Test 3 (Mod 3) Flashcards
(398 cards)
0
Q
Burn that involves the epidermis
A
Superficial partial-thickness burn
1
Q
offer most resistance to electrical burns
A
fat and bones
2
Q
Severity of burn injury is determined by
A
Depth, extent of burn in percent of TBSA, location, and patient risk factors
3
Q
Burn that involves the dermis
A
Deep partial-thickness burn
4
Q
Burn that involves fat, muscle, bone
A
Full-thickness burn
5
Q
With burns of the face, neck, and chest, think-
A
respiratory obstruction
7
Q
With burns of the hands, feet, joints, eyes, think-
A
self-care
8
Q
With burns to the ears, nose, buttocks, perineum, think-
A
infection
9
Q
Areas of the wound not closed by wound contraction will require
A
grafting
10
Q
a continuous leak of plasma from the vascular space into the interstitial space.
A
Capillary leak syndrome (third spacing)
11
Q
Cool large burns for no longer than
A
10 minutes
12
Q
Fluid remobilization starts ______________, when the capillary leak stops and capillary integrity is restored.
A
about 24 hours after injury
13
Q
Primary concerns during emergent phase of burns include
A
hypovolemic shock and edema
14
Q
The diuretic stage begins _____________as capillary membrane integrity returns.
A
at about 48 to 72 hours after the burn injury
15
Q
because of the initial fluid shifts and hypovolemia that occur after a burn injury, heart rate goes _____, and cardiac output goes ______.
A
up, down
16
Q
In burns, a normal insensible loss is
A
30 to 50 mL / hr
17
Q
In severe burns, fluid loss may be
A
200 to 400 mL /hr
18
Q
Cardiac output may remain low with burns until
A
18 to 36 hours after the burn injury
19
Q
In burns, this electrolyte shifts to the interstitial spaces and remains until edema formation ceases.
A
Sodium (Na+)
20
Q
This electrolyte shift develops with burns because injured cells and hemolyzed RBCs release this into extracellular spaces
A
Potassium (K+)
21
Q
an acute gastroduodenal ulcer that occurs with the stress of severe injury, may develop within 24 hours after a severe burn injury because of reduced GI blood flow and mucosal damage.
A
Curling’s ulcer
22
Q
Immediate care of burns focuses on
A
maintaining an open airway, ensuring adequate breathing and
circulation, limiting the extent of injury, and maintaining the function of vital organs.
23
Q
Assess the burn patient’s _____ and ___________ before assessing any other body system.
A
airway, adequacy of breathing
24
Q
Ventilator alarms should be checked ______, for patients who are receiving paralytic drugs during mechanical ventilation
A
hourly
25
Patients receiving paralytic drugs during mechanical ventilation should be given
analgesics, sedatives, and antianxiety drugs
26
______ of the fluid volume calculated for the first 24 hours after burn injury should be given in the first _____ hours post burn
Half, eight
27
As soon as fluid shifts have resolved, assist patients to
Ambulate several times each day
28
two large bore IV's for TBSA greater than
15%
29
Central line for TBSA of greater than
30%
30
Should be delayed until a patent airway, adequate circulation, and adequate fluid replacement have been established with burns
Wound care
31
Source of infection in a pt with burns is from
the pt's own flora
32
dressings on burns may be changed every
12 to 24 hours to once every 14 days. Moist wound healing is preferred.
33
When performing burn wound care with open burn wounds, the RN must wear
Disposable hat, mask, gown, and gloves
34
a chronic, episodic disorder with multiple subtypes classified as a long-duration headache because it usually lasts more than four hours.
Migraine headache
35
is characterized by an intense pain in one side of the head (unilateral) worsening with movement, and occurs with either photophobia (sensitive to light) or phonophobia (sensitive to noise).
Migraine
36
alleviates pain during the aura phase or soon after the start
Abortive therapy
37
Given routinely to all burn patients
Tetanus immunization
38
triptans, ergotamine preparations, and anti-epileptic drugs.
Drugs used to treat migraines
39
manifested by brief (30 minutes to 2 hours), intense unilateral pain that generally occurs in the spring and fall without warning.
Cluster headaches
40
classified as the most common chronic short-duration headaches.
Cluster headaches
41
Caloric needs for a burn patient
about 5000 kcal / day
42
Resting metabolic expenditure may be increased by ___ to ___ above normal in the burn patient
50 to 100%
43
The pain from this is usually accompanied by ipsilateral eye tearing, rhinorrhea, congestion, ptosis, facial sweating, eyelid edema, and miosis.
cluster headache
44
the most common type of chronic long-duration headache, lasting more than 4 hours and are caused by stress and tension.
Tension headache
45
Early, continuous enteral feeding promotes optimal conditions for wound healing with
burns
46
an abnormal, sudden, excessive, uncontrolled electrical discharge of neurons resulting in alteration in consciousness, motor or sensory ability, or behavior.
