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S3 1538 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Goal for aging family members with disability

A

Return home after learning to manage disability

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2
Q

What does managing disability in the elderly involve

A

ADLs/personal care
Meal prep
Physical therapy/exercise
Dr Appts

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3
Q

Each family is _

An illness in one member affects…

A

Unique

The other members

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4
Q

During time of illness provide… to PT

AND… to fam

A

Functional support

Emotional support

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5
Q

Antecedents of emotional support in a family

A

Trust
Safety/security
Boundary respect
Communication

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6
Q

When assisting elderly with goal or returning home, first…

A

Assess support system

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7
Q

When providing support to fam and patient give_ and be_

A

information

nonjudgmental

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8
Q

Info to give to PTs fam

A

As much as possible with PT consent

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9
Q

To build trust with PT and fam

A

Demonstrate use of equipment

Transfer and mobility skills

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10
Q

At home changes for disability may involve

A

Making a safe environment

Instructions on new diet or meds

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11
Q

Supportive info to provide elderly with disabilities

A

Where to get med supplies and DME (durable medical equipment)

Where to find support groups

Where to find recreation

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12
Q

What to evaluate for newborns with disabilities

A

Evaluate parents psych
Willingness to learn
What is the support system

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13
Q

Fantasy of family expansion

A

Real life is much more difficult and straining on family members

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14
Q

Adaptation to parenthood is

A

NOT easy

Have realistic expectation

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15
Q

Things to consider during family expansion

A

Partner struggles
Partner involvement
Sibling jealousy

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16
Q

Interventions for sibling rivalry

A

Expect and tolerate regression
Encourage discussion
Encourage participation in decisions
Make special time for siblings

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17
Q

First question when expanding fam

A

What is the support system

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18
Q

Teaching points for expanding family

A

Teach baby care
Teach breastfeeding
Provide info

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19
Q

Encourage mom/parents to

A

Provide interaction as much as possible

Praise efforts

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20
Q

Blended family

A

Significant other comes with baggage

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21
Q

Blended fam transition will take more

A

TIME

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22
Q

Children’s feelings in blended families

A

May feel jealous to stepparent

May feel disloyalty to biological parent

Competition/rivalry to other stepchildren

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23
Q

With blended families encourage

A

mutual respect

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24
Q

Blended families need _ and _ communication

A

Open

Honest

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25
Q

Parenting responsibilities in blended families

A

Must be shared

No good cop bad cop

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26
Q

What to assess for in blended families

A

Lack of support - overall or from partner to partner

Poor attachment - too much or too little

Negative behavior - retaliatory, attention seeking

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27
Q

In poor cases of blended families make

A

Referrals as needed

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28
Q

Major depressive disorder

A

2 or more weeks of sad mood or lack of interest in life

most clear up in about 6 months

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29
Q

20% of major depressive disorders have

A

psychotic features

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30
Q

To be considered major depressive disorder, sad mood must be accompanied by…

how many…

A 
Anhedonia
Weight change
Sleep change
Drop in energy
Indecisiveness

Suicidal ideation

At least 4 must be present for diagnosis

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31
Q

Neurotransmitters involved in Major depressive disorders

A

Norepinephrine and serotonin

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32
Q

Drug classes for Major depressive disorder

A

SSRIs - most
MAOIs - sometimes
Tricyclic antidepressants - seldom

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33
Q

Therapies for MDD (major depressive disorder)

A

Psychotherapy

Electroconvulsive therapy

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34
Q

Tricyclic antidepressant MOA

How long to work

A

keep serotonin and norepinephrine available to the brain

6 weeks

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35
Q

TriCyclic Antidepressants Side

effects

TCA’S

A

Thrombocytopenia
Cardiac - arrhythmia, MI, stroke
Anticholinergic - tachycardia, urinary retention
Seizures

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36
Q

Contraindications for Tricyclic Antis

A

Liver problems

Heart problems

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37
Q

MOAIs + Tricyclic Antis =

A

SEROTONIN SYNDROME

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38
Q

Nursing for MDD

History

Safety

A

Be patient, dont rush client

Find out if they are suicidal, ask DIRECTLY, ask if they have a plan

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39
Q

Nursing and MDD

Self care promotion with MDD

A

ADLs
Nutrition/hydration
Good sleep
Do activities and hobbies

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40
Q

Giving activities to MDD clients

A

One at a time

Do not overwhelm

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41
Q

Anticholinergic side effects of Tricyclic Antis

A 
Urinary problems
Eye problems - no if glaucoma
Diabetes mellites 
Thyroid problems
Heart problems
Lung problems
Kidney problems
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42
Q

