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Role and scope > Final > Flashcards

Final Flashcards

1
Q

What is azotemia?

A

an accumulation of nitrogenous waste products (urea, nitrogen, creatinine) in the blood

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2
Q

What is urea? How is it measured? What is the normal value?

A

BUN

By product of protein

=20

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3
Q

What is creatinine? How is it measured? What is the normal value?

A

By product of muscle

=1

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4
Q

What are waste products?

A

Urea
Creatinine
Electrolytes

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5
Q

Acute Kidney Injury (AKI) stage 1

A

Prerenal = decreased blood flow, decreased blood volume

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6
Q

Prerenal causes of AKI

A

Hypovolemia
Decreased cardiac output
Decreased vascular resistance
Decreased renovascular blood flow

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7
Q

Hypovolemia (prerenal) causes

A
  • dehydration
  • hemorrhage
  • GI losses (diarrhea, vomiting)
  • excessive diuresis
  • hypoalbuminemia
  • burns
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8
Q

Decreased CO (prerenal) causes

A
  • dysrhythmias
  • cardiogenic shock
  • heart failure
  • MI
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9
Q

Decreased vascular resistance (prerenal) causes

A
  • anaphylaxis
  • neuro injury
  • septic shock
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10
Q

Decreased renovascular blood flow (prerenal) causes

A
  • bilateral renal vein thrombosis
  • embolism
  • hepatorenal syndrome
  • renal artery thrombosis
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11
Q

Acute Kidney Injury (AKI) stage 2

A

Intrarenal = inside the kidney

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12
Q

Intrarenal causes

A

Nephrotoxic injury
Interstitial nephritis
Other causes

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13
Q

Nephrotoxic injury (intrarenal) causes

A
  • drugs: aminoglycosides (gentamicin), amphotericin B
  • contrast media
  • hemolytic blood transfusion reaction
  • severe crush injury
  • chemical exposure: ethylene glycol, lead, arsenic, carbon tetrachloride
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14
Q

Interstitial nephritis (intrarenal) causes

A
  • allergies: antibiotics (sulfonamides, rifampin), NSAIDS, ACE inhibitors
  • infections: bacterial (acute pyelonephritis), viral (CMV), funal (candidiasis)
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15
Q

Other causes of intrarenal

A
  • prolonged prerenal ischemia
  • acute glomerulonephritis
  • thrombotic disorders
  • toxemia of pregnancy
  • malignant hypertension
  • systemic lupus erythematosus
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16
Q

Acute Kidney Injury (AKI) stage 3

A

Postrenal = blockage in kidney! (back up of urine)

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17
Q

Postrenal causes

A
  • BPH
  • bladder or prostate cancer
  • calculi formation
  • neuromuscular disorders
  • spinal cord disease
  • strictures
  • trauma (back, pelvis, perineum)
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18
Q

AKI phases

A

Oliguric or nonoliguric
Diuretic
Recovery

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19
Q

Oliguric phase of AKI

A

*holding onto waste

  • decreased urine output <400 mL/day
  • hypervolemia
  • edema in extremities
  • hypertension
  • pulmonary edema, crackles, short of breath
  • metabolic acidosis
  • increased BUN, creatinine, K
  • decreased Na

*asterixis-flapping hand motion

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20
Q

Nonoliguric phase of AKI

A

urine output >400 mL/day

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21
Q

What should be restricted during oliguric phase?

A

Potassium
Sodium
Protein

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22
Q

If protein is low, give _______.

A

albumin

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23
Q

Diuretic phase of AKI

A

(hypo everything!)

  • urine output 5L/day
  • hypovolemia
  • hyponatremia
  • hypotension
  • hypokalemia
  • dehydration
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24
Q

Recovery phase of AKI

A
  • GFR increases
  • BUN and creatinine decrease
  • casts-tubules sloughing
  • dark, concentrated urine

*high protein and calorie diet

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25
Q

Normal GFR

A

125 mL/min

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26
Q

GFR ________ with injury

A

decreases

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27
Q

GFR ________ when recovery phase begins in AKI

A

increases

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28
Q

Chronic Kidney Disease (CKD) is…

A

progressive and irreversible

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29
Q

CKD manifestations

Psychologic

A
  • anxiety

- depression

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30
Q

CKD manifestations

Cardio

A
  • HTN
  • HF
  • CAD
  • pericarditis
  • PAD
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31
Q

