ICP, TBI
This is a complication associated with TBIs that can be prevented with a medication such as levetiracetam or fosphenytoin.
Whar are seizures?
This would be a person we would definitely not want to give tPA to(I will accept several answers)
Who are recent surgeries, GI bleeds, known active bleeds, huge lacerations, high INR, Sys BP over 185, and any others that are on the graphic on page 945?
A client with trigeminal neuralgia should do this to hopefully prevent exacerbations.
What is avoid triggers?
Shock is defined by not having enough of this.
What is cardiac output?
While most shock client's benefit from fluids, a client with this specific type of shock really shouldn't get them.
What is cardiogenic shock?
The three elements of Cushing's Triad.
What are decreased HR, irregular respirations, and wide pulse pressure?
The acronym BE FAST describes common stroke symptom. This is what it stands for. I require all six to be correct.
What are balance loss, eyesight changes, face drooping, arm weakness, speech difficulty, and time?
In addition to being the mother of nursing, Florence Nightingale is also credited with being an important contributor of this scientific field. Hint: she is credited with the first use of the rose diagram to show causes of death in the army.
What is epidemiology?
A client is going into hypovolemic shock due to GI bleeds. Their VS are HR 133, BP 82/51, RR 34, Temp 36.1° C, and 95% on 4 L NC. The nurse should prioritize this intervention to stabilize the patient.
What is administer IV fluids?
While having its own name kind of, neurogenic and anaphylactic shock fall into this larger shock category.
What is distributive?
Due to the volatile nature of TBIs, to prevent complication, nurses should be doing this thing frequently for a client with a TBI.
What is neurological assessment?
A client had a hemorrhagic stroke two weeks ago. Now, their urine output has fallen to 15 mL/hr of very concentrated urine. The client has likely developed this common complication of hemorrhagic stroke.
What is SIADH?
The Tensilon Test for myasthenia gravis is giving edrophonium and seeing if MG symptoms improve. Following the test, the nurse should vigilantly monitor this vital sign.
What is heart rate?
A client has a hemothorax. Their BP has dropped drastically, and their HR has increased drastically. The client is experiencing this type of shock, and needs this intervention to fix the underlying cause. (Two answers, both must be right)
What is obstructive shock, and a chest tube?
The priority for all forms of shock is to stabilize this in order to preserve tissue and prevent long term disability and injury.
What is oxygen saturation?
If there is ambiguity on if leakage from nostril is CSF or not, it may be tested for this substance. Also, I should mention, don't try to stop the leakage if is is suspected to be CSF.
What is glucose?
The nurse is vigilant in keeping their stroke patient's blood pressure in the prescribed range. If the client's blood pressure gets too high, this may occur.
What is hemorrhage?
We use this respiratory marker(part of pulmonary function tests) to measure a client's status in both myasthenia gravis and Guillian Barre syndrome.
What is vital capacity?
A client is receiving norepinephrine. A tip, a complication of this medication can be averted by frequently doing this assessment.
What is capillary refill?
A client with hypovolemic shock has a Swan Ganz catheter for invasive monitoring. An increase in this continuously measured value would indicate our interventions have been effective. (Yes, I am using semantics to get the answer I want, sue me).
What is central venous pressure?
If you have an increasing level in blood, CSF, or brain tissue in your cranium, this condition may occur(Guys, it is real bad).
What is herniation?
For client's experiencing a stroke, we may give this medication class which relaxes vascular smooth muscle causing vasodilation(caveat: this is not a beta blocker, so labetalol is wrong)
What are calcium channel blockers(nicardipine)?
One of the hardest decisions for a client with ALS is to decide whether they want this intervention.
What is a ventilator(I will also accept enteral feeds)?
What is metabolic acidosis?
A client is in neurogenic shock. Neurogenic shock has excessive parasympathetic activity. This means we may give vasoactive agents such as norepinephrine, and may also do this non-invasive treatment for a different symptom caused by excessive parasympathetic activity.
What is transcutaneous pacing?