Neuro
Name some factors that contribute to increased ICP
increased brain mass, increased CSF, increased blood volume, increased metabolic demands
What documents/documentation should be obtained before surgery?
Advanced directives, informed consent, history and physical
What are the three stages of shock?
Compensatory, Progressive, Irreversible
Name 4 signs and symptoms of stroke
One-sided weakness
Numbness/paralysis of face, arms, or legs
Blurred vision in one or both eyes
Difficulty speaking
Slurred speech
Facial drooping
Loss of balance/coordination
Severe headache
What is the most common cause of hemorrhagic stroke?
Uncontrolled HTN
what are the components of Cushing's Triad and what do they signify?
Bradycardia, Hypertension, Irregular Breathing (Cheyne-Stokes)
Indicate severe increased ICP and impending brain herniation
What are some nursing considerations around informed consent?
- surgeon and anesthesiologist must review
- required for non-emergent procedures
- Must include: clear description of procedure/surgery, benefits, risks, alternatives, complications, consequences without surgery)
- Nurses clarify this information with patients but should contact provider with concerns about patient understanding.
What are three causes for obstructive shock?
PE, cardiac tamponade, tension pneumothorax
What is the major symptom difference in neurogenic shock?
bradycardia
What are the different types of distributive shock?
Neurogenic Shock, Anaphylactic Shock, Septic Shock
What are some things that should NOT be done when a patient is experiencing a seizure?
Do not move them or restrain them
Do not perform rescue breathing
Do not place anything in their mouth
How would a nurse intervene to prevent atelectasis?
early ambulation, deep breathing and coughing exercises, education on incentive spirometer use
What is the core problem of anaphylactic shock?
a severe allergic reaction causes airway edema and massive vasodilation and capillary leakage, this decreases perfusion
What are some nursing interventions for a stroke patient experiencing dysphagia?
Monitor daily weights (nutritional intake)
Maintain oral hygiene (q2-4h)
Positioning of patient, ideal diet, food placement, management of behavioral and environmental factors, management of choking
What is myasthenic crisis?
When a patient forgets, or takes too little of the medication, has an infection, surgery, or some change in their treatment used for their myasthenia gravis, leading to issues such as severe respiratory failure
What is the difference between a simple partial seizure and a complex partial seizure?
Simple seizures maintain awareness, while complex seizures cause confusion, dazed behavior, or loss of consciousness
What are some common discharge nursing instructions/tasks? Name 3!
Expected outcomes and immediate anticipated post-op changes (permanent anatomic changes or function, ADLs, responsibilities)
Interventions and strategies for changes in function/structure
Ongoing therapeutic regimen including diet and activities to perform and what to limit or avoid
Med education
Access to med supplies, how to perform dressing changes/wound care, other prescribed regimens
S/S of complications
Date and time of follow-up appts
How to reach healthcare provider with questions/concerns
Community resources and referrals
Name four clinical manifestations that a patient is in the irreversible stage of shock!
unresponsive or comatose
multiorgan failure that does not respond to interventions
bradycardia; dysrhythmias
Coagulopathies (petechiae, purpura, bleeding)
Severe hypotension
Name four s/s of Septic Shock!
fever/chills OR feeling cold, weakness, confusion, dyspnea, "I just don't feel right", hypothermia, tachycardia, tachypnea, hypotension, AMS, warm or cool mottled skin, elevated lactate levels, abnormal WBC count
What are some assessments that should be done preoperatively? Name 2!
Optimal health, allergies: latex and betadine, lab studies, radiologic studies
Neurological status: ability to consent, cognitive baseline
Respiratory: obstructive sleep apnea tool, s/s of respiratory infection, smoking cessation
Cardiovascular: cardiac disease, cardiac rhythm, BP status, chest x-ray, ECG
Hepatic: ability to clear meds and anesthetic gases, LFTs, renal disease (exceptions are made)
Psychosocial Needs: evaluate support systems, coping strategies, non-pharmacological relaxation techniques, respect for alternative forms of expression/spiritual beliefs
What are the four medical managements for increased brain mass?
Mannitol (osmotic diuretic)
- Expands plasma and reduces hematocrit/viscosity
- Osmotic gradient created - moves fluid from tissues into vasculature
- Must monitor electrolyte status (serum osmolality)
Lasix (loop diuretic)
- Inhibit sodium and chloride reabsorption in the ascending loop
- Reduce blood and tissue volume and CSF production
Dexamethasone
- Steroid that treats cerebral edema; can increase BS and disrupt GI
- ONLY used for brain tumors
Hypertonic solution
- Monitor I&Os and serum Na
What are some postoperative care nursing interventions? Name 3!
Nausea/Vomiting - preventative medication, increased risk with increased pressure, aspiration risk
VTE - leg and calf exercises, early ambulation, protocols with compression socks/stockings, enoxaparin
Bleeding - monitor at surgical site for bleeding, hematoma, drain output; interprofessional collaboration for restarting anticoagulants
Infection - monitor for s/s of both local and systemic infection, maintain clean dressings, control blood sugars
Wound dehiscence and evisceration - monitor wound edges, utilize abdominal binders, split surgical site when pressure increases (ambulation, coughing)
Urinary retention - identify risk, early ambulation, adequate hydration (as ordered), avoid indwelling catheters where possible
Name the SIRS Diagnosis requirements
Requires at least 2 of the following:
RR > 20
Temp > 38 degrees
HR > 90
WBC < 4,000 or >12,000 or bandemia >10%
What is the MODS definition? Give three organ systems and examples of s/s of their failure.
Progressive impairment of two or more organ systems resulting from an uncontrolled inflammatory response to a severe illness or injury
Persistent fever or hypothermia
Signs of systemic inflammation: tachycardia, tachypnea, and hypotension despite fluid resuscitation
MODS ≥ 2 organs failing
Renal: dec urine output
Neuro: altered mental status
Cardiac: hypotension
Respiratory: inc work of breathing
Hepatic: Inc LFTs
Hematologic: dec platelets
Name all the types of shock and how they related to the gas pump analogy
Hypovolemic (no gas)
Cardiogenic (something wrong with the pump)
Obstructive (something is blocking the flow of the gas, but the pump and gas are fine)
Distributive (pipes are leaky or too big)