CKD manifestations

GI

A
  • anorexia
  • N/V
  • GI bleeding
  • gastritis
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32
Q

CKD manifestations

Endocrine

A
  • hyperparathyroidism
  • amenorrhea
  • erectile dysfunction
  • thyroid abnormalities
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33
Q

CKD manifestations

Metabolic

A
  • carb intolerance

- hyperlipidemia

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34
Q

CKD manifestations

Hematologic

A
  • anemia
  • bleeding
  • infection
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35
Q

CKD manifestations

Neuro

A
  • fatigue
  • headache
  • sleep disturbances
  • encephalopathy
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36
Q

CKD manifestations

Ocular

A

-hypertensive retinopathy

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37
Q

CKD manifestations

Pulmonary

A
  • pulmonary edema
  • uremic pleuritis
  • pneumonia
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38
Q

CKD manifestations

Integumentary

A
  • pruritis
  • ecchymosis
  • dry, scaly skin
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39
Q

CKD manifestations

Musculoskeletal

A
  • vascular and soft tissue calcifications
  • osteomalacia
  • osteitis fibrosa
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40
Q

CKD manifestations

Peripheral neuropathy

A
  • parathesias

- RLS

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41
Q

Stage 1 of CKD

A

GFR >90

manage with diet
control B/P

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42
Q

Stage 2 of CKD

A

GFR 60-89

manage with diet
control B/P

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43
Q

Stage 3 of CKD

A

GFR 30-59

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44
Q

Stage 4 of CKD

A

GFR 15-29

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45
Q

Stage 5 of CKD

A

GFR <15

Kidney failure

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46
Q

Chronic Renal Failure (CRF)

A

-diminished renal reserve
(stages 1 and 2 of CKD)

-renal insufficiency
(stages 3 and 4 of CKD)

-end stage renal disease (ESRD)
(stage 5 of CKD)

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47
Q

Diminished renal reserve

stages 1 and 2 of CKD

A
  • GFR >90 mL/min
  • control B/P
  • kidney damage with normal or increased GFR
  • decreased urinary concentration (nocturia)
  • treatment of diabetes, hypertension, renal artery stenosis
  • 24 hour urine (creatinine)
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48
Q

Renal insufficiency

stages 3 and 4 of CKD

A
  • GFR 30-89 mL/min
  • headaches
  • decreased ability to concentrate urine
  • polyuria to oliguria
  • increased BUN, creatinine
  • edema
  • mild anemia
  • increased B/P
  • weakness/fatigue
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49
Q

End stage renal disease (ESRD)

stage 5 of CKD

A
  • GFR <15 mL/min
  • confusion, weakness, fatigue
  • increased B/P, pitting edema, increased CVP, pericarditis
  • SOB, suppressed cough, thick sputum
  • amonia odor to breath, metallic taste, mouth ulcers, anorexia, N/V
  • behavior changes
  • anemia (decreased RBC, increased HR)
  • dry, flaky skin, pruritis, ecchymosis, pupura
  • cramps, renal osteodystrophy, bone pain
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50
Q

Diffusion

A

urea, creatinine, uric acid and electrolytes move from the blood to the dialysate to lower the concentration in the blood

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51
Q

Osmosis

A

glucose is added to the dialysate and creates an osmotic gradient across the membrane, pulling excess fluid from the blood

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52
Q

Advantages of peritoneal dialysis (PD)

A
  • immediate initation in most hospitals
  • less complicated
  • portable system with CAPD
  • fewer dietary restrictions
  • pts with vascular access problems
  • decreased cardio stress
  • home dialysis possible
  • preferable for diabetes pt
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53
Q

Advantages of hemodialysis (HD)

A
  • rapid fluid removal
  • rapid urea and creatinine removal
  • potassium removal
  • less protein loss
  • decreased triglycerides
  • temporary access can be placed at bedside
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54
Q

Process for PD

A

Exchange

3 phases

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55
Q

Phase 1 of PD

A

Inflow

-2L solution infuses-10 minutes

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56
Q

Phase 2 of PD

A

Dwell

  • diffusion and osmosis between pt’s blood and peritoneal cavity
  • 20 or 30 min-8 hours, depending on method
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57
Q

