cerebellar strokes
BE FAST
- time of onset is important
> 3-4hr for ischemic strokes
> TPA
sudden onset of movement and coordination difficulties
how are we responding to strokes?
1 ) neuro assessment w/ primary RN
2 ) VS
3 ) call MD after
seizure precautions
prioritize safety
protect the head
maintain airway
- recovery position
do not restrain
don’t place anything in mouth
loosen clothing
time the seizure, movement, type
CIWA assessment parameters
scoring on both obj/subj
- the higher the score, the higher chance of complications w/ their withdrawal
Alcohol withdrawal-symptom onset (unmedicated)
abrupt stop
onset = 6-12h after last drink
> minor
24-48h = withdrawal seizures
48-96 = delirium tremens
> susceptible individuals
alcohol intoxication
patho:
- ↓CNS depression
clinical man:
- altered LOC
- ataxia
- judgement, speech
diagnostic:
- blood alcohol
- 0 = no
tx:
- precautions
- recovery position
- hydration (IV)
- Intubation for at risk
ETOH W/D
patho:
- ↑CNS
clin. man:
- agitation, anxiety
- tremors/NV/speech
- sweat/aud/vis/tactile
- headache
- ↑BP/HR
diagnostic:
- IV
- 0 BAC
tx:
- CIWA-AR
- Benzo’s
> ↓hyperactive cells
hepatic encephalopathy
patho:
- ↑ammonia in brain
clin. man:
- altered LOC
- asterixis
diagnostic:
- serum ammonia
tx:
lactulose
> osmotic
> keeps ammonia from being reabsorbed
> 2-3 loose BM/day
wernike’s encephalopathy
patho:
- malnutrition
- ↓thiamine
clin. man:
- altered LOC
- ataxia
- abnormal eye movement
diagnostic
- no labs
- hx?
tx:
- thiamine
> IV, PO
rt-sided HF
- JVD
- pedal edema
- hepatomegaly
lt-sided HF
- SOB(OE)
- fine crackles in lungs
- fatigue
- dry cough
- orthopnea
lt-sided HF and pulmonary edema
fluid builds up in the lungs in the alveoli
interstitial edema > blocking diffusion
tx:
ByPAP
dry cough b/c it’s irritating but not accessible to cough out
> until pink-tinged sputum = bad
tx for HF as nurse
1 ) O2 for hypoxia
2 ) start IV
3 ) diuretics (loops) = IV
4 ) other meds for HF
5 ) fluid and Na restriction
leukocytosis
high WBC
- infection
- really high –> leukemia
leukopenia
low WBC
- infection
- chemo
neutropenia
d/t to disease process OR tx
infection risk
reverse precautions
low amount of neutrophils (WBC)
SIRS criteria
Neutrophils = < 0.1 x 10^9/L
T = 38.0, go to ER
hypoalbuminemia
low albumin
- cirrhosis
S/S edema
hyperalbuminemia
high albumin
- not being excreted
- kidney issue
common cancer complications
– infection
caused by:
- ulceration/necrosis
- compression of vital organs
- neutropenia
tx:
- prevention
- check labs
- Granulocyte Colony-Stimulating Factors (G-CSF)
- antibiotics
common cancer complications
– malnutrition
depletion of fat and muscle
intervention:
- measure albumin
oncologic emergencies obstructive
– superior vena cava syn.
d/t obstruction of vena cava by a tumor
clin. man:
- facial edema
- periorbital edema
- distended neck and chest veins
- headache
- seizure
diagnosis: CXR
tx:
- urgent radiation therapy
oncologic emergencies obstructive
– malignant spinal cord compression (MSCC)
d/t tumor compressing the spinal cord
clin. man:
- paralysis, loss of sensation
- back pain
- weakness, tingling
- bowel/bladder function
tx:
- emergent glucocorticoids
> dexamethasone
- urgent radiation therapy
- ↓inflammation
oncologic emergencies obstructive
– intestinal obstruction
d/t complete or partial obstruction d/t swelling of the intestine or solid tumor invasion
clin. man:
- projectile vomit, odd smell
- N/V, abdominal pain, distension
tx:
- NG tube on suction
- surgery
oncologic emergencies metabolic
– Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
d/t abnormal or sustained production of ADH
> small cell lung cancer
clin. man:
- fluid retention
- serum hypo-osmolality
- dilutional hyponatremia
early: muscle cramps, weakness
late: V/abd. cramp/ seizures/coma
- ↓urine output
tx:
- tx the cause!
- fluid restriction of 800-1000mL/day
