Med-Surg 2

Front 1

Confusion?

Back 1

Unable to think rapidly and clearly; easily bewildered, w poor memory & short attention span; misinterprets stimuli; judgment is impaired

Front 2

Disorientation?

Back 2

Not aware of or not oriented to person, place, or time.

Front 3

Obtundation?

Back 3

Lethargic, somnolent; responsive to verbal or tactile stimuli but quickly drifts back to sleep

Front 4

Stupor?

Back 4

Generally unresponsive, may be briefly aroused by vigorous, repeated, or painful stimuli; may shrink away from or grab at the source of stimuli; may shrink away from or grab at eh source of stimuli

Front 5

Semicomatose?

Back 5

Does not move spontaneously; unresponsive to stimuli, although vigorous or painful stimuli may result in stirring, moaning, or w/drawal from stimuli, wo actual arousal

Front 6

What is the pt. teaching for Dilantin use?

Back 6

Monitor skin rash, gingival-hyperplasia: good oral hygiene, periodic blood work, report to physician any problems: walking, coordination, slurred speech, nausea, nastagmus

Front 7

List 4 ways to apply painful stimuli?

Back 7

Supraorbital pressure, trapezius squeeze, mandibular pressure, sternal rub

Front 8

Define 6 assessments for pt. in coma?

Back 8

Papillary response, pain w/drawal, corneal/babinski reflexes, posturing, dolls eyes, caloric testing

Front 9

Decorticate posturing is protective and brings limbs in & up, Decerebrate posturing is?

Back 9

Worse and postures outward

Front 10

What ultimately will tell if someone is brain dead?

Back 10

Cerebral blood flow supply (T-one)

Front 11

S/S of brain death?

Back 11

Unresponsive w/absent motor & reflex movements, no spontaneous respirations (apnea), pupils fixed & dilated, absent ocular responses to head turning/caloric stimulation, Flat EEG

Front 12

Concussion means?

Back 12

Violent shaking

Front 13

How long can mild concussions last?

Back 13

Seconds to several hours

Front 14

S/S of a mild concussion?

Back 14

HA, drowsiness, confusion, dizziness, visual disturbances

Front 15

Describe a mild concussion?

Back 15

Momentary interruption of brain fxn

Front 16

Describe contusion?

Back 16

Bruising of brain tissue

Front 17

Where are contusions most commonly found?

Back 17

Frontal/temporal lobes, site of impact & line opp. Site of impact

Front 18

Name a contusion that occurs in both front & back of head?

Back 18

Contrecoup injury

Front 19

What type of force is caused by an external force contacting the head, suddenly placing the head in motion?

Back 19

Acceleration injury

Front 20

What type of force occurs when moving head is suddenly stopped or hits stationary object?

Back 20

Deceleration injury

Front 21

Name 6 types of head injuries?

Back 21

Concussion, contusion, intracranial hemorrhage, epidural hematoma, subdural hematoma, fracture

Front 22

Describe the most common skull fracture (80% of skull fractures)?

Back 22

Linear skull fracture- simple clean break. Impacted area of bone bends inward & area around bends outward

Front 23

What type of skull fracture is bone pressed inward into brain tissue to at least thickness of skull- often fragments get into brain tissue?

Back 23

Depressed skull fracture

Front 24

What is the WORST kind of skull fracture that can involve base of skull, sinuses, temporal bone (middle of ear)?

Back 24

Basilar skull fracture

Front 25

Name to indications of a basilar skull fracture?

Back 25

Battles sign (blood behind mastoid), racoon’s eyes (bilateral periorbital ecchymosis)

Front 26

What is the #1 thing to remember w/ a basilar skull fracture?

Back 26

No NG only OG

Front 27

An epidural hematoma results from _______ bleeding into space between _________?

Back 27

Arterial, dura & inner table of skull

Front 28

An epidural hematoma is often caused by fractures of temporal bone. Major s/s of epidural hematoma are?

Back 28

RAPID deterioration in neuro status, decrease LOC

Front 29

What does a subdural hematoma result from?

Back 29

Venous bleeding into space beneath dura & above arachnoid

Front 30

What does a subdural hematoma result from?

