Midterm 2

What is the "iceberg effect" in electrical burns?

It refers to the phenomenon where internal damage is often more severe than external injuries, due to deep tissue and organ involvement.

Why is there a risk of bone fractures in electrical burn patients?

High-voltage shocks can cause strong muscle contractions that may lead to broken bones.

What cardiac complication must nurses assess for in electrical burn patients?

Cardiac dysrhythmias; an EKG should be performed upon hospital arrival.

What renal complication can result from an electrical burn?

Acute Kidney Injury (AKI) due to myoglobin release from muscle breakdown, which can clog the glomeruli.

Which type of chemical burn is more severe: alkali or acid?

Alkali burns are more severe than acid burns.

Why are alkali burns worse than acid burns?

Alkali burns continue to cause tissue damage even after the chemical is neutralized.

What makes alkali burns difficult to manage?

They cause protein hydrolysis and liquefaction, allowing deeper tissue penetration.

Why might a patient with liver disease develop pitting edema in the lower extremities?

Due to decreased production of albumin by the liver.

What role does albumin play in fluid balance?

Albumin maintains colloidal osmotic pressure to keep fluid within the vasculature.

What happens when albumin levels are low in liver disease?

Fluid leaks from the blood vessels into the interstitial space, causing edema.

What should a nurse educate a patient with cirrhosis to avoid?

Alcohol ingestion.

Why should alcohol be avoided in patients with cirrhosis?

Because it can cause further damage to the already compromised liver.

What medication is commonly used for hepatic encephalopathy in advanced cirrhosis?

Lactulose.

How does lactulose help patients with hepatic encephalopathy?

It reduces ammonia levels by promoting its excretion in feces.

What clinical improvement is expected as ammonia levels decrease with lactulose?

Improved level of consciousness due to lowered ammonia levels.

What is paracentesis and why is it performed?

It is a procedure to remove ascitic fluid from the peritoneal cavity, often to relieve pressure and improve breathing.

How does ascites affect breathing?

Ascitic fluid increases abdominal pressure, pushing against the diaphragm and making breathing difficult.

What should the nurse ensure before paracentesis?

The patient should empty their bladder to prevent injury during the procedure.

What is ascites and what condition commonly causes it?

Ascites is fluid accumulation in the abdomen, commonly caused by liver disease and portal hypertension.

What is Neomycin used for in patients with hepatic encephalopathy?

To lower ammonia levels by targeting ammonia-producing gut bacteria.

How does Neomycin help improve hepatic encephalopathy?

It reduces ammonia production in the gut, which helps improve mental status.

What clinical improvement is expected with Neomycin in hepatic encephalopathy?

Improved level of consciousness.

What are common nursing dx for pts with cirrhosis?

• Imbalanced nutrition → Less than body requirements

• Fluid volume excess

• Ineffective breathing pattern

• Risk for injury

• Risk for acute confusion

• Disturbed body image

• Deficient knowledge

What is steatorrhea?

Fatty, frothy, foul-smelling stool due to excess fat in the stool

What causes steatorrhea?

Malabsorption of fat, often due to conditions like acute pancreatitis.

In which condition is steatorrhea commonly observed?

Acute pancreatitis

How is Hepatitis A virus (HAV) transmitted?

Through fecal-oral route

What is a key prevention method for Hep A?

Proper hand hygiene

What does increased intracranial pressure (ICP) refer to?

Elevated pressure within the skull that can affect brain function

What are common causes of increased ICP?

Tumors, traumatic brain injuries, strokes, cerebral hematomas, cerebral abscesses

What is the first signs of increased intracranial pressure?

When the pt presents with decreased level of consciousness

What types of activities should be avoided to prevent increased intracranial pressure (ICP)?

Activities like the Valsalva maneuver, coughing, hip flexion, and abdominal distention.

Why should the Valsalva maneuver be avoided in patients with increased ICP?

It increases intrathoracic pressure, which can elevate ICP—patients should avoid constipation.

How can airway secretions affect ICP?

They can trigger coughing, which increases ICP.

How does hip flexion and abdominal distention impact ICP?

