Test 2 Spinal Shock And Disaster Flashcards
- Botulism manifestations and complications(Slide 11)
Early signs 4D: diplopia, Dysarthria, Dysphonia, Dysphagia
- Paralysis of motor and autonomic nerves
• Drooping of eyes
• Generalized muscle weakness.
• Paralysis of respiratory muscles
- Smallpox manifestations(Slide 12)
• Asymptomatic for first 7 to 14 days before rash develops: high fever (101 to 104F)
• Rash begins on face, progresses to extremities similar to chickenpox lesion.
- Anthrax nursing considerations and medical management(Slide 8)
• Treated with antibiotic therapy.
- Cipro, Levaquin: treatment lasts 4 weeks or longer.
• Use standard precaution/hand hygiene and appropriate PPE.
- Nerve agent manifestation
• Cholinergic crisis including bilateral miosis.
• Increased gastrointestinal motility.
• Nausea and vomiting
• Bradycardia
• Bronchoconstriction
• Weakness
- Nerve agent medical management
• Drugs administered: atropine sulfate, diazepam.
- Gas, radiological nursing management and priority
• Priority will be to direct client to decontamination area and assess for respiratory function.
• Administer substances that interfere with organ concentration (lead) or speed up removal of radioactive substance.
• Limit external contamination
- Stay indoors, go to centrally located room or basement with few windows, turn off all fans, air conditioners, forced-air heating units, remove and place clothing and shoes in plastic bag, shower/wash with soap and water. Keep outdoor pets outside.
Chemical exposure nursing management
• Avoid fatality by assisting victims to fresh air. Higher ground: remove victims clothing, wash skin with soap and water and remove contact lens.
- Cyanide medical management(Slide 17)
• Wear protective garments and respirator masks.
• Administer cyanide antidote: amyl nitrite, sodium nitrite IV route, intravenous sodium thiosulfate.
- Triage steps for disasters(Slide 2)
- Evaluate the emergency or disaster: type of incident, number of victims, resources.
- Ask questions: sort victims, find emergency team and plan.
- Follow the systematic route to victims: start in and work out quickly.
- Evaluate and tag each victim.
- Treat victims
- Document triage results
- Know what each color represents for disaster triage and be able to ID them.
• Red- Immediate
- Airway and breathing difficulties.
- Uncontrolled or severe bleeding
- Decreased level of consciousness
- Severe medical problems
- Shock (hypoperfusion)
- Severe burns
• Yellow -Delayed
- Burns w/o airway problems.
- Major or multiple bone or joint injuries
- Back injuries with or without spinal cord damage
• Green-Minor
- Minor fractures
- Minor soft tissue injuries
• Black-Deceased
- Obvious death
- Obviously non-survivable injury, such as major open brain trauma
- Full cardiac arrest
- CSF leakage manifestations(Slide 15)
• Monitor for leakage of CSF.
- Clear drainage from nose-look for halo sign
- Epidural hematoma manifestations
• Most deadly medical emergency due to increased ICP
• Bleeding between dura mater and skull-usually arterial blood
Manifestations immediately
• Loss of consciousness then a brief period of alertness, followed again by LOC-Coma
• Nausea/ vomiting, increased ICP
- Epidural/ Cerebral hematoma medical management and surgical management (Slide 13)
Medical Management:
• Indications of surgical emergency: rapid change in LOC; signs of uncontrolled increased ICP
Surgical Management:
• Burr holes/Trephining: often with epidural hematoma
• Intracranial surgery: craniotomy, craniectomy, and cranioplasty
- Post intracranial surgery priority assessment.(Slide 16)
• Supine or side lying position.
• Regular monitoring; observe for increased ICP.
• Monitor temperature: elevate can increases brain metabolism and damage.
• Control thrombus or embolus; cerebral edema- limit fluids
- Subdural hematoma manifestations(Slide 14)
• Bleeding between dura mater and arachnoid-usually venous blood
• CSF may leak into subdural space.
• Increased ICP
• N/V
• Change in LOC
• Later Bradycardia and decreased heart rate
• Headache can come 24-48hrs after injury.
• Some neurological deficits/ confusion can still develop months after injury.
- Autonomic dysreflexia(hyperreflexia)manifestations
• Severe hypertension
• Slow heart rate
• Pounding headache
• Nausea
• Blurred vision
• Flushed skin.
• Sweating
• Goosebumps (erection of pilomotor muscles in the skin)
• Nasal stuffiness
• Anxiety
• Uncontrolled autonomic dysreflexia can lead to seizures, stroke, and death.
- Long term effect after spinal shock has resolved.
- Spinal cord injuries above T6
- Diaphoresis, Severe headache, Nausea
- ICP manifestations
• Change in level of consciousness
• Pupils change
• Impaired extra ocular movements
- Spinal shock manifestation
A loss of sympathetic reflex activity below the level of injury within 30 to 60 minutes of a spinal injury
Manifestations
• Paralysis
• Hypotension
• Bradycardia
• Warm, dry skin.
• Bowel and bladder distention
• Poikilothermia (condition in which the temperature of the body varies with that of the environment.)
If the level of injury is in the cervical or upper thoracic region
• Respiratory failure
- Spinal shock client education
• Will often repair within 1 week to months after injury.
- What are the primary survey triage letters and what do they stand for?
• A: airway
• B: breathing
• C: circulation
• D: disability
• E: exposure
C1-C3
-Breathe with assistance of ventilator
-Swallow and speak
-Use a power wheelchair with movement of head and neck control
-Operate computer or appliances, such as TV or lights, using voice-activation
device or mouth stick
C4-C5
-Breathe with ventilator assistance or possibly independently
-Use a power wheelchair with sip-and-puff or hand control
-Drink independently using a long straw and bottle
C6-C8
-Eat, groom, bathe, and attain bed mobility with assistive devices
-Transfer from bed to chair using a slide board
-Perform self-catheterization (men); more difficult for women
-Use manual wheelchair in flat environment
-Drive with hand controls
T1-T6
-Perform personal care and household activities independently
-Use manual wheelchair, including up and down curbs
-Stand between bars with leg splints
T7-T12
-Transfer from bed to wheelchair independently
-Propel wheelchair over uneven surfaces and rough terrain
-Care for bowel and bladder independently
-Perform light housekeeping and meal preparation
-Balance on legs
-Walk with splints or long leg braces
L1-L2
Drive a car with hand controls
L3-L5
Walk with support of walker or crutches
S1-S5
-Walk normally without assistive devices
-Control bladder, bowel, and sexual functions
- Spinal cord injury complications during recovery period(Slide 20)
• Respiratory arrest
• Spinal shock (areflexia): no cord function below injury; body will adjust and return; poikilothermia.
• Autonomic dysreflexia (hyperreflexia)
• Orthostatic hypotension
• Pressure ulcers
• DVT
- Concussion client education(slide 3)
• Contact primary provider.
• Return to ED if symptoms of increased ICP occurs.
• Severe headache, Slurred speech, vomiting, unilateral weakness
- Role of Nursing Disaster
Preparation pf public in case of disaster
Triage
• Divide in to triage categories-triage system.
• Immediate, delayed, minimal, and expectant.
Nursing Interventions based on priority ABC’s.
• Administer first aid to victims in immediate category by keeping airway open, covering wounds, controlling bleeding, splinting fractures.
• Delegate the care of those with minimal health needs to volunteers with first aid skills.
