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Flashcards in U2 Resp/Neuro Deck (131):
1

Transient Ischemic Attack (TIA) duration

Few minutes to <24 hrs

2

Reversible Ischemic Neurologic Deficit (RIND) duration

>24 hours but less than 1 wk

3

Cause of stroke

Change in the normal blood supply to the brain

4

Occlusive stroke

Arterial blockage or narrowing cause ischemia in the brain tissue

5

Ischemic stroke

Occlusion of a cerebral artery by thrombus or embolus
Embolic stroke associated with atrial fibrillation
Tend to occur during sleep

6

Hemorrhagic stroke

Bleeding within or around the brain
Tend to occur during activity

7

Intracerebral hemorrhage

Bleeding into the brain tissue resulting from severe HTN

8

Ischemic stroke IV therapy

2 IV lines with nondextrose, isotonic saline

9

Primary nursing role for stroke

Monitor for increasing ICP

10

Treatment for stroke

Fibrinolytic therapy
Endovascular interventions

11

Eligibility for rtPA

3 hours from time last seen normal

12

Expanded time interval for rtPA

3-4.5 hours from time LSN

13

Categories to extend time interval for rtPA

Age older than 80
Anticoagulation with INR < or = 1.7
NIHSS > 25
History of both stroke & diabetes

14

Aneurysm

Abnormal balooning or blister along a normal artery

15

Congenital aneurysm

Defect in the media & elastica of the vessel wall

16

Dissecting aneurysm

Occurs following trauma or plaque formation

17

Arteriovenous malformation

Developmental abnormality resulting in a tangled mass of malformed, thin-walled, dilated vessels
Abnormal communication between arterial & venous systems

18

Ischemic or occlusive stroke CT

Usually initially negative; purpose is to identify presence of cerebral hemorrhage

19

Ischemic or occlusive stroke CT 24hrs +

Progressive changes of ischemia, infarction, & cerebral edema

20

Ischemic or occlusive stroke MRI

Presence of edema, ischemia, & tissue necrosis earlier than CT scan

21

Fibrinolytic therapy

Dissolves the cerebral artery occlusion to re-establish blood flow & prevent cerebral infarction

22

Most common complication of stroke

Increased ICP during 1st 72 hrs after stroke

23

Carotic endarterectomy

Remove atherosclerotic plauqe
Re-establish blood flow
Decrease stroke risk

24

Aneurysm interventional therapy

Block abnormal arteries or veins
Prevent bleeding from vascular lesions of aneurysm

25

Aneurysm pt monitoring

S/S of hydrocephalus & vasospasm

26

Primary brain damage

Occurs at time of injury

27

Secondary injury

Processes that occur after the initial injury from physiologic, vascular, & biochemical events

28

Open head injury

Occurs with skull fracture or piercing by penetrating object

29

Closed head injury

Result of blunt trauma
More serious

30

Most common responses to head injury

Hypotension
Hypoxia
Ischemia
Edema

31

Leading cause of death in pts with brain injury

Increased ICP

32

Cushing's triad

Severe hypertension
Widened pulse pressure
Bradycardia

33

Uncal herniation

Shifting of one or both areas of the temporal lobe
Life-threatening

34

Brain injury CT

Identifies extend & scope of injury

35

Brain injury MRI

Diagnosis of diffuse axonal injury

36

Brain injury nursing priorities

Maintaining patent ABCs
Preventing or detecting increased ICP
Promoting F/E balance
Monitoring effects of treatments & drug therapy

37

Criteria for brain death diagnosis

Coma of known cause
Normal or near-normal core body temperature
Normal systolic blood pressure (> or = 100)
At least 1 neurologic exam

38

Primary brain tumor

Originate within CNS
Rarely metastasize

39

Secondary brain tumor

Result from metastasis from other areas of the body

40

Effects of tumor on brain tissue

Expands & invades
Infiltrates
Compresses
Displaces

41

Complications of brain tumor

Cerebral edema
Increased ICP
Neurologic defects
Hydrocephalus
Pituitary dysfunction

42

Brain tumor postop care

Monitor pt to detect changes in status
Prevent or minimize complications, esp increased ICP

43

Brain abscess

Purulent infection of brain in which pus forms in the extradural, subdural, or intracerebral area of the brain

44

Brain abscess manifestations

Begin slowly
Headache
Fever
Neurologic deficits

45

Brain abscess CT

Determines presence of cerebritis, hydrocephalus, or midline shift

46

Brain abscess MRI

Detects presence of abscess early in the course

47

Brain abscess EEG

Localize the lesion in most cases
High-voltage, slow-wave activity, or electrocerebral silence may be noted in area of abscess

48

Brain abscess treatment

Systemic antibiotic therapy

49

Brain abscess surgical treatment

Surgically draining encapsulated abscess via burr hole to reduce the mass effect of the lesion

