MedSurg2 Exam 2 -FINAL-

Question 1

Types of Strokes (4)

Answer 1

TIAS (Transient Ischiemic Attacks)
Thrombolytic Strokes
Hemorrhagic Strokes
Embolic Strokes

Question 2

Cause of TIAS and S/S (2)

Answer 2

Interruption of cerebral blood flow

impaired vision and speechlessness

Question 3

Cause of Thrombolytic Strokes and…
Common in…?
Onset…?

Answer 3

Blood clot forms and obstructs blood flow
Common in elderly w/ atherosclerotic plaque deposits
Occurs rapidly, progresses slowly, occurs at rest

Question 4

Cause of Embolytic Stroke and…
Common on…
Onset…?
Occurs when pt is…?

Answer 4

When traveling blood clot (embolism) travels to and lodges in artery of brain
Common in younger individuals
Appears suddenly w/ immediate neurological deficits
Occurs when awake and active

Question 5

Cause of Hemorrhagic Stroke and what is it REKNOWN for?

Answer 5

Intracranial hemorrhaging: rupturing of vessels in vein

BEING W/OUT WARNING AND MOST FATAL

Question 6

Zones of Injury (3)

Answer 6

Ischemic - will recover w/ blood flow
Injury - some recover/some don’t
Necrotic - CANNOT be recovered and contraction inhibited

Question 7

Stroke Fx: Aspiration 5 Interventions

Answer 7

Provide nutritional support
Evaluate swallowing (dysphagia = cranial nerve lesions)
Assess cognition
Assess positioning during eating
Monitor throat clearing/coughing

Question 8

Stroke Fx: Impaired Mobility Tx Premise (3 interventions to prevent 3 s/s)

Answer 8

Rehab, SCD tockings, and Anticoagulants to prevent pulmonary embolism, VTE, or DVT

Question 9

Stroke Fx: Communication 4 Types of Aphasia, premise, and intervention focus

Answer 9

Expressive/Brocas - difficulty speaking/writing, ↑ reliable language output
Receptive/Wernickes - difficulty understanding, ↑ comprehension
Mixed - combo of 2 above, both interventions
Global - Zero language capacity, ↑ non-verbal comms

Question 10

Stroke Fx: Urinary Elimination

Hypo/HyperReflexia and Diapers?

Answer 10

Hypo - indwelling cath ASAP, output should not ne > 400mL
Hyper - establish voiding sched.
NO DIAPERS

Question 11

Stroke Fx: GI Elimination
Constipation r/in…?
How do we influence BM?

Answer 11

Constipation - this ↑ BP

Diet/Meds that promote BM

Question 12

Stroke Fx: Sensory Perception
Key Care
R Hemisphere Issues
L Hemisphere Issues

Answer 12

Prevent ulcers, neglect, assess agnosia (counter w/ consistency)
R - visual/spatial perception
L - memory deficit

Question 13

Stroke Fx: Body Neglect
Which side ↑% injury?
Educate pt to...?
Dress which side first...?
Why turn pt head...?

Answer 13

R side
Use both sides of body
Affected Side
↑ Visual field

Question 14

Stroke: Mnemonic F.A.S.T S/S

Answer 14

Facial Drooping
Arm WEakness
Speech
Time

Question 15

Burn Pt Key Tx
How many/IV Types?
Med for Propylaxis
Burned extremities vs. Normal?

Answer 15

2 Large bores (14-16 gauge)
Tetanus Toxoid
Neutral Burned, Elevate Normals

Question 16

3 Burn phases and Main Issues

Answer 16

Emergency/Resuscitation - 24 - 48 hrs, pain meds
Acute - 2 weeks - 18 months, infection
Rehabilitation - Ø time, self-image

Question 17

Management of...
Flame
Chemical
Electrical
Radiation burns (2 ea)

Answer 17

smother flames, remove clothing/metal objects
Ø wet! ascertain type before neutralizing
start cardiopulmonary resuscitation, get EKG
undress/bath pt, send to decontamination

Question 18

What to monitor in burns and topical med of choice

Answer 18

Urine Creatinine (14 - 26)
Gentamicin Sulfate (Garamycin)

Question 19

Full Thickness Burn:
Skin Level Effected
General Look (color spread, blisters?, level edema)
Dermis look & sensation

Answer 19

Entire epidermis and dermis (no cells to repopulate)
red - white, Øblisters, severe edema
Leathery firm, Øsensation

