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NRSG 200: Med Surg 3 > [Exam 5] Chapter 68 and 70: Mx of Patients with Neurologic Trauma > Flashcards

[Exam 5] Chapter 68 and 70: Mx of Patients with Neurologic Trauma Flashcards

1
Q

Head Injury is a broad term that refers to what?

A

Injury of the scalp skull or brain.

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2
Q

Head Injuries: Most common cause?

A

Falls, Motor Vehicle Crash, Being Struck By Blunt Object

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3
Q

Head Injuries: Age associations with this include who?

A

0-7
15-19
> 65

These are who are most prone to this

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4
Q

Head Injuries: What is key for this?

A

Preventing. If riding a bike, wearing a helmet. Always trying to protect your head.

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5
Q

Patho of Brain Damage: What is a primary injury?

A

The initial damage to the brain. May have contusions, lacerations.

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6
Q

Patho of Brain Damage: What is a secondary injury?

A

This will develop hours to days after initial insult. Due to inadequate delivery of nutrients or oxygen to brain cell. May have hemorhage, cerebral edema, increased ICP

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7
Q

Patho of Brain Damage: What is a scalp injury?

A

These are minimal injuries. Vessels have poor constriction with scalp and do tend to bleed more

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8
Q

Patho of Brain Damage: What is a skull fracture?

A

A break in the skull somewhere. It can cause damage to the brain but you can still have skull fracture and there not be a brain injury associated with it

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9
Q

Patho of Brain Damage: What are the types of skull fractures?

A

Simple, Comminuted, Depressed

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10
Q

Patho of Brain Damage: What are the locations of skull fractures?

A

Frontal, Temporal, Basal

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11
Q

Patho of Brain Damage: What are the two forms of injuries?

A

Primary injury or secondary injury

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12
Q

Patho of Brain Damage: Bleeding within skull is going to increase what?

A

Contents inside of the cranium. Blood is going to increase, increasing ICP and causing brain damage.

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13
Q

Patho of Brain Damage: What is a simple fracture?

A

Simple break within the skull.

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14
Q

Patho of Brain Damage: What is comminuted fracture?

A

There are multiple fractures within skull, they are splintering.

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15
Q

Patho of Brain Damage: What is a depressed fracture?

A

Thats a bone skull fracture where the fracture is forced down into the brain tissue.

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16
Q

Patho of Brain Damage: What is a basilar skull fracture?

A

Happens at the base of the skull, right near the ear drum. With this, you will see battle sign.

May also see CSF leaking from the nose or external auditory canal.

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17
Q

Patho of Brain Damage: Why is a basilar or all skull fractures bad?

A

This is when the blood-brain barrier can be broke. CSF can escape through ear and nose.

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18
Q

Patho of Brain Damage: What is battle sign?

A

This is bruising around the mastoid process with racoon eyes.

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19
Q

Patho of Brain Damage: How to determine if fluid is CSF?

A

You can place drops of that fluid on a absorbent filter. If you get double ring sign, then you have clear ring on the outermost, that is likely CSF.

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20
Q

Patho of Brain Damage: What tests are not conclusive for CSF?

A

Total Protein, Glucose, Chloride. It may be a good indication but not guaranteed.

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21
Q

Head Injuries: With any head injury, you need to consider what

A

That there is a brain injury.

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22
Q

Head Injuries: Why is a brain injury bad?

A

Because they do not store oxygen or nutrients. Need to make sure that they are not deprived.

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23
Q

Head Injuries: What is the Patho of this after brain suffers injury??

A

Brain swelling/bleeding increases cranial volume

Right cranium allows no room for expansion so ICP increases

Pressure on blood vessels within brain cause blood flow to slow

Cerebral Hypoxia and Ischemia

ICP continues to rise. Brain may herniate.

Cerebral blood flow ceases.

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24
Q

Head Injuries - CMs: This includes what for patients that comes in?

A

Pain associated with fracture.

Basillar Skull Fracture - Mastoid process bruising and racoon eyes are the battle sign.

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25
Q

Head Injuries: Diagnostics include what?

A

CT or MRI

If they expect that skull fracture seems severe, they may jump straight to MRI

GCS Assessment

Neuro Assessment

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26
Q

Head Injuries - Med Mx: If this is not depressed, what will patient require?

A

They will not need any surgery and patient will just be observed.

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27
Q

Head Injuries - Med Mx: If there is a depression of skull fracture into brain, what do patients need?

A

Surgery to pull the piece of skull out of brain and debriding the brain tissue of any remaining skull fractures.

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28
Q

Types of Brain Injuries: What is a closed (blunt) injury?

A

This means that head will rapidly accelerate and decelerate. Its going to happen when it has collided with a object. Get hit in the head and head whips back and forth with brain shifting.

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29
Q

Types of Brain Injuries: What is a open brain injury?

A

An object has penetrated the skull and entered the brain. Got hit with a sharp object.

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30
Q

Types of Brain Injuries: What is a concussion?

A

This is damage to the protective layer of the brain. Dura membrane gets damaged graded from 1-3 scale. There is no structural damage.

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31
Q

Types of Brain Injuries: What is a contusion

A

This is a moderate to severe head injury. Brain is basically bruised here and there is damage to a specific area. Will have LOC, confused, loss of stuporedness. Will peak after 18-36 hours.

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32
Q

Types of Brain Injuries: What is a diffuse axonal injury

A

Shearing damage from the brain to the axons in the brain. Those patients are in prolonged coma

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33
Q

Types of Brain Injuries: What is a intracranial hemorrhage?

A

All of the hematomas. Collection of blood in one of the epidural, subdural, intracerebral areas.

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34
Q

Types of Brain Injuries: What is included under intracranial hemorrhage?

A

Epidural Hematoma
Subdural Hematoma
Intracerebral Hemorrhage and Hematoma

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35
Q

Types of Brain Injuries: What is Chronic Traumatic Encephalopathy?

A

Occurs from repeated concussions that happen. Causes problems later on in life

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36
Q

Types of Brain Injuries: What is epidural hematoma

A

This is when an artery has been severed. Miniature artery severed. Will experience brief loss of consciousness and then will be lucid, awake, conversing. Able to compensate through monro kelley hypothesis

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37
Q

Types of Brain Injuries: What is subdural hematoma

A

Blood between the dura and brain. Will be seen from ruptured aneurysm. Do tend to be more venous in nature. Can be acute or chronic.

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38
Q

Types of Brain Injuries: What is intracerebral hemorrhage and hematoma?

A

You have a bleed right in the tissue of the brain. This is from stab wound or gunshot wound to the head.

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39
Q

Types of Brain Injuries: What is the Monro Kelley Hypothesis?

A

If one of the three components in the skull within that cranium increases then the other one will decrease.

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40
Q

Types of Brain Injuries: How will patients compensate with epidural hematoma?

A

May see a Burr Hole created or a craniotomy to help relieve some of that pressure building.

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41
Q

Types of Brain Injuries: Where is the epidural hematoma located?

A

This will be located above the dura mater

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42
Q

Types of Brain Injuries: Where is the subdural hematoma located?

A

This will be located below the dura mater

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43
Q

Types of Brain Injuries: What is a acute subdural hematoma?

A

Thats a major head injury. Will need immediate craniotomy. High mortality rate.

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44
Q

Types of Brain Injuries: What is a chronic subdural hematoma?

A

Minimal head injury. Tends to develop over time over weeks to months if a vein has ruptured.

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45
Q

Types of Brain Injuries: How is a chronic subdural hematoma fixed?

A

Will be treated by suctioning the clot, evacuating that way.

May do Burr Holes or Craniotomies to relieve pressure

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46
Q

Types of Brain Injuries: How to fix intracerebral hemorrhage?

A

Srugery can be difficult depending on location.

