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medsurg test2

Spinal main concern is? Secondary damage—Inflammation, Edema, Ichemia
For the first 24 hrs, do neuro checks how often? q1hr.
Spinal Injury travels which direction? up
Extent of Injury is know at what timeframe? For spinal injury 2 hrs to dx. Tell Family
Level of Injury spinal *C1-C5 Jawline to armpit
Level of Injury spinal T1-T5 Armpit to inguinals
Level of Injury spinal *L1-L5 Inquinals and below
Anthing at what? Level? (Bradycardia, priapism, hypotension) T6
T1-T4 what level of plegia? Paraplegic
C1-C3 what level of plegia? Tetraplegic
Degree of Injury Central—Upper extremeties Moto weakness, sensory loss
Degree of Injury Anterior—Ischemic cause D: Moto, pain, temp. I: Touch, proprioception
Degree of Injury Brown Ips: loss motor, position, vibration Cont: Lost pain/temp
Degree of Injury Posterior Rare—D: Propioception I: Pain/temp/motor
Consus/Caudu Bladder/Bowel
Diagnostic AISA Impairment scale, Imaging—MRI shows compression
Acute Phase Prioritization Airway, Pevention of secondary injury, breathing, circulation
Immobilization postion? Neutral position
Log Roll Nose to belly. One person at head.
Skeletal Traction At all times or risk of subluxation. Infection risk!!
Surgical Decompression
Drugs Steroids. Tell pt NO benefit for first 8 hrs. Inc. infection risk
Clinical Manifestations Respiratory—Above C4 requires ________. Below C6—Diagphram __________, monitor respirations. Thoracic level do what? ventilation, exhaustion, Quad cough—Like Heimlich, tell pt to cough
Cardiovascular—Above T6. Vagal stimulation such as…. can result in? cardiac arrest (suctioning, turning, BM)
Bradycardia results in ↓ cardiac output do what? Give this med! Atropine
Urinary risk of? Problems w/? UTI risk—Incontinence r/t relax emptying
GI—above T?. Paralytic ileus—NG tube—Stress Ulcers (BLEEDING!) t5
Bowel incontinence above T?. Use what to test tone. t12, finger
Thermoregulation inability to do this results in? monitor what? ↓ sweating, ↓ shiver—Monitor temp.
Metabolic (spinal) Elyte imbalances. Could result in? Metabolic Acidosis (Shock).
Metabolic alkalosis (NG tube). Positive Nitrogen—High-protein diet
Autonomic Dysreflexia—Above what level? Occurs from what most often? T6 or higher, from uncompenseated cardio reaction mediated by symp system (parasymp dysfunction) occurs from visceral stimuli. Most often bladder distension. Could be bowels, pressure sore.
S/S of autonomic dysreflexia-- Above level of injury? Below level of injury? Ie bp?, vision? Skin? Gi? Pain? Dry or sweaty? Pulse? above-vasodilation↑ bp, flushed face, HA, ↓ pulse, distendend neck veins, ↑ sweating. Below—vasoconstriction. pale, cool. No sweating
Interventions for autonomic dysreflexia Priority, then. ELEVATE HOB Then: Call doc, assess cause, immediate Cath (for bladder)
Reflexes return w/what? Why does this matter –think family hopes. permanent injury. Family needs to know this does not mean a return to normal functioning.
Parkinson’s. do not give this drug. No Zofran.
4 S/S of parkinson’s 1. Tremors—Calories! Pill Rolling, 2. Rigidity—ROM tests. Faciel—Flat affect, drooling. ASPIRATION RISK!!! ↓ nutrition. ↓ ADL 3. dyskinesia -Difficulty initiating movement. 4. Postural Instability—Fall Risk!
Myasthenia Gravis Insidius onset via infection, emotion, pregnancy, anesthesia
Cholinergic crisis Too much __________, ↓ ___________. s/s hot, blind, dry, mad cholinesterase, Dec. acetylcholine
Hot as hades (no sweat), Blind as a bat (pupil dilation), Dry as a bone (no salivation), Mad as a Hatter (Hallucinations)
Pressure Garments—Decrease atrophic scarring. 23hrs/day
1 degree No blister. 7-10 days
Red, painful, wet! Do no remove blisters 2 degree S
White dry. Leathery. Fluid Resc. 2 degree D
Charred, white. Surgical repair. 3 degree
4 degree Bone, muscle, fascia. Necrotic.
Severity Thicker the burn, lesser BSA needed.
Stevens-Johnson Syndrome automaticually go to? Burn unit. Sulfa-drugs, anti-seizure, antibiotics
what is only IM shot u could give w/ burn victum? Tetanus
Large bore needles means what gauge? >18 guage
Fluid Resuscitation Time starts when ? burn occurs, not on admission
What is the fluid formula? 4 ml x weight(kg) x %burned, ½ in 8hr. Other ½ over 16 hrs.
Monitor I/O—Urine output >?means tx is working 30
Electrical burns concerns iswhat? Dysrythmias
Created by: kerinska