Week 1 and 2 Flashcards
Besideds FAST what is another symptom might be seen stroke pats
tongue deviation
mood changes
What needs to be checked for stroke pats before their next meal
gag reflex
Whhat are the types of aphasia
Receptive aphasia – loss of comprehension
Expressive aphasia – inability to produce language that is intelligible
What is nonfluent aphasia (Broca’s)
minimal speech activity with slow speech that requires concentrated efforts
What are fluent aphasia (Wernickes)
speech that normal speed but contains little language that is intelligible
What are soem diagnostics for strokes
CT Scan CT Angiography (CTA) MRI Magnetic resonance angiography (MRA) CT/MRI perfusion and diffusion imaging
What is the initial test for strokes
CT without contrast
Why no contrast for stroke diag
could make bleeding worse
What arteries are assessed durign a stroke
the carotid to see if stenosis
What are the main prevention care for stroke pats
Control of hypertension Control of diabetes mellitus Treatment of underlying cardiac problem No smoking Limiting alcohol intake
What is permissive HTN
a treatment for acute ischemic stroke with pats HTN over 200mg that lowers BP slowly to prevent kidney damage
What are the acute care interventions for stroke pats
Maintenance of airway
Fluid therapy
Treatment of cerebral edema
Prevention of secondary injury
What are things that change ICP
1) changes in arterial pressure; 2) venous pressure;
3) intraabdominal and intrathoracic pressure;
4) posture;
5) temperature
6) blood gases in particular CO2 levels
What is a CPP
cerebral perfusion pressure
What should your CPP be
60
How do you calculate your CPP
MAP-ICP
What is the required BP fpr keeping the brain alive
60mmHg
What might be symptoms of increased ICP
HA mild confusion shallow breathing elevated BP nausea
Why might a pat a few days after receiving CPR have a headache or confusion
cerebral edema
What is vasogenic cerebral edema
fluid leaks out of white matter capillaries into Ex cellular space
What is cytotoxic cerebral edema
happens from damage of cell membranes
What is cushings triad
for increased ICP Systolic BP increases Pulse and resp goes down For shock BP goes down pulse and resp go up
How will cushings triad present itself
you’ll start to see the vital signs trending towards the triad
What are some things that may cause vasogenic cerebral edema
brain tumors,
abscesses,
ingested toxins
What cause cytotoxic cerebral edema and what does it cause
destructive lesions or trauma to brain tissue
this edema would cause cerebral hypoxia or anoxia and syndrome of inappropriate antidiuretic hormone (SIADH)
In alaska what is one of the things that indicates the need to call the organ donors company
Glascow coma scale less than 5
when monitoring ICP what is a consideration for the transducer
it needs to be kept level with the ear
What is a Battle sign
bruising behind the ear around the mastoid
What is a Battle sign
bruising behind the ear around the mastoid
Test questions on Tumors?
no
What is used to control ICP when it cant be controled by meds or other interventions
ventriculoperitoneal shunt (VP shunt)
What are meningitis pats need to isolated
bacterial
What vertebre is where quadraplegia injuries happen
C4
Why do quadraplegic pats get intubated
cant excrete secretion so at risk for infections/atelectasis
What is the maintainance of cervical traction
need to be cleaned everyday using sterile technique
What is the first intervention for pats that might be having autonomic dysreflexia
sit them up right
What is bell’s palsy
acute facial paralysis from inflammatory of the facial nerve
What happens in guillian barre
peripheral paralysis
What is the most concerning prblem with guillain barre
inability to breath from spreading paralysis
What is a big reason for depression in stroke paats
inability to communicate
What is the monroe kelly doctrine
the idea that the brain needs certain percentages of its CSF, blood, and tissue to have normal ICP
What drug is used for increased ICP
manitol- acts like brain lasics
or set up a drain
What chemo drug will pass the BBB
temodar
What type of drug is still given after a spinal cord injury and why
steroids bec reducing the inflammation could relieve the pressure on the cord and minimize damage
What is bells palsy
inflammation of the facial nerve
Is bells palsy permanent
usu not
What is usu the steroid given to spinal cord injury pats
methylprednisone
What drug is given to pats after a brain injury from bleeding (like a hemorrhagic stroke) that may also have vasospasms
nimotop
With a basilar skull fracture what is a consideration for NG tubes or other things inserted into the nose
contact PCP before inserting bec the facture could have caused a hole that the object could fit through, possibly hitting the brain
What is normal PTT
25-30
What is normal PT
11-14
What is theurapeutic range of PT/INR
2-3
What are the rules of nines
9% per arm, head
36% for torso,
18 each legs
1 for gens
What are the strength gradings
0- no contractions 1- quiver 2- active movement, cant res gravity 3- active movement against gravity 4- active movement against res 5- normal strength
What is heparins antidote and is it PT or PTT
PTT
Protamine Sulfate
What is coumadines antidote and is it PT or PTT
PT
Vit K
What is the first sign of increased ICP
LOC changes
What are the signs of SIADH
high specific gravity
fluid retention
hyponatremia
What are the treatments of SIADH
oral care
vasopressors and democlocycline to block ADH
lasix with vit K supp
