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NS 406 Exam 1!! > Someone else's review 2 > Flashcards

Someone else's review 2 Flashcards

1
Q

Expressive aphasiaǐ

A

inability to produce language that is intelligible

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2
Q

Women can get what as a unique symptom of a stroke?

A

hiccups

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3
Q

Time of symptom onset is very important in stroke treatment, especially which kind?

A

ischemic stroke

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4
Q

Receptive aphasia

A

loss of comprehension

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5
Q

Global aphasia

A

total inability to communicate

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6
Q

Dysphasia

A

impaired ability to communicate

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7
Q

Wernicke’s aphasia

A

fluent

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8
Q

Broca’s aphasia

A

non-fluent

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9
Q

Treatment for an ischemic stroke

A

tissue plasminogen activate (tPA) IV or intraarterial, endovascular therapy

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10
Q

Treatment for hemorrhagic stroke

A

surgical decompression if indicated (hole to decrease ICP) , clipping or coiling of aneurysm

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11
Q

Diagnostic test for stroke

A

CT scan (noncontrast)

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12
Q

How many hours after stroke onset to admin tPA?

A

6 hours

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13
Q

Cerebral Perfusion Pressure equation

A

MAP-ICP=CPP

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14
Q

Want to keep the brain alive, maintain a CPP of?

A

at minimum 60

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15
Q

CPP is the pressure needed to ensure blood flow to?

A

brain

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16
Q

Increased ICP will reduce?

A

CPP

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17
Q

Coumadin

A

Changes clotting time does NOT prevent clotting

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18
Q

Tylenol antidote

A

acetylcysteine

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19
Q

Dilaudid antidote

A

Narcan

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20
Q

Versed/midazolam antidote

A

flumazenil (romazicon)

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21
Q

Heparin antidote

A

protamine sulfate

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22
Q

Coumadin antidote

A

vitamin K

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23
Q

tPA antidote

A

FFP

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24
Q

PT/INR

A

coumadin

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25
Q

PTT

A

heparin

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26
Q

Cerebral edema, dilation of pupil on ______ as mass lesion, sluggish or no response to light, inability to move eye upward or downward, ptosis of eyelid

A

ipsilateral

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27
Q

Cerebral edema, hemiparesis or hemiplegia may develop on ________ side of mass lesion

A

contralateral

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28
Q

Cushing’s Triad for increased ICP

A

increased BP, decrease pulse, decreased respirations

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29
Q

Vasogenic Cerebral Edema

A

most common type, occurs in white matter and is characterized by leakage of large molecules from the capillaries into the surrounding extracellular space. Insults causing osmotic shift include brain tumors, abscesses, and ingested toxins that may cause an increase in the permeability of the blood-brain barrier

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30
Q

Cytotoxic Cerebral Edema

A

Results from the disruption of the integrity of the cell membranes. It develops from destructive lesions or trauma to brain tissue, resulting in cerebral hypoxia or anoxia and syndrome of inappropriate antidiuretic hormone (SIADH).

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31
Q

Change in LOC

A

most sensitive and reliable indicator of patient’s neurological status

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32
Q

When patient has GCS of 8 or less and abnormal CT scan or MRI

A

may have bleeding, contusion edema, other issue

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33
Q

Normal ICP

A

5 to 15 mmHg

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34
Q

ICP measurements of more than ____ are usually treated

A

20 mmHg

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35
Q

When measuring ICP and a drainage device is in place, the drain must be closed for at least ___ minutes to ensure accurate reading

A

6 minutes

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36
Q

What is periorbital ecchymosis?

A

raccoon eyes, can occur with orbital fracture

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37
Q

What is an oval-shaped bruise behind ear in mastoid region?

A

Battle’s sign, can occur with temporal fracture

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38
Q

What type of fracture involves CSF or brain otorrhea, bulging tympanic membrane caused by blood or CSF, Battle’s sign, tinnitus or hearing difficulty, rhinorrhea, facial paralysis, conjugate deviation of gaze, vertigo?

A

basilar skull fracture

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39
Q

What is a sudden transient mechanical head injury with disruption of neural activity and a change in LOC, considered to be a minor diffuse head injury?

A

concussion

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40
Q

What is bruising of the brain tissue within a focal area?

A

contusion

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41
Q

Classic signs of an ______ hematoma include an initial loss of consciousness at the scene with a brief lucid period followed by decreasing LOC, other signs include headaches, nausea, vomiting

A

epidural

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42
Q

Epidural hematoma

A

rapidly expanding with arterial blood

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43
Q

Subdural hematoma

A

slowly expanding with venous blood

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44
Q

CT scan is best diagnostic test to evaluate

A

head trauma

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45
Q

Impending herniation

A

Cushing’s triad (systolic hypertension with widening pulse pressure bradycardia with full and bounding pulse, irregular respirations)

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46
Q

Any cord injury above __ leads to dysfunction of the sympathetic nervous system which may result in bradycardia, peripheral vasodilation and hypotension (neurogenic shock)

A

T6

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47
Q

Neurogenic shock s/s

A

warm and dry skin, does not perspire on the paralyzed parts of the body d/t blocked sympathetic activity, hypotension, bradycardia, hypothermia

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48
Q

Neurogenic bladder may involve

A

a. no reflux detrusor contractions (flaccid, hypotonic), b. have hyperactive reflex detrusor contractions (spastic), c. lack of coordination between detrusor contraction and urethral relaxation (dyssynergia)

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49
Q

GI system manifestations of SCI

A

delayed gastric emptying, stress ulcers, dysphagia, hypotension

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50
Q

Integumentary system manifestations of SCI

A

pressure ulcers

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51
Q

Thermoregulation with SCI

A

lose ability to sweat or shiver below level of injury

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52
Q

Metabolic needs in SCI

A

metabolic alkalosis d/t NG suction, increased nutritional needs

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53
Q

Autonomic hyperreflexia s/s

A

flushed face and upper chest (above the level of injury) and pale extremities, sweating above level of injury, sudden onset of acute headache, elevation in BP and/or reduction in pulse rate, nasal congestion, feeling of apprehension

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54
Q

Immediate interventions for autonomic hyperreflexia

A

raise the person to a sitting position, remove the noxious stimulus (fecal impaction, kinked urinary catheter, tight clothing), call the HCP if above actions do not relieve the s/s

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55
Q

Bell’s palsy s/s

A

inability to wrinkle brow, drooping eyelid, inability to close eye, inability to puff cheeks (no muscle tone), drooping mouth (inability to smile or pucker)

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56
Q

Ischemic Stroke- Incidence

A

Accounts for 87% of strokes

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57
Q

Thrombotic Stroke- Incidence

A

Men more than women, oldest median age

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58
Q

Thrombotic Stroke- Warning

A

TIA (30 to 50% of cases)

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59
Q

Thrombotic Stroke- Onset

A

Often during or after sleep

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60
Q

Thrombotic Stroke- Prognosis

A

Stepwise progression, s/s develop slowly, usually some improvement, recurrence in 20-25% of survivors

61
Q

Embolic Stroke- Incidence

A

Men more than women

62
Q

Embolic Stroke- Warning

A

TIA (uncommon)

63
Q

Embolic Stroke- Onset

A

Sudden onset, most likely to occur during activity

64
Q

Embolic Stroke- Prognosis

A

Single event, s/s develop quickly, usually some improvement, recurrence common w/out aggressive treatment of underlying disease

65
Q

Hemorrhagic Stroke- Incidence

A

Accounts for 13% of strokes

66
Q

Intracerebral Stroke- Incidence

A

Slightly higher in women

67
Q

Intracerebral Stroke- Warning

A

Headache (25% of cases)

68
Q

Intracerebral Stroke- Onset

A

Activity (often)

69
Q

Intracerebral Stroke- Prognosis

A

Progression over 24-hour, poor prognosis, fatality more likely with presence of coma

70
Q

Subarachnoid Stroke- Gender/Age

A

Slightly higher in women, youngest median age

71
Q

Subarachnoid Stroke- Warning

A

Headache (common)

72
Q

Subarachnoid Stroke- Onset

A

Activity (often), sudden onset, most commonly related to head trauma

73
Q

Subarachnoid Stroke- Prognosis

A

Usually single sudden event, fatality more likely with presence of coma

74
Q

Two types of Ischemic Strokes

A

Thrombotic and embolic

75
Q

Two types of Hemorrhagic Strokes

A

Intracerebral and subarachnoid

76
Q

Anterior cerebral, manifestations

A

Motor and/or sensory deficit (contralateral), sucking or rooting reflex, rigidity, gait problems, loss of proprioception and fine touch

77
Q

Middle cerebral, manifestations

A

Dominant side- aphasia, motor and sensory deficit, hemianopsia

78
Q

Middle cerebral, manifestations

A

Nondominant side- neglect, motor and sensory deficit, hemianopsia

79
Q

Posterior cerebral

A

Hemianopsia, visual hallucinations, spontaneous pain, motor deficit

80
Q

Vertebral

A

CN deficits, diplopia, dizziness, N/V, dysarthria, dysphagia, and/or coma

81
Q

Broca’s

A

Type of nonfluent aphasia

82
Q

Broca’s

A

Damage to frontal lobe of brain

83
Q

Broca’s

A

Frequently speak in phrases that make sense but are produced with great effort

84
Q

Broca’s

A

Often omit small words such as “and, is, the”

85
Q

Broca’s

A

May say “walk dog,” meaning “I will take the dog for a walk,” or “book book two table,” for “There are two books on the table.”

86
Q

Broca’s

A

Typically understand speech of others fairly well

87
Q

Broca’s

A

Often aware of their difficulties and can become easily frustrated

88
Q

Wernicke’s

A

Type of fluent speech

89
Q

Wernicke’s

A

Damage occurs in the left temporal lobe, although it can result from damage to the right lobe

90
Q

Wernicke’s

A

May speak in long sentences that have no meaning, add unnecessary words, and even create made-up words

91
Q

Wernicke’s

A

May say, “You know that smoodle pinkered and that I want to get him round and take care of him like you want before.”

92
Q

Wernicke’s

A

Often difficult to follow what person is trying to say

93
Q

Wernicke’s

A

Usually have great difficulty understanding speech

94
Q

Wernicke’s

A

Often unaware of their mistakes

95
Q

Global

A

Type of nonfluent aphasia

96
Q

Global

A

Results from brain damage to extensive portions of language areas of the brain

97
Q

Global

A

Have severe communication difficulties

98
Q

Global

A

May be extremely limited in ability to speak or comprehend language

99
Q

Diagnosis of a stroke (extent and involvement)

A

CT scan, CT angiography (CTA), MRI, magnetic resonance angiography (MRA), CT/MRI perfusion and diffusion imaging

100
Q

Diagnosis of a stroke, cerebral blood flow

A

Cerebral angiography, carotid angiography, digital subtraction angiography, transcranial Doppler ultrasound, carotid duplex scanning

101
Q

Diagnosis of a stroke, cardiac assessment

A

Electrocardiogram, chest x-ray, cardiac markers (troponin, creatine kinase-MB), echocardiography (transthoracic, transesophageal)

102
Q

Diagnosis of a stroke, additional studies

A

CBC, glucose, PT aPTT, electrolytes, renal and hepatic studies, lipid profile, CSF analysis

103
Q

Stroke Assessment, past health history

A

HTN, previous stroke, TIA, aneurysm, cardiac disease, dysrhythmias, heart failure, valvular heart disease, infective endocarditis, hyperlipidemia, polycythemia, diabetes, gout, previous head injury, family history of HTN, diabetes, stroke, CAD

104
Q

Stroke Assessment, family history

A

Neurologic disorders, aneurysms, stroke, TIAs

105
Q

Stroke Assessment, medications

A

Oral contraceptives, use and compliance with antihypertensive and anticoagulant therapy, illegal substances and drug use (cocaine)

106
Q

Stroke Assessment, functional health patterns

A

Positive family history of stroke, alcohol abuse, smoking, drug abuse, anorexia/N/V, dysphagia, altered sense of taste and smell, change in bowel/bladder patterns, loss of movement and sensation, syncope, weakness on one side, generalized weakness, easy fatigability, numbness, tingling of one side of the body, loss of memory, alteration in speech, language, problem-solving ability, pain, headache (possibly sudden and severe) (hemorrhage), visual disturbances, denial of issues

107
Q

Stroke Assessment, general

A

Emotional lability, lethargy, apathy or combativeness, fever

108
Q

Stroke Assessment, respiratory

A

Loss of cough reflex, labored or irregular respirations, tachypnea, wheezes (aspiration), airway occlusion (tongue), apnea, coughing when eating or delayed coughing

109
Q

Stroke Assessment, cardiovascular

A

Hypertension, tachycardia, carotid blunt

110
Q

Stroke Assessment, GI

A

Loss of gag reflex, bowel incontinence, decreased or absent bowel sounds, constipation

111
Q

Stroke Assessment, urinary

A

Frequency, urgency, incontinence

112
Q

Stroke Assessment, neurologic

A

Contralateral motor and sensory deficits, including weakness, paresis, paralysis, anesthesia; unequal pupils and hand grips; akinesia, aphasia (expressive, repetitive, global), dysrhythria (slurred speech), agnosias, apraxia, visual deficits, perceptual or spatial disturbances, altered LOC, babinski’s sign, decreased than increased dtrs, flaccidity followed by spasticity, amnesia, ataxia, personality changes, nuchal rigidity, seizures

113
Q

Stroke Assessment, possible diagnostic findings

A

Positive CT, CTA, MRI, MRA, or other neuroimaging scan showing size, location, and type of lesion; positive Doppler ultrasonography and angiography indicating stenosis

114
Q

C4 Injury

A

Tetraplegia, results in complete paralysis below the neck

115
Q

C6 Injury

A

Results in partial paralysis of hands and arms as well as lower body

116
Q

T6 Injury

A

Paraplegia, results in paralysis below the chest

117
Q

L1 Injury

A

Paraplegia, results in paralysis below the waist

118
Q

A=Complete

A

No s/m in sacral segment

119
Q

B=Sensory Incomplete

A

S persevered but no m below injury

120
Q

C=Motor Incomplete

A

M preserved below injury allowing for voluntary anal contraction but no s

121
Q

D=Motor Incomplete

A

M incomplete status, muscles work but weaker

122
Q

E=Normal

A

S/m WNL

123
Q

ND=Not determined

A

Based on results, unable to determine

124
Q

Know the medications that may be ordered for a SCI patient (why and typical doses)

A

Spinal cord injury inflammation occurs corticosteroids, lovenox, vasopressors (phenylephrine or norepinephrine)

125
Q

Know what diabetic teaching a patient should have upon discharge that is diabetic (whether Type I or Type II)

A

How to check your sugars, diet, exercise, medical ID, no tight fitting shoes/keep them dry/never go barefoot/inspect feet daily, s/s of hyper and hypoglycemia, teach about glucagon/insulin, when you are sick take your insulin (know parameters, don’t take it and go into DKA)

126
Q

Know what parameters are required for patient to be diagnosed with DKA - know treatment regimen

A

Diabetic ketoacidosis, type 1 diabetes, spilling ketones, greater than 250 acidotic, poor skin turgor, dry mucous membranes, tachycardia, orthostatic hypotension, anorexia, nausea, vomiting, Kussmaul respirations, sweet/fruity breath

127
Q

Know the difference between Coumadin and Heparin and what lab tests are ordered to adjust dosing

A

Heparin sq or iv to treat quickly PTT, coumadin (warfarin) orally for long term PT, vitamin K antidote, changes how your body forms clot, not a blood thinner!

128
Q

Know what cells are affected with patient with HIV, know what is symptoms are seen to assist in diagnosis of HIV

A

T cells, CD4, slowed delayed or no immune response, opportunistic infection =thrush, pneumonia,

129
Q

Know what spinal shock is - what symptoms will you see? What medications might be given and why?

A

Partial paralysis, drop in BP, steroids, decrease in reflexes, loss of sensation, absent thermoregulation, flaccid paralysis, days to weeks so it masks postinjury neurological function

130
Q

Know what happens with increased intracranial pressure/cerebral edema - symptoms of, treatment for.

A

Tissue/blood/CSF, headache, change in LOC, ring in ears, CN issues, blurry visions, CONFUSION, change in VS (systolic hypertension, widening pulse pressure, bradycardia w/ full and bounding pulses, and irregular respirations), ipsilateral dilation, contralateral hemiparesis, headache, and vomiting

131
Q

Know SIADH - symptoms/treatment/expected outcomes of treatment

A

Little pee, thirsty, loop diuretics, hyponatremia d/t dilution, fatigue, dyspnea on exertion, s/s of hyponatremia progress from muscle cramps, headache, irritability to severe vomiting, cramps, muscle twitch

132
Q

Know posturing - know the different positioning you may see

A

Decorticate to the core flexor, decerebrate is extensor outward and worse which my indicate motor damage

133
Q

Know DI - symptoms/treatment/expected outcomes of treatment/who is most susceptible

A

Common with brain surgery/most susceptible head injury, a lot of urine, DDVAP/fluids/hormones/diuretics/diet (low sodium), not enough ADH/not big enough response to ADH, polydipsia and polyuria, excrete large quantities of urine with very low specific gravity, hypernatremia, acute and accompanied by excess fluid loss

134
Q

Know what immunosuppressive therapy/drugs is used for and what complications therapy may cause

A

Autoimmune response or organ transplant, infection

135
Q

Know signs/symptoms of strokes, differences between ischemic/hemorrhagic/treatment/outcomes/assessment and care

A

Assess same way, tx different ischemic stroke=tPA clot buster antidote ffp, hemorrhagic stroke=surgery, CT noncontrast of head

136
Q

Know Cushing’s Triad

A

Increase systolic, decrease pulse/resp

137
Q

Know basilar skull fracture, signs/symptoms, care and treatment

A

Raccoon eyes, Battle sign, don’t put anything in their nose!!!!!!!! Leaky CSF

138
Q

Know which patients are at increased risk for embolus

A

Pregnant people, smokers, birth control, a fib, joint surgery, broken bones in legs

139
Q

Know what to assess for in patient post endarterectomy

A

Normally done in the carotid, LOC, hemorrhage, infection, come in from brachial/femoral/ulnar, check extemeties for circulation

140
Q

Know what you may delegate to UAP (unlicensed assistant personnel) if you are the RN

A

Vital signs, adls, NO ASSESSMENTS

141
Q

Know how to prioritize patients for care (i.e. given a group of patients with different problems - who would you see first)

A

Chronic/happened yesterday, acute/new onset stat

142
Q

Know what the reversal agents Flumazenil and Narcan are used for and usual dosing

A

Flumazenil- benzos (0.2 mg), Narcan- opioids (morphine) (4 mg)

143
Q

Know standard precautions and how/why they are used

A

Wash hands, PPE, wear gloves

144
Q

Know why you would administer 3% NS - where, how, and why

A

ICU only!, severe hyponatremia which is 120 or less

145
Q

Know normal/abnormal values of an ABG

A

pH 7.35-7.45, CÓ 35-45, HCǑ 22-26, Ó 80-100

146
Q

Know what contraindications would prevent a patient from receiving tPA

A

Hemorrhage, allergy, surgery, trauma, stroke with in last 6-8 weeks and received tPA, platelet low, H & H low

147
Q

Know what Mannitol is and what it is used for

A

Osmotic diuretic, Reducing ICP

148
Q

Know care of patient post thyroidectomy, abnormal manifestation that you should be concerned with

A

Hypocalcemia, swelling, always have a tracheostomy tray, Assess q2H for first 24 hours for s/s of hemorrhage or tracheal compression such as frequency of swallowing, choking, blood on dressing, sensation of fullness, Semi-fowler and support patient head with pillow, Monitor VS and calcium levels (monitor for tetany), Control postop pain

NS 406 Exam 1!! (9 decks)

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