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NURS 1250 > Neurological Conditions > Flashcards

Neurological Conditions Flashcards

1
Q

Increased Intracranial Pressure

A

Swelling of the brain, you would see an increased BP, decreased MAP, slow breathing

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2
Q

What are the layers of the meninges?

A

Dura Mater: outer layer, tough, thick, and firbous
arachnoid: thin, intermediate layer
pia matter: delicate, internal, vasculated layer

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3
Q

Cerebral Spinal Fluid

A

Located between the arachnoid and pia matter
Cushions the brain and spinal cord
Constantly absorbed and replenished
Normal amount is 100-150 mL

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4
Q

What is the Monroe-Kellie Hypothesis?

A

Cerebral spinal fluid, intravascular blood, and brain tissue must all exist in equilibrium. If there is a change in any of these, it will result in IIP.

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5
Q

What is normal ICP?

A

5-15 mmHg

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6
Q

At what level will ICP require treatment?

A

> 20 mmHg

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7
Q

What does the MAP tell us?

A

It is the average measurement of the systemic arterial pressure. Reflects the perfusion pressure. It is a better indicator for perfusion than the systolic BP.

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8
Q

What is the normal MAP value?

A

65-105 mmHg`

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9
Q

At what level MAP is perfusion to vital organs severely jeprodized?

A

<50 mmHg

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10
Q

How to calculate MAP?

A

Systolic BP + 2(Diastolic BP)/3

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11
Q

What is cerebral perfusion pressure (CPP)?

A

The pressure required for the heart to supply blood to the brain
Increased ICP leads to decreased CPP and decreased blood flow to the brain

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12
Q

How do you calculate the CPP?

A

MAP-ICP

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13
Q

What is normal CPP?

A

50-100 mmHg

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14
Q

What level CPP will cause irreversible neurologic damage?

A

<50 mmHg

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15
Q

What causes IIP?

A
  • intracranial mass lesions (tumors)
  • cerebral edema
  • increased CSF production
  • decreased CSF absorption
  • obstructive hydrocephalus
  • obstruction of venous outflow
  • idopathic ICH
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16
Q

Cushing’s Triad

A

CNS Ischemic response reflex, initiated by hypothalmus

  • HTN
  • bradycardia because of compression of vegas nerve
  • bradypnea because of compression of brain stem
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17
Q

IIP Clinical Manifestations

A

ALOC - most sensitive indicator
-headache, drowsiness, pupillary changes, widening pulse pressure, purposeless movements, hyperthermia (late stage), posturing

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18
Q

Decorticate Posturing

A

Limbs pulled towards core. Lesions above brainstem

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19
Q

Decerebrate Posturing

A

Lesions of the brain stem

Limbs extended and rigid.

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20
Q

IIP Diagnostic Tests

A

During physical exam check pupils - they will be dilated
Spinal Tap - after spinal tap lay flat on back for 4-6 hours
MRI
CT Scan

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21
Q

Mannitol

A

Osmotic Diuretic, pulls h2O out of brain. It begins to lower ICP in 1-5 minutes. Measure I&O while on it - normal urine 30 mL/hour
Thins blood
Starting dose 1.5-2 g/kg IV infusion

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22
Q

IIP Management

A

Keep O2 sat above 95, continuous pulse ox
Monitor fluid so BP doesnt drop too low
Keep head of bed at atleast 30 degrees to maximize venous outflow
Thermoregulation - no fever because it increases ICP. Shivering also inreases ICP
Stool Softner
Anti-Seizure medication

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23
Q

IIP Surgical Management

A
  • Evacuation of blood clot
  • Resection of a tumor
  • CSF diversion: ventriculostomy drain 1-2 mL
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24
Q

Traumatic Brain Injury

A

Injury resulting from external force
Primary: direct result from mechanical injury at time of accident
Secondary: physiologic response to the initial injury

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25
Q

What are types of penetrating injuries

A

open head wound, focal damage around injury site, skull fractures, lacerations

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26
Q

What are types of non-penetrating injuries?