Seizure
47
defined as two or more seizures experienced by a person.
Epilepsy
48
The _____ phase of burns begins with the mobilization of extracellular fluid and subsequent diuresis
Acute
49
The ______ phase of burns is concluded when the burned area is completely covered by skin grafts, or when the wounds are healed
Acute
50
A partial thickness burn wound heals from the
edges
51
must be covered by skin grafts
full thickness burns
52
Full thickness wounds require
debridement
53
In burns, hyponatremia can develop from
excessive GI suction and diarrhea
54
Hypernatremia with burns can develop following
successful fluid replacement, improper tube feedings, inappropriate fluid administration
55
Hyperkalemia may be noted in a burn patient if the patient has
renal failure, adrenocortical insufficiency, massive deep muscle injury
56
cardiac dysrhythmias and ventricular failure, muscle weakness, ECG changes, can all be caused by
Hyperkalemia
57
lengthy IV therapy without potassium, vomiting, diarrhea, prolonged gastrointestinal suction, can all lead to
Hypokalemia
58
Partial thickness burns can become full thickness in the presence of
Infection
59
The International Classification of Epileptic Seizures recognizes three broad categories of seizure disorders
generalized seizures, partial seizures, and unclassified seizures.
60
is not associated with any identifiable cause.
Primary or idiopathic epilepsy
61
result from an underlying brain lesion, most commonly a tumor, trauma, or metabolic or other disorders.
Secondary seizures
62
involve both cerebral hemispheres
generalized seizures, such as the tonic-clonic seizure
63
usually involve only one hemisphere.
Partial seizures, also called focal or local seizures
64
includes having oxygen and suctioning emergency equipment available, starting an IV access, and keeping the siderails up at all times. Indicate the reasons for the siderails to meet The Joint Commission requirements.
Seizure precautions
65
decreased ROM and contractures can occur during the acute phase of
burns
66
a medical emergency characterized by prolonged seizures lasting more than 5 minutes or repeated seizures over the course of 30 minutes.
Status Epilepticus
67
an inflammation of the meninges surrounding the brain and spinal cord.
Meningitis
68
is usually self-limiting and the patient has a complete recovery
Viral meningitis
69
potentially life-threatening form of meningitis
Bacterial meningitis
70
Speeds up removal of dead tissue from healthy wound bed with burns
Enzymatic debridement
71
may occur as a result of blockage of the flow of CSF, change in cerebral blood flow, or thrombus formation.
Increased ICP
72
Analysis of the cerebrospinal fluid is used to diagnose
Meningitis
73
an inflammation of the brain tissue and often the surrounding meninges, affecting the cerebrum, the brainstem, and the cerebellum.
Encephalitis
74
can be life-threatening or lead to persistent neurological problems such as learning disabilities, epilepsy, memory loss, and fine motor deficits.
Viral encephalitis
75
Assess level of consciousness (LOC) as a priority in patients with
Encephalitis
76
C1-7
Innervate neck accessory muscles
77
T1-11
Innervate intercostals
78
C3-5
Diaphragm
79
Initially bleeding and edema occur _____ segments higher than the spinal injury
2
80
Incomplete injury affecting upper extremities
Central cord injury
81
Incomplete lesion that involves loss of motor, pain, and temp. Proprioception, vibration, and touch intact
Anterior cord injury
82
Incomplete lesion that involves ipsilateral loss of motion, contra lateral loss of pain and temp
Brown-Sequard
83
Impaired mobility or sensation
Wounds of head neck back shoulders
Pain tenderness deformities near the spine
Unconscious after the injury
Unexplained shock (neurogenic vs spinal shock)
Indications of cord injury
84
T6-L2
Innervate abdominal muscles
85
Total loss of motion and sensation below the lesion
Spinal shock
86
Occurs with lesions above T6
Occurs after spinal shock has resolved
Bladder/bowel distention are common triggers but anything can irritate this response
Autonomic dysreflexia
87
Affect CNS above area of function
Spinal arcs below lesion are intact
Incontinent bowel and bladder
Upper motor neuron lesions
88
Disrupt reflex arc resulting in loss of activity at that level
Ex. Lesion on sacral segment results in bladder retention or loss of erection
Lower motor neuron lesions
89
Most have reflex erections but cannot ejaculate
Upper motor neuron lesion
90
Most cannot have erections
Lower motor neuron lesions
91
An inhibitory neurotransmitter and some meds for epilepsy alter the amount of this in the brain or alter how the brain responds to it
GABA (gamma-aminobutyric acid)
92
Originate from a local cortical region and include temporal, frontal, and occipital lobe epilepsy; childhood epilepsy
Localization related (focal, partial) seizures.
