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Complex DMR > Neuro > Flashcards

Neuro Flashcards

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1
Q

Normal distribution of brain contents

A

Brain tissue 80%
Blood 12%
CSF 8%

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2
Q

Monroe-kellie hypothesis

A

Sum is constant so an increase in Brain tissu/blood/csf needs to be off set by decrease in another–inside a fixd skull

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3
Q

Symptoms of Increase ICP

A

HA, N/V, dizziness, pupil changes

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4
Q

Mass effect in ICP

A

Cerebral edema, blood (100ml) to caus herniation, tumor, hematoma

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5
Q

CSF & Blood issues that results in elevated ICP

A

Obstruction to CSF flow/absorbtion, increase of CSF production

Elevated venouse pressure, heart failure , obstruction of jugular vein

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6
Q

Cushings triad

A

Inc BP with widened PP
Bradycardia in an inc to inc BP
Irregular respiratory pattern
fixed & dilated pupil (late sign)

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7
Q

ICP range

A

less than 20 (5-15 range)

`

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8
Q

CPP & Range

A

> 60

Drives cerebral blood flow to brain tissue indirectly measures cerebral blood flow

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9
Q

CPP equation

A

MAP-ICP=CPP

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10
Q

Assessment of ICP

A 
LOC (orintation confusion lethargy)
Reflex-gag and cough
GCS
Extremety weakness/strength
ICP
Vitals
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11
Q

Management of ICP

A

Airway management
Dec intracranial contents–drainage of CSF
Hyperventilation PaCo2 30-35 to vasocontrict and decrease bf to the brain
Osmotic dieuresis
–mannitol
—3% sodium chloride
Surgical managment

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12
Q

Treatment & meds for ICP

A 
Reduce metabolic demans of brain --treat fever & therapeutic hypothermia 
Control BP: CCB, BB 
increase CPP with vassopressors 
Sedation to decrease agitation 
Prevent seizure
Chemical paralysis and induced coma
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13
Q

Nursing actions for patient with ICP

A 
HOB 30-45
head neutral and avoid hip flexion 
Avoid excess stimulation do not cluster care
give patient breaks between activities
only suction ETT when necessary
treat pain/agitation and fever
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14
Q

Seizure

A

Uncontrolled sudden excessive discharge of electrical activity
Range of manifestations can be subtle or dramatic
Change in behavior happens more than loss of consciousness

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15
Q

Epilepsy is categorized as

A

2 unprovoked seizures occuring more than 24 hours apart

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16
Q

Pathophysiology of seizures

A

no conclusive explaination
two ideas are:
Genetic/developmental mutation of synapses
Inffective activity of gaba

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17
Q

Structural cause of seizure

A

Lesions to brain (tumor) ICP

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18
Q

Vascular cause of seizure

A

Stroke vasculitits

hydrocephalus, htn, encephalopathy, eclampsia

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19
Q

Most common time of the year and day of the week for trauma

A

Saturday and July

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20
Q

Most common trauma for OA & Adults

A

Falls & MVA

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21
Q

Golden Hour

A

The time following an injury when promp medical treatment has the highest likelihood of prevnting death

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22
Q

Hospital Red Resuscitation ABCDEs

A 
Obstructed airway 
stridor
B:SpO2<80
RR>35 or <8
C: HR>130 BP ,8
D: GCS<8
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23
Q

Primary survey

A

Identify life threatening injuries and begin management, bandaids in 1st hour

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24
Q

Secondary Survey

A

Performed after primary survey life saving interventions initiated and assess for other injuries not initially apparent

