Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

168.362 > Week Four > Flashcards

Week Four Flashcards

1
Q

What are the emergency care ABCDEFGHI?

A
  • Airway
  • Breathing
  • Circulation
  • Disability
  • Environment/Exposure
  • Full set of vitals/Further investigations/Facilitate family presence
  • Give comfort measures
  • History/Head to toe
  • Inspect posterior surfaces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is ICP?

A
  • Intracranial pressure

- The pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the Monro-Kellie Hypothesis?

A

Increase in volume of one of intracranial component must be compensated by decrease in one or more of other components so that volume remains fixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is normal intracranial pressure?

A
  • 5-15 mmHg

- Greater than 20mmHg must be treated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How to measure intracranial pressure?

A

With a intraventricular catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is cerebral blood flow?

A

Amount of blood that passes through the brain at any time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How much of the body’s oxygen does the brain use?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How much of the body’s glucose does the brain use?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is autoregulation?

A

The automatic alteration in the diameter of the cerebral blood flow to maintain a constant flow of blood to the brain during during systemic arterial pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does auto-regulation equal?

A

Cerebral perfusion pressure (CPP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to find how much cerebral perfusion pressure (CPP) is?

A

Map minus ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is CPP?

A
  • Cerebral perfusion pressure

- Pressure to ensure blood flow to brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is normal CCP?

A

60-100mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does CCP of lower than 50mmHg indicate?

A

Ischaemia and neuronal death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does CCP of lower than 30mmHg indicate?

A

Incompatibility with life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the implications to nursing assessment of ICP?

A
  • Frequent neurological observations (30 mins-1 hr)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why must a nurse complete frequent neurological observations for possible increased ICP?

A

Because a small change in volume can have dramatic effect on ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What can increased ICP?

A
  • Anything that increased brain tissue, blood of CSF volume

- Cerebral oedema common factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What causes cerebral oedema?

A
  • Mass lesion
  • Head injuries
  • Brain surgery
  • cerebral infection
  • Vascular insult
  • Toxic or metabolic encephalopathic conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are complications of increased ICP?

A
  • Inadequate cerebral perfusion

- Cerebral herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does herniation cause?

A

1) A potentially reversible process to become irreversible
2) Ischemia and oedema increase
3) Compression of brainstem and cranial nerves
4) Brain death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the progression of increased ICP?

A
  • Cranial insult
  • Tissue oedema
  • Increased ICP
  • Compression of blood vessels
  • Decreased cerebral blood flow
  • Decreased oxygen with death of brain cells
  • Oedema around necrotic tissues
  • Increased ICP with compression of brainstem and respiratory centre
  • Accumulation of carbon dioxide
  • Accumulation of carbon dioxide
  • Vasodilation - Increased ICP resulting from increased blood volume
  • Death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are clinical manifestation of increased ICP?

A
  • Change in LOC
  • Change in vital signs (Cushings triad=high bP with low diastolic, bradycardia, increased temp, erratic/decreased breathing)
  • Ocular signs
  • Decrease in motor function
  • Headache
  • Vomiting (projectile without nausea)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What do we assess in a neurological assessment?

A
  • Glasgow coma scale
  • Pupillary check for size and response
  • Test strength and movement
  • Vital signs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Why do we check Glasgow coma scale for a neurological assessment?

A

Measures consciousness (less than 8/15 = coma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Why do we check the pupillary check for size and response for a neurological assessment?

A

Sign CN III, IV, VI nerves are compressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why do we check test strength and movement for a neurological assessment?

A

Testing response in all four limbs for asymmetry in strength and movement fo deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Why do we check the vital signs for a neurological assessment?

A

Checking for signs of Cushing’s triad which indicates severely increased ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is a decorticate response?

A

Flexion of arms, wrists and fingers with adduction in upper extremities. Extension, internal rotation and plantar flexion in lower extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is a decerebrate response?

A

All four extremities in rigid extension, with hyperpronation of forearms and plantar flexion of feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is opisthotonic posturing?

A

When the back becomes extremely arched

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the types of head injuries?

A
  • Scalp laceration
  • Skull fractures
  • Head trauma: diffuse or focal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is a diffuse injury?

A
  • Generalised
  • Concussion
  • Diffuse axonal injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a focal injury?

A
  • Localised
  • Contusion
  • Hematoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How do you class head injuries?

A
  • Minor: GCS 13-15
  • Moderate: GCS 9-12
  • Severe: GCS 3-8
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is a coup-contrecoup injury?

A

Cerebral contusion on the side of the brain opposite the area that was hit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is a coup injury?

A

Cerebral contusion at site of impact with an object

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is a concussion?

