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Complex DMR > Neuro > Flashcards

Neuro Flashcards

1
Q

Normal distribution of brain contents

A

Brain tissue 80%
Blood 12%
CSF 8%

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2
Q

Monroe-kellie hypothesis

A

Sum is constant so an increase in Brain tissu/blood/csf needs to be off set by decrease in another–inside a fixd skull

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3
Q

Symptoms of Increase ICP

A

HA, N/V, dizziness, pupil changes

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4
Q

Mass effect in ICP

A

Cerebral edema, blood (100ml) to caus herniation, tumor, hematoma

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5
Q

CSF & Blood issues that results in elevated ICP

A

Obstruction to CSF flow/absorbtion, increase of CSF production

Elevated venouse pressure, heart failure , obstruction of jugular vein

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6
Q

Cushings triad

A

Inc BP with widened PP
Bradycardia in an inc to inc BP
Irregular respiratory pattern
fixed & dilated pupil (late sign)

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7
Q

ICP range

A

less than 20 (5-15 range)

`

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8
Q

CPP & Range

A

> 60

Drives cerebral blood flow to brain tissue indirectly measures cerebral blood flow

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9
Q

CPP equation

A

MAP-ICP=CPP

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10
Q

Assessment of ICP

A 
LOC (orintation confusion lethargy)
Reflex-gag and cough
GCS
Extremety weakness/strength
ICP
Vitals
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11
Q

Management of ICP

A

Airway management
Dec intracranial contents–drainage of CSF
Hyperventilation PaCo2 30-35 to vasocontrict and decrease bf to the brain
Osmotic dieuresis
–mannitol
—3% sodium chloride
Surgical managment

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12
Q

Treatment & meds for ICP

A 
Reduce metabolic demans of brain --treat fever & therapeutic hypothermia 
Control BP: CCB, BB 
increase CPP with vassopressors 
Sedation to decrease agitation 
Prevent seizure
Chemical paralysis and induced coma
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13
Q

Nursing actions for patient with ICP

A 
HOB 30-45
head neutral and avoid hip flexion 
Avoid excess stimulation do not cluster care
give patient breaks between activities
only suction ETT when necessary
treat pain/agitation and fever
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14
Q

Seizure

A

Uncontrolled sudden excessive discharge of electrical activity
Range of manifestations can be subtle or dramatic
Change in behavior happens more than loss of consciousness

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15
Q

Epilepsy is categorized as

A

2 unprovoked seizures occuring more than 24 hours apart

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16
Q

Pathophysiology of seizures

A

no conclusive explaination
two ideas are:
Genetic/developmental mutation of synapses
Inffective activity of gaba

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17
Q

Structural cause of seizure

A

Lesions to brain (tumor) ICP

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18
Q

Vascular cause of seizure

A

Stroke vasculitits

hydrocephalus, htn, encephalopathy, eclampsia

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19
Q

Most common time of the year and day of the week for trauma

A

Saturday and July

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20
Q

Most common trauma for OA & Adults

A

Falls & MVA

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21
Q

Golden Hour

A

The time following an injury when promp medical treatment has the highest likelihood of prevnting death

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22
Q

Hospital Red Resuscitation ABCDEs

A 
Obstructed airway 
stridor
B:SpO2<80
RR>35 or <8
C: HR>130 BP ,8
D: GCS<8
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23
Q

Primary survey

A

Identify life threatening injuries and begin management, bandaids in 1st hour

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24
Q

Secondary Survey

A

Performed after primary survey life saving interventions initiated and assess for other injuries not initially apparent

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25
Q

Most common Gender for trauma

A

Men

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26
Q

Where does each person in the clinical team stand during a trauma

A 
Airway specialist at head PT right side
Airway assistant at head PT left side 
Doctor 1 PT right side closer to head
Nurse 1 PT right side closer to head
Nurse 2 Left side closer to head
Doctor 2 PT left side closer to head
Team leader at the foot of the bed
Scribe PT's Right side by foot
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27
Q

Burns are classified by general categories of

A

Etiology, Severity, Depth, TBSA

28
Q

4 etiologies of burns

A

Electrical, chemical, radiation, thermal

29
Q

Most common burn

A

Thermal
Flash in adults (fire)
Scald in kids look out for child abuse

30
Q

What is unique about electrical burns

A

Internal damage occurs along pathway of the current

31
Q

What do you need to watch out for in a patient with electrical burns

A

Dysrhtmias us cardiac monitoring, muscle damage look for rhabdomyolysis, other traumas

32
Q

What substances can cause chemical burn

A

Acids, organic compounds, alkaline substances

33
Q

What is the treatment for chemical burns

A

**REMOVE CLOTHING*
Clean Dust off
Continuous Irrigation

34
Q

Causes of radiation burns

A

Sunburn (most common)
Chemo
Nuclear accidents
Therapeutic radiation

35
Q

Severity of radiation burns depend on

A

Type
Dose
Length of exposure

36
Q

How do you classify burns by depth

A

Superficial
Superficial partial
Deep partial thickness
Full thickness (subcu tissue and bone)

37
Q

characteristics of a superficial burn

A 
Blanchable
Painful
No blisters 
No scaring 
Minimal damage
DRY
38
Q

Characteristics of a superficial partial burn

A 
Damage to entire epidermis 
Minimal damage to dermis 
Weeping/Wet
Blisters
Blanchable
No scarring 
Painful
39
Q

Characteristics of a Deep partial thickness

A 
Damage to the entire epidermis
Deeper damage to dermis 
waxy
blisters 
minimal/no blanching 
Painful edges, sensitive to pressure 
may need graft to heal, will heal with scars
40
Q

Characteristics of a Full thickness burn

A 
Entire dermis/epidermis damaged 
Potential fat muscle and bone dramage 
Leathery &amp; dry 
Black or color may vary 
No blanching 
No pain
Will need surgery and graft
41
Q

TBSA damage`

A

Use Lung and Browder which assign percentages to parts of the body by age– used in partial and full thickness burns

42
Q

Severity of damage of the burn depends on

A

ability of the patient to tolerate treatment and heal
Inhalation injury
Location of injury
Concomitant injury: additional trauma caused by burns
Comorbid conditions:

43
Q

Anatomic changes cause by burn

A

loss of skin (protective) skin is protective against infection, thermoregulation, dehydration, up to 5 L lost from evaporation

44
Q

Areas of the body in which burns cause functional changes**

A

Face, hands, perineum, genitals, joints

45
Q

Respiratory issues associated with burns Inhalation injury symptoms (above glottis )

A

Facial burns, singed nasal and facial hair, soot in mouth nose, sputum redness of the oral pharynx, inability to swallow, tachypnea

46
Q

Inhalation injury (above glottis ) intervention

A

INTUBATE bc of oral airway swelling

47
Q

What causes a below glottis injury

A

ARDS
Aveolar damage
Prolonged smoke exposure

48
Q

Symptoms of CO poisioning (CO>30)

A

HA, Nausea, dizziness, change in LOC, tachycardia/tachypnea, vision changes, dypsnea

49
Q

Symptoms of CO poisoning (CO>50)

A

Coma, death, seizure

50
Q

Can you measure CO with SpO2?

A

No SpO2 cannot differentiate between the two

51
Q

What is burn shock?

A

combo of distributive and hypovolemic shock

52
Q

What causes burn shock

A

capillary leak 8-36 hours after injury peaking at 24 hours bc of the inflammatory process

53
Q

What do you need to do if burn shock is suspected

A

massive fluid resuscitation and electrolyte correction

54
Q

What happens in burn shock and fluid is not rescusitated

A

hypotention, tachycardia, dec UO, mental status change, if not resolved AKI, organ failure, death

55
Q

How long does hypermetabolic state last

A

1-3 years

56
Q

What is needed during a hypermetabolic state

A

Adeuqate nutrition for wound healing (early enteral support/nutrition counseling)

57
Q

Interventions to help thermoregulation in burn patients

A

Adequate warmth, once healed they cant sweat

58
Q

3 phases for burn patients

A

Emergent phase
Intermediate phase
Rehabilitative phase

59
Q

Emergent phase burn

A 
Stop burn process!!
• Airway management (Intubate!)
• Fluid resuscitation
• Prevention of hypothermia
• Pain management
• Clean wound covering
• Determine baseline status
• Determine extent of injuries
60
Q

Triage from EMS for burn patients

A
  • Mechanism of injury
  • Care in the field
  • Amount/type of fluid given
61
Q

ABCDEF nursing burns

A 
A – Airway
• Intubation if needed
• Early before swelling gets
worse!
B – Breathing
• 100% humidified O2
C – Circulation
• Remove tight clothing or
jewelry
• Neurovascular checks!
D – Disability
• Neurological exams
• Maintain C-spine precautions,
if indicated
E – Expose and examine
• Extent of burn wounds
• Possible associated trauma
F – Fluid resuscitation
62
Q

fluid resuscitation in burn pt

IV/when is it initiated/what is used

A
  • Two large-bore IVs ASAP
  • Initiated with burns ≥ 20% TBSA
  • Lactated ringers is fluid of choice
63
Q

what is the parkland formula and how long is fluid given

A

• Parkland formula
– 2-4mL of LR per kg body weight x %TBSA in 24
hours
• All electrical burn injuries – 4mL/kg
Half given in first 8 hours, half given in last 16
hours

64
Q

Burn patient emergent phase Complications

A
  • Sepsis
  • Compartment syndrome
  • Contractures
  • Scarring
65
Q

nurse management in Intermediate phase

A 
Wound care
– Dressings/hydrotherapy
– Surgical debridement 
– Wound closure 
• Thermoregulation 
• Pain management 
• Nutrition 
• Prevention of infection
66
Q

nurse management in Rehabilitative phase

A

Rehabilitative phase
• PT/OT –Mobility/functionality
• Psychosocial health – Body image
therm-pain-nutriprevent in

Complex DMR (12 decks)

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