Med Surge - Test 5 P.18

Front 1

hemorrhages cause hematomas and secondary damages
-the vessel integrity is disrupted and what results?

Back 1

it starts bleeding into the surrounding tissues

Front 2

Hemorrhages

Know where they occur and what vessels are involved

Back 2

-(basilar artery, superior cerebral, vertebral)

Front 3

Epidural Hematoma

Hematoma located between where? .

Back 3

dura and skull and it is arterial* w/ every beat of your heart you are pushing blood into this space

Front 4

Epidural Hematoma

-Results from a venous or arterial bleed?

Back 4

Results from an arterial bleed; dural artery

Front 5

Epidural Hematoma

-it may be caused by what?

Back 5

May be caused by a fracture of the temporal bone

Front 6

Epidural Hematoma

Characterized by the s/s of

Back 6

periods of several minutes of lucidness (awake and talking) followed by unconsciousness; if treated promptly, can make full recovery, if not, herniation occurs

Front 7

Epidural Hematoma

Symptoms may increase to what?

Back 7

coma

Front 8

Subdural Hematoma
-where is it located?

Back 8

between brain and dura

Front 9

Subdural Hematoma
-results from what?

Back 9

Results from venous bleeding into the space beneath the dura and above the arachnoid

Front 10

Subdural Hematoma
-does the bleeding occur faster or slower compared to an epidural?

Back 10

Bleeding occurs more slowly than from an epidural hematoma, they are insidious

Front 11

Subdural Hematoma

What are these usually associated with

Back 11

diffuse brain injury, immediate coma, cerebral edema. SDH occurs most often from a tearing of the bridging beins within the cerebral hemispheres or from a laceration of brain tissue.

Front 12

Subdural Hematoma
-what population is this seen with?

Back 12

seen in elderly population

Front 13

Subdural or Epidural Hematoma

*These have the highest mortality rate!

Back 13

Subdural Hematoma

Front 14

Subdural Hematoma

- Acute:
- subacute:
-Chronic:

Back 14

- Acute-presents within 48 hrs after injury
- subacute-48 hrs to 2 weeks
-Chronic: 2 weeks to months, slow leaker

Front 15

Assessment pieces that nurse would be looking at in relationship to hematomas

Clinical manifestations:

Back 15

increased ICP (hypotension, hypoxia, hypercapnia –increased blood levels of co2)

Front 16

Assessment pieces that nurse would be looking at in relationship to hematomas

Back 16

•Change in LOC
•Airway & breathing pattern
•Vital Signs
•Reflex Activity
•Seizures
•Headache, N & V

Front 17

Assessment pieces that nurse would be looking at in relationship to hematomas

position them how?

Back 17

Posturing-position the pt to avoid extreme flexion or extension of the neck and to maintain the head in the midline, neutral position. Log roll the pt during turning to avoid extreme hip flexion and neck flexion and keep the head of the bed elevated at least 30 degrees

Front 18

Assessment pieces that nurse would be looking at in relationship to hematomas

Pupillary changes
pinpoint and nonreactive pupils =


fixed, nonreactive, and dilated are blown pupils means what

Back 18

brainstem)


(markedly increased ICP)

Front 19

Assessment pieces that nurse would be looking at in relationship to hematomas

Nuchal rigidity of the neck – tells you what?

Back 19

that u have blood in your cerebral region. May indicate infection or blood in the CSF

Front 20

Assessment pieces that nurse would be looking at in relationship to hematomas

•CSF drainage look like what?

Back 20

will have “halo” around it

Front 21

Nursing interventions : Standard things that the nurse would anticipate doing before surgery and immediately after return from the PACU

What about pain?

Back 21

Pain – no Morphine! Avoid narcotics, its going to alter BP and it will change respiratory effort.

If you decrase RR you wil build up carbon dioxide in your brain. You need oxygen in your brain. It will mask changes in the pts neurological function

Front 22

brain herniation
What is happening to cause this?

Back 22

Due to increased ICP, the brain tissues may shift and herniate downward

Front 23

brain herniation
-where in the brain can it exit and come out?

Back 23

Foramen magnum(opening in bottom of the skull that your skull sits on your spinal column) --Axis

Front 24

What is the purpose of a Ventriculoperitoneal Shunt?

Back 24

-surgical management for increased ICP

Front 25

What is the purpose of a Ventriculoperitoneal Shunt?

whats the purpose of this surgery

Back 25

- Shunts fluid from ventricles to peritoneum (releases pressure from the brain)

Front 26

What is the purpose of a Ventriculoperitoneal Shunt?

complications ? 3

Back 26

- Infection -watch fever
- Shunt Failure
- A major complication of the shunting procedure is a subdural hematoma from the tearing of bridging veins

Front 27

Medications that are use to decreased intracranial swelling

#1 drug is?

Back 27

Mannitol - hyperosmotic agent

Front 28

Medications that are use to decreased intracranial swelling

Mannitol
-what does it do?


-expect what?

Back 28

-increases intravascular pressure & therefore draws fluid FROM the brain cells removes fluid from the brain cells and puts it into vascular space, down jugular, and heads to the kidney


-expect DIURESIS!

Front 29

Medications that are use to decreased intracranial swelling

why NOT lasix?

Back 29

lasix pulls fluid out of ciruclatory system, not tissue

Front 30

mannitol (Osmitrol) is an osmotic diuretic that is used to treat what?

Back 30

cerebral edema by pulling water out of the extracellular space of the edematous brain tissue. Its most effective when given in boluses rather than as a continuous infusion

Front 31

Medications that are use to decreased intracranial swelling

Decadron & Solu-Medrol

-SE?
-what should the nurse monitor?

Back 31

have no demonstrated benefit, although it will probably still be given!

SE of decadron is hyperglycemia, which retains fluid.

The nurse should monitor and give insulin to keep BG in the normal range

Front 32

Medications that are use to decreased intracranial swelling

Lasix is a loop diuretic often used as adjunct
-what does it reduce?

-what does it enhance?

Back 32

reduces edema & blood volume, decreases sodium uptake by brain & decreases production of CSF at the choroid plexus,

it enhances the therapeutic action of mannitol

Front 33

Medications that are use to decreased intracranial swelling


•Anti-Hypertensives
•Antipyretics
•Anti-Convulsants

Back 33

•Anti-Hypertensives – goal is to maintain normal cerebral perfusion
•Antipyretics (Tylenol – to help reduce fever) and muscle relaxants
•Anti-Convulsants – Dilantin (most will be prophylatically to prevent seizures)

Front 34

Medications that are use to decreased intracranial swelling

IV fluids
-avoid what?

Back 34

•Avoid hypertonic solutions because they can increase cerebral edema

Front 35

Care associated with the comatose pt

Nutrition -the pt who is injured usually has a decreased LOC. as a result, the pt is unable to chew or swallow and must receive nutrition and fluids by other methods (such as?)

Back 35

IV/TPN
NG/G-tube

Front 36

Care associated with the comatose pt

Stimulation

Back 36

-Meaningful
-Monitor what is said around the patient
-Speak before touching patient
-Gentle touch to prevent demarcation of ecchymosis
-Keep loud noises to a minimum loud noises produce a stimuli in the brain

Front 37

-pts who have swallowing problems, can tolerate or swallow ________________________________better than thin liquids (milk, water, juice)

Back 37

soft or semi soft foods and liquids (mechanical soft or dental diet, junior baby foods, custards, scrambled eggs)