A
  • Minor head injury

- Sudden transient mechanical head injury with disruption of neural activity and a change in LOC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are signs of a concussion?

A
  • Brief LOC
  • Amnesia regarding the event
  • Headache
  • Post concussion syndrome can last 2 weeks to 2 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are symptoms of a concussion?

A
  • Persistent headache
  • Lethargy
  • Personality and behaviour changes
  • Short attention span
  • Decreased short-term memory
  • Changes in intellectual ability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What something to be aware of with scalp laceration?

A

Profuse bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are different types of skull fracture?

A
  • Linear
  • Depressed
  • Simple
  • Comminuted
  • Compound
    Symptoms vary depending on where the fracture is
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What to watch for when a patient has a skull fracture?

A

CSP leaking from nose or ears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What does CSP leaking from nose and ear indicate?

A

Tear in dura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are clinical signs of basilar skull fracture?

A
  • Periorbital oedema and bruising
  • Bruising behind the ears
  • CSF leaking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is a basilar fracture?

A

Base of skull fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is contusion?

A

Bruising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are complications of head trauma?

A
  • Subdural hematoma
  • Intracerebral hematoma
  • Epidural hematoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is a subdural hematoma?

A

Bleeding between the dura mater and arachoid layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is a intracerebral hematoma?

A

Bleeding within the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is a epidural hematoma?

A

Neurological emergency as associated with arterial bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are nursing interventions during the acute phase (head injury/increased ICP)?

A
  • Maintaining respiratory function
  • Maintaining fluid and electrolyte balance
  • Monitoring ICP
  • Body position
  • Protection from injury
  • Psychological consideration
  • Care of the family/ significant other
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Why monitor respiratory function in the acute phase?

A

Injury stops brain regulating breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Why monitor fluid and electrolyte balance in the acute phase?

A

Injury causes excessive loss of fluids in form of urine causing abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Why monitor ICP in the acute phase?

A

Monitor through observations to ensure pressure does not increase

56
Q

Why monitor position in the acute phase?

A
  • Ensure good blood flow to the brain

- Prevent neck injury

57
Q

Why protect from injury in the acute phase?

A
  • Prevent pressure injury
  • Eye care
  • Oral care
  • Prevent bruising
  • Preventing excessive noise and light
58
Q

What are psychological considerations to have in the acute phase?

A

To reorientate the patient and keep them calm

59
Q

What care should you provide to family and significant others in the acute phase?

A
  • To give them a realistic outlook on what could happen
  • Keep the patient calm
  • Reduce fear
60
Q

What is brain stem death?

A

When there is irreversible damage to the brain stem such that it can no longer maintain independent respiratory and cardiovascular function

61
Q

What are criteria for brain stem death?

A
  • 2 doctors diagnose brain stem death
  • Test are performed twice by different doctors
  • The test firstly elicit the function of the cranial nerves through stimulation of cortical reflex, gag reflex etc
62
Q

What results confirm brain stem death?

A
  • No response to pain
  • The pupils are fixed and dilated, not responding to sharp changes in the intensity of light
  • Oculocephalic reflex (dolls eyes)
  • There is no corneal reflex
  • There is no vestibulor-ocular reflexes
  • There is no motor response
  • There is no gag or cough reflex
  • There is no respiratory effort, despite allowing the PC02 to rise above the threshold for stimulus of respiration
63
Q

What does ecchymosis mean?

A

Bruising

64
Q

What is diabetes insipidus?

A
  • Large amounts of dilute urine and increased thirst

- When the body can’t regulate how it handles fluids

65
Q

What is a trauma system and process?

A

An assembly of health care processes intended to improve survival among injured patients by reducing the time interval between injury and definitive treatment, and by assuring that appropriate resources and personnel are immediately available when a patient presents to a hospital

66
Q

What are the ATS categories?

A
  • ATS 1
  • ATS 2
  • ATS 3
  • ATS 4
  • ATS 5
67
Q

What is ATS 1?

A
  • Max waiting time: Immediate

- Performance indicator threshold: 100%

68
Q

What is ATS 2?

A
  • Max waiting time: 10 min

- Performance indicator threshold: 80%

69
Q

What is ATS 3?

A
  • Max waiting time: 30 min

- Performance indicator threshold: 75%

70
Q

What is ATS 4?

A
  • Max waiting time: 60 min

- Performance indicator threshold: 70%

71
Q

What is ATS 5?

A
  • Max waiting time: 120 min

- Performance indicator threshold: 70%

72
Q

What part of ABCDEFGHI is primary?

A

ABCDE

73
Q

What part of ABCDEFGHI is secondary?

A

FGHI

74
Q

What do you do for airway?

A
  • Airway with cervical spine immobilisation

- Avoidance of hyperextension of the neck. Cervical spine injury should always be suspected

75
Q

What are some life threatening airway problems?

