M 8 Cognition Flashcards
3 categories of brain injury based on the Glasgow Coma Scale
Mild Moderate Severe
Brain injuries are also classified by the degree of damage to the brain
Concussion
Contusion
Laceration
Ischemia
etc.
4 key event of traumatic brain injurys
Vascular events
Closed head injury
Open head injury
Skull fracture
Antecedents of TBIs
Adequate oxygenation
Tissue perfusion
Nutrition
Good neuro function
Opportunities for growth
Mild TBI S/S
LOC for a few seconds to minutes
Memory problems
Dizziness
Loss of balance
N/V
Mild assessments for TBI
Sensory (vision, hearing, taste)
Light sensitivity
Mood swings
Depression
Moderate TBI S/S
LOC from minutes to hours
Profound confusion
Combativeness
Slurred speech
Moderate assessment for TBI
Loss of coordination
Seizures
Dilation of pupils
Clear fluid from ears/nose
Children’s TBI S/S
Inconsolable crying
Change in eating
Inability to pay attention
Loss of interest in favorite toys
Diagnostics for TBI
CAT
MRI
PET
Glasgow coma scale
Consequences of TBIs
Institutionalization
Poor health
Victimization
Inability to form relationships
Primary TBI interventions
Health promotion
Disease prevention
Education
Secondary TBI interventions
Screening/diagnosis
Occurs after problem has arisen
Tertiary TBI interventions
Rehabilitation
Returning PT to highest level of function possible
TBI Critical skills
Neuro assessment
Communication
Safety assessment/impementation
TBI Collaborative interventions
Med management of Underlying Cause
Physical/occupation/speech therapy
Case manager
Social worker
Post TBI issues
Cerebral herniation
Seizures
^ICP
TBI PaCO2 greater than 50 =
^ICP BAD
TBI
O2 drop or CO2 increase = a/b balance
acidic
^ICP S/S
Early - pupil dilation
Projectile vomit
Muscle weakness
^BP
Late - Eyes roll up
Cushings triad
Irregular resps
Bradycardia
Widening pulse pressure
BAD S/S of ICP
Glasgow coma scale below 8=
Intubate
ICP Less than 15
OK
BP as pt goes from ICP to Neuro shock
First increase
Then decrease
ICP Treatment
HOB at 30 degrees
Propofol - sedative
Mannitol - diuretic
High CO2 means vaso
Low CO2 means vaso
Dilation - ICP
Constriction
Encephalopathy causes
Perfusion disruption
Tumor
Lack of oxygen
Toxins
Infection (meningitis)
Encephalopathy 101
Anything that alters brain structure or function
Encephalopathy key points
Treatment based on PRIMARY CAUSE
Interventions focus on alterations and mental status
Antecedents for encephalopathy
Oxygenation
Perfusion
Nutrition
Neuro function
What does encephalopathy impact in the long term
Interpretation of environment
Communication
Learning
Encephalopathy risk factors
Infection
Liver problems
Kidney problems
Brain tumors
Poor nutrition/alcoholism
Mental manifestations of encephalopathy
Confusion
Poor judgement
Personality change
Nervousness
Sleeping changes
Physical Encephalopathy S/S
Musty or sweet breath
Shaky hands
Slurred speech
Sluggish movement
Diagnostic test for encephalopathy
Mental status
Memory test
Coordination test
Encephalopathy assessments to look for primary cause other than GCS
CBC/blood culture - infection
Altered BP
Metabolic test
Toxin levels
Creatinine
To narrow down encephalopathy area or brain, test
Cranial nerves
Consequences of encephalopathy
Institutionalization/dependence
Poor health
Victimization
Inability to maintain relationships
Primary interventions for encephalopathy
prevention
(alcohol, diet, exercise, exposure to infection)
Secondary interventions for encephalopathy
screening
Minimize toxin exposure
Maintain healthy lifestyle
Tertiary interventions for encephalopathy
Rehabilitation
Returning patient to highest level of function
Critical skills for encephalopathy
Neurologic assessment
Communication
Safety assessment and implementation
Collaborative interventions for encephalopathy
Med management
Physical/occupational/speech therapy
Case manager
Social worker
Postpartum psychosis key points
EMERGENCY due to potential for suicide or infanticide
A form of bipolar disorder
Onset of postpartum psychosis
First 2 weeks
Causes for postpartum psychosis
hormonal loss at birth***
fam hist of bipolar disorder
Hormones that shift and cause postpart psych
estrogen
progesterone
Positive prognosis for postpartum depression is projected based off
acute onset
lack of premorbid debility
Post part psychosis treatment
pills
Antipsychotics
Mood stabilizers
Benzos
Post part psychosis treatment goal
Counseling goal
Timely remission of symptoms VITAL
Follow up appts
Why is remission important
Baby needs contact and attention immediately
Post part risk factors
Hist of bipolar, pt or fam*
Discontinuation of mood stabilizers
First pregnancy
Sleep deprivation
Lack of partner support
Mental status assessment for encephalopathy
Behavioral
Motor
Speech
Post partum psych S/S assessment
Mood
Judgement
Memory
Motivation
Consequences of postpartum psychosis
Institutionalization
Poor health
Victimization
Inability to maintain relationships
Questions for postpartum depression
Difficulty concentrating?
