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Nursing > U2 Resp/Neuro > Flashcards

U2 Resp/Neuro Flashcards

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1
Q

Transient Ischemic Attack (TIA) duration

A

Few minutes to <24 hrs

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2
Q

Reversible Ischemic Neurologic Deficit (RIND) duration

A

> 24 hours but less than 1 wk

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3
Q

Cause of stroke

A

Change in the normal blood supply to the brain

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4
Q

Occlusive stroke

A

Arterial blockage or narrowing cause ischemia in the brain tissue

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5
Q

Ischemic stroke

A

Occlusion of a cerebral artery by thrombus or embolus
Embolic stroke associated with atrial fibrillation
Tend to occur during sleep

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6
Q

Hemorrhagic stroke

A

Bleeding within or around the brain

Tend to occur during activity

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7
Q

Intracerebral hemorrhage

A

Bleeding into the brain tissue resulting from severe HTN

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8
Q

Ischemic stroke IV therapy

A

2 IV lines with nondextrose, isotonic saline

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9
Q

Primary nursing role for stroke

A

Monitor for increasing ICP

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10
Q

Treatment for stroke

A

Fibrinolytic therapy

Endovascular interventions

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11
Q

Eligibility for rtPA

A

3 hours from time last seen normal

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12
Q

Expanded time interval for rtPA

A

3-4.5 hours from time LSN

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13
Q

Categories to extend time interval for rtPA

A

Age older than 80
Anticoagulation with INR < or = 1.7
NIHSS > 25
History of both stroke & diabetes

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14
Q

Aneurysm

A

Abnormal balooning or blister along a normal artery

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15
Q

Congenital aneurysm

A

Defect in the media & elastica of the vessel wall

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16
Q

Dissecting aneurysm

A

Occurs following trauma or plaque formation

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17
Q

Arteriovenous malformation

A

Developmental abnormality resulting in a tangled mass of malformed, thin-walled, dilated vessels
Abnormal communication between arterial & venous systems

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18
Q

Ischemic or occlusive stroke CT

A

Usually initially negative; purpose is to identify presence of cerebral hemorrhage

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19
Q

Ischemic or occlusive stroke CT 24hrs +

A

Progressive changes of ischemia, infarction, & cerebral edema

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20
Q

Ischemic or occlusive stroke MRI

A

Presence of edema, ischemia, & tissue necrosis earlier than CT scan

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21
Q

Fibrinolytic therapy

A

Dissolves the cerebral artery occlusion to re-establish blood flow & prevent cerebral infarction

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22
Q

Most common complication of stroke

A

Increased ICP during 1st 72 hrs after stroke

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23
Q

Carotic endarterectomy

A

Remove atherosclerotic plauqe
Re-establish blood flow
Decrease stroke risk

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24
Q

Aneurysm interventional therapy

A

Block abnormal arteries or veins

Prevent bleeding from vascular lesions of aneurysm

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25
Q

Aneurysm pt monitoring

A

S/S of hydrocephalus & vasospasm

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26
Q

Primary brain damage

A

Occurs at time of injury

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27
Q

Secondary injury

A

Processes that occur after the initial injury from physiologic, vascular, & biochemical events

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28
Q

Open head injury

A

Occurs with skull fracture or piercing by penetrating object

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29
Q

Closed head injury

A

Result of blunt trauma

More serious

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30
Q

Most common responses to head injury

A

Hypotension
Hypoxia
Ischemia
Edema

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31
Q

Leading cause of death in pts with brain injury

A

Increased ICP

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32
Q

Cushing’s triad

A

Severe hypertension
Widened pulse pressure
Bradycardia

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33
Q

Uncal herniation

A

Shifting of one or both areas of the temporal lobe

Life-threatening

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34
Q

Brain injury CT

A

Identifies extend & scope of injury

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35
Q

Brain injury MRI

A

Diagnosis of diffuse axonal injury

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36
Q

Brain injury nursing priorities

A

Maintaining patent ABCs
Preventing or detecting increased ICP
Promoting F/E balance
Monitoring effects of treatments & drug therapy