They increase intra-abdominal pressure, which can elevate ICP.

Why should the head of the bed not be flat in patients with increased ICP?

A flat position impairs cerebral drainage and can increase ICP.

What are signs of a ischemic stroke?

• Sudden onset of facial weakness

• Unilateral weakness → opposite side

• Confusion

• Expressive aphasia / receptive aphasia

• Headache

• Nausea

• Visual disturbances

• Vertigo

• Numbness / tingling in the extremities

What are signs (not including headache) of a hemorrhagic stroke?

• Gradual onset of symptoms

• Nausea and vomiting

• Hypertension

• Confusion to altered LOC

• Headache

• Respiratory issues

What is a transient ischemic attack (TIA)?

Episodes of stroke symptoms that lasts only briefly less than 24 hour but most of them occur for less than 1 hour.

What is raccoon eyes (in basilar skul fractures)?

Bilateral periorbital ecchymosis (bruising around the eyes); suggests anterior cranial fossa fracture. Appears after ~24–48 hours.

What is battle sign (in basilar skul fractures)?

Bruising over the mastoid process (behind the ear); indicates middle cranial fossa fracture. Appears after ~24–48 hours.

What is CSF otorrhea (in basilar skul fractures)?

Clear or blood-tinged fluid leaking from the ear; indicates breach of dura near the temporal bone. Positive halo sign on gauze.

What is CSF rhinorrhea (in basilar skul fractures)?

Clear or blood-tinged fluid leaking from the nose; suggests frontal sinus or anterior fossa involvement. Positive glucose or halo test.

What is Multiple Sclerosis?

MS is a chronic autoimmune disorder where the body attacks the central nervous system (CNS), leading to demyelination of neurons in the brain and spinal cord.

What happens in the pathophysiology of MS?

The immune system mistakenly attacks myelin, the protective sheath around CNS neurons. This results in:

• Inflammation

• Demyelination (loss of myelin)

• Slowed or blocked nerve conduction

• Scar tissue (plaques) formation in CNS white matter

What is the role of myelin in the CNS?

Myelin insulates neurons and helps speed up the transmission of electrical impulses along nerve fibers. Without it, nerve signaling is delayed or disrupted.

What is the differential dx for myasthenic crisis?

• Improved strength after IV administration of anticholinesterase drugs

• Increase weakness of skeletal muscles- ptosis, bulbar signs (e.g., difficulty swallowing, difficulty articulating words), dyspnea

What is the differential dx for cholinergic crisis?

• Weakness after 1 hr after ingestion of anticholinesterase drugs

• Increase weakness of skeletal muscles ptosis, bulbar signs, dyspnea

• Effects on smooth muscles include pupillary miosis, salivation, diarrhea, nausea or vomiting, abdominal cramps, ↑ bronchial secretions, sweating, lacrimation.

What test helps differentiate between Myasthenic Crisis and Cholinergic Crisis?

The Tensilon Test (Edrophonium). Improvement = Myasthenic Crisis; Worsening = Cholinergic Crisis.

What is Amyotrophic Lateral Sclerosis (ALS)?

ALS is a progressive neurodegenerative disease that destroys upper and lower motor neurons, leading to muscle weakness and atrophy.

Which systems are impaired in ALS?

Affects voluntary muscle movement:

• Speech (dysarthria)

• Swallowing (dysphagia)

• Breathing (dyspnea)

• Limb movement (weakness, atrophy)

What functions remain intact in ALS patients?

Sensory function, cognitive function, bladder and bowel control, and eye movement are typically preserved.

What is the most common form of dementia?

Alzheimer’s disease

Is dementia a normal aspect of aging?

No, it is not a normal aspect of aging.

What are common triggers for delirium?

• Dementia

• Dehydration

• Electrolyte imbalances

• Emotional stress

• Disorders of the lung and liver

• Infection

• Being in ICU

• Drugs

• Immobility

• Untreated pain

What are key nursing interventions for managing a patient with delirium?

Assess self-care needs and provide for all basic needs.

How can nurses help reorient a patient with delirium?

Reassure and reorient the patient to person, place, time, and purpose.