Phase 3 of PD

A

Drain

  • 15-30 minutes
  • can be facilitated by gently massaging abdomen or changing position
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58
Q

Process for HD

A

1 needle pulls blood

1 needle puts blood back into pt

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59
Q

Potential complications of PD

A
  • infections
  • pain
  • peritonitis
  • heart problems
  • pulmonary problems (pneumonia, atelectasis, bronchitis)
  • protein loss
  • carb abnormalities
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60
Q

Potential complications of HD

A
  • hypotension
  • muscle cramps
  • hepatitis
  • infection
  • heart disease
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61
Q

Human Leukocyte Antigen (HLA)

A
  • antigens responsible for rejection of genetically unlike tissue
  • histocompatibility antigens
  • matching organs and tissues for transplants
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62
Q

The more HLA matches =

A

less likely for rejection

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63
Q

HLA matching for corneas

A

None needed (avascular)

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64
Q

HLA matching for liver, heart, lungs

A

some needed

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65
Q

HLA matching for kidneys and bone marrow

A

EXACT match needed

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66
Q

Positive crossmatch

A

bad reaction with donor/recipient blood

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67
Q

Negative crossmatch

A

NO reaction

-organ safe for transplantation

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68
Q

What tests are needed for transplants?

A

HLA matching
Crossmatch
ABO

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69
Q

Types of rejection

A
  • hyperacute
  • acute
  • chronic
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70
Q

Hyperacute rejection

A
  • within 24 hours
  • blood vessels destroyed rapidly from pre-existing antibodies (positive crossmatch)
  • RARE
  • No treatment
  • transplant organ needs to be removed
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71
Q

Acute rejection

A
  • within 6 months
  • recipients lymphocytes activated against donated tissue or antibodies develop after transplant
  • common with deceased organs
  • REVERSIBLE-treat with immunosuppressants and corticosteroids
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72
Q

Chronic rejection

A
  • over months or years
  • repeated acute rejections
  • fibrosis and scarring occurs
  • IRREVERSIBLE-pt placed on transplant list
  • difficult to manage, support therapy needed
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73
Q

Graft vs host disease

A

occurs when immuno-incompetent pt transfused or transplanted with immuno-competent cells

*donor T cells attack recipient

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74
Q

Graft vs host disease manifestations

ONLY 3

A

Skin-maculopapular rash to desquamation

Liver-mild jaundice to hepatic coma

GI-diarrhea, GI bleeding, malabsorption, abdominal pain

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75
Q

PCs for organ transplantation

A
  • rejection
  • susceptibility to infection
  • heart disease
  • malignancies
  • recurrence of kidney disease
  • corticosteroid-related complications
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76
Q

Determines how well pt is oxygenated

A

PaO2

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77
Q

Determines how well pt is ventilating

A

PaCO2

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78
Q

3 mechanisms that control acid/base

A

Kidney-bicarb (HCO3)

Lungs-carbon dioxide (CO2)

Buffer-electrolytes

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79
Q

Normal pH range

A

7.35-7.45

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80
Q

Normal range for PaCO2

A

35-45

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81
Q

Normal range for HCO3

A

22-26

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82
Q

ABG sites

A
  • radial artery (most common)
  • brachial artery (avoid in obese pts)
  • femoral artery (only used as last resort)
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83
Q

When doing the Allen’s test, which artery do you release pressure?

A

ULNAR ARTERY!

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84
Q

Blood will _______ into the syringe

A

pulsate

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85
Q

Blood gas syringes fill by themselves, stopping at ___

A

2mL

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86
Q

Indications for arterial lines

A
  • Frequent ABG sampling

- Continuous BP monitoring

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87
Q

Indications for continuous BP monitoring

A
  • shock
  • infusion of vasoactive drugs
  • procedures for coronary interventions
  • acute hypo and hypertension
  • respiratory failure
  • neuro injuries
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88
Q

How often should ABG draws be done if pt is on a vent?

A

Daily AM

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89
Q

Arterial line complications

A
  • hemorrhage
  • infection
  • thrombus formation
  • neuro impairment
  • loss of limb
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90
Q

True or false:

H+, CO2, and K is more acidic

A

TRUE

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91
Q

Acidosis indicates an ______ of H+, and a _______ of HCO3

A

excess; deficit

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92
Q

Alkalosis indicates an ______ of HCO3, and a ______ of H+

A

excess; deficit

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93
Q

pH <7.35

A

acidosis

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94
Q

pH >7.45

A

alkalosis

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95
Q

What does high PaCO2 indicate?

