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Med surg > week 6 > Flashcards

week 6 Flashcards

1
Q

scalp laceration complications

A

Scalp is highly vascularized

  1. bleeding
  2. infection
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2
Q

skull fracture s/s

A
  1. raccoon eyes and/ears
  2. Rhinorrhea or otorrhea
    - test for CSF
  3. Halo sign
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3
Q

how do you test drainage for CSF

A

if it has glucose then it is CSF

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4
Q

what is the halo sign

A

put a drop of drainage onto a gauze if a red spot with a halo around it appears then it indicates CSF drainage

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5
Q

when would you suspect concussion

A

if the patient passed out

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6
Q

what is diffuse axonal injury

A

injury inside the brain leading to either decortication or decerebration

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7
Q

decortication vs decerebration. What are they and which is worse

A

Decort=internal flexion
Decere-extention away from the body
Decere is worse

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8
Q

what is a contusion and what is the most common cause

A

brusing in brain tissue

-Coup-countercoup (whiplash)

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9
Q

what is a laceration of the brain

A

actual tearing of the brain tissue

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10
Q

complications of head injuries

A

1.Hematomas

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11
Q

how do you identify epidural hematomas

A

initial loss of consciousness followed by brief lucid period then degradation as ICP increases

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12
Q

how do you identify subdural hematoma

A

same as epi expect its slower

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13
Q

what is an intracerebral hematoma

A

bleeding within the brain

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14
Q

what is the gold standard diagnostic for head injuries

A

CT scan but MRI is better

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15
Q

what does a PET scan show

A

blood flow in the brain

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16
Q

what is a craniotomy

A

replacing part of the skull with metal or leaving it open. If you leave it open it is called a craniectomy

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17
Q

What is a Burr hole

A

drilling a hole in the skull to put a catheter iin

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18
Q

what makes up ICP

A

CSF is 10%
blood is 12%
the rest is brain tissue

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19
Q

what factors influence ICP

A
  1. arterial and venous pressure
  2. Intraabdominal and intrathoracic pressure
  3. temperature
  4. CO2 levels (vasodilation -> more blood to the brain)
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20
Q

what must the transducer of the ICP monitor be leveled with

A

the tragus of the ear

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21
Q

what happens when ICP goes up

A
  1. decreased cerebral perfusion

2. brain stem hernitation

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22
Q

cerebral blood flow definition

A

the amount of blood passing through 100 g of brain tissue in 1 min. normal is about 50 mL

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23
Q

cerebral perfusion pressure (CPP)

A

the pressure needed to ensure adequate perfusion to the brain. similar to MAP
normal is 60-100

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24
Q

how is CPP calculated

A

MAP-ICP

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25
Q

what happens if CPP drops below 50

A

its like a MI of the brain you got 6 minutes until perm brain damage occurs

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26
Q

compensentory mechanisms to increase cerebral blood flow

A
  1. increase CO2
  2. decrease O2 (vasodilation)
  3. increase H+ concentration, acidosis -> vasodilation
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27
Q

hypothermic measures

A

cool body to 32-35 but in practice they go down to 28.

28
Q

what do you need to monitor during hypothermic measures

A

bradycardia

29
Q

Cerebral edema

A
  1. monitor LOC
  2. give mannitol
  3. cushing triad
  4. conjugate gaze palsy
  5. Uneven and sluggish pupils
  6. Decerebrate or Decorticate
  7. Headache (major)
  8. Projectile vomiting (major)
30
Q

what is vasogenic cerebral edema

A

it is cerebral edema caused by the breakdown of the blood brain barrier (BBB)

31
Q

what is the cushing triad

A
  1. increase BP
  2. Irregular breathing
  3. decrease HR
32
Q

what is conjugate gaze palsy

A

inability to move eyes in the same direction. Either horiztonally or vertically

33
Q

how do you diagnose cerebral edema

A

CT scan

34
Q

what does EEG do

A

monitors electrical activity of the brain

35
Q

what is EEG mainly used for

A

to detect real seizures

36
Q

ventriculostomy

A
  1. CSF drains into a drainage system

2. level with tragus of ear or canthus of eye

37
Q

Hypertonic solutions (mannitol) interventions

A

give slowly

38
Q

what are barbiturates used for

A

control seizures

39
Q

what diet do you put patients with cerebral edema

A

increased glucose

40
Q

how do you assess for pain in unconscious patients

A

nail bed pinch

41
Q

gold standard stroke diagnostic

A

CT

42
Q

TPA

A
  1. give within 4.5 hours

2. minimal oozing is expected when given peripherally but gum and nose bleeding is not

43
Q

TPA contraindications

A
  1. active bleed
  2. recent major surgery
  3. recent stroke b/c they may bleed
44
Q

carotid endartrectomy

A

open carotids and take out plaques

45
Q

post stroke consideration

A
  1. bowels will slow down which may lead to impaction
  2. patients may be incontinent -> skin breakdown
  3. bed bound -> DVT -give aspirin
  4. during stroke BP shoots up to compensate for low CPP. if they have an aneurysm -> hemorrhagic stroke
46
Q

what is the acceptable BP during stroke

A

around 160 before you give the TPA

47
Q

right sided stroke cardinal sign

A

loss of spatial perception. They may not even know who they are

48
Q

can stroke patients eat food?

A

they must be NPO until they pass their swallow evaluation

-food must be eaten on unaffected side while patient sits up

49
Q

how is aneurysm treated

A
  1. Clipping

2. GDC coil- stuffing the bludge therefore inhibiting blood flow into it therefore it wont rupture

50
Q

Homonymous hemianopsia

A

total loss of a certain visual field in both eyes

51
Q

Right sided stroke

A
  1. learn better verbally
  2. impulsive
  3. lack of cordination
52
Q

Left sided stroke

A
  1. move slower
  2. fearful and anxious
  3. respond well to nonverbal
53
Q

Spinal cord injury etiology

A

cord compression by bone displacement. Leading to sciatic pain

54
Q

Spinal shock s/s

A
  1. decreased reflexes
  2. loss of sensation
  3. Flaccid paralysis below level of injury
55
Q

Neurogenic shock s/s

A
  1. loss of vasomotor tone -> venous pooling
  2. type of distributive shock
  3. decrease BP and HR
56
Q

how long do skeletal or muscular injuries take to heal

A

usually 3 weeks if it doesnt then we need to do a CT or MRI

57
Q

how do we know that we have complete cord involvement

A

both sensory and motor damage

58
Q

ASIA scale

A

monitors spinal cord injury progression

59
Q

what happens if you have an injury above c4

A

immediate intubation is required b/c of total loss of respiratory function

60
Q

what happens if the injury is below C4

A

diagphramatic breathing (shallow breathing) will retain secretion and CO2 -> hypoventilation

61
Q

Thoracic spine injury

A
  1. Neurogenic shock
  2. Abdominal paralysis -> ileus, urinary retention
    - must do NG tube decompression
62
Q

lumbar spine injury

A

1.incontinence

63
Q

Poikilothermism

A
  1. loss of thermal regulation
  2. decrease in ability to sweat and shiver
  3. many of these patients develop hyperactive reflexes but this does not indicate healing
64
Q

autonomic dysreflexia

A

increase BP due to bowel impaction or urinary retention.

65
Q

lumbar puncture contraindications

A
  1. high ICP can lead to brain herniation

2. anticoagulants can result in bleeding the compresses the spinal cord

66
Q

lumbar puncture instructions

A

have client void prior to procedure

  1. cannonball position while on side to stretch the spinal canal. they can also stretch over an overbed table if they prefer to sit
  2. remain lying for several hours post procedure to ensure that the site clots and also decrease incidence of post lumbar headaches caused by CSF leak

Med surg (35 decks)

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