A

closed injuries. Concussion, contusions

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27
Q

Types of skull fractures

A

Open facture: scalp open
Closed fracture: scalp closed, could be depressed
Basal: most serious, effects base of skull. CSF drainage

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28
Q

What is a coup and countre coup injury?

A

Head hits front of skull and then rebounds and hits the back. Common in car accidents

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29
Q

What is a laceration head injury?

A

Tears in brain tissue or blood vessels of brain. It can cause destruction of brain tissue and increased ICP.
Most common result of bullet/stab

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30
Q

Diffuse Axonal Injury

A

most intense
traumatic shearing forces lead to tearing of nerve fibers in the white matter.
Caused by shaking or strong rotation of the head by physical forces

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31
Q

Secondary Traumatic Brain Injury

A

Ischemia, hypoxia, hypotension/HTN, cerebral edema, IICP, hypercapnia, meningitis, epilepsy, biochemical changes

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32
Q

TBI Clinical Manifestations

A

headache, memory problems, blurred vision, dizziness/fatigue, sleeping difficulties

serious: persistent headache, profound confusion, slurred speech, seizure, coma

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33
Q

Neurological/Musculoskeletal Assessment

A

Pupillary, check for consensual and accomodation
Check mental status
Check or sensory function like stergonosis (tell you what hand an item is in), facial movements, light touch (with cotton ball), graphesthesia (describe what is in hand
ROM (active - no help passive - with help)
Romberg test (look for sway)
Tandem (walk heel to toe)

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34
Q

What is a concussion?

A

Most common and least serious TBI. Low velocity injury resulting in functional deficits without pathological injury.

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35
Q

What is the best possible Glasgow Coma Score?

A

4 points - spontaneously opens eyes
5 points - oriented to time, place, and person
6 points - obeys commands

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36
Q

What criteria is considered a mild TBI?

A

13-15 Glasgow coma score

< 30 minutes loss of conscious or <24 hours amnesia, < or equal to 24 hours AOC

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37
Q

What criteria is considered a moderate TBI?

A

9-12 Glasgow coma score

> 30 minutes loss of consciousness, or > 24 hours amnesia, > 24 hours AOC

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38
Q

What criteria is considered a severe TBI?

A

3-8 Glasgow coma score

> 24 hours loss of conscious, >7 days amnesia, > 24 hours AOC

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39
Q

What Glasgow coma score is usually fatal?

A

3 or less

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40
Q

What are some diagnostic tests for TBI?

A

CT are done first, identify hemorrhage, bleeds in and around brain, blood flow, brain tissue swelling, and skull fractures

MRI follows to confirm which part of brain is affected and how severe. Can check microhemorrhage, brusing, gliosis, atrophy

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41
Q

What are the pharmacology options for TBI?

A

Osmotic diuretics, anticonvulsants, electrolytes, N-Methyl-D-Asparate Receptor agonist, stimulants, dopamine agonists, SSRI, Antipsychotic, muscle relaxer, pain relievers

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42
Q

What do osmotic diuretics do for TBI? What is an example?

A

Lower intracranial pressure by withdrawing water. Mannitol is an example. This is the most common drug used for TBI

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43
Q

What do anticonvulsants do? What are an example?

A

Prevent seizures because seizures increase ICP. Gabapentin - brand name neurontin

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44
Q

What do NMDA drugs do?

A

Prevent hyperactivity and secondary injury

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45
Q

What do barbiturates do? What is an example?

A

They are sedatives/anti-seizure. Phenobarbitol is an example.

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46
Q

What do calcium channel blockers do for TBI?

A

decrease blood pressure by preventing blood vessel spasm

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47
Q

What do dopamine agonist do for TBI? What are examples?

A

increase amount of dopamine. Improve alertness. Carbidopa, levidopa

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48
Q

What do SSRIs do? What is an example?

