Diganositic Studies Flashcards
EEG studies detect (4)
seisures, sleep disorders, cerebrovascular lesions, brain injury
lumbar puncture is contraindicated in these conditions3
increased icp, bleeding disorders and infection at the site
positions during lumbar puncture
lying on the side cannon ball or seated over the overbed table
sensation during needle insertion during lumbar puncture
pain radiating down the leg
monitor for these during lumbar puncture (4)
headache, nuchal rigidity, hematoma, pain
normal csf pressure
60-150mmHG
what is in csf?
color/ ph/ sp gravity
little protein, some glucose, no rbc, no wbc, no microbes, clear, colorless, odorless, ph 7.35, sp grav 1.007,
sensation felt when the contrast dye is injected during a cereral angiogram- taste and warmth over (5)
metallic taste, warm sensation on the face, jaw, tongue, lips and behind the eyes
location of catheter placement during an angiogram (2)
groin or neck
post procedure angiogram check (5) things
check insertion site for clotting, check the extremity distal to the puncture site for color, temp, pulses, cap refile
if bleeding after angiogram, do this
put pressure on the artery and notify MD
during an eeg pt is subjected to__ and aske to ___
flashing lights and asked to hyperventilate
before the eeg, pt instructions (2)
to wash hair and to be sleep deprived
before lumbar puncture have the client needs to (2)
remove all jewelry, and empty the bladder
post lumbar puncture have client do this to prevent headaches and bleeding
lie on the back for at least 4 hours
post lumbar interventions (4)
lie flat for several hours, hydration, pain meds, check site for csf leak/ bleedin
normal icp
10-20mmhg
indications for icp monitoring (2)
comatose pt and gcs score of 8
interventions post surgical icp monitoring (3)
check site q24hr for redness swelling, drainage
recalibrate monitoring device q24hr per protocol
obeserve icp waveforms and observe for icp 15 or more
measures to prevent infection and bleeding at icp site (5)
aseptic technique limit monitoring for 3-5 days sterile dressing closed drainage system irrigate only as needed
GCS
E4V5M6
Eye opening: 1 no response 2 for eye open to voice 3 for eye open to pain 4 for spontaneous eye opening
Verbal response 1 for no response 2 for moans/sounds 3 for inappropriate words 4 for incoherent sentence 5 for coherent sentence
Motor response 1for no response 2 decerebrate 3 decorticate 4 generalized pain response 5 for localized pain response 6 for follow commands
hold before eeg ( 3)
antionvulsants and cafeine and stimulants
formula to calculate CPP
MAP-ICP
formula for MAP
2DBP+1SBP/3= MAP
s/sx increased icp (7)
restlessness, irritability dilated or pinpoint pupil slow to react altered breathing pattern (cheyne stokes apnea) deterioration motor response abnormal posturing
normal cpp
60-100
normal MAP
70-150
CPP OF 50 (2)
ischemia and neuronal death
what happens when cerebral blood vessels dilate?
there is decreased resistance, cerebral blood flow increases, resulting in loss of autoregulation or compliance; loss of compliance makes the brain sensitive to small volume reflected in increased ICP
conditions that promote cerebral vessel dilation (3)
increased paCO2
decreased PaO2
increased hydrogen ion creating an acidic environment
how does the brain respond to loss of autoregulation or compensation?
by increasing systolic BP resulting in – cushings triad -widening pulse pressure, bradycardia with full bounding pulse, altered respirations, a medical emergency
cushings triad can lead to
herniation
decerebrate presentation
upper extremities-
lower extremities-
feet-
upper extremities- extension
lower extremities- extension
feet-flexion
decorticate presentation
upper extremities-
lower extremities-
feet-
upper extremities- flexion
lower extremities- extension
feet- flexion
Sumatriptans side effects and interventions
chest pain
sumatrptans contraindications
hypertension
cad
ishemic cardiac, cerebrovascular and peripheral vascular problems
best time to take sumatriptans
right after an aura or migraine starts
side effects of topiramate (4)
hypoglycemia, paresthesia, weight lss, cognitive changes
full effect of topiramate seen in this time frame
2-3 months
topiramate is an antiseisure also effective for __
migraines
abrupt dc of topiramate can cause __
seisures
to decrease kidney stones in topiramate do this
take lots of water
drugs that decrease tension type headaches (4)
topiramate, valproic acid, amitriptyline, mirtazapine
indications for stress test
angina
MI
dysrhythmias
HF
fasting is for x hrs is required and avoid these (3) before stress test
2-4 hrs; avoid caffeine, alchohol, smoking
post procedure hemodynamic catheter placement (9)
chest xray vital signs heart rhythm sao2 resp rate and effort compare arterial bp with cuff bp observe waveform document catheter plaement secure all connections
obtain hemo reading (5)
hob 15-30 degrees level transducer at the axis zero sytem at atm pressure compare hemo redings with physical assessment monitor trends in values
complications of hemo catheter (6)
infection, bleeding, embolism, sepsis, dysrhythmias, pnemothorax
interventions to prevent embolism (2)
flush nacl, avoid introducing air
purpose of angiography (2), indications (2)
- visualize clots narrowing or occlusion in the arteries 2.location and extent of heart disease
unstable angina
ecg changes
npo xhrs for angiography
8hrs
premedication before angiography
corticosteroids and antihistamine
intraoperative angiography (4)
give sedative/analgesia
monitor v/s
monitor dysrhythmias and ready to intervene
have resuscitation equipment ready
postprocedure angiography
v/s frequency
v/s q15min x4, q30min x2, qhour x4, q4hr monitor for bleeding/hematoma thrombosis assess pedal pulse, color, temp bedrest in supine, extremities straightfor 4-6 hrs monitor dysrhythmias admin antiplatelet/thrombolytic agent admin ativan admin pain meds morphine monitor urine output increase fluids/admin iv hydration dt contrast media
complications of angiography (4)
cardiac tamponade
artery restenosis
hematoma
retroperitoneal bleeding
interventions for cardiac tamponade
iv fluids
chest xray to confirm diagnosis
prepare for pericardiocentesis
what is cardiac tamponade
accumulation of fluids in the pericardial sac
s/s of cardiac tamponade (3)
- hypotension
- paradoxic pulse (variance of 10 mm or more in sbp between expiration and inspiration
- intracardiac and pawp are elevated and similar
hematoma interventions(2)
put pressure on the artery
monitor perifpheral circulation
restonosis of vessel time of occurence and interventions (4)
immediately or several weeks after procedure; monitor cardiac rhythm monitor chest pain notify md schedule pt to cadiac lab
retroperitoneal bleeding interventions (4)
assess flank pain
assess hypotension
notify md
iv fluids/ blood
vascular acess is for administration of (4) both central and picc catheters terminate here
administration of blood, chemo, antibiotics, tpn
distal 1/3 of supervior vena cava
entry point veins used in central and picc line (2) each
central line (subclavian/ jugular) picc (basilic/ cephalic vein) one finger from the antecubital
timeframe for picc and central line
picc- more than 12 months
central line - short term use
complications with picc/central lines (6)
- emboli/thrombosis
- phlebitis
- infiltration/extravasation
- occlusion
- air emboli
- mechanical complications
how to avoid damaging the mesh on the port catheters
use a noncoring (huber) needle
to prevent air emboli in central catheters; interventions for air embolus (4) to trap and aspirate the air
clamp all tubings
assess sudden sob, place in trendelenburg on left side, give 02, notify md
PAD/PAS mm Hg
PAD 5-15
PAS 15-25
CVP/ PAWP
cvp- 1-8
pawp 4-12
sv02
60-80%
