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NCLEX > Shocks/Seizures/Strokes/TBI > Flashcards

Shocks/Seizures/Strokes/TBI Flashcards

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1
Q

Septic Shock

A

Distributive shock caused by widespread bacterial infection (Massive vasodilation, Loss of vessel tone)
= Persistent HYPOtension*** despite fluid resuscitation (massive vasodilation)
= High RR
= ARDs (SIRS casacade&raquo_space; MODS)

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2
Q

Bacterial meningitis

  • Sxs in adults / kids / neonates?
A

Inflammation of meninges caused by N.meningitis/Strep pneumoniae = increased ICP

DROPLET PRECAUTIONS
** SEIZURE**

ADULTS = Neck stiffness, (+) Brudzinski, (+) Kernig
KIDS = Rash, Neck stiffness
NEONATES = Poor feeding/suck, Bulging fontanelles

Dx via Lumbar puncture for CSF (Cloudy, high pressure @ puncture)
= Low serum glucose
= High WBC + serum protein

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3
Q

Anaphylaxis

A

Distributive shock response to allergen (Massive vasodilation, Loss of vessel tone)
= HYPOtension
= N/V
= Flushed, warm, dry
= Pruritus + Edema (wheezing)**

1st LINE tx: Adrenergics (epinephrine IM; q5min x3 dose)

  1. Antihistamines
  2. Leukotriene antagonists
  3. Glucocorticoids (stabilizes mast cells)
    * *can mask infection**
  4. Xolair (decreases IgE)
  5. Immunotherapy
  6. Support ABCs (ex. Ventolin nebulizers for bronchodilation)
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4
Q

Distributive Shock

A

MASSIVE peripheral vasodilation, loss of muscle tone (Anaphylaxis, Septic)

= High HR (but low in neurogenic shock)
= High JVP
= Warm peripheries

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5
Q

What is Neurogenic shock?

A

Caused by traumatic SCI or any Nerve injury
= Hypotension (Distributive Sxs - Massive vasodilation)
= Bradycardia**
= Hypothermia (initially warm/flushed, but then cold/clammy)

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6
Q

Hypovolemic Shock

A

Reduced blood volume (hemorrhage, dehydration)

= Low CO / BP / JVP
= Tachycardic
= Change in MS, Cold peripheries

Tx: increase BV in ECF
1. Colloid IV
2. Crystalloid IV
3. Whole blood; PRBCs

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7
Q

Cardiogenic Shock

What is the tx focus?

A

Unable to pump effectively (MI, trauma)
adequate blood volume
= Low CO / BP
= High JVP + Tachypnea
= Cold peripheries

Tx focus is to OPTIMIZE CO via:

= DECREASE WORKLOAD/BV via Diuretics
= VASODILATE via Direct Acting Vasodilators + Nitroglycerine
= BETTER CONTRACTILITY via P-inhibitors + Catecholamines

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8
Q

What is an intra-aortic balloon pump used for?

A

CARDIOGENIC SHOCK = increases CO and blood flow
(Inflates during diastole; deflates @systole)

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9
Q

What are obstructive shocks?

Tx?

A

When there is mechanical obstruction to blood flow through central circulation.
(cardiac tamponade, tension pneumothorax, PE)
= low CO, BP
= High RR?

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10
Q

Ischemic Stroke

A

No BF to brain caused by thrombus (Atherosclerosis) or Embolus (CAD/Angina - dislodges in brain)

Warning sign via “TIA”
= Undetected
= Lasts minutes to hours
= Resolves in 24 hrs w/ full functional recovery

Sxs = “BE FAST”
Pronator drift

Dx = CT scan w/o contrast to rule out hemorrhage (contraind.) and be able to tx with Thrombolytics

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11
Q

What is a special consideration for non-TPA pts undergoing Ischemic stroke?

What should the nurse do?

A

Permissive HTN b/c it can hyperperfuse the brain

Monitor BP
= Titrate CBB to correct extreme HTN > 220/120
= maintain SBP > 170 mmHg to persevere brain fx

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12
Q

Thrombolytic therapy
- Contraindications?

