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202 Flashcards

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1
Q

Difference between Low flow oxygen and High flow oxygen?

A

Low flow - Measured in L/ min titrated 1-2L, inspiratory flow not met, and uses Nasal prongs, simple mask, non-rebreather

High flow - Measured in % titrated 5-10% at a time air needs to humidified, inspiratory flow met/exceeded

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2
Q

What is an AquaPak Humidified O2 system? And when does the tubing need to be changed?

A

An attachment that contains sterile water that humidifies the air and is an AGM not a medication. Tubing needs to be changed every 7 days

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3
Q

What are the three parts of a trach tube?

A

Outer cannula with flange
Inner Cannula
Obturator

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4
Q

What are the most important safety equipment for a trach tube?

A

Suction equipment
Oxygen equipment with humidification
Two replacement tracheostomy tubes (one the same size and one smaller)
Obturator and spare inner cannula
10 ml syringe

Less important
Tracheal tube exchanger
tracheal dilator or forceps
Sterile gloves
Water soluble lubricant
spare ties
Normal saline nebule
Manual resuscitation device with appropriate size airway and mask

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5
Q

What does the placement of the chest tube mean?

A

Upper chest tube means its draining air
Lower chest tube is draining fluid

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6
Q

Is a PICC a Peripheral line or a Central line?

A

Central line

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7
Q

What size is a CVAD with multiple lumens? and do you have to flush each line?

A

18 gage with one that is different

Yes

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8
Q

When would you need a PICC?

A

Administering IV fluids and blood products quickly

Administering Vaso medication

Chemotherapy

Administer medications with extreme PH values like cloxacillin

Obtain venous blood samples

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9
Q

How many ml’s do you need to flush a Central line?

A

10 mls before

20mls after

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10
Q

How many ml’s do you need to flush a peripheral line?

A

3mls before

10 ml’s after

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11
Q

Do you need a Heparin flush for Valved PICC line?

A

No

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12
Q

Why do you need to aspirate a central line?

A

Because a fibrin sheath can form

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13
Q

How often does a transparent dressing, Securement device, Needless cap need to be changed?

A

Every 7 days and prn

Transparent dressing- gauze needs to be changed every 2 days

Needless cap should be changed when blood is unable to clear from the needless cap

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13
Q

How often does a transparent dressing, Securement device, Needless cap need to be changed?

A

Every 7 days and prn

Transparent dressing- gauze needs to be changed every 2 days

Needless cap should be changed when blood is unable to clear from the needless cap

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14
Q

What to do if the external line is different by at least 2 cms?

A

Report to IV team and document

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15
Q

Complication of a CVAD?

A

Infection
Occlusions
Phlebitis, thrombophlebitis, infiltration, extravasation
Catheter migration
Air embolism
Catheter embolism
Pneumothorax/ hemothorax
Arrhythmia

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16
Q

How to deal with a venous air embolism?

A

Lean the patient on the left side and in Trendelenburg position to move air bubble into right right atrium.

If it is an arterial air embolism should be kept in supine position

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17
Q

What ml syringe is the smallest you can use with a peripheral line and why?

A

10 ml due to the idea it can only exert 8 PSI anything smaller is too much pressure

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18
Q

What to do if an IV push med is incompatible with the IV solution?

A

Stop IV line, pinch the line, aspirate, flush with 10ml, administer the medication abiding my the time required to administer, and 10 ml post med flush.

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19
Q

What causes a catheter Occlusion? S&S? Interventions?

A

Clamped or kinked catheter, Tip against wall of vessel, Thrombosis, Precipitate build up in lumen

S&S- Sluggish infusion or aspiration, unable and/or aspirate

Intervention - Check IV line, flush with saline, anticoagulant or thrombolytic agent

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20
Q

What causes an Embolism? S&S? Interventions?

A

Catheter breaking, Dislodgement of thrombus, entry of air into circulation

S&S - Chest pain, Respiratory distress (dyspnea, tachypnea, hypoxia, cyanosis), hypertension, tachycardia

Interventions - Clamp catheter, place patient on left side with head down( if suspect or emboli), Administer oxygen, notify physician

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21
Q

What is the cause of pneumothorax? S&S? and Interventions?

