M 8 Cognition Flashcards
(153 cards)
1
Q
3 categories of brain injury based on the Glasgow Coma Scale
A
Mild Moderate Severe
2
Q
Brain injuries are also classified by the degree of damage to the brain
A
Concussion
Contusion
Laceration
Ischemia
etc.
3
Q
4 key event of traumatic brain injurys
A
Vascular events
Closed head injury
Open head injury
Skull fracture
4
Q
Antecedents of TBIs
A
Adequate oxygenation
Tissue perfusion
Nutrition
Good neuro function
Opportunities for growth
5
Q
Mild TBI S/S
A
LOC for a few seconds to minutes
Memory problems
Dizziness
Loss of balance
N/V
6
Q
Mild assessments for TBI
A
Sensory (vision, hearing, taste)
Light sensitivity
Mood swings
Depression
7
Q
Moderate TBI S/S
A
LOC from minutes to hours
Profound confusion
Combativeness
Slurred speech
8
Q
Moderate assessment for TBI
A
Loss of coordination
Seizures
Dilation of pupils
Clear fluid from ears/nose
9
Q
Children’s TBI S/S
A
Inconsolable crying
Change in eating
Inability to pay attention
Loss of interest in favorite toys
10
Q
Diagnostics for TBI
A
CAT
MRI
PET
Glasgow coma scale
11
Q
Consequences of TBIs
A
Institutionalization
Poor health
Victimization
Inability to form relationships
12
Q
Primary TBI interventions
A
Health promotion
Disease prevention
Education
13
Q
Secondary TBI interventions
A
Screening/diagnosis
Occurs after problem has arisen
14
Q
Tertiary TBI interventions
A
Rehabilitation
Returning PT to highest level of function possible
15
Q
TBI Critical skills
A
Neuro assessment
Communication
Safety assessment/impementation
16
Q
TBI Collaborative interventions
A
Med management of Underlying Cause
Physical/occupation/speech therapy
Case manager
Social worker
17
Q
Post TBI issues
A
Cerebral herniation
Seizures
^ICP
18
Q
TBI PaCO2 greater than 50 =
A
^ICP BAD
19
Q
TBI
O2 drop or CO2 increase = a/b balance
A
acidic
20
Q
^ICP S/S
A
Early - pupil dilation
Projectile vomit
Muscle weakness
^BP
Late - Eyes roll up
21
Q
Cushings triad
A
Irregular resps
Bradycardia
Widening pulse pressure
BAD S/S of ICP
22
Q
Glasgow coma scale below 8=
A
Intubate
23
Q
ICP Less than 15
A
OK
24
Q
BP as pt goes from ICP to Neuro shock
A
First increase
Then decrease
25
ICP Treatment
HOB at 30 degrees
Propofol - sedative
Mannitol - diuretic
26
High CO2 means vaso
Low CO2 means vaso
Dilation - ICP
Constriction
27
Encephalopathy causes
Perfusion disruption
Tumor
Lack of oxygen
Toxins
Infection (meningitis)
28
Encephalopathy 101
Anything that alters brain structure or function
29
Encephalopathy key points
Treatment based on PRIMARY CAUSE
Interventions focus on alterations and mental status
30
Antecedents for encephalopathy
Oxygenation
Perfusion
Nutrition
Neuro function
31
What does encephalopathy impact in the long term
Interpretation of environment
Communication
Learning
32
Encephalopathy risk factors
Infection
Liver problems
Kidney problems
Brain tumors
Poor nutrition/alcoholism
33
Mental manifestations of encephalopathy
Confusion
Poor judgement
Personality change
Nervousness
Sleeping changes
34
Physical Encephalopathy S/S
Musty or sweet breath
Shaky hands
Slurred speech
Sluggish movement
35
Diagnostic test for encephalopathy
Mental status
Memory test
Coordination test
36
Encephalopathy assessments to look for primary cause other than GCS
CBC/blood culture - infection
Altered BP
Metabolic test
Toxin levels
Creatinine
37
To narrow down encephalopathy area or brain, test
Cranial nerves
38
Consequences of encephalopathy
Institutionalization/dependence
Poor health
Victimization
Inability to maintain relationships
39
Primary interventions for encephalopathy
prevention
(alcohol, diet, exercise, exposure to infection)
40
Secondary interventions for encephalopathy
screening
Minimize toxin exposure
Maintain healthy lifestyle
41
Tertiary interventions for encephalopathy
Rehabilitation
Returning patient to highest level of function
42
Critical skills for encephalopathy
Neurologic assessment
Communication
Safety assessment and implementation
43
Collaborative interventions for encephalopathy
Med management
Physical/occupational/speech therapy
Case manager
Social worker
44
Postpartum psychosis key points
EMERGENCY due to potential for suicide or infanticide
A form of bipolar disorder
45
Onset of postpartum psychosis
First 2 weeks
46
Causes for postpartum psychosis
hormonal loss at birth***
fam hist of bipolar disorder
47
Hormones that shift and cause postpart psych
estrogen
progesterone
48
Positive prognosis for postpartum depression is projected based off
acute onset
lack of premorbid debility
49
Post part psychosis treatment
pills
Antipsychotics
Mood stabilizers
Benzos
50
Post part psychosis treatment goal
Counseling goal
Timely remission of symptoms VITAL
Follow up appts
51
Why is remission important
Baby needs contact and attention immediately
52
Post part risk factors
Hist of bipolar, pt or fam*
Discontinuation of mood stabilizers
First pregnancy
Sleep deprivation
Lack of partner support
53
Mental status assessment for encephalopathy
Behavioral
Motor
Speech
54
Post partum psych S/S assessment
Mood
Judgement
Memory
Motivation
55
Consequences of postpartum psychosis
Institutionalization
Poor health
Victimization
Inability to maintain relationships
56
Questions for postpartum depression
Difficulty concentrating?
