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MedSurg 2 > PowerPoints > Flashcards

PowerPoints Flashcards

1
Q

Droplet Precautions

A
  • Mask
  • Eyewear
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2
Q

Contact Precautions

A
  • Gown
  • Gloves
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3
Q

Airborne Precautions

A
  • N95
  • Neg pressure room
  • Keep door closed
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4
Q

Penicillins & Cephalosporins

A
  • Cross sensitivity to cefs
  • Not for renal disease, asthma, bleed d/o
  • Bumps OCs
  • Take with food
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5
Q

Fluoroquinolones

A
  • -floxacin
  • Tendon rupture
  • Photosensitive
  • Empty stomach w/H2O
  • No kids
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6
Q

Tetracyclines

A
  • Stains teeth
  • No pregnant women
  • Esophagitis = upright after taking
  • No dairy
  • -cycline
  • Empty stomach
  • Sunblock
  • No calcium
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7
Q

Aminoglycosides

A
  • Nephrotoxic
  • Ototoxic
  • Neurotoxic
  • -mycin
  • Decreases ammonia levels
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8
Q

MRDOs

Multidrug resistant organisms

A
  • MRSA
  • VRE
  • CRE
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9
Q

MRSA

A
  • Spread by wounds, trach, IV, foleys
  • Tx with vanc, linezolid, ceftaroline
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10
Q

Septic Shock

Septic HOTN despite resuscitation efforts

Resembles late hypovolemic shock

A
  • Requires vasopressor to keep MAP 65+
  • Lactate 2+ despite fluids
  • MODS evident
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11
Q

SIRS

A
  • Widespread vasodilation
  • Blood pooling
  • Earliest stage of sepsis
  • Mild HOTN
  • Oliguria
  • High RR
  • Temp varies
  • WBC high
  • ALOC
  • Low O2

Severe sepsis is defined as SIRS + Sungle/multiple organ fail + confirmed infection source

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12
Q

MODS

A

Cardiogenic shock from microthrombi

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13
Q

SCI

Cervical most common

Nontraumatic causes

A
  • 40+ yrs old
  • Arthritis
  • Cancer
  • Inflammation
  • Infection
  • Spinal degeneration of discs
  • Spinal tumors
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14
Q

Cervical SCI

A
  • C4 = Neck down
  • C6 = shoulders down

Tetraplegia

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15
Q

Thoracic SCI

A
  • T6 = paraplegic from below nipples down
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16
Q

Lumbar SCI

A
  • L1 = paraplegia from groin down
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17
Q

Complete SCI

A

No motor or sensory function below injury

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18
Q

Incomplete SCI

A

Some function below injury

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19
Q

SCI emergent stabilization

A
  • LOC monitor
  • Stabilize spine
  • Log roll
  • C collar
  • Complete neuro exam
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20
Q

Halo Traction Care & Complications

A
  • Pin site infection
  • Pin loosening
  • Dysphagia from Dural tear or extension
  • Reposition q2h
  • PRN & per shift pin care
  • Cotton applicator to clean crust
  • NO ointment or peroxide
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21
Q

Spinal shock primary injury

A
  • Cord swelling
  • HOTN
  • Excitotoxicity
  • Free radicals enter BBB
  • Apoptosis
  • Neurogenic bladder
  • Paralytic ileus
  • Flaccid paralysis
  • Autonomic dysreflexia monitoring
  • Bradycardia
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22
Q

Spinal shock management

A
  • IVF
  • O2
  • Dopamine
  • Atropine
  • Steroids
  • Heparin
  • ROM
  • SCDs
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23
Q

Neurogenic shock has

A

bradycardia

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24
Q

Spinal shock

A
  • Total immediate loss of power below injury
  • HOTN
  • Bradycardia
  • No bulbocavernous reflex
  • Flaccid paralysis
  • 2-3 days post SCI
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25
Q

Neurogenic shock

A
  • SNS signals lost
  • HOTN
  • Bradycardia
  • Variable bulbocavernous reflex
  • 2-3 days post SCI
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26
Q

Autonomic Dysreflexia

A
  • T6 or higher
  • Tight clothing
  • Full bladder
  • UTI
  • Fecal impaction
  • Pressure ulcers
  • Below injury: Pale, cool
  • Above injury: HTN, flush, HA, JVD, bradycardia, sweaty
  • Place upright first
  • Fix cause
  • Give nitro, hydralazine
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27
Q

T12 and above can impact

A

resp status

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28
Q

Injury above C4

A

diaphragm paralysis = ventilate

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29
Q

Bethanechol

A

Treats urine retention in SCI pt

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30
Q

SCI diet

A

High protein, carb, calorie

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31
Q

Frequently used meds in SCI

A
  • PPI
  • Steroids
  • Vasopressors
  • Atropine (blocks PNS)
  • H2
  • Baclofen for spasms
  • Gabapentin
  • Hep/war
  • Stool softeners
  • Anxiolytics
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32
Q

Frontal lobe injury

A
  • Personality
  • Judgment
  • Intellect
  • Language
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33
Q

Temporal lobe injury

A
  • Hearing
  • Taste
  • Memory
  • Speech
34
Q

Parietal lobe injury

A
  • Sensory
35
Q

Occipital lobe injury

A
  • Vision
36
Q

Cerebellum injury

A
  • Balance
  • Motor coordination
37
Q

Mild TBI sx

A
  • Memory
  • Communicating
  • Learning
  • Concentration
  • Problem solving

problems with

38
Q

Moderate concussion

A

Unconscious 6- hours
Amnesia post-trauma

Severe is unconscious 6+ hr

39
Q

Brain contusion

A
  • Coup/contrecoup injury
  • Frontal & occipital affected
  • Unconscious 30+ min
  • Stupor & confusion

Report
* LOC change
* Severe HA
* Vomiting

Arouse & assess frequently!