What techniques can help manage agitated behavior in delirium?

Use distraction techniques and calming interventions.

What symptoms should be managed in a delirious patient to improve outcomes?

Fever, pain, nausea, and other discomforts.

What measure should be implemented to support recovery in patients with delirium?

Promote sleep and rest.

What is an epidural hematoma?

Bleeding into the space between the skull and the dura mater.

What typically causes epidural hematomas in adults?

Skull fractures—90% of cases, especially in the temporal bone.

Which artery is commonly lacerated in an epidural hematoma?

The middle meningeal artery.

What is another possible source of bleeding in epidural hematoma besides arterial tears?

Venous bleeding from a torn superior sagittal sinus.

What is the classic progression of symptoms in an epidural hematoma?

Immediate loss of consciousness → lucid interval → rapid decline in LOC.

What symptoms may follow the lucid interval in an epidural hematoma?

Sleepiness, confusion, obtundation, coma, and potentially death.

What is a primary brain injury?

The initial mechanical insult to the brain; typically localized.

What are examples of primary brain injuries?

Lacerations, skull fractures, contusions, concussions, hematomas, diffuse axonal injury, blood vessel damage, or foreign object penetration.

What is a secondary brain injury?

The brain’s progressive response to the primary injury.

How does secondary brain injury develop?

Inadequate cerebral perfusion pressure (CPP) → cerebral ischemia → ischemia cascade → cerebral infarction.

What factors contribute to secondary brain injury?

Hypotension, hypoxia, anemia, and fever.

What is a depressed skull fracture?

A fracture where bone fragments are displaced inward, often from a comminuted fracture.

What brain injuries are commonly associated with depressed skull fractures?

Cerebral contusions and lacerations.

What infection risk is associated with depressed skull fractures?

Hair, dirt, and debris in the wound can introduce infection.

Why is TIA considered a medical emergency?

It is a warning sign for stroke—there's a 10–15% risk of stroke within 3 months after a TIA.

Why should TIAs be urgently evaluated?

Because TIA and stroke share the same underlying cause (etiology), and early intervention may prevent a full stroke.

What does the "B" in BEFAST stand for in stroke assessment?

Balance – Sudden loss of balance or coordination.

What does the "E" in BEFAST stand for?

Eyes – Sudden vision loss in one or both eyes.

What does the "F" in BEFAST stand for?

Face – Facial drooping or uneven appearance.

What does the "A" in BEFAST stand for?

Arms – One arm drifting downward or weakness.

What does the "S" in BEFAST stand for?

Speech – Slurred speech or difficulty speaking.

What does the "T" in BEFAST stand for?

Time – Act fast and call 911 immediately. Time is brain!

What is the first priority in assessing a burn patient?

ABCs – Airway, Breathing, Circulation.

When should oxygen be provided to a burn patient?

If necessary, provide oxygen via nasal cannula (NC).

What baseline assessments should be performed on a burn patient?

Vital signs and cardiac monitoring (anticipate EKG).

What neurological assessments should be performed initially for burn patients?

Glasgow Coma Scale (GCS), pupil checks, and mNIHSS if neurologic injury is suspected.

What key timeline should be determined during initial burn assessment?

Time of injury or Last Time Known Well for accurate treatment planning.

What is a hemorrhagic stroke?

Sudden bleeding in the brain not caused by trauma.

What is a common symptom of a hemorrhagic stroke?

Headache, often sudden and severe.

What is the most common cause of a hemorrhagic stroke?

Hypertension.

What are other possible causes of hemorrhagic stroke?

Amyloid angiopathy (aging), metastatic disease, vascular malformations.

What is the most common cause of a subarachnoid hemorrhage?

Ruptured aneurysm.

What assessments are required after tPA administration?

Vital signs, neurological checks, and mNIHSS.

What is the frequency for monitoring after tPA?

• Q15 min × 2 hours

• Q30 min × 6 hours

• Q1 hour × 16 hours

What are key complications to observe for after tPA?

• Sudden headache

• Oozing from orifices

• Pain (especially retroperitoneal)

• Sudden unconsciousness