A
  • Airway obstruction (complete or partial)

- Inhalation injury

76
Q

What are signs of airway obstruction?

A
  • Dyspnea, laboured respiration’s
  • Decreased or no air movement
  • Cyanosis
  • Presence of foreign body in airway
  • Trauma to face or neck
77
Q

What are signs of inhalation injury?

A
  • History of enclosed space fire, unconsciousness or exposure to heavy smoke
  • Dyspnea
  • Wheezing, rhonchi, crackles
  • Hoarseness
  • Singed facial or nasal hairs
  • Carbonaceous sputum
  • Burns to face or neck
78
Q

What do you do for breathing?

A

Every trauma patient will require supplemental oxygen

79
Q

What can affect breathing?

A

Alterations due to fractured ribs, pneumothorax, penetrating injury, allergic reactions, PE, asthma attacks, decreased LOC

80
Q

What are some life threatening breathing problems?

A
  • Tension pneumothorax, pneumothorax, or hemothorax
  • Sucking chest wound
  • Failing chest
81
Q

What to do for circulation?

A
  • Check femoral or carotid pulse
  • IV’s are inserted into large veins for aggressive fluid resuscitation
  • Direct pressure to obvious bleeding sites
  • Blood should be cross-matched
  • Blood samples - U&E’s, FBC, Coag, BAL
  • Monitoring for arrthymias
82
Q

What does an effective circulatory system include?

A
  • Heart
  • Intact blood vessels
  • Adequate blood volume
83
Q

What are life threatening circulatory problems?

A
  • External hemorrhage
  • Obvious bleeding site
  • Shock
84
Q

What are signs of shock?

A
  • Tachycardia
  • Weak
  • Thready pulses
  • Cool pale, clammy skin
  • Tachypnea
  • Altered mental status
  • Delayed capillary refill
  • Oliguria or anuria
85
Q

What to do for disability?

A
  • Brief neurological examination
  • AVPU
  • GCS
  • LOC and pupil size and reactivity to light
86
Q

What to do for exposure/environmental control?

A
  • All clothing removed

- Limit heat loss/cooling measures

87
Q

What to do for F?

A
  • Full set of vital signs
  • Further investigations
  • Facilitate family presence
    Also: Cardiac monitor, ECG, CXR, NG tube, laboratory studies
88
Q

What to do for G?

A

Give comfort measures:

  • Verbal reassurance
  • Touch
  • Pain management
89
Q

What to do for H?

A
  • History

- Head to toe assessment

90
Q

What to do for I?

A

Inspect the back

91
Q

What is the history and head to toe assessment?

A

History:
- Length of time since accident
- Accident type, location and patient position in accident
- Description of accident
- Allergies, Medications, PHx, Last meal, Events leading to accident (AMPLE)
Special cases:
Crime (domestic violence, child abuse, self-harm, attempted murder)
Head to Toe Assessment:
- All areas for cuts, bruises, breaks, internal injuries

92
Q

What is AMPLE?

A
  • Allergies
  • Medications
  • PHx
  • Last meal
  • Events leading to accident
93
Q

What are mechanisms of injury for chest trauma?

A
  • Blunt

- Penetrating

94
Q

What are thoracic emergencies for chest trauma?

A
  • Pneumothorax
  • Haemothorax
  • Tension pneumothorax
  • Flail chest
  • Cardiac tamponade
95
Q

What is an open pneumothorax?

A

Air can enter the pleural space through an opening in the chest wall

96
Q

What is a flail chest?

A

Number of ribs break and are not connected to chest cage

97
Q

What is a tension pneumothorax?

A

Rapid accumulation of air in the pleural space causing severe inter-pleural pressure, resulting in pressure in the cavity, great pressure on the heart and great vessels, eventually stopping the heart from breathing

98
Q

What is a hemothorax?

A

Accumulation of blood within the pleural cavity

99
Q

What is cardiac tamponade?

A

Increased pressure on the heart which can prevent it from beating

100
Q

What are clinical manifestations of pneumothorax?

A 
Small: 
- Tachycardia 
- Dyspnoea
Large: 
- Respiratory distress (rapid shallow respirations, dyspnoea, air hunger)
- Chest pain
- Cough
- Minimal or no breath sounds
- Hyperresonance 
- CVS collapse
101
Q

Why use a chest drain?

A
  • To remove air or fluid

- Allows lung to reexpand

102
Q

What are three compartments of a chest drain?

A
  • Water seal chamber
  • Suction control chamber
  • Collection chamber
103
Q

What should the nurse assess for a chest drain?

