Miscellaneous CPAN Topics Flashcards

Question

# Miscellaneous CPAN Topics What is Cushing's Triage?

Answer 1

Cushing's response is a physiologic response (compensatory) to increasing ICP in efforts to provide adequate CPP. Rising systolic blood pressure Widening pulse pressure (>40 to 60 systolic / diastolic difference) Declining heart rate toward bradycardia Alterations in spontanous respiratory patern leading to irregular respirations Loss of this compensatory response is termed Cushing's triad: hypertension with widening pulse pressure, bradycardia, and irregular respirations. Cushing's triad is a clinical presentatin of deterioration of brainstem function; brain herniation may have already occurred. | Requires capnography in addition to pulse oximetry.

Answer 2

decreased LOC changes in pupilary response decorticate or decerebrate posturing hemiplegia impaired brainstem reflexes such as corneal or gag alterations in vital signs / Cushing's triad Unilateral pupilary dilation is the earliest and most indicate clinical sign of brain herniation. | Treatment is craniectomy, excision of lesiion / hematoma, EVD

Answer 3

hypercapnia

Answer 4

Caused by spinal cord injury above T6. Sudden dramatic BP elevation May occur with spinal cord injury Caused by massive sympathetic response to a noxious stimulus (e.g. full bladder, IV line insertion, fecal impaction) Results to extreme hypertension, bradycardia, headache, and facial flushing, flushed skin above lesion, dry/ pale skin below lesion Occurs to para/quadriplegic patient's months or years after initial injury

Answer 5

Changed in mental status Pounding headache Flushed skin above level of lesion, palor below level

Answer 6

Straight cath to empty bladder Elevate HOB Administer antihypertensive

Answer 7

3 factors increase incidence of venous thrombosis: hypercoagulability caused by alteration of platelet and clotting factors venous stasis caused by incompetent venous valves intimal (vessel) damage caused by trauma, IV infusions, and ischemia.

Answer 8

Tachycardia Narrowing pulse pressure JVD Sudden cessation of drainage from mediastinal tube

Answer 9

BECK’S TRIAD: Increased CVP Muffled heart tones Pulsus paradoxus (fall of SBP >10 mmHg upon inspiration)

Answer 10

Right side unable to pump venous blood adequately into pulmonary circulation, results to swelling, abdominal bloating, ascites, weight gain, jugular venous distention, and dependent pitting edema.

Answer 11

Left side unable to pump blood into the systemic circulation, results to accumulation of blood into the lungs, manifested by crackles, wheezes, weakness, fatigue, cough, and orthopnea. Extra heart sounds heard R and L ventricular failure d/t filling patterns in a noncompliant ventricle.

Answer 12

ICP > 20 to 25 mm Hg or higher for > 5 minutes Clinical manifestations include: headache deterioration in LOC (indicator of brain injury) alterations in motor function pupillary size **reactivity to light** Early changes in LOC may include restlessness, confusion, agitation, irritability, and progress to lethargy.

Answer 13

Cushing’s response is a physiologic response (compensatory) to increasing ICP in efforts to provide adequate CPP. Rising systolic blood pressure Widening pulse pressure (> 40 to 60 systolic/diastolic difference) Declining heart rate toward bradycardia Alterations in spontaneous respiratory pattern leading to irregular respirations Loss of this compensatory response is termed Cushing’s triad : hypertension with widening pulse pressure, bradycardia, and irregular respirations. Cushing’s triad is a clinical presentation of deterioration of brainstem function; **brain herniation** may have already occurred.

Answer 14

decreased LOC changes in pupillary response **decorticate or decerebrate posturing** hemiplegia impaired brainstem reflexes such as corneal or gag alterations in vital signs/Cushing’s triad Unilateral pupillary dilation is the earliest and most indicative clinical signs of brain herniation. | Treatment is craniectomry, excision of lesion/ hematoma, EVD

Answer 15

Brain edema or herniation Requires capnography in addition to pulse oximetry

Answer 16

chronically elevated level of cortisol Caused by various factors, including corticosteroid medications, pituitary or adrenal tumors, or ectopic ACTH production. Symptoms include weight gain, **moon face** and abdomen, muscle weakness, high blood pressure, increased risk of infection, and mood changes. | Diagnosed by testing corstisol level in blood, urine, saliva

Answer 17

Autoimmune form of hyperthyrodisim | Treatment includes radioactive iodine, antithyroid drugs, surgery

Answer 18

**decreased** secretion of **cortisol** and **aldosterone** d/t autoimmune reaction, infection, congenital, that results to: dehydration n & v muscular weakness hypotension followed by fever marked flaccidity of the extremities hyponatremia hyperkalemia (d/t aldosterone deficiency) azotemia shock | Dexamethasone is drug of choice because it does not interfere with tests

Answer 19

usually a benign ** tumor** in the **adrenal gland** that causes hyperfunction and results in severe symptoms **Increase in catecholamine secretion** (epinephrine/ norepinephrine) Results to: Severe hypertension, tachycardia, palpitations Hyperglycemia Hypermetabolism, weight loss Nausea, Abdominal pain Irritability, diaphoresis

Answer 20

Adrenalectomy

Answer 21

Monitor BP closely! Can have **rebound hypotension** post-adrenalectomy and may require vasopressors. Will need cortisol replacement

Answer 22

PRERENAL – volume depletion, volume shifts, vascular compromise (MH, AAA) INTRARENAL – Occurs within the renal tissue (Glomerulonephritis, acute tubular necrosis, etc.) POSTRENAL – Renal stone, outlet obstruction (back-flow of pressure into kidney causes damage)

Answer 23

Body producing too much Vasopresin (anti diuretic hormoe)

Answer 24

SIADH can be caused by various factors, including: * Certain medications (e.g., chemotherapy drugs, opioids) * Lung cancer * Brain tumors * Head trauma * Hypothyroidism

Answer 25

The main symptoms of SIADH include: * Hyponatremia * High urine concentration * Excessive thirst * Headache * Nausea * Confusion * Seizures (in severe cases) | Treatment is fluid restriction

Answer 26

lack of ADH w/c leads to volume depletion and hypernatremia common in transnasal transsphenoidal surgery (TSS) or traumatic brain injury (TBI) polyuria (a symptom) is uop >300ml/hour x 2 hours or more hypernatremia leads to a water shift from intracellular to extracellular | Treatment is to replace ADH with desmopressin and H2O loss w/ NaCl

Answer 27

**P**olydipsia **P**olyuria **P**olyphagia Warm dry skin Decreased LOC Hypotension Tachycardia ECG changes Nausea & Vomiting Kussmaul respiration (late sign) Fruity breath odor

Answer 28

Cheyne-Stokes Breathing - cyclical pattern of shallow, rapid breathing followed by deep breathing and periods of apnea Primarily associated with heart failure, but can also be seen in stroke, head injuries, or brain conditions. Kussmaul Breathing - deep, rapid, and even breathing. Primarily due to metabolic acidosis, where the body attempts to expel carbon dioxide to lower blood acidity. Associated with Diabetic ketoacidosis, kidney failure, and other conditions causing metabolic acidosis. May be accompanied by a fruity odor on the breath.

Answer 29

Steal syndrome: complication due to fistula formation  can lead to ischemia

Answer 30

Thyroid storm is a rare, life-threatening condition caused by a sudden and drastic overproduction of thyroid hormones, leading to a hypermetabolic state and potentially causing fever, confusion, and other severe symptoms.

Answer 31

Untreated or poorly controlled hyperthyroidism, which can be triggered by: * Infections: Especially severe infections like pneumonia or sepsis. * Trauma: Major injuries or surgery. * Stress: Emotional or physical stress. * Medications: Certain medications, like radioactive iodine therapy for Graves' disease. * Thyroid surgery

Answer 32

Fever (over 100.5°F) Tachycardia Hypertension Confusion, delirium, and agitation: Changes in mental status, including disorientation and restlessness. Nausea, vomiting, and diarrhea Tremors and shaking Sweating: Excessive perspiration. Coma: In severe cases, loss of consciousness. Jaundice Bulging eyeballs | Compared to MH, thyroid storm does not have muscle ridgidity

Answer 33

Pallor Diminished pulses Pain distal to new graft site

Answer 34

Peroneal nerve damage, often leading to foot drop, can be caused by trauma, compression, or certain medical conditions, including knee injuries, fibula fractures, tight casts, prolonged bedrest, or nerve compression from tumors or cysts.

Answer 35

Peroneal nerve assessment: Sensory: touch lateral side of great toe, medial side of second digit Motor: dorsiflex ankle, hyperextend great toe

Answer 36

postoperative bleeding indication of bleeding - frequent swallowing, clearing of the throat, and vomiting of dark blood cardinal symptoms of hemorrhage - decreased blood pressure, tachycardia, pallor, and restlessness - notify surgeon

Answer 37

droplet-like particles of fat enter bloodstream and block blood vessels 95% of cases involve pelvic fractures or long bones S/S include: difficulty breathing (initial symptom) mental state changes (d/t affecting brain, can lead to seizure) petechial rash ## Footnote https://my.clevelandclinic.org/health/diseases/23995-fat-embolism-syndrome. 04.04.2025

Answer 38

Duty Breach of duty Causation Damages

Answer 39

Non-rebreather FiO2 of close to 80-95% Venturi mask 24-55% Simple face mask 40-60% Partial rebreather mask 60-75%

Answer 40

Venturi mask allows well-controlled titration of FiO2 and humidification.

Answer 41

Pleural effusion NOT anticipated Complications include: subcutaneous emphysema, pneumothorax, hemorrhage, post-placement obstruction. Patients report SOB despite adequate oxygenation d/t smaller diameter and anxiety

Answer 42

A patient experiencing laryngospasm represents a clinical emergency in which the vocal cords are partially or fully closed. Although it would be hard for the patient to breathe, he or she would not be able to speak in the event of a true laryngospasm. The other items listed are more representative of bronchospasm . A patient experiencing laryngospasm may not be moving any air and may not even experience stridor. In the event of partial laryngospasm, high-pitched stridor, tracheal tug, and patient anxiety or agitation are common

Answer 43

First 10kg = 4 mL/kg/hr Next 10kg = 2mL/kg/hr Weight > 20kg = 1ml/kg/hr

Answer 44

First 10kg = 4 mL/kg/hr Next 10kg = 2mL/kg/hr Weight > 20kg = 1ml/kg/hr

Answer 45

cool and bluish

Answer 46

tactile stimulation to assess neurological responses

Answer 47

maintain the patient's arm in neutral position

Answer 48

arterial thrombosis

Answer 49

nitrous oxide

Answer 50

Hypovolemic * d/t hemorrhagic loss that decreases vascular filling pressure Cardiogenic * d/t inadequate **contractility of cardiac muscle** d/t blunt cardiac injury or MI Obstructive * d/t obstruction of the great vessels of the heart (e.g. tension pneumothorax and cardiac tamponade) Distributive = Vasogenic * causes vascular system abnormality and SIRS activation (e.g. neurogenic d/t spinal cord injuries, anaphylactic, septic)

Answer 51

**3:1 rule** Replace with 3 mL crystalloid for each 1 mL of blood loss

Answer 52

Spinal shock is a form of neurogenic shock characterized by loss of motor, sensory, autonomic, and reflex activity below the level of lesion.

Answer 53

1. acute spinal cord injury 2. paraplegic or quadriplegic and have a full bladder 3. brain concussion or contusion of the basal regions of the brain 4. spinal cord injury above T6 | 3 & 4 can be direct cause of loosing sympathetic vasomotor tone

Answer 54

increase vascular capacity => decreases mean systemic pressure => decreases venous return to the heart => sympathetic nervous system causes vasoconstriction to maintain vascular tone => lost of sympathetic enervation => parasympathetic nerves dominate causing vascular dilation (or venous pooling)

Answer 55

The clinical presentation in neurogenic shock is different from that in hypovolemic shock even though the **blood pressure is low**. The patient is **frequently bradycardic**, and the skin is warm, dry, and flushed. Hemodynamic monitoring reveals a decrease in cardiac output as a result of a decrease in resistance in arteriolar vasculature and also a decrease in venous tone.

Answer 56

First phase or **hyperdynamic** response - high cardiac output and a low systemic vascular resistance Second or **hypodynamic** response - low cardiac output and an extremely high systemic vascular resistance (classic shock picture) First & Second phases known as early shock when patient’s skin is pink, warm, and dry because of the increased cardiac output and peripheral vasodilation. This progresses to fluid leaks from vascular compartment, and patient develops relative hypovolemia with decreasing cardiac output and increasing peripheral vasoconstriction. Clinical manifestations of late shock are cold and clammy skin, decreased cardiac output, severe hypotension, and extreme vasoconstriction.

Answer 57

If the surgical procedure involves C3, C4, or C5, respiratory movements should be monitored because the diaphragm muscle is innervated by the spinal outflow from these vertebrae. The patient with this nerve deficit has a lack of diaphragmatic excursion and shortness of breath and uses the intercostal and accessory muscles in breathing. If these symptoms appear, oxygen should be administered, and assistance in ventilation may be necessary.

Answer 58

Patients in halo traction should be monitored for any deficiency in the sixth cranial (abducens) nerve. Any decrease in the lateral movement of the eye is indicative of injury to the abducens nerve.

Answer 59

Arterial Thrombosis - pale cool flap that does not bleed when stuck with a needle Venous Thrombosis - congested warm mottled flap that continuously oozes dark blood. Venous thrombosis is more commonly encountered but is not an immediate threat. Any change in skin color from the normal baseline assessments that indicate imminent occlusion should be reported to the surgeon immediately.

Answer 60

increased CVP muffled heart tones pulsus paradoxus (sbp drops by 10% or more during inspiration) | Signs and symptoms of cardiac tampondade

Answer 61

changes in temperature regulation **pupil dilation** tachycardia cardiac arrhythmias diaphoresis nausea anxiety | Abuse can cause psychosis, hallucination, restlesness, agitation

Answer 62

depression tiredness insomnia unpleasant dreams increased appetite decreased cognition, and movement | Unlike ETOH or benzo, stimulant withdrawal is not life-threatening.

Answer 63

Shoulder pain on one side can occur after both thoracotomy and VATS and is thought to be primarily referred pain of diaphragmatic irritation transmitted by phrenic nerve afferents. Other factors to consider include patient position during the surgery and whether a major bronchus transection occurred. Shoulder pain occurs even when the patient receives TEA, so the patient may require anti-inflammatory drugs with or without opioids. Shoulder pain is usually temporary and is often resolved completely by the second postoperative day.

Answer 64

Adult - 3.5 to 5.5 g/dL or 35-55 g/liter Pediatric - at all ages, any albumin level below 3.3 g/dl is considered as hypoalbuminemia Albumin composes 50%-60% of blood plasma proteins. ## Footnote Albumin. June 14, 2022. Medscape. https://emedicine.medscape.com/article/2054430-overview?form=fpf Association Between... December 28, 2024. https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-05331-8

Answer 65

Person Place Time Situation ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach, 6th ed. St. Louis, MO: Sauders; 2013:374.

Answer 66

Central Venous Pressure 0-8mmHg Right Ventricular Systolic / Diastolic Pressure 15-25 / 0-8mmHg Pulmonary Artery Systolic / Diastolic Pressure 15-28 / 8-12mmHg Pulmonary Artery Wedge Pressure 6 - 12 mmHg ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders: 2013: 368-373)

Answer 67

""Involves a threat that causes the patient to be in fear of a physical injury. For example, saying, “if you do not stay still, I will put restraints on you” to a patient could lead to the charge of an assault."" ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders: 2013:

Answer 68

"Involves unauthorized touching of a patient’s body. For example, if a patient has a do-not-resuscitate order in place but cardiopulmonary resuscitation is performed on the patient, everyone involved could be charged with battery." ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders: 2013:

Answer 69

"Refers to damage caused to someone’s reputation. If the damaging information is **written**, the defamation is called **libel**; if it is **spoken**, it is called **slander**." ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders: 2013:

Answer 70

"This advance directive specifies who makes health care decisions for the patient if the patient is incompetent. The patient’s condition does not need to be terminal for this advance directive to be in effect. The durable power of attorney for health care must have been signed when the patient was competent, and it applies only to the health care decisions." ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders: 2013:

Answer 71

"Addresses a professional standard of care. The elements of negligence are applied to the determination of malpractice. An expert witness is typically used to **establish standard of care** and prove the **violation of duty** **resulted in injury** under the professional standard of care." ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders: 2013:

Answer 72

"This tort is the failure to provide care that a reasonable person ordinarily would provide in a similar circumstance. The elements that must be established to prove negligence are (1) **an established relationship**, (2) **the duty established by profession**, and (3) **a violation of that duty that results in injury**. ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders: 2013: