Exam 6

Question 1

What is spinal shock?

Answer 1

temporary loss of reflexes, sensation, rectal tone, absent thermoregulation, flaccid paralysis below level of SCI

Question 2

What is neurogenic shock?

Answer 2

interruption of autonomic pathways causing massive vasodilation and pooling of venous blood leading to hypotension, hypothermia, and bradycardia

extremities will be warm d/t blood pooling but blood is diverted away from vital organs

loss of ability to regulate diameter of vessels and to stimulate nerve impulses leading to major hemodynamic changes

only distributive shock that has bradycardia d/t parasympathetic nervous system being unopposed to SNS

common with injuries above level of T6

Question 3

What nursing interventions are done during the acute period of an SCI?

Answer 3

using ASIA scale to determine level and extent of injury
blood work
imaging
vital signs (goal: O2>93, MAP>85-90)
fluid resuscitation
vasopressor

Question 4

What type of respiratory complications may occur with SCI?

Answer 4

injury above C4: total loss of respiratory muscle function, respiratory arrest may occur within minutes of injury

C3-C5: diaphragmatic breathing d/t loss of phrenic nerve innervation to diaphragm leading to respiratory insufficiency

Question 5

What type of cardiovascular complications may occur with SCI?

Answer 5

injury above T6 leads to dysfunction of SNS: at risk for bradycardia and hypotension w/ any vagal stimulation which can lead to cardiac arrest

Question 6

What type of bladder and bowel complications may occur with SCI?

Answer 6

urinary retention, neurogenic bladder and bowel, constipation

Question 7

What thermoregulation complications may occur with SCI?

Answer 7

altered thermoregulation d/t loss of vasomotor control and sympathetically mediated dilation

poikilothermia

Question 8

What metabolic complications may occur with SCI?

Answer 8

increased nutritional needs d/t increase metabolism and protein breakdown, at risk for dysphagia

Question 9

What is autonomic dysreflexia? Interventions?

Answer 9

potentially life-threatening event (exaggeration of SNS response) triggered by some irritant below level of injury

usually involves SCI above T6

diagnosed by if pt has a sudden onset BP greater than 20-40mmHg above baseline

raise HOB>45, high fowlers, then address possible irritant stimulants

Question 10

What are the risk factors for lung cancer?

Answer 10

smoking, tobacco use, pollution, radon/radiation, asbestos, industrial agents

Question 11

Which populations are most at risk for lung cancer?

Answer 11

men more likely to get it
women develop it easier, quicker, younger, and have higher mortality
non-smoking women at more risk than non-smoking men
more likely in black individuals, least likely in asian pacific islanders

Question 12

How does lung cancer develop?

Answer 12

mutated epithelial cells secrete epidermal growth factor and develop tumor

it takes 8-10 yrs for a tumor to reach 1cm (smallest lesion detectable by xray)

primarily occurs in segmental bronchi and most commonly in upper lobes

Question 13

What are the common early manifestations of lung cancer?

Answer 13

persistent cough with sputum (most common, typically misdiagnosed as pneumonia)

hemoptysis (more common s/s of lung cancer than of TB)

dyspnea

wheezing

chest pain

Question 14

What are later manifestations of lung cancer?

Answer 14

anorexia, n/v, fatigue, weight loss
hoarsenes
unilateral paralysis of diaphragm (paradoxical chest movement = asymmetrical chest movement)
dysphagia
superior vena cava obstruction (reduces CO)
palpable lymph nodes (painful, fixed, stay notable throughout disease course)
mediastinal/cardiac involvement

Question 15

How is lung cancer screened for?

Answer 15

annually in adults 55-77 with hx of smoking: 30 pack yr hx, current smoker, quit less than 15 yrs ago

done w/ low does CT