Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CCN > quiz > Flashcards

quiz Flashcards

1
Q

2 first steps in spinal cord injury
2 other steps

A

Immobilization and stabilization of the head (collar)

assessment of airway and breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

initial tx for injury above T4

A

intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

symptoms of spinal shock 2 and the tx

A

(hypotension, bradycardia)
1st: ), fluid resuscitation with crystalloid fluids and atropine
2nd: vasopressors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is autonomic dysreflexia
where
symptoms 5
assessment

A

complication of spinal cord injury

sudden onset of very high blood pressure caused by bladder or bowel distention

usually in t6 or above

headache, flushed face, sweating above the level of injury/cool, clammy skin below, bradycardia

assess for retention of urine (bladder scan and bladder program)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

2 complications of spinal cord injury

A

autonomic dysreflexia , immobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

monroe kellie hypothesis

A

Intracranial Volume (VIC) = volume of the brain + volume of blood + volume of CSF + volume of the lesion. – if one is off it throws others off

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

compliance

A

balancing act of keeping ICP 5-15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CPP formula, what does it determine, normal, what happens when MAP is decreased and ICP is increased

A

CPP DETERMINES BRAIN O2

MAP-ICP

60-65

decreased perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

3 things assessed in GCS- whats normal, mod, severe

A

eye opening, motor response, verbal response

13-15 = normal/mild injury,

9-12 = moderate injury,

8 or less, severe injury/coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how to assess ICP 5

A

GCS
positioning- decorticate, decerebrate
pupillary response
babinski (if toes expand =abnormal)
cranial nerve assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

pupillary response - dolls eye damage to

A

CN 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

hearing problems is what CN

A

CN VIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

tumor of CNVIII

A

acoustic neuroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

cough, gag reflex tests what CN

A

CN IX and X

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

dolls eye abormal finding

A

eyes dont move

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

cold caloric test normal finding

A

eyes go to ear with cold fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ABC waves on ICP monitor

A

A waves: PROBLEM (50-100) – lasts 5-20 minutes with a rapid onset

B waves: 20-50 ICP increase not an emergency – B waves usually before A waves (example is when they get suctioned after they already have high ICP)

C waves: NORMAL up to 20 – no problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

7 nursing responsibilities of ICP monitoring with device

A
  1. NEURO CHECKS HOURLY
  2. Monitor ICP, MAP, and CPP at least hourly.
  3. Monitor the effects of nursing care (repositioning, suctioning, etc.) on the patient’s ICP.
  4. Validate accuracy of waveforms and values.
  5. Maintain strict aseptic technique (infection is the primary complication of ICP monitoring).
  6. Ensure the dressing site is clean, occlusive, and dry.
  7. Assess the system for leaks of CSF.(yellow and clear)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

gliomas vs mengiomas

A

Gliomas – malignant
Meningiomas – benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

tumor prognosis depends on

A

how fast and big tumor grows - even benign tumors can be fatal depending on location and speed bc they increase ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

risk factors for brain tumors 3

A

inherited disease
enviornment
radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when does cerebral edema occur in brain tumors

A

1mm tumor size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are brain tumor symptoms related to

A

SIZE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

focal symptoms of brain tumors 8

A

ringing in the ears,
hearing problems/loss,
decreased muscle control,
lack of coordination,
decreased sensation,
weakness or paralysis,
difficulty with walking or speech double vision.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

main pharm tx of brain tumors

A

glucocorticoids to decrease tissue swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

initial tx for meningiomas tumors

A

surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

dexamathasone
indication
MOA
nursing resp 3
9 SE

A

indicated for patients with symptomatic cerebral edema from brain tumors

It produces a reduction of cerebral edema and symptoms within 8-48 hours of first dose and effects can last as long as 72 hours.

monitoring for side effects
adjusting dose to the min needed
taper off

insomnia, visual blurring, tremor, behavioral changes, increased appetite, weight gain, hyperglycemia, hypertension, and muscle weakness in the legs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

most common cause of TBI

A

blunt trauma with falls most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

when is CT indicated in TBI

A

for minor injuries (like concussions) they are not evidence-based. They are helpful in more severe injuries, older patients, and those on anticoagulants.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

if change in VS where is brain injust

A

brainstem - medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

linear skull fracture

A

nondisplaced fracture as a result of low-impact.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

depressed skull facture

A

depression of the bone at the point of impact, may be closed (not penetrating the dura) or open (penetrating the dura). These generally require surgery for repair of the skull and dura, and debridement of bone fragments.

33
Q

basilar skull fracture

A

at the base of the skull; patients may develop a dural tear and have CSF draining from the nose and ears. Eventually the patient may develop “raccoon eyes” (ecchymoses around the eyes) and Battle’s sign (ecchymoses behind the ears).

NO LAYING FLAT, COLD CALORIC TEST OR NG TUBE

34
Q

epidural bleed

A

: arterial, fast onset of s/s (usually unconscious with quick periods of wakefulness), surgery needed ASAP

35
Q

subdural bleed and acute subdural

A

more common in TBI (below dura), result from coup and countercoup injury, VENOUS leaking, slower and progressive onset, more time to treat (don’t always need surgery)

acute: collection of thick, jellylike blood within 24-48 hours after injury. Patients present with loss of consciousness, deteriorating GCS and often focal signs (hemiparesis, dysphagia). If untreated, ICP will increase. Emergent craniotomy is indicated for clot evacuation.

36
Q

subarachnoid bleed

A

arterial, not always associated with TBI(can be caused by aneurysm), FAST onset, “worst HA of my life” , need surgery ASAP

37
Q

intracranial bleed

A

not always TBI(may be a hemorrhagic stroke), venous with TBI, Slower onset, or hemorrhagic stroke is arterial and more immediate s/s – MAYBE surgery

38
Q

risk factors for severe TBI 6

A

patient age
GCS
pupil size and response
extracranial injury
CT scan findings
hypotension

39
Q

2 ABG goals for brain injury pt

A

CO2 35-40 (hyper/hypocarbia can inc ICP)
PO2 > 96 (hypoxia can inc ICP)

40
Q

nurse resp for suctioning patient to prevent inc ICP 4

A

preoxygenate to 100% before and after
sedate before
limit to 10 sec
observe PEEP bc it can dec BP

41
Q

MAP goal

A

70-90

42
Q

if MAP is <70, or SBP <90

A

fluid volume status should be assessed, and isotonic fluids are given to maintain balance

if Na levels low, use of hypertonic saline

NO VASOPRESSORS

43
Q

when is ICP tx initiated

A

when ICP is > 20

44
Q

4 meds to manage ICP

A

sedation and pain relief- benzos and propofol

pain management - morphine, NO FENTANYL

hypertonic saline

mannitol

45
Q

mannitol
MOA
nurse rep. 7

A

osmotic diuretic that decreases ICP while reducing cerebrovascular resistance and increasing cerebral blood flow.

USE A IN LINE FILTER, monitor for hypotension, urine output, fluid vol status, monitor serum osmolality (GOAL 300-320 NORMAL), monitor hyponatremia, hypokalemia

46
Q

hypertonic saline
MOA
nurse resp 5

A

Saline decreases ICP while increasing CPP by mobilization of H2O and reduction of cerebral H2O content. It also increases BP due to plasma expansion.

> 2% should be given through a central line(because its irritating to vein

monitor serum Na levels every 6 hours to maintain 145-155 mmol/L(bc if its normal at 135-145 then that’s not good because were giving Na) ,

assess fluid volume status (weight, CVP, I&O),

monitor serum osmolality every 12 hours,

GO SLOW

47
Q

nursing resp of cerebrospinal fluid drainage 5

A

leveling the transducer and stopcock with the tragus of the ear

monitoring amount and characteristics of drainage hourly(shouldn’t be cloudy, purulent, bloody),

temporarily turning off drainage to measure ICP hourly,

maintaining strict aseptic technique (use of a mask and sterile gloves) ,

changing drainage containers ONLYwhen needed to reduce system exposure to air to reduce infection.

48
Q

when is hyperventilation used

A

purposeful reduction in pCO2 in patients with increased ICP. – this is only done when they have risk for aneurysm - ONLY IN EMERGENCIES

49
Q

when is High-dose barbiturate therapy/barbiturate coma used

A

patients have elevated ICP resistant to other treatment or in patients with uncontrolled seizures. It works by reducing cerebral metabolic rate and reducing cerebral blood flow and BP.

50
Q

nurse resp of High-dose barbiturate therapy/barbiturate coma use 7

A

monitor hemodynamic stability,

monitor ICP (the patient must have a monitor in place because normal methods to assess neurological function are not possible),

monitor ECG, for hypoventilation and hypoxia,

utilize the ventilator bundle,

monitor the temperature and maintain it (hypothermia is common with barbiturate coma),

assess for bowel sounds (ileus is common bc things are slowed down),

protect the patient’s corneas.

51
Q

targeted hypothermia

A

Done with COOLING FAST AND WAMRING SLOW – cooling banket, ice packs (monitor electrolytes during this+BG) to get temp to 35
Warming: WARM SLOW to 36-37 using antipyretics

52
Q

decompressed craniotomy

A

used in patients resistant to all other measures to decrease ICP.

Removal of part of the skull bone

If used, it should be done when early signs of brain herniation are present (unilateral fixed or dilated pupil)

-NO POSITIONING ON SIDE OF OPENING
-monitor for infection
-monitor for hydrocephalus
- fluid collection
-CSF leaks
-seizures

53
Q

4 non pharm techniques to avoid inc ICP

A

HOB 30 degrees

DON’T CLUSTER CARE: turning the patient should be spaced from other activities

use of stool softeners or laxatives to avoid valsava maneuver

Keeping external stimulation to a minimum limits rise in ICP. Do not have rounds in the room with the patient because it can raise ICP

54
Q

nutriton for TBI patient

A

full caloric replacement no later than 9 days after injury and all patients should receive enteral nutrition within 72 hours.

