Neuro, Lines and Hepatic Flashcards
Describe what titration of a medication means
Titrating medications is the process of adjusting doses to maximize the benefit of medicaitons without adverse effects. Orders for titration are written to meet parameters of lab results and should be adjusted according to orders.
Lines: State the concept of the transducer used in arterial line pressure measurement.
The transducer is the part of the arterial line that ensures proper pressure readings through its connection to the closed pressure system. In order for accurate pressures to be seen, the transducer must remain at the phlebostatic axis located at midaxillary, 4th intercostal space of the patient
Lines: Describe a normal assessment of an arterial line
The extremity distal to the arterial line should be warm to the touch and have sensation that is baseline for the patient. The site should be visible without excessive drainage and the surrounding tissue should be soft. Any altered findings should be reported immediately
Neuro: Describe autonomic dysreflexia and the priority actions for treatment
Autonomic dysreflexia is a emergent condition that occurs in people with a spinal cord injury occurring at level T5-T6 who are experiencing a stimulus somewhere below the level of injury. Patients present with a sudden increase in blood pressure, decreased heart rate, anxiety, headache, diaphoresis, and skin flushing above the injury site.
The priority action is to eliminate the source of stimuli and then treat the symptoms caused by the condition.
Common stimuli include a blocked urinary catheter, full bladder, urinary tract infection, fecal impaction, tight clothing, and many other possible stimuli.
Neuro: Describe the goal times for tPA treatment for an embolic stroke
The goal for treating an embolic stroke with tPA are time oriented. Best practice is to start tPA within 4 hours of last known well time and within 60 minutes of arrival at treatment center
Neuro: Describe the use of Mannitol for management of ICP including side effects
Mannitol is an osmotic diuretic that elevates blood plasma osmolality, resulting in enhanced flow of water from tissues, including the brain and cerebrospinal fluid, into interstitial fluid and plasma. However, it can also cause fluid to shift into the interstitial space leading to peripheral edema and if not treated, heart failure
Neuro: Describe levels of consciousness using the Glascow Coma Scale (GCS)
The higher the score on the GCS, the less severe the impact of an injury.
13-15 = mild
9-12 = moderate
3-8 = severe
A decrease in the GCS score is a priority for reporting to the doctor because it indicates a decrease in level of consciousness
Neuro: Explain the ICPS acronym for use of a patient with an ICP monitor
ICPS is the acronym used to remember ways to prevent spikes in intracranial pressure
I- immobilize the C-spine
C- keep CO2 low in order to prevent vasodilation
P- keep head of bed 30-45 degrees
S- limit the amount of times you suction, hyperventilate when you do suction, and limit attempt to less than 10 seconds.
Neuro: Describe Cheyne Stokes respirations
A respiratory pattern that involves a period of fast, shallow breathing followed by slow, heavier breathing and moments without any breath at all
Cheyne Stokes is a late sign of increased intracranial pressure
Neuro: Describe early and late signs of increased intracranial pressure
Early: Restlessness, agitation, change in level of consciousness, mental status change, vomiting without nausea
Late: irregular breathing, seizures, posturing, fixed & dilated pupils, coma, cushing’s triad
Neuro: Describe the characteristics of Cushing’s Triad
Cushing’s triad refers to a set of signs that are indicative of increased intracranial pressure (ICP), or increased pressure in the brain. Cushing’s triad consists of bradycardia, irregular respirations, and a widened pulse pressure
CVC: Describe the rationale for drawing blood with a peripheral stick rather than from a central line in the presence of potential infection
When infection is suspected and the source of infection is unknown, it is important to use blood from a peripheral lab draw so that the risk of a false positive central line infection is eliminated
CVC: Describe the methods of confirming proper placement of a central line
Use U/S guidance
CXR confirmation before use
Observe color of blood from line
CVC: Explain the rationale for using a 10ml syringe when drawing blood from or administering medications through a central line
Anything smaller than 10ml syringe may compromise the central line by altering the pressure within the line
CVC: Describe the rationale for sending a central line catheter tip to the lab for testing
When a patient with a central line manifests signs of infection, the central line should be considered suspect for infection. First, the healthcare provider must be notified and then if instructed, the line should be removed and the tip should be sent to the lab to identify the source of infection