Supportive care. Monitoring Respiratory System. Monitoring ICEP by trying to keep it down as much as possible. Monitoring electrolytes

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47
Q

Mx of Brain Injuries: Anytime a patient with a head injury occurs, you need to suspect what

A

cervical injury unless proven otherwise

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48
Q

Mx of Brain Injuries: All treatment aimed at what

A

primary injury to prevent secondary injury from happening

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49
Q

Mx of Brain Injuries: Treatment will focus on what?

A

The increased ICP

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50
Q

Mx of Brain Injuries: How is ICP managed?

A

By getting head of bed up and not allowing twisting of head or neck. Allows blood to flow from head and not back on

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51
Q

Mx of Brain Injuries: What specific support can be given here?

A

Advance Trauma Life Support (ATLS)

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52
Q

Mx of Brain Injuries: What is ATLS?

A

These is activated once a GCS score of less than 8 is gotten. Is an emergency dignosis .

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53
Q

Mx of Brain Injuries: GSC should be rated at what ?

A

8 or less that activates ATLS

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54
Q

Mx of Brain Injuries: What is included in ATLS once activated?

A

Patients are intubated, receive fluid and resuscitation, go on ventilator to keep CO2 between 30-35 to decrease ICP.

Will be receiving oxygenation, sedation to decrease O2 demand, and might be given paralysis for short acting.

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55
Q

Mx of Brain Injuries: Once ATLS has been activated and interventions have been started, what is evaluated next?

A

Is there any herniation or Deterioration?

If yes, you give more hyperventilating and give them Mannitol (0.9 mg/kg) to dehydrate the brain and pull more fluid off.

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56
Q

Mx of Brain Injuries: If the herniation or deterioration has not resolved, what is done next?

A

Will be sent to the operating room to see where bleeding is coming from

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57
Q

Mx of Brain Injuries: What is done if there is resolution from mannitol reatment?

A

Will be given a CT scan to look for surgical lesion. If not present, will be sent to ICU where ICP will be monitored and intracranial hypertension will be treated

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58
Q

Mx of Brain Injuries: Normal ICP range?

A

0-15

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59
Q

Mx of Brain Injuries: What supportive measures can be done?

A

Respiratory patients will be on vent. Seizure precautions. Nutrition. Monitor fluids and electrolytes

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60
Q

Mx of Brain Injuries: How will nutition be done?

A

Through feeding tube.

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61
Q

Mx of Brain Injuries: If sedated, will need to help deal with what?

A

Making sure that a feeding tube is placed and helping deal with anxiety that the patient may be having.

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62
Q

Mx of Brain Injuries: May experience brain death, which is what

A

Brain injury is so severe, it is incompatible with life. They can be potential organ donors however.

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63
Q

Mx of Brain Injuries: What is the role of the nurse and organ donation?

A

It is never the nurses responsibility to go in and talk about organ donation to that patient’s family. You will call Indiana Donor Network and they will come in to family.

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64
Q

Mx of Brain Injuries: What are the three cardinal signs of brain death?

A

Coma, Absence of brain stem reflexes and apnea.

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65
Q

Mx of Brain Injuries: Absence of brain stem reflexes include what?

A

If the patient has a gag reflex.

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66
Q

Brain Injury Diagnostic Evaluation: What is teh first thing done for physical and neurologic exam?

A

GCS and see what they can do.

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67
Q

Brain Injury Diagnostic Evaluation: If brain dead, GCS will be scored at what?

A

3

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68
Q

Brain Injury Diagnostic Evaluation: What does this include?

A

Skull/Spinal X-Ray
CT Scan
MRI
PET Scan (May be if they have a brain tumor)

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69
Q

Brain Injury Diagnostic Evaluation: What Brain Death testing can be done?

A

EEG

Cerebral Blood Flow Studies.

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70
Q

Brain Injury Diagnostic Evaluation: EEG would show what

A

GOing to check the waveforms of the brain.

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71
Q

Brain Injury Diagnostic Evaluation: How does cererbal blood flow study work?

A

Will inject a dye and look for that to flow through the brain. Radiologist can look at that and see if there is blood flow in the brain.

