Flashcard decks

Exam 4

188 flashcardsby Irene
Study these flashcardsFree · spaced repetition · iPhone, Android, Mac & web

All cards

1
A traumatic brain injury (closedlunt)
When the head accelerates and then rapidly decelerates or collides with another object and the brain tissue is danaged but there is no opening through the skull and dura
2
A traumatic brain injury (open/penetrating)
when an object penetrates the skull, enters the brain, and damages the soft brain tissue in its path or when blunt trauma to the skull is so severe that it opens the scalp, skull and dura to expose the brain
3
Injuries to the brain can be either
  • diffuse
  • focal
4
Focal Injuries
  • contusions (aka bruises)
  • hematomas
5
DIffuse Injuries
involves concussions and diffuse axonal injury (which is a type of TBI)
6
Cerebral Contusion
when the brain is bruised and damaged in a specific area because of severe acceleration-deceleration force or blunt trauma
7
Clinical manifestations of a contusion depend on the
  • size
  • location
  • extent of surrounding cerebral edema
8
Most celebral contusions are located in the
  • anterior portions of the frontal and temporal lobes
  • around the sylvian fissure
  • at the orbital areas
9
Cerebral contusions are less commonly located at
  • Parietal areas
  • Occipital areas
10
Contusions can be characterize by
  • loss of consciousness
  • associated with stupor and confusion
11
Collection of blood
hematoma
12
Hematomas in the brain can be located
  • Epidural (above the dura)
  • Subdural (below the dura)
  • Intracerebral (within the brain)
13
A rapidly developing hematoma in the brain, even if small, may be
fatal
14
A large, slow developing hematoma in the brain may cause
an increase in ICP
15
The space between the skull and the dura mater
Epidural (extradural) space
16
A skull fracture that causes a rupture or laceration of the middle meningeal artery can result in
a hematoma in the epidural space
17
Excessive or profuse bleeding
hemorrhage
18
Rapid pressure in the brain is caused by
a hemorrhage/hemorrhaging from the middle meningeal artery
19
The most common type of herniation syndrome associated with an EDH is
uncal herniation causing pressure on the midbrain
20
Why are epidural hematomas considered an emergency?
They can cause neurologic deficits or even respiratory arrest (can occur in minutes)
21
What is inserted into a burr hole to remove hematomas
A drain
22
Treatment for epidural hematomas
Burr holes are used to remove the clot and control the bleeding
23
A collection of blood between the dura and the brain (a space normally occupied by a thin cushion of fluid)
Subdural hematoma
24
The most common cause of SDH
trauma
25
SDHs can be acute or chronic depending on
  • the size of the vessel
  • amount of bleeding present in the CT scan
26
An acute SDH is usually caused by
a head injury (typically a fall)
27
Signs & symptoms of an acute SDH
  • Level of consciousness
  • Pupillary signs
  • Hemiparesis
  • Coma
  • Increasing BP
  • Decreasing HR
  • Slow RR
28
Chronic SDH
  • develops from seemingly minor head injuries
  • most frequently seen in older adults
29
During chronic SDH the time frame of the injury to the onset of symptoms can be
lengthy
30
Chronic SDH can be mistaken for a
stroke
31
Symptoms of chronic SDH
  • severe headache
  • alternating focal neurologic signs
  • personality changes
  • mental deterioration
  • focal seizures
32
When would a craniotomy be indicated?
When a sizeable subdural mass that can not be drained or suctioned through burr holes is present
33
Bleeding into the parenchyma of the brain
Intracerebral Hemorrhage
34
When is ICH seen?
During head injuries when force is exerted to the head over a small area
35
Other causes if intracerebral hemorrhage besides head injuries
  • Systemic hypertension
  • Rupture of an aneurysm
  • Vascular anomalities
  • Intracranial tumors
  • Bleeding disorders (eg: leukemia)
  • Complicatioons of aticoagulant therapy
36
Management of ICH
  • Supportive care
  • Control of ICP
  • Careful administration of fluids
  • Antihypertensive medications
37
Surgical Interventation of ICH
  • Craniotomy
  • Craniectomy
38
Concussion
A temporary loss o neurologic function with no apparent structural damage to the brain
39
Most TBIs are caused by
falls or concussions
40
If the brain tissue in the frontal lobe is affected, the patient may exhibit
bizarre irrational behavior
41
If brain tissue in the temporal lobe is affected it can produce
Amnesia or disorientation
42
What do you monitor in a patient with a concussion
  • A decrease in LOC
  • worsening headache
  • dizziness
  • seizures
  • abnormal pupil response
  • vomiting
  • irritability
  • slurred speech
  • numbness or weakness in the arms or legs
43
Repeated concussive incidents can lead to a syndrome known as
Chronic Traumatic Encephalopathy
44
Chronic Traumatic Encephalopathy is characterized by
  • personality changes
  • memory impairment
  • speechait disturbances
45
Diffuse Axonal Injury (DAI)
Due to widespread shearing and rotational forces that produce damage throughout the brain
46
A patient with DAI with severe head trauma may experience
  • no lucid interval
  • immediate coma
  • decorticate & decerebrate
  • posturing
  • global cerebral edema
47
Diffuse Axonal Injury (DAI) is associated with
prolonged traumatic coma
48
Scans to diagnosis DAI
  • CT scan
  • MRI scan
49
What is the inital assessment after a brain injury?
Physical and neurologic examination
50
Main diagnostic tools for brain injuries and evaluating brain structure
CT & MRI scans
51
What is used to assess brain function?
Positron Emission Tomography
52
Any patient with a brain injury is presumed to have a
cervical spine injury until proven otherwise
53
When transporting a patient with a brain injury you must
maintain head and neck in alignment via a cervical collar
54
Common causes of secondary brain injury
  • Cerebreal edema
  • Hypotension
  • Respiratory distress
  • Hypoxemia
  • Electrolyte imbalance
55
Treatments to prevent secondary brain injury
  • Stabilization of cv function
  • Stabilization of respiratory function
  • Control of hemorrhage
  • Hypovolemia
  • maintenance of optimal ABGs
56
Inital management of ICP
preventing a secondary injury and maintaining adequate cerebral oxygenation
57
How does ICP occur
  • damaged brain swells with edema
  • blood collects within the brain
58
Why is surgery required for ICP?
  • For evacuation of blood clots
  • debridement
  • elevaluation of depressed skull fractures
  • repairing deep scalp lacerations
59
How is ICP managed if it keeps increasing?
  • Maintaining adequate oxygenation
  • Elevating the head of the bed
  • maintaining normal blood volume
60
Devices to monitor ICP or to drain CSF are inserted
  • During a surgical procedure
  • bedside using aseptic technique
61
Supportive measures for ICP
  • Ventilatory support
  • Seizure prevention
  • Fluid & electrolyte maintence
  • Nutritional support
  • Management of pain and anxiety
62
What is given following seizures to prevent brain damage from hypoxia?
Anticonvulsant agents
63
If a patient is very agitated after a head injury what is given?
  • Propofol
  • Lorazepam
64
Why might a NG tube be inserted after a head injury?
Regurgiation adn aspiration are common within the first few hours due to reduced gastric motility and reverse peristalsis
65
The 3 Cardinal Signs of Brain Death
  • Coma
  • Absence of brain stem reflexes
  • Apnea
66
What tests are used to confirm brain death?
  • Cerebral Flow studies
  • EEG
  • Transcranial Doppler
  • Brain stem auditory-evoked potential
67
A history of unconsciousness or amnesia after a head injury indicates
A significant degree of brain damage
68
Assessment of thr patient after brain injury
  • LOC using Glasgow Coma Scale
  • Assessing the patient’s response to tactile stimuli
  • Pupillary response to light
  • Corneal and gag reflexes
  • Motor function
69
Three criteria of Glasgow Coma Scale
  • Eye opening
  • Verbal responses
  • Motor responses to commands or painful stimuli
70
Glasgow Coma Scale
A tool for assessing a patient’s response to stimuli. Scores range from 3 (deep coma) to 15 (normal)
71
Potential complications of traumatic brain injury
  • decreased cerebral perfusion
  • Cerebral edema and herniation
  • Impaired oxygenation and ventilation
  • Impaired fluid, electrolyte and nutritional imbalance
  • Risk for post-traumatic seizures
72
Goals for patients with TBI
  • Maintenance of a patent airway
  • Adequate CPP
  • Fluid & electrolyte balance
  • Adequate nutritional status
  • Prevention of secondary injury
  • Maintenance of body temperature
  • maintenance of skin integrity
  • improvement of coping
  • prevention of sleep deprivation
  • effective family coping
  • increased knowledge about the rehabiliation process
  • absence of complications
73
During a TBI a patient’s condition may worsen if the patient is
hypoxic
74
An obstructed aurway during TBI causes
carbon dioxide retention and hypoventilattion which can produce cerebral vessel dilation and increaded ICP
75
Interventions to ensure adequate exchange of air
  • Proper positioning that faciliatates drainage
  • Establishing effective suctioning procedures
  • Guarding against aspiration and respiratory insufficiency
  • Closing monitoring ABGs
  • Monitoring for pulmonary complications (for an intubated patient)
76
What can prevent ventilator-associated pneumonia
Good oral hygiene
77
A GCS score between 3 & 8 is
accepted as indicating a severe head injury
78
Signs of increasing ICP include
  • bradycardia
  • increasing systolic blood pressure
  • widening pulse pressure (Cushing’s relex)
79
During TBI body temperature should be maintained at
less than 38 degrees C/ 100.4 degrees F
80
Hyperthermia increases the what, in a patient with a head injury
metabolic demands of the brain and may indicate brain stem damage
81
How is motor function assessed during TBI
  • Observing spontaneous movements
  • asking the patient to raise and lower their extremities
  • comparing the strength and equality of the upper and lower extremities at periodic intervals
82
When is it importsnt to monitor electrolyte levels in patient’s with TBI?
  • patients reveiving osmotic diuretics
  • patients with syndrome of inappropiate antidiuretic hormone secretion
83
Increasing lethargy, confusion and seizures may be the result of
electrolyte imbalance
84
How is endocrine function evaluated?
by monitoring serum electrolytes, blood glucose values and I&Os
85
Why should you avoid opoids as controlling restlessness in TBI patients
they depress respirations, constrict the pupils and alter responsiveness
86
Adequate CPP
Greater than 50 mmHg, anything lower can cause ICP
87
Controlling ICP in patients with severe brain injuries
  • Elevate the head of the bed
  • Maintain the head and neck in neutral alignment
  • Prevent the Valsalva maneuver
  • maintain body temperature
  • administer O2 to maintain partial pressure of arterial oxygen >90 mmHg
  • Maintain fluid balance with normal saline
  • avoid noxious stimuli
  • administer sedation to reduce agitation
  • maintain cerebral perfusion pressure of 60-70 mmHg
88
Basal skull fractures are suspected when
CSF escapes through the ears and/or the nose
89
Drainage of CSF is a serious problem because
mengingeal infection can occur if organisms gain access to the cranial contents via the nose, ear or sinuses through a tear in the dura
90
Neurogenic shock
develops as a result of the loss of autonomic nervous system function below the level of the lesion
91
Neurogenic shock affects vital organs causing
decrease in BP, RR and cardiac output as well as pooling in the extremities ans peripheral vasodilation
92
Spinal shock
a sudden depression of reflex activity in the spinal cord that occurs below the level of injury
93
During spinal shock the muscles innervated by the part of the spinal cord segment below the level of the lesion are without
  • sensation
  • paralyzed
  • flaccid
  • reflexes are absent
  • BP may be decreased
  • patient may be bradycardic
94
Hypotension and shock can further damage the
spinal cord
95
During spinal shock the mean arterial pressure should be maintained at
85 mmHg or higher during the hypercute phase
96
Autonomic Dysreflexia
is an acute life-threatening emergency that occurs as a result of exaggerated autonomic responses to stimuli that are harmless in people without SCI. Only occurs after spinal shock has resolved
97
Symptoms of autonomic dysflexia
  • severe, poounding headache with paroxysmal hypertension
  • profuse diaphoresis abouve the spinal level of the lesion
  • nausea
  • nasal congestion
  • bradycardia
98
The sudden increase in BP during Autonomic Dysreflexia may cause
  • retinal hemorrhage
  • hemorrhagic strokemyocardial infarction
  • seizures
99
Stimuli that can trigger Autonomic Dysreflexia
  • distended bladder
  • distention or contraction of the visceral organs
  • stimulation of the skin
100
During Autonomic Dysreflexia the following measures are carried out
  • the patient is immediately placed in a sitting position
  • the bladder is emptied
  • the rectum is examined for a fecal mass
  • the skin is examined for any areas of pressure, irration or broken skin
101
The main types of anesthesia
  • General
  • Regional
  • Moderate
102
A state of narosis, analgesia, relaxation and reflex loss
anesthesia
103
Patients under general anesthesia are not
arousable, not even to painful stimuli
104
Patients under anesthesia
  • lose the ability to maintain ventilatory function
  • require assistance in maintaining a patent airway
  • have impaired cv function
105
General anesthesia STAGE ONE cause patients may feel
  • dizzy
  • detachment
  • ringing, roaring or buzzing in the ears
  • inability to move extreminities
  • become agitated
  • exaggerated noises
106
General anesthesia STAGE TWO cause patients may
  • struggle
  • shout
  • talk
  • sing
  • laugh
  • cry
  • have dilated pupils with light
  • have a rapid pulse
  • irregular respirations
107
General anesthesia STAGE THREE
  • patients are unconscious
  • have small pupils and contract with light
  • have regular respirations
  • have regular pulse rate
  • have pink or slightly flushed skin
108
General anesthesia STAGE FOUR patients may
  • reach medullary depression
  • pulse is weak
  • pupils become widely dilated and do not constrict
  • cyanosis develops
  • death can occur
109
If stage four of general anesthesia occurs, what happens?
the anesthetic agent is discontinued immediately and respiratory and circulatory support is initiated to prevent death
110
What condition diminishes peripheral blood flow and may reduce the amount of anesthetic medication required?
vasoconstriction or shock
111
Inhaled anesthetic agents include
volatile liquid agents and gases
112
Volatile liquid anesthetic agents are given in combination with
oxygen and usually nitrous oxide
113
Gas anesthetic agents are given by inhalation and are always combined with
oxygen
114
The most commonly used gas anesthetic agent
  • Nitrous oxide
  • Sevoflurane
  • Desflurane
115
The inhalation anesthetic agent may be given through an
Laryngeal mask airway (LMA)
116
The endotracheal technique may be inserted through either
the nose or the mouth
117
General anesthesia can be produced by
IV administration
118
An advantage of IV anesthesia is that the onset of anesthesia is
pleasant (none of the buzzing, roaring or dizziness like with an inhalation anesthetic)
119
IV anesthesia is useful for
short procedures
120
IV anesthesia is not indicated for those who require
intubation because of their susceptibility for respiratory obstruction
121
Multimodal analgesia
regimens in surgical patients often use a combination of scheduled, nonopioid analgesic anesthesia and regional anesthesia techniques
122
The patient receiving regional anesthesia is
awake and aware
123
In regional anesthesia an anesthetic agent is
injected around nerves so that the region supplied by these nerves is anesthetized
124
Epidural anesthesia blocks
sensory, motor nd autonomic functions
125
An advantage of epidural anesthesia is
the absence of headache that can result from spinal anesthesia
126
An extensive conduction nerve block that is produced when a local anesthetic agent is introduced into the subarachnoid space at the lumbar level, usually between L4 & L5
spinal anesthesia
127
Peripheral nerve block
are used in conjunction with general or MAC anesthesia or as a stand-alone method
128
Moderate sedation, previously referred to as conscious sedation is a form of
anesthesia that involves the IV administration or analgesic medications to reduce patient anxiety and control pain during diagnostic or therapeutic procedures
129
With moderate sedation, the patient is able to
  • maintain a patent airway
  • retain protective airway reflexes
  • respond to verbal & physical stimuli
130
The continual assessment of the patient’s vital signs, level of consciousness, cardiac function and respiratory function is an essential component of
moderate sedation
131
Local Anesthesia
is the injection of a solution containing the anesthetic agent into the tissues at the planned incision site
132
Advantages of Local Anesthesia are
  • it is simple, economical and nonexplosive
  • minimal equipment is needed
  • post-op recovery is brief
  • undesirable effects of general anesthesia are avoided
  • ideal for short and minor surgical procedures
133
Local Anesthesia is often given in combination with
Epinephrine
134
Epinephrine
constricts blood vessels which prevents rapid absorption of the anesthetic agent and thus prolongs its local action and prevents seizures
135
Local Anesthestic Systemic Toxicity (LAST)
is a potentially life-threatening event and occurs when a blous of LA is inadvertently injected into peripheral tissue or venous/arterial circulation; resulting in CV or neurologic collapse
136
Signs & symptoms of LAST
  • Metallic taste
  • oral numbness
  • auditory changes
  • slurred speech
  • arrhythmias
  • seizures
  • airway management
137
Inital treatment of LAST should be
airway management
138
To promote sound clinical reasoning and judgement, your nursing assessment should be
  • Purposeful
  • Prioritized
  • Complete
  • Systematic
  • Factual & Accurate
  • Relevant
  • Recorded in a standard manner
139
Shelly & Fish Three Spiritual Needs
  • Need for meaning and purpose
  • Need for love and relatedness
  • Need for forgiveness
140
Nurses can assist patients to meet spiritual needs by offering a compassionate presence like
  • Assisting in the struggle to find meaning
  • fostering relationships
  • facilitating the patient’s expression of religious/spiritual beliefs
141
Spirituality
anything that pertains to a person’s relationship with a nonmaterial life force or higher power
142
Aspects of spirituality include:
  • spirituality is experienced as a unfying force
  • spirituality id expressed and experienced in and through connectedness with nature
  • People express and experience spirituality in and through connectedness with other people
  • Spirituality shapes self-becoming and is reflected in a person’s being, knowing and doing
  • Spirituality permeates life providing purpose, meaning, strength, guidance and shaping the journey
143
Products of relationships
  • physical
  • emotional
144
Faith
refers to a confident belief in something for which there is no proof or material evidence
145
Atheist
is a person who denies the existence of a higher power
146
Agnostic
one who holds that nothing can be known about the existence of a higher power
147
Religion
defined as an organized system of beliefs about a higher power that often includes set forms of worship, spiritual practices, and a code of conduct
148
Hope
is the ingredient in life responsible for a positive outlook
149
Suffering
a specific state of distress that occurs when the intactness or integrity of the person is threatened or disrupted
150
Spiritual health/ Spirital well-being
is the condition that exists when the person’s universal spiritual needs for meaning, purpose, love, belongning and forgiveness are met
151
O’Brien’s Three Empirical Referents of Spiritual Well-being
  • personal faith
  • spiritual contentment
  • religious practice
152
Spiritual Healing
is the movement toward integration from bleakness to wholeness
153
Spiritual beliefs and practices are associated with
all aspects of a person’s life, including health and illness
154
Religious influences may be life affirming or life denying. Life affirming influences
  • Enhance life
  • Give meaning
  • Purpose to existence
  • Strengthen a person’s feelings of self-worth
  • Encourage self-actualization
  • health giving and life sustaining
155
Life denying influences
  • Restrict or enclose life patterns
  • limit experiences and association
  • place burdens of guilt on people
  • encourage feelings of unworthiness
  • health denying
  • life inhibiting
156
Loss
occurs when a valued person, object or situation is changed or becomes inaccessible such that its value is diminished or removed
157
Actual loss
can be recognized by others as well as by the person sustaining the loss
158
Perceived loss
  • such as a loss of youth
  • finanical independence
  • valued environment
159
Maturational loss
experienced as a result of natural development processes
160
Situational loss
is experienced as a result of an unpredictable event, traumatic injury, disease, death or national disaster
161
Anticipatory loss
occurs when a person displays loss and grief behaviors for a loss that has yet to take place
162
Grief
is an internal emotional reaction to loss
163
Normal reactions to grief may be
  • physical
  • emotional
  • social
  • spiritual
164
Mourning
the actions and expressions of grief
165
Bereavement
a state of grieving due to loss of a loved one
166
Stages of Grief
  • Shock & disbelief
  • Developing Awareness
  • Resitution
  • Resolving the loss
  • Idealization
  • Outcome
167
Shock and disbelief are usually defined as
Refusal to accept the fact of loss
168
Developing awaremess is characterized by
physcial and emotional responses such as anger, feeling empty and crying
169
Restitution involves
The rituals surrounding loss (eg: funeral services)
170
Resolving loss
dealing with the void left by the loss
171
Idealization is
the exaggeration of the good qualities of the person or object (followed by acceptance of the loss and a lessened need to focus on it)
172
Outcome, the final resolution of the grief process includes
  • Denial & isolation
  • Anger
  • Bargaining
  • Depression
  • Acceptance
173
Denial
the patient denies the reality of death and may repress what is discussed
174
Anger
The patient expresses rage & hostility
175
Bargaining
The patient tries to barter for time
176
Depression
The patient goes through a period of grief
177
Acceptance
The patient has accepted the reality of the death and is tranquil
178
With inhibited grief
suppresses feelings of grief and may instead manifest somatic symptoms
179
The Uniform Determination of Death Act
  • Irreversible cessation of circulatory and respiratory functions
  • irreversible cessation of all functions of the entire brain
180
The medical criteria used to certify a death
  • Breathing cessation
  • No response to deep painful stimuli
  • Lack of reflexes
  • Flat encephalogram
181
Heart-lung death
Cessation of the apical pulse, respirations, and blood pressure
182
Cerebral or higher brain death
When the cerebral cortex is irreversibly destroyed
183
Clinical signs of impending or approaching death:
  • difficulty talking or swallowing
  • nausea, flatus, abdominal distention
  • Urinary/ bowel incontinence/constipation
  • Loss of movement/sensationeflexes
  • Decreasing body temperature (cold/clammy skin)Weak/slow/irregular pulses
  • Decreasing BP
  • Noisy/irregular/Cheyne-Stokes respirations
  • Restlessness and/or agitation
  • Cooling/mottling/cyanosis of the extremities
184
Hospice Care
provided for people with limited life expectancy
185
Indicators for hospice referral
  • Poor performance status
  • Declining cognitive status
  • Advanced age
  • Poor nutritional status
  • Pressure injuries
  • Comorbidities
  • Previous hospital admissions for acute decompensation
186
Pallative Care
involves taking care of the whole person- body, mind, spirit, heart and soul
187
The goal of pallative care
giving patients with life-threatening illnesses the best quality of life possible by the aggressive management of symptoms
188
Advanced Directives
  • Indicates who will make decisions for the patient if the patient becomes unable to themself
  • indicates the kind of medical treatment the patient wants/doesn’t want
  • indicates how the patient wants to be treated by others
  • indicates what the patient wants love ones to know
Study all 188 cards for free