Tutor Emphasis Exam 1 Sarah

What is a seizure?

Change in LOC/sensory ability.

When do secondary seizures tend to resolve?

When underlying etiology resolves.

What are tonic seizures?

Stiffening of muscles.

What are colonic seizures?

Repeated jerking movements

What are myoclonic seizures?

Jerks/twitches of upper body

What are atonic seizures?

Loss of muscle tone

What are tonic-colonic (grand-mal) seizures?

Stiffening of body and jerks

What are absence sizures?

Stare into space

What are priorities for seizures?

airway (first thing), time, safety

What are priority seizure precautions?

Turn patient on their side, move things out of the way, pads on the bed, suction ready, don't force anything into pt.'s mouth, don't restrain pt.

How to time a seizure?

Time the start of it, duration, and frequency

What are the side effects of anticonvulsant medications?

drowsiness, ataxia, CNS depression

What is first line treatment for status epilepticus?

IV push lorazepam or diazepam

What are medications for seizures?

Keppra, Dilatin, Tegretol, Deprakote

What to monitor when giving Keppra for seizures?

don't monitor blood levels (CBC)

What can Dilantin cause?

gingival hyperplasia

What to note about Depakote?

Hepatotoxic

What is bacterial meningitis?

Acute, life threatening

What can bacterial meningitis cause?

Increased ICP which can cause siezures

What to note for viral meningitis?

Supportive care and symptom management

What are symptoms of meningitis?

Kernig's sign (k for knees can't extend), Brudzinski's sign (B for bend neck, bending neck flexes hips and knees), headache, fever, nuchal rigidity (stiff neck)

What is the precaution for bacterial meningitis?

droplet precaution

What are nursing interventions for meningitis?

Stat lumbar puncture for CSF analysis (before any antibiotics)

Corticosteroid therapy (dexamethasone) for cerebral edema

How does bacterial CSF look like in meningitis?

Cloudy CSF with low glucose present

If bacterial meningitis is suspected with lumbar puncture then what should be done?

Determine the specific bacteria and give correct antibiotics.

What are nursing interventions for craniotomy post-op?

Monitor neuro status for increased ICP

Prevent complications like immobility and infection

Risk of meningitis, cerebral edema (give dexamethasone)

What is bone flap storage for a craniotomy?

Bone flap may be temporarily stored during acute cerebral edema post op.

What is a complete spinal cord injury?

All innervation below the level of injury is eliminated.

EX. T6 injury occurs everything below T6 doesn't function.

What is a secondary spinal cord injury?

Happens from something else such as neurogenic shock, spinal shock, and autonomic dysreflexia

What is an incomplete spinal cord injury?

Some function of movement below level of injury

Ex. C4 injury, but pt. can still move feet

What to note about C3-C5 injuries?

C3-C5 controls diaphragm

Cervical injuries cause risk for respiratory insufficiency (risk for atelectasis, pneumonia, etc)

Need mechanical ventilation

What do all shocks except neurogenic shocks cause?

Low BP and high HR

What is spinal shock?

From initial injury, decreases reflexes and causes flaccid paralysis.

Acute onset and temporary

What is neurogenic shock?

Disrupts the sympathetic nervous system.

High risk for injury above T6

Hemodynamic phenomenon (low BP low HR)

What are critical features of neurogenic shock?

hypotension, bradycardia, poikilothermia (can't regulate their temperature so they're always cold)

What is autonomic hyperreflexia/dysreflexia?

High risk with injuries above T6

Stimulus below level of injury causes an imbalanced and unopposed reflex sympathetic stimulation response

What are examples of things that can cause autonomic hyperreflexia.dysreflexia>

Distended bladder, fecal impaction, tight clothes, extreme temperature.

How to intervene against autonomic hyperreflexia/dysreflexia?

remove noxious stimulation

What is a priority symptom of autonomic hyperreflexia/dysreflexia?

hypertensive crisis

What are symptoms of autonomic dysreflexia?

