Exam 4 Flashcards
(295 cards)
1
Q
what is an open fracture?
A
occurs when the skull is punctured causing the dura to be punctured exposing the brain
2
Q
what is a primary TBI?
A
damage that occurs at the time of injury due to stress on the brain
3
Q
is a open fracture primary or secondary?
A
primary
4
Q
what is a linear fracture?
A
a crack to the skull that does not move bone
5
Q
is a linear fracture primary or secondary?
A
primary
6
Q
what is a depressed fracture?
A
a portion of the skull is caved inward towards the brain
7
Q
what is a comminuted fracture?
A
fractured in one spot with many pieces
8
Q
what is a basilar fracture?
A
fracture at the floor of the skull
9
Q
what causes basilar fracture?
A
MVA, assault,
10
Q
what will a basilar fracture patient present like?
A
Bleeding from ears/nose, CSF from nose, Racoon eyes, mastoid bruising
11
Q
what is battles sign?
A
bruising at the mastoid
12
Q
what type of fracture will have a positive battles sign?
A
basilar fracture
13
Q
what is the halo test?
A
a test that looks for csf being present in blood from some ones nose
14
Q
what fracture do you do the halo test on?
A
basilar
15
Q
how can you test if what is coming from someones nose is CSF?
A
do a blood sugar the fluid if it has a glucose content its csf and the halo test
16
Q
what is a closed brain injury?
A
occurs when skull integrity is good but damage has occurred to the brain
17
Q
what is a concussion?
A
a closed brain injury that causes tissue to be stunned
18
Q
what is a contusion?
A
a closed brain injury that causes damage to the brain
19
Q
does a concussion or contusion cause brain damage?
A
contusion
20
Q
what does the contusion do to the brain?
A
causes bruising in a area
21
Q
what is a diffused axonal injury?
A
damage to the axons in the white matter
and tearing of vessels
22
Q
what is the severity of a diffused axonal injury?
A
extreme deficits
23
Q
what is a secondary brain injury?
A
something that occurs after a injury
24
Q
what are examples of secondary brain injury?
A
hemorrhage, epidural, subdural, intracerebral, brain herniation
25
what is a epidural hemorrhage?
ARTERIAL bleeding between the inner skull and the dural space
26
is an epidural bleed slow or fast?
fast bleed
27
what can trick you about an epidural bleed?
they will brief loss of LOC, get better, and then rapidly deteriorate
28
what is a subdural bleed?
Venous bleed beneath the dura and above the arachnoid…..blood touching the brain
29
is a subdural bleed slow or fast?
slow
30
what is a intracerebral bleed?
arterial and venous bleeding into the subcortical white matter inside the brain
31
what is brain herniation?
continued edema in the brain causes the brain tissue to be squeezed into structres
32
what type of bleed is usually not caught right away?
subdural because it is a slower bleed
33
what are symptoms of brain herniation?
rapid decrease in neuro status, rapid decline in LOC, pupils will change into many different things
34
how is a brain herniation fixed?
******cranioplasty to remove part of the skull
35
what should be done with the patient prior to surgery?
CT scan
36
what is done in the OR to help with increased ICP?
drains
37
how do you treat tbi patients?
like SCI
38
what precautions are TBI patients on?
spinal precautions and seizure precautions
39
whats included in spinal precautions?
lay flat, spinal board, log roll, c collar
40
what acronym should you keep in mind with TBI?
ABC
41
what questions should you ask yourself when thinking airway on TBI?
can they breath on their own, clear secretions, maintain spo2, is their pattern normal
42
what may be done prophylactically to TBI patietns?
intubation
43
what are the early neuro changes for TBI?
change in LOC, restless, irritable, coordination changes, different strength in extremities
44
what might a TBI patient be doing with their hands?
posturing
45
what are the two kinds of posturing?
Decorticate and decerebrate
46
what does decerebrate posturing look like?
arms at side and wrists extension
47
what does Decorticate posturing look like?
arms on chest and wrist in flexiom
48
what is glasgow scale?
Extent of neuro activity
49
what are the diagnostics for TBI?
full rainbow and CT/MRI
50
what are the interventions for TBI?
could be trached, could be intubated, seizure precautions, neuro checks q 2, reorient, restraints, repeat ct/mri
51
what should be used sparingly with TBI?
sedation
52
why is sedation used cautiously in TBI patients?
it can mask neuro changes
53
what meds are TBI patients on?
Dexamethasone, Fentanyl, and pheytoin
54
what does dexamethasone do for TBI?
alleviates edema and decreases ICP
55
what should you watch for when giving dexamethasone?
hypoglycemia, hyperglycemia,
56
why is fentanyl given to TBI?
pain
57
is fent iv push or continous?
both
58
why is phenytoin given to TBI?
anticonvulsant to prevent seizures
59
is phenytoin iv push or continous?
both
60
what should you always do when giving phenytoin?
run the drug through a filter, check ALT/AST, and check serum levels in blood
61
why should phenytoin be run through a filter?
it crystalizes
62
what is a good phenytoin serum level?
10-20
63
what is the monroe kellie hypothesis?
brain, blood, and CSF are in a constant equilibrium where if one increases the others decrease
64
what are early signs of increased ICP?
decline in LOC, restless, irritable, confusion, headache, unilateral weakness, pupil changes
65
what are late signs of increased ICP?
severe headache, LOC change, coma, erratic resp rate/cheyenne stokes, irregular pulse, hyperthermia, projectile vomitting, loss of corneal reflex, loss of gag reflex, posturing, seiaures, flaccidity, unreactive pupils, cushings triad
66
what reflex changes can increase ICP lead to?
loss of corneal, cough, and gag
67
what is the corneal reflex?
when you touch their eye they move their head
68
what are signs of cushings triad?
hypertension with a widened pulse pressure, bradycardia, bradypnea
69
what is a widened pule pressure?
a pulse pressure greater than 40
70
how is pulse pressure calculated?
SBP - DBP
71
in someone with increased ICP what are you monitoring?
5 lead, pulse ox, ICP, CO2
72
what is used to monitor ICP?
bolt or EVD
73
what type of ICP device is a surgical procedure?
EVD
74
why is edema in the skull bad?
leads to ischemia of the brain
75
why is CO2 monitored in increased ICP?
because CO2 has a direct effect on pressure in the skull
76
what does high CO2 do to the brain?
increases pressure
77
what does low CO2 do to the brain?
decreases venous outlfow increasing the pressure
78
what are the diagnostics done for increased ICP?
CT and MRI
79
what are the procedures done for increased ICP?
Craniotomy, burr holes, cranioplasty, and drains
80
what is a craniotomy?
cut into skull suck out blood and put the flap back
81
what are burr holes?
hole is made for needle to suck out contents
82
what is a cranioplasty?
cut into the skull and remove a portion
83
what are the interventions for increased ICP?
keep CPP greater than 70, HOB at 30 degrees or more, keep head midline, help with temp control, low stim enviroment, paralyzing to lower ICP
84
what should be avoided in increased ICP patients?
low HOB, dont cluster care, avoid hip flexion, suctioning for more than 10 seconds
85
why should you avoid hip flexion in increased ICP?
it reduce venous outflow
86
how is CPP calculated?
MAP-ICP
87
what does CPP tell us?
cerebral perfusion pressure tells you xxx
88
what meds are given for increased ICP?
mannitol, succinylcholine, and vecuronium
89
why is mannitol given for increased ICP?
reduces icp by directly targeting the brain
90
is mannitol k sparring or wasting?
wasting
91
what other med maybe given with mannitol?
furosemide
92
is mannitol continuous or bolused?
bolused
93
what should always be done when giving mannitol?
filter on IV line
94
what should be hooked up before giving mannitol?
ICP monitoring and filter
95
what happens to mannitol if it sits too long at room temp?
crystalize
96
what paralytics are given to reduce ICP?
succinylcholine and vecuronium
97
what are side effects of paralytics?
apnea
98
what paralytic is IV push only?
suc
99
what paralytic is IV drip?
vec
100
what paralytic can raise K level?
succinylcholine
101
what is a complete SCI?
spinal cord damage enough to eliminate function below injury
102
what is incomplete SCI?
injury allowing some function below injury
103
what is a hyperflexion SCI?
sudden forward acceleration
104
what is hyperextension SCI?
sudden acceleration and deccelerationw
105
what is an example of hyperflexion sci?
head on collision or diving
106
what is an example of hyperextension SCI?
rear ended
107
what is axial loading sci?
vertical compression of vertebae
108
what are some examples of axial loading SCI?
diving, falling on butt, landing on feet
109
what is a rotational SCI?
turning head beyond ROM
110
what is penetrating sci?
damage to spine due to knife, gun shot etc
111
what are secondary sci?
hemorrhage, ischemia, shock, edema
112
why are you worried about ABC with SCI?
high risk of resp complications in cervical sci because of damage to the phrenic nerve
113
what does the phrenic nerve control?
diaphragm and accessory muscles
114
how often do you assess resp function in sci?
q2
115
what might be done to SCI injury to help with oxygenation?
intubated/trach
116
what is also calculated on SCI?
glasgow scale
117
how can you assess hemodynamics in SCI?
art line
118
what is common in sci in relation to waste?
illeus and neurogenic bladder
119
what is neurogenic bladder?
they dont empty all of the way
120
what are diagnostics for sci?
ct, mri, x ray
121
what do you want MAP to be in SCI patient?
