Week 8; Neuro and Trauma Flashcards

Question

Secondary Survey and Resuscitation Interventions

Answer 1

More comprehensive head-to-toe assessment to identify other injuries or medical issues Splints applied or temporary dressings until diagnostic testing.

Answer 2

Transport to OR or interventional radiology suite Admission to inpatient unit Transfer to a higher level of care Psychiatric referral or admission HIGH Risk Alcohol abuse - Screening, Brief intervention, and referral to treatment (SBIRT)

Answer 3

D Based on the information provided, the patient experiencing upper abdominal pain and profuse sweating should be triaged first. Upper abdominal with radiating left shoulder pain are possible signs of referred chest pain which may indicate a myocardial infarction—an emergent condition. The emergent triage category implies that a condition exists that poses an immediate threat to life or limb. The urgent triage category indicates that the patient should be treated quickly but that an immediate threat to life does not exist at the moment. Examples of patients who typically fall into the urgent category are those with renal colic, complex lacerations not associated with major hemorrhage, displaced fractures or dislocations, and temperature greater than 101 F (38.3 C).

Answer 4

E, D Summon help from other ED staff! The primary survey organizes the approach to the patient so that immediate threats to life are rapidly identified and effectively managed. The primary survey is based on a standard “ABC” mnemonic with a “D” and “E” added for trauma patients: airway/cervical spine (A), breathing (B), circulation (C), disability (D), and exposure (E). The highest priority intervention is to establish a patent airway. All other actions can be completed after the airway is established.

Answer 5

B The nurse should ask the forensic nurse to see the patient. Many EDs have specialized teams that deal with high-risk populations of patients. Forensic nurse examiners (RN-FNEs) are educated to obtain patient histories, collect forensic evidence, and offer counseling and follow-up care for victims of rape, child abuse, and domestic violence, also known as intimate partner violence (IPV). They are trained to recognize evidence of abuse and to intervene on the patient’s behalf.

Answer 6

Altered immune response to an antigen that results in harm. Response may be bothersome or life-threatening

Answer 7

(IgE-mediated) Common hypersensitivity reactions Examples: allergic asthma, hay fever, hives Triggered when allergen interacts with free IgE Allergens can be ingested in foods, injected, inhaled, absorbed Systemic response Anaphylaxis, urticaria, angiodema

Answer 8

acute systemic response, may result in shock, death in highly sensitive individuals. Localized response, such as asthma, more common with strong genetic predisposition.

Answer 9

(cytotoxic) Binding of IgG- or IgM-type with antigen activates complement cascade Destruction of target cell May be stimulated by: Exogenous antigen (foreign tissue, cells) Drug reaction Withdrawal of drug stops hemolysis Endogenous antigen Results in autoimmune disorder

Answer 10

(immune complex–mediated) Results from formation of IgG or IgM antibody–antigen immune complexes in circulatory system Systemic; immune complex deposited in small blood vessels, kidneys, joints Serum sickness Localized; immune complexes accumulate at specific site

Answer 11

(delayed) Cell-mediated immune responses. Results from exaggerated interaction between antigen, normal cell-mediated mechanisms, contact dermatitis. Latex allergy; common in certain patients Spina bifida Congenital, urologic, gastrointestinal (GI), tracheoesophageal defects Multiple surgeries Diabetes requiring insulin History of atopy Often coexists with allergy to certain foods

Answer 12

Incidence and intensity increase with previous exposure, age, sex, concurrent illnesses, previous reactions to related substances. Family member with allergy. Development, severity factors: older age, lung disease, route of antigen entry, amount of antigen introduced, rate of absorption of antigen, degree of individual hypersensitivity

Answer 13

Hypotension, wheezing, GI or uterine spasm, stridor, urticaria

Answer 14

Varying manifestations, dyspnea, fever

Answer 15

Urticaria, fever, joint pain

Answer 16

Fever, erythema, itching

Answer 17

Discomfort Fatigue Lasts hours to a few days Resolve by themselves or with over-the-counter (OTC) treatment Rhinitis or asthma lasting beyond a day or two may result in localized infection

Answer 18

Localized pain and inflammation Difficulty breathing Loss of smell, taste, appetite Skin reactions: urticaria, atopic and contact dermatitis Food allergies: urticaria, GI symptoms