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72
Q

Traumatic Brain Injury - Nursing Process: What assessments will be made initially?

A

You will be asking when injury occured, what caused injury, how did head get hit direction wise.

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73
Q

Traumatic Brain Injury - Nursing Process: Neuro assessment will include what?

A

Doing a GCS and pupils. ALso checking airway to make sure it is in place.

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74
Q

Traumatic Brain Injury - Nursing Diagnosis: This focuses on what?

A

Ineffective Airway Clearance (Maintain Airway)
Ineffective Cerebral Tissue Perfusion
Deficient Fluid Volume

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75
Q

Traumatic Brain Injury - Nursing Diagnosis: This will be related to what?

A

Increased ICP and the level of consciousness.

76
Q

Traumatic Brain Injury: Goals for this will be what for increased ICP?

A

Head of bed elevated
No twisting of neck and head
No vagal maneuvers.

Focused on controlling the ICP

77
Q

Traumatic Brain Injury: We will want to minimize O2 consumption of brain how?

A

If shivering because of hyperthermic, we may want to put cooling blankets on them.

78
Q

Traumatic Brain Injury: Why is shivering bad

A

because it increases o2 consumption which causes ischemia. May further sedate and paralyse them to prevent shivering. Also want to keep SpO2 above 90.

79
Q

Traumatic Brain Injury: Cerebral perfusion pressure is normal in what range?

A

Is usually anywhere from 70-100

80
Q

Traumatic Brain Injury: What happens to cerebral perfusion pressure when there is a severe brain injury?

A

You just need to keep the pressure above 50. It will decrease but you’ll want to keep it up.

81
Q

Traumatic Brain Injury - Problems/Complications: What is included here?

A 
Decreased cerebral perfusion
Cerebral edema and herniation
Impaired oxygenation and ventilation
impaired fluid, electrolyte, and nutritional balance
Risk of post-traumatic seizures
82
Q

Traumatic Brain Injury - Problems/Complications: Cerebral perfusion peaks when?

A

48-72 hours after injury. CPP needs to be above 50 for this injury

83
Q

Traumatic Brain Injury - Problems/Complications: Treatment for this is the same as what

A

Managing the increased ICP

84
Q

Spinal Cord Injury (SCI): What is paraplegic?

A

Paralysis of the lower body

85
Q

Spinal Cord Injury (SCI): What is quadriplegic?

A

Now called tetraplegia, which is paralysis of all 4 extremities

86
Q

Spinal Cord Injury (SCI): What gender does this affect more?

A

Males, 80%

87
Q

Spinal Cord Injury (SCI): What age groups account for over half of this?

A

People aged 15-35

88
Q

Spinal Cord Injury (SCI): What ethnicity is at a higher risk?

A

African Americans

89
Q

Spinal Cord Injury (SCI): Risk factors?

A

Alcohol and drug use

90
Q

Spinal Cord Injury (SCI) - Patho: This is a result of what?

A

Concussion, contusion, laceration or compression of the spinal cord.

91
Q

Spinal Cord Injury (SCI) - Patho: Primary injury is a result of what

A

the initial trauma

92
Q

Spinal Cord Injury (SCI) - Patho: Secondary injury is usually the result of what?

A

ischemia, hypoxia, and hemorrhage, which destroys the nerve tissues

93
Q

Spinal Cord Injury (SCI) - Patho: Treatment thoughts for secondary injuries?

A

They are thought to be reversible and preventable during the first 4-6 hours after injury.

If we can get blood flow flowing back, hopefully damage can be reversed

94
Q

Spinal Cord Injury (SCI) - Patho: Treatment is needed to prevent what?

A

Partial injury from developing into more extensive permanent damage

95
Q

Spinal Cord Injury (SCI) - Patho: Location of injury will equate into what?

A

The type of manifestations you see

96
Q

Spinal Cord Injury (SCI) - Patho: What will you see if injury happens lower than the lumbar?

A

There will be a greater range of mobility

97
Q

Spinal Cord Injury (SCI) - Patho: If injury happens higher up in cervical, what type of movementw ill you see

A

will not have that much movement

98
Q

Spinal Cord Injury (SCI) - CMs: What are the two different types you can have?

A

Incomplete and Complete Spinal Cord Lesion

99
Q

Spinal Cord Injury (SCI) - CMs: What are the sections of the spinal cord?

A

Cervical -> Thoracic -> Lumbar -> Sacrum and Coccyx

100
Q

Spinal Cord Injury (SCI) - CMs: If Cervical injuried, you’re at risk for what injury?

A

Quadriplegia

101
Q

Spinal Cord Injury (SCI) - CMs: If thoracic injured, you are at risk for what injury?

A

Paraplegia

102
Q

Spinal Cord Injury (SCI) - CMs: If lumbar injured, you are at risk for what injury?

A

Paraplegia

103
Q

Spinal Cord Injury (SCI) - CMs: What is a incomplete spinal cord lesion?

A

This is going to be the sensory/motor fibers preserved below the lesion. May still have function

104
Q

Spinal Cord Injury (SCI) - CMs: What is a complete spinal cord lesion?

A

This will be the total loss of sesnation and voluntary muscle control below the lesion which can result in paraplegia . May see respiratory difficulties

105
Q

Spinal Cord Injury (SCI) - Assessment/Diagnostic: What will be done?

A

Imaging: MRI, CT.

Telemetry because we want to monitor since it can affect the heart rate and develop asystole.

106
Q

Spinal Cord Injury (SCI) - Mx: What are the phases?

A

Emergent
Medical (Acute)
Surgical

107
Q

Spinal Cord Injury (SCI) - Mx: What is the emergent phase?

A

This is the initial mx. Will need proper handling, will need to be put on backboard and c-collar. Rapid assessment and then taking into hospital

108
Q

Spinal Cord Injury (SCI) - Mx: What is the medical (Acute) phase

A

Medical tx. Primary goal is to prevent secondary injury. Will want to monitor for progression of neurological deficits and prevent complications.

109
Q

Spinal Cord Injury (SCI) - Mx: During the medical (acute ) Phase, you may see what given?

A

Medications.

High dose corticosteroid like Solu-Medrol. This is controversial.

110
Q

Spinal Cord Injury (SCI) - Medical (Acute) Phase: What will occur with respiratory?

A

Will be giving O2. Will increase the PaO2 level if they’re struggling to breathe. May get intubated.

111
Q

Spinal Cord Injury (SCI) - Medical (Acute) Phase: May have Diaphragmatic Pacing, which is what?

A

The stimulation of the phrenic nerve, stimulate the diaphragm to take a beath

112
Q

Spinal Cord Injury (SCI) - Medical (Acute) Phase: Skeletal fraction reduction includes what?

A

This is done to immobilize the spinal column and helps basically decompress. Immobilize a reduction of dislocation. Can also put weights on to help pull the spine into place and straighten everything out and relieve pressure

113
Q

Spinal Cord Injury (SCI) - Medical (Acute) Phase: What happens as amount of weight increases?

A

Space between the vertebrae widen and gives the vertebrae the chance to go back into alignment.

114
Q

Spinal Cord Injury (SCI) - Medical (Acute) Phase: What is a therapy youll see a lot with these people

A

Traction

115
Q

Spinal Cord Injury (SCI) - Surgical: When would you see this done?

A

If there’s cord compression. If the spinal cord or vertebrae or unstable or fractured. Also if bone fragments within cord.

116
Q

Spinal Cord Injury (SCI) - Surgical: What happens if patient in traction and theres a decline in neuro status?

A

They may have better outcomes the earlier they get into surgery so they may go there to help correct that.

117
Q

Spinal Cord Injury (SCI) - Complications: What complications can occur?

A

Spinal Shock
Neurogenic Shock
Autonomic Dysreflexi
VTE

118
Q

Spinal Cord Injury (SCI) - Complications: WHy is VTE a complication?