Biggest problems with antidepressants

A

Suicide up to 2 weeks, because pt how has energy to act

Not taking pills - collecting for a suicide attempt

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43
Q

MDD and therapeutic communication

A

Encourage to verbalize and describe emotions

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44
Q

MDD teaching with fam

A

Depression is an illness not a lack of willpower or motivation

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45
Q

Best MDD treatment combo

A

Meds + Therapy

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46
Q

MDD maintenance teaching for pt

A

Support groups
Follow up on appts
Instruct on med side effects - ID S/S of relapse and get immediate treatment

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47
Q

Because of how long antidepressants take to have an effect pt may

A

feel discouraged by lack of progress but have more energy to attempt suicide

biggest problem during first 2 weeks

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48
Q

Electroconvulsive therapy 101

A

delivery of electrical impulses to brain = seizure

thought to reset neurotransmitters

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49
Q

When to electro therapy

A

If antidepressants don’t work

If actively suicidal

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50
Q

How much electro therapy before progress #

best results #

Normal routine #

A

Minimum of 6 treatments to see progress

Max benefits at 12-15 treatments

3xWeek

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51
Q

1st line med for mood disorders like suicide and depression

A

SSRIs

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52
Q

MAOIs
Monoamine oxidase inhibitors
101

A

MOA enzymes break down neurotransmitters

These meds stop that,
hence the inhibitors

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53
Q

MAOI dietary restrictions

A

Avoid tyramine

Will ^ BP to point of stroke or death

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54
Q

What foods have tyramine

A

Aged cheese
Fermented foods
Beer
Soy sauce

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55
Q

Normal side effect of MAOIs

A 
dry mouth
insomnia
irritability
high BP
peeing problems
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56
Q

Serotonin syndrome S/S

MED EMERGENCY

A

Confusion
Restlessness
Sweating
Muscle jerk movements

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57
Q

How long does it take for antidepressants to work

but suicidal ideation happens at

A

3-4 weeks

2 weeks

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58
Q

Bipolar 101

A

episodes of depression and mania

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59
Q

Manic phase S/S

A

Euphoria
Sleeplessness
Poor judgement
Rapid thoughts/actions/speech

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60
Q

Depressive phase of mania S/S

A

2 or more weeks of sad mood

+

4 of the depression symptom changes in:
anhedonia
weight
sleep
energy
concentration

suicidal ideation

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61
Q

Manic onset

duration

A

rapid over a few days

a few weeks to months

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62
Q

Bipolar pts at most risk of psychosis

A

Adolescents

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63
Q

At what age does mania onset

A

teens to 30s

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64
Q

Bipolar mixed 101

A

alternates between manic depressive and normal

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65
Q

Bipolar I 101

A

Mostly mania
some normal
few depressive episodes

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66
Q

Bipolar II 101

A

Mostly depression
some normal
few manic episodes

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67
Q

Diagnosing mania

A

1 week minimum of altered behavior

at least 3 of the following

sleeplessness
flight of ideas
exaggerated self-esteem
increased activity

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68
Q

Risky behaviors during mania

A

spending sprees
sex with strangers
impulsive investments

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69
Q

Go to med for bipolar

A

Antimanic - lithium
Anticonvulsant - mood stabilizer, and protection against cycles

Antipsychotics - if psychosis

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70
Q

Lithium 101

A

Partially or completely stops illness in 75% of pts

Heavy on renal system

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71
Q

Is lithium metabolized

A

NO
excreted in urine

hence the kidney problems

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72
Q

Maintenance lithium level
Treatment lithium level
Toxic lithium level

A
  1. 5-1.0
  2. 8-1.4
  3. 5 and up
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73
Q

Client and fam need to know S/S of _ with lithium

A

Toxicity
thyroid
renal

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74
Q

1.5-2 lithium toxicity S/S

nursing intervention

A

N/V/D
drowsiness
slurred speech
muscle weakness

hold next dose, call Dr.

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75
Q

2-3 lithium toxicity S/S

nursing interventions

A 
Blurred vision
Tinnitus
Twitching
Itching/rash
Incontinence

Withhold all future doses, Call Dr.
Prepare for gastric lavage
Start IVs

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76
Q

3.0 and up lithium toxicity S/S

Nursing interventions

A 
Cardiac arrhythmia
Vascular collapse
Hypotension
Seizures
Coma

Excretion meds
Hemodialysis
Monitor resp circ immune and thyroid system

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77
Q

Lithium excretion meds

A

Aminophylline
Mannitol
Urea

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78
Q

Anticonvulsants used for mood stabilization

A

Gabapentin
Carbamazepine
Lamotrigine

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79
Q

Side effects of anticonvulsants

A

Drowsiness
Sedation
Weakness
Fatigue

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80
Q

Nursing safety interventions for anticonvulsant meds

A

Get up slowly
Monitor for hypotension

Fall risk

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81
Q

Antipsychotics 101

A

block dopamine

used in psychotic mania, psychotic depression and drug induced psychosis

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82
Q

Generations of antipsychotics

A

1st - haloperidol
2nd - quetiapine
3rd - aripiprazole

3rd has least side effects

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83
Q

side effects of antipsychotics

A

Dystonia - involuntary contractions
Pseudoparkinsonism
Dyskinesia - involuntary jerking
Akathisia - can’t be still

