CACI Exam prep Flashcards
What are 5 Non-modifiable risk factors for Cerebrovascular Disease?
Age (doubles each decade after 55) Gender (men>women) Ethnicity Family History Genetic predisposition
What are some Modifiable risk factors for Cerebrovascular Disease?
Smoking ETOH or drugs Obesity Cholesterol HTN Type 1 & 2 DM Heart disease AF Poor diet Sleep apnoea Lack of Exercise
With AF, what percentage of atrial kick do you lose?
You 30% of you kick/ejection fraction, causing blood to pool on valves. Risking a clot flicking off into the brain.
Paroxysmal AF alternates between AF and sinus rhythm
Regarding anti-platelet therapy -> What does an INR between 2-3 mean?
Blood is 2-3 times thinner than it was before. To prevent pooling and clotting. INR is tested when on warfarin and other blood thinners.
What are some common symptoms of a stroke?
Confusion. Facial droop. Slurred speech. Numbness in face/arm/leg. Weakness in face/arm/leg. Headache. Nausea and vomiting.
Right side brain strokes common symptoms?
Impulsive, left side neglect, short attention span
Left side brain stroke symptoms?
Language, Impaired speech, slow performance, depression and anxiety
What does F.A.C.E stand for in stroke?
Face - drooping?
Arms - can they lift both arms?
Speech - slurred, can they understand you?
Time - call 000, brain is minutes.
What are some diagnostic studies for suspected stroke patients?
CT scan MRI CT Angiography and perfusion (CTA/P) Chest x-ray (?aspiration) ECG Blood analysis Doppler ultrasonography Echocardiogram
What are the steps in managing an Ischaemic stroke?
- Call the stroke team
- Treat blood pressure if over 185/110 (After acute phase you want it around 130/__)
- Fluid and electrolyte balance with FB Chart (To avoid fluid overload)
- Ongoing monitoring: HR & BP
- Rest bed at 30 degrees (aspiration risk)
- Nil by mouth (Aspiration risk)
- Medication (Alteplase within 4.5hours)
- Other meds: Heparin, anticoags, statins, anti-hypertensives.
After an Ischaemic stroke how long do you have for Alteplase therapy and Endovasucular clot retrieval?
Alteplase = 4.5 hours
Clot retrieval = 8 hours
What is the desired blood pressure for Ichaemic stroke vs Haemorrhagic stoke?
After bleeding is controlled, you want the BP to remain higher in a Haemorrhagic stroke ~160mmHg (To maintain perfusion)
vs around 130mmHg in an Ischaemic stroke.
What are the steps in managing a Haemorrhagic stroke?
Call the stroke team Treat BP is over 160mmHg (maintain around 160) Ongoing monitoring (HR and BP) Monitor Intracranial pressure (ICP) RIB at 30 degrees Nil by mouth Medications: anticoag reversal (don't want them to bleed out if on Warfarin), seizure prevention, Nimodipine to reduce vasospasm. Surgery: Clipping and coiling
What are nursing interventions for stroke patients?
Close monitoring of BP for first 48 hours
Administer BP meds and evaluate
Measures to minimise ICP:
-Neutral head position
-Reduce hip flexion
-Distribute care to reduce stress on pt
Maintain temperature (can ^ through inflammatory process).
What is the Cushing’s Triad?
A physiological response to increased ICP (Intracrainial Pressure)
- Hypertension
- Bradycardia
- Irregular respirations
What are the three types of Aphasia?
Receptive Aphasia (Loss of comprehension) Expressive Aphasia (Inability to produce language) Global Aphasia (Total inability to communicate)
What are the three types of Aphasia?
Receptive Aphasia (Loss of comprehension) Expressive Aphasia (Inability to produce language) Global Aphasia (Total inability to communicate)
Which artery may be impacted with -> Motor and/or sensory deficit (contralateral), sucking or rooting reflex, rigidity, gait problems, loss of proprioception and fine touch.
Anterior cerebral
What artery is likely affected with the following symptoms -> Dominant side:Aphasia, motor and sensory deficit, hemianopsia
Nondominant side:Neglect, motor and sensory deficit, hemianopsia
Middle cerebral artery
Which artery is likely impacted with the following symptoms?
Hemianopsia, visual hallucination, spontaneous pain, motor deficit
Posterior cerebral artery
Which artery is likely impacted with the following symptoms?
Cranial nerve deficits, diplopia, dizziness, nausea, vomiting, dysarthria, dysphagia, and/or coma
Vertebral artery
What are the categories for Braden Scale?
Mild risk = 18-15
Moderate risk = 14-13
High risk = 12-10
Severe risk = 9 or below
Over how many litres of Oxygen delivery do you need to add humidification?
Over 4 Litres needs humidification via High flow system (Air vivo) and a temperature of 36/37 degrees.
Over how many litres of Oxygen delivery do you need to add humidification?
Over 4 Litres needs humidification via High flow system (Air vivo) and a temperature of 36/37 degrees.
What diagnostic studies would you expect on a respiratory patient?
Bloods: FBE, EUC (Kidney), ABG’s (Blood gases)
ECG: HR or ST changes
CXR: no abnormal pathology, normal heart boarders
Sputum specimen: culture and sensitivity. Optimum collection on waking
Peak flow: normal range 400-700 Litre/min
Spirometry: Gold Standard - diagnose airway obstruction
Pulse oximetry
What are some nursing problems for respiratory patients?
Impaired Gas Exchange Ineffective airway clearance Ineffective breathing pattern Activity intolerance Anxiety
What are some key nursing responsibilities for respiratory patients?
Medication administration:Bronchodilators, Steroids, Oxygen
Breathing and coughing techniques
Facilitate removal of secretions
Preventing future attacks
What do you look for in a IV canula check?
Patency (Flush it)
Look for: Inflammation, Skin integrity, Flebitis (heat, swelling, irritated).
Position of arm
How long its been in for (less than 3 days).
What are the symptoms of Hypoglycaemia?
Slurred speech, headache, shaking, cold and clammy, emotional, irritated, sweating, tachycardia, numbness, confused.
What are the symptoms of Hyperglycaemia?
weakness, blurred vision, adobo cramps, increase urination.
Outline 10 rights of medication administration?
Right: Patient Assessment Time Drug Dose Route Education Right to refuse Evaluation Documentation
What are the 7 parts of a medication order?
Patient Medication Date Dose Route Time and Frequency Signature of prescriber
What angle do you insert an intradermal needle?
5-15 Degrees into the epidermis around 3mm
Whats the max amount that can be injected? IM Ventrogluteal? IM Deltoid? Max dose for Subcut? Max dose Intradermal?
Ventrogluteal - 4mls
Deltoid - 2ml
Subcut - 1ml
Intradermal - 0.5ml
What are some nursing considerations following a subcut injection?
Dispose of sharps safely
Document
Evaluate
Don’t rub the area
What do drugs ending in olol do?
They are Beta blockers, they inhibit the beta receptors in the heart causing decrease in HR and BP. This allows the heart longer to fill, making it more effective when it contracts.