A

Because they are immobile

119
Q

Spinal Cord Injury (SCI) - Complications: How to prevent VTE?

A

Low-dose anticoagulant and put on STDs. Maybe Ted Hose and Anti-Embolic Stockings to help with venous return and decrease change of getting VTE.

120
Q

Spinal Cord Injury (SCI) - Complications, Neurogenic Shock: What is neurogenic shock

A

Distributive shock that causes you to have venous blood pooling. Loss of autonomic nervous system, lose function below the level of the lesion.

121
Q

Spinal Cord Injury (SCI) - Complications, Neurogenic Shock: Loss of ANS below the lesion causes what to happen

A

Lose the sympathetic and parasympathic nervous system balance. PSNS going to cause vasodilation which will cause decreased vascular resistance and decrease in heart rate to decrease tissue perfusion

122
Q

Spinal Cord Injury (SCI) - Complications, Neurogenic Shock: How do you treat this?

A

Stabilizing the spinal cord so positioning the spinal cord. Thats why traction is important. Helps with decompression of spinal cord and releases pressure on spine

Also support BP, HR. Patients need pressors like dopamine, vasopressin, Atropine to increase HR.

123
Q

Spinal Cord Injury (SCI) - Complications, Neurogenic Shock: What do you not want to give these patients?

A

Phenylephrine. This is a pressor but will reduce the heart rate even more and will be a side effect of that.

124
Q

Spinal Cord Injury (SCI) - Complications, Spinal Shock: What is this associated with?

A

Spinal cord injury as well

125
Q

Spinal Cord Injury (SCI) - Complications, Spinal Shock: What is this?

A

Sudden onset reflex activity that is depressed below the level of injury. No reflexes, no sensation, they are paralyzed.

126
Q

Spinal Cord Injury (SCI) - Complications, Spinal Shock: What does this affect?

A

Bowel and bladder function. May cause paralytic ileus so may need NG tube in place.

127
Q

Spinal Cord Injury (SCI) - Complications, Spinal Shock: How can this be treated?

A

With Solumedrol. It is in shock and just needs time to recover

128
Q

Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: What is this?

A

SCI above T6. Severe exaggerated response. Some type of painful stimulus like bladders full or developed pressure ulcer. Discomfort sensed by ANS and sends this signals causing vasoconstriction. Signals are supposed to relax the body but are not passed beyond the spinal cord.

129
Q

Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: When does this happen?

A

After spinal shock has subsided and these patients could be in rehab or at home.

130
Q

Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: What happens above and below the injury?

A

Above T6, you will see vasodilation because the body has received the signal to this point

Below T6 or site of injury, there will be vasoconstriction because signal has not been received.

131
Q

Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: How will these patients appear?

A 
Headache because of vasodilation above injury
Goosebumps 
Flushed Face
Diaphoresis (Sweating)
Hypertension , sudden onset
Nauseated
Nasal Congestion
Bradycardia
132
Q

Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: What interventions can be done for this?

A

Raise the HOB.

Find the stimulus that is causing this. Can be ulcer, fecal mass, distended bladder.

Administer meds to lower BP like nitro, hydrolyzine.

133
Q

Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: What will be done for education?

A

If getting discharged, education about this. Need to teach signs of how to identify and prevent.

134
Q

Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: Early signs will include what

A

Headache

135
Q

Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: Patients need to learn to do what?

A

Self-Cath themselves to prevent bladder from being distended. If distended, will cause painful stimulus and signal will be disruptive and not be able to go down spinal cord.

136
Q

Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: Patients need to do what with constipation?

A

Prevent this. Make sure to have a lot of fiber.

137
Q

Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: What three examples can cause this?

A

Bladder distended, constipation, and skin care from ulcers

138
Q

Spinal Cord Injury (SCI) - Nursing Process: Assessment includes what?

A

Monitoring sensory/motor function. Monitor breathing. Monitor for development of spinal shock.

139
Q

Spinal Cord Injury (SCI) - Nursing Process: Nursing Diagnosis?