93
Activation of neurons in both hemispheres and include absence, myoclonic, grand mal, Lennox-Gastaut syndrome
Generalized seizures
94
Continuous seizure lasting more than 5 minutes or two or more seizures that occur without a recovery period
Status epileptics
95
3 components in the non-expandable skull
brain, blood CSF
96
Widening pulse pressure means
Increasing ICP
97
Widening pulse pressure, Bradycardia, and change in respirations, make up
Cushing's Triad (late sign)
98
Increased systolic BP is what leads to _______
Widening pulse pressure with increased ICP
99
carotid bodies ilicit a parasympathetic response using the vagus nerve to combat the
increase in systolic BP with increased ICP
100
As a result of the vagus nerve stimulation
bradycardia occurs
101
Hypoventilation leads to an______ in CO2 in the body
Increase (CO2 potent vasodilator in the brain, thus increasing ICP even more)
102
Hypoxia will ______ ICP
Increase
103
Numerical scale making up verbal, motor, and eye opening responses
Glasgow Coma Scale
104
With GCS less than eight, think
Intubate!
105
Ideal GCS range
13-15
106
Normal pupil size
2-6 mm
107
If client is c/o a headache, assume
increased ICP
108
A high level of brain functioning is demonstrated if the client can
speak
109
Absence of movement is the ______ level of response
lowest
110
This test assesses brain stem function; eyelids open...quickly turn head to the right...eyes should move to the left; If eyes remain stationary...reflex absent
Oculocephalic Reflex (Doll's eye reflex)
111
This test assesses brain stem function; irrigate ear with 50mL of cool water...normally eyes will move to irrigated ear and rapidly back to mid-position
Ice cold water caloric test (oculovestibular reflex)
112
lateral aspect of foot is stroked and toes flex or curl up. Less than 1 year of age a positive result is ok; negative is bad
Babinski or plantar reflex
113
Normal adult response to Babinski
toes roll under or flex
114
A negative babinski is ok for ages greater than_________. Positive is _______
1 year of age
| Bad
115
For an ICP patient, to facilitate venous drainage, elevate HOB to
20 to 30 degrees
116
For an ICP patient, to reduce an increase in intra abdominal/thoracic/cranial pressure, prevent or reduce
hip flexion
117
With reflexes, 0=
absent
118
With reflexes, 1+=
present, diminished
119
Potent osmotic diuretic that draws fluid out of brain, puts it into vasculature, and is then excreted through the kidneys
Mannitol
120
Often used with Mannitol to facilitate the removal of fluid from the vasculature
Lasix
121
With reflexes, 2+=
normal
122
With reflexes, 3+=
increased but not necessarily pathological
123
Reduces cerebral edema
Decadron
124
With reflexes, 4+=
hyperactive
125
Names of drains used post-op for brain injuries
JP or hemovac
126
A shunt works by
removing excess CSF from around the brain and shunting it to the abdominal cavity, or other location
127
x-ray of cerebral circulation that goes through the femoral artery
Cerebral Angiography
128
prior to a cerebral angiography, make sure pt is
well hydrated, has voided, has peripheral pulses, and the groin is prepped
129
Anytime an iodine based dye is used the client will need to be well hydrated to promote
excretion of the dye
130
bed rest is required after a cerebral angiography for
4-6 hours
131
Major complication of cerebral angiography
Embolus (arm, heart, kidney, lung, brain)
132
If a client has a change in LOC, one sided weakness, and paralysis, or motor/sensory deficits post cerebral angiography, think
brain embolus (blood clot) (STROKE!)
133
With ICP patient, mechanical ventilation is needed to
control ventilation (prevent hypoventilation)
134
In order to maintain a calm and quiet environment for a patient with ICP, ________ activities
space out activities as much as possible
135
Records electrical activity to help diagnose ________, and is used as a screening procedure for _____, and is an indicator of ______ death.
Seizure disorders
Coma
Brain
136
Important to hold ____ prior to an EEG
Caffine
137
Make sure pt is not _____ prior to an EEG due to a possible drop in blood sugar
NPO
138
Punture site for a lumbar puncture
Lumbar subarachnoid (3rd - 4th)
139
Measures ICP with a mamometer
Lumbar puncture
140
Position client over a table with head down and arched back, or on side in the fetal position for
Lumbar puncture (opens subarachnoid space)
141
Meningitis is a complication of a
Lumbar puncture
142
Frontal lobe is responsible for
Speech, expressive language, awareness, memory, skilled movements, emotion behavior, smell
143
Temporal lobe responsible for
Language reception and understanding, hearing
144
Cerebellum is responsible for
Balance and muscle coordination and posture
145
Brain stem regulates
basic body function
146
Occipital lobe responsible for
Vision, language, reading, visual recognition
147
Parietal lobe responsible for
body sensations, spoken and written language
148
Signs of this include chills, fever, positive Kernig and Brudzinski, vomiting, nuchal rigidity, photophobia
Meningitis
149
This form of meningitis requires droplet precautions
Bacterial
150
This should be clear and colorless (looks like water)
CSF
151
Post lumbar puncture, pt needs to lie flat or prone for
2-3 hours
152
Increase ______ post lumbar puncture
fluids
153
Most common complication of a lumbar puncture
headache
154
Headache from lumbar puncture will _____ when the client sits up and ____ when they lie down
increase
| decrease
155
Headache from lumbar puncture is treated with
bed rest, fluids, pain meds, and blood patches
156
When brain tissue is pulled down through foramen magnum as a result of a sudden drop in ICP
Herniation
157
When the client's hip is flexed 90 degrees, then extending the clients knee causes pain, this is a
Positive Kernig sign
158
When flexing the client's neck causes flexion of the clients hips and knees, this is a
positive Brudzinski sign
159
Scalp is very
Vascular
160
With scalp injuries, watch for
Infection
161
In an open skull fracture, the dura is
torn
162
In a closed skull fracture, the dura is
intact
163
With basal skull fractures you would see bleeding where?
EENT (Eyes, ears, nose, and throat)
164
Do not give narcotics for head injuries due to it leading to a change in
level of consciousness
165
Bruising over the mastoid (over ear)
Battle's sign
166
Periorbital bruising
Racoon eyes
167
leaking spinal fluid from your nose
Cerebrospinal rhinorrhea
168
temporary loss of neurological function with complete recovery
Concussion
169
Will have a short (maybe seconds) period of unconsciousness or may just get dizzy / see spots
concussion
170
Teach families to watch for these signs with a pt having a concussion
```
Difficulty awakening/speaking
confusion
severe headache
vomiting
pulse changes
unequal pupils
one sided weakness
THESE ARE ALL SIGNS OF INCREASED ICP!!!
```
171
Brain is bruised with possible surface hemorrage
Contusion
172
May have a longer period of unconsciousness and have residual damage
contusion
173
Deep breathing is still necessary for ICP pt's, but avoid
coughing and blowing nose
174
A small hematoma that develops rapidly, may be
fatal
175
A massive hematoma that develops slowly may allow the client to
adapt
176
This is a rupture of the middle meningeal artery (fast bleeder)
Epidural hematoma
177
Is an epidural hematoma an emergency or not?
YES!!!
178
Treatment for an epidural hematoma
Burr Holes and remove the clot; control ICP
179
Normal ICP lab value
0-15mm Hg
180
Usually venous, can be acute (fast), subacute (medium), or chronic (slow)
Subdural hematoma
181
Care for the acute subdural hematoma
Immediate craniotomy and remove clot; control ICP
182
With your upper spinal cord injury (above T6) major complication to look for is
Autonomic dysreflexia or hyperflexia
183
A syndrome characterized by severe HTN and H/A, bradycardia, nasal stuffiness, flushing, sweating, blurred vision and anxiety
Autonomic dysreflexia
184
Sudden onset of bradycardia is usually
Hypoxia driven
185
A sudden onset neurological emergency if not treated properly, which could lead to a hypertensive stroke
Autonomic dysreflexia
186
What can cause autonomic dysreflexia to occur
Distended bladder, constipation, painful stimuli
187
Assume c-spine injury is present until proven otherwise. How do we prove otherwise?
X-ray
188
How do you tell CSF from other drainage?
CSF will be positive for glucose
189
Halo test
bloody spot with a ring of CSF around it, which will look like a halo
190
Steroids ______ cerebral edema
decrease
191
Head injury patients need an _______ in calories
increase
192
Steroids increase breakdown of _____ and _______
protein, fat
193
If having CSF rhinorrhea, pt cannot have
NG feedings
194
Do not use restraints on a head injury pt, becuase they will make
ICP go up
195
Stimuli could promote a ______ in a head injured pt.
seizure
196
Earliest sign of increased ICP
change in LOC
197
In a profound coma, pupils will be
fixed and dilated
198
with seizures remember to
protect the airway, and cushion the head
199
Arched spine, plantar flexion, BAD
decerebrate posturing
200
arms flexed inwardly; legs extended with plantar flexion
decorticate posturing
201
weakness on one side of the body
hemiparesis
202
paralysis on one side of the body
hemiplegia
203
An osmotic diuretic used for tx of increased ICP
Mannitol
204
pulls fluid from brain cells and places it in the general circulation
Osmotic diuretics: Mannitol (Osmitrol)
205
As a result of using Mannitol, circulating blood volume _______. Since this increases blood volume, it _________ the workload of the heart
increases, increases
206
Increased blood volume from osmotic diuretic use, puts the pt at risk for
FVE (fluid volume excess)
207
To combat fluid volume excess with the use of Mannitol, ______ is often used to enhance diuresis
Lasix
208
Hyperventilation leads to alkalosis, which leads to brain vasoconstriction, which make ICP go
down
209
Keep PCO2 on the low side (35) with increased ICP. Do not lower too much, as it will cause too much vasoconstriction resulting in
decreased cerebral perfusion and brain ischemia
210
with increased ICP pt's, keep temperature below
104 degrees F
211
An increased temp will _______ cerebral metabolism, which will _______ ICP
increase, increase
212
Phenobarbital (Luminal) may be used with increased ICP to induce a _______, which will decrease cerebral metabolism
Coma
213
Restrict fluids to ______ to ______mL per day in a pt with increased ICP
1200 to 1500mL
214
Greatest risk of ICP monitoring devices
Infection
215
Where do most burns occur?
At home
216
Why does plasma seep out into the tissue
Increased capillary permeability
217
When does the majority of increased capillary permeability occur?
the 1st 24 hours after the injury
218
When does the pulse increase with burns?
anytime there is a fluid volume deficit
219
Why does cardiac output decrease with burns?
less volume to pump out
220
Why does urine output decrease with burns?
Kidneys are either trying to hold onto fluid or they aren't being perfused
221
Why is epinephrine secreted with burns?
To vasoconstrict, which shunts blood to vital organs
222
Aldosterone is secreted with burns to
retain sodium and H2O
223
ADH is secreted with burns to
retain H2O
224
ADH and aldosterone are secreted in order to help the blood volume
go up
225
What is the most common airway injury?
CO poisoning
226
CO has a much higher affinity for hemoglobin, therefore preventing ________ from binding
O2
227
When a client has burns to the neck/face/chest area, you better think what?
Airway compromise
228
What might you do prophylactically for someone with burns to the face/chest/neck area?
Intubate
229
Burns of head and neck %
9%
230
Burns of trunk, both front and back %
18% for each
231
Burns of each arm %
9%
232
Burns of genital area %
1%
233
Burns of each leg %
9%
234
Parkland Formula
(4ml of LR) X (body weight in kg) X (% of TBSA burned)= total fluid replacement for the first 24 hours after burn occured
235
give 1/2 of total volume for burns in the first _____ hours
eight
236
give 1/4 of total volume for burns in the ___________ hours
Second eight hours
237
give 1/4 of total volume for burns in the ___________
Third eight hours
238
Fluid replacement therapy for burns for the first 24 hours is based on the ______________, not when the treatment ________.
injury occured
| was started
239
Where do most burns occur?
At home
240
Why does plasma seep out into the tissue
Increased capillary permeability
241
When does the majority of increased capillary permeability occur?
the 1st 24 hours after the injury
242
Wrapping a burn pt in a blanket helps by
holding in body heat, and keeping out germs
243
Why does cardiac output decrease with burns?
less volume to pump out
244
Why does urine output decrease with burns?
Kidneys are either trying to hold onto fluid or they aren't being perfused
245
Why is epinephrine secreted with burns?
To vasoconstrict, which shunts blood to vital organs
246
Aldosterone is secreted with burns to
retain sodium and H2O
247
ADH is secreted with burns to
retain H2O
248
ADH and aldosterone are secreted in order to help the blood volume
go up
249
Sudden post-stroke changes in brain function may include confusion, disorientation, trouble speaking or physical stroke symptoms, such as sudden headache; difficulty walking; or numbness or paralysis on one side of the face or the body, are all symptoms of
vascular demential
250
CO has a much higher affinity for hemoglobin, therefore preventing ________ from binding
O2
251
When a client has burns to the neck/face/chest area, you better think what?
Airway compromise
252
What might you do prophylactically for someone with burns to the face/chest/neck area?
Intubate
253
Burns of head and neck %
9%
254
Burns of trunk, both front and back %
18% for each
255
Burns of each arm %
9%
256
Burns of genital area %
1%
257
give 1/2 of total volume for burns in the first _____ hours
eight
258
Burns of each leg %
9%
259
give 1/4 of total volume for burns in the ___________ hours
Second eight hours
260
give 1/4 of total volume for burns in the ___________
Third eight hours
261
Fluid replacement therapy for burns for the first 24 hours is based on the ______________, not when the treatment ________.
injury occured
| was started
262
Parkland Formula
(4ml of LR) X (body weight in kg) X (% of TBSA burned)= total fluid replacement for the first 24 hours after burn occured
263
Priority nursing goal for burns
Hypoxia
264
Which is used to determine if fluid volume replacement therapy for burns is adequate, weight or urine output?
Urine output
265
What will stop the burning process?
Cool H2O, for no more than 10 minutes
266
Wrapping a burn pt in a blanket helps by
holding in body heat, and keeping out germs
267
a chronic, progressive, degenerative disease accounting for 60% of the dementias occurring in people older than 65 years of age, eventually causing complete disorientation and total dependence on others for care.
Alzheimer’s disease
268
characterized by loss of memory, judgment, and visuospatial perception, and by a change in personality.