50

Neurologic deficit nursing priority

Help pt achieve the highest level of functioning

51

1st sign of increased ICP

Decreased LOC

52

Pulmonary embolism

Collection of particulate matter that enters venous circulation & lodges in pulmonary vessels

53

Effect of large emboli

Obstruct pulmonary blood flow
Leads to reduced oxygenation of the whole body
Pulmonary tissue hypoxia

54

Risk factors for DVT

Prolonged immobility
Central venous catheters
Surgery
Obesity
Advancing age
Increased blood clotting
Hx of thromboembolism

55

Pulmonary embolism S/S

Difficulty breathing
Rapid heart rate
Pleuritic chest pain
Distended neck veins
Syncope
Cyanosis
Hypotension

56

Notify Rapid Response if:

Pts with sudden onset of dyspnea & chest pain

57

Heparin antidote

Protamine sulfate

58

Warfarin antidote

Phytonadione (Vit K)

59

PE pt teaching

Ways to promote venous return
Avoiding venous thromboembolism

60

Need for O2 therapy

Acute hypoxemia
Keep CO2 >60

61

PE surgical procedures

Embolectomy
Inferior vena cava interruption

62

Acute respiratory failure

PaO2 < 90%
PaCO2 >50 occuring with acidemia

63

Ventilatory failure

Ventilation perfusion mismatch
Perfusion is normal, but ventilation is inadequate

64

Hallmark of respiratory failure

Dyspnea

65

Respiratory failure assessment

Dyspnea
Change in respiratory rate or pattern
Change in lung sounds
Manifestations of hypoxemia
Hypercarbia

66

ARDS

Acute resp failure w/
Hypoxemia even with 100% O2
Decreased pulmonary compliance
Dyspnea
Bilateral pulmonary edema
Dense pulmonary infiltrates on x-ray

67

Transfusion-related lung injury

Pulmonary edema associated with inflammatory response due to plasma-containing transfusions

68

ARDS causes

Direct injury to lung tissue
Head or spinal trauma
Strokes
Tumors
Increased CSF

69

Prevention of ARDS

Early recognition of pts at high risk

70

ARDS assessment

Increased work to breath
Hyperpnea
Grunting respiration
Cyanosis
Pallor
Intercostal or substernal retractions
Sweating
Change in mental status

71

ARDS diagnosis

Lowered PaO2
Widening alveolar O2 gradient
Whited-out appearance to chest x-ray
No cardiac involvement on ECG

72

Need for aspiration precautions

Altered LOC
Poor gag reflex
Neurologic impairment
ET tube

73

ARDS hourly assessment

O2 sat
Vital sign changes
Indication of increased work of breathing
Cyanosis
Pallor
Retractions

74

Alternatives to mechanical ventilation

Airway pressure-release ventilation (APRV)
High-frequency oscillatory ventilation

75

Mechanical ventilation

Usually temporary
Lifelong for pts with severe restrictive lung disease & chronic, progressive neuromuscular disease

76

Mechanical ventilation uses

Pts with hypoxemia & progressive alveolar hypoventilation with resp acidosis

77

Tracheostomy

Recommended if pt needs airway for longer than 10-14 days

78

Goals of intubation

Maintain patent airway
Provide a means to remove secretions
Provide ventilation & O2

79

3 ways inspiration is cycled

Pressure-cycled
Time-cycled
Volume-cycled

80

Complications inhibiting weaning

Age-related changes
Increased chest wall stiffness
Reduced ventilatory muscle strength
Decreased lung elasticity

81

Emergency approach to chest injury

ABCs
Rapid assessment
Treatment of life-threatening conditions

82

Pulmonary contusion

Most common chest injury
Occurs with injuries caused by rapid deceleration
Respiratory failure develops over time

83

Pulmonary contusion causes

Follows injuries caused by rapid deceleration during vehicular accidents
Hemorrhage occurs in & between the alveoli

84

Rib fractures

Results from direct blunt trauma to the chest
Direct force drives bone ends into the chest

85

Rib fractures complications

Deep chest injury
Pulmonary contusion
Pneumothorax
Hemothorax

86

Chest trauma assessment

Tracheal position
Bilateral breath sounds

87

Chest trauma intervention

Encourage deep breaths

88

Flail chest

Inward movement of thorax during inspiration
Outward movement during expiration

89

Flail chest common cause

High-speed vehicular crashes
More common in elderly
High mortality rate

90

Pneumothorax

Caused by blunt chest trauma
Allows air to enter the pleural space
Causes rise in chest pressure & reduction in vital capacity

91

Tension pneumothorax

Rapidly developing
Life-threatening
Complication of blunt chest trauma
Air leak in lung or chest wall

92

Effects of tension pneumothorax

Collapsed affected lung
Compressed blood vessels
Limited venous return
Decreased filling of the heart & decreased cardiac output

