Term
| Drug classes used for Excessive movemnt, sedation or with short-acting paralytics and pain control. (3) |
|
Definition
Sedatives
Barbiturates
Hypnotics |
|
|
Term
| What do short-acting barbiturates c hypnotics & analgesics/lidocaine do? |
|
Definition
|
|
Term
| 10-15% of ICP patients are _____ to usual care. |
|
Definition
|
|
Term
| This drug class is used for refractory ICP. |
|
Definition
| High dose-barbiturates eg pentobarital |
|
|
Term
| Actions of barbiturates for refractory ICP. |
|
Definition
Induces pentobarbital coma
Improves vasomotor tone
Supresses metabolism |
|
|
Term
| Complication of barbiturate use. |
|
Definition
| Myocardial suppression = decreased CO & HoTN |
|
|
Term
| Rx of myocardial suppression in barbiturate use. (4 classes) |
|
Definition
Crystalloids
Colloids
Inotropes
Vasoactive drugs |
|
|
Term
| What can you monitor to judge pentobarbital dosing? |
|
Definition
|
|
Term
| Two meds to induce barbiturate coma. |
|
Definition
|
|
Term
| Why are barbiturate comas induced? (5) |
|
Definition
Tx uncontrolled ICP
Suppress cerebral metabolic activity
Dec. cerebral O2 needs
Blunt effects of noxious stimuli
More tolerant of position changes |
|
|
Term
| These are used to prevent vomiting & aspiration or to feed in barb coma. |
|
Definition
|
|
Term
| This is tech to judge level of coma. |
|
Definition
|
|
Term
| Two parameters to maintain for ICP/hemodynamics. |
|
Definition
|
|
Term
| Rx used to reduce BP with ICP issues. |
|
Definition
|
|
Term
| This medication is used to maintain serum osmolarity <310 mOsm/KG. Results occur in about 20 min. |
|
Definition
|
|
Term
| What do you need to keep in mind when giving Mannitol 20%? |
|
Definition
| Keep hydrated to prevent renal failure |
|
|
Term
| Use ____ to pull fluid into vascular system. |
|
Definition
|
|
Term
| Other diuretic to use with ICP |
|
Definition
|
|
Term
| This drug class is not effective with acute head injury. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What do you need to document with cSF drainage? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Why do you drain against a pressure of 15-20 cm of water when draining CSF? |
|
Definition
| Prevent collapsing of cerebral ventricles |
|
|
Term
| With fluid replacement in ICP maintain what fluid status to maintain CPP. |
|
Definition
| Euvolemic or slighlty hypervolemic |
|
|
Term
|
Definition
Monitor frequent neuro checks
Watch for trends in readings |
|
|
Term
| Intubate with GCS of __ or less. |
|
Definition
|
|
Term
| What may you need when intubating pt GCS <8 to intubate? |
|
Definition
| Short acting paralytic & sedative |
|
|
Term
| Maintain what precautions with airway mgmt of IICP ventilated pt? |
|
Definition
|
|
Term
| If IICP pt has adequate airway use what for O2? |
|
Definition
|
|
Term
| With IICP pts avoid _________ unless there are signs of cerebral herniation. |
|
Definition
|
|
Term
| Method to keep pt in neutral position. |
|
Definition
|
|
Term
| Method to prevent IICP pt from doing valsalva. |
|
Definition
|
|
Term
|
Definition
Head neutral
HOB 15-30 or reverese Trendelenberg
(Use position that promotes lowest ICP) |
|
|
Term
| What should you base your nursing cares on with IICP pt? |
|
Definition
| Monitor ICP & stop when pressure increases. |
|
|
Term
| For each degree above normal there is a __-__% increase in BMR. |
|
Definition
|
|
Term
IICP Pt:
Limit sxn to __s and __passes per time.
Hyperoxygenate with 100% pre & post. |
|
Definition
|
|
Term
| What do you need to assess for when ET tube is removed from IICP pt? |
|
Definition
|
|
Term
| What fluid & electrolytes do you need to monitor c IICP pt? |
|
Definition
UO
Glucose
Electrolyte levels |
|
|
Term
No sweating, shivering or variation in temp.
May get as high as 41 C or higher. |
|
Definition
|
|
Term
| Shivering prevention c central fever. |
|
Definition
| Wrap extremities in towels &/or use thorazine. |
|
|
Term
| Positioning to decrease spasticity. |
|
Definition
| Flex thighs & rotate trunk |
|
|
Term
| Move extremities of IICP pt how? |
|
Definition
|
|
Term
| Turn head towards side exercised if what? |
|
Definition
|
|
Term
| For spasms of muscles or if hands are clenched. Relaxes muscle contractions in hands by putting pressure on muscle insertions. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What do you want to do with IICP pt r/t GU? |
|
Definition
| DC foley asap, intermittent cath q 4-8 hrs. |
|
|
Term
| Shift of brain tissue through an opening at the base of the skull from an area of high pressure to an area of low pressure. |
|
Definition
|
|
Term
| Causes of brainstem herniation |
|
Definition
Rapid increase of a hematoma, tumor or cerebral edema.
