U2 Resp/Neuro Flashcards
1
Q
Transient Ischemic Attack (TIA) duration
A
Few minutes to <24 hrs
2
Q
Reversible Ischemic Neurologic Deficit (RIND) duration
A
> 24 hours but less than 1 wk
3
Q
Cause of stroke
A
Change in the normal blood supply to the brain
4
Q
Occlusive stroke
A
Arterial blockage or narrowing cause ischemia in the brain tissue
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
6
Q
Hemorrhagic stroke
A
Bleeding within or around the brain
Tend to occur during activity
7
Q
Intracerebral hemorrhage
A
Bleeding into the brain tissue resulting from severe HTN
8
Q
Ischemic stroke IV therapy
A
2 IV lines with nondextrose, isotonic saline
9
Q
Primary nursing role for stroke
A
Monitor for increasing ICP
10
Q
Treatment for stroke
A
Fibrinolytic therapy
Endovascular interventions
11
Q
Eligibility for rtPA
A
3 hours from time last seen normal
12
Q
Expanded time interval for rtPA
A
3-4.5 hours from time LSN
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
14
Q
Aneurysm
A
Abnormal balooning or blister along a normal artery
15
Q
Congenital aneurysm
A
Defect in the media & elastica of the vessel wall
16
Q
Dissecting aneurysm
A
Occurs following trauma or plaque formation
17
Q
Arteriovenous malformation
A
Developmental abnormality resulting in a tangled mass of malformed, thin-walled, dilated vessels
Abnormal communication between arterial & venous systems
18
Q
Ischemic or occlusive stroke CT
A
Usually initially negative; purpose is to identify presence of cerebral hemorrhage
19
Q
Ischemic or occlusive stroke CT 24hrs +
A
Progressive changes of ischemia, infarction, & cerebral edema
20
Q
Ischemic or occlusive stroke MRI
A
Presence of edema, ischemia, & tissue necrosis earlier than CT scan
21
Q
Fibrinolytic therapy
A
Dissolves the cerebral artery occlusion to re-establish blood flow & prevent cerebral infarction
22
Q
Most common complication of stroke
A
Increased ICP during 1st 72 hrs after stroke
23
Q
Carotic endarterectomy
A
Remove atherosclerotic plauqe
Re-establish blood flow
Decrease stroke risk
24
Q
Aneurysm interventional therapy
A
Block abnormal arteries or veins
Prevent bleeding from vascular lesions of aneurysm
25
Aneurysm pt monitoring
S/S of hydrocephalus & vasospasm
26
Primary brain damage
Occurs at time of injury
27
Secondary injury
Processes that occur after the initial injury from physiologic, vascular, & biochemical events
28
Open head injury
Occurs with skull fracture or piercing by penetrating object
29
Closed head injury
Result of blunt trauma
| More serious
30
Most common responses to head injury
Hypotension
Hypoxia
Ischemia
Edema
31
Leading cause of death in pts with brain injury
Increased ICP
32
Cushing's triad
Severe hypertension
Widened pulse pressure
Bradycardia
33
Uncal herniation
Shifting of one or both areas of the temporal lobe
| Life-threatening
34
Brain injury CT
Identifies extend & scope of injury
35
Brain injury MRI
Diagnosis of diffuse axonal injury
36
Brain injury nursing priorities
Maintaining patent ABCs
Preventing or detecting increased ICP
Promoting F/E balance
Monitoring effects of treatments & drug therapy
37
Criteria for brain death diagnosis
Coma of known cause
Normal or near-normal core body temperature
Normal systolic blood pressure (> or = 100)
At least 1 neurologic exam
38
Primary brain tumor
Originate within CNS
| Rarely metastasize
39
Secondary brain tumor
Result from metastasis from other areas of the body
40
Effects of tumor on brain tissue
Expands & invades
Infiltrates
Compresses
Displaces
41
Complications of brain tumor
```
Cerebral edema
Increased ICP
Neurologic defects
Hydrocephalus
Pituitary dysfunction
```
42
Brain tumor postop care
Monitor pt to detect changes in status
| Prevent or minimize complications, esp increased ICP
43
Brain abscess
Purulent infection of brain in which pus forms in the extradural, subdural, or intracerebral area of the brain
44
Brain abscess manifestations
Begin slowly
Headache
Fever
Neurologic deficits
45
Brain abscess CT
Determines presence of cerebritis, hydrocephalus, or midline shift
46
Brain abscess MRI
Detects presence of abscess early in the course
47
Brain abscess EEG
Localize the lesion in most cases
| High-voltage, slow-wave activity, or electrocerebral silence may be noted in area of abscess
48
Brain abscess treatment
Systemic antibiotic therapy
49
Brain abscess surgical treatment
Surgically draining encapsulated abscess via burr hole to reduce the mass effect of the lesion
50
Neurologic deficit nursing priority
Help pt achieve the highest level of functioning
51
1st sign of increased ICP
Decreased LOC
52
Pulmonary embolism
Collection of particulate matter that enters venous circulation & lodges in pulmonary vessels
53
Effect of large emboli
Obstruct pulmonary blood flow
Leads to reduced oxygenation of the whole body
Pulmonary tissue hypoxia
54
Risk factors for DVT
```
Prolonged immobility
Central venous catheters
Surgery
Obesity
Advancing age
Increased blood clotting
Hx of thromboembolism
```
55
Pulmonary embolism S/S
```
Difficulty breathing
Rapid heart rate
Pleuritic chest pain
Distended neck veins
Syncope
Cyanosis
Hypotension
```
56
Notify Rapid Response if:
Pts with sudden onset of dyspnea & chest pain
57
Heparin antidote
Protamine sulfate
58
Warfarin antidote
Phytonadione (Vit K)
59
PE pt teaching
Ways to promote venous return
| Avoiding venous thromboembolism
60
Need for O2 therapy
Acute hypoxemia
| Keep CO2 >60
61
PE surgical procedures
Embolectomy
| Inferior vena cava interruption
62
Acute respiratory failure
PaO2 < 90%
| PaCO2 >50 occuring with acidemia
63
Ventilatory failure
Ventilation perfusion mismatch
| Perfusion is normal, but ventilation is inadequate
64
Hallmark of respiratory failure
Dyspnea
65
Respiratory failure assessment
```
Dyspnea
Change in respiratory rate or pattern
Change in lung sounds
Manifestations of hypoxemia
Hypercarbia
```
66
ARDS
```
Acute resp failure w/
Hypoxemia even with 100% O2
Decreased pulmonary compliance
Dyspnea
Bilateral pulmonary edema
Dense pulmonary infiltrates on x-ray
```
67
Transfusion-related lung injury
Pulmonary edema associated with inflammatory response due to plasma-containing transfusions
68
ARDS causes
```
Direct injury to lung tissue
Head or spinal trauma
Strokes
Tumors
Increased CSF
```
69
Prevention of ARDS
Early recognition of pts at high risk
70
ARDS assessment
```
Increased work to breath
Hyperpnea
Grunting respiration
Cyanosis
Pallor
Intercostal or substernal retractions
Sweating
Change in mental status
```
71
ARDS diagnosis
Lowered PaO2
Widening alveolar O2 gradient
Whited-out appearance to chest x-ray
No cardiac involvement on ECG
72
Need for aspiration precautions
Altered LOC
Poor gag reflex
Neurologic impairment
ET tube
73
ARDS hourly assessment
```
O2 sat
Vital sign changes
Indication of increased work of breathing
Cyanosis
Pallor
Retractions
```
74
Alternatives to mechanical ventilation
Airway pressure-release ventilation (APRV)
| High-frequency oscillatory ventilation
75
Mechanical ventilation
Usually temporary
| Lifelong for pts with severe restrictive lung disease & chronic, progressive neuromuscular disease
76
Mechanical ventilation uses
Pts with hypoxemia & progressive alveolar hypoventilation with resp acidosis
77
Tracheostomy
Recommended if pt needs airway for longer than 10-14 days
78
Goals of intubation
Maintain patent airway
Provide a means to remove secretions
Provide ventilation & O2
79
3 ways inspiration is cycled
Pressure-cycled
Time-cycled
Volume-cycled
80
Complications inhibiting weaning
Age-related changes
Increased chest wall stiffness
Reduced ventilatory muscle strength
Decreased lung elasticity
81
Emergency approach to chest injury
ABCs
Rapid assessment
Treatment of life-threatening conditions
82
Pulmonary contusion
Most common chest injury
Occurs with injuries caused by rapid deceleration
Respiratory failure develops over time
83
Pulmonary contusion causes
Follows injuries caused by rapid deceleration during vehicular accidents
Hemorrhage occurs in & between the alveoli
84
Rib fractures
Results from direct blunt trauma to the chest
| Direct force drives bone ends into the chest
85
Rib fractures complications
Deep chest injury
Pulmonary contusion
Pneumothorax
Hemothorax
86
Chest trauma assessment
Tracheal position
| Bilateral breath sounds
87
Chest trauma intervention
Encourage deep breaths
88
Flail chest
Inward movement of thorax during inspiration
| Outward movement during expiration
89
Flail chest common cause
High-speed vehicular crashes
More common in elderly
High mortality rate
90
Pneumothorax
Caused by blunt chest trauma
Allows air to enter the pleural space
Causes rise in chest pressure & reduction in vital capacity
91
Tension pneumothorax
Rapidly developing
Life-threatening
Complication of blunt chest trauma
Air leak in lung or chest wall
92
Effects of tension pneumothorax
Collapsed affected lung
Compressed blood vessels
Limited venous return
Decreased filling of the heart & decreased cardiac output
93
Cause of bleeding in hemothorax
Injury to lung tissue (lung contusions or lacerations)
| Rib & sternal fractures
94
Causes of tears of tracheobronchial tree
Severe blunt trauma
