Acute Neurology
Define cerebral perfusion pressure. How is it calculated? What is ideal? What must happen if ICP increases to maintain CPP?
Pressure needed to ensure blood flow to brain. CPP= MAP-ICP. Normal is 60-100mmHg. If ICP increases, MAP must also increase to maintain CPP.
Differentiate between complete spinal cord injury and incomplete spinal cord injury.
Complete spinal cord injury- results in no nerve innervation distal to level of cord injury= paralysis and loss of sensory function
Incomplete spinal cord injury- innervation partially damaged, but some function/ movement distal to cord injury is possible
List the types of burns as classified by DEPTH. Indicate the S/S of each type. Review Rule of 9's and Parkland Burn Formula using 2 ml.
-Superficial- red dry skin, no blisters
-Superficial partial thickness- skin wet/raw, pink/cherry colored, edema, & epidermal blisters
-Deep partial thickness- cherry red or mottled, blotchy skin, deep blisters-Often nerve endings intact.
-Full thickness- white brow or black skin, hard skin, no pain, edema
-Parkland formula= 2mL x weight (in kg) x total body surface area burned (TBSA)- NOTE: TBSA of partial thickness or full thickness burns!
*1/2 of fluid to be given over first 8 hours, second half to be given over next 16 hours
What does it mean to crossmatch blood? Do we want negative or positive crossmatch for suitable donor?
Crossmatching means we mix recipient serum with donor lympocytes. No cell lysis= negative crossmatch which is what we want for donation. If there is cell lysis= positive crossmatch and will likely lead to organ/ tissue rejection.
List the 4 colors for a triage tag and what it means. Which group of clients needs to be treated first?
uBlack (expectant- unlikely to survive).
uRed (emergent)- have life threatening injuries which have high chance of survival. Seen FIRST!
uYellow (delayed)- may have serious injuries but not expected to decline significantly over a few hours.
uGreen (minor)- condition not likely to deteriorate over days.
List the clinical manifestations of increased ICP. Which of these are EARLY signs?
Changes in LOC, Cushing's triad, ipsilateral pupil dilation, eye movement difficulty, nocturnal or morning headache worsened with movement, and unexpected vomiting.
Early indicator- change in level of consciousness or mental status.
Throwback question:
SCI patients often grieve the life they once had before the injury. List the 5 stages of grief and what the client may exhibit.
denial- client feels numb mentally, refuses to believe this happened
anger- client angry this happened to them- often take anger out on healthcare worker
bargaining- try to make a deal to go back to normal. Often ask "what if?"
depression- client sad & longs to go back to normal
acceptance- accepts fate
The parameters used to determine effectiveness of fluid administration in a burn client.
Urine output, MAP, systolic BP, heart rate
Name the common drugs utilized to prevent transplant rejection. What is the most common complication seen with any of these drugs?
No adherance, increased infection risk due to immunocompromised status (to tolerate donor organ)
Name the steps for the American Heart Association Cardiopulmonary resuscitation- Basic Life Support for Providers when an adult client found unresponsive.
Check for scene safety. Check responsiveness. Call for help/ activate code. Check for pulse & breathing. No pulse, no breathing, begin CPR at compression/ventilation ratio of 30:2. When AED arrives, power on & follow prompts. After shock, immediately resume CPR X2 minutes. Reanalyze.
Which 3 factors make up ICP? Which nursing interventions lead to increased ICP? What nursing interventions are utilized to decrease the ICP?
-brain tissue, blood, CSF.
-Hypercapnia (dilates cerebral vessels), suctioning, coughing, extreme neck or hip flexion/ increased intraabdominal pressure, HOB less than 30 degrees.
-Avoid above activities, mannitol or hypertonic IV fluids, removal of CSF, decrease pain anxiety & noxious stimuli
List complications of the halo vest and interventions to fix them.
Pin/ screw infection/ osteomyelitis- freq pin site care/ cleaning
Falls- institute fall risk prevention, malnutrition, constipation
List out the Rule of Nines and %TBSA involved with each body part.
uEntire head= 9%.
uEntire front torso= 18%.
uEntire back torso= 18%.
Entire left arm= 9%.
Entire right arm= 9%.
Entire left leg= 18%.
