Combo with Complex Test 4 (Neuro) and 8 others
* When are ergotamines used? How much can be used? When are they taken?
used when analgesics do not relieve pain of migraines Up to 6mg Only taken at onset of pain
What are tonic-clonic seizures?
"grand mal", pt will stiffen, lose consciousness, fall, jerking movements, last 1-3 min, excessive saliva, incontinence, and tired and confused following seizure
What is absence seaizure?
"petit mal", brief staring, may be accompanied by blinking, mouth or hand movements
Which system is further divided into the sympathetic and parasympathetic fibers?
(ANS) Autonomic Nervous System (rest and digest); is not under "conscious" control
circle of Willis
(has to do with circulation in the brain); The anterior, middle, and posterior cerebral arteries are joined together by small communicating arteries to form a ring at the base of the brain known as the
Dermatomes
(there is a "dearnurses.com" thing on this); represent sensory input from spinal nerves to specific areas of the skin. For example, the patient with an injury to cervical spinal nerves C6 and C7 has sensory changes in the thumb, index finger, middle finger, middle of the palm, and back of the hand.
What is the fx of PET(possitron emission tomography) scan
- FX of brain - glucose and oxygen metabolism - cerebral blood flow
Collaborative management of SIADH
- Fluid restriction - Increased sodium intake - Drug therapy with demeclocycline that works in opposition to antidiuretic hormone
The steps to Malignant transformation.
- Initiation - Promotion - Progression - Metastasis
Initiation
- Mutation of genetic structure - Has potential to develop into clone of neoplastic cells
Per Mary, name brain death criteria:
- NO reflexes - NO stimuli response - absent RR - Flat EEG - GCS score of 3
Pt teaching prior to 2-3 hour PET scan:
- NPO night before for am test - NPO 4 hours prior for afternoon testing - diabetics have test in am BEFORE taking meds - blindfold or ear plugs ok to wear during procedure - pt will be asked to perform mental fx to activate parts of brain - 2 IV lines will be inserted
Process of getting PET scan:
- PT injected w/ IV deoxyglucose tagged to isotope
DECEREBRATION is r/t brainstem problem:
- abnormal rigid posturing - pronation of arms out- elbows in - opisthotonos = body spasm body bowed forward
FX of cerebral angiography with contrast medium is to detect:
- aneurysms - traumatic injuries - strictures/occulsions - tumors - blood vessel displacement from edema - AV malformations (congenital tangle)
DECORTICATION is r/t lesions that interrupt corticospinal pathways:
- arms,wrist,fingers flexed with internal rotation - plantar flexion (toes down- like ballarina)
What other NI for follow up care after cerebral angiography w/ contrast dye:
- assess VS & neuro signs - increase oral or IV fluids UNLESS contraindicated - monitor for late allergy response to dye
CT can distinguish between:
- bone - soft tissue (brain, ventricles, vascular sys) - fluids (CSF or blood)
MRI is contraindicated in pts with:
- cardiac pacemakers - implanted device like vascular stents - confused & agitated - unstable VS - older tattoos (may have lead) - continuous life support
Pt care follow up post cerebral angiography from femoral artery:
- check dressing for bleeding/ swelling - apply ice to site - keep extremity STRAIGHT/ IMMOBILIZED - pressure dressing for 2 hours
What extremity checks are done distally from insertion site of catheter for cerebral angiography:
- circulation - color,temp of skin - pulses - capillary refill
Per Mary, S/S of cognition or Level of consciousness:
- confusion - delirium - obtundation= take a strong stimulus to awaken
Plain Xrays of skull or spine are used to r/o:
- fractures - curvatures - bone erosion - bone dislocation - calcification of s/t leading to damage of nervous sys
S/S of increased ICP:
- headache - N&V - photophobia - change in level of consciousness
Per Iggy, S/S of altered mental status:
- headache - restlessness - irritability - slurred speech - unusually quiet - change in level of orientation
What are some complications post lumbar puncture:
- increased ICP - CSF leakage around needle insertion site - infection - hematoma= collection of blood outside a blood vessel into tissues
Role of isotope in PET scan:
- isotope emits activity in form of positrons - more activity of brain = increased uptake of glucose
What if bleeding is present by the groin post cerebral angiography?
- manual pressure on site and notify MD asap
NI for MRI procedure:
- no metal objects in MRI room - removal metal jewelry, hair pins, pens, watches - verify w/ radiologist about tattoo - ensure pt, self, and all equip have NO metal
Nursing Interventions for use of contrast dye:
- notify MD if pt has risk factor for renal failure - Creatinine levels greater than 1.5 mg/dl are at risk for renal failure - document date, time, name of phys or NP that was advised of allergies and their actions prescribed
Which pts may not be candidates for PET scan:
- older adults - psyc pts
EEG is used to determine:
- origin of seizure - cerebral fx w/ pathological disease - organic and hysterical or feigned blindness/deafness - brain fx during surgical anesthesia - DX sleep disorder (24 hour EEG) brain death
What are the risk factors for contrast induced renal failure (nephropathy):
- pre-existing renal disease - diabetic neuropathy - heart failure - dehydration
Name important points to advise pt with cerebral angiography with contrast dye (pg 944):
- pt head is IMMOBILIZED during procedure - do NOT move during procedure - warm,hot sensation as dye injected is normal - you will be conscious able to talk to MD; inform if any pain
If EEG sleep deprived order:
- pt must wake up 2 or 3 am and stay awake rest of day
Lumbar puncture (spinal tap) is contraindicated in ____ d/t sudden release of CSF pressure:
- pts with S/S of icnreasing ICP
Pt care follow up post PET scan:
- radioisotope eliminated in urine - no special precautions - increase pt fluid intake unless contraindicated
Pt teaching about EEG:
- recline on bed or chair in quiet room - 16 to 24 electrodes placed on head - lie still with eyes CLOSED during initial recording - no caffeine day of test - EEG test NOT dangerous or uncomfortable - wash hair morning of test; no oils or sprays on hair; no hairpins
Prior to cerebral angiography with contrast dye:
- removal of dentures & hearing aids - ask pt about allergies to shellfish or iodine dye - NPO for 4 to 6 hours prior
NI for pts undergoing CT scan:
- remove all haripins, hairpiece or wig - scanner may make noise or rocking sound - pt will be able to communicate with MD during procedure
CT (computed tomography) can r/o :
- tumors - infarctions - hemmorhage - hydrocephalus - bone malformations
Post lumbar puncture NI:
- vitals & neuro checks - Bedrest; pt remains flat - pt increase fluid intake unless contraindicated - provide drug for headache relief: inform MD if headache dies not go away
Pt Prep for PET scan:
- withold caffeine, tea, alcohol, tobacco 24 hours prior to test - No insulin prior to test for diabetics - No glucose solutions or other drugs that alter glucose metabolism
triage
-"To sort" -Process of rapidly determining patient acuity -Represents a critical assessment skill
Drugs for Migraine Headache Beta Blockers:
---Propranolol/Timolol
Status epilepticus
-A state of constant seizure OR -A condition in which seizures recur in rapid succession without return to consciousness between seizures - A medical emergency
Drugs for Migraine Headache • Non-specific analgesics:
-Acetaminophen -Butalbital
Drugs for Migraine Headache Triptan Preparations:
-Almotriptan (Axert) -Sumatriptan (Imitrex) -Isometheptene
Active external rewarming
-Body-to-body contact -Fluid- or air-filled warming blankets, radiant heat lamps
interventions to enhance elimination
-Cathartics (e.g. sorbitol) -Whole-bowel irrigation -Hemodialysis -Antidote *Poison related*
• Tonic-clonic seizures (grand mal)
-Characterized by loss of consciousness and falling -Body stiffens (tonic) with subsequent jerking of extremities (clonic) -Cyanosis, excessive salivation, tongue or cheek biting may occur -Postical phase for tonic-clonic characterized by muscle soreness, and fatigue; --Patient may sleep for hours -May not feel normal for days -No memory of seizure Keep accurate notes to describe!!!
Drugs for Migraine Headache Antiepileptic Drugs:
-Depakote -Topamax p. 953 Table 44-1
Drugs for Migraine Headache Non-steroidal anti-inflammatory (NSAIDs):
-Ibuprofen -Naproxen
Possible etiology of seizures related to extracranial disorders
-Liver -Systemic lupus erythematosus -Diabetes mellitus -Septicemia
emergencies
-MVA-Abdominal Injuries -Crushing Injury -Wounds -Bite wound -Temperature injuries (heat emergency, mild hypothermia, moderate hypothermia, severe hypothermia, frost bite) -Drowning -Anaphylaxis -Ingestion Injuries -Psychiatric (overactive/violent behavior, suicidal)
Passive external rewarming
-Move patient to a warm, dry place -Remove damp clothing -Place warm blankets on patient
EMTALA (Emergency Medical Treatement and Active Labor Act)
-Prevents "patient dumping" -Medical screening examination will be performed before a patient presenting to the ER is questioned about their ability to pay. -The patient must be stabilized at the facility and transferred when stable -Cannot refuse to treat pt
Preparation for Terrorism
-Recognition and awareness -Personal protective equipment (PPE): diff lvls -Decontamination
active core rewarming
-Use of heated, humidified oxygen -Warmed IV fluids -Peritoneal, gastric, or colonic lavage with warmed fluids
Aura may include sensory field & motor dysfunction such as:
-Visual field defects -Tingling or burning sensations -Paresthesias -Weakness -Paralysis
Pt teaching of lumbar puncture:
-some discomfort when local anesthetic injected - pain in leg possible when needle inserted
Migraine Headaches may be precipitated/triggered by what?
-stress, excitement -bright lights, menstruation -alcohol, or certain foods
Monoclonal antibodies
...
The clinician then touches the patient in two places on the same extremity with two objects, such as cotton-tipped applicators. A person can normally identify two points fairly close together depending on the location of the stimuli. When an area is heavily innervated, the two-point discrimination will feel closer.
...
The serial-seven test to determine attention may also be used. The patient is asked to count backward from 100 by 7 (the examiner stops when the patient reaches 65 successfully). Depending on education and other factors, it may be better to ask the person to subtract by three or to add forward by five.
...
What are the personnel roles for disaster management?
...
Atherosclerosis
... a type of arteriosclerosis, involves the formation of plaque within the arterial wall and is the leading risk factor for cardiovasuclar disease. Exact pathophysiology is not known.
Clinical manifestations of a hypertensive crisis are...
... headache Seizures Nausea Stupor and Coma Blindness/Blurred vision Nausea/Vomiting Confusion Renal insufficiency
A BP less than 90/60 mm Hg
... this reading may be inadequate for providing proper and sufficient nutrition to body cells.
Blood Pressure (BP)
...= Cardiac Output x Peripheral Vascular Resistance
Ischemic Stroke
...Accounts for 80% of all strokes, and is the result of inadequate blood flow to the brain.
Prehypertension
...Includes BP readings of 120 to 139 mm Hg systolic, or 80 to 89 mm Hg diastolic without antihypertensive drug therapy.
Hypercalcemia
...Occurs most often in clients with bone metastasis
Preload
...Refers to the degree of myocardial fiber stretch at the end of diastole and just before contraction.
Heart Rate (HR)
...Refers to the number of times the ventricles contract each minute.
Impedance
...The peripheral component of afterload; The pressure that the heart must overcome to open the aortic valve.
Tumor Angiogenesis Factor (TAF)
...Triggers capillaries and other blood vessels in the area to grow new branches into the tumor.
Arteriosclerosis
...a thickening or hardening, of the arterial wall that is often associated with aging.
Hyperlipidemia
...an elevation of serum lipid levels
Hypercapnia
...an increase in partial pressure of arterial carbon dioxide and acidosis.
Benign Cells
...are normal cells growing in the wrong place or at the wrong time.
• Akinetic, atonic, and astatic seizures:
...are used interchangeably for drop attacks and fainting spells • This type of seizure involves tonic episode or paroxysmal loss of muscle tone and person falls • Consciousness usually returns by time the person hits the ground and can resume normal activity • Great risk for head injury
Ankle-Brachial Index (ABI)
...can be used to assess the vascular status of the lower extremities. A BP cuff is applied to the lower extremity just above the malleolus.
Staging of Cancer
...classifies clinical aspects of the cancer and determines exact location and degree of metastasis at diagnosis.
Hypertensive Crisis is...
...defined as an severe and ABRUPT elevations of diastolic BP of 120-130
Euploid
...is a feature of most normal human cells. These cells have 23 pairs of chromosomes, the correct number for human beings.
Normal BP
...is a systolic BP less than 120 mm Hg and diastolic pressure less than 80 mm Hg.
Paradoxical blood pressure
...is an exaggerated decrease in systolic pressure by more than 10 mmHg during the inspiratory phase of the respiratory cycle (normal is 3 to 10 mm Hg).
Neoplasia
...is any new or continued cell growth not needed for normal development or replacement of dead and damaged tissues. p. 400.
Hypertrophy
...is cell growth that causes tissue to increase in size by enlarging each cell.
Hyperplasia
...is growth that causes tissue to increase in size by increasing the number of cells.
Stroke Volume (SV)
...is the amount of blood ejected by the left ventricle during each contraction.
Diastolic BP
...is the amount of pressure/force against the arterial walls during the relaxation phase of the heart.
Glasgow Coma Scale (GCS)
...is used in many health care settings as a reliable measure of neurological assessment. The highest possible score for which is 15.
Spinal Cord Compression
...is when a tumor directly enters the spinal cord or the vertebrae collapse from tumor degradation of the bone.
Baroreceptors
...located in the arch of the aorta and at the origin of the internal carotid arteries, they are stimulated when the arterial walls are stretched by an increased BP.
Toe Brachial Pressure Index (TBPI) * Iggy; 706-709, 716
...may be performed instead of or in addition to the ABI to determine arterial perfusion in the feet and toes.
Carcinogenesis & Oncogenesis
...names for cancer development.
Metastasis
...occurs through a progression of steps: - Extension into surrounding tissues - Blood vessel penetration - Release of tumor cells - Invasion - Local seeding - Blood-borne metastasis - Lymphatic spread
Grading of Malignant Tumors
...on the basis of cell appearance and activity compares the cancer cell with its normal parent tissue.
Thiazide Diuretics
...prevent sodium ans water reabsorption in the distal tubules while promoting potassium excretion.
Apoptosis
...programmed cell death. Cancer cells do not respond to signals for this.
Loop Diuretics...
...such as furosemide (Lasix), depress sodium reabsorption in the ascending loop of Henle and promote sodium and potassium excretion.
Systolic BP
...the amount of pressure/force generated by the left ventricle to distribute blood into the aorta with each contraction of the heart. It is a measure of how effectively the heart pumps and is an indicator of vascular tone.
Cytokines
...these enhance the immune system.
Arteries
...transport the cellular wastes to the excretory organs (e.g., kidneys and lungs) to be reprocessed or removed. Also contribute to temperature regulation in the tissues.
Living Will
...written instructions for what life-sustaining treatment a person does or does not want at some time in the future if he or she becomes unable to make decisions about end-of-life care.
Normal levels of creatinine in blood:
0.6 to .12 mg/dl
What are 4 references to LOC:
1. alert = awake and responsive 2. Lethargic = drowsy but easily awakened 3. Stuporous= arousable only with painful stimulation 4. Comatose = unconsciousness and cannot be aroused
What are the 3 criteria measured in Glasgow Coma Scale:
1. eye opening 2. motor response 3. verbal response
What are the 3 parameters measured during EEG:
1. hyperventilation = induce seizure 2. photic stimulation = strobe light 3. sleep = natural or induced
Methods of applying painful stimuli to arouse a patient:
1. supraorbital pressure 2. trapezius muscle squeeze 3. mandibular jaw pressure 4. sternal (breastbone) rub
Ativan or Dilantin
10-15% of stroke victims will have seizures usu w/in 24 hrs. What drugs can be given for anti-seizures?
hyperthermia
103 deg cool water sponge bath
What is the fluid resusc for children?
10ml/kg
We have ____ PAIRS of cranial nerves and ____ PAIRS of spinal nerves.
12; 31
What is the blood loss to fluid resuscitation to give?
1:3
What is the ratio for blood loss to blood replacement?
1ml/1ml
Burns (Superficial Burns)
1st degree injure only the epidermis. may be pink and painful but generally heal in 3 to 6 days
65 55
2/3's of all strokes happen to those over what age? Risk doubles every decade after how many years of age?
How much of the bodies glucose and O2 does the brain use?
20% O2, and 25% glucose
How much does the Hct drop with every unit of blood?
3% drop
What is the onset age for Huntington's Dz?
35-45
What are the contributing factors with migraine HAs?
3X more women then men, often before menstrual cycle, attack precipitated by triggers
A desirable HDL-C level
40 mg/dL or above
What is a cluster HA?
5X more common in men, cluster of 1-8/day (same time of day), occurs for 6-8 wks (cyclical), starts behind one eye (excruciating pain), may be half of head & face, sweating, tearing flush, onset associated with sleep relaxation, client walks/paces/rocks during pain, vascular HA
Which patients need a more thorough dx study?
>50 w/ osteoporosis, immunosuppression, long term use of steroids, IV drug abusers
forensic
A _______ nurse is a nurse with specialized training in forensic evidence collection, criminal procedures, legal testimony expertise, and more.
Hemorrhagic Stroke
A burst blood vessel in the brain with bleeding into the brain; accounts for 15% of all strokes.
sorbitol
A cathartic commonly used to enhance elimination of ingested poisonous substances. If activated charcoal is ordered, this should be given with the first dose of activated charcoal to stimulate intestinal motility/increase elimination.
With or without consent?
A client that is unconscious is unable to provide information or consent, and the necessity for timely intervention is a special circumstance when treatment may be provided immediately and consent obtained at a later time.
Afterdrop
A decrease in body temperature observed as a complication during rewarming of a hypothermic patient. It is believed to be the result of redistribution of cooler blood.
Activated Charcoal
A form of carbon that has been processed to make it extremely porous and thus to have a very large surface area available for adsorption or chemical reactions. Due to its high degree of microporosity, just 1 gram of activated carbon has a surface area in excess of 500 m2 (about one tenth the size of an American football field), as determined typically by nitrogen gas adsorption. Sufficient activation for useful applications may come solely from the high surface area, though further chemical treatment often enhances the adsorbing properties of the material. This is usually derived from charcoal.
Carotid Endarterectomy
A frequently used procedure; It is the removal of atherosclerotic(atheromatous?) plaque from the inner lining of the carotid artery.
Ewald tube
A gastric tube used for emptying the contents of the stomach named after a German gastroenterologist who lived from 1845-1915.
Cigarette smoking
A major modifiable risk factor for CVD, specifically CAD and peripheral vascular disease (PVD)
The left brain The right brain
A patient who is suffering... - Impaired speech/language aphasias - Impaired right/left discrimination - Slow performance, cautious - Awareness of defecits, depression, anxiety - Impaired comprehension in relation to language, math ...has recently had damage to which side of the brain? In contrast, a person who is displaying signs of - Left sided neglect - Spacial perceptual defecits - Tending to deny or minimize problems - Rapid performance, short attention span - Impulsiveness, safety problems - Impaired judgement - Impaired time concepts ...has recently had damage to which side of the brain?
High risk situation
A patient with a ______ ______ _____ is a patient you would put in your last open bed.
Palliative Care
A philosophy that provides a compassionate and supportive approach to clients and families who are living with life-threatening illnesses. A holistic approach that does not hasten or postpone death, but provides relief of symptoms experienced by the dying client while providing emotional and spiritual support to improve the quality of care at the end of life
...constantly monitored for aspiration including coughing, dyspnea, and cyanosis.
A plan of care for "Impaired Swallowing" requires that the patient be...
Malignant Hypertension
A severe type of elevated BP that rapidly progresses
The left side. Left sided hemiplegia.
A stroke affecting the right side of the brain effects which side of the body?
Thrombotic Stroke
A subcategory of Ischemic strokes that accounts for more than half of all strokes.Commonly associated with the development of atherosclerosis (plaque development on the inner wall of a blood vessel). A clot FORMS and interrupts blood flow to the brain tissue. MOST COMMON CAUSE.
Hypertension
A systolic pressure of 140 mm Hg or higher, or a diastolic pressure of 90 mm Hg or higher, or taking drugs to control BP.
Bruit
A turbulent swishing sound in larger arteries that is considered abnormal.
Primary Survey
A(airway), B(breathing), C(circulation), D(disability), Expose/prevent hypothermia
After seizure care
ABCs; suction, take VS, Check O2 sat, glucose level, serum level q6-12 hours for therapeutic level of meds; check for injury, reorient patient, stay until lucid, document episode detailed
Dry drowning tests
ABG BMP
Level 0=Full self-care (completely independent) Level 1=Requires use of equipment or device Level 2=Requires assistance or supervision of another person. Level 3=Requires assistance or supervision of another person and equipment or device. Level 4=Is dependent and does not participate.
Ability to successfully achieve ADL's are scored from Level 0 to Level 4. What do these different levels mean?
Decerebration
Abnormal posturing and rigidity characterized by extension of the arms and legs, pronation of the arms and plantar flexion; usu assoc w/ dysfuntion in the brainstem.
Decortication
Abnormal posturing seen in client with lesions that interrupt cortispinal pathways; arms, wrists, and fingers are flexed with internal rotation and plantar flexion of the legs.
The inability to shake your head "no" may result from damage to the:
Accessory nerve
APN
Advanced Nurse Practitioner
ACLS
Advanced cardiac life support) specialized training course that prepares healthcare professionals to perform advanced lifesaving skills and techniques on clients. Standardized by AHA
Myocardial contractility
Affects stroke volume, and CO, and is the force of cardiac contraction independent of preload.
Nonmodifiable (uncontrollable) risk factors
Age, gender, ethnic background, and family history of CVD are all...
What is the primary survey?
Airway, Breathing, Circulation,
What are some LOC terms?
Alert: awake and responsive, Lethargic: drowsy, sleepy, easily awakened, Stuporous: arounsed only with vigorous or painful stimulation, comatose: unconscious and can't be aroused
Transient Ischemic Attack (TIA)
Also called a "silent stroke", this is a warning sign to an actual Ischemic stroke. Multiple occurrences indicate a high stroke risk.
gastric lavage
Also commonly called stomach pumping or Gastric irrigation, is the process of cleaning out the contents of the stomach. It has been used for over 200 years as a means of eliminating poisons from the stomach. Such devices are normally used on a person who has ingested a poison or overdosed on a drug or consumed too much alcohol. They may also be used before surgery, to clear the contents of the digestive tract before it is opened. It is sometimes used to confirm levels of bleeding from the upper gastrointestinal tract. It may play a role in the evaluation of hematemesis. It can also be used as a cooling technique for hyperthermic patients.
What are the related nrg dx for brain tumors?
Altered cerebral tissue perfusion, Pain r/t ICP & HA, Risk for injury, Anxiety/fear, impaired physical mobility, impaired verbal communication, sensory perceptual alterations, self care deficits, care giver role strain
What are the nrg dx for Alzheimers?
Altered thought process r/t neuronal degeneration, deficient diversional activity r/t decreased attention span, risk for injury r/t impaired judgement, restlessness and wandering, self care deficit, risk for imbalanced nutrition, risk for ineffective coping, respite care for family
cathartic
An agent for purging the bowels, especially a laxative; "fit for cleansing, purgative," from katharsis "purging, cleansing"; evacuating the bowels; purgative
Hospice Care
An interdisciplinary approach facilitates both quality of life and a peaceful death for clients who are nearing the end of their lives.
emergency medical system (EMS)
An organized and coordinated system of pre-hospital providers, ground and air ambulances, and hospital emergency departments. Includes EMT, paramedic, 911, police, fire rescue.
Afterload
Another factor affecting stroke volume... the pressure or resistance that the ventricles must overcome to eject blood through the semilunar valves and into the peripheral blood vessels.
Bleeding
Apply pressure Dont remove objects
Impaired swallowing
Aspiration Pneumonia Decreased Weight Impaired Oral Hygiene & Decreased Foot and Fluid intake Can all be caused by...after a stroke. Pg. 1041 in Iggy
saltwater
Aspiration of _________ -> Sodium draw fluid into alveoli -> Surfactant destruction, Alveolitis, Destruction of alveolar-capillary membrane -> Respiratory failure
freshwater
Aspiration of _________ -> Water rapidly leaks to capillary bed and circulation -> Surfactant destruction, Alveolitis, Destruction of alveolar-capillary membrane -> Respiratory failure
Use the stick figure to test what?
Asymmetry of reflexes: 0 = absent, no response; 1(+) = weaker than normal, hypoactive; 2 (+ +) = normal; 3 (+++) = stronger or more brisk than normal; 4 (++++) = hyperactive
What are migaine symptoms?
Aura, HA, Lasts 4-72 hours, may be debilitating, temporary neuro changes
Tx of Cluster HA (not meds)
Avoid ETOH, get reg sleep
Bioterrorism and Terrorist Attacks
Bacillus anthracis (anthrax) Brucella organism (brucellosis) Yersinia pestis (plaque) Francisella tularensis (tularemia)
BLS
Basic Life Support basic life saving skills and techniques such as CPR, abdominal thrust and defibrilation
Thiazide diuretics
Because of the lower cost and effectiveness of these type diuretics, they are usually the drugs of choice for patients with uncomplicated hypertension, as a single agent or in combination with other classes of drugs. However, teach men that use of these may lead them to experience decreased libido, and decreased sexual performance.
Confidentially
Before receiving treatment in the EC or UC setting the client must sign consent for treatment and confidentiality forms. If the client is unable to sign a legal responsible party or power of attorney may sign consent forms\. Forms include valuables, procedures and HIPAA. All forms must be signed and in the chart.
A desirable LDL-C level
Below 100mg/dL for healthy people, and below 70 mg/dL for those diagnosed with CVD or who are diabetic
What are meningiomas?
Benign and slow growing, encapsulated; arises from meninges (especially dura), women, elderly; complete removal possible
Men have a higher risk for CAD than women of all ages, except in the oldest age-group of 80 years and older.
Between Men and Women, who has a higher risk for Coronary Artery Disease (CAD)?
Cardiac Output (CO)
Blood flow from the heart into the systemic arterial circulation is measured clinically as...
Deformity of the hand which to take first a blue hand or a broke hand.
Blue hand due to lack of oxygen/circulation
More vulnerable to fracture.
Bone exposed to radiation is what?
VI Abducens Nerve
Book: Motor - Eye movement via lateral rectus muscles; Mine: Motor AND Sensory (as in some propriorecption) - Eyeball (turns eye laterally - outward?)
IV Trochlear Nerve
Book: Motor - Eye movement via superior oblique muscles; Mine: Motor (some extrensic eye muscles) AND Sensory (as in proprioreception) innervates superior oblique, turns eye downward and laterally - inward?
XI Accessory Nerve
Book: Motor - Skeletal muscles of the pharynx and larynx and sternocleidomastoid and trapezius muscles; Mine: Motor - Swallow and move head (using neck muscles; head turning/shoulder shrugging); Sensory (as in some propriorecetpion) (think "necklace" b/c a necklace is an accessory item and we ware it on neck) (controls trapezius & sternocleidomastoid; controls swallowing movements)
XII Hypoglossal Nerve
Book: Motor - Skeletal muscles of the tongue; Mine: Motor - tongue (swallow AND speak) (tongue movement) (hypo: under) (gloss: tongue); Sensory (as in some proprioreception) (controls tongue movements)
VIII Vestibulocochlear Nerve (auditory) (aka Acoustic)
Book: Sensory - Hearing Equilibrium; Mine: Sensory; Vestib=equilibrium; Coch=Hearing; (hearing, equilibrium, sensation) (hearing and equilibrium/balance)
VII Facial Nerve
Book: Sensory - Pain and temperature from ear area; deep sensations from the face; taste from anterior two thirds of the tongue; Motor - Muscles of the face and scalp; Parasympathetic motor - Lacrimal, submandibular, and sublingual salivary glands; Mine: Motor AND Sensory (as in some proprioreception) - controls most facial expressions secretion of tears & saliva, taste (smiling/blowing out cheeks)
X Vagus Nerve
Book: Sensory - Pain and temperature from ear; sensations from pharynx, larynx, thoracic and abdominal viscera; Motor - Muscles of the soft palate, larynx, and pharynx; Parasympathetic-motor - Thoracic and abdominal viscera; cells of secretory glands; cardiac and smooth muscle innervation to the level of the splenic flexure; Mine: (Gag and swallow) Motor: Parasympathetic for lungs, heart, upper GI tract, glands, sensory, some organs; Vagus is the only one not soley for servicing the head and neck) (senses aortic blood pressure; slows heart rate; stimulates digestive organs, taste)
IX Glossopharyngeal Nerve
Book: Sensory - Pain and temperature from ear; taste and sensations from posterior one third of tongue and pharynx; Motor - Skeletal muscles of the throat; parasympathetic-motor - Parotid glands; Mine: Motor: Saliva (think glossy tongue) (swallowing), sensory info is taste (info comes from tongue) and BP (b/c of the "pharyngeal" part and carotid artery being in neck - how we can know if too much or too little blood is getting to brain) (taste, senses carotid blood pressure)
V Trigeminal Nerve
Book: Sensory - Sensation from skin of face and scalp and mucous membranes of mouth and nose; Motor - Muscles of mastication (chewing); Mine: Divides in 3: (1) index finger: Opthalmic - Sensory - forehead, eyelid, upper part of nose, corneal reflex - blink; (2) Middle Finger: Maxillary - Sensory - nasal cavity, upper teeth and upper lip, LOWER eyelid (face & mouth, touch & pain)
Lab tests
CBC Triponin CK-MB Chest Pain, Heart Attack BMP Basil Metabolic Panel CMP Comprehensive metabolic Panel Liver enzymes ALT AST ABG's Other Diagnostic xray CT kidney function
Base line tests looking for infectious diseases
CBC with a differential count Sed Rates pinpoints inflammation and infectious disease parimeters.
What kind of assessment needs to be done with musculoskeletal injuries?
CMS, compare extremeties
If client has no pulse
CPR is done Immediately 30 compressions for every 2 breaths revised guidlines also recommend that emergency personnel cool the body tem of cardiac arrest clients to 90F for 12 to 24 hours
During times of inadequate tissue perfusion during cardiac arrest
CPR provides core circulation of blood to the organs to sustain life during times of pulselessness.
How do we dx basilar skull fracture?
CSf in nose and ears, complications are infection and cranial nerve damage
Claustrophobia must be r/o for pt getting a __
CT - sedation may be required
If bleeding is the ONLY concern (trauma pt), CT __ scans are usually NOT used
CT contrast
PET has the same level of radiation exposure as 6 xrays but less than:
CT scan
What is the dx for seizure disorders?
CT, EEG, EEG with closed circuit TV, telemetry on scalp
Disrupting the physiologic process.
Cancer can cause death by metastasizing (spreading) into vital organs and doing what?
Embolic Stroke
Caused by a clot or group of clots that break off from one area of the body and travel to the cerebral arteries via the carotid artery or Vertebrobasilar system.
...die outright, or become unable to divide.
Cells damaged by radiation...
Sudden Onset Secondary HAs could be indicative to what?
Cerebral aneurysm, may be a CVA "Worst headache I've ever had"
Pronator drift
Cerebral motor or brainstem integrity may also be assessed. Ask the patient to close his or her eyes and hold the arms perpendicular to the body with the palms up for 15 to 30 seconds. If there is a cerebral or brainstem reason for muscle weakness, the arm on the weak side will start to fall, or "drift," with the palm pronating (turning inward). This is called a ______ ______.
collected, labeled, sealed, documented, lab
Chain of custody for handling forensic evidence: -Specimens are ______, ______, and ______ -Persons handling and receiving specimen(s) is _______ until specimen reaches the _____
What is the theory of Migraine HAs?
Change in blood vessel activity due to dopamine and or serotonin activation, its ancascade inflammatory
8, 40, 52, otitis media, chest pain, upper respiratory infection, abdominal pain, 79, 6, transferred died
Characteristics of Clients Using the ED: Type of patients: -___% of the cases were emergent -___% being urgent -___% non-emergent Top four diagnoses were _____ _____, ______ ______, _______ _______ _______, and __________ _______ Disposition: -___% were discharged to home -___% were admitted to the hospital -Remaining were _________ to another facility or _______.
Promotion
Characterized by the REVERSIBLE proliferation of altered cells. Activities of ... (e.g. obesity, smoking, alcohol) are reversible
Progression
Characterized by... - Increased growth rate of tumor - Invasiveness and metastasis - Development of its own blood supply is critical for survival - Tumor angiogenesis (TAF)
What are the meds for Alzheimers?
Cholinergic drugs it inhibits the breakdown of acetylcholinesterase (tacrine, donepezil), Antideppressants (amitryptiline)
What are the symptoms of Huntingtons Dz?
Choreiform movements (involuntary jerking), Emotional disturbances (depression), metal deterioration
- Oral hydration - Drug therapy - Dialysis
Collaborative management of Hypercalcemia includes:
- Prevention (the best measure) - Intravenous antibiotic therapy - Anticoagulants, cryoprecipitated clotting factors
Collaborative management of Oncologic Emergencies includes:
...high-dose radiation therapy, but surgery only rarely.
Collaborative management of Superior Vena Cava Syndrome includes...
- Prevention - Hydration - Drug therapy
Collaborative management of Tumor Lysis Syndrome includes what?
Systole
Consists of the contraction and emptying of the atria and ventricles.
Safety The EU and UC settings create safety concerns for clients and staff.
Contagious diseases Fainting/Falls Loss of blood Fractures.
Diminished bowel sounds, Paralytic ileus, Ingestion of substance poorly absorbed by charcoal
Contraindications to using activated charcoal. (DPI)
Bad thing about CPOE
Could take away secretary's job
What is the peripheral nervous system made up of?
Cranial nerves, spinal nerves: ANS:Sympathetic and Parasympathetic nervous system
What is a CISD?
Critical Icident Stress Debriefing (strictly confidential, 2-3 specially trained, 1-3 hrs, food, questions, tell your story
Cervical Spine Alignment
Cspine manual maneuver performed by an individual to maintain the client in proper spinal alignment. Most often requires application of a riged cervical stabilizing collar and towel rolls. "Soft collar isn't recommended in stabilizing Cspine"
Signs of respitory distress
Cyanosis Decreased O2 sat increased Respirations (tachypnea) Mneumonic C DIRT
How do we assess reflexes?
DTRs, pt needs to relax, cutaneous reflexes (plantar and abdominal)
180, 50, 160, 40, 140, 30, 100, 20
Danger Zone Vitals: Age HR RR SaO2 <3mo >___ >___ <92 3mo-3yr >___ >___ <92 3-8yr >___ >___ <92 >8yr >___ >___ <92
drowning
Death from suffocation after submersion in water.
family, non-heart beating
Death in the Emergency Department -Follow hospital rituals when caring for ________ (e.g., collecting belongings, viewing the body) -Determine if the patient is a candidate for ________ _______ donation. Tissues and organs (e.g., corneas, heart valves, skin, bone, kidneys)
Epilepsy
Defined as two or more seizures experienced by a person. • A condition in which a person has spontaneously recurring seizures caused by an underlying chronic condition
Stroke
Defines a disruption in the normal blood supply to the brain.
Postural (Orthostatic) Hypotension
Definition for a decrease of more than 20 mm Hg of the systolic pressure or more than 10 mm Hg of the diastolic pressure, as well as a 10% to 20% increase in heart rate.
Emetogenic
Definition of vomiting inducing.
Cachexia
Definition of wasting & malnutrition.
Secondary Survey
Definition: Brief, systematic process to identify all injuries -Exposure/Environmental control -Full set of vital signs/Five interventions/Facilitate Family presence -Give comfort measures -History and Head-to-toe assessment -Inspect the posterior surfaces
forensic
Definition: belonging to, used in, or suitable to the courts or to public discussion and debate; relating to or dealing with the application of scientific knowledge (as of medicine or linguistics) to legal problems
caustic
Definition: capable of destroying or eating away organic tissue and especially animal tissue by chemical action (i.e. nitrate and sulfuric acid)
vesicant
Definition: producing a blister or blisters, as a medicinal substance; (in chemical warfare) a chemical agent that causes burns and destruction of tissue both internally and externally.
Goals of MCI
Do the greatest good for the greatest number. No heroic measures. It uses up too much time and resources. Manage limited resources Do not relocate the disaster
Immunotherapy
Drugs that modify the body's responses to tumor cells, fall under this category.
Chest pain
EKG tests troponin levels creatinine phosphokinase, lactase dehydrogenase, electrolytes
Poisining
Eliminate poisining Identify poisining monitor tournequette not to the point of stopping circulation can get serum sickness from antibody
double
Emergency and MCI: Total number of casualties expected = _______ number of casualties that arrive in the first hour
EDIS
Emergency data information systems
What are the guidelines for prioritizing?
Emergent, Urgent, Non-urgent, expectant
Nose bleeds
Epitaxis Generally treated with cold packs to the nose and check for 10 to 20 minutes Pinch nose and lean forward
Labs, ECG, X-rays, CT-MRI-ultrasound-angiography, IV, medications, specialty
Examples of Resources: (LEXCIMS) -_______ -_______, _______ -____________________ -___ fluids (hydration) -IV or IM or nebulized _________. -________ consultation
What are the dx studies for blood loss and trauma?
FAST, DPL (dx peritoneal lavage), CT, xray, MRI
What is FBSS?
Failed back surgery syndrome, patient not happy; complex combo of organic, psychological, sociological and socioeconomic factors
Manifestations of Hypercalcemia
Fatigue, loss of appetite, nausea and vomiting, constipation, polyuria, severe muscle weakness, loss of deep tendon reflexes, paralytic ileus, dehydration, electrocardiographic changes; are all what?
Box 47-4
First AID
Emergency Severity Index
Five-level triage system that incorporates illness severity and resource utilization. This triage sorts patients based on these assessment questions: A. Requires immediate life-saving interventions? Y/N B. High-risk situation? or Confused/lethargic/disoriented? or Severe pain/distress? Y/N C. How many different resources are needed? None/One/Many->D. Danger zone Vitals
HYPOVOLEMIC SHOCK
Fluid loss, bleeding, burns, fluid and electrolyte imbalances related to excessive diarrhea or vomiting or sepsis from trauma or injury. Very Pale (clammy) ex Burns S/S Pallor Diaphresis= sweating Hypotension Oliguria decreased urine Tachycardia Tachypnea LOC Level of Conciousness MNEUMONIC LOC PD HOTT
The staff is responsible for
Following protocols for standards of privacy and consent for treatment.
%What are some causes of HA?
Foods, stress, lack of sleep, sinus congestion, allergies, hormones, overeating, ETOH, fumes, illness, noise
Burns (FULL THICKNESS)
Full thickness 3rd degree burns blackened, charred, and white to leatherly Dermis Epidermis, and Subcutanous is involved
4=Spontaneous 3=To sound 2=To pain 1=Never
GCS scores in regards to eye openings? 4=? 3=? 2=? 1=?
6=Obeys commands 5=Localizes pain 4=Normal flexion (withdrawal) 3=Abnormal flexion 2=Extension 1=None
GCS scores in regards to motor responses? 6=? 5=? 4=? 3=? 2=? 1=?
5=Oreinted 4=Confused Conversation 3=Inappropriate words 2=Incomprehensible sounds 1=None
GCS scores in regards to verbal responses? 5=? 4=? 3=? 2=? 1=?
Migraine with and without aura can include:
Generalized edema, irritability, pallor, nausea and vomiting, and sweating may occur
charcoal intestinal
Give cathartics with first dose of _______ to stimulate _______ motility/increase elimination
What is the drug for Lou Gehrig's Dz>
Glutamate Blocker called Riluzole which prolongs life before tracheostomy and ventilators needed, **toxic to liver monitor LFTs**, rest of care is supportive and palliative (emotional support, muscle relaxants, etc)
relocate
Goals of MCI: Do not _______ the disaster. Prioritize at the scene.
good, number
Goals of MCI: Do the greatest _____ for the greatest ______.
personnel, equipment, facilities
Goals of MCI: Manage limited resources. Central command coordinates the use of ________, ________, and ________.
heroic, time, resources
Goals of MCI: No _______ measures. I uses up too much ______ and ______.
Foods linked with cancer prevention.
Green Tea, Soy, Tomatoes, Grapes, Chocolate
water saline, Decontamination
Guidelines for non-ingested poison emergencies: -Dermal cleansing/eye irrigation with _____ or _____. -____________ takes priority over all interventions except basic life support measures
PO, NGT OGT 60, absorbs neutralizes, before, during, shortly
Guidelines for using activated charcoal in poison emergencies: Administer _____ or via ____/____ within ___ minutes of poison ingestion. Charcoal ______/______ antidotes. Do not give antidotes immediately ______, _____ or _____ after charcoal.
intubate, 2, caustic materials, nontoxic subtances, sharp objects, NS, Fowler's
Guidelines for using gastric lavage in poison emergencies: _______ the patient before inserting lavage if the patient has an altered LOC or decreased gag reflex. Perform lavage within __ hours of ingestion. Do not use if patient ingested ______ ______, _______ _______, or co-ingested ______ ______ . Flush the tubing using _______. Have the patient in a _______ position.
Assessment of sensory FX is done for problems with spinal cord or nerves, like __
Gullian Barre syndrome (GB)
What are the key symptoms with meningitis>
HA (severe), fever, changes in mental statis, photophobia, N/V, signs of increased ICP, RED MACULAR RASH
What is the physical assessment for brain tumors?
HA, V unrelated to food intake, changes in visual field, eye alignment, hemiparesis or hemiplegia, decreased tactile discrimination, seizures, aphasia, facial pain or weakness, dysphagia, or decreased gag reflex, ataxia, behavior or memory changes
Cardiogenic shock
Heart has injury or trauma resulting in pump failure. Ex Acute MI, conjestive Heart failure, dysrhythmia and blunt,, penetrating chest trauma are know causes of cardiogenic shock S/S Pallor Diaphresis= sweating Hypotension Oliguria decreased urine Tachycardia Tachypnea LOC Level of Conciousness PE JVD MNEUMONIC LOC PD HOTT PE JVD
Basic data collection for the EC
Height weight, vital signs, level of pain, Note!! Height is important because of peak flow meter ranges are based on age and height. Client provides Subjective data Objective data may be obtained through inspection-auscultation-percussion-and palpatation. Data collection also includes health history by obtaining biographical data, the chief complaint, present illness, past history, current health information and family history
Abdominal Thrusts
Heimlic Maneuver Victims who are conscious and choking should not be touched if they can talk, cough, or speak in a high pitched tone. If client asks or becomes unconscious abdominal thrusts are administered (GIVEN BELOW THE XIPHOID PROCESS) of the mid epigastric region.
What are the effects of blood loss?
Hgb of 7 and Hct of 21 at minumum for body functions
Acuity HIGH/LOW
High ICU Low med surg
CO = Heart rate x Stroke volume
How is Cardiac Output calculated?
What are the dx tests for MS?
Hx and s/s, MRI (primary tool for showing small plaques), PET, CSF exam (elevated cell count and protein),
When are advanced neurological issues be indicated?
Hx of fever, chills, UTIs, progressive motor and sensory loss, difficulty w/ urination and bm
Failure to protrude the tongue against resistance is a sign of dysfunction of which nerve?
Hypoglossal
95, 86
Hypothermia occurs when the body's core temperature is < ___F. Core temperature of <___F is potentially life-threatening
Afterdrop, Dysrhythmias, Hypotension
Hypothermia: Risks of rewarming. (ADH)
What is some migraine management?
ID and avoid triggers, first line defence are OTCs (NSAIDs, ASA, Naproxen, Acetaminophen+ASA+Caffeine (Excederin)
How do we prevent encephalitis?
ID and vaccinate of vulnerable populations, PPE, Handwashing
Pupil constriction is FX of Cranial Nerve __
III
What cranial nerve is responsible for pupil constriction?
III
Test for trauma
Imaging techniques such as. Radiography, position-emision tomography PET scans CT scan MRI 12 lead ECG allows for immediate treatment of heart attacks before client arrives at the EC
STAT
Immediate ordering of Ex... labs
What is temporal arteritis?
Immune vasculitis
What is a complex partial seizure?
Impaired consciousness (decreased resp ~30-120 seconds); may have automatisms (chewing, swallowing, lip smacking, picking at clothes, tapping); may vocalize in repetitive manner; followed by period of confusion
Synapse
Impulses are transmitted to their eventual destination through ________s, or spaces between neurons. There are two distinct types of synapses: neuron to neuron and neuron to muscle (or gland). Between the terminal knob and the next cell is a small space called the synaptic cleft. The knob, the cleft, and the portion of the cell to which the impulse is being transmitted make up the __________.
MCI
In emergency medicine/nursing, an emergency is any extraordinary event that can be managed by a community's existing resources. However, an ____ is an extraordinary event that overwhelms the community's ability to respond with existing resources.
mass casualty incident
In emergency nursing, what does MCI stand for?
Consent for minors
In most cases nurses obtain consent for minors from a parent or guardian. Exceptions to this rule are the following a life-threatning situation, sexually transmitted infections, drug or alcohol abuse or pregnancy. If no parent or guardian is present the decision to treat is really up to the PCP
life, vision, limb
In the ED, patients who have a threat to their _______, _______, or _______ are treated before other patients. (LVL)
T= Primary Tumor N= Regional Lymph Nodes M= Distant Metastasis x= Cannot be assessed (Goes with the above three) T0= No evidence of primary tumor T1-4= Increasing size and/or local extent of the primary tumor N1-3= Increasing involvement of regional lymph nodes. M0= No distant metastasis M1= Distant Metastasis is= In situ (In the site, hasn't traveled)
In the staging of Cancer (Using the TNM Classification) What do the following mean? T= N= M= x= is= T (0-4)= N (0-3)= M(0-1)=
What are the diff types of radiation therapuy?
Ionization of tumor cells/little damage to normal cells, stereotactic radiotherapy and gamma knife, proton therapy
Seizure:
Is an abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in a change in level of consciousness (LOC), motor or sensory ability, and/ or behavior. Often symptoms of underlying illness.
Cardiac Index
Is determined by dividing the CO by the body surface area...The normal range is 2.7 to 3.2 L/min/m(m)
Dry Drowning
Is laryngeal spasm without aspiration of fluid
The effects of carbon dioxide on the CNS, are 10 times stronger.
Is the direct effect of carbon dioxide on the CNS stronger or weaker than the effect of hypoxia on the peripheral chemoreceptors?
What diet management can help with seizures?
Ketogenic diet, high fat low CHO, and protein diet for seizure control, mild fluid restricion, up to 2 years on diet, include meds for epilepsy, may include sx interventions
Pentrating Trauma
Knife, Gun
Decerebrate, decorticate posture, pinpoint/dilated pupils, or unresponsive pupils are s/s of :
LATE mental deterioation
hemorrhage, cyanosis, change in mental status, decreased cardiac output, and hypotension.
LATE stage signs of Superior Vena Cava Syndrome include what?
__ is the FIRST indication that central neurologic function has declined
LOC = level of consciousness
how do you turn some one with a cspine injury
LOG ROLL them
What is the dx tests for meningitis?
LP for evaluation of CSF-WBCs, pressure, microbiology, glucose levels, blood culture (id organism)
Good Samaritan Law
Law that provides protection for individuals rendering assistance to others who are injured or ill. Specifics vary based on area of practice. Under this law, a nurse who renders care in an emergency situation and adheres to accepted scope of nursing practice cannot be held liable for an untoward outcome.
What are the different levels of trauma care?
Level 1 (neurosurgeon on staff), Level 2 (most patients), level 3 (stabilizes major injuries for transport), Level 4 (advanced life support for transport)
initiate ECG monitoring, initiate Pulse oximetry, insert indwelling catheter, insert orogastric/nasogastric tube collect blood for laboratory studies
List the Five interventions (initiations) for the secondary survey. (EPIOB)
Bomb threat, Water emergencies, Internal disaster, Hostage situation, External disaster, Fire, Loss of power (and/or telecommunications)
List the types of plans a hospital would have for an MCI. (BWIHEFL)
Motor cortex
Located in the frontal lobe, the _____ ______ controls voluntary movement.
Recent
Loss of memory, especially ... memory, tends to be an early sign of neuro problems.
What is Amyotrophic Lateral Sclerosis?
Lou Gehrig's Dz, it is a progressive and fatal dz with unknown etiology
Risk Factors for Atherosclerosis
Low HDL-C High LDL-C Increased triglycerides Genetic predisposition Diabetes mellitus Obesity Sedentary Lifestyle Smoking Stress African American or Hispanic
5 years.
Low-risk people 20 years of age and older are advised to have their total serum cholesterol level evaluated at least once every...
Describe cerebral perfusion pressure.
MAP - ICP = CCP, goal is to keep the ICP<20, MAP should be between 70-80mm/Hg, CPP= 50-55
red
MCI triage color: -Highest priority -Patients with life threatening injuries requiring immediate intervention. -Resp problems: rate >30 or 0 with open airway -Perfusion: absent radial pulse -Mental status: fails to follow commands -Severe burns: 25% TBSA
black
MCI triage color: -Lower priority -Dead or non-salvageable -Resp problems: rate 0 without open airway
yellow
MCI triage color: -Second priority -Patients with non-life threatening injuries such as burns but no airway problems, bone joint injuries
green
MCI triage color: -Third priority -"Walking wounded" -Patients with minor pain minor pains and cuts -This group should me moved to a supervised area
15
MCI triage differs from usual ED triage and is conducted in < __ sec. Colored tags/ribbons designate seriousness of injury and likelihood of survival.
EEG pt should withhold anticonvulsants ONLY if:
MD advised - monitor pt carefully if AED (antiepileptic drug) withheld
What are the dx studies for LBP?
MRI, CT, EMG
What are the dx studies for cervical neck pain?
MRI, plain rads, electromyography or a combo, diskogram
Choking (tools that can be used)
Magill Forcepts Suction
What are gliomas>
Malignant tumors arising from neuroglial cells, Ages 60-80; Men; Infiltrate and invade
History
Medication History, allergies, over the counter (OTC) medications, vitamins, cultural treatments, and complementary medicines are vitally important information.
What is the medical management for seizure?
Meds (phenytoin, clonazepam, carbamazepine, gabapentin, diastat),may take several months, monitor blood levels, taper gradually
Gynecomastia
Men who take estrogens may develop...
What is the nursing care for meningitis?
Monitor: LOC, VS, CMS, Seizures; Airway and breathing: keep O2 handy; Circulation:monitor for shock, cap refill, control fever, monitor fluid status, +/- isolation
III Oculomotor Nerve
Motor to eye muscles: Eye movement via medial and lateral rectus and inferior oblique and superior rectus muscles; lid elevation via the levator muscle; Parasympathetic-motor: Pupil constriction; ciliary muscles
White matter
Myelinated axons appear whitish and therefore are also called __________
Primary (Essential) Hypertension
No known cause for this type of hypertension, but risk factors include: Age greater than 60 years Family history of hypertension Excessive calorie consumption Physical inactivity Excessive alcohol intake Hyperlipidemia African American ethnicity High intake of salt or caffeine Reduced intake of potassium calcium, or magnesium Obesity Smoking Stress
Gray matter
Nonmyelinated axons have a grayish cast and are called ___________
1) To develop normal tissue 2) To replace lost or damaged tissue
Normal cells divide for which two reasons?
Diastole
Normally about two thirds of the cardiac cycle, & consists of relaxation and filling of the atria and ventricles.
Not having a regular healthcare provider
Not having a regular healthcare provider makes follow up and preventive health care
II Optic Nerve
ONLY Sensory fibers; CENTRAL & PERIPHERAL VISION
Which cranial nerve innervates the muscles that raise the upper eyelid?
Oculomotor
The cranial nerves that innervate the extrinsic ocular (eye) muscles include the:
Oculomotor, Abducens, and Trochlear nerves
5-15%
Of those people who have had strokes in the past, what percentage have a recurrence within 1 year?
Urgent care
Offers care for minor injuries and acute illnesses e.g., (strep throat) when clients cannot see thier PCP or if they do have a designated healthcare providers.
What is a tension pnuemo?
Once the accumulation of air builds up to a certain amount and puts pressure on other structures
Shock
One of the most urgent concerns in urgent care Life threatning condition of inadequate tissue perfusion
Mnemonic
Only Ovaltine Offers True Taste After Finishing Very Good Vegetables And Hordorves
Ear Lavage
Ordered by PCP
MIEMSS
Organization that oversees and coordinates statewide EMS. Several hospitals are included in the network.
How can we help the medically disabled with disaster management?
PLANNING!! Should have extra medicine, back up O2 and ventilator,
What are the s/s of shock?
PaO2 dropping and pH, rising base deficits, diminished UOP, increasing lactate levels, decreased H&H
What are the sx tx's for Parkinson's Dz?
Pallidotomy/Thalamotomy and Deep Brain Stimulation
Targeted Therapy
Part of Gene Therapy...Injection into tumor cells, enabling the immune system to better recognize cancer cells as foreign and kill them, is called what?
Burns (Deep partial-Thickness) (Superficial partial thicknes burns)
Partial thickness burns also called second degree burns may be superficial or deep Deep partial = epidermis and dermis the burn remains red in appearance. blistered areas may lack some sensation but have a painful are of injury surrounding them. Superficial partial thickness = they involve the epidermal layer. they are generally painful to touch and red in appearance
allergies, medication hx, past medical hx, last meal, events/environment preceding illness
Parts to be included in the history section of the secondary survey. (AMPLE)
Airway must be maintained for
Patency (openess) Airflow, Adequate ventilation
130/90
Patients with diabetes and heart disease should have a BP below what?
Modifiable (controllable) risk factors
Personal habits including: cigarette use, physical inactivity, obesity, and psychological variables are all...
Personal Planning for disaster
Pet disaster and family disaster plan, HAVE ONE!!
Full set of vital signs/Five interventions/Facilitate family presence
Phase of the Secondary Survey: -Blood pressure (bilateral) -Heart rate -Respiratory rate -Temperature (rectal) -Initiate ECG monitoring -Initiate pulse oximetry -Insert indwelling catheter (not always) -Insert orogastric/nasogastric tube (not always) -Collect blood for laboratory studies -Code situations (normal, DNR, DNI)
Inspect the posterior surfaces
Phase of the Secondary Survey: -Logroll patient (while maintaining cervical spine immobilization) to inspect the posterior surfaces. Check for GSWs.
History and Head to toe physical
Phase of the Secondary Survey: -Obtain history from patient, family, and emergency personnel -Perform head to toe assessment
Give comfort measures
Phase of the Secondary Survey: -Pain management strategies--combination of pharmacologic measures and nonpharmacologic measures
NOTE Oxygen Requires
Physicians Order
Cardiac Reserve
Physiological changes in the cardiovascular system occur with advancing age. Many of these changes result in a loss of...
Interventions for patients under emergency care for a hypertensive crisis
Place patient in a semi-Fowler's position Administer oxygen Administer IV nitroprusside (Nitropress) or other drugs as prescribed Monitor BP every 5 to 15 minutes until diastolic pressure is below 90 and not less than 75 Observe for neurologic or cardiovascular complications such as seizures, numbness, weakness, or tingling of extrimities, dysrhythmias or chest pain
Drug Therapy is aimed at what?
Prevention • Stabilize nerve cell membranes and prevent spread of epileptic discharge • 70% of patients controlled with medication • Monitor drug serum levels!!
Disaster Management
Prevention, mitigation, preparedness (ability to mobilize a large amount of supplies and get them where they are needed)
Airway Management
Primary Concern - Oxygen therapy and adjuncts are frequently used in maintaining airways.
Airway Management
Primary Survey ______ ______: Least to most invasive method -Open airway -Suction and/or remove foreign body -Insert naso/oro-pharyngeal airway -Endotracheal intubation
Interventions for Circulation
Primary Survey: Assess -Central pulse (peripheral pusles may be absent due to injury or vasoconstriction) -Skin for color, temperature, moisture -Mental status -Capillary refill Interventions -Insert two large-bore IV catheters -Initiate aggressive fluid resuscitation using NS or LR solution
Interventions for Breathing
Primary Survey: Assess -For dyspnea -For cyanosis -For paradoxic/asymmetric chest wall movement -For decreased/absent breath sounds -For tachycardia hypotension Interventions: -Administer high-flow O2 via a nonrebreather mask -Bag-value-mask (BVM) ventilation with 100% O2 and intubation for life-threatening conditions -Monitor patient response
Interventions for Disability
Primary Survey: Assess -LOC -AVPU (alert, responsive to voice, responsive to pain, unresponsive) -Glasgow Coma Scale -Pupillary reaction
Interventions for Airway
Primary Survey: Assess -For dyspnea -For inability to vocalize -For presence of foreign body -For trauma to face or neck Interventions: least to most invasive method: -Open -Suction and/r remove foreign body -Insert naso/oro-pharyngeal airway -Endotracheal intubation Sabilize/immobilize cervical spine -Face, head, or neck trauma and/or significant upper torso injuries.
What are the categories of HAs?
Primary and Secondary
airway, breathing, circulation, disability, life-threatening, immediately, next
Primary survey focuses on ________, _______, _______, and _______. -Identifies _________ conditions. -Begin interventions ________ and before proceeding to the ________ step of the survey
insurance, serious, crisis, maintenance, Chronic, Medications, shared, followup diagnostic
Problems Created for the ED Nurse: -PCP for people without _________ -Lack of resources -> more ______ illness -People in ______ -Fear -Lack of health _________ Results -________ diseases poorly treated -________ not purchased -Medications ______ -Failure to get __________ care and _________ studies
Soft Tissue Injury
RICE Rest the injured area Ice for 48 to 72 hrs Compression via splint, bandage, cast Elevate the extremity above the heart PCP may order XRAY and arthroscopy in creating a definitive diagnosis
Brachytherapy
Radiation source is implanted within the client, so client emits radiation for a period of time and is a hazard to others, ie: Cesium
75, PCP, distance, cultural ethnic, age
Reasons People Choose to Come to the ED -___% of pts had PCP -A large number of the ED visits occurred at times when ____ were not available: weekends or after hours -Other factors: _______, _______ & _______ patterns of utilization, & _______. (DCEA)
Cancer
Reduced immunity and hematopoietic function. Altered gastrointestinal structure and function - Anorexia - Cachexia Motor and sensory deficits - pain Decreased respiratory function Without intervention, ... invasion leads to death ...are all things that can develop from?
Clamedia
STI
Near Drowning
Salt water- Fresh water- Different electrolyte imbalances due to different water
tetanus, assessment, response, general unit, telemetry, intensive care unit, facility
Secondary Survey: Evaluate need or _______ prophylaxis. Provide ongoing _________ and evaluate patient's _________ to interventions. Prepare to... -transport for diagnostic tests (e.g., x-ray). -admit to _______ _______, _______, or _______ _______ _______ -transfer to another ________
Peripheral chemoreceptors
Sensitive primarily to hypoxemia (a decrease in the partial pressure of arterial oxygen. When stimulated, these...send impulses along the vagus nerves to activate a vasoconstrictor response and raise BP.
Death in the EC setting
Sensitivity and awareness by the nurse are expected during times of death. Counseling and assisting the family are of the utmost importance during a crises or after the death of a loved one. The nurse must document interventions and outcomes
Things to assess in the emergency care of patients with a Hypertensive crisis
Severe Headache, Extremely high BP, Dizziness, Blurred vision, Disorientation.
SANE nurse
Sexual Assualt Nurse Examiners is a specially certified RN who assist the PCP in collecting high-quality forensic evidence from rape victims.
...generalized and sometimes severe inflammatory reactions, peripheral neuropathy, skin rashes, increased depression
Side effects of Immunotherapy include...
edema of face, Stokes' sign, edema of arms and hands, dyspnea, erythema, and epistaxis.
Signs of Superior Vena Cava Syndrome include what?
Immediate life-saving intervention required
Situation that calls for airway, emergency medications, or other hemodynamic interventions (IV, supplemental O2, monitor, ECG or labs DO NOT count); and/or any of the following clinical conditions: intubated, apneic, pulseless, severe respiratory distress, SPO2<90, acute mental status changes, or unresponsiveness.
Eyes
Snelling Chart
maceration
Softening of the tissues after death by autolysis, especially of a stillborn fetus. Also, the softening and whitening of skin that is kept constantly wet.
Secondary Hypertension
Specific disease states and drugs elevate a person's BP.
SLP
Speech Language Pathologist
Blunt
Steering wheel
Women
Stroke occurrence is almost equal between men and women, but which gender dies most often from strokes?
Where does CSF circulate?
Subarachnoid space
Superior vena cava is compressed or obstructed by tumor growth.
Superior Vena Cava Syndrome is what?
Painful methods to employ with the GCS are
Supraorbital (over eyes) pressure; Trapezius muscle squeeze; Mandibular (jaw) pressure; Sternal (breastbone) rub
near-drowning
Survival from potential drowning.
What is the tx for MS?
Symptomatic, no cure, steroids to reduce inflamm and improve nerve conduction, avoid stress, promote rest, passive ROM, low fat diet, hyperbaric O2
Septic Shock
Systemic reaction and infection in the body. the body becomes overwhelmed with poisons (endotoxins) that cause the blood vessels to dialate. the body attempts to compesate for the fluid loss and interstital spacing or third spacing. Phase 1 pink or red phase normal Bp pulse and urine ouput. Often the client becomes febrile with flushed skin. Phase 2. White phase hypotension, bradycardia: oliguria, cold clammy extremites and a normal temp (afebrile)
Stage 1 Hypertension
Systolic or Diastolic: 140-159 mm Hg / 90-99 mm Hg
Stage 2 Hypertension
Systolic or Diastolic: Greater than or equal to 160 mm Hg / 100 mm Hg
Hyperthermia
Temp usually greater than 103 may be confused, lethargic, and unable to perspire essential to cool the client immediately ice packs loosen clothes shade/ airconditioning pg 1294
Changes in bowel/bladder habits A sore that won't heal Unusual bleeding or d/c Thickening or lump Indigestion or diff. Swallowing Obvious change in wart/mole Nagging cough or hoarseness
The CAUTION acronym for Cancer warning signs stands for what?
Cardiopulmonary arrest, Rape, Blood alcohol level, Chain of custody
The Forensic nurse becomes that liason between the medical profession and that of the criminal justice system in relation to these topics. (CRBC)
• F - Face - Sudden drooping of ONE side of the face. • A - Arm - Sudden numbness, clumsiness, or weakness in ONE arm / leg. • S - Speech - Sudden difficulty speaking or understanding language; slurred speech. • T - TIME - Call 911; Get to the hospital immediately.
The acronym "FAST" stands for what?
Total systemic vascular resistance
The amount of impedance depends on aortic compliance and ...
Bodily functions that can be affected by a stroke...
The below, are all examples of what? • Motor activity • Elimination • Intellectual function • Spatial-perceptual alterations • Personality • Affect • Sensation • Communication
Reticular activating system (RAS)
The brainstem includes the midbrain, pons, and medulla. Throughout the brainstem are special cells that constitute the _____ ______ ______, which controls awareness and alertness. For example, this tissue awakens a person from sleep when presented with a stimulus like loud noise, when there is pain, or when it is time to awaken.
Babinski sign
The definition of a pathologic or abnormal reflex. (e.g. Dorsiflexion of the great toe and fanning of the other toes after stimulation in anyone older than 2, would be a positive ...) A negative ... would be a normal response.
Pulse pressure
The difference between the systolic and diastolic values.
Beta blockers
The drug of choice for hypertensive patients with ischemic heart disease (IHD) because the heart is the most common target of end-organ damage with hypertension.
Supratentorial/Infratentorial
The dura also lies between the cerebral hemispheres and the cerebellum and is called the tentorium. It helps decrease or prevent the transmission of force from one hemisphere to another and protect the lower brainstem when head trauma occurs. Clinical references may be made to a lesion (e.g., a tumor) as being supratentorial (above the tentorium) or infratentorial (below the tentorium).
What is the golden hour?
The first hour needing to be seen at an advanced support facility (the first 60 minutes are the most important time)
Goals for End-of-Life Care (EOLC)
The following are all examples of what? • Control symptoms • Identify client needs • Promote meaningful interactions between the client and significant others • Facilitate a peaceful, meaningful death
Cancer Prevention Strategies.
The following are an example of what? • Avoidance of known or potential carcinogens • Modification of associated factors • Removal of "at-risk" tissues • Chemoprevention • Screening programs • Gene therapy
Signs and Symptoms of a progressive cerebrovascular disease.
The following are examples of what? - Tinnitus - Dysphagia - Vertigo - Ataxia - Blurred vision - unilat or bilat numbness - Dysarthria or weakness
Side effects of Radiation Therapy. And they vary according to the site.
The following pertain to what? • Local skin changes and hair loss that will likely be permanent depending on the total absorbed dose • Altered taste sensations • Fatigue related to increased energy demands • Inflammatory responses that cause tissue fibrosis and scarring
Ratings on the GCS
The higher the number means you're getting response; Lower response = lower number; Highest possible not intubatedis 15; Highest for intubated is 11t; Comatose = 7
(Starling's Law)...the more forcefully it contracts.
The more the heart is filled during diastole (within limits),...
What is the diff btw mass casualty and multiple causualty?
The number of people and how it overwhelms the system
Clinical Death
The short interval after the cessation of heartbeat and breathing when no evidence of brain function is present, is called what?
Clonus
The sudden, brief, jerking contraction of a muscle or muscle group often seen in seizures.
Role of the LPN
They are primarily responsible for data collection administering nursing interventions and assisting RN's in discharge planning (if applicable).
Drug classes used for Hypertension management
Thiazide diuretics Loop diuretics Potassium sparing diuretics Calcium channel blockers Beta-adrenergic blockers (Cardioselective and noncardioselective) ACE inhibitors Angiotensin II receptor blockers Aldosterone receptor antagonists.
heat emergency
This emergency is the result of prolonged exposure to heat, and occurs when thermoregulation mechanism cannot compensate for increase in temp. Accompanied by sweating, vasodilation, and increased respirations.
Hypothermia
This emergency occurs when the body core temperature is < 95F. Risk factors include old age, alcohol intoxication, and diabetes. Core temp <86F is potentially life-threatening.
The Vascular System
This serves several purposes: Provides a route for blood to travel from the heart to nourish the various tissues of the body. Carries cellular wastes to the excretory organs. Allows lymphatic flow to drain tissue fluid back into the circulation. Returns blood to the heart for recirculation.
Thiazide, Loop, & Potassium Sparing diuretics
Three basic types of diuretics used to decrease blood volume and lower BP.
Latent Period
Time from initial genetic alteration to clinical evidence of cancer
effective
To decrease absorption of ingested poisonous substances, use of activated charcoal is the most ________ intervention.
Below 200 mg/dL
Total serum cholesterol levels should be...
Blood viscosity (thickness) and arteriolar constriction
Total systemic vascular resistance is a combination of what?
Chemotherapy
Treating cancer with chemical agents - cytotoxic (cell-damaging) effects against cells (inc healthy cells)
What are the features of Parkinson's Dz?
Tremors, masklike faces, stooped posture, rigidity, hips and knees slightly flexed, arms flexed at elbows and wrists, short shuffling steps, micrographia, pill-rolling, dysphagia and drooling, depression, freezing gate and dementia
critical
Triag system: Categorizes patients so that the most ______ are treated first.
Primary Survey
Triage Survey that Focuses on: 1. Airway with c-spine stabilization and/or immobilization 2. Breathing 3. Circulation 4. Disability
The cranial nerves that innervate the tongue include the:
Trigeminal, Facial, Glossopharyngeal, Vagus, and Hypoglossal
Failure of a patient to execute lateral movement of the eye could indicate dysfunction of which of the following cranial nerves?
Trochlear and abducens
True
True or False. Surgery as a treatment by itself can result in a cure.
False
True or False...You can provide lotions to ease the pain of patients undergoing radiation therapy.
True.
True or false. Cancer can develop in any organ/tissue.
cipro, doxycycline
Two drugs used to treat anthrax and/or smallpox.
Consent by phone
Two nurses will listen to the adult give consent. Then documentation on the clients chart must reflect the decision making process and methodology for obtaining verbal consent that the nurse used.
drowning/near-drowning
Type of Injury Assess: -ABCs -Hypoxia -ABGs -Core temp Interventions: -Correct hypoxia; ventilator with PEEP -Correct acid-base and fluid imbalances -Support basic physiologic functions -Rewarm if hypothermia present
Frostbite
Type of Injury Assess: -Cause, extent of injury Interventions -Immobilize extremity -Controlled but rapid rewarming -Analgesic during rewarming -Protect affected area from further injury -Separate digits to prevent maceration -Whirlpool to promote circulation and for debridement
Profound Hypothermia
Type of Injury Assess: -Core temp <86F -Pt appears dead -Warm patient to 90F before pronouncing dead Interventions: -Manage and maintain ABCs, O2 -Rewarm patient gradually -Correct dehydration and acidosis -Treat cardiac dysrhythmias -Active core rewarming
Overactive/Violent behavior
Type of Injury Assess: -LOC -Behavior -Affect Interventions: -Prevent injury to self and/or others -Gain control of the situation -Call for security -Apply restraints (last resort) -Allow client to ventilate feelings -Medicate as necessary -Emotional support -Discharge planning
Suicidal
Type of Injury Assess: -LOC -Behavior -Affect Interventions: -Treat effects of suicidal attempt -Prevent further injury -Direct observation -Room is emptied of all equipment -Plastic utensils/disposable trays -Inspect beddings -Crisis intervention -Disposition -> intensive care, psych unit
Moderate Hypothermia
Type of Injury Assess: -Rigidity -Bradycardia, bradypnea -Blood pressure by Doppler -Coma Interventions: -Manage and maintain ABCs, O2 -Rewarm patient gradually -Correct dehydration and acidosis -Treat cardiac dysrhythmias -Active core rewarming
Mild Hypothermia
Type of Injury Assess: -Shivering -Lethargy, confusion -Minor heart rate changes Treatment: -Manage and maintain ABCs, O2 -Rewarm patient gradually -Correct dehydration and acidosis -Treat cardiac dysrhythmias -Passive external rewarming -Active passive rewarming
heat emergency
Type of Injury Assess: -Thirst, fatigue, weakness -Lightheadedness, mild confusion -Hot, dry skin -Nausea/vomiting -Profuse diaphoresis -> e-lyte imbalance -Feelings of impending doom -Inc HR, RR -Dec BP due to dehydration Interventions: -ABCs -Initiate cooling methods: place patient in a cool area, remove clothing, cover with wet sheets, use large fan, immerse in ice water bath -Administer/lavage with cool fluids -Replace electrolytes -Monitor for signs of rhabdomyolysis, myoglobinuria
poisoning
Type of Injury Assess: -Type, concentration, route of exposure -Accident, occupational, recreational, intentional Interventions: -Decrease absorption -Enhance elimination -Hemodialysis -Antidotes -Implement toxin-specific interventions per PCC -Seizure precautions -Blood and urine toxicology -Mental health referral (not always)
first degree frostbite
Type of frostbite called frostnip and this only affects the surface skin, which is frozen. On onset there is itching and pain, and then the skin develops white, red, and yellow patches and becomes numb. The area affected by frostnip usually does not become permanently damaged as only the skin's top layers are affected. Long-term sensitivity to both heat and cold can sometimes happen after suffering from frostnip.
third and fourth degree frostbite
Type of frostbite where the muscles, tendons, blood vessels, and nerves all freeze. The skin is hard, feels waxy, and use of the area is lost temporarily, and in severe cases, permanently. The deep frostbite results in areas of purplish blisters which turn black and which are generally blood-filled. Nerve damage in the area can result in a loss of feeling. This extreme frostbite may result in fingers and toes being amputated if the area becomes infected with gangrene. If the frostbite has gone on untreated they may fall off. The extent of the damage done to the area by the freezing process of the frostbite may take several months to assess, and this often delays surgery to remove the dead tissue.
second degree frostbite
Type of frostbite where the skin may freeze and harden, but the deep tissues are not affected and remain soft and normal. Second-degree injury usually blisters 1-2 days after becoming frozen. The blisters may become hard and blackened, but usually appear worse than they are. Most of the injuries heal in one month but the area may become permanently insensitive to both heat and cold.
Alcohol Intoxication
Type of injury Assess: -Stupor->belligerent -Thorough and frequent assessment (airway) Interventions: -Restraints -Turn head to side to avoid aspiration of vomit -Sedation (Librium) -Place in a quiet room -Place in a well lit room to minimize hallucinations
MVA->Abdominal Injuries
Type of injury Assessment: -Chest trauma -Hypovolemic shock: injuries to internal organs-liver, spleen, rupture of major blood vessels -Injuries to other organs: Kidney, bladder Interventions: -Peritoneal lavage to determine bleeding and/or organ rupture -Prep for OR
Crushing Injury
Type of injury Assessment: -Neurovascular checks -X-ray -Arteriogram Interventions: -Care for open wounds -Immobilize and splint -Prep for OR -Monitor for renal failure (myoglobinuria) -Antibiotics -Tetanus -Rehab -Health promotion-> safety
Wound
Type of injury Assessment: -Type: abrasion, laceration, stab, etc Interventions: -Cleansing with NS -Closure: primary, delayed (if tissue is lost, or if there's a high risk for infection) -Tetanus prophylaxis
Frostbite
Type of injury caused by freezing of tissue fluid and intercellular spaces. The goal of treatment is to restore normal body temperature
emergency nursing
Type of nursing that deals with patients with life-threatening or potentially life-threatening problems enter the hospital through the emergency department (ED).
tertiary intention
Type of wound healing where Delayed primary closure or secondary suture The wound is initially cleaned, debrided and observed, typically 4 or 5 days before closure. The wound is purposely left open examples:healing of wounds by use of tissue grafts.
primary intention
Type of wound healing where... -Involves epidermis and dermis without total penetration of dermis healing by process of epithelialization -When wound edges are brought together so that they are adjacent to each other (re-approximated) -Minimizes scarring -Most surgical wound healing -Wound closure is performed with sutures (stitches), staples, or adhesive tape -Examples: well-repaired lacerations,well reduced bone fractures,healing after flap surgery
secondary intention
Type of wound healing where... -The wound is allowed to granulate -Surgeon may pack the wound with a gauze or use a drainage system -Granulation results in a broader scar -Healing process can be slow due to presence of drainage from infection -Wound care must be performed daily to encourage wound debris removal to allow for granulation tissue formation -Examples: gingivectomy,gingivoplasty,tooth extraction sockets, poorly reduced fractures.
anthrax, smallpox, cipro, doxycycline, immediately, cremate
Types of terrorism Biological: -Main examples are _______ and _______ -Treatment: _______, _______ -Vaccination (smallpox) may be given _________ after exposure -_______ body: spores can survive for decades
vesicants, nerve, blood, pulmonary, Atropine, 2-4, 3
Types of terrorism Chemical: -Main types are _______, ______, ______ and _______ agents (VNBP) -Sarin: paralyzes resp muscles -> antidote: ______ ___ mg, repeat q __ min
Biological, Chemical, Nuclear radiation exposure
Types of terrorism concerning emergency nursing. (BCR)
First and foremost nurses must use the
Universal Precautions at all times gloves, gown, masks, protective eyeware, face shields and of course meticulouse hand hygiene
What is the etiology of Parkinson's Dz?
Unknown
"Do you have enough energy for your activities & activities of daily living (ADL's)?"
Using Gordon's Functional Health Patterns as a means of a rapid neurological assessment; Activity tolerance can be assessed with what question?
"Have you noticed any changes in your vision? Hearing? Memory" "difficulty making decisions? Learning?"
Using Gordon's Functional Health Patterns as a means of a rapid neurological assessment; Cognitive-Perception issues can be assessed with what question?
"How would you describe your general health?"
Using Gordon's Functional Health Patterns as a means of a rapid neurological assessment; Health Perception can be assessed with what question?
High Acuity
Very urgent and possibly life threatining
What is the most common meningitis?
Viral, tends to be self limiting
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Water is reabsorbed to excess by the kidney and put into system circulation. ...is most commonly found in carcinoma of the lung
ESI-2
What ESI level would this patient be? -Patient does not require immediate life-saving interventions. -Patient is in either a high risk situation, confused/lethargic/disorientetd, or in severe pain/distress.
ESI-4
What ESI level would this patient be? -Patient does not require immediate life-saving interventions. -Patient is not in either a high risk situation, confused/lethargic/disorientetd, or in severe pain/distress. -Requires one total resource.
ESI-3
What ESI level would this patient be? -Patient does not require immediate life-saving interventions. -Patient not is in either a high risk situation, confused/lethargic/disorientetd, or in severe pain/distress. -Requires 2 or more total different resources. -Shows no "danger zone vitals"
(consideration for) ESI-2
What ESI level would this patient be? -Patient does not require immediate life-saving interventions. -Patient not is in either a high risk situation, confused/lethargic/disorientetd, or in severe pain/distress. -Requires 2 or more total different resources. -Shows one or more "danger zone vitals"
ESI-5
What ESI level would this patient be? -Patient does not require immediate life-saving interventions. -Patient not is in either a high risk situation, confused/lethargic/disorientetd, or in severe pain/distress. -Requires no resources.
ESI-1
What ESI level would this patient be? -Patient requires immediate life-saving interventions
Age, Gender, Race, Heredity
What are examples of non-modifiable risk factors?
• Alopecia or hair loss • Nausea and vomiting • MUCOSITIS IN THE ENTIRE GASTROINTESTINAL TRACT • Skin changes • Anxiety, sleep disturbance • Altered bowel elimination • Decreased mobility
What are some other side effects of chemotherapy?
Systolic BP often >200 Diastolic BP often >150 or >130 with pre-existing conditions
What blood pressures are common in people experiencing malignant hypertension?
Acne & Hypercalcemia Liver dysfunction may occur with prolonged therapy
What complications may develop for men and women as a result of taking androgens?
Durable Power of Attorney for Health Care (DPOA)—a legal document assigning decision-making power to another
What does DPOA stand for, and what is its purpose?
Multiple Organ Dysfunction Syndrome.
What does MODS stand for?
oral gastric tube
What does OGT stand for?
Renal failure, Left Ventricular failure, Stroke
What incidents may befall a patient with malignant hypertension if left untreated?
Hypertension
What is THE MOST IMPORTANT modifiable risk factor?
Severe Headache.
What is a significant manifestation of a Hemorrhagic Stroke?
Spironolactone
What is an example of a potassium sparing diuretic?
<120 Systolic <80
What is considered normal BP
Renin
What is produced by the kidney when blood flow to the kidney falls or in decreased serum sodium concentrations?
Angiography
What is the "gold standard" for imaging the carotid arteries?
A change in the Level of Consciousness (LOC)...Even a subtle change applies.
What is the FIRST indication that central neurological function has declined?
Prevention
What is the most effective way to decrease the burden of a stroke?
Hypertension Ruptured Aneurysms & Arteriovenous malformations (AVM's)
What is the most important cause of a hemorrhagic stroke? What are some other causes?
CT scan
What is the primary diagnostic test after a stroke?
To destroy cancer cells with minimal exposure of the normal cells to the damaging actions of radiation
What is the purpose of radiation therapy for cancer?
Pain
What is the symptom of dying that patients fear most?
More than 50%...and many more go on to live beyond 5 years of treatment. But many do die.
What percentage of clients are cured of cancer using treatment?
Anemia (Decreased numbers of RBC's), Neutropenia (decreased WBC counts), & Thrombocytopenia (Low platelets)
What side effects on the hematopoeietic (blood-producing) system can be life threatening?
nonjudgmental, cultural, followup, medication sharing, financial health
What the Nurse Can do about Problems Created for the ED nurse: -____________ attitude -________ sensitivity -Teach about: the need for _________ care, the danger of not taking ___________ as prescribed or __________ medications -Help patients connect to __________ resources and _________ care
Thrombolytic therapy; Administration of rtPA
What type of drug therapy dissolves a cerebral artery occlusion for an acute ischemic stroke (AIS), to re-establish blood flow and prevent cerebral infarction?
Antiplatelet drugs; Namely, Aspirin 81-325 mg.
What type of drug therapy is most frequently used to prevent the development of an embolism in at-risk patients?
Computed Tomography (CT Scan)
What type of imaging assessment is preferred over Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI) for patients who have experienced a stroke?
Computed Tomography (CT Scan)
What type of imaging assessment is preferred over Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI)?
Gene Therapy
What type of therapy is still considered experimental as a cancer treatment?
• Sudden severe headache. • Sudden weakness, paralysis, numbness of face, arm or leg, especially on one side of the body. • Sudden dimness or loss of vision unilat or bilat. • Sudden loss of speech, confusion, difficulty speaking or understanding speech. • Unexplained sudden dizziness, unsteadiness, loss of balance or coordination.
What warning signs of stroke should be taught to patients?
1 hr prior to meals.
When are anti-emetics given to patients undergoing cancer treatment?
resources, tests, resource, resources
When counting the number of __________, count the number of different types, not the individual _____ or x-rays. Example: CBC, electolytes and coags equals one ________; CBC plus chest x-ray equals two ________.
...change course to maintain quality of life and facilitate death with dignity
When death becomes a probability, nurses must...
When they have a Triglyceride level that is 150 mg/dl or greater
When is a patient considered to have Hypertriglyceridemia
Tumor Lysis Syndrome
When large numbers of tumor cells are destroyed rapidly, resulting in intracellular contents being released into the bloodstream faster than the body can eliminate them.
Within 3 hours of onset of clinical stroke symptoms.
When must rtPA be administered?
...Retain sodium & water, which makes BP rise.
When renal blood flow or pressure decreases, the kidneys...
face trauma, head trauma, neck trauma, significant upper torso injuries
When to stabilize/immobilize the cerivcal spine (FHNS)
The skin, hair, intestinal tissues, spermatocytes, and blood-forming cells
Which are the normal cells that are most affected by chemotherapy?
African American, Hispanic, Native American, & Asian people.
Which demographics have a higher incidence of strokes?
Androgens & Antiestrogen
Which two drug types have a masculinizing effect on women?
Because it is frequently asymptomatic
Why is hypertension called the "Silent Killer"?
Less sensitive
With age, Baroreceptors become...
Increases to compensate for the stiff arteries
With age, systolic BP...
Thicken and become stiffer and less distensible
With age, the aorta and other large arteries...
Increases...stiff and less distensible
With age, the size of the left ventricle...it also becomes...
Subdural space
_______ ______ is located between the dura mater and the middle layer, the arachnoid.
Not
________ Resources: -History & physical (including pelvic). -Point-of-care testing. -Saline or heplock. -PO medications. -Tetanus immunizations -Prescription refills. -Phone call to PCP -Simple wound care (dressing's, recheck) -Crutches, splints, slings
Peritoneal lavage
________ _______ is a test used to determine the presence or absence of internal bleeding within the abdomen. Injury to the abdomen can result from blunt forces (i.e. motor vehicle accidents) and from penetrating objects (knife wounds and bullets). Determining the significance of an internal injury can often be based on the results from this test. This test is performed by introducing a long, flexible plastic tube into the abdomen. A small incision is made adjacent to the naval using a local anesthetic. The tube is advanced to a certain depth into the abdomen so that fluid can be aspirated with a syringe. The presence of blood in the aspirate confirms significant injury that will require surgery. If the aspirate is free of blood, fluid (salt water solution) will be delivered through the tube into the abdominal cavity. It will then be allowed to flow back out for microscopic analysis.
arteriogram
_________ is an imaging test that uses x-rays and a special dye to see inside the arteries. It can be used to see arteries in the heart, brain, kidney, and many other parts of the body.
Unresponsive
_________ is defined as a patient that is either: 1. Nonverbal and not following commands (acutely) 2. Requires noxious stimulus (P or U on AVPU scale-->responds only to "pain" or "unresponsive")
Severe pain/distress
_________ is determined by clinical observation and/or patient rating of greater than or equal to 7 on 0-10 scale.
point-of-care testing (POCT)
____________________ is defined as medical testing at or near the site of patient care. The driving notion behind this method is to bring the test conveniently and immediately to the patient. It includes: blood glucose testing, blood gas and electrolytes analysis, rapid coagulation testing, rapid cardiac markers diagnostics, drugs of abuse screening, urine strips testing, pregnancy testing, fecal occult blood analysis, food pathogens screening, hemoglobin diagnostics, infectious disease testing and cholesterol screening.
High flow O2 is always administered with
a BVM unit while compressions are performed (Bag Valve Mask)
What is the first indication that central neuro function has declined?
a change in the LOC (responsiveness and mental status
neurotransmitter
a chemical that is released by a neuron for the purpose of carrying information across the gaps (synapses) between neurons; Each neuron produces a specific _______________ substance, or chemical (e.g., acetylcholine or serotonin), that can either enhance or inhibit the impulse but cannot do both.
Cardiopulmonary Resuscitation
a combination of oral resuscitation and external cardiac massage (always performed on clients in the EC who have an absent pulse.
What is the pathogenesis of Parkinson's Dz?
a slow progressive loss of function, degeneration of the substantia nigra, shortage of dopamine
Myelin sheath
a white, lipid covering of the axons (the "tail" of a neuron);
Gordon's Cognative-precept pattern question's
a.) Any changes in vision, hearing, memory?; b.) Do you feel you are having difficulty making decisions ? In learning?; c.) Are you experiencing any discomfort? Pain? Weakness?
What are partial seizures?
abnormal electrical burst in one area of the brain; one cerebral hemisphere; simple or complex
Decerebration
abnormal posturing and rigidity characterized by extension of the arms and legs, pronation of the arms, plantar flexion, and opisthotonos (body spasm in which body is bowed forward). Decerebration is usually associated with dysfunction in the BRAINSTEM area.
Decrotication
abnormal posturing seen in the patient with lesions that interrupt the CORTICOSPINAL PATHWAYS. The patient's arms, wrists, and fingers are flexed with internal rotation and plantar flexion of the legs.
What is the tx for encephalitis?
acyclovir for herps, supportive care as in meningitis
How is chemo used?
adjunct to surgery, meds do not cross the BBB well, sugar soltuin aids in the tx of tumors by opeing barrier, ommaya reservoir )intraventriclular meds,
What is the tx for meningitis>
after CSF cultures give ABX, steroids, fluids, seizure control meds, mannitol
What is emergent triage? Red
airway/breathing, uncontrolled/severe bleeding, decreased LOC, severe medical, shock, severe burns, resp distress, CP w/diaphoresis, active bleeding, unstable VS
What is tetraplegia?
aka: quadriplegia, involves are 4 extremities, injury in the upper thoracic region
Modified Trendelenburg
all people going in to shock
What is an avulsion?
also a degloving injury the skin pulls off
If a wound is large client is
also at risk for loss of fluid and body heat called (Ineffective Thermoregulation)
EC (Emergency Care)
also called ER for the Emergency room where staffing is maintained around the clock to provide care for High Acuity
What are the manifestations of Head injuries?
altered LOC, confusion, pupil changes, VS alterations, altered reflexes (corneal/gag), HA, Dizziness, Vision & hearing, seizures, motor and sensory impairment
What is a flutter valve?
always enter the top of the rib to avoid a vein, walk off the rib, its a one way valve that allows air to escape but won't go back in
Guillain-Barre Syndrome- (GBS)
an acute autoimmune disorder characterized by varying degrees of motor weakness and paralysis. May also be called "acute idiopathic polynervitis" or "polyradiculoneuopathy"
What is Huntingtons Dz?
an autosomal dominant hereditary disease that creates dementia and choreiform movements
What are the tx's for Tension HA?
analgesics, muscle relaxants, massage, heat, biofeedback/relaxation, stress management, couseling
Describe the conventional open surgical approach.
anterior cervical diskectomy and fusion is comonly performed depending on extend of herniation, patient is fitted with large brace before sx
What is the drug tx for Parkinson's Dz?
anticholinergics to tx tremors, dopaminergics for motor function, dopamine agonists; bromocriptine to activate the release of dopamine, COMT inhibitors to break down levodopa, MAOIs to reduce breakdown of dopamine
When doing a neuro assessment what are the first things we should be noticing?
appearance, assess speech, affect, motor function
What are some of the symptoms with sphincter and genital difficulties with MS?
areflexic bladder, frequency and urgency, nocturia, constipation, decreased erections and vaginal secretions
Stuporous
arousable only with vigorous or painful stimulation
Assessing ATTENTION
ask the patient to repeat a series of three numbers, such as 4, 7, and 3. The series is increased by one number with each successful repetition until seven or eight digits are achieved. If the patient has difficulty at any level (cannot repeat the series), repeat the numbers. If the patient cannot repeat, stop the procedure. Next, ask the patient to repeat the numbers backward, starting again with three digits and increasing by one each time. Normally, a person should be able to repeat five to eight digits forward and four to six backward. Education, occupation, interest, culture, anxiety, and depression affect mental status, and what is considered "normal" may not be so for a particular patient.
Describe patient assessment for SCI?
assess ABCs, assess for head injury, spinal shock, pneumothorax, hemothorax, fractured ribs, intraabdominal hemorrhage or hemorrhage around fractured sites;use glasgow scale; detailed assessment of motor and sensory status to assist in dtermining the level of injury and to serve a baseline data for future comparison
What is the etiology of myasthenia gravis?
autoimmune disease resulting in weakness of voluntary muscles, injury of myoid cells in the thymus, development of antibodies to ACh receptors
Alert
awake and responsive
proprioreception
awareness of position of movements of body parts (arm is over your head? you know where your arm is)
Health care professionals are at high risk for?
back injuries from lifting or handling clients in a emergency situation.
What is the most serious meningitis?
bacterial
Why is mechanism of injury important?
because there are normal injuries associated with certain mechanisms
Without universal precautions nurses and other sttaff could?
become infected and perhaps cause infection to others.
What is the home care management for back sx's?
bed board under mattress, stair activity limited, return to work 4-6 weeks, no more than 5#'s can be lifted will increase with time, no driving until surgeon releases you, resume normal activity as tolerated 3d-3weeks, shower 3-4days
Descending tracts
begin in the brain and end in the spinal cord.
What are the migraine preventive medications?
beta-blockers (decreased BP), Calcium Agonist, tricylic antidepressants ,serotonin antagonists, anticonvulsants, Triptans: Imitrex, Maxalt
deep tendon reflexes (DTRs)
biceps, triceps, brachioradialis, and quadriceps muscles and of the Achilles tendon can be tested as part of the routine neurologic assessment. Striking the tendon with the reflex hammer should cause contraction of the muscle.
Health care professionals are also the front line in providing care in
bioterrorism, weather emergences, and hazardous material (hazmat situations) they must be familiar with the use of protective equipment. Safety and readiness for unexpected situations must be primary concerns for healthcare professionals at all times.
What is a cardiac tamponade?
bleeding into the pericardial sack and compresses the heart
What are some dx tests for neurological assessments?
blood cultures, genetic testing, biopsies, lumbar puncture for CSF sample, x-rays, cerebral angiography, CT, MRI, PET, etc
What is aortic disruption?
blunt trauma, rapid deceleration
What are the main components of the CNS?
brain and spinal cord
Cerebral angiography (arteriography) = visualize circulation or detect blockage in ___
brain, head, neck
How do we tx ARDS?
breathing support, high O2, PEEP, reduce inflamm, tx underlying cause (infection, ABX), remove fluid from lungs
What is myoclonic seizure?
brief, shock like jerks of muscles or muscle groups
What is a contusion?
bruising of brain, accel/decel, LOC>brief, hemorrhage, swelling, Increased ICP
Where is the epidural space located?
btw the skull and outer layer of the dura, extends down the spinal cord. Delivery of epidural analgesics
What is the most common cause of cervical neck pain?
bulging herniation of the nucleus pulposus in a interveterbral disk or bony spur, trauma, injury, muscle strain, ligament sprain, lifting incorrectly, tumor or infection
What is urgent-delayed temporarily (45') Yellow
burns w/o airway, major/multiple bone or jpint, back injury including spinal cord, severe abd pain, renal colic, displaved multiple fractres, complex soft tissue, new onset resp infection
How can we help patients with myasthenis gravis avoid exacerbations?
by avoiding abrupt lifestyle changesm overheating, hard exercise, infection, enemas and strong cathartics
Affordability and insurance of the client
can affect the clients outcome in todays cost=saving health care enviroment. This includes clients who have insurance for PPO
SENSORY changes in older adults
can affect their daily activities. Pupils decrease in size, which restricts the amount of light entering the eye, and adapt more slowly. Older adults need increased lighting to see. Touch sensation decreases, which may lead to falls because the older person may not feel small objects or a step underfoot. Vibration sense may be lost in the ankles and feet. (See the discussion on fall prevention in Chapter 3.) Hearing also decreases, especially for high-pitched sounds.
How do we assess cerebellar function?
can be done sitting of the side of exam table, fine coordination muscle is tested. Heel slide, touch finger to the nose 2 or 3 times with eyes opened or closed, gait (to evaluate balance; tip toe and heel to toe walking, equilibrium (eyes closed arms at side, check for swaying)
Testing for recent memory
can be tested during history and checked on med records. EX. Appts, time of admin, transportation to hosp.
What happens with herniation of the nucleus propulsus?
can create pressure on adjacent nerves, and when this occurs in the lumbar area the sciatic nerve creates a burning or stabbing sensation down leg and foot
What organs are likely affected from traumatic SCI?
cardiovascular, resp, GI and GU
Sometimes OTC or over the counter herbal treatment can be the ?
cause of the clients problem.
Motor
causing movement or motility
Sensory
causing sensation
EEG (electroencephalography) records elecrical activity of __ hemispheres
cerebral
Sedation is generally NOT used for __ angiography but can be given meds to relax
cerebral - numbing agent put on groin area as catheter inserted into femoral artery
Depending on facility policy the nurse may administer?
certain meds to clients (usually to reduce fever) before the provider examines them. ex ASA for a client with complaints of chest pain as a routine EC standing order. Fever
In head trauma, priority is to r/o:
cervical spine FX
What is the red flag with secondary HAs?
change in progression and pattern
• Atypical absence seizures
characterized by staring spell with other signs and symptoms • Brief warnings • Peculiar behavior during seizure • Confusion after
Who are the at risk groups in disaster?
children, elderly, medically disabled, mentally ill, patients with dementia
What are some food triggers for HAs?
chocolate, sugar, caffeine, nuts, ice cream
What medications are give for myasthenia gravis?
cholinesterase inhibitors to increase acetylcholine and immune suppresive drugs (Imuran, Cytoxan, Cyclosporine and corticos)
What is the pathology for Myasthenia Gravis?
chronic autoimmune dz of neuromuscular junctions, decreased # and effectiveness of acethylcholine receptors, excessive secretion of cholinesterase, nerve impulse not transmitted
What is the pathogenesis of Multiple Sclerosis?
chronic autoimmune dz that affects the CNS, myelin sheath is damaged, nerve fibers are exposed and the inflammattory process occurs
Normal CSF is :
clear and colorless with FEW cells
Debridement
clearing of necrotic tissue
What is usually normal with Parkinson's disease?
cognition and sensation
What are the Symptoms of Alzheimers?
cognitive disorder, memory loss, difficulty concentrating, inappropriate behavior, poor reasoning, impaired judgement and social interaction
Nurses Role in disaster
collaborates w/ med commander, triage, float to high needs, called in during event, creativity and flexibility
Glasgow Coma Scale (GCS) score of 7 =
comatose state
Midrin is a...
combination drug. It is the most common isometheptene combination given for treating migraines and is an excellent option when ergotamine preparations are not tolerated or do not work. pg. 953
Describe a physical assessment for LBP.
complete pain assessment, recent injury?, document 7 pain assessment steps, inspect pt's spine for misalignment, redness, inflamm, lack of symmetry in paravertebral muscles, is there paraesthesia?
CPOE
computerized physician order entry
What are some medical diagnoses associtated with HAs?
congestion of inner and middle ear, FE imbalances, TMJ, dental problems, temporal arteritis, subarachnoid hemorrhage, meningitis, CVA, increased Intracranial pressure
What is the cushings triad?
contents of brain may start to herniate thru your brains stem, you will get systolic HTN with brachycardia and bradypnea
What post op teaching for LBP surgical patients would we do?
continue weight reduction, stop smoking, use moist heat, perform strengthening exercises
What is the "fifth lobe" and what does it do?
controls biological rhythms, sexual behavior, emotions, rage, helps balace extremes of emotions, modulates behavior, essential for normal memory
SPINAL CORD
controls body movement (mobility); regulates organ function; processes sensory information from the extremities, trunk, and many internal organs (sensation); and transmits information to and from the brain. It contains H-shaped gray matter (neuron cell bodies) that is surrounded by white matter (myelinated axons). The white matter is divided into posterior, lateral, and anterior columns. Groups of cells in the white matter (ascending and descending tracts) have been fairly well identified.
Lumbar puncture is not done if skin site has infections because:
could introduce infective organisms into CSF
How do we deal with PTSD?
counseling, support each other, monitor each other, take breaks, talk, nutrition, family friends and SO, don't work more than 12 hours
PERRLA
cranial nerve 3; To test for pupil constriction, ask the patient to close his or her eyes. Bring a penlight in from the side of the patient's head, and shine the light in the eye being tested as soon as the patient opens his or her eyes. The pupil being tested should constrict (direct response). The other pupil should also constrict slightly (consensual response). To test accommodation, ask the patient to focus on a distant object and then immediately look at an object 4 to 5 inches from the nose. The eyes should converge, and the pupils should constrict.
What is an Acoustic Neuroma
cranial nerve VIII, Genetic; slow growing; benign, ecapsulated; Tinnitus, vertigo, and decreased hearing
In the pre-hosp measures what info will we need for the hx of the event?
damage, extrication, death, ejection, saftey devices, substance use, head or spinal cord injury, psychiatric problems
What is the third peak of death?
days to weeks, sepsis and organ failure
What is the pathogenesis for Huntingtons Dz?
decrease in gamma aminobutyric acid production which is an inhibitroy neurotransmitter, increased glutamate which is a major excitatory neurotransmitter
What are the s/s for tension and pneumo?
decreased bs, tachypnea, decreased perfusion
CT post procedure follow up:
delayed reaction to contrast medium (if used)
What are the interventions for LBP?
depends on severity and chronicity of the problem, conservative therapies started first, sx last resort
oxygen titration
determine the correct volume to be used
What is nuchal rigidity?
difficult neck flexion
What are some dilutional coagulopathies?
dilutional thrombocytopenia, reduced fribrinogen, reduced fator V and VIII, High citrate in products, platelet dysfunciton
How to prepare for a terorism attack
do drills to prepare
What is an atonic seizure?
drop seizure, brief loss of muscle strength; eyelid drooping, nodding of head, dropping of objects, reslts often in falls
lethargic
drowsy or sleepy but easily awakened
PET scan is used to evaluate:
drug metabolism & deect areas of metabolic alteration in dementia, Alzheimers, epilepsy
What are the secondary HAs?
due to other pathologies
Plexus
each nerve axon leaves the spinal cord, it joins other spinal nerves to form ________s (clusters of nerves). Plexuses continue as trunks, divisions, and cords and finally branch into individual peripheral nerves.
Loss of memory, especially recent memory, is an __ sign of neuro decline
early
Why would EEG pt need to wash hair after procedure?
electrode glue in hair that held them in place
What is the limbic lobe responsible for?
emotional/visceral patterns connected with survival learning and memory
What are some additional complications associated with meningitis?
encephalitis (if bacteria in brain), organ damage, ARDS, death (from toxin of bacteria in blood, or bc of multi-system failure
Collaborative care (continuous communication and updating of clients services and information are necessary to
ensure quality of care for EC clients. and collaboration with ex xray, lab, pharmacy departments
Lab test (PEAK FLOW)
evaluates maximum airflow during forced expiration.
What are the symptoms for myasthenia gravis?
excessive fatigue and weakness (ocular movements, facial expression, respirations, chewing and swallowing, loss of bladder and bowel control), no loss of reflexes, no change in sensation
What is a craniectomy?
excision of portion of skull and removal of bone flap, decompression after cerebral edema
What does the Glasgow Coma Scale give us info about?
eye opening, motor response, verbal response, Score of 15 normal and 7 is comatose
What kind of teaching needs to be done post-op with open back sx?
family and patient to check for CSF leak, HA, any drainage, bulging at incision
What is granulovascular degeneration?
faster vascular degeneration in which the nerve cells are unable to function properly
In cerebral angiography, a contrast medium is injected in:
femoral artery
Pt having lumbar puncture is positioned:
fetal position and mus remain still - 2 or more healthcare personnel may need to assist if pt is restless
Central Nervous System (CNS)
fight or flight; controls mobility, sensation, and cognition
What info is needed with spinal cord injury?
find out about accident, how did it happen, any changes, who was there, immobilization devices used, any complications during transport, **DO NOT TOUCH THE SCI PATIENT**
touch discrimination
for testing, the patient closes his or her eyes. The practitioner touches him or her with a finger and asks that he or she point to the area touched. This procedure is repeated on each extremity at random rather than at sequential points. Next, the practitioner touches the patient on each side of the body on corresponding sites at the same time. The patient should be able to point to both sites.
Meninges
form the protective covering of the brain and the spinal cord. The outside layer is the dura mater.
What is Broca's area?
frontal lobe, formation of words
COGNITIVE changes in older adults
functions of perceiving, registering, storing, and using information often change as a normal part of aging. Therefore it is important to differentiate between these expected findings and those of dementia, depression, and delirium (3Ds). Failure to correctly diagnosis pathologic cognitive problems may lead to a poor patient outcome.
Which type of meningitis is most often associated with immune deficiency?
fungal, and it is opportunistic
What are the tx for Huntington's Dz?
genetic counseling, no cure, supportive meds to manage s/s, block dopamine production/use with haloperidol, antipsychotics for mental s/s, and antidepressant
What is the etiology of seizures?
genetic, brain tumor, trauma, stroke, toxic substances, CNS infection/irritation (especially in children)
When you stumble upon a scene what is the first thing that needs to be done?
get the walking wounded moved out and they are now green
Aura symptoms in migraines with auras develop...
gradually over more than 4 minutes.
If the client becomes unconcious during the Heimlic Maneuver
he/she should be carefully positioned on the ground.
9's
head 4 1/2 body 18 arm 9 leg 9 perineum 1 percent
What happens with a + Brudzinski's sign?
head flexed, hips and knees flex
What does the secondary survey consist of?
head to toe eval, head and neck, chest, abdomen, pelvis, perineum, extremeties, back
What are the organisms assocaited with viral meningitis?
herpes virus, enterovirus, HIV and the patient may have viral symptoms such as sore throat, rash, enlarged lymph nodes
Chest trauma
high flow 02 rebreather Complications of injuries pneumothorax hemothorax flail chest INTERVENTIONS IV, O2 Cardiac Monitors not sure about this card
Lightning and Drowing you can die
hours after the incident occured
What are some mechanisms of injury?
hyper flexion, hyperextension, axial loading or vertical compression, excessive rotation, penetrating injuries
What can you give for septic shock
hypertonic solution and Albumin
What is ARDS presentation?
hypoxemia, rising CO2 levels, tachypnea, dyspnea, pulmonary HTN, decreased lung compliance, changes in CXR
What is an unprovoked seizure?
idiopathic, could be symptomatic for tumor or stroke, etc; cryptogenic (suspected cause but not definitive)
What types of medication do we use for MS?
immune supression, muscle spasticity, paresthsias, ataxia, bladder control
What kind of symptoms occur later in Alzheimers?
impaired balance, hyperorality, personality changes
What happend with penetrating trauma?
impalement infection and debris is important, resulting from a stab or GSW
How does Deep Brain Stimulation help with Parkinson's Dz?
implant, current delivers impulses to interfere with tremors
Pneumatic antishock garment
improves circulation in the heart, brain, lungs Increases perfusion
Shock
inadequate tissue perfusion Vital signs include tachycardia, tachypnea and hypotension. Nurses must also monitor the possible effects of shock on the endocrine system. ex insulin production, polyuria
criothyroidectomy
incision in the trachea Performed by a PCP or licensed professional in the EC to make a direct opening into the trachea.
What is encephalitis?
inflammation of brain tissue (demylination of axons, destruction of brain tisue, prognosis is dependent on degree of damage)
What is meningitis?
inflammation of meninges in response to infection of CSF
What does dopamine do for the neurons?
inhibits them and allows refined movement
What is incomplete spinal cord injury?
injuries that allow some function or movement below the level of injury
Autonomic nervous system (ANS)
innervates many body systems to make them function; ex. the sacral spinal nerves (part of the ANS) stimulate the detrusor muscle to contract when the urinary bladder is full; is considered "thoracolumbar" b/c of its anatomic location.
Defibulator is
instrument that provides various voltages of electricity measured in (Joules) to trigger the electrical impulses of the heart.
What is the occiptal lobe for responsible for?
integrates visual stimuli
Head Trauma
intercranial bleeding, intercranial pressure and edema death may result if client is not treated immediately Monitor LOC Glasgo Coma scale 3 15
Prior to contrast dye use, assess for metformin use because it:
interferes with renal perfusion
What are we looking for during a motor function assessment?
involuntary movement (pill rolling, tremors, attention tremors), strength (bilat), use 5 point scale
Reflex arc
is a closed circuit of spinal and peripheral nerves and therefore requires no control by the brain.
Subarachnoid space
is situated between the arachnoid and pia mater is the subarachnoid space, where CSF circulates.
Thalamus
is the major "relay station," or "central switchboard," for the CNS.
Glasgow Coma Scale (GCS)
is used to help describe the patient's level of consciousness (LOC); establishes baseline data in each of these areas: eye opening, motor response, and verbal response. The patient is assessed and assigned a numerical score for each of these areas. A score of 15 represents normal neurologic functioning. A score of 7 represents a comatose state. Thus the lower the score, the lower the patient's LOC. For patients who are intubated and cannot talk, record their score with a "t" after the number. The best possible score for this patient would be 11t.
What is the nursing care for head injury?
keep midline, HOB elevated, ABCs, hyperventilation, neuro function, pulmonary toilet, ICP and perfusuin pressures, CSF drainage
Wernicke's area
language area located in the temporal lobe allows processing of words into coherent thought and understanding of written or spoken words
What nursing care needs to be done for minimal and conventional back sx's?
log rolling q2hrs, deep break q2hrs to prevent atelectasis, SCD/TEDs to prevent DVT and the more invasive sx's focus on positioning and pain management
Remote memory
long term memory; can be tested by asking patients about their birth date, schools attended, the city of birth, or anything from the past that can be verified. Nurses often ask the maiden name of the patient's mother, which is sometimes listed on the admission form and can be checked.
Testing for remote memory- long term
long term- ask about birthday, schools attended, city of birth, anything in the past you can verify.
What are the 3 types of memory that needs to be tested?
long-term (remote), recall (recent), immediate memory
What is the tx for status epilepticus?
lorazepam and phenytoin as ordered and transfer to ICU
what is the definition of Spinal Cord Injury?
loss of motor function, sensation, reflex activity, bowel and bladder control. +/- behaviorla and emotional problems as a result in changes in body image, role performance and self-concept
Hypoactive reflexes may result from
lower motor neuron disease (damage to the spinal cord), disease of the neuromuscular junction, muscle disease, or health problems such as diabetes mellitus, hypothyroidism, or hypokalemia.
What are the areas most affected by pain in the back and why?
lumbosacral and cervical bc they atre the most flexible part of the spine
MRI do not use ionizing radiation, but _ _ to produce clear images
magnetic fields
Decribe post-op for cervical neck surgery?
maintaining the airway, swelling from the sx can narrow the trachea causing partial obstruction
Who gets depressed more often in response to having had a stroke? men or women
men
Fever and nuchal rigidity with HAs could be indicative of what?
meningitis
Bites Animals insects
minimize risk of infection control bleeding provide pain management Acess for anaphylaxis and edema of the tounge and airway. Administer epinephrine or antihistamines as ordered by a physician.
What is non-urgent (delayed until last)? Green
minor fractures, minor soft tissue, skin rash strains and sprains, colds, simple fracture
What is the second peak of death?
mins to several hours, pneumothorax and ruptured organ
Describe lumbosacral/low back pain (LBP)
more common than cervical, usually caused by trauma or injury and by muscle strain or spasm, ligament sprain, disk degeneration, herniation of nucleus pulposus,
What are pituitary tumors?
most are benign, slow growing, encapsulated, 90% nonsecreting, may encroach an optic chiasm/affect vision
what are the most common etiology for encephalitis?
most often viral; west nile virus, herpes simplex
Creatinine is a chemical waste product of __ metabolism of creatine phosphate or high protein meats
muscle
If a patient with myasthenia gravis suddenly has an increase in weakness and problems w/ breathing, swallowing and secretions what could be happening?
myasthenic crisis which is undermedicating with anticholinesterase drugs OR cholinergic crisis which is overmedication
What is rhabdomyolosis?
myoglobin is broken down to the muscle tissue, clogs the filter of the kidneys, massive fluids, can have pain, V, Confusion, ATN, and ARF
Low flow devices
nasal cannulas, Venturi masks and simple face masks.
To keep the airway open an apparatus may be placed into the?
nasopharyngeal or oral cavity. Endotrachael intubations may also be done.
Immediate memory
new memory; is tested by giving the patient two or three unrelated words, such as "apple," "street," and "chair," and asking him or her to repeat the words to make sure they were heard. After about 5 minutes, while continuing with the examination, ask the patient to repeat the words. An alternative to this method is to give a three-step command and observe whether it is carried out correctly. For example, "Pick up the paper, fold it in half, and draw a square on it."
High FLow
non-rebreather masks, bag-valve-masks BVM units endotracheal tubes
GCS score of 15 =
normal neurologic functioning
What are some other signs of meningeal irritation
nuchal rigidity, Kernigs sign, Brudzinski's
Electroencephalography (EEG) (P.947 Do's and don'ts chart):
o Thoroughly explain procedure to patient o If patient is to be sleep deprived, remind patient to wake up around 2 or 3 AM and to stay awake for the rest of the night. o Instruct patient to avoid central nervous system depressants or stimulants o Not to drink caffeine containing fluids. o Reassure patient that the test is not dangerous or uncomfortable o Ask patient to wash his or her hair on the morning of the test. Instruct the patient not to apply sprays or oils after the hair has been washed. o The patient should remove all hairpins, ribbons, and other hair accessories o Patient will need to wash the hair after the test to remove the electrode glue.
Who is expectant (dead or dying)? Black
obvious death, obvious non-survivable injury, full cardiac arrest
Anaphylactic Shock
occurs in clients who experience hypersensitivity reactions to various antigens. It is a severe allergic reaction that can involve the entire body. Expoxure to substance or foreign body can trigger anaphylaxis. ex Med, blood products, bites/stings, latex and foods (involves compromise of the respitory and immune systems. Dyspnea, Larangeal Spasm edema Bronchiospasm DLEB
What are the symptoms with MS?
often mimics other neurologic dz's, weakness and parasthesias (unsteady gait), visual disturbances (optic neuritis), abnormal reflexes (flexor spasms at night and hyperactive DTRs), intention tremor, impaired sense of touch, pain and temp, cognition
What is a provoked seizure?
one with a reversible cause, from metabolic disturbance, med tox, substance abuse, withdrawal, *usually don't require anti-seizure meds**
What is a craniotomy?
open skull; remove tumor
Contralateral
opposite side of the body
Ascending tracts
originate in the spinal cord and end in the brain.
What are seizures?
outburst of uncontrolled electricl activity in the brain, manifestations depends on location
Incindent Manager in Disaster
overall leader, # of patients,
How do we tx FBSS?
pain meds needed for life, multiple therapies, disability, life style changes, image changes
What is paraplegia?
paralysis, usually only involves lower extremities as in in lower throacid and lumbosacral injuries
EEG may be normal even when:
pathologic condition present - tumors, abscess, hematoma,injury, drug intoxication,metabolic disease
Describe Pronator Drift.
patient closes eyes and hold arms perpindicular to the body with palms up for 15-30 seconds, muscle weakness due to brainstem origin. Arm on weak side will drift with palm pronating
Medical Commander in disaster
patient related issues, # of paitens and resources needed
What are some other causes for Secondary HAs?
patients with cancer or pregnancy, HA with altered loss of consciousness, HA triggered by exertion, sex, valsalva
PALS
pediatric advanced life support which is a specialized training course that prepares health care professionals to perform advanced lifesaving skills or techniques on pediatric clients.
What is the parietal lobe responsible for?
perception of general sensation spatial perceptions and interrelationships. Interacts with motor area
What is the frontal lobe responsible for?
personality, behavior, higher intellectual functions, Primary voluntary motor area
What are senile or neuritic plaques?
plaques of abnormal protein amyloid, tissue atrophies and loses function
Hypothalamus
plays a major role in autonomic nervous system control (controlling temperature and other functions) and intellectual function (cognition).
Hyperactive reflexes indicate
possible upper motor neuron disease, tetanus, or hypocalcemia.
What is the non-sx management of LBP?
postitioning (change if it one pos too long, Williams position), NSAIDS, Opioids, epidural injections, steroids, antiepileptics, Heat to increase blood flow (moist X 20-30min), PT, Weight control, complementary and alternative therapies
What conditions can precede a myasthenis gravis flare up?
pregnancy, anesthesia, infection, emotional upset
How do we correct extrenal bleeding?
pressure
What is the health promotion and maintenance for LBP?
prevent by taking measures such as good posture, exercise, proper lifting technique
What is the nursing care of conventional open sx for LBP?
preventing and assessing for complications, fever, pain, hypotension, infection, neuro compls (do neuro exam q 4hrs) can patient void?
When a patient is brought in what is the "blue wave"?
primary survey, expose the patient, secondat assessment, full set of VS/catheter/labs, inspection of hidden injuries
Triage
process used by health care providers to determine which person has the most emergent (pressing) problem. It is routinely in the EC and UC settings . Usually clients are prioritized by ABCD Airway breathing Circulation and Deformities. With triage clients are prioritized in a range from critical to stable.
What is the pathogenesis of Lou Gehrig's Dz?
progressive degeneration of motor system with destruction of neurons and atrophy of muscles
What are the symptoms of Lou Gehrig's Dz?
progressive weakness and atrophy of muscles, muscle twitching, spacisity, hyperactive reflexes, limb/swalling/speech muscles, resp failure
Neurolglial cells
provide protection, structure, and nutrition for the neurons. They are classified into four types: astroglial cells, ependymal cells, oligodendrocytes, and microglial cells. These cells are also part of the blood-brain barrier and help regulate cerebrospinal fluid (CSF).
Emergency medical techs
provide the first treatment to victims outside the healthcare enviroment.
What is a simple partial seizure?
pt is conscious, may involve motor:abn movement or weakness in one part of body; sensory (changes in feeling, hallucinations, distortion of surroundings); autonomic (unpleasant feelings, HR, RR, goose bumps, and diaphoresis); psychic (changes in emotion, perception and speech)
Breathing must be evaluated for
rate, rhythm and quality.
Describe the nsg dx of: Altered thought process r/t neuronal degeneration
reality orientationin early stages, Stage 2-3; Validation therapy, picture on door, pictures of relatives, promote communication, free of distractions, diversion for agitation
What does the cerebellum do?
receives immediate and cont info about condition of muscle, jionts and tendons, right controls right and left controls left
Recall memory
recent memory; can be tested during the history and checked on the medical record: The accuracy of the medical history; Dates of clinic or physician appointments; The time of admission; Health care providers seen within the past few days; Mode of transportation to the hospital or clinic.
What is the temporal lobe responsible for?
recieving stimuli from senses (hearing taste, and smell, visual fibers, integrates memory)
What are some other types of management for migraines?
referral to HA clinic, Narcotics, Anti-emetics, lie still in dark, quiet room
UC
requires continious monitoring of clients for acute changes. However they are generally treated first come, first served rule.
What are the sx interventions for seizures?
resect focal point on brain (patient is alert); resect tumor; vagal nerve stimulator (connected to vagus nerve in cervical area, delivers electrical impulse, external programing)
What is the dx for myasthenia gravis?
response to edrophonium which is a fast acting anticholinesterase
What are the 4 Cardinal Symptoms of Parkinson's Dz?
resting tremors, akinesia/bradykinesia, rigidity of muscles and postural instability
What is a clonic seizure?
rhythmic jerking movements of both arms and legs impaired consciousness
What is the conservative tx for cervical neck pain?
same as LBP except exercise are focused on the shoulders and neck
What is stereotaxy?
scanning device that creates a 3-dimensional map of the tumor
What is the first peak of death?
seconds to minutes with decapitations and large vessel ruptures
What is an aura?
sensation b4 a seizure occurs, several seconds up to an hour b4, monitor person he/she reports unusual sensations and perceptions
Pain and light touch are assessed in __ FX
sensory
What are the high risks associated with bacterial meningitis?
septic emboli, DIC
What is a complete spinal cord injury?
severed or damaged to an extent that patient has lost all innervations below level of injury
What is status epilepticus?
single generalized seizure >5minutes OR a series of seizures lasting longer than 30 min without regaining full consciousness, high mortality in elderly,
Ipsilateral
situated on the same side
Occasionally, pt going in for CT may report:
slight, metallic taste
I Olfactory Nerve
smell
What happens with blunt trauma?
solid organs can easily rupture
What is triage>
sorting, give patients a disctinciton of priority
Broca's area
speech area located in the frontal lobe responsible for the formation of words or speech
What makes up the PNS?
spinal nerves, cranial nerves, and the ANS
What are some defects that can lead to LBP
spondylosis, spondylolisthesis, spinal stenosis
If a client may have an allergic reaction
stay in room for 20 30 min
What is the nursing care for seizures?
stay with person call for help, maintain airway, turn in side to prevent injury (protect head, do not restrain, loosen clothing, lay on flat surface, push furniture away, bed in low position/side rails up); nothing in mouth, provide privacy
EEG pt should avoid CNS __ and __
stimulant & depressants
What are the organisms associated with acute bacterial meningistis?
strep pneumoniae, meisseria meningitidis, strep agalactiae, hemophilus influenza (HIB)
What is the pathogenesis of Alzheimers?
structural changes (neurofibrillary tangles and senile or neuritic plaques, granulovascular degeneration
Lumbar puncture is insertion of spinal needle into __ space between 3rd and 4th lumbar
subarachnoid
What is a tonic seizure?
sudden stiffening movements of head trunk and extremities, common when patient is drowsy
What to watch for in psychiatric emergencies
suicide risk
What is the symptomatic treatment of Parkinson's Dz?
supportive/palliative (communication, injury prevention, cogntion changes), exercise (maximise strength and ROM, improve mood, PT, massage, Diet: swallow eval, Ca, Vits for bone density (adequate cals and limit ETOH), Bowel program (adequate fluid intake), physchological support, physical therapy to prevent contractures, abdominal and diaphragmatic and abdominal muscles for decreased chest expansion/breathing
What is Pallidotomy/Thalamotomy?
surgical destruction of brain tissue to interrupt tremors, rigidity and dyskinesia
What are neurofibrillary tangles?
tangled masses of neurons which are also found in Down syndrome
What is a concussion?
temp loss of function, no damage, LOC brief, amnesia, post concussion syndrome
What is the Wernickes area?
temporal lobe, allows processing of words into coherent thought and understanding of written or spoken words
What are the primary HAs?
tension, migraine, cluster
Traige Priniciple with Mass Casualty
the greatest good for the greatest number bc things will be limited, and hard decisions may need to be made, who can be delayed, who is hopeless and who is not?
Initial protocols
the nurse may initiate treatment while the client is in the waiting room before evaluation by the PCP. Ex hot or cold packs for an injured area or bandages applied to minimal wounds.
Clonus
the sudden, brief, jerking contraction of a muscle or muscle group often seen in seizures.
What are some considerationd for the OA and seizures?
their are changes in hepatic and renal function and metabolism of meds, increased cerebrovascular dz, drug interactions, cost of meds
What happens with a + Kernig's sign?
thighs flexed, cannot extend lower leg
What is the sx intervention for myasthenia gravis?
thymectomy (bc 15% have a tumor and 80% have hyperplasia)
Describe tension HAs
tight muscles in shoulders, upper back, sore neck, unilateral and bilateral, steady, band-like pressure, stress related
Standards of privacy may be stretched
to ask other individuals for information about the client even though the person providing the information is not legally supposed to give or receive client information.
Why do we assess cranial nerves?
to establish a baseline from which to compare progress or deterioration
What happens with acetylcholine and Parkinson's Disease?
transmits excitatory impulses and causes tremors
What is the most serious type of head injury?
traumatic brain injury, MOI very important to know!!
Meds for Cluster HA
tricyclic antidepressants, vasoconstricting meds
HAs with neurological deficits may mean what?
tumor
When is radiation therapy indicated?
tumors that are not surgically accessible or cannot be totally excised
What is epilepsy?
two or more seizures without a clear cause
Comatose
unconscious and cannot be aroused
The tounge is the most common obstruction in
unconscious clients. Many times the relaxation of the muscle allows the tounge to fall back into the throat
LPN/LVN always works
under the supervision of PCPs in EC and UC settings
What are the associated s/s of a HA (migraine)?
unilateral or bilateral, photophobia/phonophobia, N/V
What is the etiologiy for brain tumors?
unknow, viral, immune system malfunction, carcinogens (irradiation etc), genetics, secondary tumors from lung breast and prostate
Healthy kidneys remove creatinine from blood and deposit in __ for removal from the body
urine
Romberg sign
used to test equilibrium; ask the patient to stand with arms at the sides, feet and knees close together, and eyes open. Check for swaying, and then ask him or her to close his or her eyes and maintain position. The examiner should be close enough to prevent falling if the patient cannot stay erect. If he or she sways with the eyes closed but not when the eyes are open (the _____ _____), the problem is probably proprioceptive (awareness of body position). If the patient sways with the eyes both open and closed, the neurologic disturbance is probably cerebellar in origin.
Transcranial Doppler (TCD) =
uses soundwaves to measure blood flow through arteries - cerebral vasospasms or narrowing
Describe a fat embolism.
usually occirs from trauma of long bone, pelvis, or multiple fx, 24-48hrs after, presents as low grade fever, new onset of tachycardia, dyspnea, tachypnea, abnormal ABGs, thrombocytopenia, petechiae, lipuria
cutaneous (superficial) reflexes (+ other terms associated)
usually tested are the plantar reflexes and sometimes the abdominal reflexes. The plantar reflex is tested with a pointed (but not sharp) object, such as the handle end of the reflex hammer or the rounded end of bandage scissors. The normal response is plantar flexion of all toes. Dorsiflexion of the great toe and fanning of the other toes (Babinski's sign) is abnormal in anyone older than 2 years and represents the presence of central nervous system (CNS) disease. The term "positive Babinski's sign" (abnormal response) and "negative Babinski's sign" (normal response) are clinically used terms but are not correct. Babinski's sign is a pathologic, or abnormal, reflex. Health care providers may also use the terms "upgoing" or "downgoing" to refer to the toes of the stimulated foot. "Upgoing" toes is an abnormal response that indicates the presence of pathology in the CNS. Babinski's sign can occur with drug and alcohol intoxication, after a seizure, or in patients with multiple sclerosis or liver disease.
What is a big concern with open frature?
vasculature and infection
What are the long tern vasoconstriction meds?
verapamil, methysergide, lithium
Failure by the patient to walk a straight line could show dysfunction in which cranial nerve?
vestibulocochlear
How is meningitis transmitted?
via infectious agent (direct contact droplet, direct extension via blood stream, viral, bacteria, fungal
What is the pathophys of meningitis?
virus/bacteria spreads to cerebral circulation, engorgment of meningeal vessels, inflammation, edema, +/- increase ICP (risk for permanent brain injury)
What are the associated s/s with an aura?
visual disturbances, tingling of lips and hands, unilateral weakness/numbness
What is the nursing assessment before and during a seizure?
visual, auditory, olfactory and emotional disturbances; record where movements start, record type of movements and area of the body involved; duration of each phase, incontinence, cognotive behavioral status after
hypothermia
warm the body in a bath. slowly 96.2
What is paraparesis?
weakness
Desribe risk for injury r/t impaired judgement, restlessness and wandering
wear ID badge, check freq., stop signs and alarms, take person on walks freq, shop for clothes in closet, remove knives, keys etc.
When is back pain considered chronic?
when pain lasts for more than 3 months
Hypothermia
when tem drops below 96.2 at this point tissue damage and ischemia may result. Drowsiness may occur as respirations, heart rate and body processes occur.
Neurogenic Shock
when there is trauma or malfunction to the nervous system. Most frequently know as spinal shock. ex vehicle crashes. s/s Fluid loss, bleeding, burns, fluid and electrolyte imbalances related to excessive diarrhea or vomiting or sepsis from trauma or injury. Very Pale (clammy) ex Burns S/S Skin Warm and dry Hypotension Oliguria decreased urine Heart Rade decreases Tachypnea LOC Modified trendelenburg
The triage nurse in the EC unit must be able to explain
why clients with non-urgent problems must wait without making them feel that they do not deserve health care.
What are generalized seizures?
wide-spread excessive electrical discharge, involves both hemispheres; may be tonic, atonic, myoclonic, absence
What does an organized physical assessment start?
with a mental statis
20/20
you can see the chart at 20ft
What are some risk factors for MS?
young (20-40), higher above the 37th parallel, more in caucasians and higher socioeconomic class
Possible etiologies of seizures related to metabolic disturbances
• Acidosis • Electrolyte imbalances • Hypoglycemia • Hypoxia • Alcohol or barbiturate withdrawal • Dehydration or water intoxication
Nursing Diagnoses for patients with migraines:
• Acute pain • Anxiety • Hopelessness
Complications of Seizures
• Are considered a neurologic emergency • Can involve any type of seizure • The brain uses more energy than supplied • Neurons become exhausted and cease to function • Permanent brain damage can result
Fatigue
• Aspiration precautions • Mouth care and moisture for lips • Altered routes of medication administration if needed—choose the least invasive route of medication administration with the most effective treatment ...are all things to do for managing what?
Phases of a seizure: Aural
• Aural phase with sensory warning
Generalized seizures
• Characterized by bilateral synchronous epileptic discharges in the brain from seizure onset • Keep accurate notes to describe!!! • No warning or aura as entire brain is affected • Loss of consciousness from seconds to minutes
• Myoclonic seizure
• Characterized by sudden, excessive jerk of body and extremities • Can be forceful enough to cause fall • Brief and may occur in clusters • Keep accurate notes to describe!!!
Psychosensory symptoms that may occur during complex partial seizure include:
• Distortions of visual or auditory sensations • Vertigo • Alterations in memory • Alterations in thought processes
Phases of a seizure: Ictal
• Ictal phase with full seizure
Lumbar Puncture
• Insertion of spinal needle into the subarachnoid space (between the third and fourth lumbar vertebrae) • Contraindicated in clients with increased intracranial pressure • Empty bladder • Position: Patient should bend over. May have in fetal position on bed or hunched over a table • Spinal headache possible from spinal tap
Clinical manifestations in patients during EOLC
• Lethargy with long periods of sleep • Difficulty in communication • Distress • Constipation • Cold, mottled, cyanotic skin • Decreased BP, heart rate, respiratory rate The above are all examples of what?
• Tonic-clonic status epilepticus
• Most dangerous because it can cause: -Ventilatory Insufficiency---Provide oxygen!! -Hypoxemia--Provide oxygen!!! -Cardiac Arrhythmias -Hyperthermia -Systemic Acidosis • Trauma during seizures can cause severe injury and death
* Migraine without aura involves at least one of the following
• Nausea and vomiting • Photophobia and phonophobia
Benign Cells
• Normal cells - wrong place or wrong time • Look like tissues they come from • ENCAPSULATED • Do not migrate • Are euploid & small nucleus
• Typical absence seizures (petit mal)
• Occurs only in children and rarely into adolescence • May cease or develop into another type • Typical symptom is staring spell for only a few seconds and usually goes unnoticed • Brief loss of consciousness • May occur up to 100 times/day if untreated • EEG demonstrates pattern unique to this type of seizure • Often precipitated by hyperventilation and flashing lights
Primary drugs for treatment of generalized tonic-clonic and partial seizures:
• Older: Dilantin, Tegretol, Phenobarbital, and Depakote • Newer: Neurontin, Lamictal, Topamax, Gabitril, Keppra, and Zonegram
Partial seizures (Not Generalized anymore)
• Partial seizures referred to as partial focal seizures • Begin in a specific region of the cortex • May be confined to one side of the brain and remain partial or focal in nature • May involve entire the brain, cumulating in tonic-clonic seizure
Phases of a seizure: Postictal
• Postictal phase with rest and recovery
Phases of a seizure: Prodromal
• Prodromal phase precedes seizure with signs or activity
Nervous system changes associated with aging:
• Recent memory loss • Decreased touch sensation • Change in perception of pain • Change in sleep patterns • Altered balance and/or decreased coordination
Migraine Headache
• Recurring • Characterized by unilateral or bilateral throbbing pain • Triggering event or factor • Family history • Women affected more often than men
What types of generalized seizures exist?
• Tonic-clonic seizures (grand mal) • Typical absence seizures (petit mal) • Atypical absence seizures • Myoclonic seizure • Akinetic, atonic, and astatic are used interchangeably for drop attacks
Migraine without aura involves at least two of these characteristics:
• Unilateral location • Pulsating quality • Moderate-to-severe intensity • Worsening with activity