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25
Most common Gender for trauma
Men
26
Where does each person in the clinical team stand during a trauma
``` Airway specialist at head PT right side Airway assistant at head PT left side Doctor 1 PT right side closer to head Nurse 1 PT right side closer to head Nurse 2 Left side closer to head Doctor 2 PT left side closer to head Team leader at the foot of the bed Scribe PT's Right side by foot ```
27
Burns are classified by general categories of
Etiology, Severity, Depth, TBSA
28
4 etiologies of burns
Electrical, chemical, radiation, thermal
29
Most common burn
Thermal Flash in adults (fire) Scald in kids look out for child abuse
30
What is unique about electrical burns
Internal damage occurs along pathway of the current
31
What do you need to watch out for in a patient with electrical burns
Dysrhtmias us cardiac monitoring, muscle damage look for rhabdomyolysis, other traumas
32
What substances can cause chemical burn
Acids, organic compounds, alkaline substances
33
What is the treatment for chemical burns
**REMOVE CLOTHING* Clean Dust off Continuous Irrigation
34
Causes of radiation burns
Sunburn (most common) Chemo Nuclear accidents Therapeutic radiation
35
Severity of radiation burns depend on
Type Dose Length of exposure
36
How do you classify burns by depth
Superficial Superficial partial Deep partial thickness Full thickness (subcu tissue and bone)
37
characteristics of a superficial burn
``` Blanchable Painful No blisters No scaring Minimal damage DRY ```
38
Characteristics of a superficial partial burn
``` Damage to entire epidermis Minimal damage to dermis Weeping/Wet Blisters Blanchable No scarring Painful ```
39
Characteristics of a Deep partial thickness
``` Damage to the entire epidermis Deeper damage to dermis waxy blisters minimal/no blanching Painful edges, sensitive to pressure may need graft to heal, will heal with scars ```
40
Characteristics of a Full thickness burn
``` Entire dermis/epidermis damaged Potential fat muscle and bone dramage Leathery & dry Black or color may vary No blanching No pain Will need surgery and graft ```
41
TBSA damage`
Use Lung and Browder which assign percentages to parts of the body by age-- used in partial and full thickness burns
42
Severity of damage of the burn depends on
ability of the patient to tolerate treatment and heal Inhalation injury Location of injury Concomitant injury: additional trauma caused by burns Comorbid conditions:
43
Anatomic changes cause by burn
loss of skin (protective) skin is protective against infection, thermoregulation, dehydration, up to 5 L lost from evaporation
44
Areas of the body in which burns cause functional changes**
Face, hands, perineum, genitals, joints
45
Respiratory issues associated with burns Inhalation injury symptoms (above glottis )
Facial burns, singed nasal and facial hair, soot in mouth nose, sputum redness of the oral pharynx, inability to swallow, tachypnea
46
Inhalation injury (above glottis ) intervention
INTUBATE bc of oral airway swelling
47
What causes a below glottis injury
ARDS Aveolar damage Prolonged smoke exposure
48
Symptoms of CO poisioning (CO>30)
HA, Nausea, dizziness, change in LOC, tachycardia/tachypnea, vision changes, dypsnea
49
Symptoms of CO poisoning (CO>50)
Coma, death, seizure
50
Can you measure CO with SpO2?
No SpO2 cannot differentiate between the two
51
What is burn shock?
combo of distributive and hypovolemic shock
52
What causes burn shock
capillary leak 8-36 hours after injury peaking at 24 hours bc of the inflammatory process
53
What do you need to do if burn shock is suspected
massive fluid resuscitation and electrolyte correction
54
What happens in burn shock and fluid is not rescusitated
hypotention, tachycardia, dec UO, mental status change, if not resolved AKI, organ failure, death
55
How long does hypermetabolic state last
1-3 years
56
What is needed during a hypermetabolic state
Adeuqate nutrition for wound healing (early enteral support/nutrition counseling)
57
Interventions to help thermoregulation in burn patients
Adequate warmth, once healed they cant sweat
58
3 phases for burn patients
Emergent phase Intermediate phase Rehabilitative phase
59
Emergent phase burn
``` Stop burn process!! • Airway management (Intubate!) • Fluid resuscitation • Prevention of hypothermia • Pain management • Clean wound covering • Determine baseline status • Determine extent of injuries ```
60
Triage from EMS for burn patients
- Mechanism of injury - Care in the field - Amount/type of fluid given
61
ABCDEF nursing burns
``` A – Airway • Intubation if needed • Early before swelling gets worse! B – Breathing • 100% humidified O2 C – Circulation • Remove tight clothing or jewelry • Neurovascular checks! D – Disability • Neurological exams • Maintain C-spine precautions, if indicated E – Expose and examine • Extent of burn wounds • Possible associated trauma F – Fluid resuscitation ```
62
fluid resuscitation in burn pt | IV/when is it initiated/what is used
* Two large-bore IVs ASAP * Initiated with burns ≥ 20% TBSA * Lactated ringers is fluid of choice
63
what is the parkland formula and how long is fluid given
• Parkland formula – 2-4mL of LR per kg body weight x %TBSA in 24 hours • All electrical burn injuries – 4mL/kg Half given in first 8 hours, half given in last 16 hours
64
Burn patient emergent phase Complications
* Sepsis * Compartment syndrome * Contractures * Scarring
65
nurse management in Intermediate phase
``` Wound care – Dressings/hydrotherapy – Surgical debridement – Wound closure • Thermoregulation • Pain management • Nutrition • Prevention of infection ```
66
nurse management in Rehabilitative phase
Rehabilitative phase • PT/OT --Mobility/functionality • Psychosocial health – Body image therm-pain-nutriprevent in

Complex DMR (12 decks)

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