A

help with serotonin levels. Treat emotional distress. Prozac, floxitine, zoloft, celexa

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49
Q

What is a craniotomy?

A

Surgical opening into cranium

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50
Q

What is endoscopic ventricuolostomy

A

Drilling of a hole into fluid filled ventricle to rain it for pt. with hydrocephalus

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51
Q

What is Ventriculoperitoneal Shunt Surgery?

A

Shunt is put in ventricles to drain fluid into circulation - for hydrocephalus

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52
Q

What is a decompressive craniectomy?

A

For increased ICP. Remove a part of the skull so more area for brain to grow

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53
Q

What is a cranioplasty?

A

Repair of the skull

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54
Q

What is the most common complication of TBI?

A

Irritability

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55
Q

What are some nursing priorities for TBI?

A

Establish a baseline for the patien
Airway/breathing (ABG’s)
vital signs - maintain CPP, Cushing’s Triad
Early detection of subtle changes, report small changes immediately
Positioning
Neurological examinatiosn
*have suction ready at bedside incase of aspiration

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56
Q

What is complete spinal cord injury?

A

both sensory and motor functions are lost

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57
Q

What is an incomplete spinal cord injury?

A

some function remains

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58
Q

What is tetrapalegia/quadriplegia?

A

paralysis of arms and legs

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59
Q

What is paraplegia?

A

paralysis from waist down

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60
Q

what is hemiplegia?

A

paralysis on one side

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61
Q

what is triplegia?

A

paralysis of 3 limbs, one arm and both legs

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62
Q

What will an injury to cervical - neck, result in?

A

tetraplegia, quadriplegia. Most severe of spinal cord injuries

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63
Q

What will thoracic injury result in?

A

paraplegia

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64
Q

What will lumbar injury result in?

A

some loss of function in hips and legs. Will result in little or no voluntary control in bowel or bladder

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65
Q

What will sacral injury result in?

A

S1 - hips and groin
S2 - back of thighs
S3 - medial buttock
S4-S5 - perineal

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66
Q

What are some risk factors for spinal cord injury?

A

male, age 16-30, alcohol use, risky behavior, some dseases

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67
Q

What is emergency care for spinal cord injury?

A

Cervical collar, back board

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68
Q

What are some medications for spinal cord injury?

A

pain relievers, muscle relaxer, corticosteroids

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69
Q

What are some surgical options for spinal cord injury?

A

craniotomy, decompressive laminectomy

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70
Q

What is the pathophysiology of a stroke?

A

blood flow to an area of the brain is cut off

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71
Q

What are some risk factors for a stroke?

A

> 65, men, HTN, DM, smoking

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72
Q

What is an ischemic stroke?

A

Caused by a clot/blockage to the brain. Can be transient, thrombotic, or embolic

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73
Q

What is a hemorraghic stroke?

A

Bleeding into brain. Artery into brain leaks blood or ruptures. Can be a intracerebral hemorrhage, or subarchnoid hemorrhage

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74
Q

What is the etiology of an ischemic stroke?

A 
Arrythmia/heart valve disease/infection
HBP, DM, HLD
intracranial disease (chronic HTN)
cancer, blood clotting disorder
autoimmune disease
sickle cell anemia
HIV
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75
Q

What is a transient Ischemic attack?

A

a mini stroke. blood flow to the brain is blocked for only a short time. caused by blood clots. if not treated 10-15 % will have a major stroke within 3 months

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76
Q

What is a penumbra? How is it treated?

A

It is the reversibly damaged brain around the ischemic core. Survival depends on timely return of adequate circulation, degree of cerebral edema, alteractions in local blood flow

Less than 4 hours after stroke symptoms start TPA.

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77
Q

What should TPA be started for a stroke?

A

Within 4 hours of stroke symptoms

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78
Q

What is the nursing goal of hemorrhagic stroke?