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37
Q

Criteria for brain death diagnosis

A

Coma of known cause
Normal or near-normal core body temperature
Normal systolic blood pressure (> or = 100)
At least 1 neurologic exam

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38
Q

Primary brain tumor

A

Originate within CNS

Rarely metastasize

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39
Q

Secondary brain tumor

A

Result from metastasis from other areas of the body

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40
Q

Effects of tumor on brain tissue

A

Expands & invades
Infiltrates
Compresses
Displaces

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41
Q

Complications of brain tumor

A 
Cerebral edema
Increased ICP
Neurologic defects
Hydrocephalus
Pituitary dysfunction
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42
Q

Brain tumor postop care

A

Monitor pt to detect changes in status

Prevent or minimize complications, esp increased ICP

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43
Q

Brain abscess

A

Purulent infection of brain in which pus forms in the extradural, subdural, or intracerebral area of the brain

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44
Q

Brain abscess manifestations

A

Begin slowly
Headache
Fever
Neurologic deficits

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45
Q

Brain abscess CT

A

Determines presence of cerebritis, hydrocephalus, or midline shift

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46
Q

Brain abscess MRI

A

Detects presence of abscess early in the course

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47
Q

Brain abscess EEG

A

Localize the lesion in most cases

High-voltage, slow-wave activity, or electrocerebral silence may be noted in area of abscess

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48
Q

Brain abscess treatment

A

Systemic antibiotic therapy

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49
Q

Brain abscess surgical treatment

A

Surgically draining encapsulated abscess via burr hole to reduce the mass effect of the lesion

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50
Q

Neurologic deficit nursing priority

A

Help pt achieve the highest level of functioning

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51
Q

1st sign of increased ICP

A

Decreased LOC

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52
Q

Pulmonary embolism

A

Collection of particulate matter that enters venous circulation & lodges in pulmonary vessels

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53
Q

Effect of large emboli

A

Obstruct pulmonary blood flow
Leads to reduced oxygenation of the whole body
Pulmonary tissue hypoxia

54
Q

Risk factors for DVT

A 
Prolonged immobility
Central venous catheters
Surgery
Obesity
Advancing age
Increased blood clotting 
Hx of thromboembolism
55
Q

Pulmonary embolism S/S

A 
Difficulty breathing
Rapid heart rate
Pleuritic chest pain
Distended neck veins
Syncope
Cyanosis
Hypotension
56
Q

Notify Rapid Response if:

A

Pts with sudden onset of dyspnea & chest pain

57
Q

Heparin antidote

A

Protamine sulfate

58
Q

Warfarin antidote

A

Phytonadione (Vit K)

59
Q

PE pt teaching

A

Ways to promote venous return

Avoiding venous thromboembolism

60
Q

Need for O2 therapy

A

Acute hypoxemia

Keep CO2 >60

61
Q

PE surgical procedures

A

Embolectomy

Inferior vena cava interruption

62
Q

Acute respiratory failure

A

PaO2 < 90%

PaCO2 >50 occuring with acidemia

63
Q

Ventilatory failure

A

Ventilation perfusion mismatch

Perfusion is normal, but ventilation is inadequate

64
Q

Hallmark of respiratory failure

A

Dyspnea

65
Q

Respiratory failure assessment

A 
Dyspnea
Change in respiratory rate or pattern 
Change in lung sounds
Manifestations of hypoxemia
Hypercarbia
66
Q

ARDS

A 
Acute resp failure w/ 
Hypoxemia even with 100% O2
Decreased pulmonary compliance
Dyspnea
Bilateral pulmonary edema
Dense pulmonary infiltrates on x-ray
67
Q

Transfusion-related lung injury

A

Pulmonary edema associated with inflammatory response due to plasma-containing transfusions

68
Q

ARDS causes

A 
Direct injury to lung tissue
Head or spinal trauma
Strokes
Tumors
Increased CSF
69
Q

Prevention of ARDS

A

Early recognition of pts at high risk

70
Q

ARDS assessment

A 
Increased work to breath
Hyperpnea
Grunting respiration
Cyanosis
Pallor
Intercostal or substernal retractions
Sweating
Change in mental status
71
Q

ARDS diagnosis

A

Lowered PaO2
Widening alveolar O2 gradient
Whited-out appearance to chest x-ray
No cardiac involvement on ECG

72
Q

Need for aspiration precautions

A

Altered LOC
Poor gag reflex
Neurologic impairment
ET tube

73
Q

ARDS hourly assessment

A 
O2 sat
Vital sign changes
Indication of increased work of breathing
     Cyanosis
     Pallor
     Retractions
74
Q

Alternatives to mechanical ventilation

A

Airway pressure-release ventilation (APRV)

High-frequency oscillatory ventilation

75
Q

Mechanical ventilation

A

Usually temporary

Lifelong for pts with severe restrictive lung disease & chronic, progressive neuromuscular disease

76
Q

Mechanical ventilation uses

A

Pts with hypoxemia & progressive alveolar hypoventilation with resp acidosis

77
Q

Tracheostomy

A

Recommended if pt needs airway for longer than 10-14 days

78
Q

Goals of intubation

A

Maintain patent airway
Provide a means to remove secretions
Provide ventilation & O2

79
Q

3 ways inspiration is cycled

A

Pressure-cycled
Time-cycled
Volume-cycled

80
Q

Complications inhibiting weaning

A

Age-related changes
Increased chest wall stiffness
Reduced ventilatory muscle strength
Decreased lung elasticity

81
Q

Emergency approach to chest injury

A

ABCs
Rapid assessment
Treatment of life-threatening conditions

82
Q

Pulmonary contusion

A

Most common chest injury
Occurs with injuries caused by rapid deceleration
Respiratory failure develops over time

83
Q

Pulmonary contusion causes

A

Follows injuries caused by rapid deceleration during vehicular accidents
Hemorrhage occurs in & between the alveoli

84
Q

Rib fractures

A

Results from direct blunt trauma to the chest

Direct force drives bone ends into the chest

85
Q

Rib fractures complications

A

Deep chest injury
Pulmonary contusion
Pneumothorax
Hemothorax

86
Q

Chest trauma assessment

A

Tracheal position

Bilateral breath sounds

87
Q

Chest trauma intervention

A

Encourage deep breaths

88
Q

Flail chest

A

Inward movement of thorax during inspiration

Outward movement during expiration

89
Q

Flail chest common cause

A

High-speed vehicular crashes
More common in elderly
High mortality rate

90
Q

Pneumothorax

A

Caused by blunt chest trauma
Allows air to enter the pleural space
Causes rise in chest pressure & reduction in vital capacity

91
Q

Tension pneumothorax

A

Rapidly developing
Life-threatening
Complication of blunt chest trauma
Air leak in lung or chest wall

92
Q

Effects of tension pneumothorax

A

Collapsed affected lung
Compressed blood vessels
Limited venous return
Decreased filling of the heart & decreased cardiac output

93
Q

Cause of bleeding in hemothorax

A

Injury to lung tissue (lung contusions or lacerations)

Rib & sternal fractures

94
Q

Causes of tears of tracheobronchial tree

A

Severe blunt trauma

Rapid deceleration involving mainstem bronchi

95
Q

TIA deficits

A

Blurred vision, double vision, blindness in one eye, tunnel vision
Weakness, gait disturbance
Numbness in extremities, vertigo
Aphasia, dysarthria (slurred speech)

96
Q

Stroke assessment

A

Aphasia (speech), alexia (written), agraphia (can’t write)
Hemiplegia & hemiparesis, hypotonia, flaccid paralysis
Agnosia (recognizing common objects), apraxia (learned movements), neglect syndrome, ptosis

97
Q

Right hemispheric damage

A

Difficulty performing ADLs & ambulation

98
Q

Left hemispheric damage

A

Memory deficits

Changes in ability to carry out simple tasks

99
Q

Right hemispheric damage interventions

A

Frequent verbal & tactile cues
Approach from unaffected side
Patch over eye for double vision

100
Q

Left hemispheric damage interventions

A

Assist with memory problems
Establish a consistent routine or schedule
Ask family to bring pictures or other familiar things

101
Q

Expressive aphasia (Broca’s)

A

Pt understands what is said, but cannot communicate verbally & has trouble writing

102
Q

Receptive aphasia (Wernicke’s)

A

Pt can’t understand spoken or written word

Speech is often meaningless

103
Q

Global aphasia

A

Profound speech & language problems

No speech or sounds that can be understood

104
Q

Brain injury S/S

A 
Amnesia
Seizure
Loss of consciousness
Restlessness
Personality changes
105
Q

Severe head injury S/S

A 
Pupil changes 
Bradycardia
High blood pressure/widened pulse pressure
Tachycardia (hypovolemic shock)
CSF leak
106
Q

Linear fracture

A

Clean break

Impacted area bends inward & surrounding area bends outward

107
Q

Depressed fracture

A

Bone is pressed inward into the brain to at least the thickness of the skull

108
Q

Comminuted fracture

A

Fragmentation of the bone with depression of bone into brain tissue

109
Q

Normal ICP level

A

10-15 mmHg

110
Q

Epidural hematoma

A

Results from arterial bleeding into the space between the dura & inner skull
Neurosurgical emergency

111
Q

Hydrocephalus

A

Abnormal increase in CSF volume

Leads to increased ICP if not treated

112
Q

Brain death criteria

A 
Glasgow coma scale <3
Apnea
No pupil response
No gag reflex
No oculovestibular reflex (cold water in ears)
No oculocephalic reflex (dolls eyes)
113
Q

Mannitol

A

Osmotic diuretic–pulls water off of brain

Requires filter in tubing or filtered needle

114
Q

Ventilatory Failure

Extrapulmonary Causes

A 
Neuromuscular disorders (myasthenia gravis, Gluillain-Barre Syndrome)
Spinal cord injuries
CNS dysfunction (stroke, meningitis)
Chemical depression (opioid analgesics, sedatives)
115
Q

Ventilatory Failure

Intrapulmonary Causes

A

Airway disease (COPD, asthma)
Pulmonary embolism
Pneumothorax
ARDS

116
Q

Oxyenation failure

A

Air moves in & out without difficulty, but does not oxygenate the pulmonary blood sufficiently
Ventilation is normal, but lung perfusion is decreased

117
Q

Oxygenation failure causes

A 
Pneumonia
High altitudes
CO poisoning
Pulmonary embolism
CHF with pulmonary edema
ARDS
118
Q

Assist-control ventilation

A

Ventilator takes over breathing for the pt

Tidal volume & ventilatory rate are preset

119
Q

Synchronized intermittent mandatory ventilation (SIMV)

A

Tidal volume & ventilatory rate are preset

Allows spontaneous breathing at pt’s own rate

120
Q

BiPAP

A

Ventilator provides a preset inspiratory pressure & expiratory pressure similar to positive end expository pressure (PEEP)

121
Q

Tidal volume

A

Volume of air the pt receives with each breath

Average is 7-10 mL/kg

122
Q

FiO2

A

Oxygen level delivered to the pt

123
Q

Peak inspiratory pressure (PIP)

A

Pressure needed by ventilator to deliver a set tidal volume at a given lung compliance
Highest pressure reached during inspiration

124
Q

Continuous positive airway pressure (CPAP)

A

Applies positive airway pressure throughout entire respiratory cycle
Keeps alveoli open during inspiration

125
Q

Positive end expiratory pressure (PEEP)

A

Positive pressure exerted during expiratory phase
Enhances gas exchange
Prevents atelectasis

126
Q

Reasons to suction

A

Secretions
Increased PIP
Rhonchi (wheezes)
Decreased breath sounds

127
Q

Barotrauma

A

Damage to lungs by positive pressure
Pneumothorax
Subcutaneous emphysema

128
Q

Volutrauma

A

Damage to the lung by excess volume delivered to one lung over the other

129
Q

Pulmonary contusion

A

Bloody sputum
Decreased breath sounds
Crackles & wheezes

130
Q

Pneumothorax assessment

A

Reduced breath sounds
Hyper-resonance on percussion
Deviation of trachea away from or toward the affected side

131
Q

Tension pneumothorax intervention

A

Large bore needle into 2nd intercostal space in mid-clavicular line of affected side
Chest tube placed later into 4th intercostal space

Nursing (9 decks)

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