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189 Cards in this Set

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An approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems physical psychosocial and spiritual
Palliative Care
What is the Goal of Palliative Care
To prevent and relieve suffering, To support the best quality of life. Regardless of Age, Stage of disease.
An RN assisting with Palliative Care needs a High knowledge of Pain & Symptom Control, True or False
True
List the four psycho social components of Suffering
Physical, Emotional, Spiritual & Psychosocial
List two things that are ways to provide effective care for a dying individual
Adequate knowledge base & Attitude or Behavior
When a RN is assisting a PT with the dying process does this palliative care RN need to understand Death is a natural part of life? True or False
True this falls under attitude
True or False Transfusions can be a part of Palliative care
True
Ventilation is part of Palliative Care True or False
False Generally not Palliative
Control of Dyspnea is Palliative Care True or False
True
Providing Emotional and Spiritual Support is reflective of Palliative Care True or False
True
Assisting with CPR is an important Palliative Care function True or False
False Generally not Palliative
Controlling Nausea and Vomiting is a function of Palliative Care True or False
True
What is the #1 Problem in having the Necessary conversation
Silence
A Palliative Care RN should always have these two P’s in Mind
Perceptive regarding change & Proactive in communication with family.
List the following challenges in the Final Days
Functional decline in ADLs, Loss of Appetite, Can’t Swallow, Increased Discomfort, Sleeping more, Confusion, Concern for family and friends
A PT has become restless in his final days, what type of medication can the RN give
Benzodiazepine
This type of medication is given to Palliative Care PT with Pain or with Dyspnea….what is
Opioid
A family member asks if the Opioids are contributing to the dying process, the best response by the RN is, A. with excessive opioid dosing we would see pinpoint pupils, B. the patient would code or C. gradual slowing of respiratory rate
A & C
List the three types of breathing patterns most common in the final hours
Cheyne-Stokes, Rapid Shallow, Agonla /Ataxic
Absence of brain stem reflexes is a criteria used to establish brain death True or False
True
Corneal and Cold Calorics is a test to establish what in healthcare
Brain Death
The proper term for Life Support is
Mechanical Ventilation
AND is an acronym for
A Natural Death
True or False A Living Will, Durable Power of Attorney and a Lien Release are Advanced Directives
False on the Living Will & DPOA
Which State in the USA has made Assisted Suicide Legal
Oregon
As a Palliative RN what is most important for the remaining family members
Resources for Support in the Community and Referral Groups.
CT stand for
Computed Tomography
True or False a CT can be done with or without contrast
True
When using Contrast what is the primary function of the RN, r/t patient care
Check for Shellfish/ Iodine Allergy
When assisting with a LP the RN knows the doctor will insert the needle at ________ th lumbar vertebrae into the subarachoind space
3-5th LV
This is contraindicated with ICP, what is
Lumbar Puncture
After a LP how long will the patient have to remain prone
2-3hours
What is the number one reported complication with LP
Headache
The RN is treating a PT for Complication with LP. The RN can administer which of the following Fluid Replacement, Analgesic, Blood Patch
Fluid Replacement, Analgesic Only Dr. must do Blood Patch.
How much of the cardiac output is needed for Brain function ___________%?
15-20%
What percent of the blood glucose is used by the brain ______%
20%
True or False An RN completes a Neuro assessment he has checked the following LOC, Motor, Pupillary Reflexes, VS & I/O
False , everything except I/O, this not a part of Neuro assessment
What is the highest GCS (Glasgow Coma Scale) Score
15
List the important pupillary features of the eye assessment
Size, Shape, Reaction to light, Comparison of one pupil to the other.
Cranial Never V is the
Corneal Reflex
Explain Cold Calorics
small amount of cold water placed in the inner ear canal
What is the reaction that should occur with cold calorics if the PT is in a coma
Both eyes tonically deviate toward the cold water.
