Endocrine
What is the MAIN cause of DKA/ HHS:
1. INFECTION ex. pnuemonia, uti, etc.
Other causes: surgery, illness, trauma, medications, poorly controlled DM, or not diagnosed.
What are the two main purposes of a ventriculostomy (EVD)?
To monitor intracranial pressure and drain cerebrospinal fluid.
C1- C4 Injuries require what? (ABC's)
Mechanical Ventilation
what is the #1 priority for all patients with an alteration in sensory perception?
SAFETY
What is the pathophysiology of Chronic Traumatic Encephalopathy?
What it is: A progressive degenerative brain disease found in people with a history of repeated head trauma (e.g., multiple concussions).
Pathophysiology: Repeated injuries lead to the buildup of an abnormal protein called tau in the brain, which kills brain cells.
What to do when patient's blood glucose is so high the standard glucometer cannot read it?
GET A STAT SERUM GLUCOSE BLOOD DRAW
What are the three components of cushings triad in increased cranial pressure?
Systolic BP GOES UP (with Widening Pulse Pressure): The body tries desperately to raise blood pressure to force blood into the compressed brain. Widening pulse pressure means the difference between the systolic and diastolic numbers gets larger (e.g., 180/60 mmHg).
Heart Rate GOES DOWN (Bradycardia): The intense pressure on the brainstem triggers a reflexive slowing of the heart.
Respiratory Rate GOES DOWN (Irregular Respirations): The respiratory center in the brainstem is failing. You may see patterns like Cheyne-Stokes (cycles of deep breathing followed by apnea).
What is a critical safety check you MUST do before sending a patient to get an MRI?
A critical safety check before an MRI is to ensure the patient has NO metal or hardware in their body from previous surgeries or trauma. A patient with metal implants cannot have an MRI.
What is a nurses priority pre-op for any eye surgery?
Medication History Review:
Crucial Point: Check for any medications that increase bleeding risk, such as anticoagulants (Warfarin, Eliquis, Lovenox) or antiplatelet drugs (Plavix, Aspirin).
Action: If a patient is on these, you must immediately report it to the surgeon. These are typically held for a week before eye surgery
Describe Cerebral Autoregulation?
The brain's intrinsic ability to maintain constant blood flow despite changes in systemic blood pressure. It does this by constricting or dilating cerebral blood vessels.
What is the clinical motivator of arrythmias in DKA?
The critical driver of arrhythmias in DKA is potassium instability, combined with acidosis and volume depletion. This combination makes the heart's electrical system extremely unstable. You MUST have these patients on a continuous EKG monitor.
What are the two signs called of a skull fracture?
Battle's Sign: Bruising over the mastoid bone (behind the ear). Indicates a possible basilar skull fracture. Associated with CSF otorrhea and hearing loss.
Raccoon Eyes: Bruising around the eyes (periorbital ecchymosis). Often due to orbital or zygomatic (cheekbone) fractures.
What GCS score do you give a patient for the speech portion if they have a trach/ vent?
T1
In glaucomas, what is the main goal of medication administration?
The goal of all these medications is to lower intraocular pressure.
What is the classic sign of spinal stenosis?
The patient's pain gets better when they bend forward (like leaning on a shopping cart). This posture temporarily opens the spinal canal and relieves nerve pressure.
Why must nurses carefully and gradually administer insulin/ and fluid replacement?
If we correct fluid and glucose levels too quickly, we can cause a dangerous fluid shift into the brain cells, leading to cerebral edema. This is a deadly complication, especially in children.
What is the first-line diagnostic test for an acute head injury?
Non contrast CT scan of the head
What are the signs and symptoms of Autonomic Dysreflexia? Sympathetic specifically
Sympathetic Response (Below the level of injury):
🚨 Severe, Extreme Hypertension: Blood pressure can skyrocket to 180/100 or even 200+.
🚨 Sudden, Pounding Headache.
Pale skin below the injury level.
🚨 Goosebumps or "goose skin" (piloerection). The professor called this a telltale sign. If you see this and the room isn't cold, suspect AD.
What are the RED FLAG signs and symptoms of retinal detachment?
🚨 Photopsia: Sudden, bright flashes of light in one eye.
🚨 Floaters: A sudden increase in the number of "cobwebs" or specks floating in their vision.
🚨 A "curtain" or shadow falling over their field of vision.
🚨 Blurred or distorted vision.
The professor also mentioned asking about yellow rings as a possible visual disturbance.
What is Lhermitte's Sign in MS?
An "electric shock" sensation that runs down the spine when bending the neck forward.
What is the only insulin you can give via IV?
Regular Insulin
What lab test is the gold standard for confirming a CSF leak?
Beta-2 transferrin.
What is optic neuritis in MS?
Why it's important: This is often one of the first and most telltale signs of an MS exacerbation.
What it is: Inflammation of the optic nerve, causing pain with eye movement and central vision loss.
Symptoms of Meniere's Disease during an acute attack?
🚨 Vertigo, Nausea, and Vomiting: The vertigo is so intense that patients are often confined to bed and cannot move their head without becoming severely nauseous and vomiting.
🚨 Nystagmus: You may observe uncontrolled, jerky eye movements.
🚨 Imbalance: They will be unable to stand or walk. The professor said, "the first time you ever see it, you're not going to forget it."
Describe what a Laminectomy is indicated for and what the surgery is:
Bonus if you can state the nursing priority when you are moving a patient after having a spinal cord injury!
Laminectomy: Removes part of a vertebra to relieve pressure on the spinal cord or nerves.
Nursing Priority: When moving a patient after spine surgery, you must control their head and use the log roll technique to maintain spinal alignment.