A

Inadvertent puncture of the lung at the time of inserting needle in vein

Decreased or absent breath sounds, respiratory distress (cyanosis, dyspnea, tachypnea), chest pain, distended unilateral chest

Interventions - Position in semi Fowler’s position, administer O2, administer analgesic if ordered, Prepare for xray/chest tube insertion

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22
Q

What causes Catheter migration? Signs and Symptoms? Intervention?

A

Improper suturing, insertion site trauma pressure, changes in intrathoracic pressure, forceful catheter flushing, spontaneous

Sluggish infusion or aspiration, edema of chest for neck during infusion, Client complaint of gurgling sound in ear, Dysrhythmias, Increased external catheter length

Fluoroscopy to verify position, assist with removal and new CVAD placement

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23
Q

Where are Non tunneled CVAD’s located?

A

Jugular, femoral, and subclavian

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24
When would you want to use a non tunneled CVAD?
Short term emergency therapy, external jugular, or subclavian vein Requires a sterile dressing Non valved Only good for 7 days or less due to risk of infections
25
When would you use a CVAD?
Used for long term intermittent or continuous access to Administer ... - Chemo therapy, Vasopressors or dilator, give large volumes of IV and normal IV, irritant medications, Extreme PH values, hypertonic solutions, obtain venous blood samples, and monitor central venous pressure Proximal end is tunneled subcutaneously from the insertion site 10-15 cm Have a Dacron Cuff on the tunneled portion of the catheter 3-4 weeks so granulation tissue can form around it
26
When would you use an IVAD (Implanted Vascular Access device?
Located in the upper chest that connects to the distal third vena cava of superior vena cava Used for chemo therapy (aka people who need a port very long term outside the hospital) Requires heparin flush every 8 weeks to maintain patency
27
When would a hemodialysis cuff would need a cuff?
Uncuffed - used for an emergency or less than 3 months Cuffed - longer than 3 months
28
Things to know if giving TPN through CVAD
Total parenteral nutrition is given through CVAD and Partial parenteral nutrition is given with PVAD Needs a dedicated line and an inline filter
29
What happens when there is Unilateral dilation in the eyes?
Brain hematoma Brainstem herniation Migraine Compressed cranial nerve 3
30
Why is there Bilateral Dilation with fixed versus sluggish pupils?
Mid brain injury Poor prognosis if GCS less than 3 Patient is approaching death Sluggish - Eye disease Illicit substances Post seizure
31
What does bilateral Constriction mean?
Brain trauma (pons CVA) opioids/ narcotics Medication Environmental toxins eye trauma Diseases (diabtes, MS, Neuro-syphillis) heat stroke
32
Unilateral constriction mean?
Horner's syndrome Iris inflammation Adhesion Medication
33
Which cranial nerve number is responsible ears?
8 the acoustic
34
Right now identify where the cranial nerves are
Refer to the first neuro pp
35
How many pairs of dermatomes are there?
31 pairs of spinal nerves only 30 dermatomes
36
How many cervical, thoracic, lumbar, Sacral, and coccygeal nerves are there?
7 Cervical C1 is not a dermatome so it starts at C2 12 Thoracic 5 lumbar 5 Sacral 1 Coccyx numbered as zero
37
How do dermatomes run?
Bilaterally across horizontally
38
Are there Dermatomes on your face?
No cause Cranial nerves
39
Describe where the cervical nerves are?
Back of head to Lower back, inner arms, ring fingers (back of head to mid shoulder blades)
40
Describe where the thoracic dermatomes are
Upper back/ back of arms to Lower abdomen and mid back
41
Describe where the Lumbar dermatomes are
Lowe back/ hip and goin to Lower back, front and outside of calf
42
Sacral Dermatomes location?
Lower back to perianal region and next to anus
43
Methods to assess motor functions?
Gait Romberg test finger to finger test heel to shin test Strength Symmetry
44
Difference between Cerebellar ataxia versus Sensory ataxia?
Cerebellar - uncoordinated muscle movement Sensory - Impaired feeling Ataxia - without coordination
45
What does DTR stand for?
Deep tissue reflex
46
What can cause abnormal reflexes?
