Med Surg Exam 3

Signs and symptoms of Neurogenic Shock

- Bradycardia - Decreased or absent bowel sounds - Warm, dry skin - Hypothermia - Hypotension

High altitude cerebral edema (HACE)

- Cannot perform ADLs - Ataxia (defective muscular coordination) - Change in mental status/confusion - Cranial nerve dysfunction - Seizures - Stupor, coma, death

Potential Complications of Cataract Surgery

- Cataract surgery is a procedure used to remove the natural lens in the eye when it becomes clouded. The natural lens is replaced with a plastic, artificial lens. · IOP · Hemorrhage · Infection · Teach patient to immediately report any reduction of vision in the eye with the cataract removed!!!

Altitude Sickness First Aid/ treatment

- Descent to lower altitude (MOST IMPORTANT) - Oxygen - Acetazolamide (Diamox) is used to treat and prevent AMS - Dexamethasone for moderate to severe AMS - For HACE: early recognition and lower altitude - HAPE: lower altitude and Cialis or Viagra, Oxygen Seeing, preventing and treating altitude related illness

Family guidelines for CPR

- Families have the right to be present if they wish to.

First Aid care for snake bite

- First priority is to move the person to a safe area away from the snake and encourage rest to decrease venom circulation. - Remove jewelry and constricting clothing. - Immobilize affected extremity in a position of function. - Maintain the extremity at the level of the heart. - Keep individual warm and calm. - Do not offer any stimulants such as caffeine. - If transportation is delayed, apply a 2 to 4 cm constricting band that is not used as a tourniquet. - Assess distal circulation frequently. - Do not incise and suck or apply ice to the wound.

Treatment for heat stroke

- In the pre-hospital setting, rapid cooling is the first priority of care after ensuring that the patient has a patent airway, effective breathing, and circulation Hospital care—oxygen therapy, IV 0.9% saline solution, Foley, aggressive cooling methods, continuous core temperature monitoring Thorazine 25 to 50 mg IM or IV for shivering Valium for seizure activity

What are some of the risk factors for stroke?

- Ischemic stroke: blockage of cerebral or carotid artery by thrombus or embolus · Thrombotic stroke (clot) -- HTN -- Atherosclerosis · Embolic stroke (dislodged clot) -- Cardiac Disease - Hemorrhagic stroke: · Intracerebral Hemorrhage: bleeding into the brain tissue generally resulting from sustained or severe HTN. · Subarachnoid Hemorrhage: bleeding into the subarachnoid space of the brain -- HTN -- Vessel Disorders (Arteriovenous malformation; Ruptured aneurysm) -- Genetic factors

· Pathophysiologic Effects of Pit Viper venom

- Local tissue necrosis - Massive tissue swelling - Intravascular fluid shifts and hypovolemic shock - Pulmonary edema - Renal failure - Hemorrhagic complications from DIC

Drug therapy for TBI

- Mannitol, furosemide - Opioids, sedatives - Antiepileptic drugs - Acetaminophen or Ibuprophen - Barbiturate coma

Complications of Heat Stroke

- Multiple organ dysfunction syndrome (MODS) - Renal impairment - Electrolyte and acid-base disturbances - Coagulopathy - Pulmonary edema - Cerebral edema

Lightning Strike Prevention

- Observe weather forecast when planning to be outside A lightning strike is the minute that your hair stands up on end, you see a blue Hill around objects, and you hear high-pitched or crackling noises. If you cannot move away from the area immediately, crouch on the balls of your feet can talk your head down to minimize the target size; do not lie on the ground or may contact with your hands to the ground Seek shelter when you hear thunder. Go inside the nearest building or an enclosed vehicle. Avoid isolated sheds in cave entrances. Do not stand under an isolated tree or small structure such a ski lift flagpole boat last powerline and then open area such as a field bridge or hilltop. Lightning tends to strike high points. Instead, seek a low area under a thick growth of saplings or small trees Leave water immediately including an indoor shower bathtub and move away from any open bodies of water Avoid metal objects such as chairs or bleachers; put down tools, fishing rods, garden equipment, golf clubs, and umbrellas; stand clear of fences, exposed pipes, motorcycles, bicycles, tractors, and golf carts. If inside a car with a solid punch close the windows and stay inside if into convertible, leave the car at least 49 yards away and huddle on the ground If inside a tent, stay away from the metal tent poles and what fabric of the tent walls If you're caught out in the opening cannot seek shelter, attempt to move to a lower ground such as a ravine or valley; stay away from any tall trees or objects that could result in a lightning strike splashing over you; Place insulating material between you and the ground It's inside a building stay away from open doors, windows, fireplaces, metal fixtures, and plumbing Turn off the electrical equipment, including computers, televisions, and stereos to avoid damage Stay off landline telephones. Lightning can either interested to telephone line and produce heat next trauma, including cataracts in tympanic membrane disruption. Death can result. Avoid use of cellular phones, which can transmit loud static that can cost acoustic damage.

High altitude pulmonary edema (HAPE)

- Occurs within 2-4 days after ascent. Most commonly on the second night - Most common cause of death related to high altitude - May notice poor exercise tolerance - Fatigue, weakness - Persistent dry cough - Cyanosis of the lips and nail beds - Tachycardia and tachypnea at rest - Pink, frothy sputum is late sign

Treatment for moderate - severe hypothermia

- Prevent ventricular fibrillation - Horizontal position - Maintenance of ABCs - After-drop - Extracorporeal rewarming methods - Caution with administration of medications - Not dead, until you warm and dead

What is a primary brain injury

· Occurs at the time of injury, resulting from the physical stress (force) within the tissues · Open head injury: skull fractures; skull is pierced by a penetrating object; dura is violated; exposure to outside contaminants occurs · Closed head injury: Skull is intact - Mild concussion - Diffuse axonal injury - Contusion (coup and contrecoup injury) - Laceration - TBI: classified as mild, moderate, and severe

How is Glaucoma Tested/ Diagnosed

· Ophthalmoscope examination - tonometry - Normal IOP 10-21 mm Hg - Open angle IOP 22-32 mmhg - Closed angle IOP may be >30 mm hg · Visual field testing

Cholinergic Crisis

· Over-stimulation at a neuromuscular junction due to an excess of acetylcholine (Ach · Sx: cramps, increased salivation, lacrimation, muscular weakness, paralysis, muscular fasciculation, diarrhea, and blurry vision

Symptoms of MG

· Progressive paresis of affected muscle groups that is partially resolved by resting · Most common symptoms—involvement of eye muscles, such as ocular palsies, ptosis, diplopia, weak or incomplete eye closure' dysphagia, difficulty swallowing

autonomic dysreflexia Interventions

· Raise HOB immediately to help reduce BP Notify RRT or PCP for drug therapy r/t BP Determine/ manage cause of Autonomic Dysreflexia Ex: kink in catheter bag

Primary Interventions for survey trauma

· Remove wet sheets or clothing · Cover patient with blankets · Infuse only warm solutions · Keep room temperature 75-80 degrees Fahrenheit

symptoms of cataracts

· Slightly blurred vision and decreased color perception · No pain or eye redness is associated w/ age -related cataract formation · Absent red reflex

autonomic dysreflexia Symptoms

· Sudden significant rise in BP with bradycardia · Profuse sweating above level of the lesion · Blurred Vison · Nasal stuffiness · Flushing · Feeling of apprehension · Sudden headache

What is spinal shock?

· This condition occurs immediately as the cord's response to the injury. · Complete but temporary loss of motor, sensory, reflex and autonomic function · Often resolves in 48 hours but can last several weeks

Hospital care for snake bite

- Supplemental oxygen - Two large-bore IV lines for NS or LR - Continuous cardiac and BP monitoring - Opioids - Tetanus prophylaxis - Wound care - Broad-spectrum antibiotics - Baseline labs and coagulation profile - Assess the bite site every 15-30 minutes: measure and record the circumference of the extremity - Contact the regional poison control center so that toxicologists can provide specific advice for antivenom dosing and medication management. Not all bites require antivenom - Newer and safer antivenom made from sheep usually given within 6 hours of bite, 4-6 vials over 60 minutes - Use antivenom cautiously in patients who may have reactions to sheep protein, mercury containing products or those who are pregnant.

Secondary Survey of trauma

- The purpose of the secondary survey is to obtain a detailed history Perform a head-to-toe physical exam, Reassess all vital signs, and obtain pertinent lab and imaging studies to identify injuries and metabolic abnormalities · NGT- to decompress the GI tract and to prevent N&V · Foley Catheter - to measure urine output · Prepare for diagnostic tests · Comprehensive exam

Normal IOP

10-21 mm Hg · If too much aqueous humor, increased IOP - Extra presses on blood vessels & becomes ischemic - Eye sight can be lost and permanent blindness - Painless

Moderate hypothermia

28° C to 32° C 82.5° F to 89.6° F - Muscle weakness - Increased loss of coordination - Acute confusion - Apathy - Incoherence - Possible Stupor - Decreased clotting (caused by impaired platelet aggregation and thrombocytopenia)

Mild hypothermia

32° C to 35° C 89.6° F - 95° F - Shivering - Dysarthria (slurred speech) - Decreased muscle coordination - Impaired cognition (mental slowness) - Diuresis (caused by shunting of blood to major organs)

Severe hypothermia

<28° C or < 82.5° F - Bradycardia - Severe hypertension - Decrease respiratory rate - Cardiac dysrhythmias, including possible ventricular fibrillation or asystole - Decreased neurologic reflexes to coma - Decreased pain responsiveness - Acid-base imbalance

What is glaucoma

A group of eye conditions that damage the optic nerve. This damage is often caused by an abnormally high pressure in the eye. · One of the leading causes of blindness for people over the age of 60

Heat stroke

A true medical emergency in which body temperature may exceed 104° F (40° C). High mortality rate if not treated in a timely manner. Exertional heat stroke—sudden onset, typically caused by strenuous physical activity in hot, humid conditions. Classic heat stroke—occurs over a period of time as a result of chronic exposure to a hot, humid environment.

What is primary survey in trauma?

A-B-C-D-E Airway (& cervical spine protection) - Securing the airway is the highest priority while protecting the cervical spine. (includes suctioning, intubation if needed, oxygen mask for the spontaneously breathing patient, bag-valve-mask for the pt. needing ventilatory assistance. Breathing: Are ventilatory efforts effective (includes the pts' and our efforts) Is chest decompression needed? Needle thoracostomy or tube thoracostomy. Circulation: Common threats are cardiac term-15arrest, myocardial dysfunction, and hemorrhage (internal or external) IV access is a common intervention at this point Disability: Nuerologic statuss baseline: - AVPU (Alert, responsive to voice, responsive to pain, unresponsive) and/or - Glasgow Coma Scale (GCS) Exposure: in final step of primary survey- clothes are removed or cut away to allow thorough assessment.

concerning symptoms of trauma patients

ABC Hemorrhage ????

Course of Disease for GBS

Acute period (1- 4 weeks) - Onset of symptoms, progression, leveling (no further deterioration) Plateau period (days to 2 weeks) Recovery phase (4 - 6 months, up to 2 years) - Remyelination and axonal regeneration Healing occurs in reverse, Neurons affected last are first to recover

What is Disaster Preparedness plan?

An event in which illness or injuries exceed resource capabilities of a community or medical facility: · Violence · Illness outbreaks · Severe weather · Earthquakes · Avalanches · Fire

What is a traumatic brain injury (TBI)?

An injury to the brain sustained by physical trauma or external force. Can lead to temporary or permanent impairment Direct & indirect Does not include brain damage due to strokes, tumors, and progressive or transient neuropathologies.

Administrative review

Another type of debriefing involving an administrative review of staff and system performance during the event to determine whether opportunities for improvement in the emergency management system exist.

How is epilepsy treated?

Antiepileptic drugs (AED) - Phenytoin - Fosphenytoin - Carbamazepine - Oxcarbazepine · Teach patient the importance of compliance pg. 866 - Serum drug levels are checked every 6-12 hours after loading dose and then 2 weeks after oral phenytoin has started.

Disaster Triage Tag System

Tagging is an activity that should occur simultaneously to the primary triage process, when a patient is classified it should be tagged so that rescue technicians identify those that need to be transported and treated. · Red Tag—emergent (class I) patients · Yellow Tag—patients who can wait a short time for care (class II) · Green Tag—nonurgent or "walking wounded" (class III) · Black Tag—patients who are expected to die or are dead (class IV)

Because of ED exposure the following are needed interventions.

Hypothermia complicates management of the pt. by causing vasoconstriction, difficulty with venous access and arterial assessment, coagulopathy, increased bleeding, slowed drug metabolism.

Surgical management of TBI

ICP monitoring devices: o Intraventricular catheter (IVC) (External ventricular device EVD) o Subarachnoid screw or bolt o Epidural bolt: Fiber optic transducer catheter or sensor o Subdural catheter Decompressive Craniotomy may be performed in extreme instances of elevated ICP. Allows additional space

What is meningitis?

Inflammation of the meninges' that surround the brain and spinal cord

Cause of Sensorineural Hearing loss

Inner ear or auditory nerve is damaged- Prolonged exposure to noise - Presbycusis - Ototoxic Substance - Acoustic neuroma - DM - Infection Myexedema

Edrophonium

Cholinesterase inhibitor, prevents break down of acetylcholine

What is Myasthenia Gravis?

Chronic autoimmune disease characterized by weakness primarily in muscles innervated by cranial nerves, as well as in skeletal and respiratory muscles Caused by: Attachment of antibodies to acetylcholine receptors ànerve impulses are not transmitted to the skeletal muscles

What are the types of hearing loss?

Conductive Hearing Loss: Obstruction of soundwave transmission Sensorineural Hearing Loss: Inner ear or auditory nerve is damaged

Initial Assessment for SCI:

· First priority is assessment of the patient's airway, breathing pattern, and circulation status · Assessment for indications of intra-abdominal hemorrhage or hemorrhage or bleeding around fracture sites · Assessment of level of consciousness using Glasgow Coma Scale · Establishment of level of injury: tetraplegia, quadriplegia, quadriparesis, paraplegia, and paraparesis

Spinal Cord Injury Assessment

· First priority is assessment of the patient's airway, breathing pattern, and circulation status · Assessment for indications of intra-abdominal hemorrhage or hemorrhage or bleeding around fracture sites · Assessment of level of consciousness using Glasgow Coma Scale · Establishment of level of injury: tetraplegia, quadriplegia, quadriparesis, paraplegia, and paraparesis · Assess for neurogenic shock

Frostbite

· Frostbite is accompanied by initial pain, numbness, and pallor of the affected area. · Deep frostbite requires aggressive management in a medical facility. Recognition is essential to early, effective intervention and prevention of further tissue damage Do not apply dry heat or massage the frostbitten areas as part of warming. This can produce further tissue injury Respond by by using other warming techniques such as rapid rewarming bath of 99-102 F to preserve tissue integrity

Risk factors of Autonomic Dyreflexia

· GI, GU, Vascular stimulation · Bladder distension · UTI · Epididymitis · Scrotal compression · Bowel distension · Impaction from constipation · Irritation of hemorrhoids · Tight clothing · Contact with hard or sharp objects · Temperature fluctuation/ altered sensory perception

Signs and Symptoms fo meningitis

· Headache, nausea, vomiting, and fever · Photophobia, phonophobia, myalgia · Nuchal rigidity (stiff neck) and positive Kernig's and Brudzinski's signs in some patients · Seizure, decreased mental status, focal neurologic deficits, increased ICP, systemic inflammation (SIRS), DIC, and gangrene

Whayt is a Primary Spinal Cord Injury (SCI)

· Hyperflexion injury · Hyperextension injury · Axial loading injury or vertical compression such as those that occur in jumping · Excessive rotation of the head beyond its range · Penetration injury, such as those wounds caused by a bullet or a knife

Myasthenia Gravis Nonsurgical Management

Drugs: - cholinesterase inhibitors - cholinergic drugs - Immunosupressants · Plasmapheresis · Respiratory support (due to muscle weakenss) - O2, bag-valve-mask, suction at bedside · Promoting mobility -- Prevent fatigue

MG Prognosis/ Diagnostic Testing

Dx: Response to cholinergic drugs (edrophonium) -- This is also helpful in distinguishing between cholinergic crisis or myesthenic crisis) -- Within 30 to 60 sec after injection of edrophonium, most myasthenia patients show marked improvement in muscle tone that lasts 4 to 5 minutes. Thyroid function (some MG patients have thyrotoxitosis) Antibody testing Repetitive nerve simulation Electromyography (emg)

Hypothermia

· Hypothermia occurs at core body temperature of <95° F (35° C)

Cause of GBS

· Likely Result of an altered immunity · Often associated with bacterial or viral infection

Diagnostic testing for GBS

· Lumbar puncture for CSF · Electrophysiologic studies

What is Status Epilepticus?

· Medical emergency · Prolonged seizures lasting > 5 minutes or repeated seizures over the course of 30 minutes · Last longer than 10 minutes can cause death

What is neurogenic shock?

· Neurogenic shock occurs with injuries above T6 · Caused by an alteration in the function of the ANS · Starts 24 hours post injury, lasts 2-3 weeks · Neurogenic shock is an EMERGENCY · Need to perfuse the spinal cord

Abnormal posturing

decorticate and decerebrate

What symptoms or assessment findings would you expect to see in a patient with a brand new cervical spine cord injury?

Loss or decreased mobility, sensory perception, and bowel/ bladder control

What is a cataract?

OPACITY OF THE LENS THAT DISTORTS THE IMAGE PROJECTED ON THE RETINA (blurred vision & decreased color perception; loss of vision is gradual)

Cause of Conductive Hearing loss

Obstruction of sound-wave transmission - Cerumen - Foreign body - Perforation of tympanic membrane - Edema - Infection of external or middle ear - Tumor Otosclerosis

Heat Stroke Assessment

Profoundly elevated body temperature (>104° F or 40° C) Mental status changes as a result of thermal injury to the brain Hypotension, tachycardia, tachypnea Hot and dry skin; however, persons may continue to perspire

What is the trauma system? And what is their purpose

Standards set by The American College of Surgeons Committee on Trauma Level I: "A facility that is capable of providing leadership and total care for every aspect of injury, from prevention through rehabilitation." Level II: Provides full care to most injured patients - Transfer pts to higher trauma centers - Located in community hospitals Level III: Stabilizes major injuries (usually have general surgeons and orthopedic surgeons available) - Transfer pts to higher trauma centers - Located in community hospitals Level IV: located in rural and remote areas. Provides advanced life support - Transports to higher trauma levels when available.

What is the antidote to edrophonium?

· Atropine sulfate is the antidote for edrophonium (Tensilon) complications (Vfib and cardiac arrest).

Risk factors for Meningitis

· Bacterial and viral infections · Otitis media · Pneumonia · Acute or chronic sinusitis · Tooth abscess · Immune compromised patient (cancer) · Organ transplant pt. · Cont. pg. 867

Lightning Injury

· Both the cardiopulmonary and the central nervous systems are profoundly affected by lightning injuries. · Most lethal initial effect on the cardiopulmonary system is asystole. · Treatment includes immediate CPR. · "Reverse Triage" · Rescuer is in no danger of electrical charge from contact with the victim.

Meningitis Treatment

· Broad-spectrum antibiotic · Anticonvulsants · Prophylaxis treatment for those who have been in close contact with the meningitis-infected patient · Vaccine · Prevent transmission through good handwashing · Droplet isolation precautions for bacterial meningitis · Monitor neurologic status Care of pt. w/ meningitis pg. 868 - A.B.C's - Vitals and neuro check Q2-4 hr. prn - Manage pain

Causes of Secondary Brain Injury

· Causes: - Hypotension and Hypoxia (goal MAP >70 mm Hg) - Increased ICP (10-15 mm Hg normal) - Leading cause of death from head trauma pts. that reach the hospital alive - Hemorrhage/ hematoma development: -- Epidural -- Subdural -- Intracerebral - Hydrocephalus - Brain herniation

Meningitis Diagnostics and Laboratory Testing

· Cerebrospinal fluid analysis · Cell count, differential count, protein, gram stain, C&S, and glucose · CT scan · Blood cultures · Counterimmunoelectrophoresis · Presence of virus or protozoa · Possible bacteria after C&S · Complete blood count · X-ray study to determine presence of infection

Symptoms of ICP

· Change or Loss of consciousness · Behavior change: restlessness, irritability, and confusion · Headache · Nausea and Vomiting · Aphasia · Dysarthria (change in speech) · Change in sensory motor status: -- Blown pupil or constricted/ non-reactive pupils is a late sign!! · Ataxia · Seizures (w/in 24 hours after stroke) · Cushing's traid (very late sign) · Abnormal Posturing (very late sign) - Decebrate - Decorticate

What is autonomic dysreflexia?

· Commonly seen in patients with upper spinal cord injury, T6 and above, as a result of noxious visceral or cutaneous stimuli below the level of injury · This can be a pain or irritant such as tight clothing or something pinching the skin or a normal function that the body may not notice (such as having a full bladder and needing to urinate or constipation/fecal impaction). · This stimuli causes massive, uninhibited reflex sympathetic discharge, leading to potentially life-threatening hypertension

Increased intracranial pressure

· Content of Cranial Compartment: CSF, blood, brain tissue · Cranial Compartment is a rigid compartment with a fixed volume · Increase in one volume must have a decrease of volume in another · Increase in one volume without compensation of another will increase ICP · CPP = MAP - ICP Normal ICP (10-15 mm Hg) CPP cerebral perfusion pressure · ICP > 20 mm Hg is considered detrimental to the brain because neurons begin to die

What is Guillain-Bare syndrome?

· Demyelination (destruction of the myelin sheath) of the peripheral nerves, progressive motor weakness and sensory abnormalities (paresthesia's) · Ascending paralysis, begins in the legs, spreading to the arms, upper body, and cranial nerves (difficulty smiling, swallowing)

Treatment for TBI's goal

The goal is to decrease Inter Cranial Pressure

Interventions for GBS

· Drug therapy (IV immunoglobulin) · Plasmapheresis -- removes the circulating antibodies assumed to cause the disease. -- Plasma is selectively separated from whole blood; the blood cells are returned to the patient without the plasma. -- Plasma usually replaces itself, or the patient is transfused with albumin. · Monitoring respiratory status and managing the airway · Managing cardiac dysfunction · Improving mobility and preventing complications of immobility · Managing pain · Promoting communication · Providing emotional support

What is the edrophonium test?

· Dx: response to cholinergic drugs · Within 30 to 60 sec after injection of edrophonium, most myasthenia patients show marked improvement in muscle tone that lasts 4 to 5 minutes. · Cholinergic crisis is due to overmedication. · Myasthenia crisis is due to under medication. Both cholinergic and myasthenic crisis may present with muscle weakness

Altitude-Related Illness

· Elevations >5000 ft can produce physiologic responses in the body that can be fatal · Acclimatization is the process of adapting to high altitudes High altitude disease include Acute mountain sickness, High altitude cerebral edema, and High altitude pulmonary edema

How is Status Epilepticus treated

· Establish an airway- notify HCP or RRT · ABGs · IV push lorazepam, diazepam; rectal diazepam (Benzodiazapines) · Loading dose IV phenytoin

spinal shock signs and symptoms

· First no reflexes, then return of reflexes, lastly hyperreflexia and spastic movements (reflexes) · Muscle spasticity begins in patients with cervical or high thoracic injuries as spinal shock resolves

What is epilepsy?