Difficulty sleeping?
Do you have thoughts of harming self or others?
57
Encourage postpart psych patients to verbalize
Feelings
58
Post partum psych interventions
Meds and their side effects
Discharge planning BEFORE leaving hospital
Referral to intensive therapy
ECT*
59
Schizophrenia moa
Altered dopamine levels
60
Schizophrenia 101
Altered thinking, language, emotions
Abnormal interpretation of reality
61
Attributes of schizophrenia
Environment interpretation
Communication issues
Learning issues
62
Schizo causes
Genetic predisposition
Environmental stressors
Alterations in brain structure
63
Fam hist risk factors for schizo
Maternal malnutrition
Paternal age
Infection during pregnancy
Childhood trauma
Mind altering drugs
64
Assessment for schizo
Memory
Mood
Judgement
Concentration
Motivation
65
Positive schizo symptoms
Negative schizo symptoms
Cognitive schizo symptoms
excess distortion
loss of normality
loss of info processing
66
Positive shizo symptom examples
Hallucination
Delusions
Disorganized speech
67
Negative schizo symptom examples
Flat affect
Speech poverty
Anhedonia
Asociallity
68
Cognitive schizo symptom examples
attention and memory problems
inability to understand
inability to problem solve
69
Consequences of schizophrenia
Institutionalization
Poor health
Victimization
Inability to maintain relationships
70
Nursing diagnosis for schizophrenia
Disturbed though
Disturbed identity
Impaired communication
Social isolation
Risk for violence
71
Schizo interventions ACUTE
Safety and stabilization
Establish trust
Prevent harm
DONT encourage irrational thinking
Adequate nutrition
72
Schizo interventions Chronic
Appt follow ups
Med compliance
Ongoing learning
Increased mental strength
73
Supporting measure for schizo patients
Case management
Rehab
Social support
Partial hospitalization
Avoid drugs and alcohol
74
Meds for schizophrenia
Antipsychotics
Antianxiety
Antidepressants
75
Antipsychotic med categories
First generation - haldol, thorazine
Second generation - Zyprexa, abilify, latuda
76
Side effects of antipsychotics
Extrapyramidal effects
Anticholinergic effects
Weight gain
Neuroleptic malignancy syndrome NMS
77
Extrapyramidal effects
EPS
Involuntary motor ticks
Dystonia, Akathasia, Pseudoparkinsonism
78
Neuroleptic malignancy syndrome
NMS
SRIOUS PROBLEMS/S
FEVER
Confusion
Rigid muscles
Sweating
^ HR
79
Later NMS S/S
FEVER
Encephalopathy
Unstable vitals
Elevated CPK
80
Which antypsychotics have less EPS symptoms, but higher metabolic risks
Second generation
81
Best med for resistant schizophrenia
Clozapine
second gen
82
Long acting schizo med names and how to use
Haldol, abilify, Invega
Benefit is, it is just 1 or 2 injections a month as opposed to daily pills
83
Schizo assessment tools
BPRS Brief psych rating scale
symptoms
SANS/SAPS scale for assessment of negative/positive symptoms
AIMS abnormal involuntary movement scale
84
Pharmacology for schizo cognition
drug categories
Analgesics
Anti-psychotics
Anti-anxiety
Anti-convulsant
Anti-depressants
85
Muscle relaxants
Sedatives
Stimulants
for schizo
reduce muscle spasms
induce sleep
increase alertness
86
If schizo is untreated pt is at risk of
danger to self and others
social isolation
chronic sorrow and helplessness
87
Significant difference between postpartum blues and postpartum psychosis
Intensity and duration
88
If schizo pt is hallucinating
redirect
prioritize safety
89
first priority with postpart psych
Safety
90
Biggest concern with TBIs
bleeding, increases pressure on the brain
91
Is high number good in Glasgow coma scale
YES
92
Glasgow coma scale less than 8
Intubate!!!