Inc ICP beyond compensatory potentials. |
|
|
Term
| Lateral & downward movement of temporal lobe. |
|
Definition
|
|
Term
| Pupil changes in uncal herniation |
|
Definition
| Unilateral dilating pupil c change in LOC. |
|
|
Term
| Downward movement of cerebrum & diencephalon to brainstem. |
|
Definition
|
|
Term
| Change in LOC is 1st subtle change in this kind of herniation |
|
Definition
|
|
Term
| Downward displacement of brainstem through foramen magnum. |
|
Definition
| Infratentorial herniation |
|
|
Term
| 2 types of supratentorial herniation |
|
Definition
|
|
Term
| Why did we not worry about ethical considerations with brain death prior to 1968. |
|
Definition
|
|
Term
| 1988 ANA states that the nurse has the duty to what? |
|
Definition
|
|
Term
| Brain death test where vent is withdrawn and wait 10 min to see if pt breathes. |
|
Definition
|
|
Term
|
Definition
Hereditary
Cranial irradiation
Chemical exposure |
|
|
Term
| Brain tumors highest incidence demographics. |
|
Definition
|
|
Term
| Fastest grown and most malignant brain tumor |
|
Definition
| Glioblastoma multiforma grade III or IV or astrocytoma |
|
|
Term
| First Sx Glioblastoma multiforma |
|
Definition
|
|
Term
| Usually progression of disease for Glioblastoma multiforma. |
|
Definition
| Usually death, quickly. Some can live 8-9 yrs |
|
|
Term
| Slow growing, usually benign brain tumor. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Where do brain tumors commonly metastasize to? |
|
Definition
|
|
Term
| Judgement & personality lobe |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Psychomotor seizures lobe affected |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Coordination & equilibrium lobe |
|
Definition
|
|
Term
| This type of tumor has endocrine dysfunction, visual deficits & HA. |
|
Definition
|
|
Term
| Most common clinical presentation brain tumors. |
|
Definition
Changes in LOC, HA (worse in AM)
Seizures, Vomiting |
|
|
Term
|
Definition
|
|
Term
|
Definition
CT/MRI w/ or w/o dye
EEG
Endocrine studies if pituitary suspected |
|
|
Term
| If the chemo used for a brain tumor does not cross BBB how do you delivery it? |
|
Definition
| Via Ommaya reservoir (under scalp, straight into ventricles) |
|
|
Term
| Tx of choice for inoperable tumors or tumors not completely resected |
|
Definition
|
|
Term
| Surgical opening into cranial cavity. Use a series of burr holes. |
|
Definition
|
|
Term
| Deformed skull fix/bone flap removed surgery |
|
Definition
|
|
Term
| removal of bone flap (can store in lab or abdomen) |
|
Definition
|
|
Term
This type of tumor Tx technique includes:
Use of skull frame
Locate tumor by various computerized measurements
Use laser beam for deep tumors (less damage)
Biopsy tumor |
|
Definition
|
|
Term
This type of Tx includes:
Radiation to precise area of brain
Heavily shielded helmet
One Tx is all pt can take for life. |
|
Definition
| Gamme knife (not actual knife) |
|
|
Term
| HOB/monitoring post cranial surgery? |
|
Definition
30 deg (to inc venous drainage)
VS
Neuro checks
Monitor ICP |
|
|
Term
| Keep ____ between 32-35 mm HG to decrease cerebral vasodilation. (ICP) |
|
Definition
|
|
Term
|
Definition
Osmotic diuretics (mannitol)
Glucocorticoids |
|
|
Term
| Why are glucocorticoids Rxd post cranial surgery |
|
Definition
|
|
Term
| CSF drainage system (Left on for 24-48 hrs) |
|
Definition
|
|
Term
| Drip chamber of ventriculostomy should be __-__ cm above what? |
|
Definition
15-20 H20;
Foramen of Monroe |
|
|
Term
|
Definition
|
|
Term
| How do you monitor for CSF drainage? |
|
Definition
| Check for glucose or halo on dressing. If pt is swallowing a lot. May come out of ears, nose or throat. |
|
|
Term
| Check pH of gastric content & Tx with H2 antagonists or antacids for this issue. |
|
Definition
|
|
Term
| Why is CSF drainage so serious? |
|
Definition
| Bacterial infection possibility |
|
|
Term
| Why is CSF drainage so serious? |
|
Definition
| Bacterial infection possibility |
|
|
Term
| Endocrine problem with cranial surgeris |
|
Definition
|
|
Term
| What must you not to in order to prevent contamination of area leaking CSF? |
|
Definition
Do Not:
Suction nose or use nasal packing.
No fingers in nose or ears |
|
|
Term
| What must you do to prevent CSF contamination? |
|
Definition
| Dressing under nose. Dressing under ear and turn to side of leak. |
|
|
Term
| positive when the leg is bent at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance). |
|
Definition
|
|
Term
| The appearance of involuntary lifting of the legs in meningeal irritation when lifting a patient's head off the examining couch, with the patient lying supine. |
|
Definition
|
|
Term
| Your post craniotomy pt. is pulling at his lines, what do you? |
|
Definition
| Put mits on. Restraining inc ICP. |
|
|
Term
| To dec. risk of IICP avoid neck ___ or ________. |
|
Definition
|
|
Term
| If large bone flap or mass is removed place patient on ___________ side to decrease venous congestion of operated site. |
|
Definition
|
|
Term
| What do you base your care of potential IICP pt on? |
|
Definition
| ICP.. if goes up stop what you are doing. |
|
|
Term
| What does IICP pt need to avoid? |
|
Definition
| Coughing,sneezing, straining to have bowel movement |
|
|
Term
| You IICP pt has a change of LOC, what technical problem could be happening? |
|
Definition
|
|
Term
| New onset of seizures post cranial surgery could indicate what? |
|
Definition
|
|
Term
| Fluid endocrine problems pt could develop. |
|
Definition
|
|
Term
| Most important aspect neuro assessment. |
|
Definition
|
|
Term
| Oval pupils are indicative of what? |
|
Definition
|
|
Term
|
Definition
| Irreg HR can progress to bradycardia |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Lack of temp regulation r/t hypothalamus damage |
|
|
Term
| Most sensitive indicator cerebral functioning |
|
Definition
|
|
Term
| What should you try to find out about pt asap upon admission? |
|
Definition
| Who they are & who to call b/c LOC maychange |
|
|
Term
|
Definition
Eye Opening
Verbal Response
Motor Response |
|
|
Term
|
Definition
|
|
Term
| Score of __ intubate, Score of __ coma. |
|
Definition
|
|
Term
| Accepted/recommended noxious stimulation |
|
Definition
|
|
Term
|
Definition
| Coma; not brain stem function |
|
|
Term
| Your patient has a head injury from a car wreck. He was driving under the influence, what is not applicable? |
|
Definition
| GCS - not for altered sensorium |
|
|
Term
| Pt tries to remove noxious stimulus |
|
Definition
|
|
Term
| Who is GCS limited for eval? |
|
Definition
Intubated/sedated
Swollen eyes
Wired jaws |
|
|
Term
| GCS 3; flexion & internal rotation at wrist, shoulders & LEs internally rotated. |
|
Definition
|
|
Term
| Part of brain damaged in decorticate posture. |
|
Definition
| Diencephalon (thalamus & hypothalamus) |
|
|
Term
| GCS 2; External & internal rotation of upper and LEs w/head extended. |
|
Definition
|
|
Term
| Part of brain damages in decerebrate |
|
Definition
|
|
Term
| Pinpoint, nonreactive pupils |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Both eyes in same position in eye socket |
|
Definition
|
|
Term
| Eyes in different position horizontally |
|
Definition
|
|
Term
| Eyes in different position vertically |
|
Definition
|
|
Term
| When move head to right, eyes to left. |
|
Definition
| Present oculocephalic reflex (doll's eyes) |
|
|
Term
| Abnormal Oculocephalic reflex indicates _______ injury; absent indicates significant brainstem injury. |
|
Definition
|
|
Term
| What must you verify before checking oculocephalic reflex? |
|
Definition
| Absence of cervical injury |
|
|
Term
| Used to test brainstm function; supine w/head flexed 30 degrees; 20-30 mL ice water squirted into ear canal. |
|
Definition
| Oculovestibular reflex (Iced water calorics) |
|
|
Term
| What do you need for iced water calorics? |
|
Definition
|
|
Term
| Conjugate movement toward stimulus |
|
Definition
| Normal oculovestibular reflex (brainstem intact) |
|
|
Term
| Disconjugate movement towards stimulus or absent movement in oculovestibular reflex indicative of what? |
|
Definition
| Abnormal/absent oculovestibular reflex |
|
|
Term
| This protective reflex requires cranial nerve V & VII |
|
Definition
|
|
Term
| These protective reflexes require cranial nerves V, VII, IX & X |
|
Definition
|
|
Term
| Aspects of Cushing's Triad (IICP) |
|
Definition
Systolic HTN (widening pulse pressure)
Bradycardia
Irregular respirations |
|
|
Term
| This test reflects integrity of all brain functions. |
|
Definition
|
|
Term
| This test checks sensory & motor functioning of all 12 cranial nerves. |
|
Definition
|
|
Term
| Indicates damage or injury to specific nerve roots. |
|
Definition
|
|
Term
| Tests integrity of somatic system |
|
Definition
| Evaluation of motor function |
|
|
Term
| This test visualizes calcifications, tumors, intracrainial shifts, herniation, brain edema, cysts & bleeds. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| This test shows greater detail; visualizes brainstem injuries, hemorrhage, infarcts & non-hemorrhagic lesions. |
|
Definition
|
|
Term
| What do you need to check before MRI |
|
Definition
|
|
Term
| Detects brain function rather than anatomy; detects epilepsy, dementia, CVA, trauma & mental illness. Can see brain light up differently for different senset. |
|
Definition
| Positron Emission Tomography (PET) |
|
|
Term
| Definitive test for vascular problems; can use with angioplasty or coiling of cerebral aneurysm. |
|
Definition
|
|
Term
| Visualize spinal column for herniated discs, tumors, congenital problems. |
|
Definition
|
|
Term
| For this dye type in myelogram head up 30-45 degrees. |
|
Definition
|
|
Term
| For this type of myelogram dye lie flat 6-24 hrs; assess for HA & spinal leak. |
|
Definition
|
|
Term
| Records brain waves & checks for abnormal electrical activity. |
|
Definition
|
|
Term
| Detects muscle activity by electrical stimulation. Small needles placed into certain muscles that are supplied by each nerve root. |
|
Definition
|
|
Term
| Indicates inc or dec blood flow during cerebral vasospasm to determine brain death. |
|
Definition
| Cerebral blood flow studies (CBFS/ Brain scanning) |
|
|
Term
| Used to detect carotid artery occlusion or CVA. |
|
Definition
| Transcranial doppler ultrasound |
|
|
Term
| Used to measure CSF & send specimen to lab. |
|
Definition
|
|
Term
| Puncture @ C1/C2 -- used to measure CSF & send specimen. |
|
Definition
|
|
Term
| ICP provides info about intracranial ________. |
|
Definition
|
|
Term
Head contents -
__% blood
__% CSF
__% Brain tissue. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| The amt of pressure that must be maintained at a correct level so that O2 and glucose get to the brain. |
|
Definition
| Cerebral perfusion pressure (CPP) |
|
|
Term
|
Definition
|
|
Term
| Provides approximate cerebral blood flow (CBF) |
|
Definition
|
|
Term
CPP >__ mm HG ideal.
CPP <__ mm HG too low. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What can cause ICP >100 mm Hg |
|
Definition
|
|
Term
| 20-25 mm Hg ICP pressure; ominous sign |
|
Definition
|
|
Term
| Sustained ICP >60 mm Hg = ______. |
|
Definition
|
|
Term
| Position at level of foramen of monro; HOB >30, fluid can be REMOVED witht his type of ICP monitoring device. |
|
Definition
|
|
Term
| Zeroed at insertion time & transducer located at tip of catheter. No adjustment with movement of head. (ICP monitoring device) |
|
Definition
|
|
Term
| 2 types ICP monitoring devices. |
|
Definition
|
|
Term
Placed in lateral ventricle of head, drains CSF
Must level & re-level w/head movement. |
|
Definition
| Intraventricular catheter (Ventriculostomies) |
|
|
Term
| Tip sits in subarachnoid space, unable to drain CSF, must level c movement of head. |
|
Definition
| Subarachnoid bolt or screw |
|
|
Term
| No adjustment needed c head movement, easiest to place, unable to drain fluid. |
|
Definition
|
|
Term
| Catheter placed into brain tissue, can't drain. |
|
Definition
| Intraparenchymal catheter |
|
|
Term
| Accurate and reliable catheter that can be placed epidural, subdural or parenchymal. Can't drain. |
|
Definition
|
|
Term
| Combines fluid-filled intraventricular catheter drainage system with fiberoptic transducer. Wave forms in relationship to pt's heart beat. Can't drain. |
|
Definition
| Newest! (no name given in notes, woohoo) |
|
|
Term
| Corresponds to each heart beat (p1, p2, p3) |
|
Definition
|
|
Term
|
Definition
| IICP & dec cerebral compliance |
|
|
Term
| When does plateau wave A occur? |
|
Definition
| Sudden, sustained rise in ICP |
|
|
Term
| How long does A wave last? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Can RNs irrigate CSF catheter? |
|
Definition
|
|
Term
| Common between 15-25 yo w/ peaks in infants and elders. M:F 2:1 |
|
Definition
|
|
Term
| Moving head hits stationary object. |
|
Definition
| Acceleration/Deceleration |
|
|
Term
| Movement of brain back & forth inside the skull |
|
Definition
|
|
Term
|
Definition
|
|
Term
Presents with racoon eyes or panda eyes
Blood or CSF from nose |
|
Definition
| Anterior basilar skull fracture |
|
|
Term
Bruising over mastoid bone
Blood & CSF from ears |
|
Definition
