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S4 2539 > M 8 Cognition > Flashcards

M 8 Cognition Flashcards

1
Q

3 categories of brain injury based on the Glasgow Coma Scale

A

Mild Moderate Severe

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2
Q

Brain injuries are also classified by the degree of damage to the brain

A

Concussion
Contusion
Laceration
Ischemia

etc.

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3
Q

4 key event of traumatic brain injurys

A

Vascular events
Closed head injury
Open head injury
Skull fracture

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4
Q

Antecedents of TBIs

A

Adequate oxygenation
Tissue perfusion
Nutrition
Good neuro function
Opportunities for growth

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5
Q

Mild TBI S/S

A

LOC for a few seconds to minutes
Memory problems
Dizziness
Loss of balance
N/V

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6
Q

Mild assessments for TBI

A

Sensory (vision, hearing, taste)
Light sensitivity
Mood swings
Depression

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7
Q

Moderate TBI S/S

A

LOC from minutes to hours
Profound confusion
Combativeness
Slurred speech

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8
Q

Moderate assessment for TBI

A

Loss of coordination
Seizures
Dilation of pupils
Clear fluid from ears/nose

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9
Q

Children’s TBI S/S

A

Inconsolable crying
Change in eating
Inability to pay attention
Loss of interest in favorite toys

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10
Q

Diagnostics for TBI

A

CAT
MRI
PET
Glasgow coma scale

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11
Q

Consequences of TBIs

A

Institutionalization
Poor health
Victimization
Inability to form relationships

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12
Q

Primary TBI interventions

A

Health promotion
Disease prevention
Education

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13
Q

Secondary TBI interventions

A

Screening/diagnosis
Occurs after problem has arisen

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14
Q

Tertiary TBI interventions

A

Rehabilitation
Returning PT to highest level of function possible

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15
Q

TBI Critical skills

A

Neuro assessment
Communication
Safety assessment/impementation

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16
Q

TBI Collaborative interventions

A

Med management of Underlying Cause
Physical/occupation/speech therapy
Case manager
Social worker

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17
Q

Post TBI issues

A

Cerebral herniation
Seizures
^ICP

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18
Q

TBI PaCO2 greater than 50 =

A

^ICP BAD

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19
Q

TBI
O2 drop or CO2 increase = a/b balance

A

acidic

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20
Q

^ICP S/S

A

Early - pupil dilation

Projectile vomit
Muscle weakness
^BP

Late - Eyes roll up

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21
Q

Cushings triad

A

Irregular resps
Bradycardia
Widening pulse pressure

BAD S/S of ICP

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22
Q

Glasgow coma scale below 8=

A

Intubate

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23
Q

ICP Less than 15

A

OK

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24
Q

BP as pt goes from ICP to Neuro shock

A

First increase
Then decrease

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25
Q

ICP Treatment

A

HOB at 30 degrees
Propofol - sedative
Mannitol - diuretic

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26
Q

High CO2 means vaso
Low CO2 means vaso

A

Dilation - ICP
Constriction

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27
Q

Encephalopathy causes

A

Perfusion disruption
Tumor
Lack of oxygen
Toxins
Infection (meningitis)

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28
Q

Encephalopathy 101

A

Anything that alters brain structure or function

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29
Q

Encephalopathy key points

A

Treatment based on PRIMARY CAUSE
Interventions focus on alterations and mental status

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30
Q

Antecedents for encephalopathy

A

Oxygenation
Perfusion
Nutrition
Neuro function

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31
Q

What does encephalopathy impact in the long term

A

Interpretation of environment
Communication
Learning

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32
Q

Encephalopathy risk factors

A

Infection
Liver problems
Kidney problems
Brain tumors
Poor nutrition/alcoholism

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33
Q

Mental manifestations of encephalopathy

A

Confusion
Poor judgement
Personality change
Nervousness
Sleeping changes

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34
Q

Physical Encephalopathy S/S

A

Musty or sweet breath
Shaky hands
Slurred speech
Sluggish movement

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35
Q

Diagnostic test for encephalopathy

A

Mental status
Memory test
Coordination test

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36
Q

Encephalopathy assessments to look for primary cause other than GCS

A

CBC/blood culture - infection
Altered BP
Metabolic test
Toxin levels
Creatinine

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37
Q

To narrow down encephalopathy area or brain, test

A

Cranial nerves

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38
Q

Consequences of encephalopathy

A

Institutionalization/dependence
Poor health
Victimization
Inability to maintain relationships