What is the reaction that should occur with cold calorics if the PT has a brain injury or death
The eyes should move away from the cold water and slowly back
True or False In motor function symmetry is the most important factor
True
An individual arrives in the ED with sleep awake cycles, arousal but no interaction with environment & no local response to pain. This PT GCS is <3, what is the state Moderate, Severe, Vegetative
Vegetative State Less then 3
PT is in a coma
unconscious state. No meaningful response, no voluntary activity, PT state is Moderate, Severe, Vegetative
If my PT has one pupil that is larger than the other she has ______________/
Anisocoria
__________ posture results from damage to the upper brain stem. In this posture the arms are abducted and extended with the wrist pronated and the fingers flexed. The legs are stiffly extended with plantar flexion of the feet
Decerebrate
Brain’s ability to change the diameter of blood vessels to maintain cerebral blood flow is __________?
Autoregulation
A patient presents with edema and swelling of the optic nerve this is called
Papilledema
What are the three classic signs of Cushing’s Triad
Bradycardia, Hypertension, Bradypnea seen with pressure on the medulla as a result of brain stem herniation
How often should Neuro, LOC & GCS check be completed by the RN
Every Hour
What are some situations related to PT care that increase ICP
Suctioning, Turning, Bathing, Head Flexion, Valsalva Manuever
True or False a DO NOT MOVE PATIENT sign should be posted on the door of the Patients room with an EVD
True
True or False The EVD and Lumbar Drain both have a leveling point of (0) zero?
False The EVD has a leveling point of zero, Lumbar Drain has no leveling reference point.
As an RN if I wish to Drive CPP through manipulation of ICP what can I use
Vasopressors, Fluids, CSF Drain.
What steps/elements can I take or use as the RN to minimize the increase of ICP
Sedation, Opiates, barbiturates, propofol, Osmotic Agents, Ventriculostomy, Positioning, Paralytics
If I use a Sedation/or Paralytic to assisted my PT with increased ICP what mechanized can I used to measure the level of sedation
Train of Four looking for 2-3 impulses
LICOX Catheter measures what two things
Temperature & Oxygen Level
What is the normal range for PbtO2 (brain tissue oxygen)
20-40mm Hg
True or False Hypoxia, Decreased ICP, Decreased Temp & Decreased CPP/MAP all Decreased Brain O2
False Hypoxia, Increased ICP, Increased Temp & Decreased CPP/MAPP drive a decreased in Brain O2
Barbiturates decrease or increase the need for O2 to the brain
Decrease
True or False Hypoxia is bad for the brain
True
List commonly used vasopressors
Dopamine, Norepinephrine, Nesoynephrine, Vasopressin
Intubation occurs when an individual has a GCS of ________
< or = 8
What is the desired temperature for a PT with ICP
Normothermia
True of False Increased PEEP in an ICP PT will Incr. cardiac output, Incr. vent , Incr. ICP.
True
EBP provides results that indicate if early gut feedings are started the risk for __________is decreased
Sepsis
A PT has just come from ED a Dx of Dehydration. You have an order for fluids and an order for vasopressors. When will it be safe for the RN to begin Administration of the vasopressin? ASAP before any other activity or after the PT has received adequate hydration
After the PT has received adequate hydration
Increased Temp & increased metabolic rate also increases _____ _________ consumption
brain oxygen
The PT in Neuro has begun to shiver, the RN knows this is not good for the PT what action can she take
Meds: Acetaminphen, Mag Sulfate, Meperidine, Sedation, Neuromuscular Blockade
A PT presents “Too Wet” with decreased urine output, wt gain, confusion, NA <135, SIADH is the primary root cause. True or False
True
Tx for SIADH is
Restrict Fluids, Pitressin, Diuretics, Serum Osmolarity,
A MICU PT is on the Vent his eyes are partially closed how can the RN prevent injury
Tape eye closed, provide eye drops, provide ointment.
What is needed every 2 hours to prevent VAP
Oral Care
How do RN’s prevent DVT
Heprin Drip or Lovenox Injections
An opening of the skull is
Craniotomy
An excision of a portion of the skull is
Craniectomy
A Repair of a cranial defect using a plastic or metal plate is
Crainoplasty
Circular opening are known as
Burr Holes
Infratentorial Cranial Surgery PT has returned PCAU for recovery what is key related PT positioning? The HOB should be at what degree
The HOB should not be elevated, allow PT to lie flat
This cranial approach is usually used for pituitary surgery what is _________________?
Transphenoidal
Ceberal edema peaks at which timeframe post intracranial surgery 12, 24, 48, 72 hours
24 Hours
A patient with a neurologic disorder is at risk for disuse syndrome due to musculoskeletal inactivity and neuro impairment. Which nursing intervention facilitates function, Repositioning or Keep body in neutral position
Keep Body in Neutral Position
What is Colnus
Colnus occurs when the foot is abruptly dorsiflexed
Which of the following terms refers to difficulty reading Agnosia or Alexia
Alexia
Bleeding between the dura mater and the arachoid membrane is Epidural, Subdural, Extradural
Subdural Hematoma
What is bleeding between the inner skull and the dura, compressing the brain underneath
Epidural Hematoma
What is the term for weakness in both legs and the lower part of the trunk
Paraparesis
A GCS of less then & is generally interpreted as
COMA
True or False The use of cocaine can cause insults and abnormalities most common causes of ischemic stroke?
True
Which of the following is an approaching sing of death
Irregular breathing pattern
What are the following immediate complications with a spinal cord injury Respiratory Arrest, Paralegia, Spinal Shock
Respiratory Arrest, & Spinal Shock
Homonymous hemianopsia refers to
blindness in the right or left halves of the visual field of both eyes
What is the normal ICP pressure _____ - _____ mmHg
10-20mmHg
True or False the Aura of a migraine headache usually last less than an hour
True
A posttraumatic sz generally occur 1-2 days, 1-4 days, 1-7 days after the event
1-7 days of injury
A type of comprehensive care for patients whose disease is not responsive to cure is
Palliative Care
Aneurysm rebleeding occurs most frequently during which timeframe after the initial hemorrhage, 48 hours, first week, , first 2 weeks
First 2 Weeks
An osmotic such as mannitol is given to PT with ICP why?
To reduce edema, and dehydrate the brain to lower ICP
Which cerebral lobe controls abstract thought Frontal, Temporal, Parietal, Occipital
Frontal
What word describes jerky, rapid, involuntary or purposeless movement of the extremities or Chorea or Bradykinesa
Chorea
Which of the following is inaccurate manifestation of Cushing Triad Bradykinesa, Bradypnea, Tachycardia & Hypertension
Tachycardia
Later Signs of increased ICP include increased pulse rate, narrowed pulse, decreased BP or projectile vomiting, select the best answer
Projectile Vomiting
Thrombolytic therapy should be initiated within what timeframe for ischemic stroke to have the best outcome 3, 6, 9, or 12 hours
3 Hours
Taking Warfin and Garlic supplement can greatly increase INR which increased the risk of
bleeding
What is the most common cause of spinal cord injury MVA or Sports
Motor Vehicle Accidents
A Halo sign is highly suggestive of CSF Leak True or False
True
The dynamic equilibrium of cranial contents is called the what ______-_______ hypothesis
Monro-Kellie
Secondary Epilepsy is related to brain tumor, acute alcohol withdrawal, electrolyte imbalance, drugs True or False
True
List trigger factors for SZ
Increased Physical Activity, Hormonal Shift, Stress, Fatigue, Alcohol, Caffine, Some Chemicals, Medications
How do you DX a SZ
R/O cerebral mass, EEG, MRI
Absent SZ typical occur during which age range childhood, adolescent, adulthood
Childhood
Describe SZ precautions
Standby O2, Suction, IV access, Side rails up, Bed in lowest position
A Post op nurse is performing a pain assessment on client, she should do which of the following, check v/s, client report of pain using pain scale, nonverbal communication
Client report of pain using pain scale
A Patient present to ED with severe eye pain with blurred vision, a dx of angle-closure gl aucoma is made the nurse should anticipate the admin of IV osmotic diuretics, Corticosteroid drops, IV epi
IV osmotic diuretics
A client presents within 2 hours to ED after a embolic cerebrovascular accident, what medication should the nurse anticipate giving
TPA Tissue Plasminogen Activator
A client has been dx with a basilar skull fracture from a fall from a ladder, what findings need to be reported to the doctor
clear drainage from the nose, ICP above 20
When caring for a client post cataract surgery how long should the pt sleep upright
24 hours
When a pt is taking Dilantin what education information is key
The pt should take the medication everyday at the same time to maintain therapeutic levels.
A PT with a detached retina will have see what exactly: Complete Blindness, Flashes of Bright Light, Photophobia
Flashes of bright light
A client who is recovering from a cerebrovascular accident has right-sided homonymous hemianopsia. To help the client adapt the nurse need to communicate which of the following: Check the PT checks for food on the right side after eating, Provide Client with large eating utensils, Remind PT to consciously look at both sides of the meal tray
Remind PT to consciously look at both sides of the meal tray
A right hemispheric stroke lend to which: Aphasia, Impulsive Behavior, Inability to read
Impulsive Behavior
Sudden loss of function resulting from disruption of blood flow supply to part of the brain is called what
Brain Attack
What is the most common type of Ischemic Stroke…Large or Small Artery
Small Artery one or more vessels are impacted
What is the root cause of Cryptogenic Shock
Cause Unknown
The Brain must have these two things and does not store these items
Oxygen & Glucose
The Brain Needs constant blood flow True or False
True
Ischemic Strokes are what % ______
85%
Hemorrhagic are what % ______
15%
What is the Penumbra region
area of low blood flow r/t infarction
How do you DX a SCI
Xray, CT bone, MRI soft tissue
What is the most common type of SCI 48%
MVA
What gender is more likely to have a SCI Male or Female
Male
Bruising and Bleeding into the tissue is a
Contusion
DAI or Diffuse axonal injury occurs with what type of trauma
Shaken Baby, Shearing of Brain
A tear in the cord, permanent injury is a
Laceration
Severing of the cord with complete loss of function below the level of the injury
Transection
A temporary loss of function is a
Concussion
Falling on ones head would be considered what type of injury
Axial Loading Compression
A GSW (GUN SHOT WOUND) is an example of what type of trauma
Penetrating
List the NSG Intervention to prevent 2nd Injury related to SCI Trauma
Airway Mngt, Oxygenation, Ventilation, F/V Mngt, ICP Mngt, DVT prevention, Pneumo Prevention, Skin Integrity,
True or False there is no TX for Linear FX
True
True or False Depressed FX may require surgery
True
True or False Basilar FX involve the base of the skull and can leak CSF from Nose, Ear
True
True or False When a PT presents with a Basilar FX an NG is always required
False NO NG!!!
With a Basilar FX what S/S should the RN be looking for in assessment
Bleeding Behind Ears, Blood Clotting, Swelling Around the Eyes.
What are the Modifiable Risk to Prevent Stroke
HTN, A Fib, Smoking, Alcohol Use, DM Control, Diet, Exercise, TIA warning, Periodontal Disease,
What are the Non-Modifiable Risk to Prevent Stroke
>55 Age, Male, African American
What are two types of Meningitis
Bacterial & Viral, Bacterial is most common
Which common meningitis organisms is each to treat Strep, Neisseria, Hemophilus
Neisseria
What the clinical presentation signs of Meningitis
Fever, Nuchal Rigidity, Photophobia, Rash, SZ, HA, Irritability, Kerning&Brudzinki
What medication is used to Treat Encephalitis
Acyclovir
True or False blood can damage brain tissue if a hemorrhage occurs
True
Micrographic is a manifestation of what disease
Parkinson’s
What is the drug of choice for Parkinson’s
Levodopa
What does DNR stand for =
DO NOT RESUSCITATE, This is a free b! HAHAH! Hope you got it right!