|
|
Term
| Bruising over mastoid bone |
|
Definition
|
|
Term
| _________ cause tearing of brain tissue; _______ cause bruising of brain tissue. |
|
Definition
|
|
Term
| Lucid then deteriorate rapidly head injury. |
|
Definition
|
|
Term
| Epidural bleed is between ____ and ____. |
|
Definition
|
|
Term
| 2nd in mortality & morbidity head injury. Happens a lot in older people. Develops over 24-72 hrs and is subacute 72 hrs - 2 wks. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Bleed into parenchyma of brain; falls, MVCs, anticoags |
|
Definition
|
|
Term
| Caused by GSW, knives, arrows etc. |
|
Definition
| Penetrating injury to head |
|
|
Term
| Diffuse injury with amnesia <6 hrs; tearing of brain tissue & nerve cells, mortality 60-70% |
|
Definition
|
|
Term
| Located between arachnoid & pia mater; cerebral vasospasms possible 3-7 days. |
|
Definition
| Traumatic subarachnoid head injury |
|
|
Term
| Tx vasospasms with traumatic subarachnoid. |
|
Definition
| Minodipine (Ca++ channel blocker) |
|
|
Term
| May not be recognized or symptomatic, ppl may think lazy. |
|
Definition
|
|
Term
| Mild, HA, difficulty thinking, can last wks to months. |
|
Definition
|
|
Term
Related to biophysical & biochemical changes to cerebral perfusion.
Leads to neuronal dysfunction. |
|
Definition
|
|
Term
| With this brain injury all body functions can be affected. |
|
Definition
|
|
Term
| Possible system impact ABI |
|
Definition
Inc. glucocorticoids & mineral corticoids.
Release ADH/no ADH (SIADH/DI)
Inc. catecholamine release (HTN & dysrhythmias)
Hyperglycemia
Occlusions/DIC/anemia
Pneumonia/secondary infection
Dec. GI motility & inc. gastric acid production (Curling's ulcer) |
|
|
Term
| Crescendo to decrescendo to apnea(then repeats) respirations (ABI) |
|
Definition
|
|
Term
| Very rapid shallow breathing, indicates involvement of tentorial herniation, may retain CO2 |
|
Definition
| Central neurogenic hyperventilation |
|
|
Term
| We only hyperventilate a patient when what is happening? |
|
Definition
| Brainstem herniation - stopgap measure |
|
|
Term
| Imbalance central neurogenic hyperventilation leads to |
|
Definition
| Resp. acidosis (CO2 vasodilates, inc. blood, inc. ICP) |
|
|
Term
| Prolonged inspiration withtentorial herniation. |
|
Definition
|
|
Term
| Patternless breathing with long periods of apnea; herniation at foramen magnum. |
|
Definition
|
|
Term
| Mesures both arousal & awareness |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| No ____ tubes in head injury. |
|
Definition
|
|
Term
| Blind in outside or inside visual fields. |
|
Definition
|
|
Term
| Blind in R or L side of each eye |
|
Definition
|
|
Term
| What must you use when delivering mannitol? |
|
Definition
|
|
Term
| ICP that does not respond to Tx. |
|
Definition
|
|
Term
| Rx to decrease workload of the brain. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What should CSF look like? |
|
Definition
| Clear or yellowish, no blood or cloudiness (infection) |
|
|
Term
| Common causes of this are MVCs, diving, falls, contact sports and GSWs. Commonly 15-20 yo males; drugs/ETOH involved. |
|
Definition
|
|
Term
| Most common mechanism of injury in cervical injuries. Ligament that connects spinous processes tears. Most unstable. |
|
Definition
|
|
Term
| Whiplash injury; most common SCI tear - anterior ligament & stretches cord. |
|
Definition
|
|
Term
| Vertical compression injury |
|
Definition
|
|
Term
|
Definition
Hyperflexion
Hyperextension
Penetrating Injury
Rotation
Axial loading |
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Term
| Most at risk level of injury |
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Definition
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Term
| This type of SCI falls on rear & sacrum pushes up |
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Definition
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Term
| Total loss of motor or sensory function below level of injury |
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Definition
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Term
| Result of mechanical forces that disrupt neuro tissue and/or its vascular supply. |
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Definition
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Term
| Occurs at moment of impact |
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Definition
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Term
Complex biochemical proceses affecting cellular function.
