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Nursing 4 Exam 3 > Unit 14 Metabolic Coma/Drugs > Flashcards

Unit 14 Metabolic Coma/Drugs Flashcards

1
Q

When can coma occur?

A

When pressure is put on the brainstem

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2
Q

What is there an increased risk of with ICP Monitoring?

A

Infection

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3
Q

What is the 1st indicator of ICP/brain issue?

A

ALOC

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4
Q

What is the definition Encephalopathy or (Metabolic Coma)?

A

-Broad term for any brain disease that alters brain function or structure.

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5
Q

What are some causes of metabolic coma?

A
  • Drug induced
  • Diseases: Viral and bacterial
  • Anoxia (absence of oxygen)
  • Hypo/hyperglycemia
  • Meningitis
  • DKA
  • Carbon monoxide poisoning
  • SIADH
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6
Q

What are characteristics of metabolic coma?

A

Change in LOC

Absence of brain lesions/abnormalities

Lab values will show abnormality somewhere

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7
Q

What is Meningitis?

A

Inflammation of the arachnoid and pia matter of brain and spinal column. (spreads rapidly)

Bacteria and viral organisms (aseptic meningitis) are most often the cause.

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8
Q

What is the pathophysiology of Meningitis?

Most common cause?

A

Organism enters CSF via bloodstream and crosses the blood-brain barrier.

Can be caused by direct entry

-Infection is most common cause

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9
Q

Describe Bacterial Meningitis.

A

-Often related to Upper Respiratory Infection.

Pathogens - Pneumoniae, Neisseria meningitis (meningicoccal), H. Flu

  • Contagious
  • Has more favorable outcome if detected early and treatment is begun.
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10
Q

What are the symptoms of Bacterial Meningitis?

A

Fever (40-41C)*
Stiff neck/Nuchal Rigidity*
Headache*** (Hallmark signs of bacterial meningitis)

Purpuric Rash

Photophobia
Seizures
Cold extremities
N and V

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11
Q

What can be assessed in bacterial meningitis?

A

Nuchal rigidity

+ Kernig’s sign: PT flat on back, knee bent to 90 degrees then straightened up, if back pain then it is positive sign

+ Brudzinski’s sign: flat on back, when flexing head, knees automatically bend = + sign

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12
Q

What is the Diagnosis for Meningitis?

A

Analyze CSF by lumbar puncture (L3 and L4):
-Confirms

CT scan:
-to rule out other causes

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13
Q

What are complications of meningitis?

A

ICP

Seizures may occur

SIADH may occur

Shock

SIRS/SEPSIS

Septic emboli may lead to blocked circulation

Disseminated Intravascular Coagulation (DIC) may occur

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14
Q 
What is the collaborative care for meningitis?
What kind of precautions?
What kind of feedings?
What about those in close contact?
What about ICP in Meningitis?
A

Broad spectrum antibiotics (penicillin, cephalosporins, vancomycin) until C and S result (do first): 10 days on antibiotics

Prophylactic treatment w/ rifampin (24-48hrs) for those in close contact

Droplet precautions

Treat and prevent elevated ICP w/corticosteriods

Monitor neuro status, GCS

Antipyretics

Maintain O2

Enteral feedings

Prevent constipation

Supportive care

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15
Q

Describe Viral Meningitis.

What will be obtained in the CSF culture?

A

Often associated to other viral illnesses such as: mumps, measles, varicella, herpes simplex

No organisms will be obtained in CSF culture.

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16
Q

What will be assessed in Viral Meningitis?

A

Nuchal rigidity

Fever

Photophobia

Lumbar puncture for CSF has no bacteria/cultures

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17
Q

What is the treatment of viral meningitis?

A

Symptom management

Possibly antivirals

Antipyretics

IV fluids

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18
Q

When should the vaccine for meningitis be given?

What are they called?

A

At 11-12 years of age
Booster at 16-24

Vaccines are: (meningiconjucate) Menactra, Menveo

Strep group b meningitis vaccine for teens and adults

19
Q

What is Encephalitis?
Caused by?
Who’s most at risk?

A

Inflammation of the brain tissue and often meninges

Caused by: virus, bacteria, fungus, parasite

Elderly most at risk

20
Q

What is the pathophysiology of Encephalitis?

A

Virus reproduces in brain tissue causing an inflammatory response

Edema and compression of blood vessels cause elevated ICP

21
Q

What are specific diseases causing Encephalitis?

A

Herpes Simplex (most common)

West Nile Virus

MMR

Chicken pox

Rabies

22
Q

What are the symptoms of Encephalitis (arbovirus)?

A
  • Flulike symptoms
  • Fever
  • Confusion
  • Coma
  • Arthralgia
  • Lethargy
  • Rash
  • Motor dysfunction
  • Ataxia
  • Photophobia
  • Increases WBCs (normal if viral)
23
Q

What test measures antibodies in the blood to check what’s causing Encephalitis(arbovirus)?

A

Elisa Test

24
Q

What is used to diagnose Encephalitis?

A

Symptoms

Lumbar puncture to rule out meningitis

Elisa test

Serology testing

25
Q

What is the collaborative care for Encephalitis?

