MDC 4 Final Exam

Classic heat stroke

a heat stroke that occurs over a period of time as a result of chronic exposure to a hot, humid environment such as living in a home without air conditioning in the high heat of summer

Compression Dressings

-a dressing that is applied after grafts heal to help prevent contractures and tight hypertrophic scars, which can inhibit MOBILITY. -They also inhibit venous stasis and edema in areas with decreased lymph flow. -they may be elastic wraps or specially designed, custom-fitted, elasticized clothing that provides continuous pressure. -Best effectiveness, pressure garments worn at least 23 hours a day, every day, until scar tissue is mature (12 to 24 months). -Can be uncomfortable with itchiness and increased warmth. -Reinforce to the patient and family that wearing pressure garments is beneficial in saving mobility and reducing scarring.

General Anesthesia

-a form of anesthesia with reversible LOC, inhibits neuronal impulses -two types: Inhaled or Intravenous ***Note: the blockage of all body sensations, causing un-consciousness and loss of reflexes.***

Incentive spirometer

-a resistive breathing device that helps patients exercise their breathing muscles -patients take strong and slow inhale breaths -it Allow the lungs to stretch, increases lung volume, assists in opening prevents lung infection, improve sputum expectoration -where has a Flutter valve where the patient blows into this device and it creates a vibration to mobilize mucous

cardiac tamponade

-a type of obstructive shock where accumulation of fluid in the pericadial sac impairs diastolic filling and reduces cardiac output -Signs and System: § Distended neck veins (JVD) § Hypotension § Muffled Heart Sounds -Interventions: § immediate pericardiocentesis

Carbon Monoxide Exposure

-exposure to a colorless, odorless, tasteless gas released in the process of combustion that causes the "cherry red" color in these patients who are exposed for long periods of time ***Note: a classic sign include cherry rid lips*** -Intervention: Administer high-flow oxygen for at least 6 hours to these patients

Stage 3 of frosbite

-in this stage of frosbite, the appearence of small blisters that contain dark fluid and an affected body part that is cool, numb, blue, or red and does not blanch -full-thickness and subcutaneous tissue necrosis occurs and requires débridement.

Extubation

-removal of a previously inserted tube -Hyper oxygenate patient -Thoroughly suction ET and oral cavity -Rapidly deflate ET cuff -Remove tube at peak inspiration -Instruct patient to cough -Provide oral care/suctioning -Monitor patient every 5 minutes; assess ventilatory pattern for respiratory distress

atelectasis

Collapse of lung tissue; can occur postoperatively if the patient does not change positions and breathe deeply

Stage 2 of Parkinson's disease

Mild stage where Both arms are affected, shuffling gate and masklike face appear

Dantrolene

Muscle Relaxant administered IV to treat Malignant Hyperthermia

Cushing Triad

Vital Sign changesand LATE SIGN of increased intracranial pressure that includes: -Hypertension (HTN) with widening pulse pressure (widening pulse presure normal BP 120/80 but widen BP 140/80) -bradycardia -irregular respiration/bradypnea (Cheyne-Stroke Respirations) **This triad of cardiovascular changes usually indicates imminent death.**

Parkland formula

-4ml x TBSA (%) x body weight (kg) = Total Fluid; the total fluid is then divide by two -HALF (50%) given in first eight hours; 50% given in next 16 hours.

Stage 2 of frostbite

in this stage of frosbite, large, clear-to-milky, fluid-filled blisters develop with partial-thickness skin necrosis

Dehiscence

-a wound opening where their is a separation of layers, usually of a surgical incision -it is occurs occurs, apply a sterile nonadherent (e.g., Telfa) or saline dressing to the wound and notify the surgeon. Instruct the patient to bend the knees and avoid coughing. A wound that becomes infected dehisces by itself, or it may be opened by the surgeon through an incision and drainage (I&D) procedure. In either case the wound is left open and is treated as described previously.

Multi Casualty Event

-a disaster even in which a limited number of victims or casualties are involved and can be managed by a hospital using local resources -Managed by hospitals using local resources

regional anesthesia

-a form anesthesia where it is injected around major nerves to block sensation and pain to a specific area of body -allows participation from patient -does not affect gag or cough reflex -no way to control agent after administration -not practical for extensive procedures because of the drug amount required to maintain effect -Type: ● Field Block: series of injections around surgical site ● Nerve Block: injection of a local anesthetic into or around one nerve group ● Spinal anesthesia: injected into CSF ● Epidural: injected into epidural space ***Note: Temporary interruption of nerve conduction, is produced by injecting an anesthetic solution near the nerves to be blocked.***

Psychosocial Response of Survivors

• Disaster experience can produce immediate and long-lasting effects • Lifestyle, roles, routines may be altered • Coping ability may be severely stressed • Nurses communicate and provide sense of safety • Monitor for signs of PTSD • IES-R questionnaire [Impact of Event Scale-Revised, 10th grade reading level, do not use with short term memory loss] High scores require a referral to a counseling source.

acute respiratory distress syndrome (ARDS) Interventions

-Interventions: • V/S hourly for hypotension, tachycardia, dysrhythmias, fever • ECMO (extracorporeal membrane oxygenation heart-lung bypass equipment) • ET intubation, mechanical vent with PEEP • Sedation and paralysis • Antibiotics • Vit C and E,N-acetylcystiene, nitric oxide, surfactant • Conservative IV fluids vs diuretics • Nutrition therapy (enteral nutrition, TPN, parenteral) • Q2 turn every hour to prevent stress ulcers • ET intubation, mechanical ventilation with PEEP • Assess lungs hourly • oxygen, prevent complications, and support lungs.

Medical Reserve Corps (MRC)

-Medical volunteer agency that is committed to supporting public health and emergency response in the community -they are volunteers of physicians and nurse and serve to alleviate large amounts of patients ***Note: they do not have their own equipment and must be supplied***

External Disaster

-Occurs outside the facility and has an impact on normal operations -Event outside of the facility (community, local, or state) -May need extra personnel and supplies -Emergency management plan in place -external disasters can be either natural such as a hurricane, earthquake, or tornado, or technologic such as an act of terrorism with explosive devices or a malfunction of a nuclear reactor with radiation exposure

Flail Chest

-Paradoxical chest movement of "Sucking inward" of loose chest area during inspiration, "puffing out" during expiration -more than 3 ribs fractured in two or more places. Usually compression force. -True emergency: Leads to rib cage instability, pulm emergency -A: Chest Pain (CP), dyspnea, tachy, death -Dx: CBC (infection/bleeding), CXR, CT, ABG -I: stability, repair, pain control, adequate ventilation. Intubation/Ventilator with PEEP, IV fluids

Hypothermia Health Promotion

-Teach the importance of wearing synthetic clothing because it moves moisture away from the body and dries fast. Cotton clothing, especially worn as an undergarment, holds moisture, becomes wet, and contributes to the development of hypothermia. It should be strictly avoided in a cold outdoor environment; this rule applies to gloves and socks as well because wet gloves and socks promote frostbite in the fingers and toes. Wearing too many pairs of socks can decrease circulation and lead to frostbite. -Teach people to keep water, extra clothing, blankets, food, and essential personal medications in their car when driving in cold climates and in winter in case the vehicle becomes stranded. Maintaining personal fitness and conditioning is an important consideration to prevent hypothermia and frostbite. People should not diet or restrict food or fluid intake when participating in winter outdoor activities. Undernutrition and dehydration contribute to cold-related illnesses and injuries. -it is important for people to know their physical limits and to come in out of the cold before those limits have been reached.

Moderate Alzheimer's disease (middle-stage)

***2nd stage of dementia; longest stage and can last for many years; may act withdrawn, confused about where they are, need help with ADLS*** • Lasts 2-3 years • Withdrawal, confusion, decrease in self care, poor judgement, and difficulty in communications • Behavioral/ psychotic changes- anger, frustration, restlessness, wandering, visuospatial deficits, paranoia, difficulty sleeping • Dependence on others for care increases • Most patients are diagnosed in this stage ****IMPORTANT: difficulty sleeping, loss of social engagement, wandering, and aggressiveness are signs of this stage****

Fibrinolytic therapy

***AKA: Clot buster*** -The therapy that uses medications that act to dissolve blood clots. -Dissolves occlusions to re-establish blood flow -Altapase (tPA)- only drug approved for ischemic stroke (thrombotic) treatment -Weight based -If hypertension is present, may need rapid antihypertensive medication first (labetalol, nicardipine) ***Note: Treatment for Ischemic Stroke (Thrombotic)*** ***IMPORTANT: before administering TPA (Altapase) the nurse needs to know the last know normal of the patient before administering the medication****

NPO

***AKA: nothing by mouth*** - patient not to ingest anything by mouth for 6 to 8 hours before surgery: • it decreases risk for aspiration • give patients written/oral directions to stres adherence • surgery can be canceled if instructions not followed • if the patient is a diabetic, the are usually scheduled first thing ****IMPORTANT: No chewing gum, brush teeth- no increases saliva content, no ice, mouth swabs. Why; to prevent aspiration when they sedated, relaxed esophagus and epiglottis, contents travel back up and can go into the trachea, vomiting could delay or cancel surgery. It pt is going for surgery at 1600 that day they may be able to eat breakfast instead of being NPO since midnight.****

Severe Alzheimer's Disease (late stage)

***In the *final stage* of this disease, individuals *lose the ability to respond to their environment*, to *carry on a conversation* and, eventually, to *control movement*.*** • Typically lasts 1-3 years • Completely incapacitated, will not eat unless fed • May become non-verbal, family members become unrecognizable • Loss of bodily functions/control • Suffers from agnosia

Trigeminal Neuralgia

-A Painful disorder of the trigeminal nerve (CN V). Pain is paroxysmal, severe and unpredictable. -Affects one or more of the three nerve branches (ophthalmic, maxillary, and mandibular) -Effects women more than men -Typically, first identified in the dentist office -Explain what pt is at risk for and education that is needed -Pain management is the priority nursing intervention: • Anti-epileptics, gabapentin (carbazapine), muscle relaxers to relieve pain, Botox • Acupuncture • Microvascular decompression • Radiofrequency thermocoagulation (Percutaneous Stereotactic Rhizotomy)

preventative therapy

-A therapy for migraine that is used to suppress the onset of headaches that can occur as frequently as twice a week. -Medication include: • Beta blockers (Propranolol, Timolol), calcium channel blockers (verapamil)- These aid in preventing vascular changes and are used to manage, not treat acute episodes • Antiepileptic drugs-topiramate (Topamax) • Tricyclic antidepressant -nortriptyline (Pamelor) and onabotulinumtoxinA (Botox)

mechanical ventilation

-A ventilation device that provides respiratory support through the controlled delivery of ventilation and oxygenation via an enditracheal tube, tracheostomy tube, or noninvasive ventilation via mask through continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BIPAP) -Nursing interventions include: ***Note: Ensure that the patient has a manual ventilation resuscitation bag in their room (near their bed)*** • Explain the procedure to the patient • Establish a means of communication such as asking yes or no questions, provide writing material, picture communication board or read lips • Maintain a patent airway by ensuring airway device is secure • Preventing accidental extubation (wrist restrain may be required) • Suction oral and tracheal device • Assess respiratory status every 1 to 2 hours • Monitor ventilation settings and alarm. ****IMPORTANT: NEVER TURN OFF VENT MACHINE**** ***IMPORTANT: IF THE CAUSE OF AN ALARM CANNOT BE IDENTIFIED AND CORRECTED, THE NURSE SHOULD VENTILATE THE CLIENT USING A MANUAL RESUSCITATION BAG UNTIL THE ISSUE IS RESOLVED*** -Motinor for Low-pressure to High pressure alarms

Pulmonary artery wedge pressure (catheter)

-Allows for monitoring of vascular tone, myocardial contractility, intracardiac pressures, cardiac output, and fluid balance. -Insertion of a CVP catheter allows pressure to be monitored in the patient's right atrium or superior vena cava while providing venous access -High readings with heart failure (fluid overload) -Low readings with hypovolemia

R.A.C.E.

A fire evacuation plan that occurs in this following order: -R = RESCUE anyone in immediate danger from the fire, if it does not endanger your life -A = ALARM: sound the alarm by calling "2600" (oncampus locations only) and activating a pull station alarm box -C = CONFINE the fire by closing all doors and windows -E = EXTINGUISH the fire with a fire extinguisher, or EVACUATE the area if the fire is too large for a fire extinguisher.

Pre-op Checklist

Checklist the day of Surgery includes: -preoperative education completed -informed consent signed -NPO- bowel prep -Skin prep-shower or bath in anti-microbial soap -documentation/checklist of valuables -voided prior to transfer -Pre op meds- given and charted -side rails up after pre-op bed in low position -hospital gown -Allergy band -ID Band -Denture, Eyeglasses, Hearing aids, contacts-left in place or removed -makeup and nail polish removed -vital signs before transfer -pre-op lab work on chart surgeon notified of abnormal values -Medications, history, MAR on chart, EHR/EMR up-to-date, and high alert meds noted

Autonomic Dysreflexia Emergency Care

Emergency care for this spinal cord injury include: • Place patient in a sitting position (first priority!), or return to a previous safe position. • Assess for and remove/manage the cause: -Check for urinary retention or catheter blockage. -Check the urinary catheter tubing (if present) for kinks or obstruction. -If a urinary catheter is not present, check for bladder distention and catheterize immediately if indicated. (Consider using anesthetic ointment on tip of catheter before catheter insertion to reduce urethral irritation.) • Determine if a urinary tract infection or bladder calculi (stones) are contributing to genitourinary irritation. • Check the patient for fecal impaction or other colorectal irritation, using anesthetic ointment at rectum. Disimpact if needed. • Examine skin for new or worsening pressure injury symptoms. • Monitor blood pressure every 10 to 15 minutes. • Give nifedipine or nitrate as prescribed to lower blood pressure as needed.

Drowning

-The process of experiencing respiratory impairment from submersion or immersion in liquid. -a leading cause of accidental death in the United States -Prevention: • Constantly observe people who cannot swim and are in or around water. • Do not swim alone. • Test the water depth before diving in head first; never dive into shallow water. • Avoid alcoholic beverages and substance use when swimming and boating and while in proximity to water. • Ensure that water rescue equipment such as life jackets, flotation devices, and rope is immediately available when around water. -Interventions: • Once rescuers gain access to the victim, the priority is safe removal from the water. • Spine stabilization with a board or flotation device should be considered only for victims who are at high risk for spine trauma. Time is critical; efforts directed toward a rapid rescue have the most potential benefit. • Initiate airway clearance and ventilatory support measures, including delivering rescue breaths, as soon as possible while the patient is still in the water. • If hypothermia is a concern, handle the victim gently to prevent ventricular fibrillation. -Hospital Care: • Once the person is safely removed from the water, airway and cardiopulmonary support interventions begin, including oxygen administration, endotracheal intubation, CPR, and defibrillation, if necessary. • gastric decompression with a nasogastric or orogastric tube is needed to prevent aspiration of gastric contents and improve ventilatory function. • full spectrum of critical care technology may be needed to manage the pathophysiologic complications of drowning, including pulmonary edema, infection, acute respiratory distress syndrome (ARDS), and CNS impairment. ***Note: Surfactant reduces surface tension in the alveoli, increasing lung compliance and decreases work of breathing. Loss of surfactant destabilizes alveoli, leading to increased airway resistance resulting in pulmonary edema*** ***IMPORTANT: Monitor for ARDS, Pulmonary Edema, Infections, and CNS Impairment***

CSF leakage

-Trauma to the face (facial orifices) can result in leakage of fluid from the subarachnoid space into the nasal cavity from a traumatic brain injury -fluid is placed on a white absorbent paper or linen can be distinguished from other fluids by the "halo sign", a clear or yellowish ring surrounding a spot of blood. -Although other body fluids can be used, a halo sign is most reliable when blood is in the center of the absorbent material because tears and saliva can also cause a clear ring in some conditions **When CT scans are used with head and brain injury, these fractures are often visualized before bruising appears.**

emergency department

-Usually located in a hospital and provide emergency treatment of patients -staffed by emergency department and nurse -it treats strokes, heart attacks, asthma, broken bones, fainting, severe pain, severe vomiting and diarrhea, and other conditions -Patients are triaged by a specially trained nurse, with life-threatening conditions seen first -goal is to stabilize patients who may be admitted for further care.

Chemical Burn

-a burn cause by exposure to •Strong acids, alkalis phenols, creoles (petroleum products), & phosphorus -Severity of injury R/T chemical involved, concentration, length of exposure, immediate treatment -Damage to skin and underlying tissues continue to occur over several hours ****IMPORTANT: Irrigate with copious amounts of fluid if chemical substances is known**** -Occur in household and industrial settings ***Note: Contaminated clothing is removed and chemicals in powder form are brushed off. Then the burn is cautiously irrigated with large amounts of water. DO NOT WET THE DRY CHEMICALS DIRECTLY*** -INTERVENTIONS: • Brush off any dry chemicals present on the skin or clothing. • Remove the patient's clothing. • Ascertain the type of chemical causing the burn. • Do not attempt to neutralize the chemical unless it has been positively identified and the appropriate neutralizing agent is available.

Status Epilepticus

-a life-threatening emergency where Tonic-clonic seizure lasting more than 30 minutes -OR Convulsions are so frequent that the next seizure starts before the previous post-ictal period ends. This means there is no regain of consciousness. -After 5 minutes of continuous episode, patient is treated as status epilepticus. 30 minutes or more of seizure activity will result in neurological consequences. -Cause Hypoxia, Hyperthermia, Hypoglycemia, and Exhaustion ***NOTE: MEDICATION OF CHOICE IS LORAZEPAM*** ***NOTE: IF ADMINISTERING PHENYTOIN, PUSH IV SLOWLY AND DO NOT MIX WITH GLUCOSE***

pulmonary embolism (PE)

-a life-threatening hypoxic condition caused by a collection of particulate matter (solid, gas, or liquid) that enters venous circulation and lodges in the pulmonary vessels causing pulmonary blood flow obstruction -S/S: Dyspnea, tachycardia, tachypnea, restlessness, diaphoresis, crackles, cough, hemoptysis, fever, hypotension, right ventricular failure, petechiae, syncope, sense of impending doom, decreased O2 Saturation, pleural effusion, crackles and cough -Interventions: • O2, Venous access, Q30 min respiratory assess, High fowlers, bleeding precautions (assess bleeding Q2hr), PTT for Heparin, PT/INR for Warfarin • Assess respiratory status and vital signs • Position in high-fowler's • Initiate IV access -Patient education: • Bleeding precautions • Home Oxygen therapy -Risk factors include: • Sedentary lifestyle • female patient on oral contraceptives and smoking • Smoking • long distance truck drivers

Heat stroke

-a medical emergency in which body temperature may exceed 104°F (40°C). It has a high mortality rate if not treated in a timely manner -the patients thermoregulation mechanisms fail and cannot adjust for a critical elevation in body temperature ***IMPORTANT: Can lead to organ dysfunction and death if patient does not respond to treatment*** -two type: Exertional and Classic ***Note: exhibits similar signs and symptoms 3rd and 4th stage hypovolemic shock***

Glasgow Coma Scale (GCS)

-a scale used to assess the consciousness of a patient upon physical examination, typically in patients with neurological concerns or complaints -the lowest scores is 3 and as high as 15 -Best score Eye response: 4, Verbal response: 5, Motor response: 6 ● Severe : GCS 8 or less ● Moderate : GCS 9-12 ● Mild : GCS 13-15 ***Note: A change of 2 points is considered clinically important and requires notification to provider*** ***IMPORTAN: If the score is 8 or less, the patient needs intubate*** -A decrease in arousal, increased sleepiness, and increased restlessness or combativeness are all signs of declining neurologic status. -a scale used to assess the consciousness of a patient upon physical examination, typically in patients with neurological concerns or complaints

Guillain-Barre syndrome

-an acute inflammatory and autoimmune disorder of the peripheral nervus system -Diagnostics: Electrophysiologic studies (EPSs)--demonstrates demyelinating neuropathy ***IMPORTANT: Cause by a Virus*** -Progressive paralytic ascending muscle weakness/ paralysis ****IMPORTANT: IT IS A PROGRESSIVE PARALYTIC ASCENDING MUSCLE WEAKNESS/PARALYSIS DISORDER MEANING IT STARTS FROM THE LOWER EXTREMETIES AND ASCEND UPWARDS TO OTHER PARTS OF THE BODY BILATERALY*** -Antibodies attack the myelin sheath that surround the axons, causing destruction that slows the transmission of impulses -Sign and Symptoms: • Respiratory Compromise • Decreased Deep Tendon Reflex • Ataxia ( appears "drunk") • Ascending paralysis: Symmetrical muscle weakness leading to flaccid paralysis without atrophy • Cranial Nerve Changes • Autonomic Manifestations • Changes in sensory perception: Paresthesia, Pain -Treatment: Plasmapheresis and IV immunoglobulin (IVIG) ***IMPORTTANT: PATIENT AT RISK FOR ASPIRATION from the Inability to maintain airway--potentially fatal with ascending paralysis***

Lightening Strikes injuries

-an electric charge generated within thunderclouds that may become cloud-to-ground lightning—the most dangerous form to people and structures. -Cardiopulmonary: • Most lethal effect of lightening is cardiac arrest (heart may resume normal electrical rhythm spontaneously) • Prolonged respiratory arrest can produce hypoxia and subsequent injury or a second cardiac arrest • ABCs and CPR- priority treatment • Appearance of mottled skin and decreased or absent peripheral pulses is from arterial vasospasm and typically resolves over the next few hours -CNS: • Temporary BLE paralysis- keraunoparalysis- resolves on its own over the next few hours, but assessment for spinal cord injury is necessary -Skin: • Skin burns- full thickness, charring, and contact burns • Tree like branching marks on the skin- Lichtenberg figures- are not burns, but thought to be caused by coagulation of blood cells in the capillaries -Other signs and symptoms: • Cataracts • Tympanic membrane rupture • Cerebral hemorrhage • Depression • PTSD

Non-urgent (Stable: low risk)

-care where the patient can usually wait several hours for care without risk -Not a risk of deterioration and care can be delayed -Dermatitis, medication refills, toothaches, sprains, strains

spinal cord injury (SCI)

-damage to spinal cord as result of trauma; spinal cord can be bruised or completely severed -primary assessment include: • Airway • Breathing • Circulation -involving C3-5 innervate the phrenic nerve controlling the diaphragm. This can greatly compromise the client's ability to maintain their own airway. ****Note: C3 or higher requires ventilation and airway maintenance due to loss of respiratory innervation and function**** ****T6 and higher can result in cardiovascular compromise due to reduced or lack of innervation of sympathetic fibers to ANS**** ****IMPORTANT: Airway management is key for C spine pts****

Inotropic Agents

-drugs that stimulate the heart to increase the force of contractions -Directly stimulate beta-adrenergic receptors on the heart muscle, improving contractility -Medication: § Dobutamine (Dobutrex) § Milirone (Primacor) -Interventions: § Assess for chest pain- increase myocardial consumption leading to angina or infarction § Assess blood pressure Q15minutes- hypertension is a symptom of overdose

Heat Related Illnesses

-high environmental temperature (above 95°F [35°C]) and high humidity (above 80%) -common conditions are Heat Exhaustion and Heat Stroke -Those at risk include: • Older adults (less fluid volume) • Mental health disorders • Outside workers • Homeless • Athletes • Military stationed in high temp climates -Comorbidities include: • Obesity • Heart disease • Fever • Infection • Existing burns • Medications: Lithium, Seizure meds, Beta blockers, ACE inhibitors and diuretics -Prevention include: • Avoid Alcohol and caffeine • Prevent overexposure and wear sunscreen • Rest frequently and take breaks • Limit heat of the day activities • Clothing should be suitable for the environment • Know your limitations • Take cool baths or showers to reduce body temp • Stay indoors if possible • Check on your elderly neighbors or those without AC

Disaster Medical Assistance Team (DMAT)

-medical professionals that respond to disaster areas with equipment and supplies to sustain operations for 72 hours. Considered federal employees while activated, so license is good in all 50 states. -specialized teams designed to provide medical care following a disaster ***Note: they have their own equipments and supplies**

ABGs

-pH 7.35- 7.45 -HCO3 (Bicarbonate) normal values 22-26 mEq/L -PaCO2 ( CO2 or carbon dioxide content) 35-45 mm Hg -PaO2 (oxygen saturation in arteria blood)- 80-100 mm Hg

Complex Partial Seizures

a partial seizure where syncope or black out, may wander or develop amnesia. Lasts 1-3 minutes. Temporal lobe is typically involved. Most common seizure in adults, but most difficult to diagnose bc symptoms mimic dementia and other neuro issues. Can become a generalized type of seizure as well.

Simple Partial Seizures

a partial seizure where the patient remains conscious, "Deja-vu" feeling, altered smells and auras, sudden pain response, autonomic changes. During seizure, may have one sided movement of an extremity.

Shock Position

a position where the head of the patient is flat and elevate the patients feet where shock occur

Low-pressure alarms

a ventilator alarm that indicates low volume and is usually associated with tube disconnection, cuff leak, or tube dislodgement

Stage 5 of Parkinson's disease

final stage where the patient needs total dependence for mobility and ADLs

Heat stroke Interventions

Interventions for this heat related illness include: - placing patient on NPO status for risk of aspiration - Airway, Breath, Circulation: • High flow O2 • Aggressive Fluid resuscitation • Cooling measures until rectal temp is less than 102. External- ice packs, cooling blankets and Internal- ice lavage to stomach and/or bladder • Prevent shivering • Indwelling catheter • No ASA or antipyretics

Autonomic Dysreflexia Nursing Care

Nursing care to prevent complications for this spinal cord injury include: -Turn the client every two hours and assess the skin for breakdown. -Monitor vital signs, intake and output, and weight. -Monitor the client's hydration and nutrition closely. -Nutritional requirements that are important to monitor are proteins, vitamins, and iron, particularly for the client that is quadriplegic and is unable to drink or eat without assistance. Since the client is immobile, bones are at risk for developing osteopenia which puts the client at risk for fractures. Another complication of immobility is the development of venous thromboembolism (VTE). The client will be on an anticoagulation or antiplatelet to prevent the formation of VTE.

Nursing Considerations of an Intubated Patient

Nursing consideration include: -Keep the HOB elevated 30 degrees. -Be sure that all alarms are set. -Do not ignore or silence ventilator alarms without assessing. -Empty the ventilatory tubing when moisture collects. -Assess the client for the need to suction. -Perform mouth care every 2 hours. -Turn and reposition every 2 hours. -Communicate with both the client and the family by explaining all procedures. -Keep the family informed and be supportive of their concerns, questions, and anxieties. -The intubated client is in the ICU (intensive care unit) and depending on the acuity may be a 1:1 ratio. -Assess tube placement, cuff leak, breath sounds, pilot balloon, soft wrist restraints. -Always assess pt first then vent -Ambu bag at HOB, Monitor O2 status, ABG, Volume status and hydration, alarms, suctioning, Q2 turn and oral care -VAP (ventilator associated events)- Tracheal damage, unplanned extubation, ventilator associated pneumonia, stress related mucosal, anxiety, impaired nutrition

Post-op Respiratory Care

Post-op care include: -Deep (diaphragmatic) breathing- sitting upright, gentle breath in through mouth, breath out completely, deep breath through nose and mouth, hold breath and count to 5 -Expansive breathing- sit upright with knees bent (bent knees decreases tension on the abdominal muscles, decreased respiratory resistance/ discomfort, place hands on rib cage, deep breath in nose, move shoulders back to expand lungs, exhale- concentrative of moving chest, then moving lower ribs inward, gently squeezing the rib cage and forcing air out of lungs -Splinting of the Surgical Incision- unless contradicted, place pillow/towel/folded blanket over surgical incision, take 3 slow, deep breaths to stimulate the cough reflex, inhale through nose and exhale through mouth, do the 3rd deep breath to clear secretions from lungs while holding the pillow/towel/folded blanket over incision ***Note: This is Post-op care to prevent pneumonia and atelectasis***

Autonomic Dysreflexia Sign and Symptoms

Signs and Symptoms for this spinal cord injury include: • Sudden, significant rise in systolic and diastolic blood pressure, accompanied by bradycardia • Profuse sweating above the level of lesion—especially in the face, neck, and shoulders; rarely occurs below the level of the lesion because of sympathetic cholinergic activity • Goose bumps above or possibly below the level of the lesion • Flushing of the skin above the level of the lesion—especially in the face, neck, and shoulders • Blurred vision • Spots in the patient's visual field • Nasal congestion • Onset of severe, throbbing headache • Flushing about the level of the lesion with pale skin below the level of the lesion • Feeling of apprehension

Traumatic Brain Injury

• Damage to the brain from an external mechanical force • Not caused by neurodegenerative or congenital conditions. • it can lead to temporary and permanent impairment in COGNITION, MOBILITY, SENSORY PERCEPTION, and/or psychosocial function ***Note: The first priority is the assessment of the patient's ABCs—airway, breathing, and circulation. Because TBI is occasionally associated with cervical spinal cord injuries, all patients with head trauma are treated as though they have cord injury until radiography proves otherwise.*** ***IMPORTANT: COMPLICATIONS INCLUDE Increased ICP, CSF Leakage, and Bleeding (Epidural and subdural Hematoma)*** -treatment: Therapeutic Hypothermia ***Note: Interventions are directed toward preventing or detecting secondary brain injury and monitoring the effects of treatments and drug therapy*** • IV fluids or drug therapy to prevent severe hypertension or hypotension • Dysrhythmias Document and report the presence of cardiac dysrhythmias, hypotension, and hypertension to the primary health care provider.

Malignant Hyperthermia

● Rare, Acute life-threatening medical emergency ***NOTE: IT IS A CALCUIM ISSUES*** ● Inherited muscle disorder that anesthesia induces chemically ● Hypermetabolic condition causing an alteration in calcium activity in muscle cells (muscle rigidity, hyperthermia, and damage to the CNS) ● Triggering agents include inhalation anesthetic agents and succinylcholine. ● Increased carbon dioxide level, decreased oxygen saturation level, and tachycardia occur first, followed by dysrhythmias, muscle rigidity, hypotension, tachypnea, skin mottling, cyanosis, and muscle-cell protein in the urine (myoglobinuria). ***Note: Symptoms include muscle rigidity, tachycardia, fever, dysrhythmias, tachypnea, hypotension, and cyanosis*** ● Extremely elevated temperature is a late manifestation: increasing as high as 44° C (111.2° F). -Interventions: ● Anesthesiologist will stop succinylcholine, or anesthetic agent. Terminate surgery if elective or deepen anesthesia with other medications if needed. -NURSING ACTIONS ● Administer IV dantrolene, a muscle relaxant. ● Administer 100% oxygen. ● Obtain specimens for ABGs to monitor metabolic acidosis and serum chemistry to evaluate potassium level. ● Infuse iced IV 0.9% sodium chloride. ● Apply a cooling blanket; ice to axillae, groin, neck, and head; and iced lavage. ● Insert an indwelling urinary catheter to monitor output and the presence of blood.

Stage 4 of Parkinson's disease

severe stage where the patient exhibits Akinesia and muscle rigidity

Stage 1 of Parkinson's disease

the initial stage where minimal weakness with trembling typically in one arm

Stage 1 of frostbite

this stage of frosbite is the least severe type of frostbite, involves hyperemia (increased blood flow) of the involved area and edema formation.

Battle signs

-Bruising behind the ears, indicative of a basilar skull fracture from a traumatic brain injury -A bruise that indicates a fracture at the bottom of the skull indicating leakage **When CT scans are used with head and brain injury, these fractures are often visualized before bruising appears.**

Care for Pts with Parkinson's Disease

-Caring for patients with this disorder include: • Administer medications promptly on a schedule • Provide extra time for pt to speak • May need to place pt on Fall Precautions • Monitor's pt. ability to eat and safely swallow • Provide extra time for pt to complete ADLs -Treatments: • Surgery to help relieve symptoms • Exercise and ROM to maximize function • Nutrition and safety as patient begins to lose ability to independently feed or perform other ADLs

acute respiratory distress syndrome (ARDS)

***Note: a form of the sudden onset of severe lung dysfunction affecting both lungs, making breathing extremely difficult*** -it is an Acute Respiratory Failure with features such as: • Hypoxemia when 100% oxygen is given (refractory hypoxemia, a cardinal feature) • Decreased pulmonary compliance • Dyspnea • Noncardiac-associated bilateral pulmonary edema • Dense pulmonary infiltrates on x-ray (ground-glass appearance) -S/S: Hyperpnea, noisy respirations, Sweating, respiratory effort, ABNORMAL lung sounds not heard on auscultation, V/S hourly for hypotension, tachycardia, dysrhythmias, Abnormal lung sounds are not heard on auscultation, Edema occurs first in the interstitial spaces and not in the airways, and Fever ***Note: the trigger is a systemic inflammatory response that activates a variety of pro-inflammatory cytokines that maintain a continuing inflammation in the alveoli and pulmonary vasculature.***

Pulmonary Edema

**Note: fluid in the air sacs and bronchioles** -complication of acute event -cardiogenic (from cardiac compromise) -non-cardiogenic (from ARDS) -Sign and Symptoms: + Dyspnea + Diaphoresis + Pitting Edema ***Pink frothy sputum (starbucks pink drink) -Treatment: Furosemide (Lasix)

Raccoon Eyes

-Bruising around the eyes, indicative of a basilar skull fracture from a traumatic brain injury -purplish discoloration around eyes that can follow fracture of the skull's base. **When CT scans are used with head and brain injury, these fractures are often visualized before bruising appears.**

Multiple Sclerosis

-A chronic disease caused by immune, genetic, and/ or infectious factors that affects the myelin and nerve fibers of the brain and spinal cord. ***AKA Demyelination of the brain and spinal cord*** -Manifestations: • sclerotic plaques (patches) through the brain and spinal cord showed on MRI • Fatigue •Visual disturbances, nystagmus, blurred vision, diplopia • Slurred Speech • Spasticity and/or weakness of extremities, paresthesia, numbness, and pain • bladder spasticity ****IMPORTANT: Intravenous immune globulin is a medication reduces the production of acetylcholine antibodies in this disorder**** -Teach patients receiving drug therapy to avoid crowds and anyone with an infection. -To treat muscle spasms: Baclofen (Lioesal, Apo-Baclofen), Tizanidine (Zanaflex), Dantrolene sodium (Dantrium) -Paresthesia: Carbamazepine and Tricyclic Antidepressant

Ventilatory Failure

-A failure where problem in oxygen intake (air movement or ventilation) and blood flow (PERFUSION) causing ventilation-perfusion (V̇/Q̇) mismatch • Normal blood flow (perfusion) • Inadequate air movement (ventilation) ***Note: Failure of the respiratory system to remove CO2 from the body resulting in an abnormally high PaCO2*** -Chest pressure does not change to permit air movement to the lungs. • Too little oxygen reaches the alveoli, and carbon dioxide is retained. • Poor GAS EXCHANGE and hypoxemia. -Results from: physical problem of lungs or chest wall; defect in respiratory control center in brain; or poor function of respiratory muscles, diaphragm. -pH of 7.25 or less with high PaCO2 and PaCO2 level above 45 mm Hg

Acute Respiratory Failure

-A mismatch of ventilation (V) (air movement) or perfusion (Q) (oxygenation-gas exchange failure), or a combination of both. When there is a VQ mismatch, gas exchange is decreased, which can cause respiratory failure. ABGs are ordered to evaluate the client's gas exchange anticipating that the client is hypoxemic. -Classified by abnormal blood gas values such as: • PaO2 less than 60 mm Hg (hypoxemic/oxygenation failure) • PaCO2 more than 45 mm Hg occurring with acidemia (pH <7.35) (hypercapnic/ventilatory failure) • SaO2 less than 90% in both cases ***Note: the inability of the lungs to perform their ventilatory function*** ***Important: the patient is always hypoxemic (has low arterial blood oxygen levels.)*** -Three hallmark s/s: • Cough • Dyspnea • Hemoptysis (spitting blood)

Triage Process

-A process that begins with an across-the-room assessment, using your senses to gather vital information and form a general impression of the patient's health status: ° Use sight to assess sick or not sick status, obvious deformities or amputations, method of arrival, body habitus, dress, chronic illness, activity level, blood on clothing or skin, breathing, skin color, and level of consciousness. ° Use hearing to assess the patient's breathing and speech. ° Use smell to determine the presence of stool, urine, vomit, ketones, alcohol, cigarettes, poor hygiene, pus, and chemicals. -interview: confirm patient's identity, ° introduce yourself, ° explain purpose of the triage process, ° document chief complaint and relevant signs and symptoms, ° and gather information about medications, medical history, allergies, last menstrual period, immunizations, weight, and height. **Note: For trauma deaths, suspected homicide, and abuse cases: leave IV lines, indwelling tubes in place**

Alzheimer's disease (AD)

-A progressive disease that destroys the brain's neurons, gradually impairing memory, thinking, language, and other cognitive functions, resulting in the complete inability to care for oneself; the most common cause of dementia. ***IMPORTANT: Steady, gradual cognitive decline**** -consist of three stage: mild, moderate, and severe ***Note: Only definitively diagnosed post-mortem (Autopsy)***

Mass Casualty Event

-A public health or medical emergency involving thousands of victims -overwhelms local medical capabilities -may require the collaboration of multiple agencies and health care facilities to handle the crisis -State, regional, and/or national resources may be needed to support the areas affected by the event Trauma centers have a special role in all emergency preparedness activities, providing critical levels of expertise and specialized resources for complex injury management

Abortive therapy

-A therapy for migraine that is most affective when administering the prescribed medication during the aura or shortly after the headache has begun. -medication include: • Tylenol or Ibuprofen for mild HA • Acetaminophen (APAP) • Naproxen (Naprosyn) • Caffeine (causes vasoconstriction) • Triptans for severe HA: like umatriptan (Imitrex), eletriptan (Relpax), naratriptan (Amerge), and almotriptan (Axert) • Ergotamine: like cafergot, Dihydroergotamine (DHE)- Migranal • Midrin • Migraine HA tablets that contain caffeine

Distributive Shock

-A type of shock that occurs when blood volume is not lost from the body but is distributed to the interstitial tissues where it cannot perfuse organs -It can be caused by blood vessel dilation, pooling of blood in venous and capillary beds, and increased capillary leak. -All these factors decrease MAP and may be started either by nerve changes (neural induced) or by the presence of some chemicals (chemical induced). -the most common type is Septic shock -other types include: Anaphylaxis, Neurogenic, and obstructive shock

informed consent

-An ethical principle requiring that research participants be told enough to enable them to choose whether they wish to participate. -it is required for surgical procedures, invasive procedures (biopsy, paracentesis, scopes), and any procedure requiring sedation or anesthesia, involving radiation, or that places the client at risk -Two witnesses may be required if the client is able to only sign with an "X," has vision or hearing impairments, or speaks English as a second language. ***Note: A legal guardian can sign the surgical consent form if the client is not capable of providing consent or if there is no family.*** -The Nurse's Role: • Once surgery has been discussed as treatment with the client and significant other, family member, or friend, it is the responsibility of the provider to obtain consent after discussing the risks and benefits of the procedure. The nurse is not to obtain the consent for the provider in any circumstance. • The nurse can clarify any information that remains unclear after the provider's explanation of the procedure. The nurse may not provide any new or additional information not previously given by the provider. • The nurse's role is to witness the client's signing of the consent form after the client acknowledges understanding of the procedure. -the nurse should determine if the client is: • 18 years of age or emancipated. • Mentally capable of understanding the risks, reason, and options for surgery and anesthesia. • Under the influence of medication that affects decision‑making or judgment (opioids, benzodiazepines, sedatives). • Do not have the client sign the informed consent if medications have been administered. ****IMPORTANT: ONLY THE PHYSICIAN OR HEALTHCARE PROVIDER CAN PROVIDE CONSENT, NURSES ROLE IS TO VERIFIED CONSENT WAS GIVEN**** ****IMPORTANT: ENSURE THAT THE CONSENT IS IN THE PATIENT'S PRIMARY LANGUAGE****

Inhalation injury

-An injury to the airway as a result of breathing smoke and toxic chemicals into the lungs and airway. -this injury includes change in respiratory pattern, drooling, or difficulty swallowing may indicate a pulmonary injury and impairment of gas exchange, Black carbon particles in the nose, mouth, and sputum and edema of the nasal septum indicate smoke inhalation as does a "smoky" smell to the patient's breath, coughing black sputum -Interventions: • Listen for hoarseness, brassy cough, wheezes, and stridor • Place the patient upright • Apply oxygen • Report any of these signs immediately to the health care provider.

Management for Alzheimer's Disease

-Communication technique for dealing with this progressive disease include: • Always identify yourself, address patient by name each time you meet and speak slowly, using short simple phrases. • Maintain face to face contact and be near the patient while speaking to them. • One thing at a time! Don't overwhelm the patient • Encourage reminiscence, acknowledge feelings and reinforce reality. • Validate feelings • Never argue or refute delusions! • Sensory aids should be made readily available • Limit choices as not to frustrate or confuse -Health Promotion for this progressive disorder include: • Maintaining a healthy lifestyle, exercising, eating a healthy diet, cognitive stimulation and memory training • Avoid potentially harmful habits that can increase one's risk for stroke and cardiovascular disease • Assess functional status • Collaborate with other healthcare professionals (i.e. occupational therapy physical therapy, speech therapy) -treatment is gear toward preserving mental function, managing behavioral symptoms, and slowing down certain problems, such as memory loss ***IMPORTANT: drugs don't change the underlying disease process. They are effective for some but not all people and may help only for a limited time***

Brain Dead

-Complete cessation and irreversible loss of cognitive function. Life-support systems could keep the body operating but pointless. -Before it is declared, contact the local organ-procurement organization per facility guidelines. -Determine if the patient consented to be an organ donor. This information is typically on a driver's license or other state-issued card or advance directive -The patient's wishes should be followed unless he or she has a medical condition that prevents organ donation. -The organ donor agency representative or physician discusses the possibility of organ donation with the family. -Some families may not agree with the patient's decision, which can cause an ethical dilemma. Many health care agencies have an ethics specialist of committee members who can help with these situations. -"Required request" law: it is mandatory to offer the option to donate organs and tissues to the family of the deceased. -"Required referral" law: The hospital is required to notify the OPO of all deaths, and if appropriate, in collaboration with the OPO, to advise the family of their right to donate.

Vasoconstrictors

-Drugs that cause constriction of the blood vessels, that increases blood pressure -Medication that increase MAP by increasing peripheral resistance, increasing venous return, and increasing myocardial contractility -Medication: § Dopamine (Intropin) § Norepinephrine (Levophed) (assess for chest pain) § Phenylephrine HCI (Neosynephrine) -Interventions: § Assess for chest pain- increase myocardial consumption leading to angina or infarction § Monitor urine output hourly- higher doses decrease kidney perfusion § Assess blood pressure Q15minutes- hypertension is a symptom of overdose § Assess for headache- early symptom of drug excess

Agents Enhancing Myocardial Perfusion

-Drugs that improve myocardial perfusion by dilating coronary arteries rapidly for a short time. -Medication: § Sodium nitroprusside (Nitropres, Nipride) -Interventions: § Protect drug container from the light- because light degrades the drug quickly § Assess blood pressure at least Q15mins - drug can cause systemic vasodilation and hypotension , especially in older adults

Frosbite intervention

-First Aid Interventions include: • Recognition of frostbite is essential to early, effective intervention and prevention of further damage to tissue integrity • observe for early signs of frostbite such as a white, waxy appearance to exposed skin, especially on the nose, cheeks, and ears, is an effective strategy to identify the problem before it worsens. • Teach patients to place their warm hands over the affected areas on their face or to place cold hands under the arms. • Pad between fingers and toes, do not break blisters, and loosely rewrap the rewarmed area -Hospital Interventions: • For all degrees of partial-thickness-to-full-thickness frostbite, rapid rewarming in a water bath at a temperature range of 99° to 102°F (37° to 39°C) is indicated to thaw the frozen part • The part should be swirled in the water and not allowed to touch the sides of the container to prevent tissue damage. Because patients experience severe pain during the rewarming process, this intervention is best accomplished in a health care facility; however, it may be done in another setting if no other options exist for prompt transport or rescue. • Administer analgesics, IV opiates, and IV rehydration as prescribed. Ibuprofen should also be administered as prescribed, as it decreases thromboxane production in the inflammatory cascade and may reduce secondary tissue injury in frostbite -Nursing Assessment: • Assess pulses and circulation • Assess for muscle weakness • Tetanus injection • Watch closely for compartment syndrome (at least hourly) such as Increased level of pain after meds are given, Numbness, and tingling.

Cold related Illness

-Illness caused by being in the cold for too long -Two common cold-related injuries are hypothermia and frostbite. -since both types can be prevented, educate patients on ways to prevent these injuries through methods to maintain thermoregulation, which can range from minor pain to major systemic complications. -Risk Factors include: • Older adults • Mental health disorders • Outside workers • Homeless • Military stationed in low temp climates • Cold water immersion • Windchill • Infection • Traumatic Injury • EtOH intoxication or substance abuse • Malnutrition • Hypothyroidism • Medications: Phenothiazines and barbiturates

Mass Casualty Incident Triage

-In mass casualty or disaster situations, implement a military form of triage -Traditional is most critical first (worst is first), MCI is most likely to survive •desired outcome of doing the greatest good for the greatest number of people. -Typical examples of black-tagged patients are those with massive head trauma, extensive full-thickness body burns, and high cervical spinal cord injury requiring mechanical ventilation -Limited resources must be dedicated to saving the most lives rather than expending valuable resources to save one life at the possible expense of many others. -Triage include: • Red- (class I/critical)- Emergent! Treat first. Immediate threat to life or limb Compromised ABG tx within 2 hours • Yellow- (class II/ urgent/ intermediate)-need close monitoring, treated after red. Open fractures (with a pulse), large wounds. Not at risk for rapid decompensation tx within 4 hours • Green- (class III/ minimal)- walking wounded, most of the pts, non-urgent, often used to help treat others • Black- (class IV)- pts who are expected (and allowed) to die or dead. comfort measures if resources allow.

Allergies

-Inappropriate or excessive immune responses to antigens -A part of the medical history is client allergies. Here are some relational allergies that may impact decisions for the OR team. -Allergy to povidone-iodine (Betadine) is the same allergens found in shellfish. -Allergy to avocados, bananas, strawberries--alerts the team to a possible latex allergy. -Allergy to egg, peanut, or soy should be an alert for the anesthesiologist. The client may adversely react to propofol (Diprivan). -Allergy to metal. Joint replacements are made from metal. Clients with a known nickel allergy will receive an implant that is made from titanium to prevent a systemic allergic response to the implanted item.

Increased Intracranial Pressure (ICP)

-Increased pressure in the skull from either an increase in blood volume or CSF, or brain tissue edema (brain herniation), and is caused by meningitis or brain injury. -normal cranial pressure levels between 10 to 15 mm Hg -Nursing actions: • Monitor for decreased level of consciousness (Flattening Affect, decrease orientation and attention, and coma), pupillary changes (papilledema), and impaired extraocular movements • provide interventions such as elevate the head of the bed at 30 degrees, avoid coughing and straining during defecation (stool softeners), and reduce environmental stimuli • Changes in vital signs: Cushing's Triad ***IMPORTANT: ADMINISTER MANNITOL IV TO REDUCE THIS COMPLICATION*** ****IMPORTANT: EARLIEST SIGNS INCLUDE CHANGES IN LEVELS OF CONSCIOUSNESS SUCH AS RESTLESSNESS, CONFUSION, DROWNSINESS, LETHARGY OR STUPOR; MOTOR AND SENSORY CHANGES**** ***Note: Lumbar puncture is a contraindication to this disorder*** ***Note: Nursing care is very similar to hydrocephalus and meningitis***

Meningitis

-Infection in the meninges of the spinal cord & brain (pia mater and arachnoid) -Types: Bacterial and viral -Diagnosis: • Lumbar puncture • Cell count, differential count, protein, and glucose concentrations • Blood cultures • CBC (expected increase in WBC) • BMP (for fluid and electrolyte monitoring) ***IMPORTANT: Complication of this infection include INCREASE INTRACRANIAL PRESSURE, pressure on arteries, & Compresses brain tissue*** ***Note: factors that increase risk include: close communal living*** ***IMPORTANT: COMPLICATION AND INTERVENTIONS ARE SIMILAR TO INCREASE INTRACRANIAL PRESSURE*** -Expected Findings: • Excruciating, constant headache • Nuchal rigidity (stiff neck) • Photophobia (sensitivity to light) • Altered level of consciousness (confusion, disorientation, lethargy, difficulty arousing, coma) • Seizure

Pulmonary Contusion

-Injury or bruising of lung tissue that results in hemorrhage. -Potentially lethal injury -May be asymptomatic at first, later develop respiratory failure -Bloody sputum, decreased breath sounds, crackles, wheezes -Treatment: —Maintenance of ventilation and oxygenation, IV fluids

Trauma Center Levels

-Located within the Emergency Department, staffed by specially trained surgeons, emergency physicians, and nurse -treat multiple injuries from car crashes, elderly falls, traumatic brain injury, gunshot wounds, or any injury that threatens life or limb ****IMPORTANT: Patients with severe injuries are treated immediately AND IS NOT USED TO TREAT ABDOMINAL PAIN**** -Level 1: Provides leadership and total collaborative care from prevention through rehabilitation -Level 2: Can provide care to majority of injured patients -Level 3: Focuses on initial injury stabilization and patient transfer -Level 4: ACLS in rural or remote settings; transfers patient after stabilization -Nursing Principles: ± Injury management is a key component ± Accredited trauma centers: additional opportunities for development of expertise

Lightening Strikes injuries assessment and intervention

-Pre-hospital interventions for this electrical injury inlcude: • ABCs • Spine stabilization • Cardiopulmonary arrest is the priority, not burns • Victims are not electrically charged, there is no risk of contact shock to rescuer • Only supply care if rescuer is not in danger themselves • Lightening can and does strike the same place twice! -In Hospital Assessment/Interventions include: • Focus is ACLS • Cardiac monitoring/ mechanical ventilation • Identify obvious and occult traumatic injuries • CK measurements (rhabdomylosis can lead to renal failure) • Burns are assessed and treated • Tetanus vax given • Possible transfer to burn center

Heat exhaustion

-a syndrome resulting primarily from dehydration and is caused by heavy perspiration and inadequate fluid and electrolyte intake during heat exposure over hours to days -Profuse diaphoresis can lead to profound dehydration and hyponatremia caused by excessive sodium lost in perspiration **Note: if left untreated it will lead to heat stroke**

Heat Stroke Best Practice QSEN

-QSEN Best Practice for this heat related illness include: -At the Scene • Ensure a patent airway. • Remove the patient from the hot environment (into air-conditioning or into the shade). • Contact emergency medical services to transport the patient to the emergency department. • Remove the patient's clothing. • Pour or spray cold water on the patient's body and scalp. • Fan the patient (not only the person providing care, but all surrounding people should fan the patient with newspapers or whatever is available). • If available, place ice in cloth or bags and position the packs on the patient's scalp, in the groin area, behind the neck, and in the armpits. • If immediate immersion in cold water is possible, support the patient in the water for rapid cooling and protect the patient's airway. (Note: this is the best method to treat heat stroke.) -At the Hospital • Give oxygen by mask or nasal cannula; be prepared for endotracheal intubation. • Start at least one IV with a large-bore needle or cannula. • Administer fluids as prescribed, using cooled solutions if available. • Use a cooling blanket. • Obtain baseline laboratory tests as quickly as possible: urinalysis, serum electrolytes, cardiac enzymes, liver enzymes, and complete blood count (CBC). • Do not administer aspirin or any other antipyretics. • Insert a rectal probe to measure core body temperature continuously or use a rectal thermometer and assess temperature every 15 minutes. • Insert an indwelling urinary drainage catheter. • Monitor vital signs frequently as clinically indicated. • Assess arterial blood gases. • Administer muscle relaxants or benzodiazepines as prescribed if the patient begins to shiver. • Measure and monitor urine output and specific gravity to determine fluid needs. • Stop cooling interventions when core body temperature is reduced to 102°F (39°C).

Stages of Sepsis and Septic Shock

-Stage 1: SIRS- temperature more than 100.4 F and less than 96.8 F, respiratory rate more than 20, heart rate more than 90, white blood cell more than 12,000 or less than 4,000 and more than 10% bands ***Note: it takes two to become SIRS positive*** -Stage 2: Sepsis- 2 SIRS and a confirmed or suspected infections for positive sepsis -Stage 3: Severe Sepsis- Sepsis, signs of end organ damage, hypotension (SBP less than 90), and Lactate more than 4 mmol for this stage. ***IMPORTANT: any Lactate levels higher than 4 is consider sepsis*** -Stage 4: Septic Shock- Svere sepsis with persistent signs of end organ damage, hypotension (SBP less than 90) -multiple organ failure evident; uncontrolled bleeding occurs and death rate for patients in this stage is very high -treat with antibiotics and monitor for hyperglycemia (glycolosis)

Resuscitation Phase of Burn Injury

-The first phase of a burn injury, beginning at the onset of injury and continuing for about 48 hours -During this phase, the injury is evaluated and priorities of care are determined based on extent and severity of the burn. -The priorities of care during the emergent phase include: (1) securing the airway (Provide oxygen therapy and Evaluate for direct airway injury that occurs by inhalation of smoke, heat, or chemicals.) (2) supporting circulation and perfusion (accomplished by fluid replacement (Parkland formula)) ***Note: Be alert for signs and symptoms of pulmonary edema*** (3) maintaining body temperature (4) keeping the patient comfortable with analgesics (5) providing emotional support. ***IMPORTANT: Priority-Continous airway assessment*** -INTERVENTIONS: • Secure airway and supporting oxygenation/ circulation • Preventing hypovolemic shock • Preventing inadequate gas exchange • Manage pain • Maintain temperature -Nonsurgical Management: • IV fluids: large bore CVC • Monitoring patient response to fluid therapy • IV Pain medication (Morphine, Opioids) • Proton Pump Inhibitor (PPIs-like omeprazole)/H2 Blockers for ulcer prophylaxis

Triage

-The process of sorting or classifying patients into priority levels depending on illness or injury severity, with the highest acuity needs receiving the quickest evaluation and treatment. -"Gatekeeper" -Sorts patients into priority levels based on illness or injury severity -Highest acuity receives quickest intervention -The nurse must possess expert assessment skills, demonstrate competent interview and organizational skills, maintain extensive knowledge of diseases and injuries, think critically, and use past experiences to identify subtle clues to patient acuity. -Rapid assessment classification or priority for care 1. Identify patient requiring immediate care 2. Use space and resources efficiently 3. Facilitate patient flow into the ED 4. Provide assessment and reassessment of patients 5. Alleviate fear and anxiety of patients and visitors 6. Improve guest relations 7. Initiate legal accountability

Drains and Tubes

-The surgeon inserts a drain into or close to the wound if more than a minimal amount of drainage is expected. -A Penrose drain (a single-lumen, soft, open, latex tube) is a gravity-type drain under the dressing. Drainage on the dressing is expected with open-tube drains. -Closed-suction drains such as Hemovac, VacuDrain, and Jackson-Pratt (JP) drains include a reservoir that collects drainage. Drainage on the dressing around the drain is not usually present. Assess closed drainage systems for maintenance of suction. -Specialty drains such as a T-tube may be placed for specific drainage purposes. For example, a T-tube drains bile after a cholecystectomy. -Chronic wounds or wounds that heal by delayed primary intention are typically drained with a negative-pressure wound device. -Negative-pressure wound therapy has been shown to improve healing of closed surgical incisions and reduce SSI

Pseudo seizures

-a "false" but these are not false seizures... they are every bit as real as an epileptic seizure -Often misdiagnosed as an epileptic seizure -A physiological manifestation of psychological distress -There is typically an underlying mental illness -Treated with antidepressants and other psychological medications. -Unclear if antiepileptic medications are truly therapeutic ***seizure-like activity such as twitching or loss of consciousness without electrical disruptions in the brain***

Electrical Burn

-a burn caused by electrical current passed through the body -Lateral extensive deep tissue damage to muscles, nerves, soft tissue, and internal organs -damage depends of length of contact, intensity of current -risk for cardiac arrhythmias and respiratory arrest, seizures -entry and exit wounds -INTERVENTIONS: • At the scene, separate the patient from the electrical current. • Smother any flames that are present. • Initiate cardiopulmonary resuscitation. • Obtain an electrocardiogram (ECG).

Radiation Burn

-a burn caused from prolonged exposure to solar ultraviolet radiation (sunlight) or overexposure to tanning beds -Nonsolar radiation (alpha, beta, gamma) sources occur when electrical current passes through body ***IMPORTANT: Use tongs or lead protective gloves to remove clothes*** -INTERVENTIONS: Remove the patient from the radiation source. • If the patient has been exposed to radiation from an unsealed source, remove his or her clothing (using tongs or lead protective gloves). • If the patient has radioactive particles on the skin, send him or her to the nearest designated radiation decontamination center. • Help the patient bathe or shower.

Thermal Burn

-a burn where an external heat sources including flame, hot liquids (scalding), direct contact with hot objects, or steam -Area of burned tissue usually confined to area of contact -Damage depends on temperature of heat source and length of contact ***Important: 2 seconds of exposure to 148 F liquid causes burns serious enough to require surgery.*** ***Note: Coffee is often served at 175 F, making it high-risk for causing.*** -INTERVENTIONS: Smother the flames and Remove smoldering clothing and all metal objects

Contact Burn

-a burn where hot metal, tar grease contacts skin causing full thickness injury -Tar/Asphalt 400 degrees -Deep injuries occur within seconds -Hot grease injuries from cooking are usually deep because of the high temperature of the grease

Hemothorax

-a chest trauma where their is blood in the pleural cavity -bleeding in pleural space -treament: chest tube

Hypothermia

-a cold related illness where the core body temperature below 95°F (35°C) -Environmental temp below 82 F can produce impaired thermoregulation -Common predisposing conditions include: • Cold-water immersion • Acute illness (e.g., sepsis) • Traumatic injury • Shock states • Immobilization • Cold weather (especially for people who are homeless or work outdoors) • Older age • Use of medications (e.g., phenothiazines, barbiturates) • Inappropriate alcohol and substance use • Undernutrition • Hypothyroidism • Inadequate clothing or shelter (e.g., the homeless population) -Wind chill- heat loss increases as wind speed increases -Wet conditions increase heat loss -Three Stages: Mild, Moderate, Severe

Frostbite

-a cold-related injury where the body tissue freezes causing impaired tissue integrity -1st ,2nd , and 3rd degree may all appear the same as white and waxy skin until the tissue has thawed, then level of damage is apparent. -risk factor: • inadequate insulation against cold weather (i.e., the skin is exposed to the cold, or the person's clothing offers insufficient protection, which leads to injury) • Wet clothing is a poor insulator and facilitates the development of frostbite. Fatigue, dehydration, and poor nutrition are other contributing factors. • People who smoke, consume alcohol, or have impaired peripheral circulation -consist of 4 stages ***Note: it is classified until the tissue is defrosted***

Pneumothorax

-a collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse due to a loss of negative pressure -signs to monitor for include: unequal rise and fall of the chest due to the one lung collapse. -intervention: tube thoracostomy (Chest tube) in the pleural space, not the lung -monitor airway -chest tube helps re-inflate lung ***Note: caused by high ventilation pressure. nurse should auscultate lung sounds frequently. if respiratory distress, the patient will need immediate action like a CHEST TUBE***

Rib Fracture

-a common injury to the chest wall, often resulting from direct blunt trauma to the chest. The force applied to the ribs fractures them and drives the bone ends into the chest. Thus there is a risk for deep chest injury such as pulmonary contusion, pneumothorax, and hemothorax. -1 to 2 ribs that are fracture -Focus: adequate ventilation -maintained: pain meds (NSAIDS/Tylenol) Opioids for Severe pain, PCA Pump, and epidural anesthesia -Teaching: continue activity, oral pain meds 30 minutes before activity • Avoid driving, important decisions, operating heavy machinery narcotics. • No taped splint to constrict movement, but pillow splint is okay • Cough and deep breath to prevent atelectasis and pneumonia • No contact sports for 6 weeks -Chest wound covered by 4x4 dressing 4th side un-taped -intervention: Pain meds, Oral pain meds, 30 min before activity, avoid driving, no taped splint to contrict movement, cough and deep breath ***Note: The patient has pain on movement and splints the chest defensively. Splinting reduces breathing depth and clearance of secretions. If the patient has pre-existing lung disease, the risk for atelectasis and pneumonia increases.****

Multiple Organ Dysfunction Syndrome (MODS)

-a complication of inadequate perfusion to body tissues depriving cells of oxygen, which leads to anaerobic metabolism (lactic acid) with acidosis, hyperkalemia, and tissue ischemia. -Progressive impairment of two (renal and liver) or more organ systems resulting from an uncontrolled inflammatory response to a severe illness or injury and The extent of metabolites and toxins in the system causes a sequence of cell damage ***IMPORTANT: it takes 2 organ failure to be considered multiple organ failure*** -When the body is hypoxic and acidotic, a lethal dysrhythmia such as ventricular fibrillation or asystole can occur, which ultimately leads to lack of cardiac output and perfusion. Shortly after cardiac arrest, respiratory arrest occurs. When respiratory arrest occurs first, cardiac arrest follows within minutes. -Pt presentation: § Rapid LOC § Non palpable pulse § Cold, dusky extremities § Slow, shallow respirations § Unmeasurable O2 sats **Note: Fluid replacement is no longer effective, even if the cause of shock is corrected and map temporarily returns to normal**

Myasthenic Crisis

-a complication of myasthenia gravis characterized by worsening of muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation. ***IMPORTANT: it is a medical emergency***

4th degree burn

-a deep full thickness burn that extend beyond the skin, damaging muscle, bone and tendons. ***Note: in this burn stage, the burn injury may have expose bone without sensation*** -Wound is blackened and depressed -Absent sensation -Grafting will be needed if amputation can be avoided

Internal Disaster

-a disaster in which a healthcare facility itself is in danger or damaged and its function is impaired -any incident happening within a facility that may endanger patients or staff -JC requires a disaster preparedness plan, including evacuation and fire -mandated yearly training regarding fire plans (no need for evacuation during drill)

posttraumatic stress disorder (PTSD)

-a disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia that lingers for four weeks or more after a traumatic experience -Signs and symptoms: including flashbacks, avoidance, less interest in previously enjoyable events, detachment, rapid heart rate, and insomnia -Intense physical/psychological response to traumatic event (days - years) -Implementation: psychotherapy support groups, meds -ED nurses at riskUse two sides of brain (emotions vs critical incident) -Proactive (protect themselves) deal with routine stress to care for themselves and coworkers -Eat well-balanced meal, water, limit caffeine, limit sugar, exercise, sleep -Decompress, cry, meditate, talk, self-reflect

Bridging therapy

-a drug that serves as a transition to another drug when moving a patient from one treatment to the next; commonly used in clotting disorders -example of this therapy include: • Heparin therapy usually continues for 5 to 10 days. • Heparin infused for at least 5 days and continues for 24 hours after INR is greater than 2. • Start oral anticoagulant (warfarin) on day one or two of heparin therapy • Oral anticoagulant use continues for 3 to 6 weeks, but some patients may take it indefinitely. • Therapy with both heparin and warfarin continues until international normalized ratio (INR) reaches 2.0 to 3.0 and aPTT normal range is 20-30 sec, and therapeutic range is 40-80 sec. • Monitor the platelet count and INR during this time.

Oxygenation (Gas Exchange) Failure

-a failure where chest pressure changes are normal, and air moves in and out without difficulty but does not oxygenate the pulmonary blood sufficiently -V̇/Q̇ mismatch: normal air movement and oxygen intake (ventilation: • Decreased lung blood flow (PERFUSION) • Many lung disorders can cause oxygenation failure -Problems include: impaired diffusion of oxygen at the alveolar level, right-to-left shunting of blood in pulmonary vessels, V̇/Q̇ mismatch, breathing air with low oxygen level, and abnormal hemoglobin that fails to bind oxygen. • Areas of the lungs have PERFUSION, but GAS EXCHANGE does not occur, L/T hypoxemia. • Systemic venous blood (oxygen-poor) passes through lungs without being oxygenated and is "shunted" to left side of heart and systemic arterial system. • Arterial blood not oxygenated, applying 100% oxygen does not correct the problem. ***IMPORTANT: A classic cause of such a V̇/Q̇ mismatch is acute respiratory distress syndrome (ARDS).***

Ischemic Strokes (Embolic)

-a form of stroke where a Plaques break loose and occlude vessels of the brain -Emboli that travel from other parts of the body and lodge in the brain -Ischemia develops behind the occlusion -Characterized by the SUDDEN development of symptoms -Symptoms may resolve over a few days, may be very short if embolisms are absorbed and blood flow is returned -Warning Signs: Trasient Ischemic Attack -No treatment -Usual source of embolism is the heart (Afib, Valvular disease, valve replacement, endocarditis) ****Note: Needs Anticoagulants (Blood thinners) to treat for Atrial fib****

Ischemic Strokes (Thrombotic)

-a form of stroke where a blood clot blocks a blood vessel in the brain (atherosclerosis) -Account for more than ½ off all strokes and are commonly related to atherosclerosis (in carotid arteries) -When the clot is sufficient size, blood flow is occluded -Characterized by GRADUAL onset of symptoms due to the slow nature of build up- several minutes to hours. ****Note: Medication Statins, Aspirin, Clopidogrel (Antiplatelets), Coumadin (anticoagulants), Nimodipine (Calcium Channel Blocker)**** -Warming signs: Trasient Ischemic Stroke, Mild headache, speech deficits, visual problems -Treatment: IV Fibrinolytic Therapy, Mechanical embolectomy (clot removal), and Carotid artery angioplasty with stenting

3rd degree burn

-a full thickness burn where there is destruction of the entire epidermis and dermis -Exhibit Waxy white, deep red, yellow, brown, or black -Skin does NOT regrow -Eschar: hard, inelastic -Skin: Black, brown, yellow, white, red -Edema: Severe under the eschar -Painful: no -Weeks to months to heal -Grafting required

Exertional heat stroke

-a heat stroke that is sudden onset and is often the result of strenuous physical activity especially wearing too heavy clothing in hot, humid conditions -this heat stroke is common with athletes

2nd degree (superficial partial thickness) burn

-a partial thickness burn that Involves entire epidermis and dermis (varying depths) -Exhibits Pink to red and white, Mild edema, Painful from potentially exposed nerves, Blisters present, Eschar (soft, dry if present) -Healing time 2-6 weeks -it is categorized as a Scalds, flames, brief contact with hot object, Tar, grease ****Important: blisters stop increasing in size when cell/protein breakdown ends.**** -small blisters remain intact; large blisters opened, debrided to promote healing. -heals with scarring but has some pigment changes.

2nd degree (full or deep partial thickness) burn

-a partial thickness burn that is deeper into dermis, fewer healthy cells remain -Exhibit Red and white, dry -blanches slowly or not at all, Moderate edema, Pain is less bc of nerve destruction, and Blisters typically do not form due to damage done to the capillaries ***Note: if blisters are present, it could indicate worse damage burn*** -Healing time 2-6 weeks, with scar formation and May need grafting for optimal healing -Inadequate care may lead to full thickness conversion

Pre-operative period

-a period that happens before the opperation that begins when patient is scheduled for surgery; ends at time of transfer to surgical suite ***Note: it begins 2-3 weeks before the operation*** -Assessment in this period include: • Detailed history: like medical history, surgical history, tolerance of anesthesia, medication use, complementary or alternative practices (herbals), substance use (for tolerance indications), psychosocial history, cultural considerations • Allergies: Medication, Latex, contrast agents, and food products. allergies to banana or kiwi indicates a high risk for latex reaction. eggs or soybean oil is contrainindication to the use of propofol. shellfish allergies is an indication of povidone-iodine. • Anxiety: providing information regarding the procedure, provide a support systems, coping mechanism, and financial concerns. ***Note: do not give the patient false reassurance** • Baseline Data: by performing a head-to-toe assessment, obtaining vital signs, and oxygen saturations • Venous Thromboembolism Risk: evaluation based on surgical procedure, patient history, anticipated time the patient will be immobilized following surgery

Viral Meningitis

-meningitis caused by a virus and not as severe as pyrogenic meningitis • The Most common type, and also called aseptic meningitis, because no organisms are typically isolated in cultures • Self limiting- you feel like you're dying, but you probably won't • The most common viral causative organism is enterovirus • Antibiotics may be given for secondary infections, antivirals if beneficial

Autonomic Dysreflexia

-a potentially life-threatening condition in which noxious visceral or cutaneous stimuli cause a sudden, massive, uninhibited reflex sympathetic discharge in people with high-level Spinal Cord Injury -Triggers a sympathetic response (fight or flight) below the level of injury -leading to an increased BP below the level of injury. Will not resolve until antagonist is corrected. ***Note: focus on client care that centers on preventing complications for immobility and skin breakdown such as appropriate bladder, bowel, and skin-care practices and recognition of early signs or symptoms*** ***IMPORTANT: Patients with complete Spinal Cord Injury are at a high risk for complications that result from prolonged impaired mobility, including pressure injuries and venous thromboembolism (VTE). Assess skin integrity with each turn or repositioning. Monitor for signs of VTE with vital signs, including lower extremity deep vein thrombosis (DVT).*** ***Note: prophylactic administration of a vasodilator may be needed before intercourse.*** ***IMPORTANT: educate patient to avoid wearing constricted clothing to prevent this disorder***

30-2-can do

-a simple mnemonic that states if If the victim's respirations are more than 30, if capillary refill takes more than 2 seconds, or the victim cannot follow simple commands, they are categorized as "Immediate." ***IMPORTANT: As soon as they fail one test, categorize them immediate and proceed to the next patient.*** -Mnemonic goes: • R-respirations more than 30 breaths a minute- RED TAG • P-perfusion (cap refill) is more than 2 seconds-RED TAG • M-mental status, if the patient cannot follow simple commands-RED TAG

Moderate Hypothermia

-a stage of hypothermia where body temperature drops to (82.4° to 90°F [28° to 32°C]) -Signs and Symptoms: • Muscle weakness • Increased loss of coordination • Acute confusion • Apathy • Incoherence • Possible stupor • Decreased clotting (caused by impaired platelet aggregation and thrombocytopenia) -Interventions: • airway, breathing, and circulation • Protect patients from further heat loss and handle them gently to prevent ventricular fibrillation • Positioning the patient in the supine position prevents orthostatic changes in blood pressure from cardiovascular instability. • Administer drugs with caution and/or spaced at longer intervals because metabolism is unpredictable in hypothermic conditions. • Initiate CPR for patients without spontaneous circulation • Applying external heat with heating blankets can promote core temperature "after-drop" by producing peripheral vasodilation • administration of warm IV fluids; heated oxygen or inspired gas to prevent further heat loss via the respiratory tract; and heated peritoneal, pleural, gastric, or bladder lavage

Severe hypothermia

-a stage of hypothermia where body temperature drops to (below 82.4°F [28°C]) -Signs and Symptoms: • Bradycardia • Severe hypotension • Decreased respiratory rate • Cardiac dysrhythmias, including possible ventricular fibrillation or asystole • Decreased neurologic reflexes to coma • Decreased pain responsiveness • Acid-base imbalance -Interventions: • airway, breathing, and circulation • Protect patients from further heat loss and handle them gently to prevent ventricular fibrillation • Positioning the patient in the supine position prevents orthostatic changes in blood pressure from cardiovascular instability. • Administer drugs with caution and/or spaced at longer intervals because metabolism is unpredictable in hypothermic conditions. • Initiate CPR for patients without spontaneous circulation • Applying external heat with heating blankets can promote core temperature "after-drop" by producing peripheral vasodilation • administration of warm IV fluids; heated oxygen or inspired gas to prevent further heat loss via the respiratory tract; and heated peritoneal, pleural, gastric, or bladder lavage • Extracorporeal rewarming methods such as cardiopulmonary bypass or hemodialysis. Cardiopulmonary bypass, which requires specialized personnel and resources, is the fastest core rewarming technique. • Monitor for early signs of complications that can occur after rewarming such as fluid, electrolyte, and metabolic abnormalities; acute respiratory distress syndrome (ARDS); acute renal failure; and pneumonia.

mild hypothermia

-a stage of hypothermia where body temperature is (90° to 95°F [32° to 35°C]) -Signs and Symptoms: • Shivering • Dysarthria (slurred speech) • Decreased muscle coordination • Impaired cognition ("mental slowness") • Diuresis (caused by shunting of blood to major organs) -Intervention: • Patients needs to be sheltered from the cold environment, have all wet clothing removed, and undergo passive or active external rewarming. • Passive methods involve applying warm clothing or blankets. Active methods incorporate use of heating blankets, warm packs, and convective air heaters or warmers. • If a heating blanket is used, monitor the patient's skin at least every 15 to 30 minutes to reduce the risk for burn injury • have patient drink warm high-carbohydrate liquids that do not contain alcohol or caffeine can aid in rewarming ***IMPORTANT: Alcohol is a peripheral vasodilator; both alcohol and caffeine are diuretics. These effects can potentially worsen dehydration and hypothermia.***

Hemorrhagic Stroke

-a stroke where the blood loss is caused by the rupture of a blood vessel. occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed -it is abrupt onset and patients is in a deep stupor or coma -it is cause by HTN, Aneurysms (Arteriovenous malformation AND Cerebral aneurysm) and Cocaine use -warning signs is Increased intracranial pressure (ICP) -treatment: Surgical removal (resection), Endovascular embolization, and Stereotactic radiosurgery -two types: Subarachnoid Hemorrhage (SAH) and Intracerebral hemorrhage (ICH)

Transient Ischemic Attack (TIA)

-a sudden temporary episode of neurological dysfunction lasting usually less than 1 hour secondary to decreased blood flow to then brain ***IMPORTANT: IT GOES AWAY BUT IS IS A WARNING SIGN THAT COULD INDICATE A POSSIBILITY OF A STROKE*** -Contributing factors: • Non-modifiable: Advanced age, Gender (male), genetic • Modifiable: Hypertension, hyperlipidemia, diabetes mellitus, smoking, and artial fibrillation -Manifestation: • Sudden change in visual function • Sudden loss of sensory or motor functions -Nursing Interventions: • Encourage the patient to stop smoking and limit alcohol intake • DASH diet (high fruits and vegetables, moderate in low-fat dairy products, and low in animal protein) • Stress the importance of maintaining ideal body weight with regular exercise -Medications: • Antiplatelet: clopidogrel, dipyridamole+aspirin, triclopidine • Anticoagulant: Warfarin • Lipid-lowering agents: Statin

1st degree burn

-a superficial thickness burn -it is the least damaging; the epidermis is only part of the skin that is injured -the appearence is pink to red, mild edema, discomfort, increased sensitivity to heat -Desquamation (peeling of dead skin) occurs 2 to 3 days after burn -Heals with 3-6 days w/o scars or complications -No Blisters, No Eschar, or No Grafts ****AKA a Sunburn, flash burn****

Parkinson's disease

-a terminal disease caused by the degeneration of the substantia nigra cells in the basal ganglion which decreases dopamine (dopamine normally functions to promote voluntary muscle and SNS control) -A progressive degenerative neurological disorder characterized by 4 cardinal signs: Tremors, Muscle rigidity, bradykinesia, postural instability -consist of 5 stages: Initial, Mild, Moderate, Severe, and Complete ADL -Symptoms include: Stooped posture, masked face, back rigidity, foward tilt of trunk, flexed elbows and wrists, reduced arm swing, hand tremor, tremors in the legs, slightly flexed hip and kness, shuffling, short stepped gait ****Note: Dopamine is produced in the substantia nigra and the adrenal glands and is transmitted to the basal ganglia along a connecting neural pathway for secretion when needed. ACh is produced and secreted by the basal ganglia and in the nerve endings in the periphery of the body.**** ****Note: ACh-producing neurons transmit excitatory messages throughout the basal ganglia. Dopamine inhibits the function of these neurons, allowing control over voluntary movement. This usual system of checks and balances usually allows for refined, coordinated movement, such as picking up a pencil and writing.****

Neurogenic shock

-a type of distributive shock that is caused by spinal cord injury, certain medication, or hypoglycemia -it is characterized by warm, dry skin and bradycardia -it causes a loss of blood vessel tone (vasodilation) after severe cord injury may result in hypoperfusion (poor PERFUSION) resulting in hypotension -it causes: § peripheral vasodilation § lost of temperature regulation § lost of sympathetic tone to heart diminished baroreceptor response to changes in BP (causes bradyarrhythmia) -Presentation: § Flaccid paralysis § Bradycardia § hypothermia § decreased CO/hypotension -Treatments: § Treat hypovolemia with fluids; Prevent hypoxemia § Promote normal body temperature § Monitor for dysrhythmias § Inotropic and vasoconstrictor drugs to increase heart contractility and increasing blood pressure

Sepsis and Septic Shock

-a type of distributive shock that is life threathing and is an extreme response to infection that can cause tissue damage, organ failure, and death if not treated promptly and appropriately. -it is a combination of a systemic inflammatory response syndrome (SIRS-Wide spread systemic inflammation) and sepsis with multiple organ dysfunction syndrome (MODS) -Signs and symptoms include a lower oxygen saturation, hypotension (decrease cardiac output), rapid respiratory rate (TACHYPNEA), decreased-to-absent urine output, and a change in the patient's cognition and affect. -it is identified in patients who: • Require vasopressor therapy to maintain a mean arterial pressure (MAP) of at least 65 mm Hg • or Have a serum lactate level greater than 2 mmol/L (18 mg/dL), despite adequate fluid resuscitation (rapid administration of 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.) ***IMPORTANT: EARLY SIGNS INCLUDE FEVER, LOW URINE OUTPUT, AND LIGHTHEADEDNESS*** ***REMEMBER: A LACTATE LEVEL HIGHER THAN 4 MMOL/L AND A MAP BELOW 61 MM HG IS CONSIDERED THIS SHOCK***

Tension Pneumothorax

-a type of obstructive shock where air enters the pleural space, compresses the lungs and heart, and shifts the mediastinum -Signs and System: § Tracheal Deviation § Decreased breath sounds § Hyperresonance -Interventions: § needle thoracostomy which is a needle decompression in the 2nd intercostal space at the midclavicular line, followed by tube thoracostomy

Obstructive Shock

-a type of shock caused by problems that impair the ability of the normal heart to pump effectively. The heart itself remains normal, but conditions outside the heart prevent either adequate filling of the heart or adequate contraction of the healthy heart muscle. -Common causes include: § Cardiac Tamponade: intervention include immediate pericardiocentesis § Constrictive Pericarditis § Tension Pneumothorax (the lung and heart is being compressed): intervention needle thoracostomy § Massive Pulmonary Embolism: intervention thrombolysis or surgical embolectomy -Signs and Systems: § Pulsus Paradoxus- (a decrease of 10mmHg or more in systolic blood pressure during inspiration) § Jugular Vein Distention

Hypovolemic Shock

-a type of shock that occurs as a result of loss of vascular volume, resulting in a decreased mean arterial pressure (MAP) and, in some cases, a loss of circulating red blood cells (RBCs). -The reduced MAP slows blood flow, decreasing tissue perfusion and The loss of RBCs decreases the ability of the blood to oxygenate the tissue it does reach. These gas exchange and perfusion problems lead to anaerobic cellular metabolism. -A decrease in MAP of 5 to 10 mm Hg below the patient's normal baseline value ***NOTE: Causes Hypotension from decrease cardiac output and increase Increased heart rate (tachycardia) is often the first sign of this shock*** ***Note: Clinical dehydration*** -it is caused by: § Decreased body fluid § GI loss from bleedin, vomitting, and diarrhea § Diabetes insipidus from low ADH causing fluid lose and dehydration § Diuresis § Plasma loss through burns § Hemorrhage -Labs: • Potassium: increased (dehydration) • Hemoglobin and Hematocrit: Increase due to dehydration or decrease due to hemorrhage • ABGs: Acidosis • Lactic Acid: increased due to anaerobic metabolism with buildup of metabolites

Cardiogenic Shock

-a type of shock that occurs when the heart muscle is unhealthy and pumping is impaired (not physically pumping effectively) -it is most often associated with acute myocardial infarction -Specific causes or Risk Factors: § Myocardial Infarction (mi) § Cardiac Arrest § Ventricular dysrhythmias § Cardiomyopathies § Myocardial degeneration -Signs and Systems: § Hypotension (decrease cardiac output) and tachycardia § Cool clammy skin § Crackles/ sob/dyspnea § Anxiety/ restlessness § Fatigue, pitting edema, JVD, liver engorgement, ascites, cyanosis, tachycardia, weak/thready pulse, crackles, etc. (right ventricular failure) § Wt. gain 2lb/24hr or 5lb/wk. sign heart or kidney (right ventricular failure) -Aggressively treat the underlying cause: Vasodilators (nitro), fluids resucitation, vasopressors (dopamine)

Bell Palsy

-a unilateral facial paralysis -Thought to be a reactivation of a dormant herpes simplex virus. Reactivation triggered by infection or altered immunity or exposure to cold ***IMPORTANT: THE DIFFERANCE BETWEEN THIS DISORDER AND STROKE IS THIS DISORDER ONLY AFFECTS THE FACE*** -Affects cranial nerve VII but may also involve CN V (trigeminal) and VIII (auditory). -Sign and Symptoms: • One sided paralysis of facial muscles • Cannot wrinkle forehead, close eye, smile on affected side • Loss of corneal reflex on affected side • Loss of taste on affected side • Excess tearing on affected side • Excess drooling, unable to sip or chew from affected side -Medications may include: • Corticosteroids to suppress inflammation around nerves • Antivirals • Analgesics • Gabapentin • Artificial Tears -Patient Teaching: • Tape eye closed or wear a patch QHS, protective glasses while awake • Manually close eyelid often • High calorie snacks, soft diet • Warm, moist compresses and massage to affected area

Evisceration

-a wound opening with protrusion of internal organs outside of the body ****IMPORTANT: it is a surgical emergency**** -the surgeon should be contacted immediately, and the patient returned to the surgical suite. -Provide support by explaining what happened and reassuring the patient that the emergency will be handled competently. -Place the moistened dressings (saline) over the exposed viscera. Then, place a sterile, waterproof drape over the dressings to prevent the sheets from getting wet until the surgery is down

Disseminated intravascular coagulation (DIC)

-an abnormal problem with blood clotting in small vessels throughout the body that cuts off the supply of oxygen to distal tissues, resulting in damage to body organs -is triggered by many severe illnesses, including cancer. In patients with cancer DIC often is caused by sepsis from a variety of organisms (bacterial, fungal, viral, or parasitic). -widespread clotting in the blood vessel causing a depletion of circulating clotting factors and platelets. As this happens, extensive bleeding occurs. ***Note: widespread bleeding and clotting at the same time (shows skin mottling)***

Emergency Medical Treatment and Active Labor Act (EMTALA)

-an act that ensures patients as access to emergency care regardless of the patient's ability to pay -it is requires hospitals that participate in Medicare and every hospital with an emergency department to: • Provide a medical screening examination to every patient who presents for care to determine if an emergency medical condition exists. • Stabilize the patient within the facility's capabilities before transfer, if an emergency condition exists. • Arrange for transfer if the patient cannot be stabilized and needs care beyond the hospital's capabilities or if the patient requests a transfer.

Seizures

-an episodes of excessive and abnormal amounts of electrical activity in the brain. -This abnormal brain activity causes skeletal muscle disturbances, sensations, auras, and changes in behavior and consciousness -episodes of sudden, uncontrolled electrical discharge of neurons excessive and abnormal amounts of electrical activity in the brain. -may result in change in level of consciousness and Change in sensory or motor ability -consist of generalized (involves both cerebral hemispheres) and partial (focal or local in one hemisphere and divided into two subcategories) -Medication: Antipileptic • Phenytoin • Divalproex Sodium • Valporic Acid • Carbamazepine • Gabapentin • Lamotrigine -Other Medication: Diazepam, Lorazepam, Phenobarbital

Anaphylactic Shock

-an extreme type of allergic reaction. It begins within seconds to minutes after exposure to a specific allergen in a susceptible adult causing widespread blood vessel dilation, decreased cardiac output, and bronchoconstriction. -Life-threatening: § airway edema (stridor) § Swelling of eyelids, face, lips, tongue, & throat § SOB, low BP, impending doom § Alterations in HR (bradycardia, arrhythmias) § Flushed skin, hives, & itching -Treatment: Epinephrine 0.3-0.5mg or 0.01mg/kg ***Note: Epinephrine causes HYPERTENSION (raising blood pressure) and MONITOR FOR CHEST PAIN HAS IS CAN INDICATE AN ADVERSE AFFECT OF THE DRUG***

Migraines

-an intense headaches, typically perceived from one half of the head, that recur regularly and can be difficult to treat ***Note: painful, unilateral, and throbbing in nature*** -Signs and Symptoms: • Unilateral head pain often behind one eye or ear • Sensitive scalp (hair hurts) • Anorexia • Photophobia • Phonophobia • visual changes • Nausea with or without vomiting -Common Triggers: • Monosodium Glutamate (MSG), chocolate, caffeine, alcohol, tyramine high foods, foods with yeast, nuts, artificial sweeteners, and red wine • Some medications • Stress related and environmental causes • Low blood sugar • Sinus infections

Refractory Stage of Shock

-at this stage of shock, too much cell death and tissue damage result from too little oxygen reaching the tissues. -Vital organs have extensive damage and cannot respond effectively to interventions, and shock continues. -So much damage has occurred with release of metabolites and enzymes that damage to vital organs continues despite interventions. -Once the damage has started, the sequence becomes a vicious cycle as more dead cells open and release metabolites. These trigger small clots (microthrombi) to form, which block tissue perfusion and damage more cells, continuing the devastating cycle. Liver, heart, brain, and kidney functions are lost first. The most profound change is damage to the heart muscle leading to multiple organ dysfunction syndrome (MODS) -Signs are a rapid loss of consciousness; nonpalpable pulse; cold, dusky extremities; slow, shallow respirations; and unmeasurable oxygen saturation. -For Hypovolemic Shock: • 40% volume loss • CV: severe tachycardia, hypotension, skin cyanotic with diaphoresis, no peripheral pulses • Pulm: failure • Renal: Failure • Neuro: comatose ****Note: Therapy, including fluid replacement, is not effective in saving the patient's life, even if the cause of shock is corrected and MAP temporarily returns to normal.****

Heat stroke signs and symptoms

-signs and symptom for this heat related illness include: • Profound elevated body temperature above 104F (40C) • Hypotension • Tachycardia • Tachypnea • Oliguria Hot and dry skin Electrolyte imbalances (such as hypernatremia and hypo/hyperkalemia) • Hot and dry skin • Decreased renal function (oliguria) • Coagulopathy (abnormal clotting) • Pulmonary edema (crackles) ***Although the patient's skin is hot and dry, the presence of sweating does not rule out heat stroke—people with heat stroke may continue to perspire.*** -Mental status changes occur as a result of thermal injury to the brain and are the hallmark finding in this heat related illness -Mental status changes such as: • Acute confusion • Bizarre behavior • Anxiety • Loss of coordination • Hallucinations • Agitation • Seizures • Coma

Emergent Care (Critically Ill-level 1)

-care where the patient has immediate threat to life or limb, and requires immediate treatment -Patient with loss of life or limb -Unresponsive, anaphylaxis, stroke-like symptoms

Urgent Care (Intermittent-level 2)

-care where the patient should be treated quickly but immediate threat to life does not exist at the moment -Prompt evaluation -Fractures w/o N/V compromise, abdominal pain, nosebleeds

Cerebrovascular Accidents (CVA)

-commonly referred to as a stroke or "brain attack"; the sudden loss of brain function resulting from a disruption of blood supply to the involved part of the brain; causes temporary or permament neurological deficits -a medical emergency and should be treated immediately to reduce or prevent permanent disability -Contributing factors: Hypertension, obesity, smoking, cocaine, hyperlipidemia, diabetes mellitus, peripheral vascular disease, aneurysm or cranial hemmorrhage -Two types of Stroke: Ischemic and Hemorrhagic stroke -Assessment: National Institutes of Health Stroke Scale, Glascow Coma for baseline and report changes (scale 3-15), assessing for hypoglycemia (even in nondiabetic), and assessing for hypoxia -Manifestations: • Change in mental status • Slurred speech, aphasia, and dysphagia • Numbness or weakness of the face or extremities, especially on one side of the body • Visual disturdance • Cranial nerve disturbance • Loss of balance or coordination • Sudden severe headache

Rehabilitative Phase of Burn Injury

-final phase of burn injury that begins with wound closure and ends when the patient achieves his or her highest level of functioning -The emphasis of this phase is on the psychosocial adjustment of the patient, the prevention of scars and contractures, and the resumption of preburn activity, including resuming work, family, and social roles. -This phase may last years or even a lifetime if patient needs to adjust to permanent limitations -After intervention, the patient with a burn injury is expected to have positive perception of his or her own appearance, body functions, and self-worth. -Indicators include that the patient should consistently demonstrate these behaviors: • Willingness to touch the affected body part • Adjustment to changes in body function • Willingness to use strategies to enhance appearance and function • Successful progression through the grieving process • Use of support systems -Management: Pain management with opiod analgesics and non-opioid analgesics due to tisue injury, damaged or exposed nerve endings, debridement, dressing changes, invasive procedures and donor sites.

Compensatory (Non-Progressive) Stage of Shock

-in this stage of shock the MAP decreases by 10 to 15 mm Hg from baseline -both the Kidney and hormonal compensatory mechanisms are activated because cardiovascular responses alone are not enough to maintain MAP and supply oxygen to vital organs. -with the decrease in MAP, this triggers the release of renin, antidiuretic hormone (ADH), aldosterone, epinephrine, and norepinephrine to start kidney compensation and increase blood pressure. -Urine output decreases, sodium reabsorption increases, and widespread blood vessel constriction occurs to maintain he fluid volume within the central blood vessels. -Signs and symptoms: • thirst and anxiety • restlessness • tachycardia (increased respiratory rate) • decreased urine output • falling systolic blood pressure, rising diastolic blood pressure, and narrowing pulse pressure • cool extremities • decrease in oxygen saturation. -For Hypovolemic Shock: • 15-30% volume loss (1500ml) • CV: increasing HR, narrow pulse pressure, , decreased cap refill, cool clammy skin • Pulm: increased resps, deeper breaths to try to compensate ABGs alkalosis • Renal: Decreased urine output • Neuro: ALOC, restless, anxiety

Progressive Stage of Shock

-in this stage of shock where the MAP is more than 20 mm Hg from baseline. -Compensatory mechanisms are functioning but can no longer deliver sufficient oxygen, even to vital organs. -Vital organs develop hypoxia, and less vital organs become anoxic (no oxygen) and ischemic (cell dysfunction or death from lack of oxygen). As a result of poor perfusion and a buildup of metabolites, some tissues die. -The patient may express a sense of "something bad" (impending doom) about to happen. He or she may be confused, and thirst increases. -Sign and symptoms: • rapid, weak pulse; low blood pressure; pallor to cyanosis of oral mucosa and nail beds; cool and moist skin; anuria; and a 5% to 20% decrease in oxygen saturation • Laboratory data may show a low blood pH, along with rising lactic acid and potassium levels. ***IMPORTANT: Rising Lactic Acid and Hyperkalimia*** -For Hypovolemic Shock: • 40% total volume loss (2000ml) • CV: increased HR, dysrhythmia, skin ashen and cold • Renal: severely decreased urine output, possible anuria elevated BUN/Cr • Neuro: continued deterioration of LOC

Initial Stage of Shock

-in this stage of shock, the patient's baseline MAP is decreased by less than 10 mm Hg -at this stage, the Compensatory mechanisms are effective at returning systolic pressure to normal at this stage; thus oxygen perfusion to vital organs is maintained. -Cellular changes include increased anaerobic metabolism in some tissues with production of lactic acid, although overall metabolism is still aerobic **Note: there are less production of Lactic Acid at this stage, meaing it is unmeasurable.*** -The compensation responses of vascular constriction and increased heart rate are effective, and both cardiac output and MAP are maintained within the normal range. **Note: heart rate, blood pressure, and vital signs remain the same and stable*** -In hypovolemic shock: • Decrease in mean arterial pressure (MAP) of 5-10 mmHg from baseline value (Intravascular Volume is depleted 15% or 750ml) • Increased sympathetic stimulation • Mild vasoconstriction • Increased heart rate

Bacterial Meningitis

-inflammation of the protective membranes covering the brain and spinal cord caused by various types of bacteria • It is a Medical Emergency • High fatality rate, even with treatment, typically within 24-48 hours • Very contagious • Most likely to occur in high population living areas- dorms, shelters, jails, barracks • Broad spectrum antibiotics • Typically three stages: -1st - introduction of bacteria typically through nasal passages or throat- no symptoms -2nd- invasion of the blood- fever, may develop rash -3rd- intense inflammation in the meninges, causing severe headache and pus exudate. ***NOTE: THIS PATIENT SHOULD REMAIN ON DROPLET PRECAUTIONS***

Mean Arterial Pressure (MAP)

-is defined as the average pressure in a patient's arteries during one cardiac cycle. It is considered a better indicator of perfusion to vital organs than systolic blood pressure (SBP) -equation is (SBP+(2XDBP))/3 -SBP= Systolic blood pressure -DBP= Diastolic blood pressure ***IMPORTANT: Remember, anything under 60mm hg= ineffective organ perfusion*** ***Note: sepsis patient have a low blood pressure of 78/52 with a MAP of 61***

Secondary Survey and Resuscitation Interventions

-it comes after the primary survey where the immediate life threatening conditions as been adressed and the nurse can anticipate such as inserting a gastric tube for decompressiom of the GI tract to prevent vomiting and aspiration, An insertion of a urinary catheter to allow careful measure of urine output, and prepare for diagnostic studies -The resuscitation team also performs a more comprehensive head-to-toe assessment to identify other injuries or medical issues that need to be managed or that might affect the course of treatment.

mechanism of injury (MOI)

-it describes how the patient's traumatic event ocurred, such as a high-speed motor vehicle crash, a fall from a standing height, or a gunshot wound to the torso. -Two of the most common injury-producing mechanisms are blunt trauma and penetrating trauma -Blunt trauma results from impact forces such as those sustained in a motor vehicle crash; a fall; or an assault with fists, kicks, or a baseball bat. Blast effect from an exploding bomb also causes blunt trauma. The energy transmitted from a blunt-trauma mechanism, particularly the rapid acceleration-deceleration forces involved in high-speed crashes or falls from a great height, produces injury by tearing, shearing, and compressing anatomic structures. Trauma to bones, blood vessels, and soft tissues occurs. -Penetrating trauma is caused by injury from sharp objects and projectiles. Examples are wounds from knives, ice picks, other comparable implements, and bullets (gunshot wounds [GSWs]) or pellets. Fragments of metal, glass, or other materials that become airborne in an explosion (shrapnel) can also produce penetrating trauma.

Primary Survey and Resuscitation Interventions

-it is an organized system to rapidly identify and effectively manage immediate threats to life. -it is typically based on a standard "ABC" mnemonic plus a "D" and "E" for trauma patients: airway/cervical spine (A); breathing (B); circulation (C); disability (D); and exposure (E). Resuscitation efforts occur simultaneously with each element of the primary survey ***IMPORTANT: In the presence of excessive bleeding (hemorrhage) circulation techniques takes the highest priority intervention. the priority would be Circulation (C), Airway/Cervical Spine (A), and Breathing (B)*** ***Note: Disability (D) means if they can follow directions or have the ability to follow directions. Exposure (E) mean we are to remove everything on the patient (strip the patient)***

Multiple Sclerosis Management

-management of the demyelination of the brain and spinal cord disorder include: • there is no cure, so treatment is aimed at relieving symptoms and decrease the frequency and severity of relapses • during exacerbation, adminiter corticosteroids as prescribed • Stress management techniques to prevent exacerbations • promote independence and maintain an active normal lifestyle • Aerobic exercise to improve strength and reduce fatigue and depression. • Vitamin D can help lower the risk of developing MS and can delay its progression • Memory boosting program can improve memory, attention and processing for MS patients, half of whom develop some cognitive problem. • Reduce salt intake • No smoking • Avoid extreme temperatures -Therapy: • Physical Therapy • Speech Therapy • Occupational Therapy

Inhaled General Anesthesia

-mask, most common, most easily administered & controlled form of general anesthesia -Single or combination agents (to increase LOC or paralytics for muscle relaxation) -Depresses CNS, leading to amnesia and analgesia -Induction and reversal accomplished with pulmonary ventilation -Post op nausea and shivering -quick and fast acting

Intravenous General Anesthesia

-rapid and pleasent form of general anesthesia -Low incidence of side effects -Contraindicated for those with liver or kidney disease (metabolism) -Increased cardiac and respiratory suppression

Cholinergic Crisis

-severe muscle weakness and respiratory paralysis due to excessive acetylcholine; often seen in patients with myasthenia gravis as an adverse effect of drugs used to treat the disorder -caused by taking too much of the anticholinesterase drugs. It causes an over-stimulation at a neuromuscular junctions. -Causes Symptoms: • Salivation • Lacrimation • Urination • Defecation

Heat Exhaustion signs and symptoms with interventions

-signs and symptom for this heat related illness include: • Flu like symptoms - headache, weakness, nausea and vomiting • Cool clammy pale skin • Rapid weak pulse • No significant increase in body temp • May continue to perspire -Immediate intervention include: • Instruct the patient to immediately stop physical activity and move to a cool place • Use cooling measures such as placing cold packs on the neck, chest, abdomen, and groin • Soak the individual in cool water or fan while spraying water on the skin • Remove constrictive clothing. • Sports drinks or an oral rehydration-therapy solution can be provided. Mistakenly drinking plain water can worsen the sodium deficit **Note: Do not give salt tablets, which can cause stomach irritation, nausea, and vomiting. If signs and symptoms persist, call an ambulance to transport the patient to the hospital.** -Clinical Intervention include: • Monitor vital signs • Rehydrate the patient with intravenous solution as prescribed if nausea or vomiting persists • Draw blood for serum electrolyte analysis

Right Hemisphere Stroke

-stroke that affects proprioception, personality changes, and Altered mental status -Impaired Sense of Humor -Memory- Disorientation to time, place, and person, Inability to recognize faces -Vision- Visual spatial deficits, Neglect of the left visual field, Loss of depth perception, Cortical blindness -Behavior- Impulsiveness, Lack of awareness of neurologic deficits, Confabulation, Euphoria, Constant smiling, Denial of illness, Poor judgment, Overestimation of abilities (risk for injury) -Hearing- Loss of ability to hear tonal variations -Left side hemiplegia or hemiparesis ***NOTE: If brainstem or cerebellum is involved, pt may experience quadriparesis, cranial nerve deficits, and ataxia***

Left Hemisphere Stroke

-stroke that affects the center for langauge, math, and analytics -Language • Aphasia- inability to speak or comprehend • Alexia (dyslexia)- difficulty reading • Agraphia- difficulty writing • Acalculia- difficulty with math calculations -Memory- possible deficit -Vision- Inability to discriminate words and letters, Reading problems, Deficits in the right visual field, Cortical blindness -Behavior-Slowness, Cautiousness, Anxiety when attempting a new task, Depression or a catastrophic response to illness, Sense of guilt, Feeling of worthlessness, Worries over future, Quick anger and frustration, Intellectual impairment -Hearing- no deficit -Right side hemiplegia or hemiparesis ***NOTE: Left-Side is learning***

Skin graft

-surgical procedure to transplant healthy tissue by applying it to an injured site -Homografts (allograft) human skin obtained from cadaver. Heterografts (xenografts) skin from other species. -Compression dressing are applied AFTER grafts heal to help prevent contractures and tight

Acute Phase of Burn Injury

-the second phase of burn injury that begins about 36 to 48 hours after injury, when the fluid shift resolves, and lasts until wound closure is complete -During this phase, the nurse coordinates interprofessional care that is directed toward continued assessment and maintenance of the cardiovascular and respiratory systems, as well as toward nutrition status, burn wound care to preserve tissue integrity, pain control, and psychosocial interventions. -Nurses should provide burn wound care, Pain control, and Psychosocial interventions -The priority problems for patients with burn injuries greater than 25% TBSA in the acute phase of recovery include: • Wound care management • Potential for infection (isolation care and proper hand washing: infection prevention and Vistor control) • Weight loss (Nutrition 5,000 cal/day 20% protein, 50% carb, 30% fat) • Decreased mobility • Decreased self-esteem • Pharmacology morphine, antibiotics, PPI (prevent stress ulcers), steroids, bacitracin (partial thickness) silvadene broad-spectrum deep partial to full thickness burns

Stage 4 of frosbite

-this stage of frosbite is the severe form, there are blisters over the carpal or tarsal (instead of just the digit); the part is numb, cold, and bloodless. -The full-thickness necrosis extends into the muscle and bone -At this stage, gangrene develops, which may require amputation of the affected part

Rule of 9s

-use to calculate BSA% -Head (4.5% Anterior, 4.5% Posterior) -Arms (4.5% Anterior 4.5% Posterior) -Torso (18% Anterior 18% Posterior) -Leg (9% Anterior, 9% Posterior) -inguinal (1%)

Burn complication and management

Complication: • Acid-base imbalances • Hypovolemia (associated with a high mortality rate of burn victims) • Metabolic acidosis • Hyperkalemia • Hyponatremia • Hemoconcentration (increases blood osmolality=increased blood viscosity = tissue hypoxia) Management Include: -Airway and Breathing is the top priority -Fluid and electrolyte balance (burns): o Fluid and electrolyte imbalance due to cardiovascular changes. Fluid remobilization after 24 hrs. Diuretic stage 48-72 hr after burn o Monitor urine color, odor, presence of particles/foam, output -Care for burn injury/burn shock: o Respiratory assessment: carbon monoxide poisoning (cherry red lips). Brassy cough or difficulty swallowing. ASSESS for airway patency. o Administer O2. Cover pt with blanket. Keep pt on NPO status. Elevate extremities if no fractures obv. Initiate IV line for fluids. Administer Tetanus toxoid. -Coping with psychosocial impact of burn injury: o Pt should show: willingness to touch affected body part, adjustment to body fx, willingness to use strategies to enhance appearance and function, successful progression through grieving. -Optimal pain control and increase comfort for the patient with a burn injury: o Drug therapy (Morphine, Hydromorphone, Paracetamol, Dipyrone), Music, meditative breathing, hypnosis, quiet and warm

Stage 3 of Parkinson's disease

Moderate stage where the patient exhibits Postural instability and increased gait problems

Cerebrovascular Accidents (CVA) Nursing Care

Nursing Care for this brain attack include: -maintain airway -monitor neurological function and vital signs -establish baseline level of function and glasgow coma scale -maintain fluid and electrolyte balance -monitor for aspiration due to risk of dysphagia. feed the client slowly, placing food in the back of the mouth and to the unaffected side -provide psychological support to the client who is experiencing aphasia -encourage slow deliberate speech -range of motion: to prevent flexion contractures, keep extremities in a position of extension or neutrality -Maintain skin integrity -Hemiparesis, hemiplegia: will cause safety issues in the client -help the client to achieve bowel and bladder control -hemianopsia: place articles within clients visual range -Referrals: • Occupational and Physical Therapy • Speech Therapy

Meningitis Nursing Care

Nursing care for this infection of the meningis include: -Isolate the client as soon as meningitis is suspected. initiate droplet precautions until antibiotics have been administered for 24 hour and oral and nasal secretions are no longer infectious. -implement fever-reduction measures, such as a cooling blanket -report meningococcal infections to the public health department -decrease environmental stimuli -provide a quiet environment -minimize exposure to bright light (natural and electric) *****IMPORTANT INTERVENTION IS TO MAINTAIN THE PATIENT ON BED REST WITH THE HEAD OF THE BED ELEVATED TO 30 DEGREES****** *****IMPORTANT: monitor for Increased Intracranial Pressure and altered levels of consciousness****** -tell the client to avoid coughing and sneezing to those who have Increased Intracranial Pressure -Maintain client safety, such as seizure precautions -replace fluid and electrolytes as indicated by laboratory values -older adults monitor for PNEUMONIA -Monitor for signs of septic shock

Nursing Considerations for Seizures

Nursing consideration for this neurologic disorder include: -During an active seizure (ictal phase) • Observe and document the time and length of the seizure and of each phase • Protect the patient from injury- do not restrain! • DO not place anything into the mouth • Maintain the airway by Turn to prevent aspiration and O2 and suction at bedside • Note facial expressions, assess pupils -While patient is post-ictal: • Monitor closely for LOC, orientation, and motor ability to return to baseline ****Note: A seizure lasting more than 10 minutes can become fatal!****

Hypovolemic shock treatment

Treatment include: -Fluid replacement § Aggressive fluid replacement with close monitoring, crystalloid or colloid § Colloids and Fluids help pull from the interstitium back to intravascular space § Ex: Mannitol, albumin -Blood Transfusion § PRBCs § Whole blood products § Fresh frozen Plasma § Platelets § Cryoprecipitate -Fluid Restrictions § Monitor for fluid overload § Lung sounds § JVD § Increased pulmonary artery pressure § Arterial wedge pressures § R atrial pressures

High-pressure alarms

a ventilator alarm that indicates increase pressure, which may be caused by secretions, kinking of the tube, pulmonary edema, or the client coughing or bitting the tube, along with mucus plug secretions

Myasthenia Gravis

• A progressive-acquired autoimmune disease characterized by muscle weakness as a result of impaired acetylcholine receptors • May present as mild disturbances to rapid progression leading to death from respiratory failure • Weakness is typically proximal to the body and progresses distally. Advanced disease- all muscles are weak ****IMPORTANT: THE DISEASE PROCESS STARTS WITH THE CORE AND PROGRESS TO THE EXTREMETIES**** -Signs and Symptoms: ● Ptosis ● Diplopia ● Dysphagia ● Fatigue ● Respiratory compromise ● Progressive muscle weakness that worsens with repetitive use - improves with rest ● Decreased sense of smell and taste ● Paresthesias • Sensory Manifestations: Muscle achiness, Paresthesia, and Decreased sense of smell or taste • Motor Manifestations: Progressive muscle weakness, Poor posture, Ocular palsies, Ptosis (drooping eyelids), Diplopia (double vision), Respiratory compromise, Loss of bowel and bladder, Fatigue and Dysphagia -Pharmaceutical treatment: • Anticholinesterases or cholinergic drugs • Immunosuppressive drugs or corticosteroids • Plasmapheresis • Thymectomy **NOTE: DIAGNOSIS: TENSILON TEST** ***IMPORTANT: Patient at risk of death from rapid development of muscle weakness which can induce respiratory failure***

Frostnip

• A superficial cold injury/ no tissue integrity degradation that produces Pain, Numbness, and Pallor or Waxy appearance of the affected area but is easily relieved by applying warmth • Can lead to frostbite with continued exposure