A

Ineffective breathing pattern and ineffective airway clearance. Goal will be to maintain airway and acceptable breathing pattern. May need to be intubated or sedated.

Skin breakdown, impaired mobility, urinary elimination

140
Q

Spinal Cord Injury (SCI) - Nursing Process: Goals/Interventiosn will be what?

A

Focus on diagnosis. If breathing pattern affected, make sure to monitor respiratory status and lung sounds.

Make sure airway is patent

Impaired mobility -> make sure you to range of motio

Impaired skin integrity -> turning patient every 2hours.

Urinary elimination -> monitor this and bowel function

141
Q

Spinal Cord Injury (SCI) - Nursing Process: What complications can occur?

A

VTEs, Neurogenic Shock, Spinal Shock, Autonomic Dysreflexia

142
Q

Spinal Cord Injury (SCI) - Halo Systems: Used for what injury?

A

Cervical and thoracic injuries

143
Q

Spinal Cord Injury (SCI) - Halo Systems: What do the pins do?

A

They are placed above eyebrow to hold the system in place.

144
Q

Spinal Cord Injury (SCI) - Halo Systems: What do they do?

A

They immobilize the spinal column

145
Q

Spinal Cord Injury (SCI) - Halo Systems: If patient going home, education will be on what?

A

Education on pin care, vest care, signs and symptoms of infection because pins poking into head,

146
Q

Spinal Cord Injury (SCI) - Halo Systems: THis is basically what?

A

Traction. Provides decompression therapy that releases and relieves pressure on the spine.

147
Q

Spinal Cord Injury (SCI) - Long-Term complications: What do these include?

A 
Premature Aging
Disuse Syndrome
Autonomic Dysreflexia 
Bladder/Kidney Infection
Spasticity
Depression
Pressure Ulcers; Osteomyelitis and Sepsis
Heterotopic Ossification
148
Q

Spinal Cord Injury (SCI) - Long-Term complications: Goal of rehab is what?

A

Maintain independence

149
Q

Spinal Cord Injury (SCI) - Long-Term complications: Disuse syndrome occurs why

A

Because they are not using the extremity.

150
Q

Spinal Cord Injury (SCI) - Long-Term complications: What is autonomic dysreflexia

A

exaggerated response to a stimulus

151
Q

Spinal Cord Injury (SCI) - Long-Term complications: Why are bladder/kidney infections common?

A

Because they cannot go to the bladders sometimes. Quadriplegics often come in with raging UTIs.

152
Q

Spinal Cord Injury (SCI) - Long-Term complications: What is heterotopic ossification

A

The bone forming into the tissue.

153
Q

Spinal Cord Injury (SCI) - Long-Term complications: Often seen with what injury?

A

The complete lesion injury

154
Q

NCP for Patient with Tetraplegia or Paraplegia: Nursing Diagnosis includes what?

A

Impaired Bed/Physical Mobility and Impaired Skin Integrity : Big Two!

RF Disuse Syndrome
Impaired Urinary Elimination
Constipation
Sexual Dysfunction
Ineffective Coping
Knowledge Deficit
155
Q

Oncologic tumors: What are brain tumors?

A

They grow as a mass and infiltrate the brain tissue. Can cause increased ICP, seizures, hydrocephalus. Can be pretty debilitating.

156
Q

Oncologic tumors: What are the different types of primary tumors?

A

They originate from the cell within the brain. It is not from metastasis.

157
Q

Oncologic tumors: What is a mengiomas?

A

Theres a tumor within the covering of the brain either in dura, arachnoid, or pia mater.

158
Q

Oncologic tumors: What are angiomas?

A

Masses of abnormal blood vessels

159
Q

Oncologic tumors: What is a metastatic tumor?

A

These are secondary tumors. They are more common than the actual primary tumors. Sometimes, its the secondary metastatic tumors that help reveal the primary cancer when they have neurological changes.

160
Q

Brain Tumor - CMs: What does this include?

A

Increased ICP

Localized Symptoms

161
Q

Brain Tumor - CMs: What symptoms may be caused by increased ICP?