A

Maintain cerebral tissue perfusion

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79
Q

What is the etiology of hemorrhagic stroke?

A

HBP, CAD, brain aneurysm, heart defects/failure, arteriovenous malformation, bleeding disorders

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80
Q

What is an intercerebral hemorrhage?

A

bleeding within the brain, artery in brain bursts, flooding surrounding tissue with blood. most common

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81
Q

What is a subarachnoid hemorrhage?

A

bleeding into the spaces around the brain.

82
Q

What are some risk factors for a stroke?

A

lack of excercise, sleep apnea, heavy alcohol, smoking/drugs, diabetes, cardiovascular disease, high cholesterol, HBP, obesity

83
Q

What does BEFAST stand for?

A

balance - loss of balance, headache/dizziness
eyes - sudden loss of vision in 1 or both eyes
face - uneven
arms - weakness
speech - slurred
time - act quickly, call 911

84
Q

What are the types of aphasia?

A

Expressive Aphasia: Can’t express self via any language (manual, written). Can understand.

receptive aphasia: able to speak well, but what they say may not make sense

anomic aphasia: can’t remember writing/speaking

global aphasia: all of the above

85
Q

What care/assessments would you give to a person with a stroke?

A 
neurologic assessment, vital signs, blood glucose, actual weight
NIHSS, cardiac monitor
STAT EKG, CBCD, PT, PTT, BMP, Troponin
Brain CT w/o contrast
IV access gauge 18 or 20 X 2
IV fluids - isotonic
strict NPO
86
Q

What is considered a severe stroke on the NIHSS scale?

A

score 21-42

87
Q

What is considered a moderate/severe stroke on the NIHSS stroke scale?

A

16-20

88
Q

What is considered a moderate stroke on the NIHSS stroke scale?

A

5-15

89
Q

What is considered a minor stroke on the NIHSS stroke scale?

A

1-4

90
Q

Stroke Pharmacology

A

Thrombolitics (TPA), blood thinners (anti-platelet, anticoagulants)
BP lowering meds (ACE, ARB, B Blockers, Ca Channel blockers, diuretics)
Cholesterol lowering medications (fibrates, niacin, resins, statins)

91
Q

What is TPA?

A

“clot buster” AKA alteplase. Gold standard for ISCHEMIC stroke, contraindicated for hemorrhagic.
Must lower SBP <185 and DBP <110
No major surgical procedures within 14 days

92
Q

nursing management for stroke

A 
maintain cerebral perfusion
promote physical mobility
promote self care
promote verbal communication
promote urinary and bowel elimination
maintain safety
93
Q

What is osteoporosis?

A

Chronic, progressive, metabolic bone disease resulting in decreased bone density. Bone reabsorption (osteoclast) exceeds bone deposition (osteoblast)

94
Q

What do osteoclast do?

A

reabsorption

95
Q

What do osteoblasts do?

A

laying of new bone

96
Q

Does osteoporosis have symptoms?

A

Yes, but it’s usually a silent disease

Symptoms are: height loss, dowager’s hump, low back pain, fragility related fractures

97
Q

What vitamin is deficient in osteoporsis?

A

vitamin D and calcium

98
Q

What are risk factors for osteoprosis?

A 
After 35
women
disease: DM, HTN, kidney disease
Lifestyle
Smoking
Excessive alcohol: slows osteoblast and liver dysfunction - liver imp. for activating Vit. D
Diet low in Ca
Excessive caffeine : increased urination of Ca and Vit D
99
Q

What medications are a risk factor for osteoporosis

A

Corticosteroids - affect absorption of Ca and increase osteoclast
Antiseizure drugs
Aluminum coated antacids
Excessive thyroid hormotes

100
Q

What laboratory tests should be done for osteoporosis?

A

Serology - look for increased calcium and phosphorus

101
Q

What imaging should be done for osteoporosis?