A

Respiratory acidosis

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96
Q

What does low PaCO2 indicate?

A

Respiratory alkalosis

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97
Q

What does high HCO3 indicate?

A

Metabolic alkalosis

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98
Q

What does low HCO3 indicate?

A

Metabolic acidosis

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99
Q

Respiratory acidosis causes

A

(Hypoventilation)

  • COPD
  • OD/sedation
  • chest trauma
  • severe pneumonia
  • pulmonary edema
  • atelectasis
  • respiratory muscle weakness
  • mechanical hypoventilation
  • phrenic nerve injury (C2)
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100
Q

Respiratory alkalosis causes

A
  • hyperventilation
  • stimulated respiratory center
  • mechanical hyperventilation
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101
Q

Respiratory alkalosis hyperventilation causes

A
  • hypoxia
  • PE
  • anxiety
  • fear
  • pain
  • exercise
  • fever
  • high altitudes
  • pregnancy
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102
Q

Respiratory alkalosis stimulated respiratory center causes

A
  • septicemia
  • encephalitis
  • brain injury
  • salicylate poisoning
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103
Q

Metabolic acidosis causes

A
  • DKA
  • diarrhea
  • renal failure
  • shock
  • salicylate OD
  • sepsis
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104
Q

Metabolic alkalosis causes

A
  • loss of gastric secretions (NG suction, severe vomiting)
  • diuretic therapy (K wasting diuretics)
  • overuse of antacids
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105
Q

Normal intracranial pressure (ICP)

A

5-15 mmHg

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106
Q

Normal compensatory adaptations

A
  • changes in CSF volume

- cerebral vasodilation or vasoconstriction

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107
Q

Cerebrospinal fluid =

A

10%

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108
Q

Intravascular blood =

A

12%

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109
Q

Brain tissue =

A

78%

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110
Q

Autoregulation of cerebral blood flow (CBF)

A
  • brain has ability to regulate own blood flow
  • ensures adequate blood flow to brain
  • influenced by systemic arterial pressure
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111
Q

How much glucose and O2 does brain need?

A

25% and 20%

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112
Q

Cerebral perfusion pressure (CPP)

A

pressure needed to ensure blood flow to brain

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113
Q

Normal CPP

A

60-100 mmHg

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114
Q

How to calculate CPP

A

MAP-ICP=CPP

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115
Q

CPP <50 mmHg

A

associated with ischemia and neuronal death`

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116
Q

Compliance

A

expandibility of the brain

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117
Q

Stage 1 of CBF

A
  • high compliance
  • increase of volume in brain does not increase ICP
  • autoregulation intact
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118
Q

Stage 2 of CBF

A
  • compliance lessens

- increase of volume in brain increases risk of increasing ICP

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119
Q

Stage 3 of CBF

A
  • decrease compliance
  • small addition of volume increases ICP
  • loss of autoregulation
  • B/P rises to maintain CPP
  • decompensation about to happen
  • cushing’s triad
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120
Q

Stage 4 of CBF

A
  • ICP at lethal levels with little increase in volume

- herniation of brain

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121
Q

Cushing’s triad

A

EMERGENCY!!!

  • systolic HTN with widening pulse pressure
  • bradycardia with full and bounding pulse
  • altered respirations
122
Q

Types of brain herniation

A
  • tentorial herniation
  • uncal herniation
  • cingulate herniation
123
Q

Tentorial herniation

A

herniation downward through the brainstem opening

124
Q

Uncal herniation

A

lateral and downward

125
Q

Cingulate herniation

A

lateral, beneath the falx cerebri

126
Q

High CO2 in the brain =

A

cerebral vessels to dilate = increases CBF

127
Q

Low CO2 in the brain =

A

cerebral vessels to constrict = decreases CBF

128
Q

Low levels of O2 in brain =

A

cerebral dilation = increases CBF

129
Q

Most sensitive indicator for evaluating pt’s neuro status

A

Level of consciousness (LOC)

130
Q

Cranial nerve III

A

oculomotor nerve

131
Q

What happens if CN III is compressed?