A

Headache from sudden movement
Vomiting (Not related to food intake, is projectile)
Visual Disturbances (May be pressure on occipital lobe)
Seizures

162
Q

Brain Tumor - CMs: What are the localized symptoms?

A

Signs related to the area of the brain. That is why its important to understand the different lobes of the brain

163
Q

Brain Tumor - CMs: If there is a cerebellular tumor, what changes may occur?

A

Ataxia, dizziness

164
Q

Brain Tumor - CMs: If frontal lobe tumor, may have changes with what

A

emotional state and personality

165
Q

Brain Tumor - Diagnostic: How is this diagnosed?

A

Neurologic Exam
CT Scan
MRI
PET Scan - Supplements MRI to help diagnose and guide treatment
EEG
Cytologic Study of CSF - To detect malignant cells
Biopsy - To see if cancerous or not.

166
Q

Brain Tumor - Med Mx: Specific treatment depends on what?

A

Type, location, and accessibility of the tumor

167
Q

Brain Tumor - Med Mx: What are some different examples?

A

Surgery
Radiation Therapy
Chemotherapy

168
Q

Brain Tumor - Med Mx: What falls under radiation therapy?

A

External Beam Radiation

Brachytherapy

169
Q

Brain Tumor - Med Mx: Surgery is best why

A

Because you want to remove as much as possible without causing any deficits

170
Q

Brain Tumor - Med Mx: What is external beam radiation?

A

Where they use this beam to help destroy the tumor

171
Q

Brain Tumor - Med Mx: What is brachytherapy?

A

Internal dosing. May place seeds or rods within tumor itself.

172
Q

Brain Tumor - Med Mx: Why would chemotherapy be used?

A

To help destroy those cancer cells

173
Q

Brain Tumor - Med Mx: What meds may be given?

A

Decadron to help reduce the brain tumor size. Is a steroid.

174
Q

Cerebral Metastases: Med treatment will be what?

A

Palliative. Will get baseline medical characteristics of headache.

175
Q

Cerebral Metastases: What education will be given?

A

The need for them to adhere to prophylactic anti-seizure medications since they are at risk for seizures.

176
Q

Cerebral Metastases: What will be assessed?

A

Their baseline medical characteristics of the headache and also vital signs.

Also want to assess nutritional status to help prevent nausea and vomiting in these patients.

Assess how they are functioning.

177
Q

Cerebral Metastases: Nursing Assessment includes what?

A

Checking on patient, nutrition status, neuro status.

178
Q

Cerebral Metastases: Nursing diagnoses will focus on what?

A

Self-care deficit, imbalanced nutrition, anxiety, interrupted family process.

179
Q

Spinal Cord Tumors: How are they classified?

A

According to their anatomic relation to the spinal cord

180
Q

Spinal Cord Tumors: What are the different classifications?

A

Intramedullary

Extramedullary, extradural

181
Q

Spinal Cord Tumors: What is intramedullary?

A

Within the cord

182
Q

Spinal Cord Tumors: What is extramedullar?

A

Outside of the dural membrane

183
Q

Spinal Cord Tumors: CMs incldue what?

A

Pain, Weakness
Loss of Motor Function
Loss of Reflexes
Loss of Sensation

184
Q

Spinal Cord Tumors: Treatment depends on what

A

Type of tumor and location

185
Q

Spinal Cord Tumors: What is most often done for treatment?

A

Surgical Removal if they are able to

186
Q

Spinal Cord Tumors: Other than surgical removal, what else can be done for treatment?

A

Measures to relieve compression:

Dexamethasone combined with radiation to help reduce the tumor size.

This is done to help give patients back some motor function that they lost due to tumor pressing on spinal cord.

187
Q

Spinal Cord Tumors: Dose of Dexamethasone?

A

will be a high dose. This is associated with a tumor of some sort whether it be a brain tumor or spinal cord tumor.

Same thing for decadron.

NRSG 200: Med Surg 3 (46 decks)

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