Neurological Conditions Flashcards
1
Q
Increased Intracranial Pressure
A
Swelling of the brain, you would see an increased BP, decreased MAP, slow breathing
2
Q
What are the layers of the meninges?
A
Dura Mater: outer layer, tough, thick, and firbous
arachnoid: thin, intermediate layer
pia matter: delicate, internal, vasculated layer
3
Q
Cerebral Spinal Fluid
A
Located between the arachnoid and pia matter
Cushions the brain and spinal cord
Constantly absorbed and replenished
Normal amount is 100-150 mL
4
Q
What is the Monroe-Kellie Hypothesis?
A
Cerebral spinal fluid, intravascular blood, and brain tissue must all exist in equilibrium. If there is a change in any of these, it will result in IIP.
5
Q
What is normal ICP?
A
5-15 mmHg
6
Q
At what level will ICP require treatment?
A
> 20 mmHg
7
Q
What does the MAP tell us?
A
It is the average measurement of the systemic arterial pressure. Reflects the perfusion pressure. It is a better indicator for perfusion than the systolic BP.
8
Q
What is the normal MAP value?
A
65-105 mmHg`
9
Q
At what level MAP is perfusion to vital organs severely jeprodized?
A
<50 mmHg
10
Q
How to calculate MAP?
A
Systolic BP + 2(Diastolic BP)/3
11
Q
What is cerebral perfusion pressure (CPP)?
A
The pressure required for the heart to supply blood to the brain
Increased ICP leads to decreased CPP and decreased blood flow to the brain
12
Q
How do you calculate the CPP?
A
MAP-ICP
13
Q
What is normal CPP?
A
50-100 mmHg
14
Q
What level CPP will cause irreversible neurologic damage?
A
<50 mmHg
15
Q
What causes IIP?
A
- intracranial mass lesions (tumors)
- cerebral edema
- increased CSF production
- decreased CSF absorption
- obstructive hydrocephalus
- obstruction of venous outflow
- idopathic ICH
16
Q
Cushing’s Triad
A
CNS Ischemic response reflex, initiated by hypothalmus
- HTN
- bradycardia because of compression of vegas nerve
- bradypnea because of compression of brain stem
17
Q
IIP Clinical Manifestations
A
ALOC - most sensitive indicator
-headache, drowsiness, pupillary changes, widening pulse pressure, purposeless movements, hyperthermia (late stage), posturing
18
Q
Decorticate Posturing
A
Limbs pulled towards core. Lesions above brainstem
19
Q
Decerebrate Posturing
A
Lesions of the brain stem
Limbs extended and rigid.
20
Q
IIP Diagnostic Tests
A
During physical exam check pupils - they will be dilated
Spinal Tap - after spinal tap lay flat on back for 4-6 hours
MRI
CT Scan
21
Q
Mannitol
A
Osmotic Diuretic, pulls h2O out of brain. It begins to lower ICP in 1-5 minutes. Measure I&O while on it - normal urine 30 mL/hour
Thins blood
Starting dose 1.5-2 g/kg IV infusion
22
Q
IIP Management
A
Keep O2 sat above 95, continuous pulse ox
Monitor fluid so BP doesnt drop too low
Keep head of bed at atleast 30 degrees to maximize venous outflow
Thermoregulation - no fever because it increases ICP. Shivering also inreases ICP
Stool Softner
Anti-Seizure medication
23
Q
IIP Surgical Management
A
- Evacuation of blood clot
- Resection of a tumor
- CSF diversion: ventriculostomy drain 1-2 mL
24
Q
Traumatic Brain Injury
A
Injury resulting from external force
Primary: direct result from mechanical injury at time of accident
Secondary: physiologic response to the initial injury
25
What are types of penetrating injuries
open head wound, focal damage around injury site, skull fractures, lacerations
26
What are types of non-penetrating injuries?
closed injuries. Concussion, contusions
27
Types of skull fractures
Open facture: scalp open
Closed fracture: scalp closed, could be depressed
Basal: most serious, effects base of skull. CSF drainage
28
What is a coup and countre coup injury?
Head hits front of skull and then rebounds and hits the back. Common in car accidents
29
What is a laceration head injury?
Tears in brain tissue or blood vessels of brain. It can cause destruction of brain tissue and increased ICP.
Most common result of bullet/stab
30
Diffuse Axonal Injury
most intense
traumatic shearing forces lead to tearing of nerve fibers in the white matter.
Caused by shaking or strong rotation of the head by physical forces
31
Secondary Traumatic Brain Injury
Ischemia, hypoxia, hypotension/HTN, cerebral edema, IICP, hypercapnia, meningitis, epilepsy, biochemical changes
32
TBI Clinical Manifestations
headache, memory problems, blurred vision, dizziness/fatigue, sleeping difficulties
serious: persistent headache, profound confusion, slurred speech, seizure, coma
33
Neurological/Musculoskeletal Assessment
Pupillary, check for consensual and accomodation
Check mental status
Check or sensory function like stergonosis (tell you what hand an item is in), facial movements, light touch (with cotton ball), graphesthesia (describe what is in hand
ROM (active - no help passive - with help)
Romberg test (look for sway)
Tandem (walk heel to toe)
34
What is a concussion?
Most common and least serious TBI. Low velocity injury resulting in functional deficits without pathological injury.
35
What is the best possible Glasgow Coma Score?
4 points - spontaneously opens eyes
5 points - oriented to time, place, and person
6 points - obeys commands
36
What criteria is considered a mild TBI?
13-15 Glasgow coma score
| < 30 minutes loss of conscious or <24 hours amnesia, < or equal to 24 hours AOC
37
What criteria is considered a moderate TBI?
9-12 Glasgow coma score
| > 30 minutes loss of consciousness, or > 24 hours amnesia, > 24 hours AOC
38
What criteria is considered a severe TBI?
3-8 Glasgow coma score
| > 24 hours loss of conscious, >7 days amnesia, > 24 hours AOC
39
What Glasgow coma score is usually fatal?
3 or less
40
What are some diagnostic tests for TBI?
CT are done first, identify hemorrhage, bleeds in and around brain, blood flow, brain tissue swelling, and skull fractures
MRI follows to confirm which part of brain is affected and how severe. Can check microhemorrhage, brusing, gliosis, atrophy
41
What are the pharmacology options for TBI?
Osmotic diuretics, anticonvulsants, electrolytes, N-Methyl-D-Asparate Receptor agonist, stimulants, dopamine agonists, SSRI, Antipsychotic, muscle relaxer, pain relievers
42
What do osmotic diuretics do for TBI? What is an example?
Lower intracranial pressure by withdrawing water. Mannitol is an example. This is the most common drug used for TBI
43
What do anticonvulsants do? What are an example?
Prevent seizures because seizures increase ICP. Gabapentin - brand name neurontin
44
What do NMDA drugs do?
Prevent hyperactivity and secondary injury
45
What do barbiturates do? What is an example?
They are sedatives/anti-seizure. Phenobarbitol is an example.
46
What do calcium channel blockers do for TBI?
decrease blood pressure by preventing blood vessel spasm
47
What do dopamine agonist do for TBI? What are examples?
increase amount of dopamine. Improve alertness. Carbidopa, levidopa
48
What do SSRIs do? What is an example?
help with serotonin levels. Treat emotional distress. Prozac, floxitine, zoloft, celexa
49
What is a craniotomy?
Surgical opening into cranium
50
What is endoscopic ventricuolostomy
Drilling of a hole into fluid filled ventricle to rain it for pt. with hydrocephalus
51
What is Ventriculoperitoneal Shunt Surgery?
Shunt is put in ventricles to drain fluid into circulation - for hydrocephalus
52
What is a decompressive craniectomy?
For increased ICP. Remove a part of the skull so more area for brain to grow
53
What is a cranioplasty?
Repair of the skull
54
What is the most common complication of TBI?
Irritability
55
What are some nursing priorities for TBI?
