up, platelets down, fibrinogen down, FDPs up. Treat the cause first (antibiotics for sepsis) → fluids → heparin → blood products.
Transfusions: two-nurse verification, 0.9% NS only (dextrose hemolyzes, LR clots), stay with her the first 15 min, infuse within 4 hours.
Reactions: acute hemolytic (ABO mismatch — fever, chills, flank pain, hemoglobinuria); febrile non-hemolytic (most common); allergic/anaphylactic; TRALI (respiratory distress without overload signs); TACO (crackles, JVD, hypertension from too much too fast).
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
Show 5 moreHide these 5
HIT: platelets 220,000 → 90,000 in 48 hours on day 7 of heparin. Stop the heparin, daily platelet counts, notify, and assess for thrombosis — HIT clots as well as bleeds. Do not give vitamin K (that is warfarin’s antidote) and do not start warfarin. Heparin is monitored with aPTT, not the platelet count. Warfarin → PT/INR.
Aplastic anemia hits all three cell lines. Masks, handwashing, transfusions, bleeding precautions. An iron-rich diet does nothing — the marrow is not short of raw material, it is shut down.
DIC lab triad: ↓platelets, ↓fibrinogen, ↑D-dimer. To address organ ischemia specifically the answer is oxygen and IV fluids — holding pressure and vitamin K do not perfuse organs.
ITP: petechiae and a 10-minute nosebleed can wait. Severe headache with vomiting in a thrombocytopenic client means intracranial hemorrhage.
Von Willebrand is treated with desmopressin — the same drug as DI. Avoid IM injections, aspirin and contact sports; soft toothbrush; watch for hematuria and melena.
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Hemophilia: a clotting factor is missing, so the platelet plug never stabilizes. A hemarthrosis is not simply rested — elevate, give factor replacement, no ROM, because the joint is far too painful to exercise through. Never aspirin or NSAIDs.
Pressure-holding times: 5 minutes for venipuncture, 10+ for arterial. "2 minutes" is a distractor.
Platelets: under 20,000, and especially under 10,000, is significant bleeding risk. They used both 150,000–450,000 and 140,000–400,000 as "normal" and told students not to be thrown by lab-to-lab variation.
Multiple myeloma trend case: calcium 10.2 → 11.6 → 13.2, creatinine 1.1 → 1.6 → 2.4, with confusion, vomiting and falling urine output. The immediate-intervention findings are calcium, creatinine, confusion, decreased output.
Myeloma care: fluids 3 L/day to flush M proteins · fall precautions, because some fracture just standing up · a walker, not a cane or a wheelchair — a cane is not stable enough and a wheelchair deconditions her · monitor hypercalcemia · NSAIDs contraindicated.
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Bisphosphonates: sit upright, full glass of water, stay upright 30–60 minutes.
Calc (reconstitution):1 g at 250 mg/mL → add 4 mL. 1.5 g to yield 300 mg per 2 mL → add 10 mL.
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Aplastic anemia: the marrow is not producing. Iron will not help — the building blocks are already there. More oxygen will not raise a hemoglobin either. She needs transfusion and marrow support, and she will not build stamina until the hemoglobin comes up.
ITP: an immune destruction of platelets, commoner in children. Petechiae are expected; the feared event is intracranial hemorrhage. Short term steroids and IVIG; long term splenectomy, because the spleen is doing the destroying.
Bleeding precautions:no intramuscular injections — bleeding into muscle is prolonged and painful — soft-bristled toothbrush, monitor for hematuria and melaena, and teach her the signs of internal bleeding.
Show 5 moreHide these 5
TRALI: sudden dyspnea within hours of starting a transfusion. Stop the transfusion, keep the line open with normal saline, oxygen, notify. Do not flush the remaining blood through.
Transfusion reactions by severity: a febrile reaction is the mildest and the transfusion may only be paused. A hemolytic reaction and TRALI are stop-immediately-and-do-not-restart.
Urine output is the floor:30 mL/hr is the minimum accepted. Below that the kidneys are being sacrificed to keep the heart and brain perfused.
Sickle cell crisis: hydration and oxygen come before anything else — the cells are sickling precisely because they are short of oxygen and fluid.
Reconstitution: read the target concentration, not the vial. If you hold 1 g and need 300 mg in every 2 mL, work to the concentration they asked for and stop when the units cancel.
⚠️ Exam traps
TRALI vs TACO — the discriminator is whether there are fluid-overload signs.
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
ATI Active Learning Template — System DisorderAnemias
Filled from ATI chapter 42, row by row from that chapter’s own sections — 10 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Covers anemia's causes (blood loss, poor RBC production, hemolysis, nutrient deficiency), risk factors, expected findings, lab workup (CBC, RBC indices, iron studies), and treatments including iron, B12, folic acid, and transfusions, plus heart failure risk.
Health Promotion & Disease Prevention
Pregnant or menstruating clients need iron-rich foods or an iron supplement.
If cholesterol is high, get iron from fortified cereal, fish, poultry, or legumes instead of red/organ meat.
Eat folate-rich foods like spinach, lentils, bananas, and folic-acid-fortified grains or juice regularly.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Blood-loss risk: trauma, menorrhagia, GI bleeding (ulcer, tumor), surgical loss, or chemical/radiation exposure.
Rapid metabolic demand raises anemia risk: pregnancy, adolescence, or infection.
Sickle-cell disease: malformed RBCs during hypoxia block capillaries in joints and organs.
G6PD deficiency impairs glycolysis, which raises the risk for hemolysis.
Hemolysis can follow transfusion reactions, autoimmune disease, a mechanical valve, or cardiopulmonary bypass.
Pernicious anemia stems from a lack of intrinsic factor needed to absorb vitamin B12.
Pica means eating nonfood items for at least 1 month, which can crowd out nutritious choices.
Bone marrow suppression from radiation or chemical exposure can cause aplastic anemia.
Assessment — Expected Findings
Mild anemia may cause few or no symptoms at all.
Common findings include pallor, fatigue, somnolence, headache, irritability, and dyspnea on exertion.
Anemia can cause limb numbness/tingling and increased sensitivity to cold.
Sickle-cell crisis brings severe pain along with tissue hypoxia.
Exam findings include tachycardia, palpitations, and orthostatic hypotension on standing.
Watch for dizziness or fainting when standing or exerting.
Pallor shows in nail beds and mucous membranes; skin feels cool to touch.
Chronic anemia can cause spoon-shaped nail deformities over time.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Hgb carries oxygen/CO2 and indicates blood's oxygen-carrying capacity.
Hct is the percentage of RBCs within total blood volume.
MCV shows RBC size: normocytic, microcytic, or macrocytic.
MCH shows Hgb per RBC: normochromic (normal) or hypochromic (low).
MCHC shows the percent of Hgb relative to cell size.
Diagnostic Procedures
Bone marrow aspiration/biopsy diagnoses aplastic anemia, where marrow fails to make RBCs, platelets, and WBCs.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Encourage more dietary intake of the deficient nutrient: iron, B12, or folic acid.
Monitor oxygen saturation to decide if oxygen therapy is needed.
Give anemia medications at the right time and technique for best absorption.
Teach energy conservation and warn about dizziness risk when standing.
Teach the client the expected time frame for anemia to resolve.
With erythropoietin, monitor blood pressure and check Hgb/Hct weekly.
Watch for a cardiovascular event if Hgb rises more than 1 g/dL in 2 weeks on erythropoietin.
Give B12 by the route matching the cause: oral, parenteral, or intranasal.
Give parenteral B12 IM or deep subQ, and never mix it with other drugs in the syringe.
Medications
Oral iron (ferrous sulfate, fumarate, gluconate) replenishes iron stores needed for Hgb and O2 transport.
Parenteral iron (iron dextran) is reserved for severe anemia only.
Give parenteral iron using the Z-track injection method.
Normal indices (normocytic, normochromic) point to bleeding, sickle-cell disease, long-term illness, or aplastic anemia.
Microcytic, hypochromic anemia (low indices) suggests iron deficiency, thalassemia, or chronic blood loss.
Therapeutic Procedures
Blood transfusion rapidly improves cell counts and anemia symptoms.
Transfusions are reserved for clients with significant anemia symptoms, given infection risk.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Recheck hemoglobin in 4-6 weeks to confirm iron therapy is working.
Taking vitamin C alongside iron supplements boosts oral absorption.
Take iron supplements between meals if tolerated, to improve absorption.
Iron supplements can turn stools green to black.
Epoetin alfa is a growth factor that boosts RBC production.
B12 therapy for intrinsic-factor loss or irreversible malabsorption continues lifelong.
Ongoing B12 replacement is given as a monthly injection.
Interprofessional Care
Not a section in this chapter. Fill from lecture if your instructor covers it.
⚠️ What goes wrongComplications
Complications
Not a section in this chapter. Fill from lecture if your instructor covers it.
ATI Active Learning Template — System DisorderCoagulation Disorders
Filled from ATI chapter 43, row by row from that chapter’s own sections — 7 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Coagulopathies involve platelet or clotting-factor problems that impair or overdrive clotting. Covers ITP, TTP, HIT, DIC, and hemophilia — their causes, mortality risk, and why some cause bleeding while others trigger dangerous clots simultaneously.
Health Promotion & Disease Prevention
Not a section in this chapter. Fill from lecture if your instructor covers it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
ITP most often develops in people assigned female at birth, ages 20-50.
ITP risk: certain medications, viral infection (HIV, hepatitis C), or another autoimmune disorder.
In children, ITP often follows a recent viral illness.
The main TTP risk factor is having another autoimmune disorder.
HIT risk factors include female sex assigned at birth.
HIT risk rises with heparin exposure over 1 week; unfractionated heparin is more likely to trigger it.
HIT risk also rises with postsurgical thromboprophylaxis (clot-prevention therapy).
DIC can follow septicemia, cardiac arrest, or major trauma (hemorrhage, burns, crush injury).
Assessment — Expected Findings
Watch for spontaneous gum or nose bleeding along with oozing from incisions or cuts.
Look for petechiae and ecchymoses on the extremities, upper chest, and neck.
Hematuria and excess bleeding from IV sites, injections, or minor trauma can occur.
Expect tachycardia, hypotension, and diaphoresis as bleeding or shock develops.
Microemboli can cause organ failure and respiratory distress.
Cyanotic, dark, or gray nail beds signal microvascular clotting.
HIT causes redness, warmth, swelling, and pain in the lower legs.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Hemoglobin drops with DIC and ITP; normal is 14-18 g/dL (male), 12-16 g/dL (female).
Platelets fall (thrombocytopenia) with DIC, TTP, and ITP; normal range is 150,000-400,000/mm3.
Fibrinogen drops with DIC; normal range is 200-400 mg/dL.
Prothrombin time rises with DIC; normal range is 11.0-12.5 sec.
Partial thromboplastin time rises with DIC; normal aPTT is 30-40 sec, PTT 60-70 sec.
Diagnostic Procedures
Not a section in this chapter. Fill from lecture if your instructor covers it.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
In DIC, treat the underlying cause (sepsis, malignancy, hemorrhage) to stop the clotting cascade.
In DIC, work to prevent organ damage from microemboli and replace lost clotting factors.
Watch for microemboli signs: cyanotic nail beds and localized pain.
Recheck vital signs and hemodynamic status often in DIC, HIT, ITP, and TTP.
Watch for organ failure or intracranial bleed: falling urine output, declining level of consciousness.
Trend clotting lab values closely to catch a worsening coagulopathy.
Give fluid volume replacement as ordered to support perfusion.
Transfuse blood, platelets, and other clotting products as needed.
Watch closely for complications from any blood product transfusion.
Medications
ITP is treated with corticosteroids and immunosuppressant medications.
TTP is treated with antiplatelet medications such as aspirin, alprostadil, or plicamycin.