Spinal cord ischemia & loss of neuro function. |
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Definition
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Term
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Definition
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Term
| Transection or lesion of 1/2 spinal cord; rare; usually penetrating trauma. Mixed loss of motor & sensory function. |
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Definition
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Term
Brown-Sequard syndrome:
Loss of ____ function on same side of injury & loss of _____ and ____ on opposite side of injury. |
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Definition
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Term
| Associated with cervical hyperextension-hyperflexion & hematoma formations in center of cord. Recovery depends on extent of hemorrhage and ability to release pressure placed on spine. |
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Definition
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Term
Central cord syndrome:
Motor & sensory deficit more pronounced in ___ extremities than ___ extremities. |
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Definition
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Term
Loss of motor function & loss of sensations of pain & temp below level of injury. Below level of injury position sense & sensations of pressure & vibration remain.
Compression of anterior spinal cord due to flexion injury. |
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Definition
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Term
| Associated with cervical hyperextension injury c damage to posterior cord. Loss of position sense, pressure & vibration below level of injury. May or maynot be able to ambulate due to loss of position sense. |
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Definition
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Term
| What is intact in posterior cord syndrome? |
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Definition
| Motor function & sensation of pain |
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Term
| Condition that can occur immediately or within several hours after traumatic injury to spinal cord. No Tx, duration variable (days towks) |
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Definition
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Term
| Complete loss of all muscle tone & normal reflex below level of injuyr; body loses its ability to regulate temp (poikilothermia) |
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Definition
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Term
| lose ability to vasodilate/constrict. |
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Definition
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Term
| How do youknow spinal shock has resolved? |
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Definition
| DTRs below level of injury return & skel muscles become spastic (spasticity can be long or shor term) |
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Term
| Form of shock associates with cervical and upper thoracic injuries. Results from injury to descending sympathetic pathways in spinal cord to systemic vasculature of heart and peripheral vascular resistnce (loss of vasomotor tone) |
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Definition
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Term
| Neurogenic shock is form of _______ shock. Vasodilation leads to hypervolemia & hypotension. Interruption of SNS leads to bradycardia and decreased CO. |
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Definition
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Term
Life threatening complication that occurs after acute phase (after spinalshock has resolved)
Pts with injury at T6 or above |
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Definition
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Term
| triggers autonomic dysreflexia |
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Definition
Full bladder
pain
Distended bowel
Pressure ulcers
Drastic change of temp
wrinkle in sheet
ejaculation |
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Term
| Trigger produces ______ discharge that causes ______ of the blood vessels (below level of injury) that leads to extreme, rapid ______. |
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Definition
| sypathetic; vasoconstriction; hypertension |
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Term
| Autonomic dysreflexia ____ below level of injury and ______ above level of injury. |
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Definition
| vasoconstriction; vasodilation |
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Term
| Nsg actions autonomic dysreflexia |
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Definition
Immediately raise HOB
Try to find cause |
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Term
| HA, HTN, flushed & sweating above level of injury, pale below injury, pupil dilation |
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Definition
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Term
| Rx autonomic dysreflexia (antihypertensive) |
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Definition
| nifedipine, methyldopa, hydralazine, diazoxide, can use nitropaste at home. |
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Term
| 15% of trauma pts with injury will have _____ _______ injury. |
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Definition
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Term
| What test is done to R/O SCI? |
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Definition
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Term
| ____ may be used as definitive diagnosis of SCI. |
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Definition
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Term
| This Rx SCI prevents posttraumatic spinal cord ischemia, improves energy metabolism, restores extracellular calcium, improves nerve impulse conduction, Reduce edema. |
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Definition
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Term
| Guidelines for methylprednisone with SCI. |
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Definition
Give within 8 hrs of injury
Loading dose weight based delivered over 15 min.
Start infusion and give over next 23 hrs. |
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Term
| When can you not give methylprednisone for SCIs. |
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Definition
After 8 hrs
Open ord injuries |
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Term
| Anterior/posterior ligaments & 1 lamina or spinous process are intact. |
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Definition
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Term
| Ligaments holding spine together torn; cannot maintain normal alignment. |
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Definition
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Term
| Used to realign vertebra and remove any bone fragments, usually seen with unstable fractures. |
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Definition
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Term
| Removal of lamina which allows for decompression and removal of bony fragments. |
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Definition
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Term
| Fusion of 2 to 6 vertebral elements; uses bone parts or chips taken from iliac crest, cadaver or wire. |
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Definition
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Term
| Harrington rods placed on either side of the column to provide stabilization. |
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Definition
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Term
| Used when pt is stable and can be moved. Pins & vest. |
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Definition
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Term
| With any cervical injury watch for ______ on the back of hte head. |
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Definition
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Term
| Usually Txd with immobilization until fractures heal. May use body cast or fiberglass brace. |
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Definition
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Term
| Why do we intubate C1-C5 usually? |
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Definition
| Airway maitenance - edema can develop and not be able to intubate later. |
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Term
| Injuries above TF have no SNS influence, what do their vitals loot like? |
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Definition
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Term
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Definition
IVF & vasopressin for HoTN
Atropine for bradycardia |
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Term
| Common psychological issue for SCIs. |
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Definition
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Term
T1 and > = _____
T2 and < = _____ |
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Definition
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Term
| ____ and lower injuries can transfer selves. |
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Definition
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Term
| A state of hyperthyroidism that can lead to death if not treated. |
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Definition
| Thyrotoxic crisis (Thyroid storm) |
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Term
| What is death from thyrotoxic crisis r/t? |
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Definition
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Term
| Major stressors, systemiv infections, DM out of control, MI, surgery, trauma, levothyroxine are all potential causes of what? |
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Definition
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Term
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Definition
| Tachycardia, HTN, Fever irritable, termors, weakness, heat intolerance, Afib/angina/sob |
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Term
| 2 types of ppl at risk for thyrotoxic crisis. |
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Definition
| UnDxd or inadequately treated hyerthryoidism |
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Term
| Dx tests for thryotoxic crisis |
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Definition
Elevated T3 & T4
Decreased level of TSH |
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Term
| Nsg actions thyrotoxic crisis |
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Definition
Lower BMR - cooling blankets
Tyelenol
Assess neuro & cardiac status
O2
Check blood sugar
IVF
propylthiouracil |
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Term
| What drug do you NOT NOT NOT give during thyrotoxic crisis and why? |
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Definition
| ASA - inc. free thyroid hormone levels |
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Term
| Blocks conversion of T4 to T3 and binds iodine; therfore reduces the amt of circulating thyroid. |
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Definition
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Term
| Block release of thyroid hormones |
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Definition
| Iodide preparations SSKI & NaI |
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Term
| Thyroid suppressants must be given __-__ hrs after anti-thyroid medication is administered. |
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Definition
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Term
| Use _____ for those sensitive to Iodine |
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Definition
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Term
| Steroid that blocks conversion of T4 to T3, given IV. |
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Definition
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Term
| Given to thyrotoxic crisis to decrease demand on the heart, not to Tx thyroid level. |
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Definition
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Term
| If hyperthyroid medication does not work or patient is non compliant what can be given? |
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Definition
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Term
| Given to hyperthyroid to minimize anxiety and promote rest. |
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Definition
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Term
| Removal of part of the thyroid gland. |
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Definition
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Term
| What do you worry about post thyroidectomy |
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Definition
| Effect on parathryoid (Ca++ & PO4-3) |
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Term
| Avg onset 39 yo, women, usually anterior lobe of pituitary and non-malignant. |
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Definition
| Adenomas (Pituitary tumors) |
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Term
| Microadenoma <__cm, macroadenoma >__cm |
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Definition
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Term
| Can lead to hormone imbalances; deficiencies or excesses so can look different in everyone. |
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Definition
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Term
| Hormones in pituitary (8) |
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Definition
ADH
Oxytocin
Prolactin
ACTH
TSH
GH
LH
FSH |
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Term
| Location of pituitary tumor |
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Definition
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Term
| HA, visual disturbances, dec libido, impotence, menstrual irregularities, personality, seizures, dementia, weakness, fatigue, cold sensitive, breast discharge can all be Sx of this disease. |
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Definition
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Term
| What cna brain tumors lead to? |
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Definition
| Displacement & herniation |
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Term
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Definition
Skull XRays
CT/MRI
Angiogram |
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Term
| Rx for prolactin secreting tumors; shrinks prolactic secreting tumors in 1-6 months. |
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Definition
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Term
| Pre-op for surgical Tx of pituitary adenomas (3) |
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Definition
Tx thyroid deficiencies
Pre-op dose hydrocortisone
Nasal antibiotic spay |
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Term
| Surgical tx for macroadenomas |
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Definition
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Term
| surgical tx of microadenomas |
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Definition
| transphenoidal hypophysectomy |
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Term
| freeze tumor with probe via transphenoidal route |
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Definition
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Term
| What do you need to avoid post adenoma surgery? |
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Definition
Anything that inc. ICP
Do not remove nasal packing (impregnated with abx) |
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Term
| Sella tursica is packed with fat from where? |
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Definition
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Term
| 4 things need to monitor carefully post adenectomy |
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Definition
CSF leak
Compromised airway
IICP
dsg on thigh, nose packing & surgical site |
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Term
| Possible hormone issues after adenectomy, how do you tx this? |
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Definition
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Term
| Possible infection r/t adenectomy |
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Definition
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Term
| Oral care post adenectomy |
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Definition
| toothettes, rinse mouth c chlorhexidine |
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Term
| Caused by decrease in production or release of ADH; can be due to several causes eg lesion or injury of hypothalamus or pituitary gland; maybe after neurosurgeries eg transphenoidal hypophysectomies. |
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Definition
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Term
| DI from brain tumors, IC, hemorrhage. Dec. amt of ADH produced. |
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Definition
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Term
| DI r/t meds, elyte disturbances. |
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Definition
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Term
| Compulsive H20 drinking of 5 L or more/day. |
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Definition
| Psychogenic (no toilet/sink access alone) |
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Term
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Definition
| dehydration; polydipsia; polyuria (>300 mL/hr) |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| concentrated & hypernatremic |
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Term
| DI has similar Sx to ____. You can tell the difference b/c DI has no _____ in urine. |
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Definition
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Term
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Definition
Confusion
Irritability
Coma
Seizures |
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Term
DI lab values:
Serum sodium >____.
