Nurs623

Front 1

When is rectal sparing assessed?

Back 1

To help determine complete or incomplete spinal cord injury

Front 2

What kind(s) of spinal cord injury is associated with central cord syndrome?

Back 2

Cervical hyperextension/flexion injury -> hematoma formation in the center of the cervical cord

Front 3

How is central cord syndrome manifested?

Back 3

Produces motor and sensory deficit more pronounced in the upper extremities than the lower & varying degrees of bowel/bladder dysfunction

Front 4

What is Brown Sequard?

Back 4

Damage to only one side of the spinal cord

Front 5

How is Brown Sequard manifested?

Back 5

Loss of voluntary motor movement on the same side as the injury along with loss of pain, temp & sensation to opposite side. Functionally, the side of body with better motor has little or no sensation while the side of the body with better sensation has little or no motor control.

Front 6

What is Anterior Cord Syndrome?

Back 6

Associated with injury to anterior gray horn cells (motor), the spinothalmic tract (light touch) and the corticospinal tracts (temp)
Commonly caused by flexion injuries or acute herniation of an intervertebral disk

Front 7

How is anterior cord syndrome manifested?

Back 7

It results in loss of motor fx as well as loss of the sensation of pain & temp below level of injury.
Proprioception, pressure sensation & vibration remains intact below level of injury.

Front 8

What is posterior cord syndrome?

Back 8

It is associated with cervical hyperextension injury with damage to posterior column.

Front 9

How is posterior cord syndrome manifested?

Back 9

Results in loss of proprioception, pressure, vibration below level of injury. Motor fx, sensation of pain & temp remains intact.
May not be able to ambulate b/c lack of position sense impairs spontaneous movement

Front 10

What is spinal shock?

Back 10

Occurs shortly after traumatic injury to spinal cord -> complete loss of all normal reflex activity below level of injury

Front 11

How is spinal shock manifested?

Back 11

Includes bradycardia & hypotension.
Intensity is influenced by level of injury, duration of shock state & can persists up to one month after injury.

Front 12

What are some clinical considerations by the nurse when caring for a ptaient with spinal shock?

Back 12

Repositioning can cause orthostatic hypotension.
May need BP support including vasoactives.

Front 13

What is neurogenic shock?

Back 13

Type of distributive shock most commonly r/t spinal cord injury at T6 and is caused by suppression of sympathetic tone (disruption of the SNS)

Front 14

How is neurogenic shock manifested?

Back 14

Results in decreased tissue perfusion. It occurs within minutes of injury & may last for days - mths.

Front 15

What is autonomic dysrreflexia?

Back 15

A life threathening condition
caused by massive SNS response to noxious stimuli(full bladder, line insertions, fecal, impactions)
Results in bradycardia, H/A, HTN, facial flushing.
Immed intervention is needed to prevent brain hemorrhage, seizures & acute pulmonary edema.
Good bowel & bladder regimen helps with management

Front 16

In intracranial pressure monitoring where is an epidural sensor placed?

Back 16

Into the epidural space.
Indirectly measures ICP, does not drain CSP. It is relatively noninvasise, less accurate, causes less infection and is less reliable b/c it is outside dura mater.

Front 17

When is intracranial monitoring indicated?

Back 17

When there is an abnormal CT & GCS =/< 8 or normal CT with GCS =/< 8 & has two these three things: age of > 40yrs old, posturing on one or both side or SBP < 90, >40yrs old

Front 18

What is the imaging modality of choice in the diagnosis of head injuries?

Back 18

CT scan

Front 19

What does the CT Scan show?

Back 19

Shows space occupying lesions, tumors, brain shifts, edema, hemorrhage.

Front 20

What detects DAI's better, CT scan or MRI

Back 20

MRI

Front 21

After obtaining a CT scan, in what instance (s) would you get an MRI?

Back 21

If clinical picture does not match CT results then get an MRI
If clinical picture does not match CT results, when need to see the brain stem well scan or if you need to determine DAI injury.

Front 22

What is the major reason why the MRI is usually not used emergently for pts coming through the ER/shock trauma?

Back 22

You do not know metalic status

Front 23

With regards to ICP monitoring, intraventricular catheter

Back 23

The intraventricular catheter or ventriculostomy sits in the anterior horn of the lateral ventricle; remains the gold standard of ICP monitoring; allows for measurement of ICP as well as drainage of CSF; can be externally transduced via strain gauge transducer or a hybrid catheter with an internal strain gauge microchip or fiberoptic
transducer.