Alzheimer’s disease
269
The most important risk factors are age, female gender, and family history.
Alzheimer’s disease
270
```
Noxious stimuli is the cause
SCI T6 and above
Bradycardia
Severe HTN
Severe H/A
Flushing above the injury level
Cool below the injury level
Uninhibited SNS response to stimulus
```
Autonomic Dysreflexia
271
A condition in which a person has significant difficulty with daily functioning because of problems with thinking and memory
Demential
272
A decline in thinking skills caused by conditions that block or reduce blood flow to various regions of the brain, depriving brain cells of vital oxygen and nutrients
Vascular dementia
273
Sudden post-stroke changes in brain function may include confusion, disorientation, trouble speaking or physical stroke symptoms, such as sudden headache; difficulty walking; or numbness or paralysis on one side of the face or the body, are all symptoms of
vascular demential
274
Pooling of blood -decrease
venous return, decrease cardiac
output, hypotension,
bradycardia
Neurogenic Shock
275
Massive vasodilation caused by
inflammatory response of body
due to overwhelming infection
Septic Shock
276
```
Massive vasodilation,
suppression of the sympathetic
nervous system, injury/disease
to the spinal cord at T6, spinal
anesthesia
```
Causes of neurogenic shock
277
Poor trunk control from this spinal injury
T1-T8
278
Head and neck SCI
C1-C2
279
Diaphram SCI
C3
280
Deltoids, biceps SCI
C4-C5
281
Wrist extenders SCI
C6
282
Triceps SCI
C7-C8
283
Hand SCI
T1
284
Chest muscles SCI
T3-T7
285
Abdominal Muscles SCI
T7-T12
286
Leg muscles SCI
L1-L5
287
Bowel and bladder SCI
S1-S2
288
Sexual function SCI
S4
289
Heel of foot SCI
S1
290
Respiratory issues with this SCI
Thoracic
291
Bowel and bladder issues with this SCI
Sacral
292
Immediate after injury to 48 hours.
Total loss of motor/sensory below injury (flacid paralysis)
Spastic paralysis when resolved
Spinal Shock
293
This drug does not affect the metabolism of other drugs and is very suitable for adjunctive therapy
Gabapentin (Neurontin)
294
```
Noxious stimuli is the cause
SCI T6 and above
Bradycardia
Severe HTN
Severe H/A
Flushing above the injury level
Cool below the injury level
Uninhibited SNS response to stimulus
```
Autonomic Dysreflexia
295
```
Total loss of motion and sensation below the lesion
Flaccid paralysis
Bladder - bowel retention
Absent reflexes
Lasts days to weeks
```
Spinal Shock
296
MAP needs to be greater than or equal to ______ in pt's with SCI
85
297
Initial phase of rehab for SCI deals with
mobility and communication
298
Physical therapy for SCI focuses on
muscle strengthening
299
Occupational therapy for SCI works to
redevelop fine motor skills
300
Vocational therapy for SCI helps to get
potential work /employment capabilities
301
Recreational therapy for SCI
builds abilities to participate in recreational or athletic activities
302
How do antiepileptic (AEDs) work?
witnin a seizure focus, they suppress neuron discharge.
| Suppress progression of seizure activity from focus to other brain areas
303
How do AEDs achieve suppression of a seizure?
suppress sodium influx: reversibly bind to sodium channels producing prolonged channel inactivation, decreasing the ability of neurons to fire at high frequency.
Suppression of Calcium influx: transmitter release is promoted by influx of calcium through voltage-gated calcium channels. Drugs suppress this transmission by blocking calcium channels
Antagonism of Glutamate: in the central nervous system, glutamate is the primary excitatory transmitter. Drugs block the actions of glutamate and suppress excitation of neurons
304
Discontinuation of AEDs can be considered after pt has been seizure free for a minimum of
2 years
305
Most widely used AED.
Used to treat all forms of seizures except absence
Suppression of sodium influx that suppresses hyperactivity of the neurons.
Therapeutic levels are 10-20 mcg/mL
Phenytoin (Dilantin)
306
What meds cannot be taken with Phenytoin (Dilantin)?
Coumadin and Topamax
307
Used for partial and tonic-clonic seizures, but not effective against absence seizures.
Some consider this the first drug of choice for partial seizures
Carbamazepine (Tegretol)
308
Suppression of sodium influx that suppresses hyperactivity of neurons.
Grapefruit juice can increase peak and trough levels by 40%
Carbamazepine (Tegretol)
309
Treats a wide variety of seizure types.
Suppression of sodium influx that suppresses hyperactivity of neurons.
Suppression of calcium influx.
Increases inhibitory influence of GABA
Valproic Acid (Depakote)
310
Liver levels must be monitored and drug should not be given to those with pre-existing liver dysfunction.