A
  • Instruct patient to deep breath and cough
  • Change position
  • Observe and report unusual respiratory signs
  • Observe, S,D,B in tube
  • Maintain H20 seal
104
Q

What should the nurse document for a chest drain?

A
  • Chest tube size and suction pressure
  • Character of drainage (amount, colour, consistency)
  • Patient tolerance of tube
  • Vital signs
105
Q

How to maintain pressure in chest drain?

A
  • Keep bottles below level of chest

- Maintain suction control

106
Q

What is S, D, B in a chest drain?

A
  • Swinging (movement of fluid with breathing)
  • Draining
  • Bubbling (air coming out of tube)
107
Q

How to manage a patient with chest drain?

A
  • Ongoing assessment (ABCD)
  • Pain management
  • Education
  • Hydration
  • Nutrition
  • Position/mobilisation
  • Multidisciplinary involvement
  • Psychological needs
108
Q

What does the water seal chamber do?

A
  • Acts as a one way valve

- Seals off chest wall preventing air from entering

109
Q

What does the suction control chamber do?

A

Controls the amount of suction imposed on the patient

110
Q

What does the collection chamber do?

A

Measure drainage from the chest cavity

111
Q

What is a fracture?

A

Disruption or break in continuity of the structures of the bone

112
Q

What can fracture occur from?

A
  • Traumatic injuries

- Secondary to disease process

113
Q

How is a fracture described?

A
  • Type
  • Communication with/without environment
  • Location in bone
114
Q

What are the different types of fractures?

A
  • Simple
  • Compound
  • Comminuted
  • Greenstick
  • Oblique
  • Spiral
  • Impacted
  • Transverse
  • Compression
  • Avulsion
  • Depressed
115
Q

What is a simple fracture?

A

Fracture straight through bone

116
Q

What is a compound fracture?

A

Fracture that communicates with environment

117
Q

What is a comminuted fracture?

A

Fracture that has lots of fragments and parts

118
Q

What is a greenstick fracture?

A

When a fracture does not break across the whole bone (common in children)

119
Q

What is an oblique fracture?

A

Fracture that goes up the bone

120
Q

What is a spiral fracture?

A

Fracture that spirals around the bone

121
Q

What is an impacted fracture?

A

Fracture from landing on hard surface whereby bone lands on another

122
Q

What is a transverse fracture?

A

Fracture that goes straight through bone

123
Q

What is a compression fracture?

A

Fracture in the spine

124
Q

What is an avulsion fracture?

A

Fracture occurring form pulling of ligament on the bone

125
Q

What is a depressed fracture?

A

A depression in the skull

126
Q

What are clinical manifestations of fractures?

A
  • Oedema and swelling
  • Pain and tenderness
  • Muscle spasm
  • Deformity
  • Discolouration of skin from blood in subcutaneous tissue (Ecchymosis)
  • Loss of function
  • Crepitation (grating or crunching of bony fragments together)
  • Shortening of extremity
127
Q

What is collaborative care for a fracture?

A
  • Anatomical realignment of bone fragments (reduction) (Open or Closed Reduction)
  • Immobilisation to maintain realignment (Internal or External fixation)
  • Restoration of normal or near normal function
128
Q

What is open reduction with external fixation?

A

With external fixation, pins are inserted through the skin into the bone and held in place by an external frame. The usual indications are open fractures such as a tibia fracture which requires dressings or attention to a wound or flap

129
Q

What is the technique of nailing for tibial fractures?

A
  • Internal fixation

- Open reduction

130
Q

What is the nursing assessment for fractures?

A 
Subjective data
Objective data
- General appearance
- Integumentary
- Cardiovascular
- Neurovascular
- Musculoskeletal
131
Q

What is the plan of care of a patient with a fracture?

A
  • Risk for peripheral neurovascular dysfunction
  • Acute pain
  • Risk for infection
  • Risk for impaired skin integrity
  • Impaired physical mobility
  • Self-care deficit
  • Knowledge deficit
  • Pre and post operative management
132
Q

What do to for a neurovascular assessment?

A
  • Looking for nerve or vascular damage
  • Causes (original trauma, constrictive cast or dressing, poor positioning and physiologic response to injury)
  • Peripheral vascular and neurological assessment
  • The 5 P’s
133
Q

What are the 5 P’s?

A
  • Pain
  • Pallor
  • Pulse
  • Paralysis
  • Parasthesia
134
Q

What are the general principles of traction?

A
  • Maintain the established line of pull
  • Prevent friction on the skin
  • Maintain countertraction
  • Maintain continuous traction unless ordered otherwise
  • Maintain correct body alignment
135
Q

What are complications of fractures?

A
  • Infection
  • Compartment syndrome
  • Venous thrombosis
  • Fat embolism syndrome

168.362 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions