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Med/Surg II
Nursing School
| Question | Answer |
|---|---|
| 4 Lobes of CNS | Frontal, Parietal, Temporal, Occipital |
| What is the function of the frontal lobe? | Abstract thinking, motor abilities |
| What is the function of the parietal lobe? | depth, coordination, spatial |
| What is the function of the temporal lobe? | Memory, Auditory (Werniecke's), interpreting speech |
| What is the function of the occipital lobe? | Visual |
| What are the 4 parts of the brain? | Cerebrum, Cerebellum, Diencephalon, Branstem |
| What does the diencephalon contain? | Hypothalamus/Thalamus/Sensory Nerves |
| What does the hypothalamus do? | regulates temperature and sleep/wake cycle |
| What does the brainstem contain? | midbrain, pons, and medulla |
| What does the brainstem/medulla do? | respiratory center; controls HR, BP, cough, vomit, sneeze |
| Signs of spinal cord herniation? | eye pupil will bulge and dilate, non-reactive, pupils unequal, irregular/decreased respirations, failure of thermoregulatory center causing hyperthermia |
| Normal ICP range? | 0-15 |
| What are dermatomes? | nerves coming out from middle of spinal cord; |
| Name 3 meninges superficial to deep. | Duramater, Arachnoid, Piamater |
| What does the ANS control? | Has 2 sub systems- Para/SympatheticParasympathetic: slows down everything; releases ACHSympathetic: fight or flight; releases norepinephrine |
| What to assess in neuro exam? | LOC, language, motor function, family/drug hx, meds |
| What is Cushings Triad? | change in VS due to pressure on brainstem which cause an increase in ICP |
| S/S of Cushings Triad? | widened pulse pressure (100+), Bradycardia (>60), change in respiratory pattern, |
| LOC: Obtunded? | arousable but falls back to sleep |
| LOC: Stupor? | not arousable but moves to push away |
| How to assess for coma? | assess dolls eye and cold caloric reflex (ear) |
| Dolls eye? | eyes move opposite way that head turns...absent=abnormal which could mean brain death |
| Cold Caloric Reflex of Ear? | Insert cold NS, 50mL into ear and expect to see slow movement of eyes to opposite sides and then back to middle and move back and forth....no movement = abnormal = possible brain death |
| What is a good Glascow Coma Scale score? | above 8 and no higher than 15 |
| What is aphasia? | can't speak, write or sign may be associated with Frontal/Parietal lobe |
| What is hemianopsia and what is it seen in? | blindness in half field of vision in both eyes; usually seen in strokes |
| Oculomotor nerve: | #3; eye movement |
| Olfactory nerve: | #1; smell |
| Optic nerve: | #2; vision; use snellen chart |
| Trochlear nerve: | #4; eye movement |
| Trigeminal nerve: | #5; blink/corneal reflex, face movement |
| Abducens nerve: | #6; eye movement |
| Facial nerve: | #7; smile, facial movement/expression |
| Vestibulocochlear nerve: | #8; hearing |
| Glossopharyngeal nerve: | #9; taste, gag reflex, cough, |
| Vagus nerve: | #10; swallowing |
| 4 Lobes of CNS | Frontal, Parietal, Temporal, Occipital |
| What is the function of the frontal lobe? | Abstract thinking, motor abilities |
| What is the function of the parietal lobe? | depth, coordination, spatial |
| What is the function of the temporal lobe? | Memory, Auditory (Werniecke's), interpreting speech |
| What is the function of the occipital lobe? | Visual |
| What are the 4 parts of the brain? | Cerebrum, Cerebellum, Diencephalon, Branstem |
| What does the diencephalon contain? | Hypothalamus/Thalamus/Sensory Nerves |
| What does the hypothalamus do? | regulates temperature and sleep/wake cycle |
| What does the brainstem contain? | midbrain, pons, and medulla |
| What does the brainstem/medulla do? | respiratory center; controls HR, BP, cough, vomit, sneeze |
| Signs of spinal cord herniation? | eye pupil will bulge |
| Normal ICP range? | 0-15 |
| What are dermatomes? | nerves coming out from middle of spinal cord; |
| Name 3 meninges superficial to deep. | Duramater, Arachnoid, Piamater |
| What does the ANS control? | Has 2 sub systems- Para/SympatheticParasympathetic: slows down everything; releases ACHSympathetic: fight or flight; releases norepinephrine |
| What to assess in neuro exam? | LOC, language, motor function, family/drug hx, meds |
| What is Cushings Triad? | change in VS due to pressure on brainstem which cause an increase in ICP |
| S/S of Cushings Triad? | widened pulse pressure (100+), Bradycardia (>60), change in respiratory pattern, |
| LOC: Obtunded? | arousable but falls back to sleep |
| LOC: Stupor? | not arousable but moves to push away |
| How to assess for coma? | assess dolls eye and cold caloric reflex (ear) |
| Dolls eye? | eyes move opposite way that head turns...absent=abnormal which could mean brain death |
| Cold Caloric Reflex of Ear? | Insert cold NS, 50mL into ear and expect to see slow movement of eyes to opposite sides and then back to middle and move back and forth....no movement = abnormal = possible brain death |
| What is a good Glascow Coma Scale score? | above 8 and no higher than 15 |
| What is aphasia? | can't speak, write or sign may be associated with Frontal/Parietal lobe |
| What is hemianopsia and what is it seen in? | blindness in half field of vision in both eyes; usually seen in strokes |
| Oculomotor nerve: | #3; eye movement |
| Olfactory nerve: | #1; smell |
| Optic nerve: | #2; vision; use snellen chart |
| Trochlear nerve: | #4; eye movement |
| Trigeminal nerve: | #5; blink/corneal reflex, face movement |
| Abducens nerve: | #6; eye movement |
| Facial nerve: | #7; smile, facial movement/expression |
| Vestibulocochlear nerve: | #8; hearing |
| Glossopharyngeal nerve: | #9; taste, gag reflex, cough, |
| Vagus nerve: | #10; swallowing |
| Spinal Accessory nerve: | #11; shoulder shrug |
| Hypoglossal nerve: | #12; tongue movement |
| What tests are used to assess muscle strength? | pronator drift and romberg's |
| Stereognosis? | recognize object with eyes closed |
| Graphesthesia? | identify word w/o writing it |
| 2-point discrimination? | sharp/dull |
| Anesthesia? | pain response; only assess if no WNL assessments |
| When is a LP not done? | when there is a suspected bleed |
| What should CSF look like? | clear, colorless, odorless; cloudy CSF indicates infection |
| What is the nurses job after client has a LP? | log roll for 4-6 hours, keep them FLAT! |
| When is an EEG used? | to detect seizures, braindeath |
| When is a CT scan used? | to detect stroke, ischemia, tumor and fluid on brain |
| If using a CT scan with contrast what are the precautions? | Be sure pt. is not allergic to iodine or shellfish |
| When is an MRI used? | to detect edema and more detailed about ischemia |
| When is a myelogram used? | to detect herniated disc or spinal stenosis |
| When is a cerebral angiogram used? | to detect bleeding in brain and vessels |
| What is Delirium? | acute mental change developing in short period of time; can be reversed as long as "illness" is fixed |
| What is Dementia? | change in mental status over long time; irreversible |
| Define: apraxia | can't recognize action |
| Define: aphasia | can't recognize speech |
| Define: agnosia | can't recognize object |
| What is a Grandmal Seizure? | seizure lasting more than minute with periods of apnea and muscle twitching |
| Nurses job in Grandmal Seizure? | maintain airway by turning to side, safety by protecting head and shielding from harm, observe the duration and activity |
| What causes a seizure? | increase in temp. or metabolic changes |
| Partial vs. Generalized Seizure? | partial is in one hemisphere of body, generalized is all over |
| Absent seizure, S/S? | blank stare from 10-30 seconds; usually seen in kids |
| Atonic seizures, S/S? | brief loss in muscle tone in one area |
| Myoclonic seizures, S/S? | specific muscle group twitch |
| Tonic-Clonic seizures, S/S? | aura, has two phases: ictal and postictal; ictal is the actual seizure, postictal is the amnesia or unconscious after seizure |
| Status epilepticus, S/S? | constant seizure one after another; need medicine STAT like Valium or Ativan |
| Dilantin | long term management of epilepsy; always given with NS; has cardiac effects, monitor BP, be on cardiac monitor; TL is 10-20 mcg/mL |
| Depakene | given secondary; monitor LFTs; TL 50-100mcg/mL; for seizures |
| Tegretol | pain management and anticonvuslant; only PO, TL 4-12 mcg/mL |
| Education for pt. on anticonvuslant? | rest, sleep, no caffeine, med alert bracelet, no alcohol, don't stop meds abruptly |
| Primary brain tumor vs. Metastatic | primary tumor is from brain, metastatic tumor is from cancer and usually more than one |
| How are brain tumors graded? | graded 1-4, 1 being least problematic to 4 being very large |
| Most common brain tumor? | glioblastoma; Highly malignant |
| S/S of Brain Tumor? | Headache, mental change, seizures, diplopia, increase of ICP |
| Rx of Tumor? | radiation, chemo, surgery |
| With surgery of tumor, what is given to client for pain relief? | Tylenol ONLY, NO Sedative |
| Mannitol? | given to decrease ICP; osmotic diuretic (rid of Na/H2O; IVPB; dehydration, monitor BP, diet, daily wt, I&O; Must have filter set |
| What to do after craniotomy? | give Tylenol only for pain; assess LOC/mental status STAT |
| Possible complications of craniotomy? | hydrocephalus, respiratory failure, CSF leak, corneal abrasions, gastric ulceration, DI, SIADH |
| Define: hydrocephalus | too much CSF; increased ICP; Rx by inserting V/P shunt |
| Define: respiratory failure in r/l to craniotomy | increase pressure on pons/medulla, need constant pulse ox |
| Define: CSF leak | CSF will leak out of nose/ears |
| Define: Corneal abrasions | no blinking due to pressure on trigeminal nerve |
| Define: Gastric ulceration in r/l to craniotomy | ulcer in stomach, rx: azole/tidine |
| Define: Diabetes Insipidus (DI) | Not enough ADH, causes dehydration |
| DI s/s: | lots of urine output and urine is clear, low urine SG, polyuria/dipsia, weight loss |
| Rx of DI: | give Vasopressin, fluids, Tegretol, monitor I&O, daily weight |
| Define: SIADH | increased amt of ADH, causes water intoxication, caused by increased ICP |
| SIADH S/S: | high urine SG, low urine output, weight gain, edema, crackles, JVD |
| Rx of SIADH: | limit fluid intake, osmotic diuretics, monitor Labs |
| Possible Infections of Craniotomy? | meningitis and encephalitis |
| Causes of Menigitis: | sinus infection, ear infection, craniotomy, basailar skull fracture, CSF leak |
| S/S of Menigitis: | Headache, nuchal rigidity, fever, irritability, cloudy CSF |
| How to test for Menigitis noninvasively? | Kernigs and Brudzinski's TestKernig's: hold leg out at 90 degrees, and pull up...will have pain in hamstring when knee is flexed Brudzinski's: flex neck and automatically leg moves upward |
| Causes of Encephalitis: | bacterial, viral, fungal |
| S/S of Encephalitis: | fever, headache, seizures, decreased LOC, nuchal rigidity |
| RX of Encephalitis: | seizure precautions, monitor ICP, stat antibiotics |
| Stroke can be caused by? | clot or bleeding in brainclot is most common at night b/c BP drops in bedbleeding is usually during up and moving times of day |
| Stroke risk factors: | Age, sex (male),race (Black, Hispanic), hypertension, diabetes, heart disease, smoking, obesity, family history |
| To reduce stroke in women over 35? | NO Birth Control Pills!!!!! |
| Indication of possible stroke with stethoscope? | Carotid Bruit, heard with the bell over the carotid arteries, makes swooshing noise |
| Stroke warning? | TIA (transient ischemic attack), may have just a few sec/min of weakness/numbness or visual disturbance on one side of body |
| Major problem with TIA/Stroke? | Dysphagia: no feeding b/c risk of aspiration, NPO until seen by speech therapist. |
| Nurses job if pt. is having a stroke? | Maintain airway, admin. O2, admin tpa within 3 hrs (blood thinner), give heparin, give aspirin |
| Decadrone: | steroid; increases blood sugar, antiinflammatory; give slowly IV or PO |
| What to do after craniotomy? | give Tylenol only for pain; assess LOC/mental status STAT |
| Possible complications of craniotomy? | hydrocephalus, respiratory failure, CSF leak, corneal abrasions, gastric ulceration, DI, SIADH |
| Define: hydrocephalus | too much CSF; increased ICP; Rx by inserting V/P shunt |
| Define: respiratory failure in r/l to craniotomy | increase pressure on pons/medulla, need constant pulse ox |
| Define: CSF leak | CSF will leak out of nose/ears |
| Define: Corneal abrasions | no blinking due to pressure on trigeminal nerve |
| Define: Gastric ulceration in r/l to craniotomy | ulcer in stomach, rx: azole/tidine |
| Define: Diabetes Insipidus (DI) | Not enough ADH, causes dehydration |
| DI s/s: | lots of urine output and urine is clear, low urine SG, polyuria/dipsia, weight loss |
| Rx of DI: | give Vasopressin, fluids, Tegretol, monitor I&O, daily weight |
| Define: SIADH | increased amt of ADH, causes water intoxication, caused by increased ICP |
| SIADH S/S: | high urine SG, low urine output, weight gain, edema, crackles, JVD |
| Rx of SIADH: | limit fluid intake, osmotic diuretics, monitor Labs |
| Possible Infections of Craniotomy? | meningitis and encephalitis |
| Causes of Menigitis: | sinus infection, ear infection, craniotomy, basailar skull fracture, CSF leak |
| S/S of Menigitis: | Headache, nuchal rigidity, fever, irritability, cloudy CSF |
| How to test for Menigitis noninvasively? | Kernigs and Brudzinski's TestKernig's: hold leg out at 90 degrees, and pull up...will have pain in hamstring when knee is flexed Brudzinski's: flex neck and automatically leg moves upward |
| Causes of Encephalitis: | bacterial, viral, fungal |
| S/S of Encephalitis: | fever, headache, seizures, decreased LOC, nuchal rigidity |
| RX of Encephalitis: | seizure precautions, monitor ICP, stat antibiotics |
| Stroke can be caused by? | clot or bleeding in brainclot is most common at night b/c BP drops in bedbleeding is usually during up and moving times of day |
| Stroke risk factors: | Age, sex (male),race (Black, Hispanic), hypertension, diabetes, heart disease, smoking, obesity, family history |
| To reduce stroke in women over 35? | NO Birth Control Pills!!!!! |
| Indication of possible stroke with stethoscope? | Carotid Bruit, heard with the bell over the carotid arteries, makes swooshing noise |
| Stroke warning? | TIA (transient ischemic attack), may have just a few sec/min of weakness/numbness or visual disturbance on one side of body |
| Major problem with TIA/Stroke? | Dysphagia: no feeding b/c risk of aspiration, NPO until seen by speech therapist. |
| Nurses job if pt. is having a stroke? | Maintain airway, admin. O2, admin tpa within 3 hrs (blood thinner), give heparin, give aspirin |
| Decadrone: | steroid; increases blood sugar, antiinflammatory; give slowly IV or PO; given for bells palsy, MS |
| Define: Trigeminal Neuralgia | sharp, sudden (paroxism) pain, throbbing |
| Rx: Trigeminal Neuralgia | tegretol, be sure to watch for corneal abrasions so give drops |
| Define: Bell's Palsy | paralysis due to herpes simplex, no pain |
| S/S of Bell's Palsy | pytosis of eye, dysphagia, possible aspiration |
| Rx of Bell's Palsy | steriods and acyclovir |
| Define: Alzheimer's | common form of dementia where brain begins to atrophy, affects the hippocampus |
| S/S of Alzheimer's | apraxia, delusions, agitation, apathy, contractures |
| Rx of Alzheimer's | no true treatment but to slow progression give Aracept and antianxiety/antidepressants |
| Define: Parkinson's | decrease of dopamine |
| S/S of Parkinson's | TRAP aka Tremor's, Rigidity, Akinesia (slow moving), postural instability |
| Classic signs of Parkinson's | shuffling gait, pinrolling, facial mask, fatigue |
| Rx of Parkinson's | Sinemet which helps to decrease dopamine and reduce S/S and Eldepryl helps prevent breakdown of dopamine and Anticholinergics like Artane and Cogentin |
| Sinemet (side effects, etc.) | give PO, SE: anxiety, confusion, memory loss, tremors, give same time everyday with food, don't stop abruptly, no alcohol, for Parkinson's |
| Eldepryl | MAOI, for Parkinson's |
| Anticholinergics: Artane/Cogentin | improves mobility, given PO, SE: include constipation, dry mouth, decrease peristalsis, urinary retention, confusion |
| Define: MS aka Mutiple Sclerosis | inflammation and decrease of myelin sheath, causes paralysis, onset is 30 |
| S/S of MS: | tremors, spasticity, bladder spasms |
| Rx of MS: | Baclofen and Decadron |
| Baclofen | given with MS; skeletal muscle relaxant, given PO; SE: include seizures, dizzy, weak, orthostatic BP (toxicity); taper drug and no alcohol |
| Define: Guillan-Barre Syndrome | Acute inflammation of peripheral nerves; Paralysis starts in FEET and moves upward |
| S/S of Guillan-Barre | weakness, paralysis, respiratory infections/failure |
| Rx: Guillan-Barre | plasma exchange, therapy |
| Define: Myasthenia Gravis | decreased ACH receptors, thymus is 2x normal size |
| S/S of Myasthenia Gravis: | diplopia, pytosis, muscle weakness, more use of muscle the weaker they get |
| Rx of Myasthenia Gravis: | give anticholenesterase; Mestinon |
| Mestinon | rx for myasthenia gravis; muscle stimulant; PO, IM, IV; seizures, cardiac arrest, bronchospasms; NEED ATROPINE to reverse in case of toxicity; VS before/during |
| Myasthenia Gravis Crisis | Two types: Myasthenia and Choniergic |
| Myasthenia Crisis | needs more medicine, problems with breathing/swallowing; with Tensilon will get stronger and feel better |
| Cholinergic Crisis | over medicated, increased weakness, respiratory failure; with Tensilon will stay same or get weaker |
| How to test for Myasthenia Gravis Crisis? | use Tensilon test; |
| Define ALS: | degeneration of motor pathways; paralysis; awake and alert just can't feel or move |
| S/S of ALS: | muscle cramping, fatigue, descending progression of paralysis |
| Rx of ALS: | Riluzole, which slows progession of ALS |
| How apnea relates to ICP? | if apnic, CO2 levels will rise=Increased ICP; to fix must allow pt to hyperventilate |
| Pressing on Hypothalamus: | when ICP is increased the brain has pressure on hypothalamus causing temperature changes like hyperthermia which means Temp is HOT and decrease in BP b/c of vasodilation; MUST INSERT ICP monitor |
| Monitoring ICP | CPP (cerebral perfusion)=MAP (mean arterial pressure) - ICPneed to be above 70! |
| Rx of Increased ICP: | dilantin, mannitol (reduce swelling), decadron(decreases edema), pentobarbital, diprovan; stop bleeding and suction blood, no turning in bed or valsalva maneuvers |
| Pentobarbital | given with Increased ICP, barbiturate coma; induces pt. into coma in order for edema to be resolved |
| Diprovan | given with increased ICP; short acting sedative; looks like milk and uses a dial to induce and exduce coma |
| Normal Pulse Pressure? | 40-50 |
| Normal PaCO2? | 25-30 |
| Normal CO2? | 35-45 |
| Normal CPP? | Above 70 |
| Trauma Brain Injury: Primary vs Secondary | Primary is due to trauma, Secondary is in response to trauma like edema |
| With fractures nurses need to be cautious of? | hypoxia, hypotension and infections like meningitis |
| Problems with Basilar Fracture? | CSF leak, meningitis, battle's sign or raccoon's sign |
| 4 types of Hemorrhage? | Epidural, Subdural, Intracerebral, Subarachnoid |
| Epidural Hemorrhage | most common, arterial bleed, triad symptoms of unconscious-awake-unconscious |
| Epidural Hemorrhage Rx: | Suction blood, CT scan, if not treated will herniate! |
| Subdural Hemorrhage | venous bleed, headaches! |
| Subdural Hemorrhage Rx: | monitor LOC, slower |
| Intracerebral Hemorrhage | either arterial or venous, inside brain |
| Subarachnoid Hemorrhage | either arterial or venous, injury or aneurysm |
| Rx of Overall Hemorrhage | NO N/G tube that could go into sinus cavities,use CT scan to identify location of bleed, craniotomy, burr holes, patent airway, monitor GCS, neurochecks, ICP, DI vs SIADH, pulse ox, CSF leaks, no turning/blowing nose, meds to prevent seizures/decrease ICP |
| Spinal Cord Injury | contusion=bruise, laceration=tear, permanent, cervical most at risk for injury |
| Neurogenic Spinal Shock S/S | BP decreases, bradycardia, warm, flushed, dry skin, w/t hours to days after spinal cord injury, decreased tissue perfusion |
| Rx of Neurogenic Spinal Shock | fluids, vasopressors (increase BP) like Dopamine, will be very cold but unnoticeable |
| Complications of Spinal Cord Injury | DVT, Pain, urinary problems, skin breakdown |
| Rx of Spinal Cord Injury | cough, deep breathe, incentive spirometer, SCDs, ted hose, heparin, baclofen, neuroten (pain), Gardner tongs/halo vest, |
| Nursing jobs for Spinal Cord Injury | bladder/bowel training, perform ADLs |
| Bladder training how to? | pull on pubic hair/run water in order to relax spinchter muscles |
| With spinal cord injuries rehab remember to: | decrease BP, possible Foley cath, solumedrol to help with inflammation and lovenox to prevent clots |
| Neuroten | anticonvulsant also used for neuro pain; PO; ataxia, dizzy, confusion, blood problems like leukopenia, NO alcohol |
| Halo Vest/Gardner-Wells Tongs | goes into head so worry about infection, worry about aspiration, decreased metabolic needs |
| Spinal Cord Injury at T-6 or higher: s/s | Worry of Autonomic Dysreflexia: severe BP increase, flushed face, white/cold feet, headache, JVD, decreased HR |
| What to do for pt. with Autonomic Dysreflexia? | remove restrictive clothes, empty bladder, empty fecal |
| Warning signs after head injury in 24 hours: | increased ICP, decreased brain perfusion, changes in LOC, increased drowsy, seizures, bleeding/drainage from nose/ears, pupils slow reaction, visual problems, slurred speech, projectile vomiting |
| Normal Magnesium levels | 1.5-2.5 |
| Normal Na+ levels | 135-145 |
| Normal Specific Gravity levels | 1.005-1.035 |
| Normal K+ levels | 3.5-5.0 |
| Normal Ca+ levels | 8-10 |
| Normal PaCo2 levels | 35-45 |
| Normal PaO2 levels | 80-100 |
| Normal HCO3 levels | 22-26 |
| Normal Hemoglobin levels | 12-15 |
| Normal WBCs levels | 4000-10000 |
| Normal RBCs levels | 4-5 million |
| Normal Hematocrit Levels | 40-50% |
| Normal BUN levels | 7-18 |
| Normal Creatinine levels | 0.6-2.0 |
Created by:
dukedreamr
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