3rd year semester 1 final exam Flashcards
Phlebitis
Inflammation Mechanical (movement) & chemical (the actual fluid given)
Late signs of ICP?
decreased LOC bradycardia irregular respirations cheyne stokes respirations decerebrate or decorticate posturing fixed and dilated pupils
what is stupor?
marked diminution in reactivity to environmental stimuli and can be aroused only by continual stimulation
what are the stages of shock?
compensatory, progressive, irreversible
what degree should the HOB be raised to with ICP?
approx. 30 degrees
how do you figure out hourly infusion rate for a child?
100mL/kg for first 10 kg, 50mL/kg second 10kg, then 20mL/kg for remainder
divide all that by 24 to get the hourly rate
early signs of ICP?
headache vomiting blurred or double vision dizziness decreased pulse and respirations increased BP and pulse pressure pupil reaction time decreased, unequal or both changes in LOC, irritability
how long is peripheral parenteral nutrition usually given?
5-7 days
expected urine output for child?
1-2 mL/kg/hr
Obtunded
decreased arousal and awareness, inability to follow commands
what are some overall management strategies for shock?
respiratory support
fluid replacement - crystalloids (eg. NS, LR) to add more fluid, colloids (albumin) to expand blood volume
vasoactive meds
nutritional support (d/t metabolic demands)
what is MAP and what is the norm?
Mean Arterial Pressure
CO x peripheral resistance
normal 70-105 mmHg
what signs show that death is inevitable?
coma with fixed dilated pupils
impaired respirations
what is the critical low of MAP and what does it mean?
65 mmHg or lower
inadequate perfusion
why do we use IVs?
fluid replenishment
fast pain management
blood products
what three things need to be adequate in order to properly perfuse tissues and organs?
cardiac pump
vasculature
blood volume
what are ways ICP is managed?
Sedation, osmotic diuretics, restricting fluids, draining CSF, controlling fever, oxygenation, managing BP
what are the s&s of hypovolemic shock?
Skin cold and clammy
Disoriented
Restless
what is cushings reflex?
results from significant decrease in cerebral blood flow
increased arterial blood pressure - Causes rise in SBP (as high as 270)
widening of the pulse pressure
slowing of the heart rate
coma definition
state of unarousable unresponsiveness
no purposeful responses to internal or external stimuli Comas usually last 2-4 weeks
Persistent vegetative state
wakeful after coma but devoid of cognitive or affective mental function
name three things that can cause altered LOC
- Alcohol
- Epilepsy/ electrolytes
- Infection
- Overdose
- Uremia
- Trauma
- Insulin
- Psychosis
- Stroke/ seizures
Hematoma
collection or pocket of blood
Shock
end organs receive insufficient oxygenation for normal metabolic processes
what are the types of altered LOC?
neurologic
toxicologic
metabolic
how often should an IV site be changed in an adult?
q72-96 hours
what is cushings triad?
Bradycardia, HTN, irregular breathing pattern
Herniation, occlusion of blood flow
s and s of compensatory shock
cool & clammy skin decreased urinary output no bowel sounds increased respiratory rate narrowing/decreased pulse pressure
Infiltration/extravasation
when fluids are leaking outside the IV. Certain fluids can cause damage in the tissues around the site
what are reasons to use a central line?
lack of peripheral access
longer term
irritating solutions
rapid dilution
which type of altered LOC includes an abnormal papillary response?
neurologic
pH compatible with life?
6.8 - 7.8
what’s a nursing action that you can do during compensatory shock?
apply supplemental oxygen
decreased metabolic demand
what is the normal range of bicarb?
19-25
what are some characteristics of progressive stage of shock?
decreased MAP
significant drop in SBP (<90 or 40 below baseline)
interstitial edema (pulmonary edema), SOB & crackles
low o2 sat
high RR
tachycardia
chest pain
locked-in syndrome
lesion affecting the pons
results in tetraplegia
inability to speak
vertical eye movements and lid elevation remain intact
what scenario would intraosseous infusion be used for?
emergency such as burn (pediatric clts)
what are the two types of circulatory shock?
sepsis & anaphylactic
Akinetic mutism definition
unresponsiveness
patient makes no voluntary movement or sound sometimes opens eyes
what needs to be kept in mind when discontinuing central TPN?
abrupt d/c can lead to a drop in blood glucose d/t the dextrose in the sol’n
