1
Q
Droplet Precautions
A
- Mask
- Eyewear
2
Q
Contact Precautions
A
- Gown
- Gloves
3
Q
Airborne Precautions
A
- N95
- Neg pressure room
- Keep door closed
4
Q
Penicillins & Cephalosporins
A
- Cross sensitivity to cefs
- Not for renal disease, asthma, bleed d/o
- Bumps OCs
- Take with food
5
Q
Fluoroquinolones
A
- -floxacin
- Tendon rupture
- Photosensitive
- Empty stomach w/H2O
- No kids
6
Q
Tetracyclines
A
- Stains teeth
- No pregnant women
- Esophagitis = upright after taking
- No dairy
- -cycline
- Empty stomach
- Sunblock
- No calcium
7
Q
Aminoglycosides
A
- Nephrotoxic
- Ototoxic
- Neurotoxic
- -mycin
- Decreases ammonia levels
8
Q
MRDOs
Multidrug resistant organisms
A
- MRSA
- VRE
- CRE
9
Q
MRSA
A
- Spread by wounds, trach, IV, foleys
- Tx with vanc, linezolid, ceftaroline
10
Q
Septic Shock
Septic HOTN despite resuscitation efforts
Resembles late hypovolemic shock
A
- Requires vasopressor to keep MAP 65+
- Lactate 2+ despite fluids
- MODS evident
11
Q
SIRS
A
- Widespread vasodilation
- Blood pooling
- Earliest stage of sepsis
- Mild HOTN
- Oliguria
- High RR
- Temp varies
- WBC high
- ALOC
- Low O2
Severe sepsis is defined as SIRS + Sungle/multiple organ fail + confirmed infection source
12
Q
MODS
A
Cardiogenic shock from microthrombi
13
Q
SCI
Cervical most common
Nontraumatic causes
A
- 40+ yrs old
- Arthritis
- Cancer
- Inflammation
- Infection
- Spinal degeneration of discs
- Spinal tumors
14
Q
Cervical SCI
A
- C4 = Neck down
- C6 = shoulders down
Tetraplegia
15
Q
Thoracic SCI
A
- T6 = paraplegic from below nipples down
16
Q
Lumbar SCI
A
- L1 = paraplegia from groin down
17
Q
Complete SCI
A
No motor or sensory function below injury
18
Q
Incomplete SCI
A
Some function below injury
19
Q
SCI emergent stabilization
A
- LOC monitor
- Stabilize spine
- Log roll
- C collar
- Complete neuro exam
20
Q
Halo Traction Care & Complications
A
- Pin site infection
- Pin loosening
- Dysphagia from Dural tear or extension
- Reposition q2h
- PRN & per shift pin care
- Cotton applicator to clean crust
- NO ointment or peroxide
21
Q
Spinal shock primary injury
A
- Cord swelling
- HOTN
- Excitotoxicity
- Free radicals enter BBB
- Apoptosis
- Neurogenic bladder
- Paralytic ileus
- Flaccid paralysis
- Autonomic dysreflexia monitoring
- Bradycardia
22
Q
Spinal shock management
A
- IVF
- O2
- Dopamine
- Atropine
- Steroids
- Heparin
- ROM
- SCDs
23
Q
Neurogenic shock has
A
bradycardia
24
Q
Spinal shock
A
- Total immediate loss of power below injury
- HOTN
- Bradycardia
- No bulbocavernous reflex
- Flaccid paralysis
- 2-3 days post SCI
25
Neurogenic shock
* SNS signals lost
* HOTN
* Bradycardia
* Variable bulbocavernous reflex
* 2-3 days post SCI
26
Autonomic Dysreflexia
* T6 or higher
* Tight clothing
* Full bladder
* UTI
* Fecal impaction
* Pressure ulcers
* Below injury: Pale, cool
* Above injury: HTN, flush, HA, JVD, bradycardia, sweaty
* Place upright first
* Fix cause
* Give nitro, hydralazine
27
T12 and above can impact
resp status
28
Injury above C4
diaphragm paralysis = ventilate
29
Bethanechol
Treats urine retention in SCI pt
30
SCI diet
High protein, carb, calorie
31
Frequently used meds in SCI
* PPI
* Steroids
* Vasopressors
* Atropine (blocks PNS)
* H2
* Baclofen for spasms
* Gabapentin
* Hep/war
* Stool softeners
* Anxiolytics
32
Frontal lobe injury
* Personality
* Judgment
* Intellect
* Language
33
Temporal lobe injury
* Hearing
* Taste
* Memory
* Speech
34
Parietal lobe injury
* Sensory
35
Occipital lobe injury
* Vision
36
Cerebellum injury
* Balance
* Motor coordination
37
Mild TBI sx
* Memory
* Communicating
* Learning
* Concentration
* Problem solving
| problems with
38
Moderate concussion
Unconscious 6- hours
Amnesia post-trauma
| Severe is unconscious 6+ hr
39
Brain contusion
* Coup/contrecoup injury
* Frontal & occipital affected
* Unconscious 30+ min
* Stupor & confusion
Report
* LOC change
* Severe HA
* Vomiting
| Arouse & assess frequently!
40
Brocas aphasia
1.
41
GCS
15 best
3 worst
8 or less = coma
42
Basal skull fractures
* Through temporal bone
* Raccoon eyes
* Battle sign behind ear
* Hemotympanum
* Halo sign from ear
43
Epidural hematoma
* Between skull & dura
* Emergency
* Surgery & resp support required
44
Subdural hematoma
* Between dura & brain
* Acute or chronic
45
Subarachnoid hematoma
* Worst HA of my life
* Emergency
* Below arachnoid
46
Intracerebral hematoma
Bleed in brain
Supportive care
47
Hematoma causes
* HTN
* Head trauma
* Aneurysm
* AV malformation
* Meds
* Bleed d/o
* Liver disease
* Alcoholism
48
epidural hematoma is always
surgical
49
Nimodipine is given for
hematoma
50
Mannitol can also be given for
hematoma
51
Sudden behavior change in client is a sign of
worsening ICP
| report immediately
52
53
Normal ICP range
0-15
54
Cerebral blood flow
50-60 mmHg
55
ICP above 20 causes
brain ischemia
56
* Bilateral
* Pinpoint
* <1 mm
* Nonreactive
Pons lesion post-hemorrhage
57
* Bilateral
* Nonreactive
* Fixed
* 2 mm
Midbrain from edema, hemorrhage, infarction, laceration, contusions
58
* Bilateral
* 4 mm
* Fixed
* Nonreactive
Severe midbrain damage
Cardiopulmonary arrest
Hypoxia
Anticholinergic OD
59
* Unilateral
* 4 mm
* Fixed
* Nonreactive
Uncal herniation
Oculomotor nerve damage
Brain stem compression
High ICP
Tentorial herniation
Hematoma from head trauma
May be normal in some!
60
High ICP manifestations
* Papilledema
* Blurry vision
* HA
* Diplopia
* Pupil changes
* Dolls eye
* Projectile vomiting
* Decorticate & decerebrate
61
High ICP Complications
* Pressure ulcers
* Pneumonia
* DVT
* Contracture
* Meningitis
* SIADH
* DI
62
SIADH
* H2O retained
* Low sodium
* Oliguria
* Tremor
* Irritable
* HA
* Fatigue
* Fluid restriction to 800 mL/day
* 3% NaCl if Na <118
63
DI
* Low ADH
* Excess urination
* Hypernatremia
| Desmopressin to tx it
64
DI & SIADH present with
extreme thirst
65
Hydrocephalus
* HA
* Blurry vision
* Incontinence
* Catheterize
* Stool softeners
* HOB 30
66
GCS 8 or less
Intubate & ventilate
67
Cushing triad for ICP
| Late sign
1. Wide pulse pressure
2. Bradycardia
3. Irregular respirations
| Herniation of brainstem or hypothalamus
68
Brain tissue herniates at
ICP of 25
69
Early signs of brain herniation
Ipsilateral papillary abnormality
70
Later S&S of brain herniation
* Contralateral hemiparesis
* ALOC
* Coma
* Altered RR
* Pathological positioning
* Dilated & fixed (very late)
71
Cerebral edema management
* Hyperosmotics
* HOTN monitoring
* Arterial BP & CVP monitor
* Ventilate
* CPP 70+
* Mannitol via filtered tubing
* Foley is a must
* Serum osmolality 310-320
* Furosemide
* Steroids to dec cerebral edema
* Nimodipine to control MAP
* Barbiturate coma to reduce brain activity (pentobarbital)
* Phenytoin for seizure pvx
* Pantoprazole
* Morphine, fentanyl
| Potential ARDS
72
73
Cerebral edema injury prevention
* Adequate lighting to reduce visual hallucinations
* Wake cycles
* Skin care
* Mittens
* No restraints
* Padded side rails
* Side lying (seizure prec)
74
Persistent vegitative state
* Coma
* Awake w/no cognitive awareness
* Normal vitals
* No communication
75
Brain death
1. Coma
2. Absent brain stem reflexes
3. Apnea
4. 2 doctors declare dead
76
Parkinsons 4 cardinal S&S
1. Tremor
2. Rigid muscles
3. Bradykinesia
4. Postural instability
77
Parkinsons RF
* 40+
* Chemical & metal exposure
* Genetics
* Male
78
Parkinsons cues
* Tremor
* Masklike face
* Labile
* Speech change
* Fatigue
* Bladder/bowel change
| Hypomimia (masklike face)
79
Levodopa
Parkinsons
Coverts to dopamine
80
Pallidotomy
destroys globus pallidus in brain
| responsible for parkinsons sx
81
thalamotomy
removes part of thalamus to alleviate movement d/o
