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Critical Care Nursing > Diganositic Studies > Flashcards

Diganositic Studies Flashcards

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1
Q

EEG studies detect (4)

A

seisures, sleep disorders, cerebrovascular lesions, brain injury

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2
Q

lumbar puncture is contraindicated in these conditions3

A

increased icp, bleeding disorders and infection at the site

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3
Q

positions during lumbar puncture

A

lying on the side cannon ball or seated over the overbed table

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4
Q

sensation during needle insertion during lumbar puncture

A

pain radiating down the leg

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5
Q

monitor for these during lumbar puncture (4)

A

headache, nuchal rigidity, hematoma, pain

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6
Q

normal csf pressure

A

60-150mmHG

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7
Q

what is in csf?

color/ ph/ sp gravity

A

little protein, some glucose, no rbc, no wbc, no microbes, clear, colorless, odorless, ph 7.35, sp grav 1.007,

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8
Q

sensation felt when the contrast dye is injected during a cereral angiogram- taste and warmth over (5)

A

metallic taste, warm sensation on the face, jaw, tongue, lips and behind the eyes

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9
Q

location of catheter placement during an angiogram (2)

A

groin or neck

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10
Q

post procedure angiogram check (5) things

A

check insertion site for clotting, check the extremity distal to the puncture site for color, temp, pulses, cap refile

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11
Q

if bleeding after angiogram, do this

A

put pressure on the artery and notify MD

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12
Q

during an eeg pt is subjected to__ and aske to ___

A

flashing lights and asked to hyperventilate

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13
Q

before the eeg, pt instructions (2)

A

to wash hair and to be sleep deprived

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14
Q

before lumbar puncture have the client needs to (2)

A

remove all jewelry, and empty the bladder

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15
Q

post lumbar puncture have client do this to prevent headaches and bleeding

A

lie on the back for at least 4 hours

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16
Q

post lumbar interventions (4)

A

lie flat for several hours, hydration, pain meds, check site for csf leak/ bleedin

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17
Q

normal icp

A

10-20mmhg

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18
Q

indications for icp monitoring (2)

A

comatose pt and gcs score of 8

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19
Q

interventions post surgical icp monitoring (3)

A

check site q24hr for redness swelling, drainage
recalibrate monitoring device q24hr per protocol
obeserve icp waveforms and observe for icp 15 or more

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20
Q

measures to prevent infection and bleeding at icp site (5)

A 
aseptic technique
limit monitoring for 3-5 days
sterile dressing
closed drainage system
irrigate only as needed
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21
Q

GCS

E4V5M6

A 
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
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22
Q

hold before eeg ( 3)

A

antionvulsants and cafeine and stimulants

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23
Q

formula to calculate CPP

A

MAP-ICP

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24
Q

formula for MAP

A

2DBP+1SBP/3= MAP

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25
Q

s/sx increased icp (7)

A 
restlessness,
irritability
dilated or pinpoint pupil
slow to react
altered breathing pattern (cheyne stokes apnea)
deterioration motor response
abnormal posturing
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26
Q

normal cpp

A

60-100

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27
Q

normal MAP

A

70-150

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28
Q

CPP OF 50 (2)

A

ischemia and neuronal death

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29
Q

what happens when cerebral blood vessels dilate?

A

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

30
Q

conditions that promote cerebral vessel dilation (3)

A

increased paCO2
decreased PaO2
increased hydrogen ion creating an acidic environment

31
Q

how does the brain respond to loss of autoregulation or compensation?

