Test #1

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Sarahs129
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256506
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Test #1
Updated:
2014-03-05 09:50:33
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Critical Care Test
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Specific Traumatic Injuries, Mechanical Ventilation, Concepts in Emergency and Trauma Nursing, Dysrhythmias, Invasive Monitoring
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  1. What combination of blunt forces can occur coup-contrecoup injury?
    • Sheering
    • Acceleration
    • Deceleration
  2. Exsanguiation
    Blood loss of a significant degree.
  3. Solution of choice to replace fluid loss from exsanguinations?
    • Lactated Ringers or Plasmolyte IV flud
    • Packed RBCs
  4. Treatment of an open pneumothorax.
    • Sterile occlusive dressing taped on 3 sides
    • Chest tube ASAP
  5. What action should the nurse do it a missile is impaled in the body?
    • Leave it in place.
    • Protect from displacement.
  6. What is never used to treat hypotension when in hypovolemic shock?
    Vassopressors
  7. What IV fluids are best to correct hypotension in hypovolemic shock when large amounts of IV fluids are needed?
    • Crystalloids
    • -Lactated ringers or Plasmolytes
  8. Examples of PPV.
    • Mouth-to-mouth
    • Bag-valve-mask
    • PEEP
  9. Manifestations of flail chest.

    d/t?
    Uncoordinated, papadoxical movement of flailed section of chest

    d/t 2+ consecutive broken ribs
  10. What can precipitate and relieve Vena Cava Syndrome?
    • Precipitate -- supine position
    • Relieve -- left-lateral
  11. Best predictors of poor patient outcomes in traumatic injuries.
    • Inreased lactic acid.
    • Decreased base levels.
  12. What actions occur during "E" phase of primary survey?
    • Heat concervation.
    • Transfer to an appropriate level trauma center.
  13. Types of traumatic injuries causing partial or complete airway obstruction.
    • Maxillo-facial fractures.
    • Crushing of larynotracheal tree.
  14. What to monitor to evaluate the status of splenic injuries?
    Trend H & H.
  15. Elevaed lactic acid and decreased base levels represent, what?
    • Severity of tissue ischedmia.
    • Hypoprerfusion.
  16. Assessments to be included during "C" phase of primary survey?
    • Strength, rate, rhythm and symmetry of pulses.
    • Capillary refill.
    • Skin tempature.
    • Level of consciousness.
  17. Manifestations of tension pneumothorax.
    • Absent breath sounds.
    • Neck vein distention.
    • Tracheal deviation.
    • Pulsus paodoxus.
  18. Pulsus Paradoxous.
    Decrease in systolic BP and HR with inspiration.
  19. Treatment for tension pneumothorax.
    • Emergent needle thoracotomy.
    • Chest tube.
  20. What type of blood is given in an emergent traumatic injury?
    Uncrossed O-
  21. Name 4 intra- and postop complications for traumatic injuries.
    • Hypothermia.
    • Coagulopathies.
    • Metabolic acidosis.
    • Intraabdominal compartment syndrome.
  22. Pericardiocentesis.
    Procedure performed to aspirate fluid from pericardial sac in cardiac tamponade.
  23. Manifestations of cardiac tamponade.
    • Beck's triad.
    • Pulsus paradoxus.
    • PEA.
  24. Beck's triad.
    • Elevated RA pressure.
    • Hypotension.
    • Muffled heart sounds.
  25. Surgical airways.
    • Needle cricothyroidotomy.
    • Surgical cricothyroidotomy.
    • Emergency tracheostomy.
  26. Area of body which large amounts of clood could collect without overt signs of blood loss.
    • Retroperitoneum.
    • Peritoneum.
    • Pelvic regions.
  27. What interventions should the nurse do following endotracheal intubation?
    Obtain an order for naso- or OG tube to decompress the stomach.
  28. What to use autotransfusions to replace loss of blood for?
    Massive hemorrhagic chest trauma
  29. Primary goal of "B" phase in primary survey.
    Ventilate patient.
  30. Primary survey.
    Phase in trauma care that focuses the attention on identification of life-threatening injuries.
  31. Actions that need to occur immediatly after ET intubation to confirm placement.
    • Ausculatate all lung fields.
    • Portable CXR.
  32. 2 injuries from shearing force in blunt trauma.
    • Coup-contrecoup.
    • Aortic tearing.
  33. Traumatic injuries in which pulsus paradoxux can monifestate.
    • Tension pneumothorax.
    • Cardiac tamponade.
  34. Location of LeForte fractures.