TTP: immunosuppressive therapy lessens the severity of complications.
HIT is treated with direct thrombin inhibitors: argatroban, lepirudin, or bivalirudin.
DIC: heparin can limit new microclot formation and clotting-factor depletion.
Therapeutic Procedures
TTP can be treated with plasma exchange therapy.
ITP: splenectomy may be performed if medical management fails.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Not a section in this chapter. Fill from lecture if your instructor covers it.
Interprofessional Care
Not a section in this chapter. Fill from lecture if your instructor covers it.
⚠️ What goes wrongComplications
Complications
Not a section in this chapter. Fill from lecture if your instructor covers it.
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
MCV sorts the anemias: microcytic = iron deficiency; normocytic = chronic disease or kidney; macrocytic = B12, folate or alcohol. Ferritin low + TIBC high = iron deficiency. Hgb electrophoresis confirms sickle cell. Bone marrow biopsy (posterior iliac crest) diagnoses aplastic anemia and leukemia.
Fatigue is the #1 anemia sign. Transfuse chronic anemia around Hgb <7 g/dL; long-term management is subQ epoetin alfa.
Polycythemia vera is the opposite — marrow overproduces RBCs → thick blood, ruddy face, itching after a warm shower, splenomegaly, high clot risk. Therapeutic phlebotomy is the mainstay; nursing priority is clot prevention.
Sickle cell crisis: IV fluids, IV opioids (PCA/morphine, not PO Tylenol — do not withhold opioids), oxygen, transfusion PRN. Ice is contraindicated. Prevention: avoid high altitude and temperature extremes.
Platelets normal 150,000–450,000/mm³; fibrinogen 170–340 mg/dL. Neutropenic precautions start at ANC <1,000/mm³.
Hemophilia: give clotting factor before and after any procedure. Priority labs are coags, not CBC (platelets are normal). Compression beats a factor injection if she is bleeding right now. Ice, not heat. No aspirin. Deep joint bleeds are ~75% of bleeds.
DIC: bleeding and clotting at once from an underlying cause. Labs: PT/PTT/INR up, platelets down, fibrinogen down, FDPs up. Treat the cause first (antibiotics for sepsis) → fluids → heparin → blood products.
Transfusions: two-nurse verification, 0.9% NS only (dextrose hemolyzes, LR clots), stay with her the first 15 min, infuse within 4 hours.
HIT: platelets 220,000 → 90,000 in 48 hours on day 7 of heparin. Stop the heparin, daily platelet counts, notify, and assess for thrombosis — HIT clots as well as bleeds. Do not give vitamin K (that is warfarin's antidote) and do not start warfarin. Heparin → aPTT. Warfarin → PT/INR.
DIC lab triad: ↓platelets, ↓fibrinogen, ↑D-dimer. To address organ ischemia specifically the answer is oxygen and IV fluids — holding pressure and vitamin K do not perfuse organs.
ITP: petechiae and a 10-minute nosebleed can wait. Severe headache with vomiting in a thrombocytopenic client means intracranial hemorrhage.
Hemophilia hemarthrosis: elevate, give factor replacement, no ROM, never aspirin or NSAIDs.
Pressure-holding times: 5 minutes for venipuncture, 10+ for arterial. "2 minutes" is a distractor.
Platelets: under 20,000, and especially under 10,000, is significant bleeding risk. They used both 150,000–450,000 and 140,000–400,000 as "normal" and told students not to be thrown by lab-to-lab variation.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
Chemotherapy kills fast-dividing cells — it cannot tell cancer from healthy tissue.
Every classic side effect is simply the body’s other fast-dividing cells: bone marrow, hair
follicles, and the lining of the gut.
Fast-dividing tissue
Result
What you watch for
Bone marrow
Myelosuppression
Infection, bleeding, fatigue
Hair follicles
Alopecia
Body image; hair regrows
GI lining
Mucositis, nausea, diarrhea
Nutrition, mouth care
🚨 Neutropenia is the one that kills
ANC < 500
Severe neutropenia. A fever is now an emergency — the patient cannot mount normal
signs of infection, so temperature may be the only clue.
In a neutropenic patient, a single temperature of 100.4F / 38C is a medical emergency. Report it immediately.
Nadir — the lowest count — is typically 7–10 days
after a dose. That is the highest-risk window.
✅ Neutropenic precautions
Private room; strict hand hygiene is the single most effective measure
No fresh flowers or standing water — they harbor organisms
No raw fruit, vegetables or undercooked food
Avoid crowds and anyone with an infection
No rectal temperatures, suppositories or enemas - they break mucosa
Oncologic emergency
Recognize it by
Priority
Spinal cord compression
Back pain first, then weakness, then bowel/bladder change
Steroids, radiation — act on the back pain
Superior vena cava syndrome
Facial and neck swelling, distended veins, dyspnea
Elevate head, radiation
Tumor lysis syndrome
High K⁺, phosphate, uric acid; low calcium
Hydration, allopurinol
Hypercalcemia
Confusion, constipation, weakness
Hydration, bisphosphonates
⭐ Back pain in a cancer patient is never “just” back pain
It is the first sign of spinal cord compression, and it appears before any weakness.
Acting at the pain stage preserves the ability to walk; waiting for weakness does not.
💐 End-of-life care — what the exam rewards
Hospice is comfort-focused care when curative treatment stops, usually a prognosis of
6 months or less. Palliative care is comfort alongside treatment and can start at
diagnosis.
For pain at end of life, there is no maximum opioid dose when titrated to comfort.
Respiratory depression is not a reason to under-treat dying patients’ pain.
The most therapeutic response is usually the one that stays and listens rather than
reassuring or redirecting.
⭐ High-yield — what the exam actually asks
Show 5 moreHide these 5
CAUTION: Change in bowel/bladder, A sore that will not heal, Unusual bleeding or discharge, Thickening or lump, Indigestion or dysphagia, Obvious change in a wart or mole, Nagging cough or hoarseness.
Prevention tiers: primary = remove the risk (do not smoke, HPV and hep B vaccine); secondary = screening; tertiary = preventing recurrence and complications.
Biopsy confirms the diagnosis. Imaging and tumor markers support but never replace tissue. Grading = how abnormal the cells look; staging = TNM = how far it has spread.
External beam radiation: she is NOT radioactive. Priority is skin protection — no rubbing with a towel, no ointments unless infected, avoid midday sun.
Brachytherapy: she IS radioactive while the source is in. Stay 6 feet away, 30 min maximum exposure, private room with the door closed. A dislodged seed is picked up with tongs into a lead container, never by hand. Strain urine 7–10 days. At home: separate bedrooms and toilets, flush repeatedly.
Show 5 moreHide these 5
Chemo: antiemetics before and after. Small frequent nutrient-dense meals; cold or room-temperature food is better tolerated; stop fluids ~1 hr before meals; plastic utensils cut the metallic taste; megestrol for appetite.
Stomatitis: normal saline or bicarb rinses, never alcohol-based mouthwash, topical anesthetic before meals, avoid spicy/acidic/salty, ~2 L water/day. Alopecia starts 7–10 days after treatment.
Extravasation from a peripheral line: stop the infusion first, notify the provider, give the antidote subQ around the site, attempt to aspirate.Do not remove the catheter and do not flush. Ice is right (it localizes the drug; heat would spread it). A central line is the ideal chemo route.
HSCT: conditioning leaves her profoundly pancytopenic — strict reverse isolation through engraftment. Watch for GVHD in allogeneic transplants (skin, GI, liver), affecting 30–50% of allogeneic recipients.
Oncologic emergencies — SVC syndrome: facial, neck and upper-body swelling with distended veins, worse lying flat → keep the HOB up. Tumor lysis syndrome: after starting chemo, potassium, phosphorus and uric acid all up, calcium down → arrhythmias and AKI; prevent with aggressive hydration plus allopurinol or rasburicase. Spinal cord compression: new back pain is the first sign — delay means permanent paralysis.
Show 1 moreHide these 1
Palliative care can run alongside curative treatment at any stage. Hospice requires a terminal prognosis (typically ≤6 months) and a shift to comfort-focused goals.
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
Show 5 moreHide these 5
Hospice = terminal, prognosis 6 months or less, curative treatment stopped. Palliative runs alongside curative treatment at any stage. “Curative treatment discontinued” plus “at home” is their cue for hospice at home. Follow the client’s stated goal, not the one you would pick. The client, not the family, decides while she is capable.
Neutropenic fever is the one "give antibiotics without proven infection" exception.ANC 800 with temp 100.8°F outranks post-cisplatin vomiting, petechiae and a pain request. Cultures plus IV antibiotics, likely admission.
ANC cutoffs they used: <1,500 neutropenic, <500 severe.
Neutropenic teaching corrections: no sushi or raw food even from a good restaurant · discard drinks left out over 1 hour · avoid gardening and cat litter · report temp over 100°F.
Stomatitis: salt-and-soda rinses before and after meals, avoid glycerin- and alcohol-containing mouthwashes, at least 2 L water, lidocaine gel or analgesia before meals so she can actually eat.
Show 5 moreHide these 5
SVC syndrome: metastatic chest tumor, dyspnea, facial swelling and erythema, JVD, neck tightness. Oncologic emergency → high-dose radiation plus corticosteroids (steroids shrink the inflammation around the tumor).
Tumor lysis labs: ↑K, ↑phosphate, ↓calcium, ↑uric acid, ↑creatinine — phosphate leaks out and binds serum calcium down. Aggressive IV fluids, allopurinol, sodium polystyrene for the potassium, diuretics for output. Methotrexate is chemo, not a treatment.
Brachytherapy staff safety: limit time · ≥6 feet when not providing care · your own dosimeter, never shared · lead apron · rotate caregivers, the opposite of normal continuity · pregnant staff not assigned at all · linens and dressings stay in the room.
Radiation skin care: mild soap with fingertips, not a washcloth · nothing unprescribed on the site · loose soft clothing · SPF 15 is not enough, cover or avoid sun · never wash off the ink marks — they are how the beam is aimed, and it is the single most repeated radiation question they set.
CINV: cold and bland foods, add protein powders for calories, antiemetics before and after treatment, rest after meals, loose clothing.
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Their palliative SATA framing: pain control, small frequent meals, wigs and turbans, light activity are in. Daily weights and strict balanced-meal rules are out — they are rigid metrics, not comfort.
Calc:1 g ceftriaxone to 250 mg/mL → 4 mL diluent.
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Hospice is covered by most health plans including Medicare and Medicaid. That is a teaching point for families weighing their options, not a detail.
Palliative care treats the patient and the family as one unit, and it continues into bereavement after the death.
External beam radiation skin care: mild soap, warm water, fingertips only. No ice, no heat, no unprescribed powders or ointments, no sun on the field. Moisturise with the approved lotion and stay hydrated.
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Stomatitis:no alcohol-based mouthwash — it burns an open surface. Saline or a prescribed rinse instead.
Nutrition on chemotherapy: add protein and calories. Do not avoid dairy — it is calories she needs. Do not eat only raw fruit and vegetables — she is immunocompromised and cannot fight the bacteria on them.
Tumor lysis syndrome: cells die so fast they dump their contents — potassium, phosphate and uric acid — into the blood. Hydration and monitoring; watch the potassium.
Neutropenia: an ANC of 800 against a normal of 2,500 to 6,000 is significant. Protective precautions, no fresh flowers, no raw produce. Staff radiation safety is time, distance and shielding.
⚠️ Exam traps
Palliative ≠ hospice. This is asked constantly.
External beam clients are not radioactive; brachytherapy clients are.
Do not flush an extravasated line. The instinct to flush is the wrong answer.
🧠 Mind maps 3
One per disorder, built from the structure of your ATI chapter.
General Principles of Cancer
🎯 Who gets it
Cancer incidence rises with age; highest among older adults.