A

by increasing systolic BP resulting in – cushings triad -widening pulse pressure, bradycardia with full bounding pulse, altered respirations, a medical emergency

32
Q

cushings triad can lead to

A

herniation

33
Q

decerebrate presentation
upper extremities-
lower extremities-
feet-

A

upper extremities- extension
lower extremities- extension
feet-flexion

34
Q

decorticate presentation
upper extremities-
lower extremities-
feet-

A

upper extremities- flexion
lower extremities- extension
feet- flexion

35
Q

Sumatriptans side effects and interventions

A

chest pain

36
Q

sumatrptans contraindications

A

hypertension
cad
ishemic cardiac, cerebrovascular and peripheral vascular problems

37
Q

best time to take sumatriptans

A

right after an aura or migraine starts

38
Q

side effects of topiramate (4)

A

hypoglycemia, paresthesia, weight lss, cognitive changes

39
Q

full effect of topiramate seen in this time frame

A

2-3 months

40
Q

topiramate is an antiseisure also effective for __

A

migraines

41
Q

abrupt dc of topiramate can cause __

A

seisures

42
Q

to decrease kidney stones in topiramate do this

A

take lots of water

43
Q

drugs that decrease tension type headaches (4)

A

topiramate, valproic acid, amitriptyline, mirtazapine

44
Q

indications for stress test

A

angina
MI
dysrhythmias
HF

45
Q

fasting is for x hrs is required and avoid these (3) before stress test

A

2-4 hrs; avoid caffeine, alchohol, smoking

46
Q

post procedure hemodynamic catheter placement (9)

A 
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
47
Q

obtain hemo reading (5)

A 
hob 15-30 degrees
level transducer at the axis
zero sytem at atm pressure
compare hemo redings with physical assessment
monitor trends in values
48
Q

complications of hemo catheter (6)

A

infection, bleeding, embolism, sepsis, dysrhythmias, pnemothorax

49
Q

interventions to prevent embolism (2)

A

flush nacl, avoid introducing air

50
Q

purpose of angiography (2), indications (2)

A
  1. visualize clots narrowing or occlusion in the arteries 2.location and extent of heart disease
    unstable angina
    ecg changes
51
Q

npo xhrs for angiography

A

8hrs

52
Q

premedication before angiography

A

corticosteroids and antihistamine

53
Q

intraoperative angiography (4)

A

give sedative/analgesia
monitor v/s
monitor dysrhythmias and ready to intervene
have resuscitation equipment ready

54
Q

postprocedure angiography

v/s frequency

A 
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
55
Q

complications of angiography (4)

A

cardiac tamponade
artery restenosis
hematoma
retroperitoneal bleeding

56
Q

interventions for cardiac tamponade

A

iv fluids
chest xray to confirm diagnosis
prepare for pericardiocentesis

57
Q

what is cardiac tamponade

A

accumulation of fluids in the pericardial sac

58
Q

s/s of cardiac tamponade (3)

A
  • hypotension
  • paradoxic pulse (variance of 10 mm or more in sbp between expiration and inspiration
  • intracardiac and pawp are elevated and similar
59
Q

hematoma interventions(2)

A

put pressure on the artery

monitor perifpheral circulation

60
Q

restonosis of vessel time of occurence and interventions (4)

A 
immediately or several weeks after procedure;
monitor cardiac rhythm
monitor chest pain
notify md
schedule pt to cadiac lab
61
Q

retroperitoneal bleeding interventions (4)

A

assess flank pain
assess hypotension
notify md
iv fluids/ blood

62
Q

vascular acess is for administration of (4) both central and picc catheters terminate here

A

administration of blood, chemo, antibiotics, tpn

distal 1/3 of supervior vena cava

63
Q

entry point veins used in central and picc line (2) each

A 
central line (subclavian/ jugular)
picc (basilic/ cephalic vein) one finger from the antecubital
64
Q

timeframe for picc and central line

A

picc- more than 12 months

central line - short term use

65
Q

complications with picc/central lines (6)

A
  • emboli/thrombosis
  • phlebitis
  • infiltration/extravasation
  • occlusion
  • air emboli
  • mechanical complications
66
Q

how to avoid damaging the mesh on the port catheters

A

use a noncoring (huber) needle

67
Q

to prevent air emboli in central catheters; interventions for air embolus (4) to trap and aspirate the air

A

clamp all tubings

assess sudden sob, place in trendelenburg on left side, give 02, notify md

68
Q

PAD/PAS mm Hg

A

PAD 5-15

PAS 15-25

69
Q

CVP/ PAWP

A

cvp- 1-8

pawp 4-12

70
Q

sv02

A

60-80%

Critical Care Nursing (5 decks)

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