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39
Q

Primary interventions for encephalopathy

A

prevention
(alcohol, diet, exercise, exposure to infection)

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40
Q

Secondary interventions for encephalopathy

A

screening
Minimize toxin exposure
Maintain healthy lifestyle

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41
Q

Tertiary interventions for encephalopathy

A

Rehabilitation
Returning patient to highest level of function

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42
Q

Critical skills for encephalopathy

A

Neurologic assessment
Communication
Safety assessment and implementation

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43
Q

Collaborative interventions for encephalopathy

A

Med management
Physical/occupational/speech therapy
Case manager
Social worker

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44
Q

Postpartum psychosis key points

A

EMERGENCY due to potential for suicide or infanticide
A form of bipolar disorder

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45
Q

Onset of postpartum psychosis

A

First 2 weeks

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46
Q

Causes for postpartum psychosis

A

hormonal loss at birth***
fam hist of bipolar disorder

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47
Q

Hormones that shift and cause postpart psych

A

estrogen
progesterone

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48
Q

Positive prognosis for postpartum depression is projected based off

A

acute onset
lack of premorbid debility

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49
Q

Post part psychosis treatment
pills

A

Antipsychotics
Mood stabilizers
Benzos

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50
Q

Post part psychosis treatment goal

Counseling goal

A

Timely remission of symptoms VITAL
Follow up appts

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51
Q

Why is remission important

A

Baby needs contact and attention immediately

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52
Q

Post part risk factors

A

Hist of bipolar, pt or fam*
Discontinuation of mood stabilizers
First pregnancy
Sleep deprivation
Lack of partner support

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53
Q

Mental status assessment for encephalopathy

A

Behavioral
Motor
Speech

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54
Q

Post partum psych S/S assessment

A

Mood
Judgement
Memory
Motivation

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55
Q

Consequences of postpartum psychosis

A

Institutionalization
Poor health
Victimization
Inability to maintain relationships

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56
Q

Questions for postpartum depression

A

Difficulty concentrating?
Difficulty sleeping?
Do you have thoughts of harming self or others?

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57
Q

Encourage postpart psych patients to verbalize

A

Feelings

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58
Q

Post partum psych interventions

A

Meds and their side effects
Discharge planning BEFORE leaving hospital
Referral to intensive therapy
ECT*

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59
Q

Schizophrenia moa

A

Altered dopamine levels

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60
Q

Schizophrenia 101

A

Altered thinking, language, emotions
Abnormal interpretation of reality

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61
Q

Attributes of schizophrenia

A

Environment interpretation
Communication issues
Learning issues

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62
Q

Schizo causes

A

Genetic predisposition
Environmental stressors
Alterations in brain structure

63
Q

Fam hist risk factors for schizo

A

Maternal malnutrition
Paternal age
Infection during pregnancy
Childhood trauma
Mind altering drugs

64
Q

Assessment for schizo

A

Memory
Mood
Judgement
Concentration
Motivation

65
Q

Positive schizo symptoms

Negative schizo symptoms

Cognitive schizo symptoms

A

excess distortion

loss of normality

loss of info processing

66
Q

Positive shizo symptom examples

A

Hallucination
Delusions
Disorganized speech

67
Q

Negative schizo symptom examples

A

Flat affect
Speech poverty
Anhedonia
Asociallity

68
Q

Cognitive schizo symptom examples

A

attention and memory problems
inability to understand
inability to problem solve

69
Q

Consequences of schizophrenia

A

Institutionalization
Poor health
Victimization
Inability to maintain relationships

70
Q

Nursing diagnosis for schizophrenia

A

Disturbed though
Disturbed identity
Impaired communication
Social isolation
Risk for violence