A

Bone Mineral Density - checks for thickness/solidity
Quantitative US: looks for heel, shin, kneecap
DEXA: measures hip, spine, forearm - more common

102
Q

What medication would be prescribed for osteoporosis?

A

Bisphosphanates (fosamax)
calcitonin (miacalcin)
Calcium and vitamin D

103
Q

What should you tell a patient taking Fosamax?

A

Take on an empty stomach, must stay standing for 30 min. Can cause esophageal erosion. Take with a full glass of water

104
Q

What dose of calcium should a female/male take?

A

1000 mg female, after menopause 1200

1 g for men

105
Q

What dose of vitamin D should a woman/man take?

A

600 mg, after menopause for women 800 mg

106
Q

What is a vertebroplasty?

A

inject cement to relieve compression

107
Q

What is a kyphoplasty?

A

More invasive. Cement and balloon inserted.

108
Q

What is a good diet for someone with osteoporosis?

A

dairy, spinach, canned salmon, sardines

109
Q

What are some preventive measures someone with osteoporsis can take?

A

Exercise - 30 min/day
Heat therapy
smoking cessation
avoid alcohol

110
Q

What are goals of patient care for someone with osteoporosis?

A

reduce bone loss

prevent fractures

111
Q

what is osteoarthritis?

A

alteration of bone remodeling process. cartilage that cushions ends of bones wears down. Hands and weight bearing joints are effected. Caused idiopathic or secondary

112
Q

OA clinical manifestations

A

pain with joint movement, stiffness, crepitus, hypertrophied joints, heberden’s node, bouchard’s node,

113
Q

What is Herberden’s node?

A

DIP - distal interphalangeal joints. Joints closest to tips of fingers.

114
Q

What is Bouchard’s node?

A

PIP. Proximal interphangeal joints.

115
Q

OA risk factors

A 
Over 55
BMP
Repetitive stress
Women
obesity
work related - poor posture
genetic influences
116
Q

OA Diagnostic studies - Labratory

A

synovial fluid - remains clear/yellow
CRP increased
ESR increased

117
Q

OA diagnostic studies - imaging

A

XRAY: shows bone spur, narrowing
MRI: involvement of soft tissue
CT scan: confirm

118
Q

OA Pharmacology

A

Acetominophen: 4g/4000 mg /day
NSAID: watch for GI bleed
COX-2-Inhibitor: newer NSAID, antirheumatic
Corticosteroids: harmful effects on cartilege, only give 3-4 injections/year
Topical NSAID: Icy hot
Glucosimine, chondrotin: dietary supplement, decrease pain.

119
Q

OA Collaberative interventions

A

activity/rest: rest joint during exhasberation
orthoses assitive device: immobilizer
TENS/heat therapy: neuro stimulation device
Weight Management : most beneficial
mind/body techniques
PT
Excercise

120
Q

Joint Surgery potential complications

A 
DVT
Compartment Syndrome - very painful
Infection
Bleeding - monitor H&H
dislocation - position properly, proper transfer
121
Q

Post Op Nursing Care for OA - 5 P’s

A

Neurovascular assessment - Monitor 5 P’s

pain, pressure, pulselessness, pallor, paresthesia, paralysis

122
Q

Goals of PT care for osteoarthritis

A

manage pain/inflammation
maintain/improve joint function
prevent disability

123
Q

What is Rheumatoid Arthritis?

A

Autoimmune disease
marked by periods of remission/exaceration
Effects small joints, synovial joint lining. Synovial fluid becomes inflammed

124
Q

What is the pathophysiology of RA?

A

CD4 cells activate macrophages, macrophages activate WBC, pannus foramtion (abnormal accumulation of granular tissue)

125
Q

What are the joint manifestations of RA? Extracellular?

A

boutonniere, ulnar deviation, swan neck.

rehumatoid nodules, sjogren’s syndrome, felty syndrome

126
Q

What are the symptoms of sjogren’s syndrome?