Entire right leg= 18%.
Perineum= 1%.
Name the requirements for organ harvesting. In order to take organs, what must be in place? List contraindications for donation.
Brain death or circulatory death. Organ donor on identification or family request. To donate organs, client must be supported on ventilatory until harvest time.
Contraindications: ADVANCED cancer, refractory heart disease, chronic resp failure, extensive valve disease, chronic infections, drug use, alcohol abuse (consider psychologica screening).
List the antidotes for each of the following overdoses: barbiturates, benzodiazepines, alcohol, methamphetamine, opiates, Tylenol
ubarbiturates- none (supportive care)
benzodiazepines- flumazenil (Romazicon)
alcohol- none (supportive care)
methamphetamine- none (supportive care)
opiates- naloxone (Narcan)
Tylenol- acetylcysteine (Mucomyst)
List the clinical manifestations of: brain abscess, meningitis, and encephalitis.
brain abscess- HA, fever, N/V increased ICP, seizures
meningitis- decreased LOC or orientation status, memory changes, headaches, N/V, tachycardia, sensitivity to light, nystagmus, neck rigidity, Kernig & Brudzinski signs, seizures
encephalitis- fever, HA, N/V, mental status changes
List of complications seen in a client with an acute spinal cord injury.
Altered motor/ sensory function
Resp arrest or distress pending level of injury
Impaired sympathetic nervous system- autonomic dysreflexia
Neurogenic bladder and bowel
GI stress ulcers/ bleeding
Skin breakdown d/t immobility
Poor thermoregulation
Malnutrition
High risk of clots
Pain
List complications seen with inhalation burns and circumferential burns. What nursing priorities should be in place with each type?
Inhalation- respiratory distress/poor oxygenation--> inflammation in airway= obstruction. High flow O2 & prepare to intubate.
Circumferential burns- can cause compartment syndrome distal to the burn. Assess distal pulses. Prepare for fasciotomy or escharotomy to allow room to swell.
Name the organs and tissues that may be transplanted.
Organs: heart, lung, liver, kidney, pancreas, intestine
Tissues: cornea, skin, bone marrow, heart valves, bone, connective tissue
Name the steps for Emergency Severity Index (ESI) triage. Which number is the highest acuity and needs immediate treatment?
Review- do not need to memorize
Check for life threatening emergencies. Present- ESI 1. If not- check for high risk situations/ altered mental status/ extreme pain. Present- ESI level 2. Then- ID danger VS. Present- consider ESI 2. If cause for VS identified- ESI 3. Next, identify number of resources- ESI 3,4, or 5 (none needed)
Explain the difference between epidural and subdural hematoma. Include pathophysiology and clinical manifestations!
Epidural= typical arterial bleeding between skull & dura mater- initial period of unconsciousness at scene, then brief lucid interval (normal mental status), then decrease in LOC, HA, N/V
Subdural= typical venous bleeding between brain & dura mater- slower symptoms and includes decreased LOC & HA
List the clinical manifestations of autonomic dysreflexia. Then, list the steps (in order) of fixing it once identified!
Acute severe HTN, bradycardia, sweating flushing & goosebumps above level of injury, blurry or spotted vision, nasal congestion, severe throbbing headache, pallor below level of injury, feeling of impending doom.
Tx: sit upright, loosen clothing, ID triggers & fix, call MD, meds for BP, reassess.
Burnt facial hair
Burnt or singed clothing around neck
Soot in mouth or nairs
Stridor
Within enclosed building
Define an HLA and describe what this means for organ donation.
HLA-type of molecule found on the surface of most cells in the body. Human leukocyte antigens play an important part in the body's immune response to foreign substances. Recipient must not have antibodies against donor's HLAs or rejection occurs! Some organs need a closer match to HLAs than others.
List the signs and symptoms of a client with frostbite, heat cramps, heat exhaustion, and heat stroke.
Frostbite- waxy pale yellow or white skin, blue skin, or mottled skin, “crunchy” & frozen skin, may c/o tingling, numbness, or burning
heat cramps- thirst, sweating
heat exhaustion- anxiety, extreme thirst, profuse sweating, weak pulse
heat stroke- altered LOC, hot dry skin, low BP