Severely low score
93
Blunt force trauma =
MORE swelling
ICP
94
The higher the ICP =
The worse the result
95
Cerebral infarct vs cerebral bleed treatment
Infarct treatable
Bleed, not a lot we can do
96
Epidural vs subdural bleed
which is worse
Epidural is artery - worse
subdural = slow
97
Closed or open fracture more severe
Closed = pressure increase
98
If a concussion patient gets discharged they need to be with some one for the next
24h
99
If concussion person hospitalized they need to be awoken every
30 min
LOW response = BAD
100
Most common form of child abuse
Shaken baby syndrome
101
Brain banging it self on different sides of skull
Cu-contracu
102
3 categories of GCS
Eyes
Mouth
Motor
103
Where do most burns occure
At the home
104
Major burn problems
Fluid loss
Infection
105
How to measure burns
Rule of 9s
Head 9 total
Arm 9 anterior or posterior
Chest 18 anterior or posterior
Legs 18 anterior or posterior
Genitals 1 point
106
Types of burns
Heat
Chemical
Electrical
107
Bad burn is _% or greater
25
108
Treatment for severe burn pt
FLUID RECUSITATION
pt is leaking from burn area
109
Total body edema
anasarca
happens with burns due to loss of proteins in blood
110
what temp do you want on burns
Tepid, NOT hot or cold
increases leaking or reduces perfusion
111
Total body surface area determins what part of treatmet
Fluid resuscitation volume
112
4 x total body surface area percentage burned x kg =
Volume of fluid give total
ON TEST
113
Half of total volume given has to go in during first
8H
114
The remaining half of total volume given goes over the next
16H
115
Diuretic phase of burns beguins when
What happens
72h post incident
PT may go into Fluid Volume overload because water will start returning from 3rd space to body
116
_ technique during burn treatment
give prophylactic
ASEPTIC
SHOT for TETANUS immunoglobulin (Not Booster)
antibiotics
117
Immunoglobulin
actual antibodies = immediate protection
Passive immunity
118
As burns heal pt has to
EXERCISE
increases mobility
prevents contractres
119
To treat hand burns
wrap fingers separately
Spling fingers so they dont contract
120
S/S of airway burn injury
Singed nasal hair
Singed facial hair
Sutt coming out of oral mucosa
121
smoke inhalation results in _ _ poisoning
Carbon monoxide
122
Why is carbon monoxide so dangerous
displaces O2
123
How do you know O2 is compromised with carbon monoxide poisoning
ABGs
124
Carbon monoxide attaches to RBC quicker than O2 resulting in
Lack of O2
Pulse Ox can NOT differentiate
125
At how much O2 to give to carbon monoxide PT
100%
126
What will physician prophylactically do to airway burn pts
INTUBATE
burn = swelling
127
First thing the nurse should do with a chem burn
PPE
128
First thing nurse and pt should do with a chem burn
Remove the chem before washing off for 20 min
or excess chem will turn in to running sludge
129
Debredment
Removing eschar from burns
130
Debredment types
Mechanical
Water jet
131
With electrocutions pt will be put on
C collar
C spine board
protect spine
132
In first 24h of electrocution put pt on
ECG
HAS TO BE to monitor dysrhythmias
133
Where does electrocution hit the heardest
Exit wound blows out
134
As electricity travels through the organs it destroys muscle tissue resulting in an increase of
Myoglobin
135
Myoglobin elimination happens via
Kidney and urine
Dark red urine
Can clog kidneys resulting in failure
136
Eyes with electrecutions
Could result in cataracts
137
Is a lack of urination expected with burns
YES
138
Fam violence affects
the whole family
139
Can emotional abuse be worse than physical over time
Yes
140
S/S of fam violence
Social isolation
abuse
power control
Bullying
141
Fam violence kids keep
secrets
142
Rape is classified as penetration T/F
False
143
What does a rape victim need to have if going home
Develop a plan
144
Circumferential burn consequence
circulation cut off to distal part of extremity
145
How to restore circumferential burn circulation
Escharotomy
Fassiotomy
146
Epidural hematoma TBI
Bleeding above duramater
Most common LOC cause
147
Epidural hematoma S/S
CT SCAN
headache
vomit
muscle weakness
148
Epidural hematoma bleed is arterial so S/S will onset
FAST
149
Epidural hematoma treatment
Craniotomy
150
TBI epidural hematoma S/S time onset
first good recovery
THEN changes is LOC as blood pools
151
What not to do with TBIs
NO Valsalva maneuver
NO straws
152
Sedative of choice for TBIs
Propofol
153
Do epidural hematomas cross suture lines
NO