Peripheral Neuropathy Nerve compression Trauma or Lesions Medications Hormone imbalances Electrolyte imbalances Nutrient deficiencies Disease
47
Ischemic versus Hemorrhagic stroke?
Ischemic - blood clot stops the flow of blood to an area Hemorrhagic stroke- Weakened/ diseased blood vessels rupture
48
Acronym for stroke?
FAST VAN Face Arm Speech Time Vision Aphasia Neglect
49
What is an extracranial cause of a siezure?
Excess/ Deficit- Glucose, electrolytes, triglycerides Toxins - Internal (kidney or live or metabolic disease) External poisons
50
What is an intracranial cause
Primary epilepsy (idiopathic) Secondary epilepsy - Progressive brain disease (tumor) Static brain disease (scar after trauma)
51
Three key features of seizures
Where the seizure began in the brain Level of awareness Describing the other features
52
What is a focal, generalized, and focal to bilateral seizures?
Focal - onset in one care on one side of the brain Generalize seizure - Involves both sides of the brain at the onset Focal to bilateral - one side to both
53
What are the levels of awareness during a seizure?
Focal aware - awareness remains intact, even if the person is unable to talk or respond during a seizure Focal impaired awareness - Awareness is impaired or affected at anytime during the seizure Awareness unknown - Not always possible to know f a person is aware or not Generalized - presumed to affect the person's awareness or consciousness
54
What are the other features of the seizures?
Focal motor seizure - body movement occurs (Twitching, jerking, or stiffening) or automatisms (lip licking, rubbing hands, walking/running, laughing/crying) Focal non-motor seizure: Changes in sensation, emotions, thinking, or experiences Generalized motor seizure: Tonic and clonic (tonic stiffening and jerking) Generalized non-motor seizure: primarily absence seizures involve brief changes in awareness, staring, and may present with automatisms
55
What are the phases of a seizure?
Prodromal - signs a seizure could be happening (confusion, headache, mood/behavior's changes) Early Ictal/ Aural phase - Sensory warnings prior Ictal phase - Seizure acting, loss of awareness, repeated movements, convulsions, tachycardia, trouble breathing Postictal phase - Rest and recovery
56
What is status epilepticus?
A state of constant seizure or when seizures recur in rapid succession without return to consciousness between seizures (neurological emergency) Uses more energy than is supplied - neurons become exhausted and cease to function and can cause permanent brain damage
57
What is a tonic-clonic epilepticus seizure?
Most dangerous as it can cause ventilatory insufficiency, hypoxia, cardiac arrythmias, hyperthermia, and systemic acidosis
58
What can trigger a seizure?
Stress excessive excitement Excessive fluid in take Extremely low blood sugar sunlight, heat, humidity Flickering lights SKipping meals Illness, fever, allergies Lack of sleep Withdrawal form medications, illicit drugs, alcohol Missing medications
59
Things to do and do not with seizures?
Remove hazards ensure patient safety and airway stay with client until seizure has passed and time and observe activity Turn the patient on their side if possible apply oxygen if needed suction if needed Assist with ventilation if patient does not breath Call a code blue if warranted DO NOT Restrain or insert anything into their mouth.
60
Symptoms of short term alcohol on CNS
Initial relaxation Decreased inhibition (drive faster) Lack of coordination Impaired judgement Slurred speech Anxiety or agitation Hypotension Bradycardia Bradypnea
61
Long term symptoms of alcohol
Wernicke’s encephalopathy Korsakoff's syndrome Impaired cognition Decreased psychomotor skills Impaired abstract thinking and memory Sleep disturbances Depression/labile mood Attention deficit Seizures
62
What is the CAGE tool?
A tool to ask about alcohol use Have you thought of CUTTING down? Have people ANNOYED you by criticizing your drinking? Have you ever felt bad or GUILTY about your drinking? Have you ever had in the morning (EYE OPENER) to steady your nerves or get rid of a hangover
63
What is CIWA used for?
To assess alcohol withdrawal Clinical Institute Withdrawal Assessment
64
What is the 10 categories of AWS?
Nausea/ vomiting Tremor Tactile disturbances Auditory disturbances Paroxysmal sweats Visual disturbances Anxiety Headache Agitation Orientation
65
Stages of alcohol withdrawl over 3 days?
6-12 hours - Minor withdrawal symptoms: insomnia, tremors, anxiety, gastrointestinal upset, headache, diaphoresis, palpitations, anorexia, nausea, tachycardia, hypertension 12-24 hours-Alcoholic hallucinosis: visual, auditory, or tactile hallucinations 24-48 hours -Withdrawal seizures: generalized tonic-clonic seizures 48-72 hours - Alcohol withdrawal delirium (delirium tremens): hallucinations (predominately visual), disorientation, agitation, diaphoresis
66
What is the kindling phenomenon?
The severity of each attempted to withdrawal gets more severe each time consecutive time they are withdrawing
67
Other issues with alcohol withdrawal
Alcohol is a diuretic N/V Poor appetite due to gastritis Not drinking enough water alcohol can cause pancreatitis malnourished and at risk for refeeding syndrome Gastritis caused by lack of Thiamine
68
Why is thiamine deficiency associated with alcohol withdrawal?
Thaimine is essential for energy metabolism. it converts cards into glucose BeriBeri - Dry beriberi: effects the CNS and Peripheral nervous system - Wernicke’s encephalopathy (fluid on the brain) Acute/sudden syndrome requiring urgent treatment Swelling causes damage to nerves and blood vessels in the brain Ataxia, Confusion, Nystagmus (uncontrolled eye movement vibration) If untreated can lead to Korsakoff’s Syndrome Korsakoff’s Syndrome (second step from the one above) Irreversible, significant short-term memory impairment Inability to learn new things or retain new information Some loss of long-term memory Aphasia Lack of insight Confabulation Wet: effects the heart and circulatory system -
69
What makes up most of spinal injury accidents?
Motor vehicle (35%) Falls (17%)
70
Degrees of injury
Complete - spinal cord is completely severed, Complete loss of mobility and sensation below the injury Incomplete - Incomplete or partial cord severance, Some movement and/or sensory below the level of injury
71
What is the difference between primary injury and secondary injury?
Primary is the initial contact Secondary is the inflammation that forms later
71
What is the difference between primary injury and secondary injury?
Primary is the initial contact Secondary is the inflammation that forms later
72
Collaborative care goals for spinal injury
Patient airway needs to be maintianed along with adequate ventilation, adequate circulating blood volume treat systemic and neurologic shock to maintain BP In the assessment check for motor and sensory tests, spontaneous movements, signs of ICP and LOC
73
Clinical manifestations of an injury above C4
Total loss of respiratory muscles Mechanical ventilation is required Artificial airway Paralysis of abdominal and intercostal muscles pulmonary edema
74
Clinical manifestations below C4?
Diaphragmatic breathing if phrenic nerve functional Hypoventilation common with diaphragmatic breathing Paralysis of abdominal and intercostal muscles
75
Clinical manifestations of T5 or higher
Neurogenic shock Bradycardia under 40 (administer atropine) Peripheral vasodilation Cardiac monitoring is necessary
76
Clinical manifestations under T5
Problems associated with hypomotility (bowels are slower) Constipation Paralytic ileus Gastric distension Medications such as metoclopramide may help with motility Stress ulcers are common
77
Clinical manifestations T12 or above and below T12
Reflex (spastic) bowels Cannot voluntarily relax the anal sphincter may have constipation Signals between the colon and the brain become distupted The reflex that triggers a BM still works but may not be felt Areflexic (flaccid bowel) Decreased peristalsis Loose sphincter Risk for constipation with bowel incontinence
78
Clinical manifestations of ICP
Changes in LOC Ocular signs Headache Vomiting Late signs Changes in vitals (Decreased HR, Irregular respirations, and widened BP) Decreased motor function
79
What should you monitor with ICP?
Fluid and electrolyte balance Monitor ICP should be between 5-15 mm Hg protect from injury consider of psychological considerations
80
Ranges for GCS
13-15 is mild brain injury 9-12 Moderate injury 3-8 Severe brain injury
81
What is a coup contrecoup injury?
Primary (coup) the first impact Contre coup or the secondary is when the brain hits the opposite side of impact after first

Nursing (2 decks)

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