Question 20

Full Thickness Tx Goals (4)

Answer 20

Secure Airway
Circulation
Ø Infection
Maintain Temp

Question 21

Burn Grafts:
Auto
Xeno (Hetero)
Allo (Homo) (2 ea)

Answer 21

Auto - butt to arm, 10 - 14 heal time
Xeno - animals like pigs, temp due to rejection until Allo available
Allo - humans (family, donors), triggers rejection

Question 22

Isograft/Syngraft

Answer 22

Transplantation between identical twins

Question 23

Electrical Burns:
“Grand Masquerader”
Conversion…?
4 Emergency Management Notes

Answer 23

surface injury small, internal huge
electrical converted to heat

Separate pt from current
Smother flames
Cardiopulmonary resuscitation
Get ECG

Question 24

Traumatic Brain Injury (TBI) 4 main causes and 4 mechanisms w/ examples!

Answer 24

Falls, Motor accidents, drugs, alcohol
Acceleration/Deceleration - bat/wall
Rotational - left hook
Penetrating - headshot!

Question 25

TBI Ischemic Tx | AGGRESSIVE (4) !!!

Answer 25

AGGRESSIVE tx hypoxia/hypoTN Give O2 Fluid Resuscitation

Question 26

Halo Vest Care Can I touch it...? Abnormalities...? 2 scheduled (qXhr) interventions.

Answer 26

Don't touch anything unless CPR req. Then remove. Report abnormalities to doc. Assess motor fx q2-4hr, turn q2hr

Question 27

``` Spinal Fusion Post-Op Key interventions Check for... (3) Perform... 2 qXhr interventions Follow... PCA or PO Analgesia? ```

Answer 27

``` bleeding, CSF, void ability neuro assessments log roll and deep breath q2h (counters atelectasis) exercise program BOTH OK! ```

Question 28

Fx of... Lower Motor Neurons (r/t CNS, T/L location, s/s) Upper Motor Neurons (r/t CNS, T/L location, s/s) Guillain-Barre Syndrome (what is, development s/s)

Answer 28

leaves CNS - ↓L1, Øreflex/spasm but +pain don't leave CNS, T12 - L1, spasticity/paralysis When immune system attacks nerves. Begins w/ weakness/tingling and becomes paralysis

Question 29

3 Types of Hematomas, location and cause

Answer 29

Subdural - in outer (dura mater) - venous bleeding Subarachnoid - between arachnoid/pia (inner matter) Epidural - epidural skull down spinal cord - arterial bleeding into space or fracture

Question 30

Post-Op Neuro Pt Key Ranges (2) Key ABCS (2 ea)

Answer 30

Glasgow: 3 - 15 ICP: 10 - 15 Airway - ventilated? cervical spine injury? Breathing - breathing? Hypercarbia -> ↑ ICP Circulation - preserve cerebral perfusion by 30º the bed and NO VALSALVAS!

Question 31

``` Post-Op Neuro Meds Mannitol is for..., monitor...? Pentobarbital is for...? Phenytoin is for..? Morphine/Fentanyl are for...? monitor...(2)? ```

Answer 31

↓ cerebral edema, I&O's ↑ coma to reduce metabolic demands (LAST RESORT) ↓ seizures ↓ pain, monitor BP and ABGs

Question 32

``` Shock Labs FX HH BP/O2 PaCO2 PaHCO3 BUN/Creatinine Lactate ```

Answer 32

``` ↑ ↓ Variable, ↓ w/ ↑RR ↑ r/t poor kidney perfusion ↑ r/t poor kidney perfusion ↑ ```

Question 33

SCI's | Proprioception vs Dermatomes

Answer 33

Proprioception - awareness of body part location | Dermatomes - concept that specific section of spine senses topographical part of body

Question 34

Trauma Care - Primary Survey ABCDE AVPU

Answer 34

Airway Breathing Circulation Disability (LoC/Motor Fx) - Alert, Verbal Stimuli, Painful Stimuli, Unresponsive Exposure/Evacuation - assess external injury and temp

Question 35

Trauma Care - Secondary Survey | FHGI

Answer 35

Facilitate family presence Give Comfort Hx (HTT in 90 seconds) Inspect posterior surfaces

Question 36

Trauma Care - Resuscitative Measures FNFL Occurs with what Survey?

Answer 36

Foley Insertion NG insertion Fluid Resuscitation Labs (specifically Type/Cross-Match) Occurs w/ Primary Survey