Hypertensive crisis, tachycardia, HA, diaphoresis

What is a priority of post-injury care for spinal cord injury?

Cervical spine and airway-> protect and stabilize spine and get an x-ray

How to calculate the MAP?

((2 x diastolic)+ systolic)/3

What is post-injury care for spinal cord injuries?

Immobilize injury with backboard and neck brace

STAT x-ray, spine CT, and MRI

Neuro checks q15

What are the first signs of changes of LOC?

Irritable, agitation, restlessness

What to avoid doing when giving nutrition to spinal cord injury patients?

Prevent fecal impaction (risk for autonomic dysreflexia)

Initiate bowel and bladder training

What to maintain with the cardiovascular system for spinal cord injury patients?

Maintain MAP of 80-90

Monitor HR and BP

What to monitor for in the GU system for spinal cord injury?

Monitor kidney function, kidneys are first to fail

Monitor for and prevent bladder distention

What is a transient ischemic attack (TIA)?

Reversible cerebral ischemia, resolves in 24 hrs.

Results from a brief interruption in cerebral blood flow of carotid artery stenosis

What is an ABCD assessment?

A: age of at least 60 y/o

B: BP of at least 140/90

C: Clinical TIA features

D: Duration of stroke

What is CVA?

Medical emergency

Acute ischemic stroke & hemorrhagic stroke

What can cause acute ischemic strokes?

1. Thrombotic- formation in blood flow (#1 cause=atherosclerosis)

2. Embolic-dislodged blood clot (#1 cause= A. Fib)

What is treatment for a thrombotic stroke?

1st line treatment is stent placement

What are medications for acute ischemic stroke?

TPA (fibrinolytic therapy): 3 hrs onset of symptoms and arrival to stroke center.

What is treatment for an embolic stroke (acute ischemic stroke)?

1st line treatment is TPA

If pt. is not a candidate for TPA then mechanical embolectomy (MERCI retrieval system)

What is a hemorrhagic stroke?

Bleeding in brain, immediate surgery required

Initially presents as hypovolemic shock -> hypotension and tachycardia -> body compensates -> HTN crisis

What is a sign of hemorrhagic stroke?

HTN crisis -> due to body trying to compensate by vasoconstriction to keep BF to vital organs

What are the leading causes of CVA?

Uncontrolled HTN, DM, elevated cholesterol

What assessments should be done with CVA?

CT, NIH stroke scale, EKG, coag study

When should a CT scan be done for CVA stroke patient?

Get pt. CT within 10 mins of walking into the ER: Surpasses all other assessments

Priority to determine which type of stroke it is

What is a NIH stroke scale?

Valid and reliable tool to evaluate pt. with stroke symptoms.

Used to evaluate if patient is eligible for fibrinolytic treatment

What is an EKG used for with strokes?

To see if pt. is A-fib, can be ischemic stroke,

Why is a coagulation treatment done for strokes?

Clotting times to help determine if they are on blood thinners (heparin)

What is some exclusion criteria for TPA (fibrinolytic therapy)?

Age > 80 yrs, on current anticoagulant meds (heparin/warfarin), history of stroke & DM, evidence of active bleeding, BP greater 185 systolic or 110 diastolic, history of cerebral bleed, elevated PT/INR

What is treatment for a hemorrhagic stroke?

Nurse cant do anything-pt. needs surgery asap

Clipping of aneurysm- prevents blood glow to area to prevent rupture

Coiling of aneurysm: Placing a coil in aneurysm to prevent blood from entering and clotting.

What is second impact syndrome?

Second impact that occurs before the brain can recover from the impact resulting in massive cerebral edema.

What is post concussion syndrome?

Persistent symptoms (headache, lethargy, decreased, memory, emotional lability, vertigo) that lasts months after initial injury

What is an epidural hematoma?

Arterial bleeding into epidural space (the skull and the dura)

Bleeds fast-> medical emergency

What are signs of epidural hematoma?

1. Immediate post traumatic unconsciousness

2. Lucid interval

3. pt. will fall unconscious again and go into a coma, pt. will die if they go unconscious agan

What is subdural hematoma?

Slow venous bleeds between the dura and arachnoid layers of the brain

Bleeds slow-> high mortality rate due to patient unaware of the bleed.

Who is subdural hematoma most common in?

Most common in older adults and alcoholics.

What are the types of subdural hematomas?

Acute subdural hematoma, subacute subdural hematoma, chronic subdural hematoma

What is an acute subdural hematoma and when does it show up?

shows up 48 hours after injury

most severe

What are symptoms of acute subdural hematoma?

Severe HA with gradual deterioration of LOC

When does subacute subdural hematoma develop?

48 hrs to 2 weeks after injury

When does chronic subdural hematoma develop?

Weeks to several months to develop

Does not present with rapid and dramatic deterioration of neurological function

What is treatment for epidural and subdural hematoma?

Needs immediate surgery to repair the bleed

What are the three components of ICP?

Increased volume in: Brain tissue, CSF, blood

What is a normal intracranial pressure?

10-15 mm Hg

What is the Monro-Kellie hypothesis?

An increase in volume of one component must be compensated by a decreased volume of another.

What is CPP (Cerebral Perfusion Pressure)?

Amount of pressure needed to perfuse the brain.

CPP=MAP-ICP

What are the ranges of cerebral perfusion pressure (CPP)?

70-100=Normal

60=Min requirements for perfusion

<50=brain ischemia & neuronal death (brain will die)

<30= incompatible with life

What are early signs of increased ICP?

agitation, restlessness, confusion, irritability, changes in loc, projectile vomit

What is a medium sign of increased ICP?

Changes in LOC

What is a late sign of increased ICP?

blown pupil (doll eyes), Cushing's triad, posturing (decorticate, decerebrate), seizures

What is Cushing's triad?

Cheyne-stokes respirations, bradycardia

What medication should be used for increased ICP?

Mannitol (osmotic diuretic)

What nursing interventions should be done for increased ICP?

Head of the bed raised to ar least 30 degrees

Limit suctioning

Q15 neuro checks for first 24 hrs then q4 hrs

Nothing that increases pressure (cough, sneeze, bend over, etc)

Seizure precautions

What is the primary goal for corneal abrasion, ulceration, infection?

Prevent worsening of injury and infection

What is retinal detachment?

Sudden, painless decrease in vision

A medical emergency

Who is at risk for retinal detachment?

Nearsighted, recent eye surgery, history of serious eye injury, retinopathy, family history

What are signs of retinal detachment?

Bright flashes/floating dark spots, wavy/watery vision, curtain like shadow, sudden/painless decrease in vision

What is postoperative care for retinal detachment?

Don't use eye, keep affected eye covered with an eye patch.

Avoid activities that promote rapid eye movement (reading, writing, using phone, etc.)

Report sudden reduced visual acuity, eye pain, pupil that doesn't constrict to light, s/s of detachment

How to treat eye trauma?

Do not take foreign object out of the eye

Antibiotics to avoid infection

What is a nursing intervention for eye trauma?

Assess peripheral vision and prevent infection

No MRI due to possibility of being metal

What can a nurse do for foreign body eye trauma?

Irrigate with normal saline

What is vertigo?

Problems with balance may present as vertigo. It's the sense that the person/object is moving around them or spinning

What is external otitis?

Main cause from swimming-> moisture gets trapped in ear

What are nursing interventions for external otitis?

Comfort measures to reduce inflammation, pain, and edema

Heat application 3x daily for 20 mins

Educate pt. to avoid water activities for 7-10 days and minimize any ear canal moisture

What medications are good for external otitis?

Analgesics, topical antibiotics, oral/Iv antibiotics for more serious cases.

What is acute otitis media?

Untreated/repeated attacks in early childhood may lead to chronic middle ear infections.

Increased pressure in middle ear may cause intense pain and reduced hearing.