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84
Q

Psychotherapy is not useful for what bipolar cycle

A

mania

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85
Q

Nursing when bipolar pt is depressed

A

Get History
Safety (suicide/harm prevention) ask the question

Promote ADLs
Hydration/nutrition
Do activities
Have good sleep

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86
Q

Manic comms interventions

A

Hist from fam or use short sessions
Distance respect
Use short sentences

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87
Q

Manic physical needs interventions

A

Finger foods high in calories and protein

Rest and sleep

Chanel movement into productive tasks

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88
Q

Manic psych interventions

A

Protect dignity
Promote appropriate behavior
Decrease stimuli

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89
Q

Fluid consumption when on lithium

A

2 Liters qd

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90
Q

Teach pt and fam that lithium therapy needs

have them know

A

periodic blood work

side effects and toxicity

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91
Q

Manic teaching to pt and fam

A

avoid risk taking behavior

recognize S/S or relapse

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92
Q

Risk factors for Postpartum depression

A 
Poverty
Lack of support
Unplanned pregnancy
Depression history
Decrease in self esteem

Domestic violence

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93
Q

Post partum depression onset

A

6 weeks and up to 1 year

KEY , feelings last longer than 2 WEEKS

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94
Q

Post partum Depression S/S

A 
no appetite
poor sleep
emotional lability 
mood swings
panic attacks

Depressed feelings
Rejection of infant

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95
Q

Postpartum depression if untreated

A

becomes chronic depression

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96
Q

Father and Postpartum depression

A

increased depression risk in father

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97
Q

children of post partum depression moms have an increased risk for

A

emotional and behavioral problems
sleep problems
eating problems
delays in development

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98
Q

Postpartum psychosis onset

A

2-3 week average

48h to 6months after birth

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99
Q

Post partum psychosis S/S

A

Major depression
Disorientation
Paranoia
Hallucinations

Thoughts of self harm or harming the baby

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100
Q

Postpartum psychosis is a medical _

needs

A

emergency

immediate hospitalization

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101
Q

postpartum depression prevention during pregnancy

A

Monitor for S/S
Do screening questionnaire
Support groups
Therapy

Antidepressants if severe

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102
Q

Postpartum depression prevention after birth

A

Screenings
Counseling
Therapy
Meds

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103
Q

Reluctance to do newborn care

A

Big sign of postpartum depression

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104
Q

Questions to ask for PostPartDep

A

Emotional state?
Bonding?
Hist of depression?

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105
Q

Emotional self care post partum

A

communicate feelings
rest/ask for help
take time for self
see friends

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106
Q

Physical self care post partum

A

Exercise
Eat well
Bathe
Dress

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107
Q

Breastfeeding and antidepressants

A

meds will go through milk

not a big deal

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108
Q

Drugs of choice for post partum depression

SSRIs

A

Sertraline
Paroxetine

Fluoxetine
Citalopram

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109
Q

SSRIs 101

A

Serotonin helps in

behavior
appetite
sleep
sex
function

SSRIs keep more available

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110
Q

SSRI side effects

A 
Sex problems
N/V/D
Insomnia
Joint/muscle pain
Headaches
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111
Q

Serotonin syndrome S/S

A 
Agitation/restlessness
^HR ^BP ^Sweating
Dilated pupils
Muscle twitching
Shivers, fever
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112
Q

Life threatening serotonin syndrome S/S

A

High fever seizures
Irregular heartbeat
Coma

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113
Q

St Johns’ wort and serotonin

A

Increases level = serotonin syndrome

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114
Q

How long does it take for SSRIs to work

A

4-6 weeks

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115
Q

Discontinue SSRIs

A

DO NOT stop suddenly

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116
Q

SSRI withdrawal

A

Flu symptoms

NVD
Dizziness
Fatigue

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117
Q

Suicide

A

Killing self

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118
Q

Risks for suicide

A 
Psych disorders
Chronic health issues
PT hist
Fam hist
Environmental factors
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119
Q

If you suspect suicide

A

ASK THE QUESTION

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120
Q

Determine lethality of suicidal pt

A

Is there a plan?
Are there means to execute?

Where?
Time/date? Anniversary?