Difficulty sleeping?
Do you have thoughts of harming self or others?
Encourage postpart psych patients to verbalize
Feelings
Post partum psych interventions
Meds and their side effects
Discharge planning BEFORE leaving hospital
Referral to intensive therapy
ECT*
Schizophrenia moa
Altered dopamine levels
Schizophrenia 101
Altered thinking, language, emotions
Abnormal interpretation of reality
Attributes of schizophrenia
Environment interpretation
Communication issues
Learning issues
Schizo causes
Genetic predisposition
Environmental stressors
Alterations in brain structure
Fam hist risk factors for schizo
Maternal malnutrition
Paternal age
Infection during pregnancy
Childhood trauma
Mind altering drugs
Assessment for schizo
Memory
Mood
Judgement
Concentration
Motivation
Positive schizo symptoms
Negative schizo symptoms
Cognitive schizo symptoms
excess distortion
loss of normality
loss of info processing
Positive shizo symptom examples
Hallucination
Delusions
Disorganized speech
Negative schizo symptom examples
Flat affect
Speech poverty
Anhedonia
Asociallity
Cognitive schizo symptom examples
attention and memory problems
inability to understand
inability to problem solve
Consequences of schizophrenia
Institutionalization
Poor health
Victimization
Inability to maintain relationships
Nursing diagnosis for schizophrenia
Disturbed though
Disturbed identity
Impaired communication
Social isolation
Risk for violence
Schizo interventions ACUTE
Safety and stabilization
Establish trust
Prevent harm
DONT encourage irrational thinking
Adequate nutrition
Schizo interventions Chronic
Appt follow ups
Med compliance
Ongoing learning
Increased mental strength
Supporting measure for schizo patients
Case management
Rehab
Social support
Partial hospitalization
Avoid drugs and alcohol
Meds for schizophrenia
Antipsychotics
Antianxiety
Antidepressants
Antipsychotic med categories
First generation - haldol, thorazine
Second generation - Zyprexa, abilify, latuda
Side effects of antipsychotics
Extrapyramidal effects
Anticholinergic effects
Weight gain
Neuroleptic malignancy syndrome NMS
Extrapyramidal effects
EPS
Involuntary motor ticks
Dystonia, Akathasia, Pseudoparkinsonism
Neuroleptic malignancy syndrome
NMS
SRIOUS PROBLEMS/S
FEVER
Confusion
Rigid muscles
Sweating
^ HR
Later NMS S/S
FEVER
Encephalopathy
Unstable vitals
Elevated CPK
Which antypsychotics have less EPS symptoms, but higher metabolic risks
Second generation
Best med for resistant schizophrenia
Clozapine
second gen
Long acting schizo med names and how to use
Haldol, abilify, Invega
Benefit is, it is just 1 or 2 injections a month as opposed to daily pills
Schizo assessment tools
BPRS Brief psych rating scale
symptoms
SANS/SAPS scale for assessment of negative/positive symptoms
AIMS abnormal involuntary movement scale
Pharmacology for schizo cognition
drug categories
Analgesics
Anti-psychotics
Anti-anxiety
Anti-convulsant
Anti-depressants
Muscle relaxants
Sedatives
Stimulants
for schizo
reduce muscle spasms
induce sleep
increase alertness
If schizo is untreated pt is at risk of
danger to self and others
social isolation
chronic sorrow and helplessness
Significant difference between postpartum blues and postpartum psychosis
Intensity and duration
If schizo pt is hallucinating
redirect
prioritize safety
first priority with postpart psych
Safety
Biggest concern with TBIs
bleeding, increases pressure on the brain
Is high number good in Glasgow coma scale
YES
Glasgow coma scale less than 8
Intubate!!!