Answer 19

May lead to respiratory distress, death

Answer 20

Focus on minimizing exposure to allergen, preventing hypersensitivity reaction, providing prompt, effective interventions for allergic responses, identifying allergen is key, history of exposure, type of response, onset, manifestations, withdraw allergen immediately, maintain airway, cardiac output, manage bleeding, renal failure, supportive care to relieve discomfort

Answer 21

WBC count with differential Radioallergosorbent test (RAST) Blood type and crossmatch Indirect Coombs test Direct Coombs test Immune complex assays Complement assay

Answer 22

Determine causes of hypersensitivity reactions Allergens selected according to patient’s history Epicutaneous testing done first to avoid systemic reaction Specific skin tests: prick (epicutaneous or puncture) test, intradermal test, patch test, food allergy test

Answer 23

Based on severity of hypersensitivity reaction: IV for severe reactions, oral for mild reactions Antihistamines Mast cell stabilizers Leukotriene modifiers Corticosteroids

Answer 24

Immediate treatment for anaphylaxis Patients with history of anaphylaxis should carry EpiPen

Answer 25

Dictated by severity of response, organ system affected Airway management is highest priority for patient with acute anaphylactic reaction Severe laryngospasm: emergency tracheostomy or endotracheal tube IV line, fluid resuscitation Anaphylaxis: risk for vasomotor collapse, hypotension

Answer 26

Blood passed through blood cell separator Plasma and glomerular-damaging antibody–antigen complexes removed RBCs returned to patient with albumin, plasma Done as a series of treatments Potentially risky

Answer 27

Patients with type I hypersensitivity should contact physician before using herbals, teas, aromatherapy Concern about allergic reactions to chamomile

Answer 28

food allergies, asthma

Answer 29

Older adults at greater risk Teens with food allergies at high risk Tend to eat outside home Less likely to carry their medication Allergies tend to run in families Results of studies on prevention confusing, controversial May outgrow certain allergies as patient ages Uncommon to outgrow allergy to peanuts, tree nuts, fish, shellfish Individuals who develop allergies in adulthood typically have them for rest of their lives

Answer 30

Food allergies affect ~48.5% of children ages 0–18 years Reduce risk of exposure Educate families on what to do when child has allergic reaction Peanut allergy increased significantly EPIT could be first FDA-approved treatment for peanut allergy

Answer 31

Fish and shellfish allergy most prevalent, then allergies to peanuts and tree nuts More likely to persist into adulthood than allergies to milk, eggs, wheat, soy Drug allergies not uncommon, may be cause of up to 20% of anaphylaxis fatalities

Answer 32

Mucous membranes of nose, mouth Lesions, rashes on skin Tearing, redness of eyes Respiratory rate Breath sounds

Answer 33

Goals may include that patient will: Avoid known substances that provoke hypersensitivity response Describe self-care to reduce symptoms of seasonal allergies Describe proper self-administration of medications Help determine substances that cause hypersensitivity by keeping an accurate food journal

Answer 34

Most hypersensitivity reactions treated by patient or family member Education about care for hypersensitivity is essential When/how to use anaphylaxis kit When to seek medical attention How to prevent immune complex reaction Skin care to prevent contact dermatitis

Answer 35

Highest priority in anaphylactic shock Place patient in Fowler or high Fowler position

Answer 36

Assess respiratory status, level of consciousness (LOC), anxiety, nasal flaring, use of accessory respiration muscles, chest wall movement Palpate for respiratory excursion Auscultate lung sounds, adventitious sounds Administer oxygen per nasal cannula Insert nasopharyngeal or oropharyngeal airway Administer subcutaneous epinephrine Provide calm reassurance

Answer 37

Monitor vital signs, LOC frequently Assess indicators of peripheral perfusion For anaphylactic shock Insert large-bore IV catheter(s), administer warmed IV solutions Insert indwelling catheter, monitor output Place tourniquet above site of injected venom Once breathing established, place patient flat with legs elevated

Answer 38

Obtain and record thorough history Previous transfusions Any reactions, no matter how mild Check for informed consent for blood, blood products Use two licensed healthcare professionals to check patient identity, blood type, Rh factor, crossmatch, expiration date Take and record vital signs within 15 minutes before initiating blood transfusion Administer acetaminophen and diphenhydramine before initiating transfusion Infuse blood into separate infusion site Use at least 20 gauge catheter for infusion Administer blood with normal saline to prime IV Administer 50 mL blood during first 15 minutes

Answer 39

Complaints of back, chest pain Temperature increase over 1.8°F Chills, tachycardia, tachypnea Wheezing, hypotension Hives, rashes Cyanosis Stop transfusion immediately if even mild reaction occurs Send blood and administration set to lab Fresh blood and urine samples from patient

Answer 40

Whole-body inflammatory process → acute critical illness Sepsis is SIRS resulting from infection Can occur as complication of any infection

Answer 41

Sepsis associated with acute organ failure

Answer 42

Persistently low mean arterial blood pressure despite fluid resuscitation. Results from overwhelming infection. A sepsis induced hypotension persisting despite adequate fluid resuscitation.

Answer 43

Persistently low mean arterial blood pressure despite vasopressor therapy and fluid resuscitation.

Answer 44

SIRS can occur as complication of virtually any infection of any body tissue. Severe SIRS response → sepsis can develop. Patients with sepsis are very ill, require attentive monitoring, rapid intervention

Answer 45

Disseminated intravascular coagulation (DIC)

Answer 46

Begins with septicemia d/t bacteremia

Answer 47

bacteria, their toxins in bloodstream Most often from gram-positive infections

Answer 48

Urinary system Respiratory system Gastrointestinal (GI) system Integumentary system Female reproductive system

Answer 49

Hospitalization, chronic illnesses, poor nutritional status, invasive procedures or surgery, older adults, immunocompromised, improper tampon use (TSS)

Answer 50

Watch for early signs of sepsis in infants with infectious process, individuals with cancer, especially with chemotherapy, radiation therapy. Immunization against organisms that cause pneumonia, use aseptic technique, good hand hygiene when inserting, removing, caring for catheters, IV lines.

Answer 51

Fever or hypothermia, tachycardia, tachypnea, peripheral vasodilation, septic shock, mental status changes

Answer 52

Abnormal complete blood count (CBC), clotting factors, liver enzyme, C-reactive protein, creatinine

Answer 53

Vasodilation results in hypotension and fluid shifts, weakness, warm flushed skin Septicemia → high fever, chills

Answer 54

Hypovolemia and compensatory mechanisms result in cold moist skin, oliguria, changes in mental status Death from respiratory, cardiac, renal failure

Answer 55

Sequence of cell damage caused by massive release of toxic metabolites and enzymes. Microthrombi form. Occurs first in liver, heart, brain, kidney. Myocardial depressant factor from ischemic pancreas.

Answer 56

Hemoglobin and hematocrit, arterial blood gases (ABGs), serum electrolytes, BUN, creatine, urine gravity, and osmolality, blood cultures to identify causative organism, direct treatment, WBC, serums enzymes, hemodynamic monitoring, x-ray, CT, MRI, gastric tonometry, sublingual PaCO2.

Answer 57

Broad-spectrum antibiotics, vasoactive drugs, inotropic drugs, o2 therapy, fluid replacement.

Answer 58

Broad-spectrum antibiotics; several used to ensure adequate coverage. Condition may worsen initially. Increasing numbers of toxins released into bloodstream from pathogen destruction.

Answer 59

Most effective treatment for septic shock IV fluids or blood Two large-bore peripheral lines or, more often, central line

Answer 60

Temperature instability, abdominal distention, poor feeding, lethargy, respiratory distress, hepatomegaly, vomiting, jaundice

Answer 61

Increasing incidence worldwide, small percentage resulting in death of mother and fetus. Fast action when SIRS symptoms begin to avoid complications. Routine prenatal care can assist in prevention.

Answer 62

Age-associated cardiac changes decrease compensatory responses to septic shock. Decreased ability to respond to decrease in oxygenation. Decreased skin elasticity makes dehydration assessment more difficult. Decreased immune system response increases risk. Sepsis is critical concern in older adults

Answer 63

Continuous monitoring of vital signs, hemodynamic monitoring, focused assessment to monitor adequacy of ventilation, perfusion, renal function, monitor patient’s skin color, temperature, turgor, and moisture, monitor patient’s cardiopulmonary function by assessing/monitoring blood pressure, rate and depth of respirations, lung sounds, pulse oximetry, peripheral pulse, JVD, central venous pressure (CVP) measurements, temperature, urinary output per Foley catheter hourly, LOC.

Answer 64

Sympathetic nervous system and parasympathetic nervous system

Answer 65

Often affect mobility, sensory perception, cognition, motor changes, slower processing time, recent memory loss, decreases sensory perception of touch, change in perception of pain, change in sleep, altered balance or coordination, increased risk of infection.

Answer 66

Eye opening, motor response, and verbal response. Highest score is 15

Answer 67

Laboratory assessment, imaging such as: Plain x-rays Cerebral angiography (arteriography) Computed tomography (CT) scan Magnetic resonance imaging (MRI) Positron emission tomography (PET)

Answer 68

Used to identify nerve and muscle disorders, as well as spinal cord disease, used for MS, peripheral neuropathies

Answer 69

Graphically records the electrical activity of cerebral hemispheres. Examines for various seizure activity.

Answer 70

Inflammation of the meninges (outer coverings) of the brain and spinal cord, specifically the pia mater and arachnoid. Bacterial, viral, or fungal etiology. Organisms enter the CNS via the bloodstream or are directly introduced into the CNS. Direct routes usually due to trauma, surgical procedures or a rupture brain abscess.

Answer 71

direct communication of CSF with ear or nasal passages manifested by otorrhea or rhinorrhea that is actually CSF.

Answer 72

direct communication of CSF with ear or nasal passages manifested by otorrhea or rhinorrhea that is actually CSF.

Answer 73

Include infections in eyes, ears, nose mouth or neck or throat because of proximity. Otitis media, sinusitis, tooth abscesses. Immunocompromised patients at risk.

Answer 74

enterovirus, herpes simplex, varicella zoster (chicken pox and shingles)

Answer 75

streptococcus pneumonia and Neisseria meningitides and also know as meningococcal meningitis

Answer 76

Is considered a medical emergency with a high mortality rate, often within 24 hours. HIGHLY contagious. Outbreaks most likely to occur in high population density such as college dorms, schools, military barracks. People ages 16-21 have highest rate of infection from meningococcal meningitis. Vaccine available and CDC recommends administration between the ages of 11-12 yo.

Answer 77

Fever, headache, photophobia, phonophobia, indications of increased ICP, nuchal rigidity, nystagmus, abnormal eye movements, positive Brudzinski’s and Kernig’s signs, decreased mental status, memory changes, motor responses: hemiparesis, hemiplegia, cranial nerve dysfunction, N/V, Red macular rash

Answer 78

Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.

Answer 79

A positive test is the elicitation of pain or resistance with passive extension of the patient's knees past 135 degrees in the setting of meningeal irritation.

Answer 80

CSF analysis (lumbar puncture), CT scan, blood cultures, counterimmunoelectrophoresis – presence of viruses or protozoa, polymerase chain reaction, CBC, serum electrolyte levels, x-rays to determine presence of infection

Answer 81

Accurate monitoring of and documenting their neurologic status.

Answer 82

Patients are placed on DROPLET PRECAUTIONS. Standard Precautions with good hand hygiene is essential. When possible, private room. Patients leaving room wear mask. Teach visitors about need for precautions and how to use them.

Answer 83

Prioritize care to maintain airway, breathing, circulation. Take vital signs and perform neurologic checks every 2 to 4 hours, as required. Perform cranial nerve assessment, with particular attention to cranial nerves III, IV, VI, VII, and VIII, and monitor for changes. Manage pain with drug and nondrug methods. Perform vascular assessment and monitor for changes. Give drugs and IV fluids as prescribed and document the patient's response. Record intake and output carefully to maintain fluid balance and prevent fluid overload.

Answer 84

increased intracranial pressure, vascular dysfunction, fluid and electrolyte imbalance, seizures, shock

Answer 85

Monitor body weight to identify fluid retention early. Monitor laboratory values closely; report abnormal findings to the physician or nurse practitioner promptly. Position carefully to prevent pressure injuries. Perform range-of-motion exercises every 4 hours as needed. Decrease environmental stimuli: Provide a quiet environment, Minimize exposure to bright lights from windows and overhead lights, Maintain bedrest with head of bed elevated 30 degrees. Maintain Transmission-Based Precautions per hospital policy (for bacterial meningitis).

Answer 86

Broad-spectrum antibiotic, hyperosmolar agents, anticonvulsants, steroids (controversial), prophylaxis treatment for those in close contact with meningitis-infected patient.

Answer 87

Inflammation of the brain tissue and often surrounding meninges

Answer 88

A viral agent is most often the cause, although bacteria, fungi, or parasites may also be involved (e.g., malaria). The virus travels to the central nervous system (CNS) via the bloodstream, along peripheral or cranial nerves, or in the meninges. Can be life threatening or lead to persistent neurologic problems such as learning disabilities, epilepsy, memory deficits, or fine motor deficits.

Answer 89

The typical patient with encephalitis has a high fever and reports nausea, vomiting, and a stiff neck. Assess for other signs and symptoms, including possible: Changes in mental status (e.g., agitation) Motor dysfunction (e.g., dysphagia [difficulty swallowing]) Focal (specific) neurologic deficits Photophobia (light sensitivity) and phonophobia (noise sensitivity) Fatigue Symptoms of increased ICP (e.g., decreased LOC) Joint pain Headache

Answer 90

In severe cases the patient may have increased intracranial pressure resulting from cerebral edema, hemorrhage, and necrosis of brain tissue. If patient is nonverbal or comatose at baseline, monitoring VS and pupils becomes essential for detecting worsening of neuro status. Pupils that become increasingly dilated and less responsible to light, widening pulse pressure, bradycardia, irregular respiration are urgently reported. Left untreated ICP leads to herniation of the brain tissue and possibly death.

Answer 91

Teaching regarding mosquito or tick prevention Administer medications Nursing interventions similar to that of meningitis Supportive nursing care, prompt recognition and treatment of ICP Patient should turn, cough, deep breath q 2 hours Assess VS and neuro checks every 2 hours or per provider order or hospital policy Elevate head of bed 30-45 degrees unless contraindicated Keep room darkened and reduce noise to decrease stimuli and possible agitation Provide patient and family support Rehab for anyone with permanent neuro deficits

Answer 92

Acyclovir antiviral drug of choice – beginning early is best before patient becomes stuporous

Answer 93

Hyperflexion, hyperextension, axial loading or vertical compression (caused by jumping, for example), excessive head rotation beyond its range, penetration (caused by bullet or knife, for example)

Answer 94

Hemorrhage, schemia, hypovolemia, impaired tissue perfusion from neurogenic shock, local edema

Answer 95

History, airway, breathing pattern, circulation GI/GU assessment, indications of intra-abdominal hemorrhage, or hemorrhage/bleeding around fracture sites, LOC, GCS, level of injury Examples: quadriplegia, paraplegia

Answer 96

Location and position of patient immediately after the injury Symptoms occurring immediately after the injury Changes since then Type of immobilization devices used for transport Treatment given at scene Medical History History of respiratory problems particularly if cervical injury

Answer 97

Any movement MUST be coordinated . Move patient as a unit. NO LATERAL PUSHING. Move patient up and down to prevent lateral bending. LEAD RN or person at the head “CALLS” all moves. ALL MOVES MUST be slowly executed and well coordinated. TALK THE PLAN OUTLOUD BEFORE MOVIN. Consider the final positioning of the patient prior to move

Answer 98

A, B, Cs, VS PLUS pulse strength and capillary refill, GCS, monitor for a decrease in sensory perception from baseline or new loss of motor function or mobility, presence of these changes is considered an emergence and requires immediate communication with primary provider.

Answer 99

Sometimes referred to as autonomic hyperreflexia. Potentially life-threatening condition in which noxious visceral or cutaneous stimuli cause a sudden, massive, uninhibited reflex sympathetic discharge in people with high-level SCI. Causes are typically GI, GU and vascular simulation.

Answer 100

bladder distention, UTI, epididymitis, scrotal compression, bowel distention or impaction, pain, circumferential constriction of thorax, abdomen or extremity, temperature fluctuations

Answer 101

Sudden, significant rise in systolic and diastolic blood pressure, accompanied by bradycardia Profuse sweating above the level of lesion—especially in the face, neck, and shoulders; rarely occurs below the level of the lesion because of sympathetic cholinergic activity Goose bumps above or possibly below the level of the lesion Flushing of the skin above the level of the lesion—especially in the face, neck, and shoulders Blurred vision Spots in the patient's visual field Nasal congestion Onset of severe, throbbing headache Flushing about the level of the lesion with pale skin below the level of the lesion Feeling of apprehension

Answer 102

Place patient in a sitting position (first priority!), or return to a previous safe position. Notify the primary health care provider or Rapid Response Team. Assess for and treat the cause: Check for urinary retention or catheter blockage, Check the urinary catheter tubing (if present) for kinks or obstruction, If a urinary catheter is not present, check for bladder distention and catheterize immediately if indicated, Consider using anesthetic ointment on tip of catheter before catheter insertion to reduce urethral irritation. Determine if a urinary tract infection or bladder calculi (stones) are contributing to genitourinary irritation. Check the patient for fecal impaction or other colorectal irritation, using anesthetic ointment at rectum. Disimpact if needed. Examine skin for new or worsening pressure injury symptoms. Monitor blood pressures every 10 to 15 minutes. Give nifedipine or nitrate as prescribed to lower blood pressure as needed. (Patients with recurrent autonomic dysreflexia may receive an alpha blocker prophylactically.)

