Someone else's review 2 Flashcards
(148 cards)
1
Q
Expressive aphasiaǐ
A
inability to produce language that is intelligible
2
Q
Women can get what as a unique symptom of a stroke?
A
hiccups
3
Q
Time of symptom onset is very important in stroke treatment, especially which kind?
A
ischemic stroke
4
Q
Receptive aphasia
A
loss of comprehension
5
Q
Global aphasia
A
total inability to communicate
6
Q
Dysphasia
A
impaired ability to communicate
7
Q
Wernicke’s aphasia
A
fluent
8
Q
Broca’s aphasia
A
non-fluent
9
Q
Treatment for an ischemic stroke
A
tissue plasminogen activate (tPA) IV or intraarterial, endovascular therapy
10
Q
Treatment for hemorrhagic stroke
A
surgical decompression if indicated (hole to decrease ICP) , clipping or coiling of aneurysm
11
Q
Diagnostic test for stroke
A
CT scan (noncontrast)
12
Q
How many hours after stroke onset to admin tPA?
A
6 hours
13
Q
Cerebral Perfusion Pressure equation
A
MAP-ICP=CPP
14
Q
Want to keep the brain alive, maintain a CPP of?
A
at minimum 60
15
Q
CPP is the pressure needed to ensure blood flow to?
A
brain
16
Q
Increased ICP will reduce?
A
CPP
17
Q
Coumadin
A
Changes clotting time does NOT prevent clotting
18
Q
Tylenol antidote
A
acetylcysteine
19
Q
Dilaudid antidote
A
Narcan
20
Q
Versed/midazolam antidote
A
flumazenil (romazicon)
21
Q
Heparin antidote
A
protamine sulfate
22
Q
Coumadin antidote
A
vitamin K
23
Q
tPA antidote
A
FFP
24
Q
PT/INR
A
coumadin
25
PTT
heparin
26
Cerebral edema, dilation of pupil on ______ as mass lesion, sluggish or no response to light, inability to move eye upward or downward, ptosis of eyelid
ipsilateral
27
Cerebral edema, hemiparesis or hemiplegia may develop on ________ side of mass lesion
contralateral
28
Cushing's Triad for increased ICP
increased BP, decrease pulse, decreased respirations
29
Vasogenic Cerebral Edema
most common type, occurs in white matter and is characterized by leakage of large molecules from the capillaries into the surrounding extracellular space. Insults causing osmotic shift include brain tumors, abscesses, and ingested toxins that may cause an increase in the permeability of the blood-brain barrier
30
Cytotoxic Cerebral Edema
Results from the disruption of the integrity of the cell membranes. It develops from destructive lesions or trauma to brain tissue, resulting in cerebral hypoxia or anoxia and syndrome of inappropriate antidiuretic hormone (SIADH).
31
Change in LOC
most sensitive and reliable indicator of patient's neurological status
32
When patient has GCS of 8 or less and abnormal CT scan or MRI
may have bleeding, contusion edema, other issue
33
Normal ICP
5 to 15 mmHg
34
ICP measurements of more than ____ are usually treated
20 mmHg
35
When measuring ICP and a drainage device is in place, the drain must be closed for at least ___ minutes to ensure accurate reading
6 minutes
36
What is periorbital ecchymosis?
raccoon eyes, can occur with orbital fracture
37
What is an oval-shaped bruise behind ear in mastoid region?
Battle's sign, can occur with temporal fracture
38
What type of fracture involves CSF or brain otorrhea, bulging tympanic membrane caused by blood or CSF, Battle's sign, tinnitus or hearing difficulty, rhinorrhea, facial paralysis, conjugate deviation of gaze, vertigo?
basilar skull fracture
39
What is a sudden transient mechanical head injury with disruption of neural activity and a change in LOC, considered to be a minor diffuse head injury?
concussion
40
What is bruising of the brain tissue within a focal area?