LOC is =
Level of Consciousness
A nurse is caring for a client with SCI. Which of the following changes to the PT baseline requires immediate attention, Temp 100.5, Systolic from 130 to 100, Decreased bowel sounds, Flush Face & chest
Flush Face & Chest
A Pt has returned from Brain Surgery, both eyes are edematous, what NSG interventions should the RN use to reduce the swelling
Elevate the HOB and apply cold compress.
This can be used to study a tumors blood supply or obtain info about a vascular lesion what is
Cerebral Angiography.
What is the position of the LICO in the Brain
It is placed in the White Matter
When CSF is extracted and it is pink or blood tinged this is a sign of what type of brain bleed
Subarachnoid Hemohrrage
Most PT are perscribed this anti SZ med bgore surgery to reduce the risk of SZ what is
Dilantin or Cerebyx
This corticosteroids is given to reduce cerebral edema if a patient has a brain tumor what is
Decadron
What is the first sing of increase ICP
A Change in LOC
What is the goal of postoperative management
Detecting and Reducting cerebral edema, Pain, SZ prevention, Mntr ICP, Neuro Status
Incr. pressure on the frontal lobe or deep midline structure may result in _______ -_______ respirations
Cheyne-Stokes
Flexion or adduction of the upper extremities, internal rotation of the lower extremities ans plantar flexion of the feet is an example of
Decorticate
Aphasia in Auditory receptive region is r/t damage in what area of the brain
Temporal lobe
Visual aphasisa is r/t damage in what area of the brain
Parietal - Occipital area
List the s/s of Upper Motor Neuron Lesions
Loss of Voluntary Control, Increased Muscle tone
List the s/S of Lower Motor Neuron Lesions
Loss of voluntary control, Decreased muscle tone, Flaccid muscle paralysis, Muscle atrophy, Absent or decreased reflexes
What is a complication of pituitary ablation through the transsphenoidal approach & what is the TX
diabetes insipidus & vasopressin
Which of the following neurotransmitters inhibits pain and transmission Serotonin, Enkephalin, Dopamine
Enkephalin
Which term referes to shifting of brain tissue from an area of high pressure to an area of low pressure Autoregulation or Herniation
Herniation
Ischemic stroke and Cerebrovascular accident are all names for what
"BRAIN ATTACK
Lacunar Stroke is a Large or Small Atery Stroke
Small Atery
True or False penubra region is ischemic brain tissue that can be salvaged with timely intervention
True
The Penubra area can be revitalized if given what drug with in 3 hours of the episode
TPA Tissue Plasminogen Activator
What is Hemiplegia
paralysis of one side of the body
What is Hemiparesis
weakness of osne side of the body
True or False Homonymous Hemianopsia will alway return after the stroke
False it can be temporary or pernament
S/S of Left Hemispheric Stroke
Paralysis or Weakness on Right Side, Right Visual Field Deficit, Aphasia, Altered intellectual ability, Slow Cautious behavior
S/S of Right Hemispheric Stroke
Paralysis or weakness on left side of body, Left Visual Field Deficit, Spatial Deficit, Increased distractibility, Impulsive behavior & poor judegement, Lack of awareness deficits
Once TPA is administered how long before a PT can begin anitcoagulation therapy again
Not for the Next 24 Hours
What are the contraindications for TPA, When can it not be administered
> 3 hours after TIA, a PT who is anticoagulated, or PT who has had intracranial pathology perviously TIA STROKE, HA Trauma
How is the TPA dose calculated
By Weight 0.9mg/kg
Explain Admin of TPA
Max dose 90mg, 10% bolus IV push 1 min, 90% 1hr IV infusion pump