A

dry mouth, increased tooth decay, dry eyes

127
Q

RA clinical manifestations

A

Early stage: paraesthesia, anorexia, night sweats, weakness, warm/swollen/painful joints, mild/moderate pain

Late stage: joint stiffness, atrophy, chronic pain, multiple organ involvement

128
Q

RA Labratory Test

A 
Rheumatoid Factor - increased
CBC- WBC increased
ANA: positive
Anti-CCP antibodies - positive
Synovial Fluid: cloudy
129
Q

What is a good diet for someone with RA?

A

cardiac diet, low cholesterol, low sodium

130
Q

RA pharmacology

A

NSAID, corticosteroids for acute exacerbation, DMARDS

131
Q

What are some examples of disease modifying anti-rheumatic drugs (DMARDS)

A

methotrexate
etanercept - embril
hydroxychlorquine - planquile

132
Q

RA surgical management

A

arthodesis: fusion of 2 or more bones in a joint
synovectomy: removal of synovial lining in a joint

*treat with rest, compression, elevation

133
Q

What is Gout?

A

inflammatory joint disorder resulting from deposition of uric acid crystals in joints

caused by increase of uric acid production & under excretion of uric acid by the kidneys.

Predispose patient to kidney disease

134
Q

Stage 1 Gout

A

Hyperuricemia
Asymptomatic
Uric Acid present/elevated

135
Q

Stage 2 gout

A

acute gouty arthritis
sudden: pain/swelling
can heal on own
uric acid high

136
Q

Stage 3 gout

A

intercritical Gout
accumulation of uric acid continues.
inbetween attacks, no attacks occur

137
Q

Stage 4 Gout

A

Chronic Tophaceous Gout

Large deposits of uric acid with crystals into joints

138
Q

What is the pathyphysiology of gout?

A

elevated uric acid levels - hyperuricemia (>7 mg/dL)

urate crystal formation - urate crystals will settle in joints, can lead to kidney stones

139
Q

Gout risk factors

A

Family hx
kidney disease
Diet - foods high in uric acid, organ meats, red meats, wine, seafood
Alcohol/Tabacco
Medicines - aspirins, diuretics, some chemo
DM, HTN, Artherosclerosis

140
Q

Gout lab tests

A

Serum uric acid
24 hour urine - always remind pt to collect urine
synovial fluid - look for uric crystals

141
Q

Gout imaging

A

Xray, Ultrasound - looks for what stage

142
Q

Gout Pharmacotherapy

A

Colchicine: reduce swelling/inflammation
NSAID
Corticosteroids: reduce inflammation/stiffness
Allopurinol: brand name zyloprim. Inhibits uric acid production
Probenecid: promotes renal excretion

143
Q

What does Colchicine do?

A

Reduces swelling, inflammation

144
Q

What does allopurinol do?

A

inhibits uric acid production. brand name zyloprim

145
Q

What does probenecid do?

A

promotes renal excretion

146
Q

Gout Intervention

A 
activity/rest - rest effected limb
dietary restrictions: avoid purine foods wild game, seafood, organ meat
increase fluid intake
head/cold therapy
joint protection
weight loss
147
Q

What diet should someone with gout have?

A

fruits, vegetables, whole grains, low-fat dairy, legumes, nuts

AVOID shellfish, organ meats, alcohol, soft drinks

148
Q

Gout surgical intervention

A

extracororeal shock wave lithotripsy: shock waves break up stone in ureter

149
Q

Goals of pt care with gout

A

treatment of acute attacks: rest/meds
prevent future attacks: diet, weight loss, fluid
prevent complications: renal calculi, kidney disease

150
Q

What is acute/chronic back pain?

A

acute is less than 4 weeks

chronic is greater than 3 months

151
Q

What regions carries most of body weight?

A

lumbar

152
Q

Back Problems Risk Factors

A 
Lumbar strain/sprain
Degenerative changes
Disc Herniation
Fractures
Congenital conditions (spinal stenosis)
occupational factors (healthcare, construction, factory
153
Q

What is spinal stenosis?

A

narrowing of spinal canal

154
Q

What is spondylolysis and spondylolisthesis?

A

spondylolysis: pars inticularis has a crack
sponylolisthesis: pars inticularis breaks off

155
Q

Back Pain Pharmacotherapy

A

NSAID: inflammation/pain. Risk for GI bleed, if hx of ulcer do not give
opioid analgesics: norco, percocet, dilaudid, risk of constipation
muscle relaxants: tizanadine, flexaril, baclofen
steroids: last resort.

156
Q

Back Pain Interventions

A

Activity/Rest: avoid prolonged
Heat/Cold
PT: start ASAP
pt. teaching: body mechanics, pre medicate, back brace

157
Q

Laminectomy Post Op Care

A 
Bleeding: check H&H
infection: check temp
Blood clots: ted hose, anticoagulation therapy
nerve injury risk
risk for spinal fluid leak

log roll to maintain alignment

158
Q

Back pain goals of pt. Care

A

pain relief # 1 goal
back sparing practices
return to previous level of activity
avoid constipation

159
Q

What is a fracture?

A

Disruption or break in the continuity of the structure of a bone

160
Q

Simple/Closed fracture

A

Bone separated, not broken skin

161
Q

Compound/Open Fracture

A

Break in skin, risk for osteomylitis

162
Q

Transverse Fracture

A

Runs across bone at right angle

163
Q

Spiral Fracture

A

oblique/circle

164
Q

Comminuted Fracture

A

shattered into pieces

165
Q

Impacted

A

buckle/compress fracture

166
Q

Greenstick Fracture

A

incomplete/missing a bone

167
Q

Oblique fracture

A

slant in bone

168
Q

Clinical Manifestations of a fracture

A

pain, edema (Swelling), deformity (compare limbs), muscle spasm, contusion, decreased ROM, crepitation

169
Q

Bone Union Types: Direct fx complication

A

Delayed Union: lengthy healing time
Non-Union: didn’t heal, may need more surgery
Mal-Union: not properly aligned

170
Q

Avascular Necrosis: direct fx complication

A

death of tissue due to lack of blood supply

171
Q

Venous Thrombosis: indirect fx complication

A

blood clot in the vein with fracture due to bedrest

172
Q

Fat Embolism- indirect fx complication

A

disruption of blood supply caused by fat globules in the blood vessel

173
Q

Acute Respiratory Distress Syndrome

A

Watch for SOB, altered LOC, chest pain, tachycardia
Petechaie: pinpoint rash on chest due to inadequte oxygen
Monitor pt for 24-48 hours especially with femur

174
Q

Care of pt with a fracture

A

careful immobiliztion
encourage breathing excercises
O2 therapy

175
Q

Lab tests for fractures

A

CBC check H&H

Coagulation studies

176
Q

FX Pharmacology

A

NSAID, opioid analgesics, muscle relaxer, steroids

177
Q

Fracture Management

A

reduction - immobiliztion - rehabilitation

178
Q

What is an open reduction?

A

Surgical

O - open
R - reduction
I- internal
F- fixation

179
Q

What is a closed reduction?

A

Non-surgical manual realignment of a bone. Traction and counter traction - sling/splint

180
Q

What are the types of traction? What are some care guides?

A

Skin - applies pull indirectly to the bone
Skeletal: applies directly by way of pins/wire

Remember TRACTION
T: temperature
R: ropes hang free 
A: alignment - pt. on center of bed
C: circulation - check cap refill, 5 p's
T: type and location of fracture
I: increase fluid intake
O: overhead trapeze - helps strengthen upper body
N: no weights on bed/floor
181
Q

What are indications for internal fixation? External Fixation?

A

Internal: surgical application of implants for purpose of repairing bone - wires, pins, plates, nails, bone screws

External Fixation: Used to set bone in which a cast would not allow proper alignment. Pins, screws, rods, frames, rings

Clean pins 2 x in 12 hour shift

182
Q

What is the nursing management of casts? What are the goals of patient care for cast?

A
  1. perform neurovascular assessment
  2. expose a newly applied cast to air circulation
  3. Never permit wet cast to rest directly on flat or firm surface
  4. Apply ice for first 24-36 hours
  5. Manage Pain
  6. healing occurs, proper alignment
  7. prevent secondary complications
  8. neurovascular status remains intact
  9. restore function
183
Q

What are risk factors for amputation?

A

DM most common, arthrosclerosis, traumatic event, violent incident, GSW, tissue/bone severed

184
Q

What are the types of amputation?

A

Open (Guillotine): cut off whole and wrap

Closed (flap): used skin to create a flap over. Heals faster

185
Q

What are some complications of amputations?

A

Pain
falls
infection
contracturs - do not elevate leg for first 24 hours!

186
Q

Benefits of Immediate Post Op Prosthesis

A 
*temporary*
assist wound healing
minimize edema and pain
reduce phantom pain
physcological benefits
prevent knee flexion contracture
protect risdual limb
187
Q

Amputation Teachings

A

ROM ASAP
Avoid sitting in chair for more than 1 hr with hips flexed (prevents DVT, contractures)
Avoid elevating extremity for long periods
Avoid dangling residual limb
Compression reapplied several times daily
Shrinker bandage should be washed and changed daily

188
Q

What is included in EBP?

A
  1. Best evidence from the most current research available
  2. nurse clinical expertise
  3. patient preferences and values
189
Q

What is quantitative research?

A

use of precise measurement to collect data, analyze it statistically

190
Q

What is qualitative research?

A

Investigate a question through narrative data exploring subjective experiences

191
Q

What are background questions?

A
  • generalized questions that seek more information about a topic
  • fills in gaps of knowledge
  • answered found in textbooks, medical dictionaries, drug handbooks
192
Q

What are foreground questions?

A

narrower in focus, about a specific clinical issue

answers can be found in studies conducted to elicit evidence

193
Q

What is PICOT

A
  • used to define and formulate a clinical question for EBP
  • develops foreground questions
P: patient, population, or problem
I: intervention
C: comparison (don't always need)
O: desired Outcome
T: time (not always needed)
194
Q

What are the steps of developing a PICOT statement?

A

step 1: develop/ask a clinical question
step 2: retrieve the evidence
step 3: evaluate the evidence
step 4: apply the evidence

195
Q

What is reliability vs. validity?

A

Reliability is the extent to which an experiment, test, or measuring procedure yields the same result on repeated trials under identical conditions

validity is does it measure what it’s supposed to measure?

196
Q

What does the NPA do?

A

defines scope of practice, standards for education programs, liscensure requirements, grounds for disciplinary action.

regulates nursing practice

197
Q

What does OBN do?

A

designated to apply laws to individuals

oversee licensure

198
Q

What are hypotonic, isotonic, hypertonic solutions?

A
  • hypotonic: more particles inside to pull particules/fluid into cell. 0.45% NaCl. Used in DKA
  • hypertonic: causes fluid to leave cell. D5 0.45% NaCl D5 0.9% NaCl
  • isotonic: fluid stays within the intravascular space. 0.9% NaCl, D5W (isotonic in bag, hypo. in body), lactated ringers
199
Q

How should you look for an IV insertion site?

A

start distally and work proximally

200
Q

Common gauges used for IV fluid use

A

18: blood, resuscitation fluids
24: less traumitizing, shorter term use
20-22: most common

201
Q

How to insert an IV

A

bevel UP, 15-30 degree angle

202
Q

What should you do if you suspect fluid overload?

A
  • slow IV rate
  • raise head of bed
  • may need O2
  • call physician

NURS 1250 (6 decks)

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