71
Q

Schizo interventions ACUTE

A

Safety and stabilization
Establish trust
Prevent harm
DONT encourage irrational thinking
Adequate nutrition

72
Q

Schizo interventions Chronic

A

Appt follow ups
Med compliance
Ongoing learning
Increased mental strength

73
Q

Supporting measure for schizo patients

A

Case management
Rehab
Social support
Partial hospitalization
Avoid drugs and alcohol

74
Q

Meds for schizophrenia

A

Antipsychotics
Antianxiety
Antidepressants

75
Q

Antipsychotic med categories

A

First generation - haldol, thorazine
Second generation - Zyprexa, abilify, latuda

76
Q

Side effects of antipsychotics

A

Extrapyramidal effects
Anticholinergic effects
Weight gain
Neuroleptic malignancy syndrome NMS

77
Q

Extrapyramidal effects
EPS

A

Involuntary motor ticks
Dystonia, Akathasia, Pseudoparkinsonism

78
Q

Neuroleptic malignancy syndrome
NMS
SRIOUS PROBLEMS/S

A

FEVER
Confusion
Rigid muscles
Sweating
^ HR

79
Q

Later NMS S/S

A

FEVER
Encephalopathy
Unstable vitals
Elevated CPK

80
Q

Which antypsychotics have less EPS symptoms, but higher metabolic risks

A

Second generation

81
Q

Best med for resistant schizophrenia

A

Clozapine
second gen

82
Q

Long acting schizo med names and how to use

A

Haldol, abilify, Invega

Benefit is, it is just 1 or 2 injections a month as opposed to daily pills

83
Q

Schizo assessment tools

A

BPRS Brief psych rating scale
symptoms
SANS/SAPS scale for assessment of negative/positive symptoms
AIMS abnormal involuntary movement scale

84
Q

Pharmacology for schizo cognition
drug categories

A

Analgesics
Anti-psychotics
Anti-anxiety
Anti-convulsant
Anti-depressants

85
Q

Muscle relaxants
Sedatives
Stimulants

for schizo

A

reduce muscle spasms

induce sleep

increase alertness

86
Q

If schizo is untreated pt is at risk of

A

danger to self and others
social isolation
chronic sorrow and helplessness

87
Q

Significant difference between postpartum blues and postpartum psychosis

A

Intensity and duration

88
Q

If schizo pt is hallucinating

A

redirect
prioritize safety

89
Q

first priority with postpart psych

A

Safety

90
Q

Biggest concern with TBIs

A

bleeding, increases pressure on the brain

91
Q

Is high number good in Glasgow coma scale

A

YES

92
Q

Glasgow coma scale less than 8

A

Intubate!!!

Severely low score

93
Q

Blunt force trauma =

A

MORE swelling
ICP

94
Q

The higher the ICP =

A

The worse the result

95
Q

Cerebral infarct vs cerebral bleed treatment

A

Infarct treatable
Bleed, not a lot we can do

96
Q

Epidural vs subdural bleed

which is worse

A

Epidural is artery - worse

subdural = slow

97
Q

Closed or open fracture more severe

A

Closed = pressure increase

98
Q

If a concussion patient gets discharged they need to be with some one for the next

A

24h

99
Q

If concussion person hospitalized they need to be awoken every

A

30 min
LOW response = BAD

100
Q

Most common form of child abuse

A

Shaken baby syndrome

101
Q

Brain banging it self on different sides of skull

A

Cu-contracu

102
Q

3 categories of GCS

A

Eyes
Mouth
Motor

103
Q

Where do most burns occure

A

At the home

104
Q

Major burn problems

A

Fluid loss
Infection

105
Q

How to measure burns

A

Rule of 9s

Head 9 total
Arm 9 anterior or posterior
Chest 18 anterior or posterior
Legs 18 anterior or posterior
Genitals 1 point