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121
Q

Suicide preparations

A

Giving things away

Being unnaturally happy - pt has a plan

Talking to folks one last time

Suicide notes

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122
Q

Safety and suicide nursing interventions

A

If lethality is low observe q10min

If high = one on one supervision

Contracts

Assess support system

Good attitude

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123
Q

Suicide contract

A

Have pt make a no-suicide or no-self harm contract

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124
Q

Nursing attitude toward suicidal pts

A

Be positive and non judgmental

Monitor your body language and facial expressions

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125
Q

Treatment for suicide

A

Psych Therapy

Meds- SSRIs, MAOIs, Tryc

Electrotherapy

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126
Q

Seizure 101

A

imbalance of electrical impulses rapidly firing without inhibition

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127
Q

Generalized vs partial seizure

A

Both hemispheres

1 hemisphere

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128
Q

Seizure causes

A

Fever
CNS infection

Hypoxia
Hypoglycemia
ETOH withdrawal
Acid/base imbalance

Tumor

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129
Q

Epilepsy

A

2 or more seizures more than 24h apart

130
Q

Epilepsy can be caused by

A

Chronic condition
TBI
Stroke
Meningitis

131
Q

Seizures from fever or ETOH withdrawal are not considered _

A

epilepsy

132
Q

4 stages of a seizure

A

Prodromal
Aura
Ictus
Post ictus

133
Q

Prodromal 101

S/S

A

occurs before event

mood problems - depression, anxiety, anger

134
Q

Aura 101

S/S

A

Seconds or minutes before event

Altered vision, spots, dizziness, weird tastes, deja vu feeling

135
Q

Ictus 101

S/S

A

Actual seizure - lasts 1-3 min

136
Q

As soon as seizure starts start

A

Timing

137
Q

Seizures lasting longer than 5 min

A

Status epilepticus

Med emergency

138
Q

Post ictus 101

S/S

A

Recovery - can be immediate or up to days

Tiredness, confusion, headaches
Cant remember
Injury to tongue/cheek

139
Q

Tonic/Clonic (Gran mal) seizure 101

A 
Most common
\+ aura
1-3 min 
LOC 
High injury risk
140
Q

Tonic phase

A 
Body stiffens
May groan or cry
Bite mouth
Foam at mouth
Apnea
141
Q

Clonic phase

A

Recurrent jerking
Spasms
Incontinence

142
Q

Tonic seizure 101

A

only body stiffens

LOC w/incrased muscle tone

30sec to minutes

143
Q

Clonic seizure 101

A

Recurrent jerking
Contraction and relaxation of muscle

lasts severe minutes

144
Q

Atonic seizure 101

A

Simply go limp and fall

Followed by confusin

145
Q

Seizure types recap

A

Tonic/clonic aka gran mal

Tonic

Clonic

Atonic

146
Q 
Focal seizures (partial seizures)
2 types
A

Simple partial

Complex partial

147
Q

Simple partial seizure 101

S/S

A

Aware during seizure
less than 2 min

HR change
Flushing
Pain
Offensive smell

Can lead to Complex partial seizure

148
Q

Complex partial seizure 101

S/S

A

Unaware of seizure

Unusual movements - lip smacking, rubbing hands, picking at clothes

Cant remember afterwards

149
Q

Can pt recover from status epilepticus on their own

Status epilepticus consequences

A

NO
life threatening

Hypoxia to brain
\+
Venous congestion
=
Irreversible fatal brain damage
150
Q

Meds for Status epilepticus

A

Diazepam Valium
Lorazepam Ativan

GIVE IV

will stop seizure immediately

151
Q

Medications to stop convulsions with seizures

A

Barbiturate’s
Anticonvulsants
Benzodiazepines

152
Q

Barbituates to stop convulsions

Side effects

A

Phenobarbital

lowers BP and respirations, need blood levels

causes fetal malformations

153
Q

Anticonvulsants for seizure convulsions

Side effects

2 of em

A

Phenytoin - bone marrow suppression, birth defects

Valproic acid - liver heavy, WBC and platelets need monitoring

154
Q

Benzodiazepines for convulsions

Side effects

A

Diazepam/lorazepam
FAST acting

Drowsiness, build tolerance

155
Q

2 Invasive treatments and diet for seizures

A

Surgery - remove area causing seizures

Vagus nerve stimulator - stimulation prevents seizures

Keto diet - 5% carbs, 30 % protein, 65% fat

156
Q

First thing to assess for seizure risk factors

A

Hx of seizures
Last med dose
Last drug level

157
Q

Seizure precaution

A

Padding of railing
Fall precaution
O2 and suction at bedside
IV access

158
Q

Bed position and clothing with seizures

A

Lowest position

Clothing should be non restrictive

159
Q

Priority care during a seizure

Over 5 min =

A

Prevent aspiration and trauma
Don’t put fingers in mouth

Emergency

160
Q

After seizure, to prevent aspiration with seizures

A

Keep pt on side

Make sure airway is patent

161
Q

On awakening from seizure

If confused

If agitated

A

Reorient patient

Gently guide to bed or chair

Maintain distance but be close enough to prevent injury

162
Q

Post seizure assessment and lab

A

VS
Neuro check
EEG

Blood levels

163
Q

Post seizure, document

A

Meds given

Characteristics noted

164
Q

Status epilepticus nursing actions

Emergency

A 
Activate Rapid Response Team 
IV - diazepam or lorazepam
Airway - O2 or ET tube
Labs - lytes, glucose, meds
V/S and neuro checks
165
Q

Education for seizure patients

A

Decrease stress
Increase fluids
Maintain normal glucose
Ged blood work regularly

166
Q

NOs of recreational activities for seizure patients

A

strobe lights
loud noises
alcohol
recreational drugs

167
Q

Brain tumor 101

A

Growth in brain

168
Q

Brain tumor classification

A

Cell type

Location

169
Q

Primary brain tumor

A

originates from cell within brain

170
Q

Secondary brain turmo

A

Develops from outside brain

171
Q

Brain tumors apply pressure resulting in

A

ICP

172
Q

ICP S/S

A 
Headache
N/V
Swelling of optic nerves 
Cerebral Edema
Personality changes
173
Q

Frontal lobe tumor changes

A

emotions/apathy
inappropriate behaviors
impulsiveness

174
Q

Parietal lobe tumor changes

A

Decreased sensation or seizure on opposite side of body

175
Q

Temporal lobe tumor changes

A

seizure on other side of body

Psych changes

176
Q

Occipital lobe tumor changes

A

Loss of half the visual field on opposite side of tumor

Visual hallucinations

177
Q

Cerebral lobe tumor changes

A

ataxia
gait problems
falling toward side of lesion
incoordination

178
Q

Cerebellopontine angle tumor changes

A

tinnitus
vertigo

deafness
numbness and tingling in face

face paralysis

motor problems

179
Q

Incidents of brain tumors increase with

A

AGE

180
Q

Early S/S of intracranial tumor with age

A

are often overlooked or misdiagnosed as normal cognitive decline

181
Q

Most common brain tumor S/S in elderly

A

Personality
Confusion
Speech
Gait

182
Q

Diagnosing brain tumore

A

CT w/contrast
MRI
PET

Lumbar puncture
EEG
Biopsy

183
Q

Brain tumor meds

pain

edema

A

Analgesics

Corticosteroids

184
Q

Brain tumor meds

seizures

vomiting

A

Anticonvulsants

Antiemetics

185
Q

Decreasing ICP with brain tumors

A

Diuretic Mannitol

186
Q

Surgery for brain tumore

A

craniotomy

187
Q

Radiation and chemo for brain tumors

A

Radiation - external and brachytherapy available

Chemo - with or without radiation available

188
Q

Nursing care for brain tumors

A

Seizure precaution

Headaches and nausea

Neuro deficit - poor swallowing, semisoft diet

189
Q

Normal ICP monitoring pressure

A

5-15mmHg

190
Q

S/S of ICP

A 
NV
Headache
LOC
Pinpoint pupils
Altered breathing
Abnormal posture - decerebrate or decorticate or flaccid
191
Q

Preventing ICP

A 
Elevate HOB
Maintain head and neck neutral
DONT Valsalva
Maintain body temp
Maintain fluid balance
Avoid noxious stimuli
192
Q

Corticosteroids for ICP

A

hyperglycemia and lyte imbalance

monitor blood sugar
push fluids

193
Q

Assist patient with brain tumors in

A

Self care
Walking
Injury prevention

194
Q

Assess brain tumor pts

A

Muscle strength

Eye problems

195
Q

Glasgow coma scale

A

Neuro assessment

196
Q

Magic number on Glasgow coma scale

A

8

below 70% mortality
above 90% survival

197
Q

what interferes with doing glasgow scale

A

intubation

198
Q

Glasgow coma scale
8=
9-12=
above 13=

A

severe head injury
moderate head injury
minor head injury

199
Q

Hydrocephalus 101

A

Abnormal accumulation of cerebrospinal fluid in ventricles

water on the brain

200
Q

Types of hydrocephalus

A

Communicating (non-obstructive)

Non communicationg (obstructive)

201
Q

Normal pressure hydrocephalus

A

communicating non obstructive

most common in elderly

202
Q

Infant and hydrocephaly S/S

A

High pitched cry
Poor feeding
Vomiting
LOC

203
Q

Infants and hydrocephaly head alterations

A

Increased circumference of head
Wide open bulging fontanels without pulse
Head will feel tense and full