Increases level of phenobarbital and phenytoin, combining drug with Topiramate (Topamax) can cause hyperammonemia
Valproic Acid (Depakote)
311
Used for partial and generalized seizures but not for absence seizures.
A barbiturate that causes generalized depression of CNS.
Binds to GABA receptors and potentiate effects of GABA
Phenobarbital
312
If used with valproic acid, it can increase plasma levels of phenobarbital by 40%, can cause a loss of therapeutic effects with drugs such as oral contraceptives and coumadin
Phenobarbital
313
Decreases the ability of neurons to fire at high frequency due to suppression of sodium influx.
This suppresses seizures that depend on high-frequency discharge
Oxcarbazepine (Trileptal)
314
Make oral contraceptives less effective. Can raise Phenytoin levels; phenytoin, phenobarbital, and carcamazepine can reduce levels of axcarbazepine; alcohol can increase effect; use with caution with diuretics
Oxcarbazepine (Trileptal)
315
Monotherapy in parital seizures and used in absence seizures
Decreases the ability of neurons to fire at high frequency due to suppression of sodium influx.
This suppresses seizures that depend on high-frequency discharge.
Blockade of calcium channels
Lamotrigine (Lamictal)
316
Adjunctive use in partial seizures and is recommended for monotherapy for partial seizures.
Analog of GABA but does not directly affect GABA
Gabapentin (Neurontin)
317
This drug does not affect the metabolism of other drugs and is very suitable for adjunctive therapy
Gabapentin (Neurontin)
318
Adjunctive therpy of partial seizures
Binds with calcium channel blockers on nerve terminals and inhibits calcium reflex.
Inhibits release of glutamate, norepinephrine, and substance P.
Analog of GABA.
Pregabalin (Lyrica)
319
Alcohol, opioids, benzodiazepines, and other CNS depressants intensify depressant effects
Pregabalin (Lyrica)
320
Adjunctive therapy for myoclonic seizures partial-onset seizures, and primary generalized tonic-clonic seizures.
Does not bind to any known transmitter and action is unknown.
ALL BRAIN TUMOR PTs GET THIS
Levetiracetam (Keppra)
321
Adjunctive therapy for primary generalized tonic-clonic seizures and seizures associated with Lennox-Gastaut syndrome.
Monotherapy of partial seizures or primary generalized tonic-clonic seizures.
GABA mediated inhibition.
Suppression of sodium influx.
Blocks calcium channels.
Blocks gutamate.
Topiramate (Topamax)
322
Phenytoin and carbamazepine can decrease the levels of this drug by 45% and this drug increases phenytoin levels
Topiramate (Topamax)
323
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Used to stop seizure but not used for maintenance anticonvulsant therapy.
Includes lorazepam (Ativan) and diazepam (Valium).
Depress neuronal function in multiple areas of the CNS.
Enhance GABA
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Benzodiazepines
324
Albumin holds onto _______ in the _______space
Fluid, Vascular
325
Albumin ________ vascular volume
Increases
326
Albumin ________ kidney perfusion
Increases
327
Albumin _________ BP
Increases
328
Albumin _______ cardiac output
Increases
329
Albumin corrects a fluid volume deficit by putting more fluid in the __________________
Vascular space
330
Albumin ________ the workload of the heart
Increases
331
If you stress the heart too much, the client could be thrown into ______________
Fluid volume excess
332
If fluid volume excess occurs, cardiac output will _______-
Decrease
333
With fluid volume excess, lung sounds will be _____
Wet
334
How can you ensure that you are not fluid overloading a patient?
Use CVP. It looks at the right atrial pressure. If increased too high, too fast, it can create right sided heart failure
335
Takes 2 to 4 weeks to develop their own immunity from this. (Active immunity)
Tetanus Toxoid
336
Provides immediate protection (passive immunity)
Immune globulin
337
Things to check for circulation (four things)
Pulse
Cap refill
Skin color
Skin temp
338
Relieves the pressure and restores the circulation, cut through the eschar
Escharotomy
339
Relieves the pressure and restores the circulation, but the cut is much deeper into the tissue, cut goes through the eschar and the fascia
Fasciotomy
340
Measure urine output via foley catheter every _______ for a burn patient
Hour
341
What are two reasons why no urine will return when inserting a catheter in a burn patient?
The kidneys are either attempting to hold on to the fluid or they are not being perfused adequately
342
What would you do if you saw brown or red urine with a burn patient?
Call the MD
343
What drug may be used to flush out the kidneys in a burn patient?
Mannitol (Osmotic diuretic)
344
What would you worry about if there is no urine output or if it is lessthan 30mL/hr, in a burn patient?
Kidney failure
345
After 48 hours, the burn patient will begin to diurese. Why?
Because fluid is going back into the vascular space. This can lead to fluid volume excess
346
When a burn patient begins to diurese, what will happen to urine output?
It will increase
347
Where do we find most of our K+?
Inside the cell
348
What happens to cells in burns
They rupture or lyse
349
Because of cell rupture or lysing in burns, what happens to the number of K+ ions in the serum (vascular space)?
They increase
350
Burns can lead to _________, due to an increase in the number of K+ ions in the vascular space
Hyperkalemia
351
Why are things like Mylanta, Protonix, and Pepcid ordered for burn patients?
To prevent a stress ulcer (Curlings Ulcer)
352
Aluminum Hydroxide Gel (Amphogel), Magnesium Hydroxide (Milk of Magnesium) are examples of
Antacids
353
Ranitidine (Zantac), Famotidine (Pepcid), Nizatidine (Axid), are all examples of
H2 Antagonists
354
Pantoprazole (Protonix), Esomeprazole (Nexium), are examples of
Proton Pump Inhibitors
355
Why would you want to make a burn patient NPO and have an NG tube hooked to suction?
To avoid developing a paralytic ilius
356
Causes of a paralytic ilius in burn patients include:
Decreased vascular volume, which leads to shunting.
Decreased GI motility during times of stress
Hyperkalemia
357
Burn patients need ______ calories. They need to have lots of _______ and __________.
More
| Protein and Vitamin C
358
When would you remove an NG tube?
When you hear bowel sounds
359
How can you ensure that a GI feeding is moving through the GI tract?
Check residuals (always put back in after measuring)
360
What labs might you order to check proper nutrition is being achieved and a proper nitrogen balance?
Pre-albumin, Total protein, and Albumin
361
A negative nitrogen balance indicates
poor nutrition
362
Formally called first degree burn; damage only to epidermis
Superficial thickness
363
formally called second degree burn; damage to entire epidermis and varying depths of the dermis
Partial thickness
364
Formally called third degree burn; damage to entire dermis and sometimes fat
Full-thickness
365
When hands are burned, it is important to remember to
wrap each finger separately.
| Use splints to prevent contractures
366
The number one complication with a perineal burn is ____
Infection
367
Dead tissue in a burn is called ______
Eschar
368
If eschar is not removed, can tissue regenerate?
No
369
Burn patients need to be on what kind of isolation?
Protective Isolation
370
What do enzymatic drugs do?
Eat dead tissue
371
Sutilanis (Travase) and Collagenase (Santyl) are examples of
Enzymatic drugs
372
Don't use these on the face, don't use if pregnant, don't use over large nerves, don't use if area is opened to a body cavity
Enzymatic drugs
373
Biggest worry with hydrotherapy in burns
Cross contamination
374
Soothing, apply directly, if it rubs off apply more, can lower the WBC, can cause a rash
Silver Sulfadiazine (Silvadene)
375
Can cause acid base problems, stings, if it rubs off apply more
Mafenide Acetate (Sulfamylon)
376
Keep these dressings wet; can cause electrolyte problems
Silver Nitrate
377
Stings, stains, allergies, acid-base problems
Povidone-Iodine (Betadine)
378
Why should antibiotic drugs be alternated?
To avoid bacteria from building resistance or tolerance
379
Broad spectrum antibiotics may be used until
the wound cultures have come back
380
When giving MYCIN drugs, worry about
the clients BUN and creatinine. Specifically if they increase, or if the client c/o any hearing loss
381
Irreversible hearing loss
Ototoxicity
382
Can occur from mycin drugs
ototoxicity and nephrotoxicity
383
A donor site may have a transparent dressing placed until bleeding stops, but otherwise the donor site can be
left open to air
384
Donor sites for grafting can be reharvested every _______ in a well nourished client
12 to 14 days
385
If a skin graft site should become blue or cool, what would this mean?
Poor circulation
386
Sometime a Q-tip needs to be rolled over a graft from the middle to the edges in order to
get the exudate out so that the graft can adhere
387
Flush a chemical burn with ______ for ________ minutes
H2O, 15-20 minutes
388
Electrical burns have two wounds. They are _______
entry and exit wound. Exit wound will be worse
389
First thing to do for an electrical injury
Place on a cardiac monitor for 24 hours due to high risk of V-fib
390
With electrical burns, myoglobin and hemoglobin can build up and cause ______
Kidney damage
391
Affects all innervation below the level of the lesion
Complete
392
Some fibers are still intact and can communicate messages up or down the cord
Incomplete SCI
393
Lesion affects upper extremities
Central cord injury
394
Lose motor pain and temp. Proprioception vibration and touch remain intact
Anterior cord injury
395
Ipsilateral loss of motion position and vibration on same side of injury. Loss of pain and temp on opposite side
Brown-Sequard lesion
396
Keep pt aligned and down in bed away from pulley with
Gardner-Wells tongs
397
Lesions in brain and spinal cord are called
Upper lesions
398
Peripheral lesions are called
Lower motor lesions
