TBI
The three manifestations of Cushing's triad.
What are severe hypertension, widened pulse pressure, and bradycardia?
9th pg 945
10th pg 917
Expected findings for meningitis.
What are decreased LOC, photophobia, nuchal rigidity, memory changes, nausea, vomiting, fever and chills?
Key Features Box
9th pg 881
10th pg 867
Initial and priority assessment focuses in a patient with a cervical spinal cord injury.
What is airway management?
9th pg 897
10th pg 881
Expected findings for myasthenia gravis
What are progressive weakness that improves with rest, ptosis, diplopia, respiratory compromise, loss of bowel bladder control, fatigue?
Key Features Box
9th pg 917
Expected findings for ALS.
What are fatigue, muscle atrophy and weakness, dysarthria, dysphagia, stiff and clumsy gait?
Table 43-1 9th ed pg 889
Table 40-1 10th ed pg 874
The most important variable to assess with any patient with a brain injury.
What is LOC?
"A decrease or change in LOC is typically the first sign of deterioration in neurologic status- restlessness, increased sleepiness, or combativeness"
9th pg 946
10th pg 917
Priority interventions for meningitis
Vitals and neuro checks every 2 to 4 hours to identify signs of increasing ICP and maintaining a patent airway?
Best Practice Box
9th pg 882
10th pg 868
Action Alert Box
9th pg 882
10th pg 868
Symptoms of neurogenic shock after a spinal cord injury.
What are bradycardia, hypotension and hypothermia?
A systolic BP less than 90mmHg requires treatment because lack perfusion to the spinal cord could worsen the patient's condition.
9th pg 896
10th pg 890
The medication given to MG patients to improve muscle strength.
What is pyridostigmine?
Too much of this medication can lead to a cholinergic crisis. You will see increased weakness, accompanied by hypersalivation, sweating, and increased bronchial secretions.
9th ed pg 919
True or False: Once the ALS patient experiences difficulty breathing, supportive care should begin because the patient will not get better.
What is true?
Table 43-1 9th ed pg 889
Table 40-1 10th ed pg 874
"Progressive muscle weakness and wasting leading to paralysis of respiratory muscles."
Best position for a patient with a TBI.
What is HOB 30 degrees, avoiding extreme flexion or extension of the neck and maintaining the head in midline position? Also log roll the patient, to avoid extreme hip flexion.
Action Alert Box
9th pg 947
10th pg 919
Type of isolation a patient with bacterial meningitis should be on
What is Droplet Precautions?
Action Alert Box
9th pg 883
10th pg 868
Symptoms of autonomic dysreflexia
What are sudden, significant rise in BP, profuse sweating, flushing, goose bumps, and blurred vision?
Key Features
9th pg 896
10th pg 880
The priority for the trigeminal neuralgia patient.
What is pain management?
The drug of choise for trigeminal neuralgia is carbamazepine, an anti-epileptic drug. Gapabentin, pregabalin, and baclofen can also be given.
9th ed pg 924
Expected findings for Guillan Barre Syndrome (GBS).
Ascending symmetrical muscle weakness (flaccid paralysis without muscle atrophy), decreased DTRs, respiratory compromise, ataxia, paresthesia, pain (cramping), dysphagia, diplopia, difficulty speaking, CSF that reveals elevated protein?
9th ed pg 914
Saunders pg 846
Expected findings for a mild TBI.
What are disorientation, loss of short-term memory, dizziness, headache, and irritability?
Key Features Box
9th pg 945
10th ed pg 917
Diagnostic tool for meningitis
What is a lumbar puncture and evaluation of cerebrospinal fluid?
9th pg 882
10th pg 867
Emergency interventions for Autonomic Dysreflexia (AD).
What are raise the HOB immediately, notify PCP and RRT, determine cause and treat promptly?
9th pg 898 Critical Rescue and Best Practice Box
10th pg 882
Education for the trigeminal neuralgia patient.
What are TN involves bouts of pain and then spontaneous remissions, attacks get worse the older you get, avoid chewing on the affected side, avoid cold or hot application to the affected side, use a soft bristled tooth brush for oral care?
9th ed 923
Saunders pg 845
Treatment for GBS.
What are plasmapheresis and or IV immunoglobulin (IVIG)?
Corticosteroids are not used unless medically necessary to treat other associated diseases.
Monitor respiratory status closely and prepare to initiate respiratory support, monitor cardiac status, assess for complications of immobility.
9th ed pg 915
Saunders pg 846
Education for those experiencing a mild TBI.
What are avoid sedatives, do not engage in strenuous activity for 48 hours, give Tylenol for a headache?
Education Box
9th pg 949
10th pg 921
Area where meningitis outbreaks are most likely to occur.
What are areas of high population density such as college dormitories, military barracks and crowded living areas?
9th pg 881
10th 867
Medications used to treat hypotension and bradycardia when in neurogenic shock.
What are dopamine (vasopressor) and dextran (volume expander) and atropine (bradycardia)?
9th pg 898
10th pg 881-882
Education points for Bell's palsy patients.
What are steroids will be used for a week after onset of symptoms to reduce inflammation, antivirals will be taken for 7-10 days after symptoms start, close the affected eyelid at intervals to prevent dry eye, eat and drink using the unaffected side, massage and warm moist heat can help with pain, taste impairment will resolve, ringing in the ears is expected and will resolve, and remission normally happens within 3 months of onset.
9th ed. pg 924-925
Saunders pg 846
True or false: IVIG has been shown to be most effective when given as a bolus.
What is false?
Anaphylaxis can occur so IVIG initially infuses slowly and then the rate is increased based on how the patient tolerates the medication.
9th ed. pg 915