Spinal Cord Injuries
What level of spinal cord injury indicates that the patient will DEFINITELY need respiratory support?
C4 and above
Your patient had a GCS of 11. Two hours later the nursing student calls you in for help to clean the patient up and you assess the patient again and determine the GCS is 8. What does this indicate? (Bonus points: what should we do?)
Worsening mental status (less than 8 intubate)
What is the mainline treatment for MODS?
Palliative care
What is the Parkland Formula?
4mL x BSA % x weight kg = total mL (1/2 in first 8 hours, 1/2 in next 16 hours)
What is the main consideration for ALS?
Palliative care
What is a concern for patients with a spinal cord injury below T12?
Autonomic dysreflexia
What is the earliest sign of increasing ICP?
LOC
What is the lab we monitor in sepsis? (Bonus points: what are the values we need to know?)
Lactate (2 and 4)
What are the signs and symptoms of inhalation injuries?
Burns on the face/mouth, singed facial hair, stridor, sooty sputum, cough
Explain what occurs in DIC.
Systemic microclots while bleeding, bleeding and clotting over and over again.
What is a main concern for spinal cord patients and can be resolved within 4-6 hours after injury?
Nerve fibers, swell and disintegrate causing ascending edema that can compromise the respiratory system.
Name four components of a neuro assessment?
LOC, orientation, GCS, pupils, sensation, strength, DTR, reflexes, seizure activity and more!
What are four PRIORITY interventions for shock (any kind)?
Protect airway, intubate, IV access, CV meds, BP meds, bedrest, pain management, temperature control and prophylactic care
What are the criteria for burn center referral (I have 9)?
Partial thickness burns covering over 10% of body, burns involving feet, face, hands, groin or major joints, third degree burns, chemical burns, inhalation injury, burn injury with preexisting condition, patients with burns and trauma, burned children in a facility that doesn't specialize in pediatric burns, patients requiring long term social, emotional, long term rehab
Which peripheral neuro diseases involve cognitive impairment? Which only involve motor impairment?
MS - cognitive
MG, ALS, GBS - motor
What are the interventions for a patient with AD?
Remove stimuli, call the provider, monitor BP, htn meds, monitor
What are the three main interventions for increasing ICP?
Sit them up, head midline and decrease simulation
Name all components of the sepsis bundle. (Hint. the patient is NOT doing well and needs EVERYTHING we can give them.)
Lactate, blood cultures x2, broad spectrum abx, aggressive fluid resuscitation, pressors
A patient was trying to set off fireworks to celebrate his favorite nurse's graduation (this person is me). He was burned on the front of his leg, the back of his arm, his groin and the back of his head. What % BSA is his injury?
19%
What is the diagnostic test used for MG and what does it mean?
Tensilon test (if facial muscle improves, test positive for MG)
Name and explain the 4 main spinal cord complications.
Autonomic dysreflexia (high BP, HA, sweating above, pale and cold below, response to stimuli)
Spinal shock (depression of reflexes below injury, no CV involvement)
Neurogenic Shock (loss of ANS function, CV involvement)
Respiratory compromise (unable to control/initiate breaths)
With a basilar skull fracture, what do nurses NEVER do?
Insert an NG tube
Late: lethargic, obtunded, hypotensive but NOT responsive to fluids, weak pulses, edema, tachypnea, anuria, and MORE
What are the electrolyte shifts involved in burns? Why?
High K and low Na first (K and Na released d/t cell death)
Then, low K and Na (K shifts back into cells and Na low d/t fluids and diuresis)
Explain the treatment for HIT.
Stop heparin, notify provider, initiate agotroban