    Greatest risk with this type of fracture?
    Moxillo-facial

    Compressed airway
  35. Why not use nasopharyngeal airway with basal skull fracture?
    Can enter cranial vault causing brain injury.
  36. Normal EtCO2
    35-45 mm/Hg
  37. Leading traumatic injury requiring medical attention.
    Falls
  38. Airway for: unconscious, no gag reflex.
    Oral
  39. Airway for: conscious patient
    Nasopharyngeal
  40. Airway for: conscious, basal skull fracture or cribriform
    Oral
  41. 3 things that can increase tissue deformation and displacement in penetrating injuries.
    • Change in trajectory.
    • Blast effect.
    • Fragmentation.
  42. Secondary survey
    Begins after life-threatening injuries have been addressed
  43. What occurs during secondary survey?
    Head-to-toe assessment
  44. Triage classifications.
    • Emergent - trauma, MI, PCI alert
    • Urgent - serious, non-lifethreatening - COPD
    • Non-Urgent - episodic - UTI
    • Fast-track - minor, acute - breaks, stitches.
  45. Types of blunt trauma forces
    • Shearing
    • Acceleration
    • Deceleration
    • Compression
  46. Coup-contrecoup sheering injuries.
    Occurs at?
    Why?
    • Occurs at C7 and T1.
    • Because C7 is the lowest mobile and T1is the highest immobile part.
  47. #1 affected organ with blunt force injuries.
    Spleen
  48. EtCO2 <35
    ET tube is in esophagus

    s/b 35-45
  49. Symptoms of hypovolemic shock.
    • Tachycardia
    • Hypotension
    • Tachypnea
    • Anxiety
  50. AVPU
    • Scale used during primary survey to determine LOC.
    • A-alert
    • V-response to Verbal stimuli
    • P-response to Painful stimuli
    • U-unresponsive
  51. Ventilation
    Ability to move air in and out of lungs
  52. Respiration
    Gas exhange at the cellular level

    O2 in - CO2 out
  53. Reasons for ventilation
    • Acute ventilatory failure.
    • Hypoxemia.
    • Pulmonary mechanics.
  54. Acute ventilatory failure.
    • Can't move CO2 out
    •  =acute respiratory acidosis
    •    = increase CO2, decrease pH
  55. Hypoxemia
    Insufficient O2 in blood
  56. Supplies for intubation
    • ET tube
    • laryngoscope
    • suction
    • 10mL syringe
    • lube
    • Pulse Ox
    • PPE
    • sedatives
    • tape
    • ventilatior
    • ambu-bag
  57. Pre-intubation duties and care
    • Call anesthesia and respiratory.
    • Confirm patients wishes with family.
    • Set up suction.
    • Oral care -- remove dentures.
  58. Post-intubation duties and care
    • Secure ET tube.
    • Document placement.
    • Auscultate.
    • End-tidal CO2.
    • Ventilator.
    • Patient and family needs.
  59. Tracheostomy
    Used if patient will be intubated for a long period of time.

    Improves patient comfort.
  60. Negative pressure ventilation.
    Normal breathing.

    (-) pressure in lungs causes air to be sucked in.
  61. Positive pressure ventilation
    Air being pushed into lungs.
  62. Volume-cycled PPV
    • Most common.
    • Delievers a preset Volume of air.
    • Pressure will vary.
  63. Pressure-cycled PPV
    • Deliever preset Pressure.
  64. Tidal Volume (TV)

    -complications
    Amount of air delievered to lungs with one breath in mL's

    -Barotrauma
  65. FiO2

    -complications
    Precentage of O2 in inspired air.

    -O2 toxicity
  66. Rate setting on vent.
    • # of breaths/min give to patient.
    • Can be patient or vent controlled.
  67. PEEP

    -complications
    • Keeps alveoli inflated during expiration.
    • Will increase O2 to blood by keeping more surface area on copullary wills.

    - Barotrauma, decreased CO2
  68. Peak airway pressure
    Pressure required to deliever volume of air.

    • Healthy lungs - 20 cm H2O
    • Goal - <40 cm H2O
  69. Assist control ventilation
    • Guaranteed set # of breaths/min at set TV.
    • Any additional attempts to breathe, are assited at set TV
  70. Advantages and disadvantages of Assist controlled ventilation.
    • Advantage - allows respiratory rest
    • Disadvantage - hyperventilation
  71. S-IMV ventilation
    • guaranteed set # of breaths/min @ TV.
    • Any additional attempts ot breathe, are at TV that patient sets
  72. Advantages and Disadvantages of S-IMV
    • Advantages - exercise of repiratiory muscles
    • Disadvantages - Potential for fatigue
  73. CPAP
    • No set rate or TV
    • Pt generated thier own, only a source of O2.
    • Used for weaning.
  74. High pressure alarms
    Indicates resistance

    -secretions, coughing, kinked tube
  75. Low pressure alarms
    • Pushing against little or no reisistance
    • Disconnection or leak