A
  • Care is supportive (virus)
  • acyclovir or vidarabine IV for herpes simplex or varicella
  • Treat the cause
26
Q

What are nursing interventions for Encephalitis?

A

Assess LOC

I and Os

Prevent constipation

Droplet precautions

Maintain O2

Enteral feedings

27
Q

What are preventions/teaching for Encephalitis(Arborvirus)?

A

Protection w/ DEET (bugspray)
Picaridin (insect repellent)
Oil of lemon eucalyptus
IR2525 (skin guard plus)

Long clothing

Mosquito management

28
Q

Describe Alcohol in relation to Metabolic Coma.

A

CNS depressant

Affects all levels of brain function

Most common substance abuse

Crosses blood-brain barrier

29
Q

Describe what happens with chronic alcohol use.

A

Can cause liver disorder/failure

Elevated NH3

Wernicke’s Encephalopathy - (depletion of thiamine- vitamin b1) causing confusion, ataxia, etc.)

Korsafoff’s Psychosis - Short term memory loss, possible hallucinations

30
Q

What are mild to moderate symptoms of alcohol withdraw?

A 
Tremors
N and V
Diaphoresis 
Dilated pupils
Headache
Palpations
Anxiety/Depression
Insomnia
31
Q

What is the severe complication of alcohol withdraw?

A

Delirium Tremens: life threatening complication (~3 days in)

  • Hallucinations
  • High fever
  • Intense agitation
  • Tachycardia
  • Tachypnea
  • Seizures
32
Q

What are nursing interventions/collaborative management for alcohol withdraw?

A

3’S’s of detox safety/sedation/supplements

  • Monitoring of withdraw symptoms and safe environment
  • Vitamins and minerals: B complex (thiamine replacement), C, Mg, and Calcium
  • Refer to follow up/support group
33
Q

What is the assessment tool for alcohol withdraw?
What is the criteria being assessed?
What are the score ranges?

A

CIWA (clinical institute withdrawal assessment)

Criteria:

  • N and V
  • Tremors
  • Agitation
  • Hallucinations
  • VS
  • Diaphoresis
  • LOC
  • Auditory disturbances

<8 = mild
8-15 = moderate
> 15 = severe

34
Q

What is the treatment for alcohol withdraw?

A

Librium

Benzo’s

valproic acid (Depakote)

35
Q

What is acute alcohol poisoning?

A

Depression of the CNS:

  • Often die of hypothermia, aspiration, or ingestion of other CNS depressants.
  • Brain stem and hypothalamus extremely depressed
  • Irregular/Decreased RR
  • No gag reflux
  • Decreased LOC
  • Fatal
36
Q

What are ED nursing considerations when drawing Blood Alcohol Concentration?

A

No alcohol pad used

Chain of custody for specimen

Know laws of state

Document

37
Q

What is acetaminophen overdose?
What are early symptoms?
What is the treatment of acetaminophen OD?

A

Extremely toxic to liver cells

Death can occur in 1-4 days

Early symptoms: N and V, diarrhea, abdominal pain

Treatment of OD:
-N-Acetylcysteine (mucomyst or NAC) oral or NGT - blocks absorption of acetaminophen

-Activated charcoal if presents within 1 hr of ingestion and stable consciousness

38
Q

What is the acute care for drug OD?

A
  • ABCs, Obtain VS, neuro checks, intubate if necessary
  • Bloodwork: CBC, BMP, Glucose, toxic screen, ETOH, ABG
  • Administer: IV meds: Thiamine, Narcan
  • Gastric lavage, charcoal, cathartic (NGT)
  • Treat w/specific antidote
39
Q

What are the two acronyms for assessing a PT with an ALOA?

A 
A lcohol       
E pilepsy 
I nsulin
O piates
U remia
T ruama 
I nfection
P sych
P oison
S troke
40
Q

What diagnoses tests would help w/ an unconscious patient in the ED?

A

Blood glucose

Urinalysis

History of state

VS

CT of head

41
Q

Describe Persistent Vegetative Sate.

A

No awareness of self or environment

No evidence of purposeful response to visual, auditory, or tactile stimuli

Intermittent wakefulness

Incontinence

Preserved brainstem autonomic functions

Variable cranial and spinal reflexes

42
Q

What is brain death?

A

Cessation and irreversibility of all brain functions including brain stem

Coma, apnea, pupils fixed and dilated

No ocular response

Flat EEG

43
Q

Name some club drugs.
What are the intoxication/acute effects?
What is the collaborative treatment for OD?

A

Liquid X, Liquid Ecstasy

Intoxication/acute effects: euphoria, drowsiness, confusion, memory impairment, excited or aggressive behavior

Monitor cardiac conditions
Warming blanket for hypothermia
Institute seizure & aspiration precautions

44
Q

Define CNS depressants. Name some.
What are intoxication symptoms?
What are overdose symptoms?
What is the treatment for OD?

A

Drugs that depress the central nervous system

Ex: Alcohol, Benzo’s, Barbiturates, Anti-convusants/depressants

Intoxication symptoms: Drowsiness, Confusion, Impaired coordination, Blurred vision

Overdose symptoms: Respiratory depression

Treatment: airway management
Give antidote: flumazenil for benzodiazepine overdose

Nursing 4 Exam 3 (7 decks)

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