Answer 103

Potential for respiratory distress/failure Potential for cardiovascular instability (e.g., shock and autonomic dysreflexia) Potential for secondary spinal cord injury Decreased mobility and sensation

Answer 104

Assessment Spinal Immobilization and Stabilization Halo Traction Medications Surgical interventions

Answer 105

Mobility skills Pressure ulcer prevention Bowel and bladder program Sexuality

Answer 106

Blow or jolt to head. May be result of head penetration by foreign object, acceleration-deceleration injury, concussion Direct injury: a force produced by a blow to the head Indirect injury: a force applied to another body part with a rebound effect to the brain The type of force and the mechanism of injury contribute to TBI.

Answer 107

Caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. Can occur in sports even with a helmet on! Symptoms can show up immediately or take hours or days.

Answer 108

Can’t recall events prior to or after a hit or fall. Appears dazed or stunned. Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent. Moves clumsily. Answers questions slowly. Loses consciousness (even briefly). Shows mood, behavior, or personality changes.

Answer 109

Headache or “pressure” in head. Nausea or vomiting. Balance problems or dizziness, or double or blurry vision. Bothered by light or noise. Feeling sluggish, hazy, foggy, or groggy. Confusion, or concentration or memory problems. Just not “feeling right,” or “feeling down”.

Answer 110

Progressive degenerative disease of the brain found in people with a history of repetitive brain trauma (often athletes), including symptomatic concussions as well as asymptomatic subconcussive hits to the head that do not cause symptoms.

Answer 111

Results form the physical stress or force within the tissue caused by blunt or penetrating force Open versus closed head injuries Mild, moderate, severe classification Fractures

Answer 112

Any processes that occur after the initial injury and worsen patient outcomes Damage occurs because delivery of oxygen and glucose to the brain is interrupted Examples: hypotension and hypoxia, Intracranial hypertension, cerebral edema, hemorrhage

Answer 113

(outside the dura mater of the brain), subdural hematoma (under the dura mater), and intracerebral hemorrhage (within the brain tissue).

Answer 114

Venous bleeding into space beneath dura and above arachnoid Most commonly from tearing of bridging veins within cerebral hemispheres or from laceration of brain tissue Bleeding occurs more slowly, symptoms mirror those of epidural hematoma

Answer 115

History of amnesia, first priority - ABCs, spine precautions, neuro assessment, pupillary changes- uneven, non-reactive or sluggish, dilated, assess ears and nose for CSF Halo sign - a clear yellow ring surrounding spot of blood white absorbent paper, send to lab for analysis

Answer 116

Mannitol (cerebral edema)

Answer 117

Decreased level of consciousness (LOC) (lethargy to coma) Behavior changes: restlessness, irritability, and confusion Headache Nausea and vomiting (may be projectile) Change in speech pattern/slurred speech: Aphasia Change in sensorimotor status: Pupillary changes: dilated and nonreactive pupils (“blown pupils”) or constricted and nonreactive pupils, Cranial nerve dysfunction, Ataxia Seizures (usually within first 24 hours after stroke) Cushing's triad: Classic but late sign: Severe hypertension, Widened pulse pressure, Bradycardia Abnormal posturing: Decerebrate, Decorticate

Answer 118

Severe hypertension, Widened pulse pressure, Bradycardia

Answer 119

Severe TBI Admitted to ICU or Trauma Unit Mild cases may be sent home with instructions for follow up or return to ED Position TBI patient to avoid extreme flexion or extension of neck and maintain head in the midline neutral position HOB 30 degrees to prevent aspiration. Avoid sudden changes. Monitor for decreasing BP if HOB at 30 degrees VS every 1-2 ours Neuro checks IV fluids Meds to prevent severe hyper or hypotension Therapeutic hypothermia may be ordered – cool pt. to core of 89/6 to 93.2 F to reduce brain metabolism and prevent cascade of events that contribute to secondary injury Pain medication – morphine or fentanyl to decrease agitation or reduce restlessness

Week 8; Neuro and Trauma Flashcards

(143 cards)