    - check tubing, connections
  76. Complications of mechanical intubation
    • CV - decreaed CO
    • Plumonary - O2 toxicity, VAP, barotrauma
    • GI - stress ulcer
  77. What complications are possible when large amounts of NS is given to a patient with hypotension in hypovolemic shock?
    Hyperchloremic acidosis d/t large amounts of chloride.
  78. What question is important to ask prior to assessing a patient with a traumatic injury?
    "What was the mechanism of injury?"
  79. Name 3 predictable traumatic injuries that can occur from using both a lap belt and shoulder harness in a motor vehicle crash?
    • Pulmonary contusion
    • Chest wall contusion
    • Small bowel contusion
  80. What triage classification would you as a nurse, give a patient with a temp of 100.5, productive cough, SaO2 of 93% on 3L of O2?
    Non-life threathening; Urgent, serious health.
  81. Name the principle phases of trauma care according to Advanced Trauma Life Support.
    • Primary survey
    • Resusciation (along with primary survey)
    • Secondary survey
  82. What nursing actions occur during "D" Phase of the primary survey?
    Quick neuro assessment using the AVPU scale.
  83. Where is the most common location for a coup-contrecoup shearing injury to occur?
    Between C7 and T1
  84. What type of blunt injury are pregnant women at greatest risk to incur?
    Blunt abdominal trauma.
  85. What type of complications could cause death during the 3rd peak or trimodal distribution of trauma-related deaths?
    • Systemic inflammatory response syndrome
    • Multiple organ dysfunction syndrome
    • Acute respiratory syndrome
    • Sepsis
  86. What method of establishing an airway is contraindicated in traumatic injuries?
    Head-tilt
  87. What type of airway is contraindicated if there is suspician of a cribriform plate fracture or basal skull fracture?
    Nasopharyngeal airway
  88. Name 3 methods used to confirm the adequacy of ventilation and oxygenation.
    • ABGs
    • EtCO2
    • SaO2
  89. What diagnostic tool is used to diagnose the presence of slpeen or liver injuries in traumatic injuries?
    CAT scan
  90. What is the major complication of liver or spleen injuries?
    • Hemorrhage
    •  -- Trend H&H
  91. Name 2 metabloic phased to stress injury that occur when the body is attemping survival and recovery.
    • Ebb phase - 24-36hrs
    • Flow phase - after 36hrs
  92. What shock state is present in traumatic injury when there is acute blood loss or fluid shifts?
    Hypovolemic
  93. Classic clinical manifestations of hypovolemic shock?
    • Tachycardia
    • Hypotension
    • Tachypnea
    • Anxiety
  94. Paradoxical, uncoordinated respiratory movement.
    Flail chest
  95. Worrisome complications that can occur with flail chest.
    • Hypoxemia
    • Pneumonia
  96. How is flail chest treated?
    • High Fowler's
    • Adequate pain medication
    • PPV
    • Stabilization of rib fractures
  97. What triage classification would you give a patient with fracture ankle, alert, stable vital signs?
    Fast track; Minor acute
  98. Waht is the cause of cardiac tamponade?
    Blunt or penetrating trauma causes pericardium to fill with blood restricting myocardial contractility.
  99. What is the primary goal in "A" phase?
    Maintain the patency of the airway and cervical spine immobilization.
  100. What is a potential complication that can occur if a missle is removed from the body?
    Exsanguination
  101. What airway is recommended for a conscious patient without suspicion of basal skull fracture or cribiform plate fracture?
    Nasopharyngeal
  102. What methods of establishing an airway are approved in traumatic injuries?
    • Chin lift
    • Modified jaw thrust
  103. The temporary space that is created by displaced tissue from a penetrating missile.
    Cavitation
  104. Complications that can occur following rib fracture(s).
    • Pneumonia
    • Atelectasis
  105. What ribs are at greatest rish to fracture?
    4-9
  106. What triage classification would you give a patient with a fall from a standing position, on Coumadin, hit his head and an altered LOC?
    Emergent; Highest priority; Life-threatening.
  107. What emergency surgical intervention is performed to locate hemorrhaging great vessels in hemorrhagic chest trauma?
    Open resuscitative thoracotomy
  108. Blunt force that involoves and increase in the velocity of a moving body or structure.
    Acceleration
  109. What criteria is used by a nurse to triage ETC patients?
    • Based of severity of injury or health problem.
    • Based on immediacy of the treatment.
  110. What is the name for the collateral damage to the surrounding vessels, nerves, and organs of tissues from a penetrating missle?
    Blast effect
  111. How is the velocity of a missle related to the degree of tissue and organ damage?
    The greater the velocity the greater the tissue and organ damage.
  112. Upon initial contact in caring for a patient on a ventilator, what nursing actions should occur?
    • 1. Ausculatate all lung fields for breath sounds.
    • 2. Note demarcation line of the ET tube at the lip.
    • 3. Confirm ventilator settings.