A
  • dilation of pupil on same side (ipsilateral) as lesion
  • sluggish or no response to light
  • inability to move eye upward
  • ptosis of eyelid
132
Q

Decorticate posturing

A

internal rotation and adduction of arms with flexion of elbows, wrists and fingers.

133
Q

Why does decorticate posturing happen?

A

there’s an interruption of voluntary motor tracts in cerebral cortex

134
Q

Decerebrate posturing

A
  • arms stiffly extended, abducted, and hyperpronated

- hyperextension of legs with plantar flexion of feet

135
Q

Why does decerebrate posturing happen?

A

there’s a disruption of motor fibers in midbrain and brainstem

136
Q

Is decorticate or decerebrate posturing more serious?

A

decerebrate posturing

137
Q

What is the halo sign test?

A

to determine if drainage from ear or nose is CSF

-drip onto gauze, if yellow ring encircles the blood, CSF is present

138
Q

Interventions for pt with ICP

A
  • nutritional therapy
  • respiratory function
  • fluid/electrolyte balance
  • monitor ICP
  • semi-fowler’s position
  • protection from injuries (high risk for seizures)
139
Q

Drug therapy for pt with ICP

A
  • mannitol-pulls fluid from brain into bloodstream (rises B/P
  • hypertonic solution (NS 3%-same outcome as mannitol)
  • vasopressors-rise B/P
  • corticosteroids (if pt doesn’t have head injury)
  • prophylactic seizure meds
140
Q

3 areas assess for Glascow Coma Scale (GCS)

A
  • open eyes
  • best verbal response
  • best motor response
141
Q

Purpose of GCS

A

to assess LOC of pt

142
Q

Nutritional therapy for pt with ICP

A
  • increase glucose as needed
  • nutrition replacement within 3 days of injury
  • malnutrition promotes continued cerebral edema
143
Q

GCS of __ generally indicates coma

144
Q

Head injury is any trauma to the…

A
  • skull
  • scalp
  • brain
145
Q

GCS-eyes open score

spontaneous response to bedside approach, pain, or verbal command

146
Q

GCS-eyes open score

opening eyes to name or command

147
Q

GCS-eyes open score

lack of opening eyes to name or command, but open to pain

148
Q

GCS-eyes open score

lack of opening of eyes to stimuli

149
Q

GCS-eyes open score

untestable

150
Q

GCS-best verbal response score

A&O x4

151
Q

GCS-best verbal response score

confusion, conversant, but disoriented

152
Q

GCS-best verbal response score

inappropriate or disorganized use of words, lack of sustained conversation

153
Q

GCS-best verbal response score

incomprehensible words, sounds (moaning)

154
Q

GCS-best verbal response score

lack of sound, even with painful stimuli

155
Q

GCS-best verbal response score

untestable

156
Q

GCS-best motor response score

Obedience of verbal command (raise arm, hold up 2 fingers)

157
Q

GCS-best motor response score

localization of pain, lack of obedience but makes attempts to remove painful stimulus (pressure on nail)

158
Q

GCS-best motor response score

arm flexion withdrawal

159
Q

GCS-best motor response score

abnormal flexion-flexion of arm at elbow and pronation, making a fist

160
Q

GCS-best motor response score

abnormal extension of arm at elbow usually with adduction and internal rotation of arm at shoulder

161
Q

GCS-best motor response score

lack of response

162
Q

GCS-best motor response score

untestable

163
Q

Linear skull fracture

164
Q

Depressed skull fracture

A

broke down

165
Q

Comminuted skull fracture

166
Q

Battle’s sign

A

bruising on eyes and ears

167
Q

True or false

Blood has glucose

168
Q

Contusion

A

bruising of brain tissue

169
Q

Coup-contrecoup injury

A

bruising on 2 parts of brain due to brain shifting and hitting against skull

170
Q

Epidural hematoma

A
  • bleeding between dura and inner surface of skull
  • venous or arterial origin
  • neuro emergency if arterial!
171
Q

Subdural hematoma

A
  • bleeding between dura mater and arachnoid layer of meninges
  • usually venous
  • results from injury to brain tissue and its blood vessels
172
Q