Severely low score
Blunt force trauma =
MORE swelling
ICP
The higher the ICP =
The worse the result
Cerebral infarct vs cerebral bleed treatment
Infarct treatable
Bleed, not a lot we can do
Epidural vs subdural bleed
which is worse
Epidural is artery - worse
subdural = slow
Closed or open fracture more severe
Closed = pressure increase
If a concussion patient gets discharged they need to be with some one for the next
24h
If concussion person hospitalized they need to be awoken every
30 min
LOW response = BAD
Most common form of child abuse
Shaken baby syndrome
Brain banging it self on different sides of skull
Cu-contracu
3 categories of GCS
Eyes
Mouth
Motor
Where do most burns occure
At the home
Major burn problems
Fluid loss
Infection
How to measure burns
Rule of 9s
Head 9 total
Arm 9 anterior or posterior
Chest 18 anterior or posterior
Legs 18 anterior or posterior
Genitals 1 point
Types of burns
Heat
Chemical
Electrical
Bad burn is _% or greater
25
Treatment for severe burn pt
FLUID RECUSITATION
pt is leaking from burn area
Total body edema
anasarca
happens with burns due to loss of proteins in blood
what temp do you want on burns
Tepid, NOT hot or cold
increases leaking or reduces perfusion
Total body surface area determins what part of treatmet
Fluid resuscitation volume
4 x total body surface area percentage burned x kg =
Volume of fluid give total
ON TEST
Half of total volume given has to go in during first
8H
The remaining half of total volume given goes over the next
16H
Diuretic phase of burns beguins when
What happens
72h post incident
PT may go into Fluid Volume overload because water will start returning from 3rd space to body
_ technique during burn treatment
give prophylactic
ASEPTIC
SHOT for TETANUS immunoglobulin (Not Booster)
antibiotics
Immunoglobulin
actual antibodies = immediate protection
Passive immunity
As burns heal pt has to
EXERCISE
increases mobility
prevents contractres
To treat hand burns
wrap fingers separately
Spling fingers so they dont contract
S/S of airway burn injury
Singed nasal hair
Singed facial hair
Sutt coming out of oral mucosa
smoke inhalation results in _ _ poisoning
Carbon monoxide
Why is carbon monoxide so dangerous
displaces O2
How do you know O2 is compromised with carbon monoxide poisoning
ABGs
Carbon monoxide attaches to RBC quicker than O2 resulting in
Lack of O2
Pulse Ox can NOT differentiate
At how much O2 to give to carbon monoxide PT
100%
What will physician prophylactically do to airway burn pts
INTUBATE
burn = swelling
First thing the nurse should do with a chem burn
PPE
First thing nurse and pt should do with a chem burn
Remove the chem before washing off for 20 min
or excess chem will turn in to running sludge
Debredment
Removing eschar from burns
Debredment types
Mechanical
Water jet
With electrocutions pt will be put on
C collar
C spine board
protect spine
In first 24h of electrocution put pt on
ECG
HAS TO BE to monitor dysrhythmias
Where does electrocution hit the heardest
Exit wound blows out
As electricity travels through the organs it destroys muscle tissue resulting in an increase of
Myoglobin
Myoglobin elimination happens via
Kidney and urine
Dark red urine
Can clog kidneys resulting in failure
Eyes with electrecutions
Could result in cataracts
Is a lack of urination expected with burns
YES
Fam violence affects
the whole family
Can emotional abuse be worse than physical over time
Yes
S/S of fam violence
Social isolation
abuse
power control
Bullying
Fam violence kids keep
secrets
Rape is classified as penetration T/F
False
What does a rape victim need to have if going home
Develop a plan
Circumferential burn consequence
circulation cut off to distal part of extremity
How to restore circumferential burn circulation
Escharotomy
Fassiotomy
Epidural hematoma TBI
Bleeding above duramater
Most common LOC cause
Epidural hematoma S/S
CT SCAN
headache
vomit
muscle weakness
Epidural hematoma bleed is arterial so S/S will onset
FAST
Epidural hematoma treatment
Craniotomy
TBI epidural hematoma S/S time onset
first good recovery
THEN changes is LOC as blood pools
What not to do with TBIs
NO Valsalva maneuver
NO straws
Sedative of choice for TBIs
Propofol
Do epidural hematomas cross suture lines
NO