  113. Blunt force that involoves being pressed or squeezed by force.
    Compression force
  114. What does canopgraphy measure?
    • End Tital Volume (EtCO2)
    • Gives objective confirmation of ET tube placement.
  115. EtCO2 <35 mm/Hg?
    ET tube may be in the espohagus
  116. Why is an elderly trauma patient have limited organ function when faced with a physiologic challenge?
    Limited physiologic reserve.
  117. What factors could delay or alter an accurate neuro evelaluation of a trauma patient during the primary survey?
    Use and abuse of impairing substances.
  118. Tensile stress
    Limited longitudinal stretch or stress upon a tissue or organ that can occur in a traumatic injury.
  119. Monifestations of Tension and Open Pneumothorax
    • Midline treachea
    • Abset breath sounds on the affected side
    • Pulsus parodoxis
    • Decreased venous pressure
    • Increased intrathorasic pressure
    • Chest pain
  120. Tension pneumothorax vs. Open pneumothorax
    • Tension - damage of the lung causing air to ecsape from the lung into the pleural cavity.
    • Open - penetration of the skin casing air from the atomosphere to enter the pleural cavity.
  121. Treatment of tension vs. open pneumothorax
    • Tension - needle aspiration, chest tube
    • Open - occlusive dressing taped x3, chest tube, surgery prn.
  122. Oxygen toxicity
    -How?
    -Causes?
    -How to prevent?
    • ->80% FiO2 for over 48hrs
    • -Can damage endothelium
    • -Increased PEEP and decreased FiO2
  123. Ventilator Bundle
    • Interventions designed to prevent complications of mechanical ventilation.
    • -HOB >30
    • -Prevention of stress ulcer
    • -DVT prophylaxis
    • -Sedation vacation
    • -Oral care Q4
    • -Weaning trial
  124. RASS
    • Richmond Agitation Scale
    • -MD sets target score
    • -RM tries to match by adjusting sedation.
  125. Complications of artifical airways
    • Insertion trauma
    • Cuff trauma
    • Vocal cord paralysis or damage
    • Swallowing dysfunction
    • Tracheoesophagheal fistula
  126. Nursing Diagnoses for mechanical ventilation
    • Ineffective Airway Clearance
    • ---suction prn
    • Impaired Gas Exchange
    • ---monitor CO2 and pH
    • Ineffective Breathing Pattern
    • ---tachy, brady, dysynchrony, anxiety
    • Alteration in Cardiac Output
    • ---d/t increased PEEP
  127. Rapid Shallow Breathing Index (RSBI)
    • Used to assess a weaning trial.
    • RR / TV = RSBI
    • Target: <100
  128. Postextubation Care
    • Monitor for stridor
    • Assess breath sounds
    • Chest PT
    • Cough and deep breathing
    • Swallowing evaluation
  129. Your ventilated patient seems to be in distress. Her SaO2 is 84%, she is cyanotic and diaphoretic. What to do first?
    Bag patient with 100% O2
  130. Morphine
    -onset
    -duration
    -dosage
    • Opiate
    • -onset - 5min
    • -duration - 4-5hrs
    • -dosage - 2-4mg IV Q4
  131. Dilaudid
    -onset
    -duration
    -dosage
    • Opiate
    • -onset - 15min
    • -duration - 4-5hrs
    • -dosage - 0.2-1mg IV Q2-3
  132. Morphine vs Dilaudid
    Dilaudid is 7x's stronger than Morphine
  133. Fentanyl
    -duration
    -dosage
    • Opiate
    • -0.5-1hr
    • -dosage - 50mcg-100mcg
    • *useful for procedures
  134. Opaite reversal agent
    • Narcan
    • Will reverse all effects of opaites, including pain
  135. Midazolam (Versed)
    -onset
    -duration
    -dosage
    • Benzodiazepine
    • -onset - Rapid
    • -duration - 4hrs
    • -dosage - weight based - 1-4mg
  136. Lorazepam (Ativan)
    -onset
    -duration
    • Benzodiazepine
    • -onset - slow - 10-20min
    • -duration - 12hrs
  137. Benzodiazepine reversal agent
    Romazicon
  138. Romazicon
    Reversal agent for Benzo's
  139. Narcan
    Reversal agent for opiates
  140. Propofol (Diprivan)
    -onset
    -duration
    • General anaesthetic
    • White in color - dissolved in lipids
    • -onset - 2 min
    • -duration - 2-5min
  141. Propofol Syndrome
    • Heart failure
    • Rhabdomyolysis
    • Metabolic acidosis
    • Renal failure
  142. Neuromuscular Blockade
    -how to test?
    • Drug-induced paralysis
    • Paralyzes skeletal muscles
    • Must sedate and analgesia
    • -Test with peripheral nerve stimulator
  143. Assessment and non-verbal cues of pain
    • Facial expression
    • Body language
    • Muscle tension
    • Compliance of vent.
    • Vitals
  144. FLACC
    • Scale used for non-verbal pain assessment
    • -Face
    • -Legs
    • -Activity
    • -Cry
    • -Consolability
  145. Visual Analog Scale
    0-10 face scale used for pain assessment
  146. When is the spinal cord considered unstable?
    • When there is a lack of vertebral support
    • When there is a lock of ligament support
    • When there are 2+ damaged vertebral columns
  147. Where is the beginning and end of the spinal cord?
    • Starts at foreamen magnum
    • Ends at L1 or L2
  148. If the spinothalamic tract was injuried in an incomplete spinal injury, how might the patient present?
    • Unable to differentiate temp. below the level of injury
    • Altered and/or increased pain below the level of injury
  149. What is the most common reason for a laminectomy?
    Neural impingement stenosis
  150. How are spinal cord injuries classified according to ASIA (American Spinal Injury Association)?
    • According to the level of vertebral injury.
    • If it is complete or incomplete
  151. What type of spinal cord injury results in the absence of all motor and sensory function below the level of injury?
    Complete spinal cord injury
  152. What is the name of the spical cord injury id damage to the spical cord occurs between T2 anf L1?
    Paraplegia
  153. What type of incomplete spinal cord injury results in spastic muscles and exaggerated tendon reflexes below the level of injury?
    Upper motor neuron injury
  154. What level of vertebral spinal cord injury results in loss of phrenic nerve innervations with the diaphragm?
    Involoving C7-C3
  155. Would a patient with complete coup-contrecoup shearing spinal cord injury be concidered a tetraplegic or paraplegic?
    Tetraplegia
  156. When does the primary spinal cord injury occur?
    At the time of impact
  157. Where should a nurse being a motor assessment when evaluating the motor functioning of a spinal cord injury?
    At the head and compare left to right
  158. What does it indicate if there are the presence of reflexes below the level of injury?
    • Incomplete
    • Upper motor neuron injury
  159. Who are at greater risk for the ocurrence and severity of shock states in spinal cord injuries?
    • The higher the injury.
    • The greater the autonomic nervous system dysfunction.
    • Greater the occurence and severity of the shock state.
  160. When do you know that spinal shock has ended for a patient with an incomplete upper motor neuron spinal cord injury?
    Return of relexes below the level of injury
  161. How do you treat spinal shock?
    • No treatment.
    • Only time.
  162. At what vertebral level of incomplete spinal cord injury does an upper motor neuron injury occur?
    At or above T12
  163. What is the name for the clinical state in spinal cord injuries that is marked by massive vasodilation, hypotension and bradycardia?
    Neurogenic shock
  164. What is the rold of the nurse when turning a spinal cord injury patient
    Cervical spine immobilization
  165. Why does spinal shock occur?
    Autonomic nervous system is in dysfunction
  166. What spinal tract is injuried in an incomplete spinal injury if the patient has altered or increased pain levels?
    Spinothalamic tract
  167. What type of bladder function does a patient with an incomplete upper motor neuron have?
    Spastic neurogenic bladder
  168. What type of incomplete spinal cord injury results in hyporeflexia responses and flaccidity below the level of injury?
    Lower motor neuron injury
  169. What type of spincal cord injury causes loss of motor and sensory function of the arms, trunk, legs and pelvic regions?
    Complete tetrapleia
  170. When does the secondary spinal cord injury occur?
    Within a few minutes of the impact
  171. How is neurogenic shock treated?
    • IV fluid resusicitation
    • Atropine
    • Vasopressors
  172. Name examples of non-surgical stabilization methods used in spinal cord injuries.
    • Cervical tongs with traction
    • Halo traction
    • Spinal braces
  173. What type of spinal cord injury can be stabilized with a halp traction?
    Cervical-thorasic
  174. What is the name given to a spinal cord injury that involves injury from C1 - T1?
    Tetraplegia
  175. What medication is given as a 24 hour infusion in the early stage of care of the spinal cord injury patient to improve neurological outcome and minimize the effects of secondary spinal cord injury inflammations?
    MPSS Methylprednisolone
  176. Where should a nurse being a sensory assessment when evaluating function of a spinal cord injury patient?
    • At the feet
    • Comparing the left to the right
  177. What dies the presence of perineal reflexes indicate when there is a spinal cord injury?
    Incomplete involving upper motor neuron injury
  178. When does spinal shock occur?
    Within 30-60 minutes of primary injury
  179. What type of pulmonary complications are SCI patients at risk for which could cause impaired respiratory effectiveness?
    • Atelectasis
    • Pneumonia
    • Aspiration
  180. What spinal tract is injured, if the patient presents with altered or exaggerated sensations to touch and vibrations? 
    Posterior or dorsal spinal tract
  181. What is the etiology or reason that a secondary spinal cord injury occur?
    d/t vascular injury to the injured spinal cord
  182. At what vertebral level does a lower motor neuron injury occur?
    Below T12
  183. What is the best way of mobilizing secretions in a SCI patient?
    • Frequent turning
    • Log rolling
    • Chest PT on bed
  184. Name the perineal reflexes that are assessed in SCIs.
    • The anal wink
    • The bulbocavernosus reflex
  185. Why is suctioning to be avoided unless necessary and only then is done with extreme caution in patients with spinal cord injuries?
    Suctioning can cause bradycardia and asystole
  186. What type of SCI results in preservation of some degree of sensory and/or motor impulses below the level of injury?
    Incomplete
  187. What spinal tract is damaged if the patient is not able to differentiate temperature changes below the level of injury in an incomplete spinal injury?
    Spinothalamic tract
  188. What vertebral level of spinal cord injury will result in the patient be dependent upon a ventilator to breathe?
    C1-C3
  189. Describe the reflex function seen in an upper motor neuron incomplete SCI.
    • Hyperreflexia
    • Spastic reflexes
  190. When does spinal shock end?
    24-72 hours
  191. How does hypovolemic shock and neurogenic shock differ?
    • Hypovolemic shock - atrial hypotension and tachycardia.
    • Neurogenic shock - atrial hypotension and severe bradycardia.
  192. What is the purpose of manual or surgical stabilization of SCI?
    • Prevent worsing deformities.
    • Maximize recovery.
  193. Name the 3 examples of secondary SCIs.
    • Ischemia injury.
    • Elevated intracellular Ca+ ions resulting in destruction spinal cell membrance injury.
    • Inflammatory injury.
  194. What type of bladder function does a patient with an incomplete lower motor neuron SCI have?
    Acontractile bladder (dribble at a continuous rate)
  195. How does the SCI patient present when in spinal shock?
    Loss of motor and sensory function below the level of injury.
  196. If the corticospianl tract was injured in an incomplete SCI, how might the patient present?
    Weakness or an altered ability to move the muscles voluntarily below the level of injury.
  197. What type of SCI results in loss of motor and sensory function of the lower extermities, but still has upper extremity functioning?
    Complete paralegia
  198. How do you assess for the presence of the bulbocavernosis perineal reflex?
    Tugging the foley catheter and checking for contraction of the anal sphincter
  199. Describe the type of relex activity seen in an incomplete lower motor neuron SCI.
    • Hyporeflexia
    • Flaccidity
  200. If the patient presents with ataxia, what spinal tract has been injuried in an incomplete SCI?
    The posterior or dorsal spinal tract due to altered proprioception.
  201. Why is Methylprednisolone 24 hour infusion given in the early stages of care to a PCI patient?
    • Improve neurological outcomes
    • Minimize effects of secondary inflammation injury
  202. What conditionl in SCI is treated with IV fluid resuscitation, atropine and voasopressors?
    Neurogenic shock
  203. What should the nursing diagnosis be for any SCI involving the cervical vertrae?
    Actual or Risk of impaired ability to breathe without a vent.
  204. What is the name for the clinical condition in SCIs that are marked by temporary complete loss of sensory and motor loss of funcioning below the level of injury in incomplete SCIs?
    Spinal shock
  205. What can delay an MD from being able to assess the true extent of a SCI?
    • Inflammation from secondary SCI
    • Spinal shock
  206. Would a patient with a T6 thorasic SCI be concidered a tetraplegic or paraplegic?
    Paraplegic
  207. How would a patient with an incomplete SCI present?
    Preservation of some sersory and/or motor function
  208. What clinical finding would a nurse assess when a patient with a SCI is in spinal shock?
    • Absence of all reflex activity
    • Flaccidity
  209. What spinal tract is injured in an incomplete SCI if the patient has weakness in his ability to voluntarily move his muscles below the level of injury?
    Corticospinal
  210. What is a complication of treating neuorgenic shock with fluid restriction?
    PE
  211. How should bradycardia due to suctioning be treated in a patient with SCI?
    • Stop suctioning
    • IV atropine
  212. Poikilothermia
    Loss of thermoregulation in SCI
  213. What is the name of the nerve that can be damaged with a cervical SCI that can result in impaired or absent disphragmatic innervation?
    Phrenic nerve
  214. Neurogenic shock
    Clinical condition in patients with a SCI at or above T6 that is manifestated by severe hypotension and bradycardia.
  215. Why does poikilothermia occur in SCI?
    interruption of the signaling between the spinal cord and the hypothalamus thermoreceptors
  216. What part of the spinal cord is damaged if the patient is a tetraplegia?
    C1 to and including T1
  217. What type of metabolic state occurs in SCI?
    Hypermetabolic d/i increased energy expenditures
  218. What could a paralytic ileus occur in the first few days following a SCI?
    d/t the effects of spinal shock
  219. What is the #1 reason for mortality after SCI?
    Thromboembolism
  220. What level of vertebral SCI is more prone to have occurence of neurogenic shock?
    SCI at or above T6
  221. What causes neurogenic shock in SCI?
    d/t sudden loss of sympathetic stimulation to the blood vessels cause bradycardia and massive vasodilation and venous pooling.
  222. Would a patient with a C1-C3 cervical SCI be concidered a tetra- or para-?
    Tetra-
  223. Heterotopic ossification
    occur is patients with SCI where there is ectopic overgrowth of the bones below the level of injury
  224. Autonomic Dysreflexia (AD)
    Life-threatening emergency in SCI patients marked by accelerated HTN from amplified response from the autonomic NS
  225. Why do shock states occur in SCIs?
    Autonomic NS is disorganized
  226. What vertebral level of injury in SCI have the ocurrence of AD?
    at or above T6
  227. What can heterotopic ossification in SCI result in?
    limitation of joint mobility
  228. What joint is primarily affected in heterotopic ossification?
    Indomethacin TID
  229. Is neurogenic shock in SCI marked by vasodilation or vasoconstriction?
    Vasodilation
  230. What is 3 actions by the nurse when a patient is experiencing AD?
    • Elevated HOB
    • Finds the trigger and correct it
    • Administer IV and HTN meds
  231. Name some classic manifestations during impending or actual AS.
    • Accelerated HTN - 200+/100+
    • Severe headache
    • Flushing of face
    • Anxiousness
    • Goosebumps
    • Blurred vision
    • Feeling of doom
  232. Common trigger of AD?
    Distended bladder
  233. What method should a nurse change a position in a SCI patient?
    • Slowly
    • Prone
  234. What measures are effective in helping the patient with SCI tolerate position changes?
    • Slow
    • Abdominal binder
    • Compression stockings
  235. What long-term intervention occurs for patients with tetraplegic SCI to improve QOL d/t bladder incontinence?
    Suprapubic catheter
  236. What type of motor neuron injury has better results in bladder and bowel training in SCI?
    Upper motor
  237. I a satisfying sexual relationship possible following a SCI?
    • Yes
    • Arousals and orgasms take longer
    • Ejaculation can be stimulated by devices for future insemination
  238. What medications are effective in controlling phantom or central pain?
    • Anti-seizure (Neurontin)
    • Anti-depressants (Lyrica)
  239. Corticospinal tract transmits...
    Motor activity
  240. Spinothamlamic tract transmits...
    Pain and temperature
  241. Dorsal tract transmits...
    sensation of vibration, propioception, touch, fine touch, pressure and texture
  242. Tetraplegia
    Complete severing between C1 and T1
  243. Paraplegia
    Complete severing between T2 and L1
  244. Ischemia
    Secondary Injury
    • Decrease circulation
    • Vasospasms
    • Edema
  245. Elevated Intracellular Calcium
    Secondary Injury
    • Damage to cell membrane
    • Neuronal cell death
  246. inflammatory process
    Secondary Injury
    • Infiltration of leukocytes
    • Swelling of the injured spinal cord
    • Days to weeks
  247. Upper Motor Neuron Injury
    • Incomplete SCI at or above T12
    • -HYPERreflexia or spastic
  248. Lower Motor Neuron Injury
    • Incomplete SCI below T12
    • HYPOflexia or flaccid
  249. Preload
    Volume of blood filling the ventricles at the end of diastole
  250. S/S of increased (R) heart preload.
    (Right side is backing up)
    • JVD
    • Ascites
    • Hepatic engorgement
    • Peripheral edema
    • -->Same as fluid overload
  251. S/S of decreased (R) heart preload.
    (Right side not getting enough)
    • Poor skin turgor
    • Dry membranes
    • Orthostatic hypotension
    • Flat jugular veins
    • -->Same as dehydration
  252. S/S of increased (L) heart preload
    (Left side backing up)
    • Dyspnea
    • Cough
    • S3, S4
    • -->Pulmonary symptoms
  253. Starlings Law
    • The bigger the stretch --> the bigger the squeeze
    • Increased preload --> increased stretch, therefore --> increased CO
  254. Afterload
    The pressure the ventricle must generate to overcome resistance.
  255. Normal SVR
    (systemic vascular resistance)
    800-1200
  256. Swan-Ganz cathether
    • Simultaneously assesses hemodynamic parameters
    • -PA systolic and diastolic pressures
    • -Wedge pressure
    • -CO
    • -CVP (central venous pressure)
  257. Normal RA pressure
    (CVP)
    2-6
  258. Normal RV pressure
    • 20-30 (systolic)
    •  2-8   (diastolic)
  259. Normal CO
    • 4-8 Liters
    • Calculated by HR x SV
  260. Normal Wedge pressure
    4-12
  261. Normal CI
    (Cardiac Index)
    2.4-4 Liters
  262. Normal PA pressure
    • 20-30 (systole)
    • 8-15  (diastole)
  263. CVP
    • Measures fluid status
    • Normal 2-6
  264. PA pressures
    • Measure pressure in PA
    • Reflects the state of RV and lungs
    • Normal 20-30/8-15
  265. Wedge pressure
    • Balloon obstructs PA allowing LV pressure to be measured
    • Normal is 4-12
  266. Measuring CO using a Swan-Gantz catheter
    • Inject NSS into catheter, travels thru heart. Temp is measured when cool blood passes by the thermistor.
    • CO is calculated by how much blood is being pumped by knowing how fast it takes for the cooled blood to pass thru the heart.
  267. Cardiac Index
    • CO x BSA
    • More accurate than CO
  268. Septic shock
    • Produce arterial vasodilation
    • Sever drop in BP
    • Low SVR (below 600)
    • Increased HR and contractility
    • Increased CO (over 10)
  269. Cardiogenic shock
    • Heart loses pumping ability
    • Severe decrease in BP
    • Decreased CO (less than 3)
    • Causes vasoconstriction
    • Increased SVR (over 1600)
  270.   Septic vs. cardiogenic shock
    • Septic -- Increase CO 
    •              Decreased SVR

    • Cardiogenic -- Decrease CO
    •                      Increased SVR
  271. Know RA, RV, CO, CI, SVR, CVP, PA, Wedge
    • RA - 2-6
    • RV - 20-30/2-8
    • CO - 4-8
    • CI - 2.4-4
    • SVR - 800-1200
    • CVP - 2-6
    • PA - 20-30/8-15
    • Wedge - 4-12
  272. Why would a patient need an A-Line?
    • Hemodynamically unstable
    • Serial blood gases needed
  273. Aterial waveforms
    • At baseline - diastole
    • At peak - systole
    • Dichrotic notch - marks the closing of the aortic valve
  274. Tranducers with A-Lines
    Transducers with a Swan
    • Must be at the level of the catheter.
    • Must be level with 4th intercostal space, midaxillary line.
  275. Medications and A-lines
    Never inject medications thru an A-Line.
  276. Removal of A-Lines
    Apply pressure x5 minutes
  277. Cardiac conduction
    SA node --> AV node --> Bundle of His -->(L) and (R) bundle branches --> Purkinje fibers
  278. Q-R-S segments
    • Q is first down segment
    • R is first up segment
    • S is down segment FOLLOWING an R
    • *no R, no S*
  279. Causes of Dysrythmias
    • Electrolytes
    • Fluid volume
    • Hypoxemia/MI
    • Body temp
    • Cardiomegaly
  280. Sinus Bradycardia
    NSR with HR <60 bpm
  281. Causes of Sinus Brady
    • SSS
    • Meds
    • Hypoxia
    • Athletes
  282. Treatment of Sinus Brady
    • *Treat only if symptomatic*
    • O2
    • Meds - Atropine Sulfate
    • Monitoring
    • Temp PPM?
  283. Atropine Sulfate
    Treats symptomatic brady
  284. Sinus Tachycardia
    NSR with HR >100 bpm
  285. Causes of Sinus Tachy
    • Always has a cause - anxiety, pain, fever, activity, dehydration, HF
    • Treat cause, treat tachy
  286. Treatment of Sinus Tachy
    • Meds -- BB, CCB
    • O2
  287. Atrial Fibrillation
    • Irregular
    • No meaningful P-wave
  288. Causes of A-Fib
    chaotic firing of myocardial cells
  289. Atrial Flutter
    • HR >250 bpm
    • Sawtooth p-wave
  290. Treatment of A-Fib and A-Flutter
    • Control rate
    • BB or CCB
    • Amiodarone
    • Digoxin
    • Cardioversion
    • Anticoagulate
  291. SVT
    • HR 150-250
    • Always regular
    • paroxysmal
  292. Treatment of SVT
    • O2
    • Monitoring
    • Valsalva maneuver
    • Adenosine
    • CCB, BB
    • Cardioversion
  293. PACs
    Early atrial depolarization
  294. Causes of PACs
    stress, anxiety, fatigue, infection, etc.
  295. PVCs
    • Early ventricular contraction
    • Can be bigeminy, trigeminy, couplets, triplets
  296. Causes of PVCs
    • Age
    • Hypoxia
    • MI
    • CHF
    • Stress
    • Meds
    • Electrolytes
  297. Treatment of PVCs
    Treat the patient not the rhythm
  298. Causes of Ventricular Tachycardia
    • Cardiac disease
    • Electrolyte imbalance
    • Artifact
  299. Treatment of V-Tach
    • With a pulse - Amio
    •                      Lidocane
    •                      Mag/K
    •                      Cardioversion
    • Pulseless - CPR
    •                 Defib
    •                 Epi/Pressin/Amio
    •                 Resuscitation
  300. V-Fib
    • Will always be unconscious
    • #1 cause is an MI
  301. 1st degree AV block
    PR interval >0.20
  302. 2nd degree AV block Mobitz Type I
    • Wenkeback
    • PR interval progressively increased until QRS is dropped
  303. 2nd degree AV block Mobitz Type II
    • Some beats conducted, some not
    • Some P's with no QRS
    • respuires PPM
  304. 3rd deree AV block
    • No communication between atria and ventricles
    • All P's evenly spaced, all QRS's evenly spaced
  305. Causes of 3rd degree AV block
    • Medication - Dig toxicity
    • MI
  306. Treatment of 3rd degree AV block
    Treat symptoms

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