Sex patterns: females favor breast/lung/colorectal/uterine/skin cancer; males favor prostate/lung/colorectal/bladder/skin cancer.
Immunosuppression and chronic skin trauma/burn scars raise cancer risk.
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
ATI Active Learning Template — System DisorderGeneral Principles of Cancer
Filled from ATI chapter 89, row by row from that chapter’s own sections — 8 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Covers cancer as abnormal, invasive cell growth from genetic mutations, how tumors are named by origin tissue after metastasis, incidence and mortality data, and how benign tumors differ from malignant ones.
Health Promotion & Disease Prevention
Eat a low-fat diet rich in fruit, vegetables, and lean protein; limit sugar, salt, and processed or red meat.
Maintain a healthy weight/BMI and get regular physical activity.
Avoid all tobacco product use to lower cancer risk.
Limit alcohol to 1 drink/day for females, 2 drinks/day for males (assigned at birth).
Avoid risky behaviors: drug use, needle sharing, unprotected sex.
Limit exposure to environmental hazards like radiation or chemicals; wear PPE.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Cancer incidence rises with age; highest among older adults.
Sex patterns: females favor breast/lung/colorectal/uterine/skin cancer; males favor prostate/lung/colorectal/bladder/skin cancer.
Immunosuppression and chronic skin trauma/burn scars raise cancer risk.
Paraneoplastic syndrome: recognize new neuro changes; treat with steroids, immune factors, plasmapheresis, or irradiation.
SIADH (lung/brain cancers) dilutes sodium; watch for early nausea, then lethargy, seizures, or coma.
SIADH: give furosemide, 0.9% saline, or hypertonic saline; recheck sodium since these risk fluid overload.
Hypercalcemia (breast/lung/head-neck, myeloma, bone mets): anorexia, shortened QT, kidney stones; give 0.9% saline, furosemide, pamidronate, phosphates.
SVC syndrome (breast/lung mets): facial/periorbital edema, dyspnea, epistaxis; sit up in semi-Fowler's, urgent high-dose radiation.
Cancer-related DIC: watch for bleeding, replace clotting factors/plasma; heparin can slow the consumption cascade.
Medications
Not a section in this chapter. Fill from lecture if your instructor covers it.
Therapeutic Procedures
Not a section in this chapter. Fill from lecture if your instructor covers it.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Learn how to manage expected treatment side effects.
Eat adequate protein, carbohydrates, and calories during treatment.
Interprofessional Care
Not a section in this chapter. Fill from lecture if your instructor covers it.
⚠️ What goes wrongComplications
Complications
Not a section in this chapter. Fill from lecture if your instructor covers it.
ATI Active Learning Template — System DisorderCancer Screening and Diagnostic Procedures
Filled from ATI chapter 90, row by row from that chapter’s own sections — 6 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Covers cancer screening guidelines by age and risk for breast, colorectal, prostate, cervical, and lung cancer, common clinical warning signs, and diagnostic workup — biopsy types, imaging modalities, and lab and genetic testing — used to confirm and stage disease.
Health Promotion & Disease Prevention
Not a section in this chapter. Fill from lecture if your instructor covers it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not a section in this chapter. Fill from lecture if your instructor covers it.
Assessment — Expected Findings
Not a section in this chapter. Fill from lecture if your instructor covers it.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Labs assess for cancer or its effects (electrolyte imbalance, organ dysfunction).
CBC: elevated WBCs and blast cells can suggest leukemia is present.
Elevated liver function tests can signal primary or metastatic liver cancer.
Tumor marker assays detect elevated proteins like CEA, PSA, alpha-fetoprotein.
Urine, stool, tissue, blood, or fluid samples are checked for excess proteins/DNA patterns.
Diagnostic Procedures
Imaging (CT, MRI, PET, ultrasound, x-ray) is a secondary tool used near diagnosis to gauge severity.
Imaging shows tumor size, borders, and detects metastasis to other organs/structures.
Dye or contrast (IV pyelogram, barium enema) improves visualization on imaging.
Imaging is also used to monitor the client during remission.
Digital imaging is usually more accurate and easy to share across the care team.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Take a full health history and physical exam, including family cancer/genetic history.
Inspect for skin/color, symmetry, movement, or function changes; auscultate heart, lung, bowel sounds and major arteries.
Palpate gently for masses; some exams (e.g., digital rectal exam) are provider-only.
Percuss for dullness over the lungs, bowel, or an enlarged liver, suggesting tumor or inflammation.
Report unexpected findings to the provider and explain the need for further testing.
Before biopsy: confirm consent, withhold anticoagulants, and check coagulation studies.
After biopsy: watch for bleeding (dressing staining, hypotension, tachycardia); keep on bed rest until sedation clears.
Position post-biopsy per site, e.g., right side after liver biopsy; ensure adequate oxygenation.
Watch for contrast dye allergy: dyspnea, tachycardia, restlessness.
Medications
Not a section in this chapter. Fill from lecture if your instructor covers it.
Therapeutic Procedures
Biopsy gives a definitive diagnosis: tissue origin, cell type, and surface receptors.
Biopsy samples can be taken during endoscopy, laparoscopy, or thoracotomy.
Shave biopsy: a scalpel or razor samples outer skin layers of a raised lesion.
Needle biopsy (fine/core) aspirates fluid/tissue near the skin surface; bone marrow aspiration diagnoses leukemia/lymphoma.
Incisional/excisional biopsy cuts out part or all of a tumor.
Punch biopsy (an excisional type for skin cancer) samples 2-6 mm of subcutaneous fat.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Perform breast or testicular self-exams at home, if desired.
Report any general cancer warning sign to the provider promptly.
Watch for bowel/bladder habit changes or a new shape/texture change in the skin.
Watch for trouble eating, chewing, swallowing, or appetite loss.
Watch for non-healing sores/wounds or a persistent cough/hoarseness.
Watch for unexplained pain, night sweats, fatigue, weight change, or unusual bleeding.
Interprofessional Care
Not a section in this chapter. Fill from lecture if your instructor covers it.
⚠️ What goes wrongComplications
Complications
Not a section in this chapter. Fill from lecture if your instructor covers it.
ATI Active Learning Template — System DisorderPain Management for Clients Who Have Cancer
Filled from ATI chapter 93, row by row from that chapter’s own sections — 4 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Explains cancer pain assessment and management, covering acute versus chronic pain, neuropathic, visceral, and somatic pain types, nonverbal pain indicators, common barriers to control, and the palliative goal of comfort without curing disease.
Health Promotion & Disease Prevention
Not a section in this chapter. Fill from lecture if your instructor covers it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not a section in this chapter. Fill from lecture if your instructor covers it.
Assessment — Expected Findings
Not a section in this chapter. Fill from lecture if your instructor covers it.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not a section in this chapter. Fill from lecture if your instructor covers it.
Diagnostic Procedures
Not a section in this chapter. Fill from lecture if your instructor covers it.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Tailor nursing care to the specific cancer procedure or treatment involved.
Include family in cancer pain care and management planning.
Watch for GI bleeding (bloody stools, coffee-ground emesis) with NSAID use.
Cap acetaminophen at 4 g/day short-term or 3 g/day long-term; avoid it in liver disease.
Manage acute severe pain with scheduled opioids for 24 to 48 hr rather than PRN dosing.
Monitor opioid clients for respiratory depression; keep naloxone available to reverse effects.
Give stimulant laxatives to prevent opioid-induced constipation.
Avoid TCAs in clients with seizure disorders or a cardiac history.
Monitor anticonvulsant clients for electrolyte, liver, and blood count changes, plus rash.
Medications
Multimodal pain control can combine NSAIDs, opioids, antidepressants, anticonvulsants, steroids, and local anesthetics.
Non-opioid options, such as acetaminophen, ketorolac, aspirin, ibuprofen, and celecoxib, suit mild-to-moderate pain.
Therapeutic Procedures
Not a section in this chapter. Fill from lecture if your instructor covers it.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Take NSAIDs with food to prevent GI upset, and never crush enteric-coated forms.
Avoid driving or hazardous tasks until opioid effects are known, and skip alcohol.
Rise slowly from lying or sitting to limit orthostatic hypotension from opioids or clonidine.
Antidepressant or SNRI pain relief can take 2 to 3 weeks to take effect.
Avoid alcohol and driving early in anticonvulsant therapy; report rash or tremors.
Take corticosteroids with food, and never stop them abruptly.
Transdermal fentanyl has a slow onset but lasts 48 to 72 hr.
Interprofessional Care
Not a section in this chapter. Fill from lecture if your instructor covers it.
⚠️ What goes wrongComplications
Complications
Not a section in this chapter. Fill from lecture if your instructor covers it.
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Prevention tiers: primary = remove the risk (do not smoke, HPV and hep B vaccine); secondary = screening; tertiary = preventing recurrence and complications.
Biopsy confirms the diagnosis. Imaging and tumor markers support but never replace tissue. Grading = how abnormal the cells look; staging = TNM = how far it has spread.
External beam radiation: she is NOT radioactive. Priority is skin protection — no rubbing with a towel, no ointments unless infected, avoid midday sun.
Brachytherapy: she IS radioactive while the source is in. Stay 6 feet away, 30 min maximum exposure, private room with the door closed. A dislodged seed is picked up with tongs into a lead container, never by hand. Strain urine 7–10 days. At home: separate bedrooms and toilets, flush repeatedly.
Chemo: antiemetics before and after. Small frequent nutrient-dense meals; cold or room-temperature food is better tolerated; stop fluids ~1 hr before meals; plastic utensils cut the metallic taste; megestrol for appetite.
Stomatitis: normal saline or bicarb rinses, never alcohol-based mouthwash, topical anesthetic before meals, avoid spicy/acidic/salty, ~2 L water/day. Alopecia starts 7–10 days after treatment.
Extravasation from a peripheral line: stop the infusion first, notify the provider, give the antidote subQ around the site, attempt to aspirate. Do not remove the catheter and do not flush. Ice is right (it localizes the drug; heat would spread it). A central line is the ideal chemo route.
HSCT: conditioning leaves her profoundly pancytopenic — strict reverse isolation through engraftment. Watch for GVHD in allogeneic transplants (skin, GI, liver), affecting 30–50% of allogeneic recipients.
Oncologic emergencies — SVC syndrome: facial, neck and upper-body swelling with distended veins, worse lying flat → keep the HOB up. Tumor lysis syndrome: after starting chemo, potassium, phosphorus and uric acid all up, calcium down → arrhythmias and AKI; prevent with aggressive hydration plus allopurinol or rasburicase. Spinal cord compression: new back pain is the first sign — delay means permanent paralysis.
Palliative care can run alongside curative treatment at any stage. Hospice requires a terminal prognosis (typically ≤6 months) and a shift to comfort-focused goals.
Hospice = terminal, prognosis 6 months or less, curative treatment stopped. Palliative runs alongside curative treatment. Follow the client's stated goal, not the one you would pick. The client, not the family, decides while she is capable.
Neutropenic fever is the one "give antibiotics without proven infection" exception.ANC 800 with temp 100.8°F outranks post-cisplatin vomiting, petechiae and a pain request. Cultures plus IV antibiotics, likely admission.
ANC cutoffs they used: <1,500 neutropenic, <500 severe.
Neutropenic teaching corrections: no sushi or raw food even from a good restaurant · discard drinks left out over 1 hour · avoid gardening and cat litter · report temp over 100°F.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
Nothing here yet — drop it in when you have it
Exam 5Reproductive, disaster, mass casualty & emergencyWeeks 11–12
Sudden severe unilateral pain, swelling, nausea, high-riding testicle.
There is roughly a 6-hour window to save the testicle. This is never "watch and see".
✅ BPH vs prostate cancer
BPH — benign enlargement. Weak stream, hesitancy, nocturia, incomplete emptying.
Symptoms come early because the urethra is squeezed.