Back 30

Tearing of veins w/in cerebral hemisphere or lacerations of brain tissue

Front 31

Is bleeding more quickly in subdural or epidural hematomas?

Back 31

Epidural

Front 32

What 3 categories are subdural hematomas divided into?

Back 32

1. Acute: w/in 48 hrs of impact; 2. Sub-acute: 48-2 weeks; 3. Chronic: 2 weeks- several months

Front 33

What type of hematomas have highest rate of mortality & why?

Back 33

Subdural because bleeding occurs more slowly

Front 34

Accumulation of blood w/in brain tissue caused by tearing of small arteries/weins in subcortical white matter?

Front 35

Intracerebral hemorrhage may be single or multiple, associated w/ contusions- most often in _______ lobes?

Back 35

Frontal or temporal

Front 36

If blood vessels rupture they combine w/ CSF along surface of brain in a _______ hemorrhage?

Back 36

Subarachnoid

Front 37

Major s/s of SAH?

Back 37

Worse HA ever, neck stiffness, MRA (vascular)

Front 38

How can a lumbar spine puncture diagnose a SAH?

Back 38

See if blood in CSF

Front 39

App 50% of SAH are fatal- 85% are caused by an?

Back 39

Aneurysm

Front 40

Ts for SAH?

Back 40

Clipping, via craniotomy, coiling endovascularly, vasospam (CCB-Nimotop)

Front 41

Biggest problem with vasospasm tx?

Back 41

ischemia BP <130-150

Front 42

An increase in ICP =?

Back 42

Less perfusion to brain

Front 43

What is the equation for cerebral perfusion pressure?

Back 43

MAP-ICP

Front 44

What do you do if cerebral pressure is low?

Back 44

Vasopressor- dopamine

Front 45

A N ICP is?

Back 45

10-15mmHg or less

Front 46

ICP hypertension management requires?

Back 46

Prompt determination of cause & specific tx measures

Front 47

Cerebral blood flow accounts for 750 ml/min which is _____ % of cardiac output?

Back 47

15

Front 48

What does CPP pressure need to be above to avoid ischemia?

Back 48

>50 mmHg

Front 49

What does the intracranial compartment consist of?

Back 49

Brain, blood, CSF

Front 50

List early S/S of increased ICP?

Back 50

Decreased LOC, confusion, restlessness, lethargy, papillary dysfunction, changes in vision, deterioration of motor function, HA

Front 51

Later s/s of increased ICP?

Back 51

Continued decrease in LOC, stuporous, coma, dilated pupils- no reaction to light, hemiplegia(severe or complete loss of one side), vomiting, HTN-bradycardia, hyperthermia (swelling around hypothalamus), papiledema(optic disc swellin), herniation syndromes(shift in brain), cushing’s triad

Front 52

Cushing’s triad is a classic late sign of increased ICP- known by what 4 symptoms?

Back 52

Severe HTN w/ widened pulse pressure (Rising systolic- declining diastolic), bradycardia, irregular respiration

Front 53

What is the main treatment goal for increased ICP?

Back 53

Maintain CPP- perfusion

Front 54

Is surgery an option for ICP tx?

Back 54

yes, placement of drain, Ventricular Parientaneal shunt ( brain to gut shunt)

Front 55

What is the #1 osmotic diuretic that reduces water content of the brain d/t the establishment of an osmotic gradient between the brain and the intravascular compartment (pulls fluid back into vascular)?

Back 55

Mannitol

Front 56

Monitoring of Mannitol is very important via_______ to reduce_________?

Back 56

Serum & urnine osmolarity, serum & urine electrolytes: fluid overload especially if pt has CHF

Front 57

Remember to use a ____ when drawing Mannitol?

Back 57

Filter

Front 58

Why are loop diruetics used to tx ICP?

Back 58

Decrease blood volume which may mobilize cerebral edema

Front 59

Name the corticosteroid used and reason to tx ICP?

Back 59

Decadron, only proven to effective in reducing cerebral edema associated with BRAIN TUMORS;

Front 60

Name the Barbiturate used and why it can help w/ ICP?

Back 60

Pentobarbital; decreases cerebral metabolism and O2 requirements; leads to a decrease in cerebral blood flow and in blood volume→decreases ICP

Front 61

Why does a nurse have to be ready to intubate with Pentobarbital?