Front 24

With regards to ICP monitoring, what is the intraparenchymal catheter

Back 24

A catheter is inserted into the brain parenchyma;used for monitoring ICP when ventricular access cannot be
obtained or (CSF) drainage is deemed not necessary; quick to insert; ccurate, and reliable.

Front 25

What are the three characteristic peaks of the ICP wave form, what are their conformations in relationship to each other & what do they correlate with?

Back 25

P1 (percussion wave), P2 (tidal wave) & P3(dicrotic wave). The peaks are of decreasing height that correlate with the arterial pulse waveform.

Front 26

What are A-waves?

Back 26

A waves (plateau waves)are
abnormal ICP waveforms r/t:
ICP up to 50 to 100 mm Hg; can last for 5-20 mins;
has rapid onset and resolution; often occur from an already elevated ICP baseline; may be accompanied by clinical symptoms reflecting neurologic
deterioration; are related to situations of impaired CSF flow, decreased compliance
& may indicate

Front 27

What are B-waves?

Back 27

B waves are rhythmic oscillations that occur every 0.5 to 2 times/min;
ICP may increase up to 20–50 mm Hg; may occur with normal or increased baseline ICP; are related to fluctuations in cerebral blood flow, probably autoregulatory response to fluctuations in CPP; tend to occur more prominently in conditions of decreased intracranial compliance; occur in normal as well as pathologic conditions; may precede A waves

Front 28

What is intracranial hypertension?

Back 28

ICP greater than 20 mm Hg lasting for 5 minutes or more is termed intracranial
hypertension

Front 29

What is the normal range for SJO2

Back 29

55 - 75%

Front 30

What are the two factors that decrease SJO2 - give one or more examples of conditions/states that cause each?

Back 30

Increased cerebral O2 demand (e.g. seizures) & decreased O2 delivery (e.g. hypoxia, anemia, decreased flow)

Front 31

What factors increase SJO2? Give one or examples of conditions/states that result in each

Back 31

Increased O2 delivery (hyperoxygenation) & decreased O2 demand (e.g. brain death)

Front 32

What is cerebral oxygen extraction (CEO2)?

Back 32

SaO2 - SjO2
Normal = 24 - 40%
Low - reflects excessive flow
High - reflects insufficient flow

Front 33

What is arteriojugular oxygen content difference (AVjDO2)?

Back 33

AVjDO2 = Cerebral metabolic rate of oxygen/cerebral blood flow AVjDO2 = CaO2 - CjvO2
Normal = 4.5 - 8.5 mL/dL

Front 34

What is the formula for CaO2?

Back 34

CaO2 = (SaO2 x 1.34x HgB) + (paO2 x .0031)

Front 35

What is the formula for CvjO2?

Back 35

CjvO2 = (SjvO2 x 1.34x HgB) + (pjvO2 x .0031)

Front 36

What does an increased/decreased AVjDO2 indicate?

Back 36

Inadequate/excessive oxygenation for the metabolic demand (respectively)

Front 37

What does brain oximetry measure?

Back 37

Brain tissue paO2 (PbrO2).
Measured with a Licox catheter with sensor placed in brain tissue around damage (penumbra), or area of damage.

Front 38

How do you manage care when:
PbrO2 >20-40mmHg & ICP >20mmHg?

Back 38

If PbrO2 >20-40mmHg & ICP >20mmHg – drain CSF, reduce CO2, optimize CPP, sedation,
mannitol,

Front 39

How do you manage care when:
PbrO2 < 20mmHg & ICP >20mmHg?

Back 39

If PbrO2 < 20mmHg & ICP >20mmHg – drain CSF, increase fiO2, increase CO2 slowly,optimize CPP, sedation, mannitol.

Front 40

How do you manage care when:
PbrO2 < 20mmHg & ICP >20mmHg?

Back 40

If PbrO2 <20mmHg & ICP <20 mmHg – increase CO2, increase fiO2, evaluate hemodynamic and pulmonary status and optimize, Maintain temp 36 – 37 degrees,

Front 41

Why do we evaluate biochemical markers in the management of brain injury?

Back 41

Biochemical markers look at the metabolites released. Certain metabolites are associated with damage.

Front 42

What is serum 100B?

Back 42

A calcium binding protein in astro glia. It is elevated in injury. It plateaus after 24hrs. If still increasing after 24hrs, it tells us needs to go back to CT -possible secondary injury.

Front 43

After the shock, deep tendon reflexes below the injury will return. True or false?

Back 43

True

Front 44

Reflexes at the level of the injury will remain absent.
True or false?

Back 44

True

Front 45

What are some of the s/s of unopposed PNS stimuli in SCI?

Back 45

Engorged penis, bradycardia & hypotension,dec. thermoregulation & cause hypoventilation