Critical Care Finals

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Author:
plbernal
ID:
187899
Filename:
Critical Care Finals
Updated:
2012-12-12 12:25:32
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Part three
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Part three
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  1. Management of brain injuries
    (6)
    • Vent support
    • PaCo2 (30-35)
    • Decreased stimuli
    • Neutral body position
    • HOB 30-45
    • Call MD for any status changes
  2. Secondary brain injury cana be caused by
    (3)
    • hypoxia
    • hypotension
    • uncontrolled increased icp
  3. 3 types of subdural hematomas
    • acute: <48hrs
    • subacute: 2 days - 2 weeks
    • chronic: 2 weeks
  4. Neuro Assessment
    (10)
    • Movements
    • Paralysis/Weakness
    • Posturing
    • Sensory
    • Visual loss
    • Aphasia
    • Dyarthria
    • Agraphia
    • Agnosia
  5. What happens to neurons when brain swells
    • Actually widens synapes
    • Decreases neuro strokes
  6. Chemical features of stroke
    • Hemiperesis
    • Unilateral sensory deficit
    • Slurred speech
    • Blurry/Double vision/loss in 1 eye
    • LOC changes to loss of consciousness
    • SEVERE headache
  7. Brain Death Criteria
    (6)
    • Flat EEG
    • All brain function stopped
    • No brainstem reflexes
    • Establish irreversible brain damage by confirming cause of dysfunction
    • Evaluated by 2 different MD's
  8. Normal ICP
    BAD ICP
    • Normal: 0-15
    • Bad: >20
  9. Define stroke volume, what is the value, what is ejection fraction?
    • Amount of blood ejected by ventricles with each contraction/beat
    • 60-130 mL/beat
    • EF: 60-70%
  10. Drugs to give during a seizure
    • #1 Ativan
    • #2 Dilantin
    • #3 Propofol
  11. MAP goal for ischemic stroke patient
    120 (increases perfusion to injured areas)
  12. What fluid can you not give to increased ICP patients? Why?
    D5W because it increases cerebral edema
  13. Goal of nonsurgical increased ICP management?
    • ICP < 20
    • CPP > 70
  14. TPA Criteria
    (5)
    • Start within 3 hours of symptom onset
    • Over 18 years
    • No previous history of bleeding
    • CT to confirm ischemic stroke
    • CBC for baseline
  15. Spinal Cord Injury
    C4-C5
    Vent dependent?
    No, can us phrenic nerve stimulator
  16. Spinal Cord Injury
    C5 and down
    Vent dependent?
    No, motor function of diaphram still intact
  17. Meds for traumatic brain injury
    • dilantin
    • antipyretic
    • bp
    • cortocosteroids
    • iv fluids
    • mannitol
  18. Define angina
    Is there cell death?
    • myocardial O2 demands exceeds supply
    • No cell death yet
  19. 3 types of angina
    Which one is part of ACS
    • Stable, unstable, variant
    • Unstable
  20. What is this wave? What does it mean?
    • Normal EKG
    • Means nothing
  21. 2 compounds of ACS
    • Unstable angina (plaque ruptures & clots but blood flow continues)
    • MI (plaque ruptures & clots, blood blow stops completely = cell death)
  22. What is this wave? What does it mean?
    • Inverted T wave/ST depression
    • Myocardial ISCHEMIA
  23. Nursing interventions
    -Stroke-
    -post acute phase-
    (5)
    • Positon: 2 hrs unaffeected side; 20min affected side
    • ROM
    • Soft/semi soft foods
    • Feed upright
    • Put food back of unaffected side
  24. Complications of stroke surgery (removal of clot)
    (5)
    • Hemorrhage
    • Increased ICP
    • Hydrocephalus
    • Seizures (most common 1st 7 days)
    • Vasospasm
  25. Why don't we use contrast in post stroke CT?
    Contrast will mimic blood in brain
  26. Interventions for stroke
    (5)
    • Airway
    • V/S q 15 min
    • MAP 120-130 to keep CPP up
    • CT to determine if its ischemic or hemorrhagic
  27. Define preload
    • amount of blood in ventricles after diastole
    • CVP=2-6 mmHg
    • PAOP=8-12 mmHg
  28. Low volume will have ________resistance because______
    High resistance because vessels vasoconstrict to push blood toward vital organs in the center
  29. How to treat decreased preload
    • TOO LITTLE VOLUME
    • -fluids
    • -blood if appropriate
    • -vasoconstrict (dopamine, epi, norepi) to increase venous return
  30. Define afterload
    • Resistance blood faces on waty to tissues
    • If blood doesn't get to tissues, neither can O2
    • PVR= 20-120 dynes/sec
    • SVR= 770-1500 dynes/sec

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