Establish a baseline for the patien
Airway/breathing (ABG's)
vital signs - maintain CPP, Cushing's Triad
Early detection of subtle changes, report small changes immediately
Positioning
Neurological examinatiosn
*have suction ready at bedside incase of aspiration
56
What is complete spinal cord injury?
both sensory and motor functions are lost
57
What is an incomplete spinal cord injury?
some function remains
58
What is tetrapalegia/quadriplegia?
paralysis of arms and legs
59
What is paraplegia?
paralysis from waist down
60
what is hemiplegia?
paralysis on one side
61
what is triplegia?
paralysis of 3 limbs, one arm and both legs
62
What will an injury to cervical - neck, result in?
tetraplegia, quadriplegia. Most severe of spinal cord injuries
63
What will thoracic injury result in?
paraplegia
64
What will lumbar injury result in?
some loss of function in hips and legs. Will result in little or no voluntary control in bowel or bladder
65
What will sacral injury result in?
S1 - hips and groin
S2 - back of thighs
S3 - medial buttock
S4-S5 - perineal
66
What are some risk factors for spinal cord injury?
male, age 16-30, alcohol use, risky behavior, some dseases
67
What is emergency care for spinal cord injury?
Cervical collar, back board
68
What are some medications for spinal cord injury?
pain relievers, muscle relaxer, corticosteroids
69
What are some surgical options for spinal cord injury?
craniotomy, decompressive laminectomy
70
What is the pathophysiology of a stroke?
blood flow to an area of the brain is cut off
71
What are some risk factors for a stroke?
> 65, men, HTN, DM, smoking
72
What is an ischemic stroke?
Caused by a clot/blockage to the brain. Can be transient, thrombotic, or embolic
73
What is a hemorraghic stroke?
Bleeding into brain. Artery into brain leaks blood or ruptures. Can be a intracerebral hemorrhage, or subarchnoid hemorrhage
74
What is the etiology of an ischemic stroke?
```
Arrythmia/heart valve disease/infection
HBP, DM, HLD
intracranial disease (chronic HTN)
cancer, blood clotting disorder
autoimmune disease
sickle cell anemia
HIV
```
75
What is a transient Ischemic attack?
a mini stroke. blood flow to the brain is blocked for only a short time. caused by blood clots. if not treated 10-15 % will have a major stroke within 3 months
76
What is a penumbra? How is it treated?
It is the reversibly damaged brain around the ischemic core. Survival depends on timely return of adequate circulation, degree of cerebral edema, alteractions in local blood flow
Less than 4 hours after stroke symptoms start TPA.
77
What should TPA be started for a stroke?
Within 4 hours of stroke symptoms
78
What is the nursing goal of hemorrhagic stroke?
Maintain cerebral tissue perfusion
79
What is the etiology of hemorrhagic stroke?
HBP, CAD, brain aneurysm, heart defects/failure, arteriovenous malformation, bleeding disorders
80
What is an intercerebral hemorrhage?
bleeding within the brain, artery in brain bursts, flooding surrounding tissue with blood. most common
81
What is a subarachnoid hemorrhage?
bleeding into the spaces around the brain.
82
What are some risk factors for a stroke?
lack of excercise, sleep apnea, heavy alcohol, smoking/drugs, diabetes, cardiovascular disease, high cholesterol, HBP, obesity
83
What does BEFAST stand for?
balance - loss of balance, headache/dizziness
eyes - sudden loss of vision in 1 or both eyes
face - uneven
arms - weakness
speech - slurred
time - act quickly, call 911
84
What are the types of aphasia?
Expressive Aphasia: Can't express self via any language (manual, written). Can understand.
receptive aphasia: able to speak well, but what they say may not make sense
anomic aphasia: can't remember writing/speaking
global aphasia: all of the above
85
What care/assessments would you give to a person with a stroke?
```
neurologic assessment, vital signs, blood glucose, actual weight
NIHSS, cardiac monitor
STAT EKG, CBCD, PT, PTT, BMP, Troponin
Brain CT w/o contrast
IV access gauge 18 or 20 X 2
IV fluids - isotonic
strict NPO
```
86
What is considered a severe stroke on the NIHSS scale?
score 21-42
87
What is considered a moderate/severe stroke on the NIHSS stroke scale?
16-20
88
What is considered a moderate stroke on the NIHSS stroke scale?
5-15
89
What is considered a minor stroke on the NIHSS stroke scale?
1-4
90
Stroke Pharmacology
Thrombolitics (TPA), blood thinners (anti-platelet, anticoagulants)
BP lowering meds (ACE, ARB, B Blockers, Ca Channel blockers, diuretics)
Cholesterol lowering medications (fibrates, niacin, resins, statins)
91
What is TPA?
"clot buster" AKA alteplase. Gold standard for ISCHEMIC stroke, contraindicated for hemorrhagic.
Must lower SBP <185 and DBP <110
No major surgical procedures within 14 days
92
nursing management for stroke
```
maintain cerebral perfusion
promote physical mobility
promote self care
promote verbal communication
promote urinary and bowel elimination
maintain safety
```
93
What is osteoporosis?
Chronic, progressive, metabolic bone disease resulting in decreased bone density. Bone reabsorption (osteoclast) exceeds bone deposition (osteoblast)
94
What do osteoclast do?
reabsorption
95
What do osteoblasts do?
laying of new bone
96
Does osteoporosis have symptoms?
Yes, but it's usually a silent disease
| Symptoms are: height loss, dowager's hump, low back pain, fragility related fractures
97
What vitamin is deficient in osteoporsis?
vitamin D and calcium
98
What are risk factors for osteoprosis?
```
After 35
women
disease: DM, HTN, kidney disease
Lifestyle
Smoking
Excessive alcohol: slows osteoblast and liver dysfunction - liver imp. for activating Vit. D
Diet low in Ca
Excessive caffeine : increased urination of Ca and Vit D
```
99
What medications are a risk factor for osteoporosis
Corticosteroids - affect absorption of Ca and increase osteoclast
Antiseizure drugs
Aluminum coated antacids
Excessive thyroid hormotes
100
What laboratory tests should be done for osteoporosis?
Serology - look for increased calcium and phosphorus
101
What imaging should be done for osteoporosis?
Bone Mineral Density - checks for thickness/solidity
Quantitative US: looks for heel, shin, kneecap
DEXA: measures hip, spine, forearm - more common
102
What medication would be prescribed for osteoporosis?
Bisphosphanates (fosamax)
calcitonin (miacalcin)
Calcium and vitamin D
103
What should you tell a patient taking Fosamax?
Take on an empty stomach, must stay standing for 30 min. Can cause esophageal erosion. Take with a full glass of water
104
What dose of calcium should a female/male take?
1000 mg female, after menopause 1200
| 1 g for men
105
What dose of vitamin D should a woman/man take?
600 mg, after menopause for women 800 mg
106
What is a vertebroplasty?
inject cement to relieve compression
107
What is a kyphoplasty?
More invasive. Cement and balloon inserted.
108
What is a good diet for someone with osteoporosis?
dairy, spinach, canned salmon, sardines
109
What are some preventive measures someone with osteoporsis can take?
Exercise - 30 min/day
Heat therapy
smoking cessation
avoid alcohol
110
What are goals of patient care for someone with osteoporosis?
reduce bone loss
| prevent fractures
111
what is osteoarthritis?
alteration of bone remodeling process. cartilage that cushions ends of bones wears down. Hands and weight bearing joints are effected. Caused idiopathic or secondary
112
OA clinical manifestations
pain with joint movement, stiffness, crepitus, hypertrophied joints, heberden's node, bouchard's node,
113
What is Herberden's node?
DIP - distal interphalangeal joints. Joints closest to tips of fingers.
114
What is Bouchard's node?
PIP. Proximal interphangeal joints.
115
OA risk factors
```
Over 55
BMP
Repetitive stress
Women
obesity
work related - poor posture
genetic influences
```
116
OA Diagnostic studies - Labratory
synovial fluid - remains clear/yellow
CRP increased
ESR increased
117
OA diagnostic studies - imaging
XRAY: shows bone spur, narrowing
MRI: involvement of soft tissue
CT scan: confirm
118
OA Pharmacology
Acetominophen: 4g/4000 mg /day
NSAID: watch for GI bleed
COX-2-Inhibitor: newer NSAID, antirheumatic
Corticosteroids: harmful effects on cartilege, only give 3-4 injections/year
Topical NSAID: Icy hot
Glucosimine, chondrotin: dietary supplement, decrease pain.
119
OA Collaberative interventions
activity/rest: rest joint during exhasberation
orthoses assitive device: immobilizer
TENS/heat therapy: neuro stimulation device
Weight Management : most beneficial
mind/body techniques
PT
Excercise
120
Joint Surgery potential complications
```
DVT
Compartment Syndrome - very painful
Infection
Bleeding - monitor H&H
dislocation - position properly, proper transfer
```
121
Post Op Nursing Care for OA - 5 P's
Neurovascular assessment - Monitor 5 P's
pain, pressure, pulselessness, pallor, paresthesia, paralysis
122
Goals of PT care for osteoarthritis
manage pain/inflammation
maintain/improve joint function
prevent disability
123
What is Rheumatoid Arthritis?
Autoimmune disease
marked by periods of remission/exaceration
Effects small joints, synovial joint lining. Synovial fluid becomes inflammed
124
What is the pathophysiology of RA?
CD4 cells activate macrophages, macrophages activate WBC, pannus foramtion (abnormal accumulation of granular tissue)
125
What are the joint manifestations of RA? Extracellular?
boutonniere, ulnar deviation, swan neck.
rehumatoid nodules, sjogren's syndrome, felty syndrome
126
What are the symptoms of sjogren's syndrome?
dry mouth, increased tooth decay, dry eyes
127
RA clinical manifestations
Early stage: paraesthesia, anorexia, night sweats, weakness, warm/swollen/painful joints, mild/moderate pain
Late stage: joint stiffness, atrophy, chronic pain, multiple organ involvement
128
RA Labratory Test
```
Rheumatoid Factor - increased
CBC- WBC increased
ANA: positive
Anti-CCP antibodies - positive
Synovial Fluid: cloudy
```
129
What is a good diet for someone with RA?
cardiac diet, low cholesterol, low sodium
130
RA pharmacology
NSAID, corticosteroids for acute exacerbation, DMARDS
131
What are some examples of disease modifying anti-rheumatic drugs (DMARDS)
methotrexate
etanercept - embril
hydroxychlorquine - planquile
132
RA surgical management
arthodesis: fusion of 2 or more bones in a joint
synovectomy: removal of synovial lining in a joint
*treat with rest, compression, elevation
133
What is Gout?
inflammatory joint disorder resulting from deposition of uric acid crystals in joints
caused by increase of uric acid production & under excretion of uric acid by the kidneys.
Predispose patient to kidney disease
134
Stage 1 Gout
Hyperuricemia
Asymptomatic
Uric Acid present/elevated
135
Stage 2 gout
acute gouty arthritis
sudden: pain/swelling
can heal on own
uric acid high
136
Stage 3 gout
intercritical Gout
accumulation of uric acid continues.
inbetween attacks, no attacks occur
137
Stage 4 Gout
Chronic Tophaceous Gout
| Large deposits of uric acid with crystals into joints
138
What is the pathyphysiology of gout?
elevated uric acid levels - hyperuricemia (>7 mg/dL)
| urate crystal formation - urate crystals will settle in joints, can lead to kidney stones
139
Gout risk factors
Family hx
kidney disease
Diet - foods high in uric acid, organ meats, red meats, wine, seafood
Alcohol/Tabacco
Medicines - aspirins, diuretics, some chemo
DM, HTN, Artherosclerosis
140
Gout lab tests
Serum uric acid
24 hour urine - always remind pt to collect urine
synovial fluid - look for uric crystals
141
Gout imaging
Xray, Ultrasound - looks for what stage
142
Gout Pharmacotherapy
Colchicine: reduce swelling/inflammation
NSAID
Corticosteroids: reduce inflammation/stiffness
Allopurinol: brand name zyloprim. Inhibits uric acid production
Probenecid: promotes renal excretion
143
What does Colchicine do?