40
Q

Brocas aphasia

A

1.

41
Q

GCS

A

15 best
3 worst
8 or less = coma

42
Q

Basal skull fractures

A
  • Through temporal bone
  • Raccoon eyes
  • Battle sign behind ear
  • Hemotympanum
  • Halo sign from ear
43
Q

Epidural hematoma

A
  • Between skull & dura
  • Emergency
  • Surgery & resp support required
44
Q

Subdural hematoma

A
  • Between dura & brain
  • Acute or chronic
45
Q

Subarachnoid hematoma

A
  • Worst HA of my life
  • Emergency
  • Below arachnoid
46
Q

Intracerebral hematoma

A

Bleed in brain
Supportive care

47
Q

Hematoma causes

A
  • HTN
  • Head trauma
  • Aneurysm
  • AV malformation
  • Meds
  • Bleed d/o
  • Liver disease
  • Alcoholism
48
Q

epidural hematoma is always

A

surgical

49
Q

Nimodipine is given for

A

hematoma

50
Q

Mannitol can also be given for

A

hematoma

51
Q

Sudden behavior change in client is a sign of

A

worsening ICP

report immediately

52
Q
A
53
Q

Normal ICP range

A

0-15

54
Q

Cerebral blood flow

A

50-60 mmHg

55
Q

ICP above 20 causes

A

brain ischemia

56
Q
  • Bilateral
  • Pinpoint
  • <1 mm
  • Nonreactive
A

Pons lesion post-hemorrhage

57
Q
  • Bilateral
  • Nonreactive
  • Fixed
  • 2 mm
A

Midbrain from edema, hemorrhage, infarction, laceration, contusions

58
Q
  • Bilateral
  • 4 mm
  • Fixed
  • Nonreactive
A

Severe midbrain damage
Cardiopulmonary arrest
Hypoxia
Anticholinergic OD

59
Q
  • Unilateral
  • 4 mm
  • Fixed
  • Nonreactive
A

Uncal herniation
Oculomotor nerve damage
Brain stem compression
High ICP
Tentorial herniation
Hematoma from head trauma
May be normal in some!

60
Q

High ICP manifestations

A
  • Papilledema
  • Blurry vision
  • HA
  • Diplopia
  • Pupil changes
  • Dolls eye
  • Projectile vomiting
  • Decorticate & decerebrate
61
Q

High ICP Complications

A
  • Pressure ulcers
  • Pneumonia
  • DVT
  • Contracture
  • Meningitis
  • SIADH
  • DI
62
Q

SIADH

A
  • H2O retained
  • Low sodium
  • Oliguria
  • Tremor
  • Irritable
  • HA
  • Fatigue
  • Fluid restriction to 800 mL/day
  • 3% NaCl if Na <118
63
Q

DI

A
  • Low ADH
  • Excess urination
  • Hypernatremia

Desmopressin to tx it

64
Q

DI & SIADH present with

A

extreme thirst

65
Q

Hydrocephalus

A
  • HA
  • Blurry vision
  • Incontinence
  • Catheterize
  • Stool softeners
  • HOB 30
66
Q

GCS 8 or less

A

Intubate & ventilate

67
Q

Cushing triad for ICP

Late sign

A
  1. Wide pulse pressure
  2. Bradycardia
  3. Irregular respirations

Herniation of brainstem or hypothalamus

68
Q

Brain tissue herniates at

A

ICP of 25

69
Q

Early signs of brain herniation

A

Ipsilateral papillary abnormality

70
Q

Later S&S of brain herniation

A
  • Contralateral hemiparesis
  • ALOC
  • Coma
  • Altered RR
  • Pathological positioning
  • Dilated & fixed (very late)
71
Q

Cerebral edema management

A
  • Hyperosmotics
  • HOTN monitoring
  • Arterial BP & CVP monitor
  • Ventilate
  • CPP 70+
  • Mannitol via filtered tubing
  • Foley is a must
  • Serum osmolality 310-320
  • Furosemide
  • Steroids to dec cerebral edema
  • Nimodipine to control MAP
  • Barbiturate coma to reduce brain activity (pentobarbital)
  • Phenytoin for seizure pvx
  • Pantoprazole
  • Morphine, fentanyl

Potential ARDS

72
Q
A
73
Q

Cerebral edema injury prevention

A
  • Adequate lighting to reduce visual hallucinations
  • Wake cycles
  • Skin care
  • Mittens
  • No restraints
  • Padded side rails
  • Side lying (seizure prec)
74
Q

Persistent vegitative state

A
  • Coma
  • Awake w/no cognitive awareness
  • Normal vitals
  • No communication
75
Q

Brain death

A
  1. Coma
  2. Absent brain stem reflexes
  3. Apnea
  4. 2 doctors declare dead
76
Q

Parkinsons 4 cardinal S&S

A
  1. Tremor
  2. Rigid muscles
  3. Bradykinesia
  4. Postural instability
77
Q

Parkinsons RF

A
  • 40+
  • Chemical & metal exposure
  • Genetics
  • Male
78
Q

Parkinsons cues

A
  • Tremor
  • Masklike face
  • Labile
  • Speech change
  • Fatigue
  • Bladder/bowel change

Hypomimia (masklike face)

79
Q

Levodopa

A

Parkinsons
Coverts to dopamine

80
Q

Pallidotomy

A

destroys globus pallidus in brain

responsible for parkinsons sx

81
Q

thalamotomy

A

removes part of thalamus to alleviate movement d/o

MedSurg 2 (13 decks)

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