Back 61

Respiratory depression

Front 62

What is the brain landmark called located on temporal lobe?

Back 62

Foramen of Monroe

Front 63

How is hyperventilation used to decrease ICP?

Back 63

Titrate PCO2 to 30-35 to cause arterial cerebral vasoconstriction and a decrease in CBF & ICP

Front 64

How is CSF decreased?

Back 64

Intraventricular drain

Front 65

Person w/ ICP should be kept in a quiet dark environment w/ minimal family/nurse contact as well as fluid restrictions to?

Back 65

65-75% of N maintenance fluids

Front 66

How does hypothermia decrease ICP?

Back 66

Decrease brain metabolism

Front 67

Pt. w/ ICP should be placed midline with HOB at 25-30 degrees to promote?

Back 67

Intracranial & venous drainage

Front 68

Meningitis is most often caused by viruses or bacteria that infect?

Back 68

Meninges tissue & sometimes CSF that surround brain and spinal cord

Front 69

Is bacterial or viral meningitis worse?

Back 69

Bacterial

Front 70

What is Bacterial Meningitis most often caused by that is found in nose & throat?

Back 70

Streptococcus pneumoniae or Neissseria Meningitidis

Front 71

How is bacterial Meningitis spread , which is why bacterial meningitis is the only type of found in outbreaks of high density population places?

Back 71

Airborne

Front 72

S/S of bacterial Meningitis?

Back 72

Restlessness, agitation, irritability (personality changes), Severe HA, nuchal rigidity ( stiff neck), positive brudzinkski’s & Kernig sign ( knees up to chest- cause irritation to neck), altered LOC, photophobia, seizures, increased ICP, petachial rash→ purpura

Front 73

Where do the meningital viruses live in the body?

Back 73

Intestines

Front 74

Name clinical manifestations of viral meningitis?

Back 74

Fever, photophia, headache, myalgias, nausea

Front 75

How are brain tumors named?

Back 75

According to cell or tissue from which they originate

Front 76

How do secondary brain tumors result?

Back 76

From metastasization from other areas of body- lung cancer metastasize to brain

Front 77

More than 50% of primary turmors are _______?

Back 77

Glioblastomas- the worst kind

Front 78

S/S of brain tumors?

Back 78

HA, visual disturbances, seizures, lose function of parts of body(side of body identify what side tumor is on)

Front 79

Name the 5 types of brain tumors?

Back 79

Supratentoria, infratentorium, gliomas, meningiomas, pituitary

Front 80

What brain tumors are malignant that infilitrate and invade surrounding brain tissue?

Back 80

Gliomas

Front 81

What is the most common glioma & the most malignant?

Back 81

Astrocytoma, glioblastoma

Front 82

Hwat is the most common benign tumor?

Back 82

Meningiomas

Front 83

What can diagnose a brain tumor?

Back 83

CT Scan, MRI, EEG, lumbar puncture

Front 84

List the tx options for brain tumors?

Back 84

Surgery, radiation therapy, medications (dilantin, Decardon), Gamma Knife

Front 85

How does Decardon tx brain tumors?

Back 85

Corticosteroid that decreases inflammation

Front 86

Define seizure?

Back 86

Abnormal, sudden excessive, uncontrolled electrical discharge of neurons w/in brain that may result in alteration in consciousness, motor or sensory ability, and behavior.

Front 87

Partial seizures begin in a part of one cerebral hemisphere and include?

Back 87

Complex & Simple seizures

Front 88

Type of seizure where person loses consciousness for 1-3 minutes, Lip smacking, picking at clothes. Afterwards person may have amnesia?

Back 88

Complex

Front 89

Client remains conscious. Often reports an aura before seizure takes place?

Back 89

Simple

Front 90

Generalized seizures may occur & involve both cerebral hemispheres, name the most common?

Back 90

Tonic-clonic

Front 91

Describe tonic-clonic seizures?

Back 91

2-5 minutes begins w/ a tonic phase that is characterized by stiffness or rigidity of muscles, clonic refers to jerking of all extremities

Front 92

Name a few medications used to tx seizures?

Back 92

Dilantin, Phenobarbital, mysoline, tegretol, depaken, neurontin, lamictal, topamax