Prostate cancer — grows on the outer gland, so it is silent early. Symptoms
mean it is advanced. Screened with DRE and PSA.
Avoid anticholinergics, decongestants and antihistamines in BPH - they worsen retention.
⭐ Teaching that shows up as questions
Breast self-awareness monthly, best 7–10 days after menses starts
Testicular self-exam monthly, after a warm shower when the scrotum is relaxed
HPV vaccine protects against cervical and other cancers — give before exposure
⭐ High-yield — what the exam actually asks
Show 5 moreHide these 5
Pap every 3 years routinely (yearly if indicated). No douching, vaginal meds or intercourse for 24 hr beforehand. A total hysterectomy (uterus + cervix out) means no more Paps.
BSE monthly, 5–7 days after menses, easiest with soapy skin in the shower using fingertips. Clinical exam q3 yr ages 20–39, then yearly at 40+. Screening mammography yearly from age 40.
Mammogram teaching: no deodorant, lotion or powder in the axilla that day — metal particles mimic calcifications and cause false positives.
DCIS is non-invasive and does not metastasize (lumpectomy + radiation). Inflammatory carcinoma is rare and aggressive with peau d'orange skin.
Sentinel node biopsy: negative means no further nodes come out; positive triggers axillary dissection.
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Lymphedema after node removal: no BP, IVs, injections or blood draws in that arm. Limb alert bracelet, compression sleeve.
Ovarian cancer is the silent one — vague bloating, early satiety, pelvic pain, so it presents late. CA-125 tracks disease but is not a screening test. Endometrial cancer announces itself with post-menopausal bleeding, which is why it is caught earlier; tamoxifen and estrogen dominance are risk factors.
Endometriosis = endometrial tissue outside the uterus → pain, scarring, infertility. Not insulin-related. PID follows untreated STIs and causes scarring and infertility.
Hysterectomy: the priority post-op concern is hemorrhage, not airway. Excessive bleeding = one pad saturated in 4 hours. Foley stays 24 hr; anti-embolism stockings pre-op.
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Anything ending in -oophorectomy (both ovaries) = immediate surgical menopause at any age → HRT discussion.
STI workup: cervical swab (not blood, not urine); ask duration first (months of symptoms suggests PID); treat partners; pelvic ultrasound only if PID is suspected. HPV vaccine at 11–12, available ages 9–26.
BPH is enlargement, not cancer. Finasteride shrinks the prostate but takes up to 6 months and pregnant women must not handle it. Tamsulosin relaxes the outlet — warn about orthostatic hypotension during nighttime voiding.
TURP/CBI: three-way catheter; the irrigant is NOT counted in I&O; titrate the rate to keep urine pink or lighter; never run CBI on an IV pump. Expected: pink-tinged urine and a constant urge to void. Unexpected: bright red urine and bladder spasms → check for kinks and clots, increase the irrigation rate, then manually irrigate; call the provider if that fails. No heavy lifting, straining or intercourse for 2–6 weeks.
Prostate cancer metastasizes to bone — new back or hip pain with weight loss may be the first sign. Testicular cancer: painless lump in men 15–35, highly curable, monthly self-exam; markers AFP, beta-hCG, LDH. ED can be an early marker of vascular disease; PDE5 inhibitors are contraindicated with nitrates.
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
Show 4 moreHide these 4
Sildenafil interactions they tested: nitroglycerin, amyl nitrate, and doxazosin. Recognize "-afil" as PDE5. Acetaminophen and amoxicillin are safe.
Endometrial cancer: postmenopausal bleeding is never normal.Unopposed estrogen is the highest risk — including endogenous estrogen from obesity, because fat makes estrogen.Tamoxifen raises risk by stimulating uterine estrogen receptors. Nulliparity, late menopause and early menarche all lengthen estrogen exposure; multiparity is protective.
Post-void residual: under 50–100 mL normal, 100–300 retention, over 300 significant. Eight hours without voiding and uncomfortable after prostate surgery → bladder scan first. Do not push fluids into a bladder that cannot empty.
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TURP with CBI: bright red urine with clots means INCREASE the irrigation rate. You are aiming for a rose color. A persistent urge to void alongside the clots is the bladder spasming against an obstructed catheter, not a full bladder. Their analogy — CBI does for the prostatic bed what fundal massage does after birth. Let it run bright red and the catheter clots off, and then you are manually irrigating.
Sexual assault priority order as taught: consent → emotional support and explanation → exam and documentation → collect and label clothing as evidence. They said the first two are genuinely arguable — but collecting and labeling clothing is never the first action.
Pre-op priority: allergies — anesthesia, latex, malignant hyperthermia — over jewelry removal. Consent, ID and allergy band top the list.
Post-op endometriosis surgery: no heavy lifting and nothing in the vagina for 2 weeks. Warm compresses for comfort. Screen for depression — it is chronic, debilitating, and often takes years to diagnose.
Deteriorating post-op trend: temp 98.6 → 99.5 → 101.2°F, incision clean → red → foul-smelling, pads saturated every 6 → 4 → 2 hours. Do: vitals and I&O, IV antibiotics, notify. Ambulation, warm compresses to the incision, and oral iron are all wrong — active significant bleeding needs transfusion, not iron.
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Sildenafil plus any nitrate causes profound hypotension. Question it before giving. Watch for a nitrate buried in a name — amyl nitrite counts. The whole PDE5 group (sildenafil, tadalafil, vardenafil) carries the same interaction.
One hour post-operative:vital signs first. Not reviewing pre-operative labs, and not infection — infection takes days, not an hour. When a priority question offers something dramatic, run ABC first.
PCOS: the dietary answer is weight reduction and a low-glycemic diet, because the underlying problem is insulin resistance.
Show 3 moreHide these 3
Cystocele: pelvic floor exercises, avoid heavy lifting and straining, treat constipation, and lose weight if relevant. Surgery is for what conservative measures do not hold.
“Avoid sexual activity for 24 hours” is the wrong shape of answer when the underlying problem has not been treated yet. Treat first, then give the timeframe.
Watch for absolutes. Options containing always, never or only are usually wrong in a medication question, because different clients need different things.
Show 5 moreHide these 5
The post-op priority ladder, whatever the surgery was: airway → breathing → circulation → neuro → is the gut waking up → is she making urine → then look at the surgical site. They set this one twice.
They trap this from both sides. A frightening surgery (quintuple bypass, intracranial bleed) with a quiet ABC problem buried in it — do you go to the ABC answer first? Or a clearly stable client with a tempting airway option — do not put oxygen on someone with no airway or breathing problem. Miss neither direction.
The AND rule. When an option joins two things with and, every part has to be true for the option to be true. “Provide emotional support” alone would rank first in the assault question; “provide emotional support and explain procedures” drops below consent, because you cannot explain a procedure she has not agreed to.
Radical prostatectomy takes the whole prostate and reattaches the bladder to the urethra — which is exactly why it obstructs. Eight hours without voiding and uncomfortable is obstruction: pushing fluids makes more urine, pain medication only masks it, and ambulating guesses when a bladder scan measures.
Retention is not just uncomfortable. Urine that never fully leaves the bladder breeds infection and backs pressure up toward the kidneys. That is why a 500 mL post-void residual is a problem and not a wait-and-see.
⚠️ Exam traps
Expected vs unexpected TURP findings, and remembering the irrigant is excluded from I&O.
Fibrocystic changes are bilateral, mobile and cyclical; a cancerous mass is single, fixed and non-tender.
🧠 Mind maps 2
One per disorder, built from the structure of your ATI chapter.
Infections, Diagnostic, and Therapeutic Procedures for Reproductive Disorders
🎯 Who gets it
BV risk rises with new or multiple partners, douching, IUD use, and around menses.
Candidiasis risk factors include oral contraceptives, corticosteroids, antibiotics, pregnancy, diabetes, or HIV.
HSV recurrence can be triggered by stress, sun exposure, dental work, fatigue, or poor nutrition.
Black and Pacific Islander clients face a higher syphilis risk.
👀 What you see
BV: thin white or gray discharge with a fishy odor; wet prep shows clue cells, pH above 4.5.
Candidiasis: thick, white, cottage-cheese-like discharge with itching; pH under 5, hyphae seen on wet mount.
HSV: painful vesicles that ulcerate and crust within 2 weeks, with tender lymph nodes.
HPV: painless genital warts, sometimes cauliflower-shaped; confirmed by whitening with 3%-5% acetic acid.
🩺 What you do
HSV has no cure; management focuses on relieving symptoms and reducing recurrence.
Advise abstaining from sex while HSV lesions are active, and wash hands after contact.
Syphilis requires abstinence until lesions fully heal, and it is a legally reportable disease.
Watch for a Jarisch-Herxheimer reaction (headache, fever, tachycardia, myalgia) after syphilis treatment.
💊 Drugs
OTC antifungals like miconazole and clotrimazole treat uncomplicated candidiasis for up to 7 days.
Prescription antifungals for candidiasis include terconazole or single-dose oral fluconazole.
Complicated or recurrent candidiasis needs longer or combination antifungal therapy.
Provider-applied HPV wart treatments include trichloroacetic acid (TCA) and podophyllin resin.
💬 What you teach
Schedule a pelvic exam 6-10 days after the last period, and empty the bladder beforehand.
Perform a testicular self-exam during or after a shower, gently rolling each testicle.
Discuss prostate screening at age 40 for highest risk, 45 for higher risk, or 50 for average risk.
⚠️ What goes wrong
Untreated BV raises risk for other STIs, including HIV, and for pregnancy complications.
Untreated syphilis can cause blindness or nervous system damage and raises HIV transmission risk.
Untreated chlamydia or gonorrhea can lead to PID, ectopic pregnancy, and infertility.
PID can scar the fallopian tubes and lead to tubo-ovarian abscess or peritonitis.
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
Reproductive Physiologic Processes
🎯 Who gets it
Primary amenorrhea risk: genetic/anatomic conditions, Turner syndrome, anorexia, or PCOS.
Secondary amenorrhea risk: pituitary issues, high or low BMI/body fat, breastfeeding, menopause, PCOS, disordered eating, excess exercise.
Menorrhagia/metrorrhagia risk: malignancy, fibroids, von Willebrand disease, hormone imbalance, or infection.
AUB risk: thyroid disease, PCOS, infection, polyps/fibroids, neoplasm, or certain meds.
👀 What you see
Dysmenorrhea: insomnia, backache, headache, pelvic cramping, nausea, and dizziness.
Secondary dysmenorrhea adds pelvic pain, painful sex, and bleeding between or after intercourse.
PMS/PMDD findings start days before menses, ease days after onset; PMDD is more severe.
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
ATI Active Learning Template — System DisorderInfections, Diagnostic, and Therapeutic Procedures for Reproductive Disorders
Filled from ATI chapter 64, row by row from that chapter’s own sections — 8 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Surveys reproductive screening exams (breast, pelvic, testicular, prostate), common STIs (bacterial vaginosis, candidiasis, HSV, syphilis, HPV, chlamydia, gonorrhea, trichomoniasis, PID), and related diagnostic and therapeutic procedures like mammography, Pap testing, biopsies, and hysterectomy.
Health Promotion & Disease Prevention
Not a section in this chapter. Fill from lecture if your instructor covers it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
BV risk rises with new or multiple partners, douching, IUD use, and around menses.
Candidiasis risk factors include oral contraceptives, corticosteroids, antibiotics, pregnancy, diabetes, or HIV.
HSV recurrence can be triggered by stress, sun exposure, dental work, fatigue, or poor nutrition.
Black and Pacific Islander clients face a higher syphilis risk.
Syphilis primary stage: a painless chancre appears within at least 2 weeks, resolving in 3-12 weeks.
Syphilis secondary stage develops 1 week to 6 months after the chancre, with a palm/sole rash.
Syphilis latent phase produces no visible findings at all.