contusion
41
Classic signs of an ______ hematoma include an initial loss of consciousness at the scene with a brief lucid period followed by decreasing LOC, other signs include headaches, nausea, vomiting
epidural
42
Epidural hematoma
rapidly expanding with arterial blood
43
Subdural hematoma
slowly expanding with venous blood
44
CT scan is best diagnostic test to evaluate
head trauma
45
Impending herniation
Cushing's triad (systolic hypertension with widening pulse pressure bradycardia with full and bounding pulse, irregular respirations)
46
Any cord injury above __ leads to dysfunction of the sympathetic nervous system which may result in bradycardia, peripheral vasodilation and hypotension (neurogenic shock)
T6
47
Neurogenic shock s/s
warm and dry skin, does not perspire on the paralyzed parts of the body d/t blocked sympathetic activity, hypotension, bradycardia, hypothermia
48
Neurogenic bladder may involve
a. no reflux detrusor contractions (flaccid, hypotonic), b. have hyperactive reflex detrusor contractions (spastic), c. lack of coordination between detrusor contraction and urethral relaxation (dyssynergia)
49
GI system manifestations of SCI
delayed gastric emptying, stress ulcers, dysphagia, hypotension
50
Integumentary system manifestations of SCI
pressure ulcers
51
Thermoregulation with SCI
lose ability to sweat or shiver below level of injury
52
Metabolic needs in SCI
metabolic alkalosis d/t NG suction, increased nutritional needs
53
Autonomic hyperreflexia s/s
flushed face and upper chest (above the level of injury) and pale extremities, sweating above level of injury, sudden onset of acute headache, elevation in BP and/or reduction in pulse rate, nasal congestion, feeling of apprehension
54
Immediate interventions for autonomic hyperreflexia
raise the person to a sitting position, remove the noxious stimulus (fecal impaction, kinked urinary catheter, tight clothing), call the HCP if above actions do not relieve the s/s
55
Bell's palsy s/s
inability to wrinkle brow, drooping eyelid, inability to close eye, inability to puff cheeks (no muscle tone), drooping mouth (inability to smile or pucker)
56
Ischemic Stroke- Incidence
Accounts for 87% of strokes
57
Thrombotic Stroke- Incidence
Men more than women, oldest median age
58
Thrombotic Stroke- Warning
TIA (30 to 50% of cases)
59
Thrombotic Stroke- Onset
Often during or after sleep
60
Thrombotic Stroke- Prognosis
Stepwise progression, s/s develop slowly, usually some improvement, recurrence in 20-25% of survivors
61
Embolic Stroke- Incidence
Men more than women
62
Embolic Stroke- Warning
TIA (uncommon)
63
Embolic Stroke- Onset
Sudden onset, most likely to occur during activity
64
Embolic Stroke- Prognosis
Single event, s/s develop quickly, usually some improvement, recurrence common w/out aggressive treatment of underlying disease
65
Hemorrhagic Stroke- Incidence
Accounts for 13% of strokes
66
Intracerebral Stroke- Incidence
Slightly higher in women
67
Intracerebral Stroke- Warning
Headache (25% of cases)
68
Intracerebral Stroke- Onset
Activity (often)
69
Intracerebral Stroke- Prognosis
Progression over 24-hour, poor prognosis, fatality more likely with presence of coma
70
Subarachnoid Stroke- Gender/Age
Slightly higher in women, youngest median age
71
Subarachnoid Stroke- Warning
Headache (common)
72
Subarachnoid Stroke- Onset
Activity (often), sudden onset, most commonly related to head trauma
73
Subarachnoid Stroke- Prognosis
Usually single sudden event, fatality more likely with presence of coma
74
Two types of Ischemic Strokes
Thrombotic and embolic
75
Two types of Hemorrhagic Strokes
Intracerebral and subarachnoid
76
Anterior cerebral, manifestations
Motor and/or sensory deficit (contralateral), sucking or rooting reflex, rigidity, gait problems, loss of proprioception and fine touch
77
Middle cerebral, manifestations
Dominant side- aphasia, motor and sensory deficit, hemianopsia
78
Middle cerebral, manifestations
Nondominant side- neglect, motor and sensory deficit, hemianopsia
79
Posterior cerebral
Hemianopsia, visual hallucinations, spontaneous pain, motor deficit
80
Vertebral
CN deficits, diplopia, dizziness, N/V, dysarthria, dysphagia, and/or coma
81
Broca's
Type of nonfluent aphasia
82
Broca's
Damage to frontal lobe of brain
83
Broca's
Frequently speak in phrases that make sense but are produced with great effort
84
Broca's
Often omit small words such as "and, is, the"
85
Broca's
May say "walk dog," meaning "I will take the dog for a walk," or "book book two table," for "There are two books on the table."
86
Broca's
Typically understand speech of others fairly well
87
Broca's
Often aware of their difficulties and can become easily frustrated
88
Wernicke's
Type of fluent speech
89
Wernicke's
Damage occurs in the left temporal lobe, although it can result from damage to the right lobe
90
Wernicke's
May speak in long sentences that have no meaning, add unnecessary words, and even create made-up words
91
Wernicke's
May say, "You know that smoodle pinkered and that I want to get him round and take care of him like you want before."
92
Wernicke's
Often difficult to follow what person is trying to say
93
Wernicke's
Usually have great difficulty understanding speech
94
Wernicke's
Often unaware of their mistakes
95
Global
Type of nonfluent aphasia
96
Global
Results from brain damage to extensive portions of language areas of the brain
97
Global
Have severe communication difficulties
98
Global
May be extremely limited in ability to speak or comprehend language
99
Diagnosis of a stroke (extent and involvement)
CT scan, CT angiography (CTA), MRI, magnetic resonance angiography (MRA), CT/MRI perfusion and diffusion imaging
100
Diagnosis of a stroke, cerebral blood flow
Cerebral angiography, carotid angiography, digital subtraction angiography, transcranial Doppler ultrasound, carotid duplex scanning
101
Diagnosis of a stroke, cardiac assessment
Electrocardiogram, chest x-ray, cardiac markers (troponin, creatine kinase-MB), echocardiography (transthoracic, transesophageal)
102
Diagnosis of a stroke, additional studies
CBC, glucose, PT aPTT, electrolytes, renal and hepatic studies, lipid profile, CSF analysis
103
Stroke Assessment, past health history
HTN, previous stroke, TIA, aneurysm, cardiac disease, dysrhythmias, heart failure, valvular heart disease, infective endocarditis, hyperlipidemia, polycythemia, diabetes, gout, previous head injury, family history of HTN, diabetes, stroke, CAD
104
Stroke Assessment, family history
Neurologic disorders, aneurysms, stroke, TIAs
105
Stroke Assessment, medications
Oral contraceptives, use and compliance with antihypertensive and anticoagulant therapy, illegal substances and drug use (cocaine)
106
Stroke Assessment, functional health patterns
Positive family history of stroke, alcohol abuse, smoking, drug abuse, anorexia/N/V, dysphagia, altered sense of taste and smell, change in bowel/bladder patterns, loss of movement and sensation, syncope, weakness on one side, generalized weakness, easy fatigability, numbness, tingling of one side of the body, loss of memory, alteration in speech, language, problem-solving ability, pain, headache (possibly sudden and severe) (hemorrhage), visual disturbances, denial of issues
107
Stroke Assessment, general
Emotional lability, lethargy, apathy or combativeness, fever
108
Stroke Assessment, respiratory
Loss of cough reflex, labored or irregular respirations, tachypnea, wheezes (aspiration), airway occlusion (tongue), apnea, coughing when eating or delayed coughing
109
Stroke Assessment, cardiovascular
Hypertension, tachycardia, carotid blunt
110
Stroke Assessment, GI
Loss of gag reflex, bowel incontinence, decreased or absent bowel sounds, constipation
111
Stroke Assessment, urinary
Frequency, urgency, incontinence
112
Stroke Assessment, neurologic
Contralateral motor and sensory deficits, including weakness, paresis, paralysis, anesthesia; unequal pupils and hand grips; akinesia, aphasia (expressive, repetitive, global), dysrhythria (slurred speech), agnosias, apraxia, visual deficits, perceptual or spatial disturbances, altered LOC, babinski's sign, decreased than increased dtrs, flaccidity followed by spasticity, amnesia, ataxia, personality changes, nuchal rigidity, seizures
113
Stroke Assessment, possible diagnostic findings
Positive CT, CTA, MRI, MRA, or other neuroimaging scan showing size, location, and type of lesion; positive Doppler ultrasonography and angiography indicating stenosis
114
C4 Injury
Tetraplegia, results in complete paralysis below the neck
115
C6 Injury
Results in partial paralysis of hands and arms as well as lower body
116
T6 Injury
Paraplegia, results in paralysis below the chest
117
L1 Injury
Paraplegia, results in paralysis below the waist
118
A=Complete
No s/m in sacral segment
119
B=Sensory Incomplete
S persevered but no m below injury
120
C=Motor Incomplete
M preserved below injury allowing for voluntary anal contraction but no s
121
D=Motor Incomplete
M incomplete status, muscles work but weaker
122
E=Normal
S/m WNL
123
ND=Not determined
Based on results, unable to determine
124
Know the medications that may be ordered for a SCI patient (why and typical doses)
Spinal cord injury inflammation occurs corticosteroids, lovenox, vasopressors (phenylephrine or norepinephrine)
125
Know what diabetic teaching a patient should have upon discharge that is diabetic (whether Type I or Type II)
How to check your sugars, diet, exercise, medical ID, no tight fitting shoes/keep them dry/never go barefoot/inspect feet daily, s/s of hyper and hypoglycemia, teach about glucagon/insulin, when you are sick take your insulin (know parameters, don't take it and go into DKA)
126
Know what parameters are required for patient to be diagnosed with DKA - know treatment regimen
Diabetic ketoacidosis, type 1 diabetes, spilling ketones, greater than 250 acidotic, poor skin turgor, dry mucous membranes, tachycardia, orthostatic hypotension, anorexia, nausea, vomiting, Kussmaul respirations, sweet/fruity breath
127
Know the difference between Coumadin and Heparin and what lab tests are ordered to adjust dosing
Heparin sq or iv to treat quickly PTT, coumadin (warfarin) orally for long term PT, vitamin K antidote, changes how your body forms clot, not a blood thinner!