106
Q

Types of burns

A

Heat
Chemical
Electrical

107
Q

Bad burn is _% or greater

A

25

108
Q

Treatment for severe burn pt

A

FLUID RECUSITATION
pt is leaking from burn area

109
Q

Total body edema

A

anasarca
happens with burns due to loss of proteins in blood

110
Q

what temp do you want on burns

A

Tepid, NOT hot or cold

increases leaking or reduces perfusion

111
Q

Total body surface area determins what part of treatmet

A

Fluid resuscitation volume

112
Q

4 x total body surface area percentage burned x kg =

A

Volume of fluid give total
ON TEST

113
Q

Half of total volume given has to go in during first

A

8H

114
Q

The remaining half of total volume given goes over the next

A

16H

115
Q

Diuretic phase of burns beguins when
What happens

A

72h post incident

PT may go into Fluid Volume overload because water will start returning from 3rd space to body

116
Q

_ technique during burn treatment

give prophylactic

A

ASEPTIC

SHOT for TETANUS immunoglobulin (Not Booster)
antibiotics

117
Q

Immunoglobulin

A

actual antibodies = immediate protection

Passive immunity

118
Q

As burns heal pt has to

A

EXERCISE
increases mobility
prevents contractres

119
Q

To treat hand burns

A

wrap fingers separately
Spling fingers so they dont contract

120
Q

S/S of airway burn injury

A

Singed nasal hair
Singed facial hair
Sutt coming out of oral mucosa

121
Q

smoke inhalation results in _ _ poisoning

A

Carbon monoxide

122
Q

Why is carbon monoxide so dangerous

A

displaces O2

123
Q

How do you know O2 is compromised with carbon monoxide poisoning

A

ABGs

124
Q

Carbon monoxide attaches to RBC quicker than O2 resulting in

A

Lack of O2
Pulse Ox can NOT differentiate

125
Q

At how much O2 to give to carbon monoxide PT

A

100%

126
Q

What will physician prophylactically do to airway burn pts

A

INTUBATE
burn = swelling

127
Q

First thing the nurse should do with a chem burn

A

PPE

128
Q

First thing nurse and pt should do with a chem burn

A

Remove the chem before washing off for 20 min

or excess chem will turn in to running sludge

129
Q

Debredment

A

Removing eschar from burns

130
Q

Debredment types

A

Mechanical
Water jet

131
Q

With electrocutions pt will be put on

A

C collar
C spine board

protect spine

132
Q

In first 24h of electrocution put pt on

A

ECG
HAS TO BE to monitor dysrhythmias

133
Q

Where does electrocution hit the heardest

A

Exit wound blows out

134
Q

As electricity travels through the organs it destroys muscle tissue resulting in an increase of

A

Myoglobin

135
Q

Myoglobin elimination happens via

A

Kidney and urine
Dark red urine

Can clog kidneys resulting in failure

136
Q

Eyes with electrecutions

A

Could result in cataracts

137
Q

Is a lack of urination expected with burns

A

YES

138
Q

Fam violence affects

A

the whole family

139
Q

Can emotional abuse be worse than physical over time

A

Yes

140
Q

S/S of fam violence

A

Social isolation
abuse
power control
Bullying

141
Q

Fam violence kids keep

A

secrets

142
Q

Rape is classified as penetration T/F

A

False

143
Q

What does a rape victim need to have if going home

A

Develop a plan

144
Q

Circumferential burn consequence

A

circulation cut off to distal part of extremity

145
Q

How to restore circumferential burn circulation

A

Escharotomy
Fassiotomy

146
Q

Epidural hematoma TBI

A

Bleeding above duramater
Most common LOC cause

147
Q

Epidural hematoma S/S

A

CT SCAN
headache
vomit
muscle weakness

148
Q

Epidural hematoma bleed is arterial so S/S will onset

A

FAST

149
Q

Epidural hematoma treatment

A

Craniotomy

150
Q

TBI epidural hematoma S/S time onset

A

first good recovery
THEN changes is LOC as blood pools

151
Q

What not to do with TBIs

A

NO Valsalva maneuver
NO straws

152
Q

Sedative of choice for TBIs

A

Propofol

153
Q

Do epidural hematomas cross suture lines

A

NO

S4 2539 (11 decks)

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