Syphilis tertiary stage appears 1 to 20 years after infection, with organ damage and possible gummas.
Assessment — Expected Findings
BV: thin white or gray discharge with a fishy odor; wet prep shows clue cells, pH above 4.5.
Candidiasis: thick, white, cottage-cheese-like discharge with itching; pH under 5, hyphae seen on wet mount.
HSV: painful vesicles that ulcerate and crust within 2 weeks, with tender lymph nodes.
HPV: painless genital warts, sometimes cauliflower-shaped; confirmed by whitening with 3%-5% acetic acid.
Chlamydia is often asymptomatic but can cause mucopurulent cervical discharge and easy cervical bleeding.
Gonorrhea: yellowish-green vaginal or purulent penile discharge; females are frequently asymptomatic.
Trichomoniasis: yellow-green, frothy, foul-smelling discharge with strawberry spots on the cervix.
PID: pelvic pain and tenderness with fever and malaise, plus cervical or uterine tenderness on exam.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not a section in this chapter. Fill from lecture if your instructor covers it.
Diagnostic Procedures
Not a section in this chapter. Fill from lecture if your instructor covers it.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
HSV has no cure; management focuses on relieving symptoms and reducing recurrence.
Advise abstaining from sex while HSV lesions are active, and wash hands after contact.
Syphilis requires abstinence until lesions fully heal, and it is a legally reportable disease.
Watch for a Jarisch-Herxheimer reaction (headache, fever, tachycardia, myalgia) after syphilis treatment.
HPV can still spread to partners even after visible warts have cleared.
Retest for chlamydia or gonorrhea within 3 months of finishing treatment.
Tell chlamydia or gonorrhea partners from the past 60 days to get tested and treated.
Doxycycline can lower oral contraceptive effectiveness, so recommend backup protection.
Chlamydia, gonorrhea, and syphilis are all legally reportable diseases in every state.
Medications
OTC antifungals like miconazole and clotrimazole treat uncomplicated candidiasis for up to 7 days.
Prescription antifungals for candidiasis include terconazole or single-dose oral fluconazole.
Complicated or recurrent candidiasis needs longer or combination antifungal therapy.
Provider-applied HPV wart treatments include trichloroacetic acid (TCA) and podophyllin resin.
Client-applied HPV wart treatments include podofilox and imiquimod.
HPV lesions can also be removed with cryotherapy, surgical excision, or laser therapy.
HIV-positive females should have cytology screening within 1 year of sexual activity, repeated at 6 months.
After 3 consecutive normal Pap results, HIV-positive clients can screen every 3 years.
Therapeutic Procedures
BV's recommended treatment is oral or intravaginal metronidazole, or intravaginal clindamycin cream.
HSV antivirals (acyclovir, valacyclovir, famciclovir) shorten outbreaks and can suppress recurrence.
Syphilis treatment is a single IM dose of benzathine penicillin G, or 3 weekly doses if duration is unknown.
Penicillin-allergic syphilis clients can take oral doxycycline or tetracycline instead.
Chlamydia treatment is oral doxycycline for up to 7 days, or single-dose azithromycin.
Gonorrhea treatment is a single IM dose of ceftriaxone; treat for chlamydia too if it's also positive.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Schedule a pelvic exam 6-10 days after the last period, and empty the bladder beforehand.
Perform a testicular self-exam during or after a shower, gently rolling each testicle.
Discuss prostate screening at age 40 for highest risk, 45 for higher risk, or 50 for average risk.
An initial PSA below 2.5 ng/mL often only needs retesting every 2 years.
A PSA at or above 2.5 ng/mL usually prompts yearly retesting.
Draw PSA before a digital rectal exam, since palpation can falsely raise the level.
Avoid vaginal medication, douching, or intercourse for 24 hours before a Pap test.
Interprofessional Care
Not a section in this chapter. Fill from lecture if your instructor covers it.
⚠️ What goes wrongComplications
Complications
Untreated BV raises risk for other STIs, including HIV, and for pregnancy complications.
Untreated syphilis can cause blindness or nervous system damage and raises HIV transmission risk.
Untreated chlamydia or gonorrhea can lead to PID, ectopic pregnancy, and infertility.
PID can scar the fallopian tubes and lead to tubo-ovarian abscess or peritonitis.
Hysterosalpingography is timed 6-11 days after the last period to limit pregnancy or menses interference.
Cervical biopsy works best early in the menstrual cycle, when the cervix is less vascular.
After cervical or endometrial biopsy, avoid intercourse and vaginal insertions for about 2 weeks.
ATI Active Learning Template — System DisorderReproductive Physiologic Processes
Filled from ATI chapter 65, row by row from that chapter’s own sections — 9 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Covers the hormonal reproductive cycle and common menstrual disorders: dysmenorrhea, PMS/PMDD, amenorrhea, abnormal uterine bleeding, and perimenopause/menopause, including expected findings, diagnostic workup, nursing care, and hormone therapy considerations.
Health Promotion & Disease Prevention
Not a section in this chapter. Fill from lecture if your instructor covers it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Primary amenorrhea risk: genetic/anatomic conditions, Turner syndrome, anorexia, or PCOS.
Secondary amenorrhea risk: pituitary issues, high or low BMI/body fat, breastfeeding, menopause, PCOS, disordered eating, excess exercise.
Menorrhagia/metrorrhagia risk: malignancy, fibroids, von Willebrand disease, hormone imbalance, or infection.
AUB risk: thyroid disease, PCOS, infection, polyps/fibroids, neoplasm, or certain meds.
AUB medication risk factors include hormonal contraceptives and anticoagulants.
Assessment — Expected Findings
Dysmenorrhea: insomnia, backache, headache, pelvic cramping, nausea, and dizziness.
Secondary dysmenorrhea adds pelvic pain, painful sex, and bleeding between or after intercourse.
PMS/PMDD findings start days before menses, ease days after onset; PMDD is more severe.
Reassure clients with AUB and provide condition education.
Teach menopausal clients to report any vaginal bleeding right away.
Vaginal estrogen is preferred for atrophic vaginitis since it limits systemic absorption.
For dyspareunia from vaginal dryness, recommend a water-soluble lubricant.
Medications
Oral contraceptives can reduce how severe PMS and PMDD symptoms feel.
NSAIDs like ibuprofen ease PMS/PMDD pain by blocking prostaglandin production.
SSRIs such as fluoxetine and sertraline treat PMS/PMDD mood and physical symptoms.
Spironolactone helps manage fluid retention from PMS or PMDD.
Hormonal contraceptives regulate cycles and reduce AUB bleeding severity.
Conjugated estrogens can manage or reduce AUB bleeding.
Oral iron supplements treat anemia from AUB-related blood loss.
Menopausal HT contains estrogen alone or estrogen plus progestin.
Therapeutic Procedures
Secondary dysmenorrhea treatment targets the underlying pelvic pathology.
Amenorrhea management depends on identifying and treating the underlying cause.
Menorrhagia treatment varies widely depending on its underlying cause.
D&C diagnoses and treats AUB by dilating the cervix and scraping the uterine lining for lab exam.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Not a section in this chapter. Fill from lecture if your instructor covers it.
Interprofessional Care
Not a section in this chapter. Fill from lecture if your instructor covers it.
⚠️ What goes wrongComplications
Complications
Menopause raises osteoporosis risk from bone loss, increasing fracture risk.
Manage osteoporosis with bisphosphonates, calcium therapy, and weight-bearing exercise.
Smoking increases embolic risk with HT: MI, stroke, venous thrombosis.
Long-term HT use may raise breast cancer risk.
Long-term estrogen-only HT may raise ovarian and endometrial cancer risk.
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Pap every 3 years routinely (yearly if indicated). No douching, vaginal meds or intercourse for 24 hr beforehand. A total hysterectomy (uterus + cervix out) means no more Paps.
BSE monthly, 5–7 days after menses, easiest with soapy skin in the shower using fingertips. Clinical exam q3 yr ages 20–39, then yearly at 40+. Screening mammography yearly from age 40.
Ovarian cancer is the silent one — vague bloating, early satiety, pelvic pain, so it presents late. CA-125 tracks disease but is not a screening test. Endometrial cancer announces itself with post-menopausal bleeding, which is why it is caught earlier; tamoxifen and estrogen dominance are risk factors.
Hysterectomy: the priority post-op concern is hemorrhage, not airway. Excessive bleeding = one pad saturated in 4 hours. Foley stays 24 hr; anti-embolism stockings pre-op.
STI workup: cervical swab (not blood, not urine); ask duration first (months of symptoms suggests PID); treat partners; pelvic ultrasound only if PID is suspected. HPV vaccine at 11–12, available ages 9–26.
BPH is enlargement, not cancer. Finasteride shrinks the prostate but takes up to 6 months and pregnant women must not handle it. Tamsulosin relaxes the outlet — warn about orthostatic hypotension during nighttime voiding.
TURP/CBI: three-way catheter; the irrigant is NOT counted in I&O; titrate the rate to keep urine pink or lighter; never run CBI on an IV pump. Expected: pink-tinged urine and a constant urge to void. Unexpected: bright red urine and bladder spasms → check for kinks and clots, increase the irrigation rate, then manually irrigate; call the provider if that fails. No heavy lifting, straining or intercourse for 2–6 weeks.
Prostate cancer metastasizes to bone — new back or hip pain with weight loss may be the first sign. Testicular cancer: painless lump in men 15–35, highly curable, monthly self-exam; markers AFP, beta-hCG, LDH. ED can be an early marker of vascular disease; PDE5 inhibitors are contraindicated with nitrates.
Sildenafil interactions they tested: nitroglycerin, amyl nitrate, and doxazosin. Recognize "-afil" as PDE5. Acetaminophen and amoxicillin are safe.
Endometrial cancer: postmenopausal bleeding is never normal. Unopposed estrogen is the highest risk — including endogenous estrogen from obesity, because fat makes estrogen.Tamoxifen raises risk by stimulating uterine estrogen receptors. Multiparity is protective.
Post-void residual: under 50–100 mL normal, 100–300 retention, over 300 significant. Not voiding post-prostatectomy → bladder scan first, do not push fluids.
Sexual assault priority order as taught: consent → emotional support and explanation → exam and documentation → collect and label clothing as evidence. They said the first two are genuinely arguable.
Pre-op priority: allergies — anesthesia, latex, malignant hyperthermia — over jewelry removal. Consent, ID and allergy band top the list.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
Nothing here yet — drop it in when you have it
▸M12Disaster, Mass Casualty & Emergency NursingWeek 12
Disaster triage inverts everyday nursing. Normally the sickest patient goes first. In a
mass casualty you do the greatest good for the greatest number —
so the most critically injured may be passed over.
Tag
Means
Examples
🔴 RED
Immediate — life-threatening but survivable with quick care
Airway obstruction, tension pneumothorax, severe controllable bleeding
🟡 YELLOW
Delayed — serious, can wait 30–60 min
Open fractures, stable abdominal injury
🟢 GREEN
Minimal — “walking wounded”
Minor cuts, sprains; can often help others
⚫ BLACK
Expectant — dead, or injuries incompatible with survival
Massive head trauma, full-thickness burns >90%
🚨 The counter-intuitive rule
A patient in cardiac arrest during a mass casualty event is tagged black, not red.
Resuscitating one person consumes the staff and time that could save several.
This is the opposite of everyday practice, and that is exactly why it is tested.
🛡️ Who gets discharged to make beds
When a disaster is announced, the patients discharged first are the most stable —
typically those already awaiting discharge, day-surgery patients, and stable chronic patients.
✅ Decontamination order
1 · PPEProtect yourself first
2 · RemoveClothing — removes ~80% of contaminant
3 · WashCopious soap and water
4 · ThenTreat — decontaminate before entering the ED
You are no use to anyone as a second casualty. Scene safety and your own PPE come before patient contact - every time.