90 or more
122
what prophylaxis are SCI patietns on?
DVT/ clot
123
what are the intervention for DVT porphylaxis?
TED, SCD, ROM, heparin,warfarin, enoxaparin, IVC
124
what patients cant get blood thinning medications?
hemmorhage
125
what is an IVC
filter that goes into inferior vena cava that catches clots
126
what are sci patients at risk for resp wise?
mucus plugs, pneumonia, atelactasis
127
what can be done to help sci patients with resp comp?
incentive spirometry, suction, quad cough
128
what kind of rolling for sci patients?
log
129
what devices help keep spine neutral?
c collar, halo, and tlso
130
whats better c collar or halo?
halo
131
is a halo removable?
no
132
why cant the halo be removed?
its screwed into the skull
133
what if halo comes undone?
hold head in neutral, yell for help, keep them still
134
what meds do sci patients take?
methlyprednisone and baclofen
135
what should be avoided if taking methylprednisone?
grapfruit
136
what should be checked in patients taking methyl prednisone
hypo/hyperglycemia
137
what are then complications of sci?
spinal shock, neurogenic shock, autonomic dyseflexia
138
what does the sympathetic control?
fight or flith
139
what does parasympathetic do?
calm down
140
what happens during spinal shock?
temporary complete loss of function below the injury
141
symptoms of spinal shock?
hypotension, bradycardia, flaccid,
142
what are the interventions for spinal shock?
maintain airway, mobilize spine, fluids, control body temp
143
how long does it take to recover from spinal shock?
48 hours
144
what is neurogenic shock?
imbalance of sympathetic and parasympathetic
145
what is too high in neurogenic shock?
parasympathetic
146
what can cause neurogenic shock?
issue below the injury like urinary retention or constipation
147
what are symptoms of neurogenic shock?
hypotension, bradycardia, periphreal vasodilation, decreased LOC, and decreased UOP
148
what might neurogenic shock patients need?
pressors
149
what can neurogenic shock lead to?
organ failure
150
how can you tell the difference between spinal shock and neurogenic shock?
spinal shock has flaccidity is that it?????
151
what type of injury increases your risk of neurogenic shock?
injury above t6
152
what is anutonimc dyseflexia?
sympathetic is too high
153
symptoms of autonomic dyseflexia?
headache, hypertension, bradycardia, N/v, stuffy, flushing/sweating above injury, pale/goosbumps below the injury
154
what non med interventions for autonomic dyserflexia?
sit up, loose clothing, check catheter for obstruction, check for retention, check for impactment, adjust temp
155
what meds are given to autonomic dyserflexia patiens?
nifedipine
156
what are the types of burns?
dry heat, moist heat, contact, electrical, and chemical
157
what is dry heat?
open flame
158
what are open flame burns at risk for ?
inhalation injury
159
what is a moist hear burn?
steam or hot water
160
what is contact burn?
hot metal, grease, tar
161
what is also know as a grand masquerader ?
electrical burn
162
why are elctrical burns so bad?
it burns outside and inside the body
163
what is considered a superficial burn?
first degree
164
what causes first degree burns?
sunburn, flame, scald
165
what layers are involved in first degree?
epidermis
166
symptoms of first degree burn?
tingling, pink, red, hyperthesia, itching, peeling/desquamation, possible blisters
167
what happens if you rub first degree burns?
the epidermis wont rub off
168
what meds might help first degree burns?
Ibuprofen and cooling lotions
169
what is the other term for second degree burns?
partial thickness
170
what are some causes of second degree burns?
scalds, flames, contact
171
what layers are burned in second degree?
epidermis and part of the dermis
172
what are the symptoms of second degree burn?
pain, hyperthesia, sensitive to air
173
what does the burn look like in second degree burns?
blistered, red, weeping, edema, mottled
174
how long do second degree burns take to heal?