Urine osmo < ___
Serum osmo >____
SG < ____. |
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Definition
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Term
| Drastic change DI experiences. |
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Definition
| Wt loss (6-7 lbs in 24 hrs) |
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Term
| Way to visualize lesions in neurogenic DI |
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Definition
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Term
| What major complication of DI do you worry about? |
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Definition
| Hypovolemic shock (HR/BP are LATE sign) |
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Term
| DI stable use _____ soln; DI unstable use _______ soln. |
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Definition
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Term
| Why give isotonic to unstable DI pt? |
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Definition
| Keep fluid in vasculature to avoid shock |
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Term
| Hormonal replacement given SQ, IV, IM to DI pts (may cause angina or MI b/c vasoconstricts) |
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Definition
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Term
| ADH replacement can be given intranasally & does not vasoconstrict. Works within 20 min. |
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Definition
| Desmopressin acetate (DDAVP) |
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Term
| Caused by high secretion of ADH. Associated c disease or trauma to posterior pituitary |
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Definition
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Term
| What other pts can you see SIADH in? |
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Definition
| Oat cell lung cancer; chemotherapy recipients |
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Term
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Definition
Sodium < 135
Urine sodium <20 meq/L
Urine hyperosmolarity
Serum hypoosmolarity <275 mOsm
Anasarca
SG > 1.030
Confusion, irritability, seizures, HA (cerebral edema) |
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Term
| Biggest concern with SIADH |
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Definition
Brainswelling
(HA, LOC change, seizures, muscle twitches) |
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Term
| What precautions are SIADH pts on? |
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Definition
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Term
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Definition
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Term
| Fluid restriction causes secretion of ______; therefore kidneys conserve sodium & SIADH corrects self. |
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Definition
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Term
| Rx unsuccessful fluid restriction c Na <115 |
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Definition
| IV 3-5% saline soln; prefer to give in central line b/c burns badly |
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Term
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Definition
| Raise to 120-125 mEqs over 24-48 hrs |
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Term
| What can happen if you raise Na too fast? |
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Definition
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Term
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Definition
Lasix to remove excess fluid c cardiac problems
K+ replacement if needed
Dilantin (control seizures r/t brain swelling)
Demeclocycline (block ADH action and Tx chronic SIADH) |
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Term
| Life threatening emergency seen most often in type 2 diabetics. More common in >60 yo. Mortality rate 50% |
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Definition
| Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) |
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Term
| Provoked by stress response or meds (thiazides, dilantin, cimetidine) |
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Definition
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Term
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Definition
Polyuria
Polydipsia
Hypersomolality (>350 mOsm, may lose 15-20% body fluid)
Ortho HoTN
Hyperglycemia 300-1000
High serum osmo
No ketones present due to small amt insulin
Lethargy
Coma
seizures
hypovolemic shock |
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Term
| Give ___ IV for hypotensive w/sx of shock |
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Definition
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Term
| Give __ for normal Bp intracellular loss (replace 1/2 estimated H20 loss in 12 hrs and remainder over 24) |
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Definition
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Term
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Definition
Flash pulmonary edema
Risk emboli r/t blood viscosity |
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Term
| Add _____ to IV soln when blood glucose drops to 250 with HHNS |
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Definition
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Term
| What does adding dextrose do for HHNS pt? |
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Definition
| Prevents cerebral edema & dropping to hypoglycemic state. |
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Term
| What kind of insulin can you give IV? |
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Definition
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Term
| What is IV insulin bolus dosage based on? |
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Definition
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Term
| HHNS maintain blood sugar __-__ mg/dL |
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Definition
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Term
| 3 elytes need to replaces with HHNS |
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Definition
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Term
| 3 Rx for elyte imbalance in HHNS |
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Definition
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Term
| ____ forces K+ intracellulary so serum K+ will drop. |
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Definition
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Term
| Monitor for ______ with HHNS, can sometimes be mistaken for DKA. |
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Definition
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Term
| Hypomagnesemia can cause a type of Vtach called what? |
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Definition
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Term
| Why would you not want to give an IICP pt with DI a fluid bolus? |
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Definition
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Term
| Inc. in vol of 1 equals dec in vol of 1 or 2 of the others (ICP) |
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Definition
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Term
| Why would you not give ASA to pt with head trauma to control temp? |
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Definition
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