Acute subdural hematoma

A

24-48 hours after injury

173
Q

Subacute subdural hematoma

A

48 hours-2 weeks after injury

174
Q

Chronic subdural hematoma

A

weeks to months after injury (usually >20 days)

175
Q

Intracerebral hematoma

A
  • bleeding within brain tissue
  • in approx. 16% of head injuries
  • usually occurs within frontal and temporal lobes, possible from rupture of vessels at time of injury
  • size and location determines pt outcome
176
Q

Burr hole

A

opening into cranium with drill to remove fluid and blood beneath dura

177
Q

Craniotomy

A

removal of bone flap to remove lesion, repair a damaged area, drain blood or relieve increased ICP

178
Q

Craniectomy

A

incision into cranium to cut away bone flap

179
Q

Ventricolostomy

A
  • directly measures pressure within the ventricles
  • facilitates removal and/or sampling of CSF
  • allows for intraventricular drug administration
180
Q

Non-modifiable risk factors for stroke

A
  • age
  • gender
  • ethnicity or race
  • family history
  • heredity
181
Q

Modifiable risk factors for stroke

A
  • HTN
  • heart disease
  • diabetes mellitus
  • smoking
  • excessive alcohol consumption
  • obesity
  • sleep apnea
  • metabolic syndrome
  • lack of exercise
  • poor diet
  • drug abuse
182
Q

When blood flow to the brain is completely interrupted, neuro metabolism is altered in __ seconds.

183
Q

When blood flow to the brain is completely interrupted, metabolism stops in __ minutes.

184
Q

When blood flow to the brain is completely interrupted, cell death occurs in __ minutes

185
Q

Transient ischemic attacks (TIA)

A
  • temporary loss of neuro function
  • most resolve within 3 hours
  • leads up to a stroke
186
Q

Classification of strokes

A
  • ischemic

- hemorrhagic

187
Q

Types of ischemic strokes

A
  • thrombotic

- embolic

188
Q

Ischemic=

A

lack of O2

189
Q

Thrombotic stroke

A

MOST COMMON

  • injury to or narrowing of a blood vessel wall
  • formation of blood clot
190
Q

Embolic stroke

A
  • embolus occludes cerebral artery

- infarction and edema of area

191
Q

Types of hemorrhagic strokes

A
  • intracerebral hemorrhage

- subarachnoid hemorrhage

192
Q

Intracerebral hemorrhage

A
  • bleeding within the brain caused by rupture of a vessel

- HTN is the most important cause

193
Q

Subarachnoid hemorrhage

A
  • intracerebral bleeding into CSF-filled space between arachnoid and pia mater
  • commonly caused by rupture of cerebral aneurysm
194
Q

Sign of subarachnoid hemorrhage

A

“worst headache of one’s life”

195
Q

Receptive dysphasia

A

doesn’t understand what was said

196
Q

Expressive aphasia

A

understood but can’t express feeling

197
Q

Right-brain damage

A

Effects left side of body

“I’m right”

Safety!

198
Q

Left-brain damage

A

Effects right side of body

Language

199
Q

Lack of nutrition leads to edema where?

200
Q

CT should be obtained within __ minutes and read within __ minutes of ER arrival

201
Q

Purpose of CT with stroke

A
  • indicate size and location of lesion
  • determine if ischemic or hemorrhagic

*NO contrast

202
Q

Stroke pt should be doing what type of ROM daily

203
Q

First things to do for stroke pt

A
  • CT scan
  • NG
  • foley
204
Q

tPA

A
  • re-establish blood flow

- must be administered within 3 hours of onset of symptoms

205
Q

tPA IV

A
  • monitor VS q15min
  • ANY hint of bleeding: STOP!
  • hang saline
206
Q

Possible treatment for strokes

A
  • clipping

- coiling

207
Q

CANNOT RECEIVE tPA

A
  • clotting disorder
  • hemorrhagic stroke
  • active bleed
  • neoplasm=cancer
208
Q

Number of cervical vertebrae

209
Q

Number of thoracic vertebrae

210
Q

Number of thoracic vertebrae

211
Q

C5 =

A

phrenic nerve

“C5 keeps the diaphragm alive”

212
Q

Spinal shock

A
  • decrease reflexes
  • loss of sensation
  • flaccid paralysis below level of injury
213
Q

Treatment for spinal shock

A

supportive care

214
Q

Neurogenic shock

A

(cardiac effects)

  • loss of vasomotor tone (vasodilation)
  • hypotension & bradycardia
  • associated with T6 injury of higher
215
Q

Neurogenic shock treatment

A
  • atropine

- vasopressors

216
Q

Tetraplegia is the same as

A

quadraplegia

217
Q

C7-T1 injury =

A

tetraplegia

218
Q

T1 and below injury =

A

paraplegia

219
Q

T5 =

220
Q

T6 =

221
Q

T10 =

222
Q

T2 =

223
Q

Neurogenic shock causes a decrease in __ and __

A

B/P and HR

224
Q

Complete cord involvement

A

total loss of sensory and motor function below level of injury

225
Q

Incomplete (partial) cord involvement

A

mixed loss of voluntary motor activity and sensation

*some tracts intact

226
Q

Higher the injury =

A

more serious

227
Q

C5 and above injury

A

total loss of respiratory muscle function

228
Q

What is required with C5 and above injury?

A

mechanical ventilation

229
Q

C5 and below injury

A
  • diaphragmatic breathing

- hypoventilation if phrenic nerve is functioning

230
Q

Cervical and thoracic injuries cause paralysis of

A
  • abdominal muscles

- intercostal muscles

231
Q

Pt cannot cough effectively with cervical and thoracic injuries, leading to

A

atelectasis or pneumonia

232
Q

Acute

A

first 48-72 hours

233
Q

Any cord injury above level T6 =

A

neurogenic shock

234
Q

T6 and above injury

A
  • bradycardia
  • hypotension
  • relative hypovolemia exists because of increase in venous capacitance
235
Q

T10 and below injury

A
  • urinary retention

- bladder-atonic & distended, hyperirritable

236
Q

What is needed with T10 and below injury?

A

indwelling catheter

*increases risk for infection

237
Q

T5 and above injury

A

hypomotility

  • paralytic ileus
  • gastric distention
  • stress ulcers
  • intraabdominal bleeding may occur
238
Q

T5 and above injury nursing

A
  • NG placement
  • monitor for distended abdomen
  • increased for aspiration
  • give PPIs
239
Q

Injury of T12 or below

A

neurogenic bowel

  • bowel is areflexic
  • decreased sphincter tone
  • constipation
240
Q

Injury of T12 or below nursing

A
  • dig stim, colace, fiber
  • bowel training
  • mineral oil
241
Q

Poikilothermism

A

adjustment of body temp to room temp

242
Q

True or False

Surgery is only done when there’s cord compression

243
Q

NGT suctioning can lead to

A

metabolic alkalosis

244
Q

Decreased tissue perfusion (shock) leads to

A

metabolic acidosis

245
Q

High risk population for spinal cord injuries

A

Teens and young males

246
Q

Bones heal in

247
Q

Cervical traction is used to

A
  • decrease inflammation

- promote healing

248
Q

Autonomic dysreflexia

A

Life threatening cardio reaction by SNS

249
Q

Cause of autonomic dysreflexia

A
  • distended bladder or rectum
  • tight clothing
  • anything that causes pain
250
Q

S/S of autonomic dysreflexia

A
  • severe HTN
  • blurred vision
  • throbbing headache
  • diaphoresis (above level of injury)
  • bradycardia
  • piloerection (hairs on skin)
  • skin flushing
  • anxiety
251
Q

Goal for autonomic dysreflexia

A

Get B/P down!!!

252
Q

Nursing interventions for autonomic dysreflexia

A
  1. elevate HOB 45 degrees, or sit pt upright
  2. assess cause
  3. catheterization
  4. notify physician
253
Q

Acute Respiratory Failure (ARF)

A

-results from inadequate gas exchange

254
Q

insufficient O2 transferred to the blood

A

hypoxemia (decreased O2)

255
Q

Inadequate CO2 removal

A

hypercapnic (increased CO2)

256
Q

Adequate PaO2

257
Q

Hypoxemia is what type of failure

A

oxygenation

258
Q

Hypercapnic is what type of failure

A

ventilation

259
Q

Causes of hypoxemic respiratory failure

A
  • V/Q mismatch
  • shunt
  • diffusion limitation
  • alveolar hypoventilation
260
Q

V/Q mismatch causes

A
  • pneumonia
  • atelectasis
  • pulmonary embolus
261
Q

Gas exchangeis better in what part of the lungs?