Feedings should start slowly (25 mL/hour) with increases of 25 mL each 12 hours as tolerated until full caloric requirements are met.

*Nursing responsibilities include monitoring patient tolerance and glucose levels. (Glucose levels over 200 should be prevented, with insulin used as needed.)

55
Q

3 psychoscial support for TBI

A

Effective communication
Chaplain
Family involvement in routine care like hygiene

56
Q

coma stumulation

A

Only 1 person should speak at a time, and only 1 form of stimuli provided at a time AFTER THEY ARE RESTED and after 72 hours of stabilization

57
Q

phenytoin
moa
nurse resp
AE

A

blocking the repetitive action of the sodium channel, used to control and prevent seizures

careful administration through a patent IV,

administered only with normal saline,

administered slowly to prevent bradycardia, hypotension, heart block, and ventricular fibrillation.

The nurse must monitor the patient’s ECG and BP during administration and for at least an hour after.

AE: dyrhyth, stevens johnson

58
Q

status eliticus defintion

A

over 5 minutes of continuous seizure activity or seizures occurring in succession for 20-30 minutes without a return to consciousness.

59
Q

end of life definition

A

period of time during which an individual copes with declining health related to a terminal illness or frailties due to advanced age

60
Q

3 goals for end of life

A

Provide comfort and supportive care during the dying process

Improve the quality of remaining life

Help ensure a dignified death

61
Q

palliative care intention 3

A

focus on control of patients’ symptoms, relief of patients’ and families’ suffering, and enhancement of patients’ quality of life.

it is a continuum

does not speed up or slow down death

62
Q

5 triggers for palliative care consultation

A

Death expected in the next 12 months

Admission related to hard to control physical or psychological symptoms

Out of hospital cardiac arrest

ICU stay of greater than 7 days

Disagreement about medical, resuscitation, and non-oral feeding/hydration interventions.

63
Q

what is advanced directive

A

legally enforceable document outlining the patient’s preference for specific treatments to be provided or withheld and/or to designate an individual to make decisions for them (termed a healthcare proxy) if they are not able.

  • they can change their mind
64
Q

5 family needs at end of life

A

with patient

be helpful

assured of comfort

informed

comforted and allowed to express their emotions

65
Q

brain death defintiion and 3 criteria

A

irreversible loss of brain function, including function of the brainstem.
Three criteria are necessary to declare brain death:

Coma (no movement)

Absence of brainstem reflexes – pupils > 4 mm and not responsive to light

Apnea – remove from vent -> 100% oxygen via T-piece for 8 minutes and observed for respiratory movement. The patient must have normal BP and temperature

66
Q

bereavment vs grief

A

Bereavement – an individual’s emotional response

Grief – The lived experience in response to a loss.

67
Q

what is meningitis

A

the inflammation of the meninges and the underlying subarachnoid space that contains CSF

68
Q

what is meningitis tx

A

culture then abx before results
abx + seroid (dexamaethasone)

69
Q

CSF in meningitis

A

decreased glucose < 40, high protein (>50), high WBC (1,000-10,000) = cloudy

70
Q

meningitis symptoms

A

include neck stiffness,
fever,
change in mental status,
nuchal rigidity,
positive Kernig’s(To elicit the Kernig’s sign, patient is kept in supine position, hip and knee are flexed to a right angle, and then knee is slowly extended by the examiner.The appearance of resistance or pain during extension of the patient’s knees beyond 135 degreesconstitutes a positive Kernig’s sign)

Brudzinski’s signs(Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed),

seizures,
focal signs
papilledema.

71
Q

what is key to meningitis tx

A

prevention

72
Q

dexamaethasone MOA

A

interrupt the neurotoxic effects resulting from lysis of bacteria during the first days of antibiotic use.

73
Q

2 causes of seizures

A

brain tumors and TBI

74
Q

one time seizure tx

A

NOT anticonvulsive therapy

75
Q

5 nursing resp for seizures

A

Assessing for any warning signs a seizure might occur, including presence of aura.

Assessing for a trigger.

Noting what the patient did during the seizure – how the seizure started and progressed.

Noting how long the seizure lasted.

Maintaining patient safety.

76
Q

first line seizure tx med

A

valproic acid

77
Q

main sources of discomfort in comfort care

A
  1. pain (opioids)
  2. dyspnea (morphine/lorazepam based on RDOS scale >3 requires tx! )
  3. thirst (oral care)
78
Q

if agreement on end of life care cannot be reached, what should you do

A

ethics comittee

CCN (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions