MedSurg2 Exam 2 -FINAL- Flashcards
Types of Strokes (4)
TIAS (Transient Ischiemic Attacks)
Thrombolytic Strokes
Hemorrhagic Strokes
Embolic Strokes
Cause of TIAS and S/S (2)
Interruption of cerebral blood flow
impaired vision and speechlessness
Cause of Thrombolytic Strokes and…
Common in…?
Onset…?
Blood clot forms and obstructs blood flow
Common in elderly w/ atherosclerotic plaque deposits
Occurs rapidly, progresses slowly, occurs at rest
Cause of Embolytic Stroke and…
Common on…
Onset…?
Occurs when pt is…?
When traveling blood clot (embolism) travels to and lodges in artery of brain
Common in younger individuals
Appears suddenly w/ immediate neurological deficits
Occurs when awake and active
Cause of Hemorrhagic Stroke and what is it REKNOWN for?
Intracranial hemorrhaging: rupturing of vessels in vein
BEING W/OUT WARNING AND MOST FATAL
Zones of Injury (3)
Ischemic - will recover w/ blood flow
Injury - some recover/some don’t
Necrotic - CANNOT be recovered and contraction inhibited
Stroke Fx: Aspiration 5 Interventions
Provide nutritional support Evaluate swallowing (dysphagia = cranial nerve lesions) Assess cognition Assess positioning during eating Monitor throat clearing/coughing
Stroke Fx: Impaired Mobility Tx Premise (3 interventions to prevent 3 s/s)
Rehab, SCD tockings, and Anticoagulants to prevent pulmonary embolism, VTE, or DVT
Stroke Fx: Communication 4 Types of Aphasia, premise, and intervention focus
Expressive/Brocas - difficulty speaking/writing, ↑ reliable language output
Receptive/Wernickes - difficulty understanding, ↑ comprehension
Mixed - combo of 2 above, both interventions
Global - Zero language capacity, ↑ non-verbal comms
Stroke Fx: Urinary Elimination
Hypo/HyperReflexia and Diapers?
Hypo - indwelling cath ASAP, output should not ne > 400mL
Hyper - establish voiding sched.
NO DIAPERS
Stroke Fx: GI Elimination
Constipation r/in…?
How do we influence BM?
Constipation - this ↑ BP
Diet/Meds that promote BM
Stroke Fx: Sensory Perception
Key Care
R Hemisphere Issues
L Hemisphere Issues
Prevent ulcers, neglect, assess agnosia (counter w/ consistency)
R - visual/spatial perception
L - memory deficit
Stroke Fx: Body Neglect Which side ↑% injury? Educate pt to...? Dress which side first...? Why turn pt head...?
R side
Use both sides of body
Affected Side
↑ Visual field
Stroke: Mnemonic F.A.S.T S/S
Facial Drooping
Arm WEakness
Speech
Time
Burn Pt Key Tx
How many/IV Types?
Med for Propylaxis
Burned extremities vs. Normal?
2 Large bores (14-16 gauge)
Tetanus Toxoid
Neutral Burned, Elevate Normals
3 Burn phases and Main Issues
Emergency/Resuscitation - 24 - 48 hrs, pain meds
Acute - 2 weeks - 18 months, infection
Rehabilitation - Ø time, self-image
Management of... Flame Chemical Electrical Radiation burns (2 ea)
smother flames, remove clothing/metal objects
Ø wet! ascertain type before neutralizing
start cardiopulmonary resuscitation, get EKG
undress/bath pt, send to decontamination
What to monitor in burns and topical med of choice
Urine Creatinine (14 - 26) Gentamicin Sulfate (Garamycin)
Full Thickness Burn:
Skin Level Effected
General Look (color spread, blisters?, level edema)
Dermis look & sensation
Entire epidermis and dermis (no cells to repopulate)
red - white, Øblisters, severe edema
Leathery firm, Øsensation
Full Thickness Tx Goals (4)
Secure Airway
Circulation
Ø Infection
Maintain Temp
Burn Grafts:
Auto
Xeno (Hetero)
Allo (Homo) (2 ea)
Auto - butt to arm, 10 - 14 heal time
Xeno - animals like pigs, temp due to rejection until Allo available
Allo - humans (family, donors), triggers rejection
Isograft/Syngraft
Transplantation between identical twins
Electrical Burns:
“Grand Masquerader”
Conversion…?
4 Emergency Management Notes
surface injury small, internal huge
electrical converted to heat
Separate pt from current
Smother flames
Cardiopulmonary resuscitation
Get ECG
Traumatic Brain Injury (TBI) 4 main causes and 4 mechanisms w/ examples!
Falls, Motor accidents, drugs, alcohol
Acceleration/Deceleration - bat/wall
Rotational - left hook
Penetrating - headshot!
TBI Ischemic Tx
AGGRESSIVE (4) !!!
AGGRESSIVE tx hypoxia/hypoTN
Give O2
Fluid Resuscitation
Halo Vest Care
Can I touch it…?
Abnormalities…?
2 scheduled (qXhr) interventions.
Don’t touch anything unless CPR req. Then remove.
Report abnormalities to doc.
Assess motor fx q2-4hr, turn q2hr
Spinal Fusion Post-Op Key interventions Check for... (3) Perform... 2 qXhr interventions Follow... PCA or PO Analgesia?
bleeding, CSF, void ability neuro assessments log roll and deep breath q2h (counters atelectasis) exercise program BOTH OK!
Fx of…
Lower Motor Neurons (r/t CNS, T/L location, s/s)
Upper Motor Neurons (r/t CNS, T/L location, s/s)
Guillain-Barre Syndrome (what is, development s/s)
leaves CNS - ↓L1, Øreflex/spasm but +pain
don’t leave CNS, T12 - L1, spasticity/paralysis
When immune system attacks nerves.
Begins w/ weakness/tingling and becomes paralysis
3 Types of Hematomas, location and cause
Subdural - in outer (dura mater) - venous bleeding
Subarachnoid - between arachnoid/pia (inner matter)
Epidural - epidural skull down spinal cord - arterial bleeding into space or fracture
Post-Op Neuro Pt Key Ranges (2)
Key ABCS (2 ea)
Glasgow: 3 - 15
ICP: 10 - 15
Airway - ventilated? cervical spine injury?
Breathing - breathing? Hypercarbia -> ↑ ICP
Circulation - preserve cerebral perfusion by 30º the bed and NO VALSALVAS!
Post-Op Neuro Meds Mannitol is for..., monitor...? Pentobarbital is for...? Phenytoin is for..? Morphine/Fentanyl are for...? monitor...(2)?
↓ cerebral edema, I&O’s
↑ coma to reduce metabolic demands (LAST RESORT)
↓ seizures
↓ pain, monitor BP and ABGs
Shock Labs FX HH BP/O2 PaCO2 PaHCO3 BUN/Creatinine Lactate
↑ ↓ Variable, ↓ w/ ↑RR ↑ r/t poor kidney perfusion ↑ r/t poor kidney perfusion ↑
SCI’s
Proprioception vs Dermatomes
Proprioception - awareness of body part location
Dermatomes - concept that specific section of spine senses topographical part of body
Trauma Care - Primary Survey
ABCDE
AVPU
Airway
Breathing
Circulation
Disability (LoC/Motor Fx) - Alert, Verbal Stimuli, Painful Stimuli, Unresponsive
Exposure/Evacuation - assess external injury and temp
Trauma Care - Secondary Survey
FHGI
Facilitate family presence
Give Comfort
Hx (HTT in 90 seconds)
Inspect posterior surfaces
Trauma Care - Resuscitative Measures
FNFL
Occurs with what Survey?
Foley Insertion
NG insertion
Fluid Resuscitation
Labs (specifically Type/Cross-Match)
Occurs w/ Primary Survey
