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203D Custom > Test 3/Midterm > Flashcards

Test 3/Midterm Flashcards

(56 cards)

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1
Q

SCI Hyperextension vs. hyperflexion

A

neck forced back vs. neck forced forward

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2
Q

Most unstable mechanism of SCI injury

A

Rotation due to torn ligaments

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3
Q

SCI Initial injury (axon disruption) examples

A

cord compression (bone displacement, interruption of blood supply, pulling/stretching cord) or penetrating injury (gunshot, stab wound)

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4
Q

SCI Secondary injury (ongoing, progressive damage) complications

A

hemorrhage, edema, free radical formation, calcium influx, ischemia

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5
Q

SCI Cervical injury priority

A

breathing

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6
Q

SCI Thoracic injury priorities

A

breathing and shock

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7
Q

SCI Complete injury

A
  • worse prognosis
  • loss of voluntary movement/sensation below the injury
  • reflex activity below injury may return after spinal shock resolved
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8
Q

SCI Incomplete injury

A
  • remember ABCs
  • better prognosis
  • varying degrees of motor/sensory loss below
  • central/lateral/posterior injury
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9
Q

SCI Central cord syndrome

A
  • forced hyperextension
  • sensory/motor deficit upper>lower
  • “can walk to the door but can’t open it”
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10
Q

SCI Anterior cord syndrome

A
  • hyperflexion or spinal artery injury
  • loss of motor, pain, temp, with mixed sensory loss
  • touch, proprioception, vibration remain intact
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11
Q

SCI Brown-Sequard syndrome

A
  • penetrating trauma
  • same side as injury: loss of motor, touch, pressure, vibration, BUT pain/temp intact
  • opposite side of injury: loss of pain/temp, BUT motor, touch, pressure, vibration intact
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12
Q

SCI Cauda equina/conus medullaris

A
  • compression of lumbar/sacral area
  • conus: T11-L1/cauda: L2-sacral
  • Flacid (atonic) bowel/bladder
  • impaired sexual function
  • motor loss, but sensory unimpaired
  • motor and B/B function best indicator of return of cord function
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13
Q

C4

A

top of shoulders, if above: high risk, ventilator dependent

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14
Q

C6

A

thumb

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15
Q

C7

A

middle/ring fingers

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16
Q

C8

A

little finger

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17
Q

T4

A

below nipple line

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18
Q

T10

A

below umbilicus

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19
Q

T12

A

loss in groin

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20
Q

L4

A

variable: big toe, buttocks, genitalia

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21
Q

S1

A

top of small toe, perineal/anal numbness

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22
Q

SCI Neurogenic shock mechanism and assessment findings

A
  • SCI above T6
  • loss of sympathetic tone results in massive vasodilation
  • hypotension
  • bradycardia
  • poikilotermic
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23
Q

SCI Neurogenic shock management

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A
  • determine underlying cause
  • support airway
  • fluids (possibly, if no spinal shock)
  • vasopressors (atropine)
  • temp control
24
Q

SCI Spinal “shock”

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A
  • d/t acute SCI
  • absence of all voluntary/reflex activity/sensation below
  • recovery: bradycardia/hypotension persist after resolution, return of anal wink/spasticity/bladder
25
SCI medication therapy
- methylprednisolone (SoluMedrol) 30mg/kg over 1 hour, then 5.4mg/kg/hr for 23 hours - improves profusion, prevent cell membrane breakdown, improves energy metabolism, better odds of moving to a higher sensory/motor category
26
SCI Autonomic dysreflexia (hyper-reflexia)
- sudden onset of excessively high BP (250/150) - T6 or above - triggers: full bladder, infection, pain, skin damage
27
SCI Autonomic dysreflexia S/Sx
- hypertension/bradycardia - Below (sympathetic): cool skin (vasoconstriction), goosebumps - Above (parasympathetic): headache (#1 sign), flushed face/warm skin (vasodilation), nasal congestion
28
SCI Autonomic dysreflexia nusing assesment/priorities
- HTN/brady - empty bladder/bowel (no digital stimulation) - monitor BP q5min - find and remove negative stimuli - call MD after treatment/finding cause
29
SCI Spinal precautions
- log roll - hard collar in place if ordered - TLS orthotics on unless orders to remove - tongs in alignment
30
SCI Breathing interventions
- do not perform after eating (may induce vomiting) - quad cough - glossopharyngeal breathing
31
SCI Mobility interventions
- reduce skin breakdown - ROM, splinting - prevent PE, use PAS stockings
32
SCI Flaccid bladder nursing interventions
- PVR <100mL indicates training is working - encourage fluids to prevent stones/UTI - do not allow >500mL in bladder
33
SCI Spastic bladder nursing interventions
- stroke inner thigh - warm water over perineum - anal stimulation (not cardiac patients) - PVR<100mL
34
SCI Skin integrity nursing interventions
- check skin with every turn q2h | - maintain normal body temp
35
Meningitis take away point
knowing the specific cause will direct treatment
36
Meningitis exudate formation
Exudate formed with bacterial, NOT viral
37
Pneumococcus vs. meningococcus transmission
Pneumococcus: droplet (also viral) Meningococcus: inhalation or direct contact
38
Positive signs of meningeal irritation
Kernig's: pain in back when lifting hip/knee while supine Brudzinski's sign: severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed Nuchal rigidity: an inability to flex the neck forward
39
Meningitis most common assessment findings
fever, headache, photophobia
40
Meningitis pt. with petechial hemorrhagic rash
very ill, advanced disease process
41
Meningitis lumbar puncture: bacterial vs. viral
bacterial: cloudy CSF, low or no glucose (bacteria using), increased pressure, protein, neutrophils viral: clear or cloudy, protein/glucose normal, elevated lymphocytes
42
Meningitis hyponatremia
from SIADH
43
Lumbar problems: diagnostic gold standard
MRI
44
Lumbar problems: medical Tx
activity (limit bedrest) also: PT, hot/cold packs (with order), medications
45
Lumbar problems: Teaching post-op
- wear brace TLSO device at all times while out of bed - report changes in sensation - maintain good body alignment (log roll, no twisting)
46
Seizures: Generalized 2 types
tonic-clonic (grand-mal) and absence (petit-mal)
47
Tonic-clonic seizures
aura, loss of consciousness, tonic then clonic movement, B/B incontinence, tongue biting, salivation, post-ictal phase: HA, sore, tired, amnesia
48
Absence seizures
interruption of consciousness, seen in peds, vacant staring, altered awareness or loss of environmental contact
49
Simple partial (focal) seizure
no loss of consciousness, single muscle group progressing to adjacent, autonomic, deja vu
50
Complex partial (focal) seizure
impaired LoC, simple to complex, unaware, bizarre behavior (lip smacking, automatic movement)
51
Febrile seizures
children with high temps, treat with tylenol, tepid bath, IV/rectal if valium necessary
52
Phenytoin/Dilantin intervention
oral care
53
EEG nursing considerations
before EEG: no caffeine, tranquilizers, sedatives, etc. Call to clarify anti-convulsants. Make sure pt. eats.
54
Status Epilecticus
medical emergency: prolonged seizures without regaining consciousness for 30 mins
55
Status Epilecticus management
oxygenation (may require intubation), start IV, protect from injury, administer drugs as ordered, control seizure activity with Ativan
56
Seizure family teaching
no driving 1 year, oral care, no baths, meds at same time each day, awareness of aura, lifestyle mods

203D Custom (6 decks)

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