Reduces swelling, inflammation
144
What does allopurinol do?
inhibits uric acid production. brand name zyloprim
145
What does probenecid do?
promotes renal excretion
146
Gout Intervention
```
activity/rest - rest effected limb
dietary restrictions: avoid purine foods wild game, seafood, organ meat
increase fluid intake
head/cold therapy
joint protection
weight loss
```
147
What diet should someone with gout have?
fruits, vegetables, whole grains, low-fat dairy, legumes, nuts
AVOID shellfish, organ meats, alcohol, soft drinks
148
Gout surgical intervention
extracororeal shock wave lithotripsy: shock waves break up stone in ureter
149
Goals of pt care with gout
treatment of acute attacks: rest/meds
prevent future attacks: diet, weight loss, fluid
prevent complications: renal calculi, kidney disease
150
What is acute/chronic back pain?
acute is less than 4 weeks
| chronic is greater than 3 months
151
What regions carries most of body weight?
lumbar
152
Back Problems Risk Factors
```
Lumbar strain/sprain
Degenerative changes
Disc Herniation
Fractures
Congenital conditions (spinal stenosis)
occupational factors (healthcare, construction, factory
```
153
What is spinal stenosis?
narrowing of spinal canal
154
What is spondylolysis and spondylolisthesis?
spondylolysis: pars inticularis has a crack
sponylolisthesis: pars inticularis breaks off
155
Back Pain Pharmacotherapy
NSAID: inflammation/pain. Risk for GI bleed, if hx of ulcer do not give
opioid analgesics: norco, percocet, dilaudid, risk of constipation
muscle relaxants: tizanadine, flexaril, baclofen
steroids: last resort.
156
Back Pain Interventions
Activity/Rest: avoid prolonged
Heat/Cold
PT: start ASAP
pt. teaching: body mechanics, pre medicate, back brace
157
Laminectomy Post Op Care
```
Bleeding: check H&H
infection: check temp
Blood clots: ted hose, anticoagulation therapy
nerve injury risk
risk for spinal fluid leak
```
*log roll to maintain alignment*
158
Back pain goals of pt. Care
pain relief # 1 goal
back sparing practices
return to previous level of activity
avoid constipation
159
What is a fracture?
Disruption or break in the continuity of the structure of a bone
160
Simple/Closed fracture
Bone separated, not broken skin
161
Compound/Open Fracture
Break in skin, risk for osteomylitis
162
Transverse Fracture
Runs across bone at right angle
163
Spiral Fracture
oblique/circle
164
Comminuted Fracture
shattered into pieces
165
Impacted
buckle/compress fracture
166
Greenstick Fracture
incomplete/missing a bone
167
Oblique fracture
slant in bone
168
Clinical Manifestations of a fracture
pain, edema (Swelling), deformity (compare limbs), muscle spasm, contusion, decreased ROM, crepitation
169
Bone Union Types: Direct fx complication
Delayed Union: lengthy healing time
Non-Union: didn't heal, may need more surgery
Mal-Union: not properly aligned
170
Avascular Necrosis: direct fx complication
death of tissue due to lack of blood supply
171
Venous Thrombosis: indirect fx complication
blood clot in the vein with fracture due to bedrest
172
Fat Embolism- indirect fx complication
disruption of blood supply caused by fat globules in the blood vessel
173
Acute Respiratory Distress Syndrome
Watch for SOB, altered LOC, chest pain, tachycardia
Petechaie: pinpoint rash on chest due to inadequte oxygen
Monitor pt for 24-48 hours especially with femur
174
Care of pt with a fracture
careful immobiliztion
encourage breathing excercises
O2 therapy
175
Lab tests for fractures
CBC check H&H
| Coagulation studies
176
FX Pharmacology
NSAID, opioid analgesics, muscle relaxer, steroids
177
Fracture Management
reduction - immobiliztion - rehabilitation
178
What is an open reduction?
Surgical
O - open
R - reduction
I- internal
F- fixation
179
What is a closed reduction?
Non-surgical manual realignment of a bone. Traction and counter traction - sling/splint
180
What are the types of traction? What are some care guides?