128
Know what cells are affected with patient with HIV, know what is symptoms are seen to assist in diagnosis of HIV
T cells, CD4, slowed delayed or no immune response, opportunistic infection =thrush, pneumonia,
129
Know what spinal shock is - what symptoms will you see? What medications might be given and why?
Partial paralysis, drop in BP, steroids, decrease in reflexes, loss of sensation, absent thermoregulation, flaccid paralysis, days to weeks so it masks postinjury neurological function
130
Know what happens with increased intracranial pressure/cerebral edema - symptoms of, treatment for.
Tissue/blood/CSF, headache, change in LOC, ring in ears, CN issues, blurry visions, CONFUSION, change in VS (systolic hypertension, widening pulse pressure, bradycardia w/ full and bounding pulses, and irregular respirations), ipsilateral dilation, contralateral hemiparesis, headache, and vomiting
131
Know SIADH - symptoms/treatment/expected outcomes of treatment
Little pee, thirsty, loop diuretics, hyponatremia d/t dilution, fatigue, dyspnea on exertion, s/s of hyponatremia progress from muscle cramps, headache, irritability to severe vomiting, cramps, muscle twitch
132
Know posturing - know the different positioning you may see
Decorticate to the core flexor, decerebrate is extensor outward and worse which my indicate motor damage
133
Know DI - symptoms/treatment/expected outcomes of treatment/who is most susceptible
Common with brain surgery/most susceptible head injury, a lot of urine, DDVAP/fluids/hormones/diuretics/diet (low sodium), not enough ADH/not big enough response to ADH, polydipsia and polyuria, excrete large quantities of urine with very low specific gravity, hypernatremia, acute and accompanied by excess fluid loss
134
Know what immunosuppressive therapy/drugs is used for and what complications therapy may cause
Autoimmune response or organ transplant, infection
135
Know signs/symptoms of strokes, differences between ischemic/hemorrhagic/treatment/outcomes/assessment and care
Assess same way, tx different ischemic stroke=tPA clot buster antidote ffp, hemorrhagic stroke=surgery, CT noncontrast of head
136
Know Cushing's Triad
Increase systolic, decrease pulse/resp
137
Know basilar skull fracture, signs/symptoms, care and treatment
Raccoon eyes, Battle sign, don't put anything in their nose!!!!!!!! Leaky CSF
138
Know which patients are at increased risk for embolus
Pregnant people, smokers, birth control, a fib, joint surgery, broken bones in legs
139
Know what to assess for in patient post endarterectomy
Normally done in the carotid, LOC, hemorrhage, infection, come in from brachial/femoral/ulnar, check extemeties for circulation
140
Know what you may delegate to UAP (unlicensed assistant personnel) if you are the RN
Vital signs, adls, NO ASSESSMENTS
141
Know how to prioritize patients for care (i.e. given a group of patients with different problems - who would you see first)
Chronic/happened yesterday, acute/new onset stat
142
Know what the reversal agents Flumazenil and Narcan are used for and usual dosing
Flumazenil- benzos (0.2 mg), Narcan- opioids (morphine) (4 mg)
143
Know standard precautions and how/why they are used
Wash hands, PPE, wear gloves
144
Know why you would administer 3% NS - where, how, and why
ICU only!, severe hyponatremia which is 120 or less
145
Know normal/abnormal values of an ABG
pH 7.35-7.45, CÓ 35-45, HCǑ 22-26, Ó 80-100
146
Know what contraindications would prevent a patient from receiving tPA
Hemorrhage, allergy, surgery, trauma, stroke with in last 6-8 weeks and received tPA, platelet low, H & H low
147
Know what Mannitol is and what it is used for
Osmotic diuretic, Reducing ICP
148
Know care of patient post thyroidectomy, abnormal manifestation that you should be concerned with
Hypocalcemia, swelling, always have a tracheostomy tray, Assess q2H for first 24 hours for s/s of hemorrhage or tracheal compression such as frequency of swallowing, choking, blood on dressing, sensation of fullness, Semi-fowler and support patient head with pillow, Monitor VS and calcium levels (monitor for tetany), Control postop pain