Two or more seizures experienced by a person · Chronic disorder with recurrent, unprovoked seizure activity, may be caused by abnormality in electrical neuronal activity and/or imbalance of neurotransmitters (e.g., GABA)

What is a Secondary Spinal Cord Injury:

Worsens primary · Hemorrhage · Ischemia · Hypovolemia · Impaired tissue perfusion from neurogenic shock (medical emergency) · Local Edema

Cholinergic crisis

an acute exacerbation of muscle weakness caused by overmedication with cholinergic (anticholinesterase) drugs

Myasthenia crisis

an exacerbation of the myasthenia symptoms caused by under medication with anticholinesterases

direct brain injury

brain tissue is injured by trauma. Brain is lacerated, punctured, or bruised by broken bones of skull, bone fragments, or foreign objects.

visual field test

measurement of the area (peripheral and central) within which objects are seen when the eyes are fixed, looking straight ahead without movement of the head

Critical incident stress debriefing (CISD)

provide session for small groups of staff to promote effective coping strategies

Indirect brain injury

rebound effect causing the brain to shift within the cranium, shearing of neurons, contusion, of laceration

What is a secondary Brain injury

something we can prevent (ex. hypoxia post primary injury) · Occurs after the initial injury and worsens or negatively impacts patient outcomes

Cushing's triad -

sudden severe hypertension, widened pulse pressure, bradycardia - classic sign of impending herniation through Foramen of Monroe or laterally

Nursing interventions for Traumatic Brain Injury

· ABCs · Preventing or detecting secondary brain injury · Assessment of vital signs to prevent and detect increased ICP · Cardiac Monitoring · Neuro assessment q 1hr!!!! Changes in LOC is an early indicator of deterioration!!! "Blown pupil" and/or Cushing's triad is a late sign!! · Promote fluid and electrolyte balance · Monitor effects of treatment & drug therapy · Fever identification and control · Therapeutic hypothermia · Sedation · CO2 monitoring: Potent vasodilator that can contribute to increases in ICP · Hypoxemia prevention · HOB 30-45; Body alignment!!! Promote cerebral venous drainage!!!

What nursing interventions need to be implemented when taking care of patients with epilepsy?

· Type of seizure dictates actions · Oxygen and suctioning equipment should be readily available. · Saline lock inserted if patient doesn't have I.V access- this provides ready access if IV drug therapy must be given to stop the seizure · Turn patient on side · Remove objects · Turn head to side if possible · Maintain airway · Cyanosis (usually self limiting) · Never insert padded tongue blades into the patient's mouth during a seizure. · Keep patient safe by being creative (i.e. mattress on the floor) · Patient safety pg.865

What types of meningitis are there?

· Viral meningitis: Usually self-limiting and the patient has a complete recovery (also called aseptic meningitis) · Bacterial meningitis: Potentially life-threatening

Describe the fluid of the eye

· Vitreous humor is a set amount in adults, no new vitreous humor is made · Aqueous humor is continuously made from blood plasma · Ciliary bodies located behind the iris, in front of the lens secrete aqueous humor · Fluid flow through the pupil into the bulging area in front of the iris · Blood vessels, collected in the outer edges of the iris, collect the fluid and return it to the blood. · 1 mL of aqueous humor is present at all times and is continuously made and reabsorbed at a rate of 5 mL per day

causes of cataracts

· With age Increased density occurs, transparency is lost · Maybe present at birth or develop over time · Related to trauma, exposure to toxic agents, or aging process · Can occur earlier with heavy ultraviolet lights

Heat exhaustion

· a syndrome caused primarily by dehydration, stemming from heavy perspiration and inadequate fluid and electrolyte consumption during heat exposure over a period of hours to days. Patients feel ill, and their clinical manifestations resemble the flu. Treatment involves immediate termination of physical activity and transfer to a cool place. If left untreated, can lead to heat stroke which is s true emergency and can lead to death

Post Op cataract surgery/ Patient teaching

· dramatic improvement in vison the day of surgery, but final vision 4-6 weeks post · Steroid and antibiotic ointment right after surgery · Use Dark glasses in bright light · Instill prescribed eye drops for 2 - 4 weeks · Pain may indicate increased IOP or hemorrhage · Monitor for Infection · Avoid activities that might increase IOP: Table 42.5 pg. 941 · Teach patient to immediately report any reduction of vision in the eye with the cataract removed!!!