10-21 days
175
is there scarring in first degree burns?
no
176
what does the wound look like after its healed in a second degree burn?
scarring and pigment change
177
what is another name for a third degree burn?
full thickness burn
178
what are causes of a third degree burn
flame, prolonged hot lot liquids, eletrical burn, chemical
179
what skin layers are involved in a third degree burn?
epidermis, dermins, and some sub cu tissue....no muscle and bone?????
180
what are symptoms of third degree burn?
insensate, shock, myoglobinuria, contact points
181
what is insensate?
occurs when nerves are burned so there is no pain
182
what is myoglobin uria?
red urine due to break down of myoglobin from muscle damage
183
what are contact points?
entrance and exit wound from electrical burns
184
what does the wound look like in third degree burns?
pale, white, red, brown, black/charred, leathery, dry, edema
185
what is another term for black/charred skin?
eschar
186
what is another name for fourth degree burns?
full thickness
187
what tissue involment in fourth degree burns?
all skin layers, tissue , muscle, bone
188
what causes fourth degree burns?
prolonged exposure to hot surfaces, high voltages, chemicals
189
when do burns cause coagulated vessels?
third degree onward
190
what are symptoms of fourth degree burns?
shock, myoglobinuria, no edema, no pain,
191
what does the wound look like in fourth degree?
charred
192
what is the only treatment option for fourth degree?
amputation
193
does second degree burn require graft?
it could
194
does third degree require graft?
yes
195
what is a circumferential burn?
a burn that goes around an entire area
196
what are cirucmferential burns of the abdomen and chest at risk for?
resp issues due to the chest not being able to fully expand
197
what is an escharotomy?
a cut to the skin to allow for expansion
198
what is a fasciotomy?
a cut that is deeper than a escharotomy to allow for even more expansion
199
what should be kept in mind with electrical burns?
there is an entrance and exit but tissue internal can still be destroyed
200
what is considered a major burn?
more than 20% of the body or burn to the eyes, ears, face, hands, feet, genitals, or perenium
201
at what point do you go to burn center?
if you have more than 20% burn, third degree, electrical or inhalation
202
what systemic changes are there for major burns?
vascular changes, fluid and electrolytes shift, cv changes, pulmonary changes, renal, Gi,
203
what vascular changes occur during major burn?
clots, necrosis, and bad perfusion
204
what fluid/electrolyte changes occur from major burn?
Fluid shifts causing hypovolemia, hyperkalemia, hyponatremia, metabolic acidosis??
205
what cv changes occur during major burn?
hyperkalemia, tachycardia, decreased cardiac output low bP???
206
what pulmonary changes occur during a major burn?
pulmonary edema, swelling of airway, carbon monoxide poising, inability to breath deeply if circumfrential burn
207
what renal changes occurs during a major burn?
the kidneys dont have good blood flow due to hypovolemia/low cardiac output, pre renal failure due to the excessive amount of cellular debris
208
what gi changes occur during major burns?
ulcers, impaired motility, and bowel obstruction
209
what immunoloical changes occur during major burns?
infection/sepsis risk
210
what thermoregulation problems occur with burns?
hypothermia or hyperthermia without infection
211
what kind of shock do burn patients go in?
hypovolemic or septic
212
whats the range for ICP?
10-15
213
what are priorites during a emergent/resuscitative burn?
secure airway, support perfusion, stop burning, remove clothes/jewlery, prevent infection, maintain body temp, fluid resuscitation, and pain management
214
when will patient be intubated for burns?
if they are having trouble breathing, airway burns, cant keep spo2 high
215
if airway burn is not present what will they do for oxygenation?
100% oxygen on a non rebreather
216
what are signs of airway burns?
burnt facia/eyebrow hair, sut in mouth, cough, dry nagging cough, drooling
217
what should be inserted into burn patients?
NG, foley, and possible ET for intubation
218
what kind of IVs should you have for fluid resuscitation?
2 or more 16-18 gauge
219
besides IV what other line may burn patients have?
central line
220
how often should you check output?
hourly
221
what characteristics do you look for in urine output?
color, volume, odor
222
what are signs of fluid overload?
JVD, crackles, weight gain, SOB, High blood pressure ??????
223
what else besides urine would increase output in burn patients?
chest tube, blood, vomit, diarrhea
224
what is parklands formula?
kg x 4ml x % of body burned = fluid for 24 hours
225
what fluid is used during fluid resuscitatiuon?
lactated ringers
226
what is an expected weight gain in the first 72 hours?
15-20 %
227
how much fluid is given in the first 8 hours?
50%
228
how much fluid is given over the next 16 hours?
50%
229
what urine output indicates adequate fluid replacement in electrical burns?
electrical burns 75-100ml per hour
230
what urine output indicates adequate fluid replacemnt in burns?
0.5 -1 ml per kg/hour
231
what HR indicates adequate fluid replacement in burns?
less than 120
232
what BP indicates adequate fluid replacement?
greater than 100 systolic
233
what cvp indicates adequate fluid replacement?
2-6
234
what is used to measure cvp?
swan or equation
235
where does cvp get measured?
in the pulmonary artery
236
what is typically given for pain in burns?
morphine
237
what does morphine due to bodily function?
reduces resp functino and decreases motility
238
what non pharm interventions for burn patients in emergent phase?
relaxing, breathing, guided imagery
239
what should be avoided in emergent burn phase?
ointments
240
what shot should burn patients get?
tetanus
241
what are signs that someone is coping with burns?
dressing changes and looks at themselves
242
what are the percentages for the rule of 9s
head is 9%, arms are 9%, abdomen is 18%, back is 18%, legs are 18%, privates 1%
243
when does the acute/intermediate phase start?
after 24 hours
244
when does the diuretic phase start?
after 36-48 hours
245
what are lab values in the first phase of a burn?
hyponatremia and hyperkalemia ????
246
what are the lab values before the diuretic phase?
hyponatremia and hypokalemia???
247
what are the lab values after the diuretic phase?
xx
248
what should be assessed in relation to CV in the intermediate phase?
???
249
what should be assessed in relation to resp in the intermediate phase?
watch for pneumonia and infection
250
what should be assessed in relation to immune in the intermediate phase?
infection this is the most common time to get a infectino
251
what should be assessed in relation to muscle in the intermediate phase?
rom
252
what should be assessed in relation to neuro endocrine in the intermediate phase?
daily weights, caloric intake, loosing weight
253
when will feedings be considered in burn patients in the intermediate/acute phase?
if they lost more than 10% of initial body weight
254
when does fluid shift back into the normal spaces?
after 36-48 hours
255
what should be assessed during burn wound care?
color, drainage, odor, sloughing,
256
what should be given before wound care?
morphine and hydromorphone??
257
how to prevent infection during wound change?
aseptic technique, silver nitrate for regular burn, and mefnide acetate, monitor for s/s of infection
258
what do you need to know for mefnide acetate
only for electrical burns, penetrates eschar, painful, give pain meds
259
what does silver nitrate do to K and Na
>>
260
what do you need to know silver nitrate?
monitor wbc, k, na???????
261
what burns require silver nitrate?
xxx
262
what burns need telemetry?
electricity
263
what is the equation for ICP
Map - ICP
264
how many cal do burn patients need ?
5k or more
265
what nutrient needs to be high in burns?
high protein
266
what happens if burn patient doesnt eat?
tpn or tube feedings
267
what factors affect severity of burn?
skin, patient, agent, depth, diabetes, HF
268
what does a low cvp indicate?
dehydration
269
what does a high cvp indicated?
fluid overload
270
why would emergent burns patients need pantoprazole?
risk of stress ulcers
271
can burn patients eat during emergent phase?
no
272
what happens if brain herniation goes untreated?
resp arrest or cardiac arrest
273
what is eye opening response rate ?
1-4
274
what is a 1 eye response?
never open eyes
275
what is a 2 eye response
only open to pain
276
what is a 3 eye response?
open to voice
277
what is a 4 eye response?
spontaneous...keeps eyes open
278
what is verbal response rate by?
1-5
279
what is a 1 verbal response?
never say anything
280
what is a 2 verbal response?
only sounds no words
281
what is a 3 verbal response?
inappropriate wordswha
282
what is a 4 verbal response?
confused
283
283
what is a 5 verbal response?
oriented
284
what is best motor response rated?
1-6
285
what do you do when testing motor response?
pressure or pain
286
what does a 1 motor response mean?
no reaction
287
what does a 2 motor response mean?
extension or decerebrate
288
what does a 3 motor response mean?
flexion or decorabate
289
what does a 4 motor response mean?
withdraw hand from stimuli
290
what does 5 motor response mean?
localizes pain.....opposite hand to move the painful side away
290
what does 6 on motor response mean?
obeys command
291
what is the lowest glasgow scale mean?
coma
292
what is the lower glasgow scale score?
3
293
what is the highest glasgows scale?
15
