CACI Exam prep Flashcards by Jen Cutajar

What are 5 Non-modifiable risk factors for Cerebrovascular Disease?

Age (doubles each decade after 55)
Gender (men>women)
Ethnicity
Family History
Genetic predisposition

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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

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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

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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.

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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.

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Right side brain strokes common symptoms?

Impulsive, left side neglect, short attention span

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Left side brain stroke symptoms?

Language, Impaired speech, slow performance, depression and anxiety

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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.

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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

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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.

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After an Ischaemic stroke how long do you have for Alteplase therapy and Endovasucular clot retrieval?

Alteplase = 4.5 hours

Clot retrieval = 8 hours

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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.

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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

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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).

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What is the Cushing’s Triad?

A physiological response to increased ICP (Intracrainial Pressure)

Hypertension
Bradycardia
Irregular respirations

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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.