A

For Ischemic stroke
= Must be initiated < 4 hrs of Sx onset!!!

DO NOT GIVE TO Pts with:
- Hemorrhage/Active bleed
- Low platelets or HIGH INR/PT
- Uncontrollable HTN (> 185/110)
- Recent brain/spinal surgery

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13
Q

Concussion

A

A mild blow to the head = dizziness, headache, amnesia

= resolves fast

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14
Q

Contusion

A

Bruising to the brain tissue
= Focal Sxs

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15
Q

Diffuse Axonal Injury (DAI)

A

TBI via MVA = shearing of white matter
= Diffuse brain swelling (cerebral edema)
= COMA

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16
Q

Skull Fractures

A

Linear (along sutures), Depressed, Comminuted (fragments)

Battle sign + Raccoon eyes

If FRONTAL FRACTURE = check for CSF LEAKAGE***

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17
Q

Hematomas
- Types x 3

A

Closed TBI with blood buildup beneath skull

**Will increase ICP = monitor for altered LOC + Headache + N/V)

EPIDURAL = between skull + dura mater (arterial bleed)
SUBDURAL = dura + arachnoid (venous bleed)
INTRA-CEREBRAL = within tissues

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18
Q

Nursing interventions for TBI

A
  1. Stabilize neck + cervical spine
  2. GCS scoring (If < 8 = intubate)
  3. Monitor for ICP (headache, N/V, altered LOC)
  4. Maintain normothermia (temp)
  5. Check for CSF leakage!!
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19
Q

Cerebral Edema

A

Excess fluid in brain due to increased CSF production/blocked drainage/impaired resorption

= Cushing’s Triad (HTN - wide PP, Bradycardia, Bradypnea)
= Increased ICP (Decorticate/Decerebrate + Hyperthermia)
= Fixed pupil dilation (uni/bilateral)&raquo_space; BRAIN STEM HERNIATION

20
Q

Brain stem herniation (signs?)

A

Bilateral fixed pupil dilation!!!
EMERGENCY
Can be caused by cerebral edema

21
Q

Epilepsy

A

Chronic recurrent seizures that last <5 min each

22
Q

Status Epilepticus

A

EMERGENCY

Recurrent seizures that LASTS > 5 MIN + CONTINUOUS/NO RECOVERY PERIOD

23
Q

Tonic-Clonic seizure (Grand mal)

A

Generalized seizure (both hemi)

“Pre-seizure aura” = blurred vision, tinnitus, nausea
= Sudden contraction + jerking mvts in limbs
= Muscle rigidity, Incontinence
= LOC + Postictal

24
Q

Absence Seizure (petit mal)

A

Generalized seizure (both hemi) - usually CHILDREN

= Brief staring episodes
= Automatisms (lip smack, finger rolling)
= NO Postictal

25
Q

Myoclonic Seizure

A

Generalized seizure (both hemi)

= Jerking movements in limbs
= No LOC or Postictal

26
Q

Atonic/Akinetic Seizure

A

Generalized seizure (both hemi)
DROP ATTACK = sudden loss of all muscle control

27
Q

Simple Partial Seizure

A

Focal/Partial seizure (one hemi)

= Awareness during seizure
= No postical
= Involuntary motor (head turn)
= Sensory disturbance (smell/taste)

28
Q

Complex Partial Seizure

A

Focal/Partial seizure (one hemi)

= Altered LOC
= Automatisms
= Postictal phase

29
Q

What is the Postictal phase in seizures?

A

Drowsiness, slowed speech, confusion

30
Q

Febrile Seizure

A

Seizures only caused by high fever in children ages 6 m to age 5 (temp > 38)

*Benign = no chronic damage

SIMPLE
= once in 24 hrs, lasts < 10 min
= Brief postictal phase

COMPLEX
= Multiple times in 24 hrs, lasts >10 min

= just give ANTIPYRETICS (no Ibuprofen for kids < 6 m.)
NO TEPID SPONGING (cold water baths)!!

31
Q

Signs of high ICP?