| Rapid deceleration involving mainstem bronchi
95
TIA deficits
Blurred vision, double vision, blindness in one eye, tunnel vision
Weakness, gait disturbance
Numbness in extremities, vertigo
Aphasia, dysarthria (slurred speech)
96
Stroke assessment
Aphasia (speech), alexia (written), agraphia (can't write)
Hemiplegia & hemiparesis, hypotonia, flaccid paralysis
Agnosia (recognizing common objects), apraxia (learned movements), neglect syndrome, ptosis
97
Right hemispheric damage
Difficulty performing ADLs & ambulation
98
Left hemispheric damage
Memory deficits
| Changes in ability to carry out simple tasks
99
Right hemispheric damage interventions
Frequent verbal & tactile cues
Approach from unaffected side
Patch over eye for double vision
100
Left hemispheric damage interventions
Assist with memory problems
Establish a consistent routine or schedule
Ask family to bring pictures or other familiar things
101
Expressive aphasia (Broca's)
Pt understands what is said, but cannot communicate verbally & has trouble writing
102
Receptive aphasia (Wernicke's)
Pt can't understand spoken or written word
| Speech is often meaningless
103
Global aphasia
Profound speech & language problems
| No speech or sounds that can be understood
104
Brain injury S/S
```
Amnesia
Seizure
Loss of consciousness
Restlessness
Personality changes
```
105
Severe head injury S/S
```
Pupil changes
Bradycardia
High blood pressure/widened pulse pressure
Tachycardia (hypovolemic shock)
CSF leak
```
106
Linear fracture
Clean break
| Impacted area bends inward & surrounding area bends outward
107
Depressed fracture
Bone is pressed inward into the brain to at least the thickness of the skull
108
Comminuted fracture
Fragmentation of the bone with depression of bone into brain tissue
109
Normal ICP level
10-15 mmHg
110
Epidural hematoma
Results from arterial bleeding into the space between the dura & inner skull
Neurosurgical emergency
111
Hydrocephalus
Abnormal increase in CSF volume
| Leads to increased ICP if not treated
112
Brain death criteria
```
Glasgow coma scale <3
Apnea
No pupil response
No gag reflex
No oculovestibular reflex (cold water in ears)
No oculocephalic reflex (dolls eyes)
```
113
Mannitol
Osmotic diuretic--pulls water off of brain
| Requires filter in tubing or filtered needle
114
Ventilatory Failure
| Extrapulmonary Causes
```
Neuromuscular disorders (myasthenia gravis, Gluillain-Barre Syndrome)
Spinal cord injuries
CNS dysfunction (stroke, meningitis)
Chemical depression (opioid analgesics, sedatives)
```
115
Ventilatory Failure
| Intrapulmonary Causes
Airway disease (COPD, asthma)
Pulmonary embolism
Pneumothorax
ARDS
116
Oxyenation failure
Air moves in & out without difficulty, but does not oxygenate the pulmonary blood sufficiently
Ventilation is normal, but lung perfusion is decreased
117
Oxygenation failure causes
```
Pneumonia
High altitudes
CO poisoning
Pulmonary embolism
CHF with pulmonary edema
ARDS
```
118
Assist-control ventilation
Ventilator takes over breathing for the pt
| Tidal volume & ventilatory rate are preset
119
Synchronized intermittent mandatory ventilation (SIMV)
Tidal volume & ventilatory rate are preset
| Allows spontaneous breathing at pt's own rate
120
BiPAP
Ventilator provides a preset inspiratory pressure & expiratory pressure similar to positive end expository pressure (PEEP)
121
Tidal volume
Volume of air the pt receives with each breath
| Average is 7-10 mL/kg
122
FiO2
Oxygen level delivered to the pt
123
Peak inspiratory pressure (PIP)
Pressure needed by ventilator to deliver a set tidal volume at a given lung compliance
Highest pressure reached during inspiration
124
Continuous positive airway pressure (CPAP)
Applies positive airway pressure throughout entire respiratory cycle
Keeps alveoli open during inspiration
125
Positive end expiratory pressure (PEEP)
Positive pressure exerted during expiratory phase
Enhances gas exchange
Prevents atelectasis
126
Reasons to suction
Secretions
Increased PIP
Rhonchi (wheezes)
Decreased breath sounds
127
Barotrauma
Damage to lungs by positive pressure
Pneumothorax
Subcutaneous emphysema
128
Volutrauma
Damage to the lung by excess volume delivered to one lung over the other
129
Pulmonary contusion
Bloody sputum
Decreased breath sounds
Crackles & wheezes
130
Pneumothorax assessment
Reduced breath sounds
Hyper-resonance on percussion
Deviation of trachea away from or toward the affected side
131
Tension pneumothorax intervention
Large bore needle into 2nd intercostal space in mid-clavicular line of affected side
Chest tube placed later into 4th intercostal space
