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203D Custom > Test 3/Midterm > Flashcards

Test 3/Midterm Flashcards

1
Q

SCI Hyperextension vs. hyperflexion

A

neck forced back vs. neck forced forward

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2
Q

Most unstable mechanism of SCI injury

A

Rotation due to torn ligaments

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3
Q

SCI Initial injury (axon disruption) examples

A

cord compression (bone displacement, interruption of blood supply, pulling/stretching cord) or penetrating injury (gunshot, stab wound)

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4
Q

SCI Secondary injury (ongoing, progressive damage) complications

A

hemorrhage, edema, free radical formation, calcium influx, ischemia

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5
Q

SCI Cervical injury priority

A

breathing

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6
Q

SCI Thoracic injury priorities

A

breathing and shock

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7
Q

SCI Complete injury

A
  • worse prognosis
  • loss of voluntary movement/sensation below the injury
  • reflex activity below injury may return after spinal shock resolved
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8
Q

SCI Incomplete injury

A
  • remember ABCs
  • better prognosis
  • varying degrees of motor/sensory loss below
  • central/lateral/posterior injury
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9
Q

SCI Central cord syndrome

A
  • forced hyperextension
  • sensory/motor deficit upper>lower
  • “can walk to the door but can’t open it”
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10
Q

SCI Anterior cord syndrome

A
  • hyperflexion or spinal artery injury
  • loss of motor, pain, temp, with mixed sensory loss
  • touch, proprioception, vibration remain intact
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11
Q

SCI Brown-Sequard syndrome

A
  • penetrating trauma
  • same side as injury: loss of motor, touch, pressure, vibration, BUT pain/temp intact
  • opposite side of injury: loss of pain/temp, BUT motor, touch, pressure, vibration intact
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12
Q

SCI Cauda equina/conus medullaris

A
  • compression of lumbar/sacral area
  • conus: T11-L1/cauda: L2-sacral
  • Flacid (atonic) bowel/bladder
  • impaired sexual function
  • motor loss, but sensory unimpaired
  • motor and B/B function best indicator of return of cord function
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13
Q

C4

A

top of shoulders, if above: high risk, ventilator dependent

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14
Q

C6

A

thumb

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15
Q

C7

A

middle/ring fingers

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16
Q

C8

A

little finger

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17
Q

T4

A

below nipple line

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18
Q

T10

A

below umbilicus

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19
Q

T12

A

loss in groin

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20
Q

L4

A

variable: big toe, buttocks, genitalia

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21
Q

S1

A

top of small toe, perineal/anal numbness

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22
Q

SCI Neurogenic shock mechanism and assessment findings

A
  • SCI above T6
  • loss of sympathetic tone results in massive vasodilation
  • hypotension
  • bradycardia
  • poikilotermic
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23
Q

SCI Neurogenic shock management

A
  • determine underlying cause
  • support airway
  • fluids (possibly, if no spinal shock)
  • vasopressors (atropine)
  • temp control
24
Q

SCI Spinal “shock”

A
  • d/t acute SCI
  • absence of all voluntary/reflex activity/sensation below
  • recovery: bradycardia/hypotension persist after resolution, return of anal wink/spasticity/bladder
25
Q

SCI medication therapy

A
  • methylprednisolone (SoluMedrol) 30mg/kg over 1 hour, then 5.4mg/kg/hr for 23 hours
  • improves profusion, prevent cell membrane breakdown, improves energy metabolism, better odds of moving to a higher sensory/motor category
26
Q

SCI Autonomic dysreflexia (hyper-reflexia)

A
  • sudden onset of excessively high BP (250/150)
  • T6 or above
  • triggers: full bladder, infection, pain, skin damage
27
Q

SCI Autonomic dysreflexia S/Sx

A
  • hypertension/bradycardia
  • Below (sympathetic): cool skin (vasoconstriction), goosebumps
  • Above (parasympathetic): headache (#1 sign), flushed face/warm skin (vasodilation), nasal congestion
28
Q

SCI Autonomic dysreflexia nusing assesment/priorities

A
  • HTN/brady
  • empty bladder/bowel (no digital stimulation)
  • monitor BP q5min
  • find and remove negative stimuli
  • call MD after treatment/finding cause
29
Q

SCI Spinal precautions

A
  • log roll
  • hard collar in place if ordered
  • TLS orthotics on unless orders to remove
  • tongs in alignment
30
Q

SCI Breathing interventions

A
  • do not perform after eating (may induce vomiting)
  • quad cough
  • glossopharyngeal breathing
31
Q

SCI Mobility interventions

A
  • reduce skin breakdown
  • ROM, splinting
  • prevent PE, use PAS stockings
32
Q

SCI Flaccid bladder nursing interventions

A
  • PVR <100mL indicates training is working
  • encourage fluids to prevent stones/UTI
  • do not allow >500mL in bladder
33
Q

SCI Spastic bladder nursing interventions

A
  • stroke inner thigh
  • warm water over perineum
  • anal stimulation (not cardiac patients)
  • PVR<100mL
34
Q

SCI Skin integrity nursing interventions

A
  • check skin with every turn q2h

- maintain normal body temp

35
Q

Meningitis take away point

A

knowing the specific cause will direct treatment

36
Q

Meningitis exudate formation

A

Exudate formed with bacterial, NOT viral

37
Q

Pneumococcus vs. meningococcus transmission

A

Pneumococcus: droplet (also viral)

Meningococcus: inhalation or direct contact

38
Q

Positive signs of meningeal irritation

A

Kernig’s: pain in back when lifting hip/knee while supine

Brudzinski’s sign: severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed

Nuchal rigidity: an inability to flex the neck forward

39
Q

Meningitis most common assessment findings

A

fever, headache, photophobia

40
Q

Meningitis pt. with petechial hemorrhagic rash

A

very ill, advanced disease process

41
Q

Meningitis lumbar puncture: bacterial vs. viral

A

bacterial: cloudy CSF, low or no glucose (bacteria using), increased pressure, protein, neutrophils
viral: clear or cloudy, protein/glucose normal, elevated lymphocytes

42
Q

Meningitis hyponatremia

A

from SIADH

43
Q

Lumbar problems: diagnostic gold standard

A

MRI

44
Q

Lumbar problems: medical Tx

A

activity (limit bedrest)

also: PT, hot/cold packs (with order), medications

45
Q

Lumbar problems: Teaching post-op

A
  • wear brace TLSO device at all times while out of bed
  • report changes in sensation
  • maintain good body alignment (log roll, no twisting)
46
Q

Seizures: Generalized 2 types

A

tonic-clonic (grand-mal) and absence (petit-mal)

47
Q

Tonic-clonic seizures

A

aura, loss of consciousness, tonic then clonic movement, B/B incontinence, tongue biting, salivation, post-ictal phase: HA, sore, tired, amnesia

48
Q

Absence seizures

A

interruption of consciousness, seen in peds, vacant staring, altered awareness or loss of environmental contact

49
Q

Simple partial (focal) seizure

A

no loss of consciousness, single muscle group progressing to adjacent, autonomic, deja vu

50
Q

Complex partial (focal) seizure

A

impaired LoC, simple to complex, unaware, bizarre behavior (lip smacking, automatic movement)

51
Q

Febrile seizures

A

children with high temps, treat with tylenol, tepid bath, IV/rectal if valium necessary

52
Q

Phenytoin/Dilantin intervention

A

oral care

53
Q

EEG nursing considerations

A

before EEG: no caffeine, tranquilizers, sedatives, etc. Call to clarify anti-convulsants. Make sure pt. eats.

54
Q

Status Epilecticus

A

medical emergency: prolonged seizures without regaining consciousness for 30 mins

55
Q

Status Epilecticus management

A

oxygenation (may require intubation), start IV, protect from injury, administer drugs as ordered, control seizure activity with Ativan

56
Q

Seizure family teaching

A

no driving 1 year, oral care, no baths, meds at same time each day, awareness of aura, lifestyle mods

203D Custom (6 decks)

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