⭐ High-yield — what the exam actually asks
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Triage tags — RED: life-threatening but survivable with quick intervention. YELLOW: delayed (open or closed fractures, deep lacerations). GREEN: walking wounded. BLACK: expectant or deceased (agonal breathing, exposed brain matter, uncontrolled arterial bleed with major loss). An open fracture is yellow. A controllable arterial bleed is red; an uncontrolled one in an unresponsive client is black.
Three-tier system: emergent, urgent (treat within 2 hr), non-urgent. ESI runs Level 1 (most urgent) to Level 5.
Sequence is triage → primary survey → secondary survey. Never leave the primary survey until she is stable.
ABCDE: Airway with C-spine protection, Breathing, Circulation (control hemorrhage now), Disability (GCS/pupils), Exposure (undress fully, then prevent hypothermia). Brain death occurs within 3–5 min without an airway.
Secondary survey is head-to-toe after stabilization and includes AMPLE: Allergies, Medications, Past history, Last meal, Events.
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Tension pneumothorax is diagnosed by assessment — deviated trachea, absent breath sounds, unequal chest rise. Needle decompression first, then chest tube. Do not wait for imaging.
Chest tubes: tidaling is expected; water-seal bubbling means an air leak; never clamp during transport; keep the system below chest level. Disconnected → sterile water seal. Pulled out → occlusive dressing taped on three sides.
Intra-abdominal injury: rigid distended abdomen, guarding, Kehr's sign (referred shoulder pain = splenic injury). Crush injury: myoglobin causes AKI — aggressive fluids once the force is released. Tetanus prophylaxis if the last dose was 5–10 years ago.
Heat stroke: core >104°F with altered mental status → rapid cooling plus IV fluids. Hypothermia: core <95°F → handle gently, a cold heart is irritable. Frostbite: warm (not hot) water immersion, never rub, never rewarm if refreezing is possible.
Activated charcoal works for medications within 1–2 hours. Not for corrosives or hydrocarbons, and not without a protected airway.
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Antidotes: naloxone for opioids (watch for re-sedation), N-acetylcysteine for acetaminophen, flumazenil for benzos (can precipitate seizures), vitamin K for warfarin, protamine sulfate for heparin. Alcohol intoxication: airway and side-lying, and thiamine before glucose in chronic drinkers.
Snakebite: keep her still, limb at or below heart level, remove jewelry. No ice, tourniquet, cutting, heparin or steroids in the first 6–8 hours. Antivenom within 4–12 hr. Assess edema q15–30 min.
Sexual assault: safety and consent at every step, SANE examiner, preserve evidence but never delay care.Human trafficking red flag: a companion who will not leave the room or answers for her — interview alone with a professional interpreter.
Psychiatric emergency: de-escalate first; restraints are a last resort requiring an order and frequent reassessment. The ED is the #1 setting for staff abuse — document everything.
Agencies: FEMA coordinates federal response; CDC handles surveillance and the Strategic National Stockpile; OSHA sets PPE standards; The Joint Commission requires an emergency operations plan; HICS is the hospital chain of command. Follow your assigned task only.
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Anthrax is bacterial and NOT person-to-person — no isolation. Cutaneous, inhalation and ingestion routes; ciprofloxacin or penicillin. Smallpox (airborne) and plague (droplet) ARE transmissible. Nerve agents: decontaminate with soap and water or saline for ≥20 min — blot, do not wipe. Inhaled toxic chemicals cause pulmonary edema → intubate, not a chest tube.
Decontamination: remove all clothing and jewelry first (that alone removes most contamination), then copious head-to-toe irrigation, in a dedicated decon zone before entering the treatment area. Contain the runoff.
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
Show 3 moreHide these 3
Anthrax: IV ciprofloxacin. With hypotension and distress the first action is large-bore access and rapid isotonic fluids.
Carbon monoxide: the SpO2 is worthless. It reads 98% on room air while she is poisoned, because the probe cannot tell oxyhemoglobin from carboxyhemoglobin. You need a blood carboxyhemoglobin level. Treatment is 100% oxygen by non-rebreather. Symptoms are mostly neurologic — headache and dizziness first.
Nerve agent / cholinergic crisis — copious secretions, twitching, respiratory distress: atropine + pralidoxime + benzodiazepines for seizure risk, plus soap-and-water decontamination. Avoid plastic airway equipment, because plastic absorbs the agent.
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Frostbite is graded like burns. Clear blisters = second degree → rewarm in a water bath around 105–106°F, opioids for pain. Tetanus boosters every 10 years — but every 5 years if there is an open wound.
Disaster triage vs everyday ESI: in ESI, level 1 (the sickest) goes first. In mass casualty that same person may be black-tagged. You are hunting the red tag, not the black one.
Their field cutoffs: RR under 10 or over 30 is abnormal (10–29 acceptable) · cap refill over 2 seconds or pulse over 120 = red. No blood pressures — there is no time.
Their worked tag assignments: unconscious, RR 8, no pulse → black · walking wounded → green · RR 30 + cap refill >2 s + cannot follow commands → red · open femur fracture with stable vitals → yellow · chest burns with hoarseness and stridor → red · massive head trauma with agonal respirations → black · superficial forearm burn, alert → green.
Ingestion matrix: corrosive → endoscopy, no charcoal and no lavage · non-corrosive within 45 min → activated charcoal (the stomach empties in about 2 hours) · 3 hours out with stable vitals → supportive care only · known antidote → give the antidote. We never induce vomiting.
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Trauma with BP 60/palp and HR 144: two large-bore 18-gauge IVs and fluids. Not CT, not an NG tube.
Suicide attempt: constant observation, remove hazards, talk to her without family present, ask about suicide directly — the old “don’t say the word” belief is out — and crisis intervention now. They described a nurse who stayed with a client for ten hours outside the room: constant observation means constant. Individual therapy is not appropriate until the crisis is stabilized.
Calc: oxacillin 375 mg from 250 mg/1.5 mL = 2.3 mL. Their sanity check: "I'm giving more than I have, so my volume must exceed 1.5 mL."
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Glasgow Coma Scale runs 3 to 15 — it never starts at zero. 15 is alert and oriented. 8 or less means she is not protecting her airway: intubate. “GCS of 8, intubate” is the phrase to hold on to.
The direction matters more than the number. A GCS climbing from 10 to 14 is what you want. A falling GCS is the emergency, whatever the starting value.
Evisceration: cover the exposed bowel with sterile saline-moistened gauze, position supine with the knees flexed to take tension off the abdomen, nothing by mouth. Never dry gauze, never open to air, never push the bowel back in. If the vital signs are unstable, resuscitation still outranks the dressing.
Snake bite, what is contraindicated:a tourniquet, ice, cutting and sucking the wound, and alcohol. Keep the limb below heart level, immobilize it, remove rings and watches early, mark the leading edge of the swelling with the time, and give antivenom within 4 to 12 hours if indicated.
Show 5 moreHide these 5
Triage rule: unstable vital signs beat everything else on the list. If any option mentions resuscitation, that is the priority.
Put yourself in the room. Their repeated advice: picture the scene before reading the options. You would not walk to the cupboard for supplies before covering an open abdomen, and you would not call the provider before doing what you can.
Cutaneous anthrax — they flagged the image as one worth recognizing, because it changed a real patient’s management on their unit.
Radiation, chemical and biological exposure: decontaminate before the patient enters the department, and protect the staff first — you are no use to anyone contaminated.
In any mass casualty question, the resource is the constraint. The answer is what saves the most people with what is actually available, not what is best for one person.
⚠️ Exam traps
Disaster triage optimizes for the greatest good for the greatest number — which can mean not treating the sickest client.
Yellow vs green hinges on wound depth and mobility, not on which injury sounds worse.
Anthrax needs no isolation; smallpox and plague do.
🧠 Mind maps 1
One per disorder, built from the structure of your ATI chapter.
Emergency Nursing Principles and Management
🎯 Who gets it
Trauma victims risk hypothermia from exposure, cold oxygen, and cold IV fluids.
Children under 5 years old face the highest accidental poisoning risk.
Mid-to-late childhood kids face the highest snakebite risk.
Vulnerable clients face higher risk of trafficking exploitation.
👀 What you see
Hypothermia: shivering, impaired judgment, dysarthria, and drowsiness are common signs.
Heatstroke: temperature above 40° C (104° F) with altered mental status.
Heatstroke may show abnormal blood potassium or sodium levels.
Frostbite severity may not be clear until up to 24 hr after injury.
🩺 What you do
Airway comes first; brain injury or death can occur within 3 to 5 min without a patent airway.
Use head-tilt/chin-lift only when no cervical spine injury is suspected.
Use a modified jaw thrust if trauma is suspected, to protect the spine.
Apply direct pressure for bleeding first; use a tourniquet proximally if that fails.
💬 What you teach
Wear lightweight, loose clothing and avoid excess sun to prevent hyperthermia.
Stay indoors with fans or AC during periods of high heat.
Limit alcohol and caffeine intake in hot weather.
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🖼️ Triage at a glance 1
There is no separate disaster page on this site yet, so rather than link you to nothing, here is the chart itself.
Tag
Means
Who
RED Immediate
Life-threatening but survivable with rapid intervention
Airway obstruction, tension pneumothorax, severe hemorrhage, shock that responds
YELLOW Delayed
Serious, but can wait hours
Stable abdominal injury, large fractures, burns without airway involvement
GREEN Minimal
The walking wounded
Minor lacerations, sprains, small burns — and they can help
BLACK Expectant
Dead, or injuries incompatible with survival given available resources
Massive head injury, full-thickness burns over most of the body, no respirations after airway repositioning
🚨 This is the part that feels wrong and is right
In everyday nursing the sickest client is seen first. In a mass casualty that reverses: the goal is the greatest good for the greatest number, so the client who would consume enormous resources with little chance of survival is tagged expectant and the salvageable are treated first.
The walking wounded are moved out first — not because they matter least, but because clearing them lets you find everyone else.
📋 Active Learning Templates 1
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
ATI Active Learning Template — System DisorderEmergency Nursing Principles and Management
Filled from ATI chapter 3, row by row from that chapter’s own sections — 5 of 12 rows have content.
1 row below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
This chapter covers ED triage systems, the ABCDE primary survey, secondary survey steps, and management of heat/cold injuries, poisoning, overdose, trauma, maltreatment, psychiatric crises, and cardiac emergencies.
Health Promotion & Disease Prevention
Not a section in this chapter. Fill from lecture if your instructor covers it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Trauma victims risk hypothermia from exposure, cold oxygen, and cold IV fluids.
Children under 5 years old face the highest accidental poisoning risk.
Mid-to-late childhood kids face the highest snakebite risk.
Vulnerable clients face higher risk of trafficking exploitation.
A history of substance misuse raises trafficking vulnerability.
Assessment — Expected Findings
Hypothermia: shivering, impaired judgment, dysarthria, and drowsiness are common signs.
Heatstroke: temperature above 40° C (104° F) with altered mental status.
Heatstroke may show abnormal blood potassium or sodium levels.
Frostbite severity may not be clear until up to 24 hr after injury.
Full-thickness frostbite shows dark blisters, necrosis, and possible eschar.
Deep-tissue frostbite can cause gangrene and may require amputation.
Snakebite: pain, nausea, vomiting, numbness, and paresthesia at the site.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not a section in this chapter. Fill from lecture if your instructor covers it.
Diagnostic Procedures
Not a section in this chapter. Fill from lecture if your instructor covers it.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Airway comes first; brain injury or death can occur within 3 to 5 min without a patent airway.
Use head-tilt/chin-lift only when no cervical spine injury is suspected.
Use a modified jaw thrust if trauma is suspected, to protect the spine.
Apply direct pressure for bleeding first; use a tourniquet proximally if that fails.