A

base of lungs

262
Q

What is shunting?

A

blood exits the heart without gas exchange

263
Q

Types of shunts

A

Anatomic shunt

Intrapulmonary shunt

264
Q

What is an anatomic shunt?

A

heart defect-bypass lungs

265
Q

What is an intrapulmonary shunt?

A

inside lungs-NO gas exchange

266
Q

CO2 retention results in…

267
Q

What percentage of O2 is in room air?

268
Q

Percentage of O2 in 1L

269
Q

More CO2 retained, causes pH to…

270
Q

Ventilation is ….

A

breathing (lung and heart)

271
Q

Perfusion is ….

A

blood flow (gas exchange)

272
Q

Ratio of inhale and exhale

273
Q

Diffusion limitation

A

thickened membranes (scar tissue)

274
Q

Examples of diffusion limitation

A
  • severe emphysema
  • pulmonary fibrosis
  • ARDS
275
Q

Alveolar hypoventilation

A

decrease in ventilation

-increase PaCO2, decrease in PaO2

276
Q

Atelectasis

A

alveolar collapse, resulting in NO gas exchange

277
Q

Primary cause of alveolar hypotension

A

hypercapnic respiratory failure

278
Q

Hypercapnic respiratory failure

A

inability to remove sufficient CO2 to maintain normal PaO2

279
Q

Causes of hypercapnic respiratory failure

A
  • airway and alveoli (respiratory)
  • CNS
  • chest wall
  • neuro conditions
280
Q

The ONLY 3 respiratory issues that are related to hypercapnic

A
  • COPD
  • Asthma
  • Cystic Fibrosis
281
Q

True or False:

CO2 in the brain is a vasoconstricter

A

FALSE

CO2 is a vasodilator

282
Q

Early signs of respiratory failure

A
  • restlessness, confusion
  • tachycardia
  • tachypnea
  • mild HTN
283
Q

Late sign of respiratory failure

284
Q

Consequences of hypoxemia and hypoxia

A
  • metabolic acidosis and cell death
  • decreased CO
  • impaired renal function (decreased B/P)
285
Q

What are ways to prevent of acute respiratory failure?

A
  • early recognition of respiratory distress

- flu or pneumo vax (elderly, diabetics, anyone with low immune system)

286
Q

O2 toxicity can cause what?

A

atelectasis

287
Q

Positive-pressure ventilation (PPV)

A

intubation

288
Q

Examples non invasive PPV

A

Bi-PAP

CPAP

289
Q

Bi-PAP

A

inhalation and exhalation

290
Q

CPAP

A

continuous positive airway pressure

inhalation

291
Q

What physiologic changes in the respiratory system happen in aging?

A
  • decreased ventilatory capacity
  • alveolar dilation
  • larger air spaces
  • loss of surface area
  • diminished elastic recoil
  • decreased respiratory muscle strength
  • decreased chest wall compliance
292
Q

What is Acute Respiratory Distress Syndrome (ARDS)?

A

widespread INFLAMMATION

  • increased neutrophils (WBC-line alveoli membrane)
  • increased pulmonary capillary permeability
293
Q

Phases of ARDS

A
  • injury or exudative
  • reparative or proliferative
  • fibrotic
294
Q

What does an ARDS chest x ray look like?

A

Bilateral pulmonary infiltrates

295
Q

Injury or exudative phase of ARDS

A
  • pulmonary edema
  • surfactant (keeps alveoli open) doesn’t work anymore or body stops production, causing atelectasis
  • scar tissue from damage to alveoli becomes thick
296
Q

ARDS is what type of respiratory failure

297
Q

Reparative or proliferative phase ARDS

A

pt gets better or gets worse

298
Q

Fibrotic phase ARDS

A

the alveoli scar tissue becomes worse and stiff = NO gas exchange

*permanent damage, will most likely die

299
Q

What is mortality rate for pt’s with ARDS?

300
Q

What is FiO2?

A

Amount of O2 pt is on

301
Q

What is PEEP on ventilator?

A

Positive End Expectory Pressure

-pops alveoli open

302
Q

What gets O2 directly into lungs?

Role and scope (58 decks)

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