93

Cause of bleeding in hemothorax

Injury to lung tissue (lung contusions or lacerations)
Rib & sternal fractures

94

Causes of tears of tracheobronchial tree

Severe blunt trauma
Rapid deceleration involving mainstem bronchi

95

TIA deficits

Blurred vision, double vision, blindness in one eye, tunnel vision
Weakness, gait disturbance
Numbness in extremities, vertigo
Aphasia, dysarthria (slurred speech)

96

Stroke assessment

Aphasia (speech), alexia (written), agraphia (can't write)
Hemiplegia & hemiparesis, hypotonia, flaccid paralysis
Agnosia (recognizing common objects), apraxia (learned movements), neglect syndrome, ptosis

97

Right hemispheric damage

Difficulty performing ADLs & ambulation

98

Left hemispheric damage

Memory deficits
Changes in ability to carry out simple tasks

99

Right hemispheric damage interventions

Frequent verbal & tactile cues
Approach from unaffected side
Patch over eye for double vision

100

Left hemispheric damage interventions

Assist with memory problems
Establish a consistent routine or schedule
Ask family to bring pictures or other familiar things

101

Expressive aphasia (Broca's)

Pt understands what is said, but cannot communicate verbally & has trouble writing

102

Receptive aphasia (Wernicke's)

Pt can't understand spoken or written word
Speech is often meaningless

103

Global aphasia

Profound speech & language problems
No speech or sounds that can be understood

104

Brain injury S/S

Amnesia
Seizure
Loss of consciousness
Restlessness
Personality changes

105

Severe head injury S/S

Pupil changes
Bradycardia
High blood pressure/widened pulse pressure
Tachycardia (hypovolemic shock)
CSF leak

106

Linear fracture

Clean break
Impacted area bends inward & surrounding area bends outward

107

Depressed fracture

Bone is pressed inward into the brain to at least the thickness of the skull

108

Comminuted fracture

Fragmentation of the bone with depression of bone into brain tissue

109

Normal ICP level

10-15 mmHg

110

Epidural hematoma

Results from arterial bleeding into the space between the dura & inner skull
Neurosurgical emergency

111

Hydrocephalus

Abnormal increase in CSF volume
Leads to increased ICP if not treated

112

Brain death criteria

Glasgow coma scale <3
Apnea
No pupil response
No gag reflex
No oculovestibular reflex (cold water in ears)
No oculocephalic reflex (dolls eyes)

113

Mannitol

Osmotic diuretic--pulls water off of brain
Requires filter in tubing or filtered needle

114

Ventilatory Failure
Extrapulmonary Causes

Neuromuscular disorders (myasthenia gravis, Gluillain-Barre Syndrome)
Spinal cord injuries
CNS dysfunction (stroke, meningitis)
Chemical depression (opioid analgesics, sedatives)

115

Ventilatory Failure
Intrapulmonary Causes

Airway disease (COPD, asthma)
Pulmonary embolism
Pneumothorax
ARDS

116

Oxyenation failure

Air moves in & out without difficulty, but does not oxygenate the pulmonary blood sufficiently
Ventilation is normal, but lung perfusion is decreased

117

Oxygenation failure causes

Pneumonia
High altitudes
CO poisoning
Pulmonary embolism
CHF with pulmonary edema
ARDS

118

Assist-control ventilation

Ventilator takes over breathing for the pt
Tidal volume & ventilatory rate are preset

119

Synchronized intermittent mandatory ventilation (SIMV)

Tidal volume & ventilatory rate are preset
Allows spontaneous breathing at pt's own rate

120

BiPAP

Ventilator provides a preset inspiratory pressure & expiratory pressure similar to positive end expository pressure (PEEP)

121

Tidal volume

Volume of air the pt receives with each breath
Average is 7-10 mL/kg

122

FiO2

Oxygen level delivered to the pt

123

Peak inspiratory pressure (PIP)

Pressure needed by ventilator to deliver a set tidal volume at a given lung compliance
Highest pressure reached during inspiration

124

Continuous positive airway pressure (CPAP)

Applies positive airway pressure throughout entire respiratory cycle
Keeps alveoli open during inspiration

125

Positive end expiratory pressure (PEEP)

Positive pressure exerted during expiratory phase
Enhances gas exchange
Prevents atelectasis

126

Reasons to suction

Secretions
Increased PIP
Rhonchi (wheezes)
Decreased breath sounds

127

Barotrauma

Damage to lungs by positive pressure
Pneumothorax
Subcutaneous emphysema

128

Volutrauma

Damage to the lung by excess volume delivered to one lung over the other

129

Pulmonary contusion

Bloody sputum
Decreased breath sounds
Crackles & wheezes

130

Pneumothorax assessment

Reduced breath sounds
Hyper-resonance on percussion
Deviation of trachea away from or toward the affected side

131

Tension pneumothorax intervention

Large bore needle into 2nd intercostal space in mid-clavicular line of affected side
Chest tube placed later into 4th intercostal space