Insert large-bore IVs in both antecubital areas unless a limb is injured.
A GCS under 8 means serious brain injury; a full score of 15 is expected.
AVPU is a quick consciousness check: Alert, Voice, Pain, Unresponsive.
Contact poison control at 800-222-1222 for suspected poisoning.
Gastric lavage is only useful within 1 hr of ingestion.
Medications
Not a section in this chapter. Fill from lecture if your instructor covers it.
Therapeutic Procedures
Not in your ATI chapter — filled from StatPearls, 2023.
Triage nurses use the Emergency Severity Index to sort patients into five acuity levels within about a minute.
Level 1 marks a patient who needs an immediate life-saving intervention such as airway or hemodynamic support.
Level 2 covers high-risk, confused, or severely distressed patients, or stable patients with markedly abnormal vital signs.
Levels 3 through 5 are set by how many hospital resources the visit is expected to require.
StatPearls (NCBI Bookshelf) · Emergency Department Triage · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
Wear lightweight, loose clothing and avoid excess sun to prevent hyperthermia.
Stay indoors with fans or AC during periods of high heat.
Limit alcohol and caffeine intake in hot weather.
Apply sunscreen rated at least SPF 30 before going outside.
Take a cool shower or bath if the client feels overheated.
For frostbite, rewarm in a warm, not hot, bath to restore circulation.
Do not rub or massage frostbitten skin, even if it feels numb.
Interprofessional Care
Not a section in this chapter. Fill from lecture if your instructor covers it.
⚠️ What goes wrongComplications
Complications
Not a section in this chapter. Fill from lecture if your instructor covers it.
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Three-tier system: emergent, urgent (treat within 2 hr), non-urgent. ESI runs Level 1 (most urgent) to Level 5.
Sequence is triage → primary survey → secondary survey. Never leave the primary survey until she is stable.
ABCDE: Airway with C-spine protection, Breathing, Circulation (control hemorrhage now), Disability (GCS/pupils), Exposure (undress fully, then prevent hypothermia). Brain death occurs within 3–5 min without an airway.
Tension pneumothorax is diagnosed by assessment — deviated trachea, absent breath sounds, unequal chest rise. Needle decompression first, then chest tube. Do not wait for imaging.
Chest tubes: tidaling is expected; water-seal bubbling means an air leak; never clamp during transport; keep the system below chest level. Disconnected → sterile water seal. Pulled out → occlusive dressing taped on three sides.
Intra-abdominal injury: rigid distended abdomen, guarding, Kehr's sign (referred shoulder pain = splenic injury). Crush injury: myoglobin causes AKI — aggressive fluids once the force is released. Tetanus prophylaxis if the last dose was 5–10 years ago.
Heat stroke: core >104°F with altered mental status → rapid cooling plus IV fluids. Hypothermia: core <95°F → handle gently, a cold heart is irritable. Frostbite: warm (not hot) water immersion, never rub, never rewarm if refreezing is possible.
Activated charcoal works for medications within 1–2 hours. Not for corrosives or hydrocarbons, and not without a protected airway.
Snakebite: keep her still, limb at or below heart level, remove jewelry. No ice, tourniquet, cutting, heparin or steroids in the first 6–8 hours. Antivenom within 4–12 hr. Assess edema q15–30 min.
Sexual assault: safety and consent at every step, SANE examiner, preserve evidence but never delay care. Human trafficking red flag: a companion who will not leave the room or answers for her — interview alone with a professional interpreter.
Psychiatric emergency: de-escalate first; restraints are a last resort requiring an order and frequent reassessment. The ED is the #1 setting for staff abuse — document everything.
Anthrax is bacterial and NOT person-to-person — no isolation. Cutaneous, inhalation and ingestion routes; ciprofloxacin or penicillin. Smallpox (airborne) and plague (droplet) ARE transmissible. Nerve agents: decontaminate with soap and water or saline for ≥20 min — blot, do not wipe. Inhaled toxic chemicals cause pulmonary edema → intubate, not a chest tube.
Decontamination: remove all clothing and jewelry first (that alone removes most contamination), then copious head-to-toe irrigation, in a dedicated decon zone before entering the treatment area. Contain the runoff.
Evisceration: saline-moistened sterile gauze, supine with knees flexed. Never dry gauze, never reinsert organs, never leave it open to air.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
Nothing here yet — drop it in when you have it
FinalCumulative — Module 13 is the only new contentWeeks 13–14
Shock is not low blood pressure — it is inadequate tissue perfusion. Blood pressure
is the last thing to fall, because compensation holds it up until it cannot.
By the time BP drops, the patient has been in shock for a while.
📈 The stages, and what fails at each
1 · InitialCellular hypoxia begins. No visible signs
2 · Compensatory↑HR, ↑RR, cool clammy skin, restless. BP still normal
3 · ProgressiveCompensation fails. BP falls, urine drops, confusion
4 · RefractoryOrgan death. Largely irreversible
The earliest reliable signs are a rising heart rate and restlessness
— not hypotension. Restlessness is cerebral hypoxia and it is frequently the first thing the
nurse notices.
Type
Problem
Skin
First treatment
Hypovolemic
Not enough volume
Cold, clammy
Fluids / blood
Cardiogenic
Pump failure
Cold, clammy
Inotropes — fluids may worsen it
Septic
Vasodilation + leak
Warm, flushed early
Cultures, then antibiotics + fluids
Anaphylactic
Massive histamine release
Warm, flushed, hives
Epinephrine IM
Neurogenic
Lost sympathetic tone
Warm, dry, bradycardic
Fluids, vasopressors
🚨 The two exceptions worth memorizing
Neurogenic shock is the only shock with a SLOW heart rate. Every other type is
tachycardic. Seen after spinal cord injury above T6.
Cardiogenic shock is the one where fluids can kill. The pump is already failing;
more volume floods the lungs.
✅ Sepsis — the hour-one bundle
Measure lactate — it is the tissue-perfusion marker
Blood cultures BEFORE antibiotics
Broad-spectrum antibiotics within 1 hour
30 mL/kg crystalloid for hypotension or lactate ≥ 4
Vasopressors if still hypotensive — norepinephrine first line
Cultures come before antibiotics - but never delay antibiotics beyond an hour to get them.
⭐ High-yield — what the exam actually asks
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Four stages: initial (cellular damage, normal vitals), compensatory (tachycardia is the earliest response, then vasoconstriction), progressive (fluids, antibiotics, pressors, intubation), refractory (irreversible → MODS → death).
MAP is the perfusion indicator, goal >65. Do not panic at an SBP in the 80s–90s if the MAP is adequate. Lactate goal ≤2; lactate >2 with suspected infection means septic shock.
Confusion and altered mental status are LATE signs, not early ones.
Hypovolemic: 15–30% volume loss (~1 L). H&H high = fluid loss and hemoconcentration; H&H low = active bleeding. Fix the cause + fluids; blood products if bleeding.
Cardiogenic: pump failure, most often MI. Fluids are not the treatment — cardiac management is. MONA (morphine, oxygen, nitroglycerin SL q5 min ×3 max, aspirin ~324 mg not 81 mg); definitive treatment is cath with stent, or CABG. BNP normal <200; serial troponins.
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Sepsis bundle — order matters, all within the first hour: labs including lactate → blood cultures BEFORE antibiotics (2 sets / 4 bottles; with a central line, draw one peripherally and one from the line) → antibiotics before fluids → IV fluids → vasopressors only if fluids fail, targeting MAP ≥65.
SIRS needs 2 of 4: temp >38.3°C or <36°C, HR >90, RR >20, WBC >12,000 or <4,000 or >10% bands. Meeting criteria is not automatically sepsis.
Monitor response with serial lactate (should trend down) and MAP. Do not repeat blood cultures immediately — they take ~3 days.UTI is the most common sepsis source, especially in older adults. LR is now favored over NS.
Neurogenic: hypotension + bradycardia, the opposite of every other shock. Anaphylactic: epinephrine first, then oxygen, then fluids — fluids are not the priority. Obstructive: relieve the obstruction (needle decompression for tension pneumothorax; pericardiocentesis at the 5th intercostal space for tamponade — Beck's triad = muffled heart sounds, JVD, hypotension).
Norepinephrine is the first-line pressor. Central line, titrate to MAP. Phentolamine reverses extravasation; prolonged use causes digital necrosis. Use IO access if no line can be placed fast enough.
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Modified Trendelenburg (legs elevated) shifts ~300 mL back to the heart and tests fluid responsiveness. VS q15 min.
MODS = the original failing organ plus 2 more (3 total). Mortality exceeds 60% once 4+ organs are involved.
Intubation: preoxygenate 100%, sedate before you paralyze, and keep sedation going afterward. Confirm with bilateral breath sounds and symmetric chest rise, then ETCO2 (yellow/green = trachea, purple = esophagus → pull and retry), with CXR as the gold standard.
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
Show 5 moreHide these 5
Their four buckets: distributive = too much vasodilation · hypovolemic = not enough volume · cardiogenic = the pump · obstructive = something blocking or squeezing the pump.
Hypovolemic case: BP 78/50, HR 132, RR 28, UO 10 mL/hr, Hgb 8.2, Hct 25%. Underlying-cause treatment is rapid isotonic crystalloid — not pressors, not oxygen.
Cardiogenic case: troponin I 2.9 (normal <0.03), BNP 157 (normal <100), crackles, SpO2 88% on 4 L, UO 15 mL/hr. To improve cardiac output the answer is inotropes. No big fluid boluses, and no nitroglycerin while hypotensive — 80 becomes 60.
Obstructive / tamponade: Beck's triad — JVD, hypotension, muffled heart sounds. Definitive answer is pericardiocentesis; they note BP can jump from 78/50 to 140/80 in minutes.
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Neurogenic: C5 injury, BP 74/42, HR 48 — the one shock that does not produce tachycardia (vagus intact, sympathetic chain lost), warm skin, cap refill under 2 seconds, low temp. Treat with norepinephrine. High-dose corticosteroids are never used in spinal cord injury — dismiss that option on sight. Neurogenic shock (hemodynamic) and spinal shock (motor/sensory) are separate and can coexist.
SIRS vs septic shock as they drew it: the SIRS case had BP 110/68, WBC 18,000, lactate 1.8. Septic shock requires SBP under 90 and lactate over 2, with 4 as the key marker, plus a vasopressor need. Their progression case: BP 78/46, HR 132, cap refill over 4 s, UO 100 mL in 8 hours, lactate 4.2.
MODS = at least two major organ systems failing. Confusion (neuro), oliguria and rising creatinine (renal), high bilirubin and enzymes (hepatic), low platelets and DIC.
After a 2 L bolus in sepsis, monitor for pulmonary edema, respiratory distress, DIC, and hyperglycemia from stress glycogenolysis — not hypoglycemia, not hypernatremia.
Deterioration ABG: PaO2 58, PaCO2 80, pH 7.31 → intubate. Cranking a nasal cannula to 15 L/min is not an answer.
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Post-intubation bow tie: early complications = hypotension and VAP · immediate actions = new vital signs and repeat ABG · effectiveness = PaO2 above 80 and MAP at or above 65. Temperature and WBC are data points, not effectiveness indicators.
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What shock actually is:hypotension and hypoperfusion of the vital organs — not an emotional state. The body abandons everything except heart, lungs and brain.
The hypovolemic picture they gave: BP 78/50, HR 132, RR 28, pale and diaphoretic, black tarry stools, and urine output of 10 mL in an hour.
A urine output of ten mL/hr is the kidney refusing to let go of a single drop because the body is in serious trouble — well under the 30 mL/hr floor.
Hypovolemic: the tank is empty. Volume first — crystalloid, then blood if it is a hemorrhage. Vasopressors do not fill an empty tank, and squeezing an empty circuit makes the perfusion worse.
Cardiogenic: the pump has failed. Improve contractility (dobutamine) and reduce afterload — but vasodilators only if the pressure can tolerate them, which is why the question kept asking which cardiogenic client gets them.
Show 5 moreHide these 5
Obstructive: something is physically blocking flow — cardiac tamponade, tension pneumothorax, massive PE. The treatment is to relieve the obstruction: pericardiocentesis, needle decompression, thrombolysis. More fluid does not fix a blockage.
Distributive and septic: the tank has got bigger, not emptier. Fluids first, then norepinephrine. Lactate and cultures before antibiotics, and antibiotics inside the first hour.
Urine output is the earliest organ marker in every type of shock. It falls before the blood pressure tells you anything useful.
Why a diuretic is the wrong answer in shock: the problem is not too much fluid, it is not enough perfusion. A diuretic takes away what little volume she has.
MODS is the end point — organ after organ failing because perfusion was not restored in time. That is what all of this is trying to prevent.
⚠️ Exam traps
Warm flushed skin with bounding pulses points to septic or anaphylactic, never cardiogenic (which is cold and clammy).
JVD with muffled heart sounds is obstructive tamponade, not cardiogenic — even though it involves the heart.
No shock type increases urine output. Rising output means the treatment is working.
Bradycardia + hypotension = neurogenic. Bradycardia + hypertension is not shock at all — think ICP.
🧠 Mind maps 1
One per disorder, built from the structure of your ATI chapter.
Shock
🎯 Who gets it
Cardiogenic shock stems from MI (especially anterior wall), heart failure, cardiomyopathy, or valve failure.
Older adults face higher cardiogenic shock risk from MI and cardiomyopathy.
Hypovolemic shock follows major fluid loss (vomiting, diarrhea) or blood loss (trauma, burns, DKA).
Older adults dehydrate easily from even small fluid losses, especially with diuretics.
👀 What you see
Findings can include chest pain, lethargy, and somnolence.
Restlessness, anxiousness, and dyspnea are common shock findings.
Diaphoresis, thirst, and muscle weakness can also occur.
Nausea and vomiting are common findings across shock types.
🧪 What confirms it
ABGs show metabolic acidosis with a low pH and low PaO2 in shock.
PaCO2 first drops from hyperventilation, then rises with respiratory failure.
Blood lactic acid rises due to anaerobic metabolism.
Blood glucose levels can climb from stress-induced hypermetabolism during shock.
🩺 What you do
Maintain MAP at least 65 mm Hg to ensure adequate organ perfusion.
Report urine output below 0.5 mL/kg/hr; monitor it hourly.
Use a 100% non-rebreather mask for high-flow O2; COPD clients start at 2 L/min nasal cannula.
Position the client supine with legs elevated (Trendelenburg) to treat hypotension.
💊 Drugs
Milrinone and dobutamine strengthen cardiac contraction and increase cardiac output.
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🖼️ Infographics & deep dives 5
One page per kind of shock, plus the overview. Read the overview first.
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
ATI Active Learning Template — System DisorderShock
Filled from ATI chapter 38, row by row from that chapter’s own sections — 10 of 12 rows have content.
1 row below came from outside your ATI chapter — each one says where.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Shock is inadequate tissue perfusion that can progress to organ failure; maintaining MAP at least 65 mm Hg preserves perfusion. Four types—cardiogenic, hypovolemic, obstructive, distributive—move through initial, compensatory, progressive, and refractory stages.
Health Promotion & Disease Prevention
Reduce cardiogenic shock risk with exercise, healthy diet, stress reduction, and not smoking.
Stay well hydrated during exercise or hot weather to prevent hypovolemic shock.
Seek care early for illness, trauma, dehydration, or bleeding signs.
Know dehydration signs: thirst, low urine output, and dizziness.
Wear seatbelts and helmets; use caution around dangerous equipment or activities.
Seek early care for infection signs: redness, swelling, drainage, fever, urinary burning.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Cardiogenic shock stems from MI (especially anterior wall), heart failure, cardiomyopathy, or valve failure.
Older adults face higher cardiogenic shock risk from MI and cardiomyopathy.
Hypovolemic shock follows major fluid loss (vomiting, diarrhea) or blood loss (trauma, burns, DKA).
Older adults dehydrate easily from even small fluid losses, especially with diuretics.
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
MAP is the perfusion indicator, goal >65. Do not panic at an SBP in the 80s–90s if the MAP is adequate. Lactate goal ≤2; lactate >2 with suspected infection means septic shock.
Hypovolemic: 15–30% volume loss (~1 L). H&H high = fluid loss and hemoconcentration; H&H low = active bleeding. Fix the cause + fluids; blood products if bleeding.
Cardiogenic: pump failure, most often MI. Fluids are not the treatment — cardiac management is. MONA (morphine, oxygen, nitroglycerin SL q5 min ×3 max, aspirin ~324 mg not 81 mg); definitive treatment is cath with stent, or CABG. BNP normal <200; serial troponins.
Sepsis bundle — order matters, all within the first hour: labs including lactate → blood cultures BEFORE antibiotics (2 sets / 4 bottles; with a central line, draw one peripherally and one from the line) → antibiotics before fluids → IV fluids → vasopressors only if fluids fail, targeting MAP ≥65.
SIRS needs 2 of 4: temp >38.3°C or <36°C, HR >90, RR >20, WBC >12,000 or <4,000 or >10% bands. Meeting criteria is not automatically sepsis.
Monitor response with serial lactate (should trend down) and MAP. Do not repeat blood cultures immediately — they take ~3 days.UTI is the most common sepsis source, especially in older adults. LR is now favored over NS.
Neurogenic: hypotension + bradycardia, the opposite of every other shock. Anaphylactic: epinephrine first, then oxygen, then fluids — fluids are not the priority. Obstructive: relieve the obstruction (needle decompression for tension pneumothorax; pericardiocentesis at the 5th intercostal space for tamponade — Beck's triad = muffled heart sounds, JVD, hypotension).
Norepinephrine is the first-line pressor. Central line, titrate to MAP. Phentolamine reverses extravasation; prolonged use causes digital necrosis. Use IO access if no line can be placed fast enough.
Modified Trendelenburg (legs elevated) shifts ~300 mL back to the heart and tests fluid responsiveness. VS q15 min.
MODS = the original failing organ plus 2 more (3 total). Mortality exceeds 60% once 4+ organs are involved.
Intubation: preoxygenate 100%, sedate before you paralyze, and keep sedation going afterward. Confirm with bilateral breath sounds and symmetric chest rise, then ETCO2 (yellow/green = trachea, purple = esophagus → pull and retry), with CXR as the gold standard.
Hypovolemic case: BP 78/50, HR 132, RR 28, UO 10 mL/hr, Hgb 8.2, Hct 25%. Underlying-cause treatment is rapid isotonic crystalloid — not pressors, not oxygen.
Cardiogenic case: troponin I 2.9 (normal <0.03), BNP 157 (normal <100), crackles, SpO2 88% on 4 L, UO 15 mL/hr. To improve cardiac output the answer is inotropes. No big fluid boluses, and no nitroglycerin while hypotensive — 80 becomes 60.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
Do not reread. Retrieve. Cover the answer column, say it out loud, then check.
The struggle to recall is what builds the memory — rereading feels productive and is not.
🚨 The priority rules that decide most questions
ABC — airway, breathing, circulation, in that order
Acute beats chronic. A new problem outranks a long-standing one
Unstable beats stable. Changing vital signs outrank a scheduled task
Actual beats potential. A real problem outranks a risk
Assess before intervene — unless it is an emergency with an obvious action
Greatest good for the greatest number; arrest = black
Shock
BP falls last; neurogenic is the bradycardic one
✅ The week before
Work from this summary table outward. If you can say the right-hand column from memory for
every row, you have the spine of the course. Then go back only to the modules where you could not.
⭐ High-yield — what the exam actually asks
The final is cumulative. Module 13 (Shock & MODS) is the only content that has not already been on an exam, so it is the highest-value review target per hour.
Dosage calculation is fair game on every exam and appears on all six module review lists. Parkland, weight-based dosing, mL/hr, gtt/min, desired-over-have, mcg/kg/min pressor drips, and lb ÷ 2.2.
The Clinical Judgment Model heads every review list: recognize cues → analyze cues → prioritize hypotheses → generate solutions → take action → evaluate outcomes.
Cross-cutting priority rules that decide most "what do you do first" items: ABCs, then urgent-over-non-urgent, then assess-before-intervene, then Maslow, then least restrictive.
Values inside the normal reference range are almost always distractors in select-all and highlight items.
⚠️ Exam traps
The ATI CMS Medical-Surgical Proctored Assessment is scheduled separately from the final — check the calendar, they are days apart.
🧠 Mind maps 1
Built from this page's own content — the same four questions every time, so the shape is familiar before the topic is.
What the final actually tests
🎯 Prioritize
ABC first — airway before breathing before circulation.
Acute beats chronic; unstable beats stable; actual beats potential risk.
Maslow when nothing is unstable: physiological before psychosocial.
Fresh post-op, new confusion, and a sudden change in a stable client all jump the queue.
👀 Recognize
A sudden change in level of consciousness is the earliest sign of most deterioration.
Warm and flushed with a wide pulse pressure = early distributive shock.
Cold and clammy = every other shock.
Rising lactate and falling urine output mean perfusion is failing.
🧪 Confirm
Potassium and the ECG go together: peaked T = high, flat T with a U wave = low.
Troponin makes an infarct; without it, it is angina.
A non-contrast CT comes before any thrombolytic.
Culture before antibiotics — but never delay the antibiotic to get it.
🩺 Act
Fluid before vasopressors, and fluid before insulin in DKA.
Check the potassium before starting insulin.
Airway before fluid in burns; fluid before wound care.
When two answers are both correct, pick the one that is assessment unless someone is unstable — then act.
🖼️ Infographics & deep dives 6
The pages worth re-reading before the final, in priority order.
The ATI template layout, filled from this page. Print it, cover the right, rebuild it.
Active Learning Template — System DisorderPrioritization & Clinical Judgment
Filled from this page's own content, row by row. No ATI chapter number is given, because that chapter was not opened.
🧭 What it isAlterations in Health (Diagnosis)
Alterations in Health (Diagnosis)
The final tests the order of your actions more than the facts themselves. Most questions give several correct interventions and ask which comes first.
👀 How it shows upAssessment — Expected Findings
Assessment — Expected Findings
A stem describing several clients: the one who is changing outranks the one who is merely sick.
A stem describing one client over time: the trend matters more than any single value.
🧪 How it is confirmedDiagnostic Procedures
Diagnostic Procedures
Ask what the test would change. If the answer is nothing right now, it is not the priority action.
🩺 What you doNursing Care
Nursing Care
Assess before intervening — unless the client is unstable, in which case act.
Do the thing that takes seconds and costs nothing first: reposition, oxygen, stop the infusion.
Delegate what is stable, predictable and unchanging; keep what needs judgment.
⚠️ What goes wrongComplications
Complications
Choosing the most thorough answer instead of the first one.
Calling the provider before gathering what the provider will ask for — unless the client is arresting.
Treating a number instead of the client attached to it.
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
The final is cumulative. Module 13 (Shock & MODS) is the only content that has not already been on an exam, so it is the highest-value review target per hour.
Dosage calculation is fair game on every exam and appears on all six module review lists. Parkland, weight-based dosing, mL/hr, gtt/min, desired-over-have, mcg/kg/min pressor drips, and lb ÷ 2.2.
Cross-cutting priority rules that decide most "what do you do first" items: ABCs, then urgent-over-non-urgent, then assess-before-intervene, then Maslow, then least restrictive.
Values inside the normal reference range are almost always distractors in select-all and highlight items.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
Nothing here yet — drop it in when you have it
NUR 258 · Adult Health Nursing II · built from your own course
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