Skin - applies pull indirectly to the bone
Skeletal: applies directly by way of pins/wire
```
Remember TRACTION
T: temperature
R: ropes hang free
A: alignment - pt. on center of bed
C: circulation - check cap refill, 5 p's
T: type and location of fracture
I: increase fluid intake
O: overhead trapeze - helps strengthen upper body
N: no weights on bed/floor
```
181
What are indications for internal fixation? External Fixation?
Internal: surgical application of implants for purpose of repairing bone - wires, pins, plates, nails, bone screws
External Fixation: Used to set bone in which a cast would not allow proper alignment. Pins, screws, rods, frames, rings
**Clean pins 2 x in 12 hour shift**
182
What is the nursing management of casts? What are the goals of patient care for cast?
1. perform neurovascular assessment
2. expose a newly applied cast to air circulation
3. Never permit wet cast to rest directly on flat or firm surface
4. Apply ice for first 24-36 hours
1. Manage Pain
2. healing occurs, proper alignment
3. prevent secondary complications
4. neurovascular status remains intact
5. restore function
183
What are risk factors for amputation?
DM *most common*, arthrosclerosis, traumatic event, violent incident, GSW, tissue/bone severed
184
What are the types of amputation?
Open (Guillotine): cut off whole and wrap
| Closed (flap): used skin to create a flap over. Heals faster
185
What are some complications of amputations?
Pain
falls
infection
contracturs - do not elevate leg for first 24 hours!
186
Benefits of Immediate Post Op Prosthesis
```
*temporary*
assist wound healing
minimize edema and pain
reduce phantom pain
physcological benefits
prevent knee flexion contracture
protect risdual limb
```
187
Amputation Teachings
ROM ASAP
Avoid sitting in chair for more than 1 hr with hips flexed (prevents DVT, contractures)
Avoid elevating extremity for long periods
Avoid dangling residual limb
Compression reapplied several times daily
Shrinker bandage should be washed and changed daily
188
What is included in EBP?
1. Best evidence from the most current research available
2. nurse clinical expertise
3. patient preferences and values
189
What is quantitative research?
use of precise measurement to collect data, analyze it statistically
190
What is qualitative research?
Investigate a question through narrative data exploring subjective experiences
191
What are background questions?
- generalized questions that seek more information about a topic
- fills in gaps of knowledge
- answered found in textbooks, medical dictionaries, drug handbooks
192
What are foreground questions?
narrower in focus, about a specific clinical issue
| answers can be found in studies conducted to elicit evidence
193
What is PICOT
- used to define and formulate a clinical question for EBP
- develops foreground questions
```
P: patient, population, or problem
I: intervention
C: comparison (don't always need)
O: desired Outcome
T: time (not always needed)
```
194
What are the steps of developing a PICOT statement?
step 1: develop/ask a clinical question
step 2: retrieve the evidence
step 3: evaluate the evidence
step 4: apply the evidence
195
What is reliability vs. validity?
Reliability is the extent to which an experiment, test, or measuring procedure yields the same result on repeated trials under identical conditions
validity is does it measure what it's supposed to measure?
196
What does the NPA do?
defines scope of practice, standards for education programs, liscensure requirements, grounds for disciplinary action.
regulates nursing practice
197
What does OBN do?
designated to apply laws to individuals
| oversee licensure
198
What are hypotonic, isotonic, hypertonic solutions?
- hypotonic: more particles inside to pull particules/fluid into cell. 0.45% NaCl. Used in DKA
- hypertonic: causes fluid to leave cell. D5 0.45% NaCl D5 0.9% NaCl
- isotonic: fluid stays within the intravascular space. 0.9% NaCl, D5W (isotonic in bag, hypo. in body), lactated ringers
199
How should you look for an IV insertion site?
start distally and work proximally
200
Common gauges used for IV fluid use
18: blood, resuscitation fluids
24: less traumitizing, shorter term use
20-22: most common
201
How to insert an IV
bevel UP, 15-30 degree angle
202
What should you do if you suspect fluid overload?
- slow IV rate
- raise head of bed
- may need O2
- call physician