A

Altered LOC, Vomit, Headache

32
Q

Hydrocephalus
- Kids vs Infants?
- Tx?

A

Increased ICP in brain = N/V, Altered LOC, Headache

Kids
= Cushing’s triad (HTN, Bradycardia, Bradypnea)

Infants
= High-pitched shrill cry
= Poor feeding
= Bulging anterior fontanelle + wide suture gap (rapid increase in head circumference)
= Sunset eyes

Kids
= Cushing’s triad (HTN, Bradycardia, Bradypnea)

Tx = VP shunts (into pericardium) - lay flat for first 24 hrs, then side

33
Q

Dantrolene & Baclofen

A

Muscle relaxant - MS, Cerebral Palsy, Stroke, SCI (Spasticity)

Dantrolene
= for Neuroleptic malignant syndrome
= s/e of Hepatotoxicity

34
Q

Ethosuximide

A

Succinimides (Anticonvulsants) - block Ca from entering thalamus/decreases NM excitability
= Absence seizures
= Do not d/c rapidly or else causes seizure

35
Q

Phenytoin, Fosphenytoin, Carbamazepine*, Valproic acid

A

Hydantoins (Anticonvulsant) - blocks Na channels to induce calming effect on neurons
PhenyTOIN & Fosphenytoin (prodrug)
= TERATOGENICITY, lowers effectiveness of oral contraceptives
= Lethargy, Ataxia, Nystagmus/Diplopia, Purple Glove Syndrome
= Need to monitor blood work
= Need for folic acid supplements

(Phenytoin-like)
- Valproic acid
- Carbamazepine (also for trigeminal neuralgia; Risk of Hyperpyrexia, HTN)

36
Q

Thiamine IV

A

For chronic ETOH abuse (Wernicke’s Encephalopathy)

37
Q

Autonomic dysreflexia

A

SCI T6 and above (noxious “pain” stimuli from either distended bladder / fecal impaction / constrictive clothing)

= Severe HTN
= Bradycardia
= Throbbing headache (vasodilation)
= Nausea (vasodilation)
= Diaphoretic (vasodilation)

38
Q

What to monitor for post-Craniotomy pts?

A

= Turn onto non-operated side.
= Polyuria (damage to hypothalamus/pituitary gland)
= Assess site drainage/dressing for HALO SIGN
**Pain = give SA opioids so it doesn’t get confused with complications coming from the craniotomy

39
Q

Autonomic CVS instability

A

Gullain Barre Syndrome
= Reflexive tachycardia + Orthostatic hypotension + Dysrhythmia

40
Q

Anticonvulsants
- Indications
- Nurse actions?

A

For seizures
Monitor for:
= Toxicity (Nausea/Ataxia/Lethargy/Nystagmus)
= Do not change dose rapidly!

41
Q

Phenobarbital
- Antidote?

Lorzepam, Diazepam*, Clonazepam

A

“-BARBITAL” = Barbituates (Anticonvulsants) - enhances GABA effects
For status epilepticus

High risk of toxicity when taken w/ Phenytoins, CNS depressants (lorazepam)
= Activated Charcoal or NaHOC3

“-PAM” = Benzodiazepines (Anticonvulsants) - same MOA
OD tx = Flumazenil

Diazepam can also be for muscle spasms (muscle relaxant)

42
Q

Succinylcholine

A

Rapid + brief muscle relaxant given during SURGERY or INTUBATION
= Must have ventilation support
= Give sedative beforehand

43
Q

Benzotropine

A

Anticholinergic - Parkinson Disease’s EXTRAPYRAMIDAL DISORDERS
Take with food!!

44
Q

Carbidopa/Levodopa

A

Dopamine Agonists - Parkinson Disease
= Orthostatic hypotension, Harmless urine discoloration

TOXICITY = Spasmodic winking, Muscle twitch

45
Q

SumaTRIPTAN

A

“-triptan” (Serotonin Agonist; Migraine)

Contraind. in pts with Uncontrolled HTN + CAD because it constricts cranial BVs

46
Q
A

NCLEX (19 decks)

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