204
Q

Children with hydrocephaly S/S

A

same as infants plus

Headache complaints
Visual problems
Physical and cognitive changes

205
Q

Adult hydrocephaly manifestations

A 
Eye problems
Gait problems
Mild dementia
Personality changes
Seizures
206
Q

Diagnostics for hydrocephaly

A

Skull xray
CT
MRI

207
Q

EVD

External ventricular device

A

pulls liquid out of brain via machine

208
Q

ETV

Endoscopic third Ventriculostomy

A

pulls liquid out of brain via device

209
Q

VP shunt

Ventriculoperitoneal shunt

A

Shunt from ventricle to peritoneal space

need to be changed over time to accommodate growth

210
Q

Hydrocephaly head assessment

A

Inspect
Palpate
Percuss

211
Q

Infection S/S with VP shunt

A

elevated vitals
decreased responsiveness
seizures
vomit

local inflammation along shunt

212
Q

Malfunction S/S with VP shunt

A

Vomit
Drowsiness
Headache
Unequal pupils

Basically ICP

213
Q

Early Signs of ICP

A

Headache
Projectile vomit

Blurred vision, delayed pupils, double vision, setting sun

Seizures

214
Q

Vitals and ICP

ON test

A

Decrease in pulse and resp

Increase in BP or pulse pressure

215
Q

Infants and ICP

physical changes

A

Bulging fontanels
Wide sutures
Increased circumference
Dilated veins

216
Q

Late signs of ICP

A 
LOC
Decreased motor/sensory response 
Bradycardia
Chain-stokes resp
Dilated fixed pupils
217
Q

Body posturing and late signs of ICP

A

Decerebrate or decorticate posturing

218
Q

Teaching parent about hydrocephalus and kids

A 
Recognize complications early
Developmental disabilities will be present
Have realistic goal
Financial strain
Therapeutic listening
219
Q

TBI 101

Traumatic brain injury

A

skull or brain injury serious enough to interfere with normal function

220
Q

Primary vs secondary TBI

A

immediate damage due to impact

delayed damage due to lack of nutrition of perfusion

221
Q

Mild
Mod
Severe

TBI

A

Mild - LOC less than 15 min, disoriented and confused

Mod - LOC greater than 15 min, days or weeks confused

Severe - LOC greater than 6H

222
Q

Brain injury types

A

Contusion
Diffuse axonal injury
Intracranial hemorrhage
Concussion - mild TBI

223
Q

Contusion TBI 101

A

Damage in specific area

LOC stupor confusion

edema and hemorrhage risk peaks at 18-36h

possible ICP

224
Q

Diffuse axonal injury TBI 101

A

widespread injury

tearing, shearing or axon fibers

Immediate coma longer than 6H

225
Q

Decorticate posture

A

feet/arms toward body

cerebral damage

226
Q

Decerebrate

A

feet and arms away from body

brain stem damage

227
Q

Hemorrhage location terms

Extra axial -
Epidural -
Subdural -
Subarachnoid -

A

outside brain tissue
above dura
below dura
below arachnoid space

228
Q

Hemorrhage location terms

Intra axial -
Intracerebral -
Intraventricular -

A

Inside brain tissue
Within brain
Within ventricles

229
Q

Expanding TBI hematoma S/S

A

Brief LOC
Lucid intervals
ICP

Restless
Confused
Then Coma

230
Q

TBI hematoma Treatment

A

Craniotomy - remove clot or bleeding

231
Q

Elderly TBI injuries are most likely in what area

A

subdural

232
Q

Mild vs classic concussion

A

mild - no loc, brief confusion

classic - loc less than 5 min, amnesia, mind problems (NV, HA, memory etc.)

233
Q

What to monitor for TBIs

A 
LOC
HA
NV
Abnormal pupils
Slurred speech
Arm/leg numbness or weakness

red flags indicating further action

234
Q

Chronic traumatic encephalopathy

CTE

A

Happens due to multiple concussions

brain degeneration

235
Q

CTE S/S

A

impulsiveness
poor judgement
memory loss
emotional lability

substance abuse
suicidal thoughts

236
Q

Post concussion syndrome 101
duration

S/S

A

10 days to 3 months

Cognitive issues
Behavioral issues
NVH
visual and hearing sensitivity

237
Q

Post concussion patient teaching

A

Problems will start with going back to work or school

Avoid activities that can result in another concussion

Rest brain

238
Q

Skull fracture 101

S/S

A

persistent localized pain indicates

most common is basal

racoon eyes, battel signs, CSF leakage from ears and nose

239
Q

Diagnostics for TBIs

A

CT scan without contrast
Xray of head and neck
MRI
Angiography

240
Q

Glasgow coma scale categories

A

Eye opening - 4 point max
Verbal response - 5 point max
Motor response - 6 point max

241
Q

Coma on Glasgow scale

Severe head injury on scale

moderate injury on scale

mild injury on scale

A

3

8 or less

9-12

13-15

242
Q

TBI interventions

A 
HOB at 30 degrees
Patent airway
O2
Ventilation
Suction
243
Q

Monitoring for TBI

A 
neuro function
cerebral perfusion
lytes
nutrition
temp

skin integrity

244
Q

Late ICP finding, cushings triad

A

Hypertension
Bradycardia
Bradypnea

245
Q

Cushings triad leads to

A

Seizures

Increased ICP-herniation-death

246
Q

Devoices to monitor ICP

normal range

A

Intraventricular cath
Subarachnoid screw
Epidural sensor

5-15mmHg

247
Q

Managing ICP

A 
Oxygenation
HOB 30 degrees
Head and neck in neutral alignment 
Prevent valsalva
Body temp
Fluid balance
248
Q

Normal cerebral perfusion pressure

A

50-70mmHg

249
Q

TBI Meds

A

Diuretic - mannitol - decrease pressure

Steroid - decrease inflammation

Anticonvulsant - prevent seizure

Benzo - sedation, (makes it hard to do Glasgow)

NS - isotonic fluid

250
Q

TBI supportive measures

A

Ventilator for O2
F/E balance
Nutrition support
Manage pain/anxiety

251
Q

Brain death

3 cardinal signs

A

complete loss of function

Coma
Absence of brainstem reflex
Apnea

252
Q

Confirming brain death tests

A

EEG

CBF - cerebral brain flow

253
Q

Organ donation and fam

A

Fam can overturn decision if no documentation is complete

fam needs to be informed

254
Q

OPO/TOSA

what they do

A

Oran Procurement Organization

They will talk with family

255
Q

Keeping body viable for organ donation rule of 100s

ON TEST

A

PaO2 100mmHg
Urine output 100ml per hour
Systolic BP at 110mmHg
Temp at about 100

256
Q

2 types of stroke

A

Ischemic - occlusion by thrombus or emboli

Hemorrhagic - bleeding into brain

257
Q

FAST stroke S/S

A

Face - uneven
Arms - hanging, uncontrolled
Speech - slurred
Time - call 911 now

258
Q

Stroke is associated with what heart condition

A

Afib

259
Q

tPA treats what stroke

A

Ischemic

260
Q

tPA time frames

A

given within 3h of stroke

given within 60min of getting to hospital

261
Q

Ischemic stroke motor body problems S/S

A

numbness weakness on one side
balance and walking problems
hemiparesis, hemiplegia
apraxia

262
Q

Ischemic stroke motor face problems S/S

A

Dysarthria - speech problems
Dysphasia - swallowing problems
Aphasia - understanding speech x2

263
Q

Ischemic stroke cognitive problems S/S

A

Mental status changes
Headaches
Agnosia - perception problems
Memory loss

264
Q

Left hemisphere stoke will present as S/S

A

right side problems

Aphasia - speech and understanding

Intellectual disability

Slow cautious behavior

265
Q

Right hemisphere stroke will present as S/S

A

Left side problems

Spatial perception problems

Distractibility

Poor judgement, impulsivity

266
Q

TIA

Transient ischemic attack

A

temporary attack
lasts 1-2h less than 24

Warning of an impending stroke

267
Q

Healthy lifestyle and stroke prevention

A

No smoking
Physical activity
Healthy weight and diet
Modest alcohol consumption

268
Q

Modifiable risk factors to prevent stroke

A 
Hypertension
AFIB, stenosis
Cholesterol
Obesity
Sleep apnea
Oral contraceptive use

smoking and drinking

269
Q

Treatment of stroke

A

CT scan within 25min - determines ischemic or hemorrhagic

12 lead EKG and carotid ultrasound

MRI or brain and neck

tPA

270
Q

What does tPA do

A

dissolve clots

271
Q

regulations for admining tPA

A

2 IV sites

10% push 90% pump

V/S q15m for 2h, 30min for 6h, 1h for 24h

BP maintained ABOVE 180/105

272
Q

Side effects of tPA

A

BLEEDING

273
Q

what to monitor with tPA patients

A

Airway
Circulation
Neuro

274
Q

Stroke and carotid endartherectomy

A

surgery to remove plaque from artery

275
Q

To prevent stroke, Afib is managed by

A

Anticoagulant therapy

A fib makes pumping slow, so clotting risk goes up

276
Q

PREVENTION

Managing cholesterol with stroke

Managing clotting with stroke

Managing BP with stroke

A

Statins

Antiplatelet

Antihypertensive

277
Q

Hemorrhagic stroke 101

A

brain metabolism disrupted by blood

ICP

Secondary Ischemia from vasoconstriction due to pressure

278
Q

Hemorrhagic stroke S/S

A

Same as Ischemic plus

HA
sudden LOC
Vomiting

BACK AND NECK PAIN

279
Q

Diagnosing hemorrhagic stroke

A

CT, MRI
Cerebral angiography

Toxicology if pt under 40

280
Q

Stroke can lead to what complications

A

Cerebral hypoxia

Vasospasms

ICP

Seizures

Hydrocephalus

Hypertension

Rebleeding

281
Q

Managing hemorrhagic stroke

A

sedation and rest

surg-relieve bleeding

prothrombin to stop bleeding

dilantin - stroke prevention

Analgesics/antipyretics

282
Q

promote circulation with strokes via what device

A

Pneumatic compression devices

283
Q

Monitoring during acute phase of stroke

A 
vitals
O2
neuro
motor
pupils
BP
I&O/bleeding
284
Q

Best hospital environment for stroke patients

A 
Nonstimulating
Restrict fam
HOB at 30
No valsalva
Compression stockings

Decrease anxiety

285
Q

Post acute phase nursing for stroke patients

A

Mental status
Motor status
Skin integrity
Activity tolerance

286
Q

Most brain patients will be bed ridden, be sure to check

A

skin integrity

287
Q

Encouraging self care post stroke

A

Realistic goals
Personal hygiene
Dont neglect affected side
Use assistive devices

288
Q

Diet and nutrition interventions after stoke

A

speech therapy
Sit upright
Chin tuck swallow method
THICKENED LIQUIDS or PUREE

289
Q

Bowel and bladder interventions post stroke

A

Voiding schedule
Fiber + Fluids
Bowel and bladder retraining

290
Q

Education post stroke

A

Med education
Safety measures
Exercise
Recreation

291
Q

Meningitis 101

A

Inflammation of brain

292
Q

2 major bacteria that cause meningitis

A

Nisseria meningitides

Streptococcus pneumoniae

293
Q

Primary prevention of meningitis

A

Meningococcal Vaccine

initial at 11-12y

booster at 16

given to individual living closely together

294
Q

Meningitis vaccine for kids

A

HIB b

4 shots

2m4m6m 12-15m

295
Q

Meningitis vaccine for immunocompromised adults or over 65

A

Pneumococcal polysaccharide vaccine
PPSV23

given q5years

296
Q

Meningitis S/S

A

SEVERE HA
fever/chills
N/V

disorientation
restlessness
photophobia
rash

297
Q

Nuchal rigidity

A

Stiff neck

Indicates meningitis

298
Q

Kernig’s sign

Brudzinski’s sign

A

Pain with extension from flexed position

Pain with knee/hip flexion + neck flexion

299
Q

Infant S/S of meningitis

A

poor feeding
weak cry
vomiting
rash

300
Q

Meningitis babies will be more consolable when

A

lying still as opposed to being held

301
Q

Opisthotonic position

A

Baby arches back

Meningitis

302
Q

Diagnosing Meningitis

A

MRI/CT
Lumbar puncture - CSF
CBC - W^

cultures

303
Q

Parkinsons 101

A

Progressive

debilitates motor function

destruction of dopamine cells in brain

304
Q

Carginal signs of Parkinsons

ON test

A

Tremors
Rigidity
Bradykinesia
Postural changes

305
Q

tremors with parkinsons

A

Shaking
pill rolling

starts with fingers and moves to hands

may disappear with purposeful movement or sleep

306
Q

muscle rigidity with parkinsons

A

cogwheel movement - jerking
kinda like a clock tick

as it progresses, pt wont be able to move face

307
Q

bradykinesia with parkinsons

A

slowing of movement

muscles issue, messages come but movement is delayed

Freezing - pt will literally stop in place because they can’t move

308
Q

Postural instability with parkinsons

A

Late sign

stooped posture
shuffling gate

309
Q

Diagnosing parkinsons

A

Based on presence 2 of the 4 cardinal symptoms

Positive response to levodopa trial

310
Q

Cure for parkinsons

A

none

311
Q

Antiparkinsonian meds

A

Levodopa - converted to dopamine by body, symptom relief

Carbidopa - added to levodopa, keeps it available for longer

312
Q

Levodopa therapy is most effective at

after that

A

1-2y

effectiveness drops
adverse effects become severe

Dyskinesia

313
Q

Biggest side effect to levodopa

A

Dyskinesia

Uncontrolled involuntary movement of head body and extremities

chewing and smacking movements

head bobbing

314
Q

Perkinsons and deep brain stimulation

A

implant of electrode into brain

pulse increases dopamine release

315
Q

criteria for getting deep brain stimulation surgery with parinsons

A

having disease for 5 years

disability due to tremors

levodopa causes dyskinesia

316
Q

Parkinsons nursing care for motion

A

Mobility - daily exercise, massages
Walking training
Physical therapy

317
Q

Parkinsons nursing for self care

A

assistive devices
bedside rails at home

bowel training
fiber+fluids

318
Q

Nutrition and diet with parkinsons

A

CHOKING is common

Sit up right
THICK LIQUID diet

monitor weight weekly

319
Q

Communication from nurse to parkinsons

A

speak slowly
face listener
annunciate

320
Q

Communication from parkinsons pt

A

Encourage deep breaths before speech

Use tool or images

321
Q

Home education for parkinsons patients

A

Plan activities for pt
DONT just do things for them

pt and fam need to know stages and severity

322
Q

Postpartum depression scales

A

Edinburgh scale

and

PDSS self screen

S3 1538 (15 decks)

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