Cardiac Structure, Neuro, Intracranial
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| What is paraplegia? | Paralysis of the lower portion of the body, sometimes involving the lower trunk. It occurs when the thoracic, lumbar, and sacral portions of the spinal cord are injured.
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| What is quadriplegia? | Also called tetraplegia, it occurs when cervical segments of the cord are injured, impairing function of the arms, trunk, legs, and pelvic organs
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| What is spinal shock? | Temporary loss of reflex function below the level of injury
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| What are spinal shock manifestations? | Flaccid paralysis of skeletal muscles, loss of all spinal reflexes, loss of sensations, and loss of ability to perspire all below level of injury. Bowel & bladder dysfunction. Shock develops in 30-60 minutes after injury & can last for minutes to months
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| What is autonomic dysreflexia? (also called autonomic hyperreflexia) | An exaggerated sympathetic response that occurs in clients with SCIs at or above the T6 level
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| When is the only time autonomic dysreflexia is seen? | Is only seen after recovery from spinal shock and occurs as a result of a lack of control of the autonomic nervous system by higher centers
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| What are signs and symptoms of autonomic dysreflexia? | Pounding headache, hypertension, sweating, goose flesh, nasal congestion, severe bradycardia
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| What triggers autonomic dysreflexia? | Distended bowel, distended bladder, stimulation of skin. A full bladder/blocked urinary catheters are the most common causes.
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| What are the treatments for autonomic dysreflexia? | Elevated HOB, drain bladder, remove impaction/tactile stimuli, B/P meds (apresoline, hyperstat), muscle relaxants
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| How do they diagnose spinal cord tumors? | Xray, CT Scan, MRI, myelogram, lumbar puncture
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| What are medications and treatments for spinal cord tumors? | Narcotic analgesics via epidural catheter, steroids (e.g. decadron) to control edema, surgical removal, radiation therapy
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| What are the appropriate nursing diagnoses for spinal cord tumor clients? | Anxiety, risk for constipation, impaired physical mobility, acute pain, sexual dysfunction, urinary retention
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| What is the most common cardiac valve dysfunction? | Aortic Stenosis
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| Where is the blood flow obstructed with aortic stenosis? | It obstructs forward blood flow from the left ventricle during systole
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| What are the causes of aortic stenosis? | Age related degenerative calcification and rheumatic disease
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| What are complications of aortic stenosis? | Risk for CHF, dilated cardiomyopathy, ineffective endocarditis, and sudden death
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| What are the cardinal symptoms of aortic stenosis? | Angina, syncope, exertional dyspnea; if severe, reduced ejection fraction and A Fib, S3 & S4
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| What is the most common early sign of aortic stenosis? | A systolic heart murmur (heard best in a forward-leaning, sitting position)
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| How do they diagnose aortic stenosis? | ECG (tall R waves, ST depression, inverted T wave), Chest xray, transthoracic echocardiography, cardiac catheterization
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| What are treatments for aortic stenosis? | HMG-CoA reductase inhibitors (statins), surgical valve replacement for severe symptomatic patients, prophylactic antibiotics before invasive procedures, avoidance of vasodilators
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| What is aortic regurgitation? | Valve doesn’t close fully during diastolic; blood flows back into left ventricle
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| What are complications of aortic regurgitation? | Leads to left ventricular hypertrophy and reduced volume, ejection fraction
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| What are causes of acute aortic regurgitation? | Aortic dissection, trauma (requires immediate surgical repair)
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| What are causes of chronic aortic regurgitation? | Hypertension, collagen vascular disease, congenital bicuspid valve
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| What are signs and symptoms of aortic regurgitation? | Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue, angina, patient aware of heartbeat
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| How do they diagnose aortic regurgitation? | Transthoracic echocardiography, cardiac catheterization, ECG
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| What are treatments for aortic regurgitation? | Vasodilator therapy, surgery in chronic regurgitation if ejection fraction falls below 55% or trauma or aortic dissection
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| How does mitral stenosis affect the flow of blood? | It impedes blood flow from left atrium to left ventricle during diastole, increasing left atrial pressure
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| What is the most common cause of mitral stenosis? | Rheumatic fever (other causes include congenital conditions, and manifested with stress of pregnancy)
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| What are common signs and symptoms of mitral stenosis? | Dyspnea, fatigue, hemopysis, orthopnea, paroxysmal nocturnal dyspnea, palpitations, resting tachycardia, irregularly irregular pulse, enlarged left atrium, lung congestion, increased pulmonary pressure
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| What are treatments for mitral stenosis? | Severe stenosis requires surgical repair, diuretics and digoxin for heart failure, beta blockers, calcium channel blockers and anticoagulants for A Fib, prophylactic antibiotics before invasive procedures
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| How does mitral regurgitation affect the flow of blood? | The blood is ejected back into the left atrium during contraction
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| What is hallmark cause of mitral regurgitation? | Chronic volume overload
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| How do they diagnose mitral regurgitation? | Echocardiography
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| What are signs and symptoms of mitral regurgitation? | SOB, orthopnea, paroxysmal nocturnal dyspnea, fatigue, and decreased exercise tolerance, atrial irritation, pulmonary congestion
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| What are treatments for chronic mitral regurgitation? | Reduce afterload with angiotensin-converting enzyme (ACE) inhibitors
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| What are treatment options for acute mitral regurgitation? | Surgery if ejection fraction below 60% or acute symptomatic mitral regurgitation. Surgery options: repair or replacement—repair preferred because it reduces need for long-term anticoagulants and replacement raises the risk of endocarditis
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| Who is at greatest risk for mitral valve regurgitation? | Young men, older women
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| Where is the obstruction of blood flow with tricuspid stenosis? | Blood flow is obstructed from right atrium to right ventricle
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| What is the primary cause of tricuspid stenosis? | Rheumatic heart disease
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| Where is the obstruction of blood flow with bicuspid (pulmonic) stenosis? | Blood flow is obstructed from right ventricle to the pulmonary system
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| What is the acute cause of heart failure? | Myocardial infarction
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| What are the chronic causes of heart failure? | Cardiomyopathy, valvular disease, coronary heart disease
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| What are the four heart valves? | Mitral, aortic, tricuspid, pulmonic (aka bicuspid)
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| What is a mitral valve prolapse? | When the mitral valve cusps fall into the left atrium. It is usually asymptomatic. Those at biggest risk are women age 14-30.
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| What is rheumatic fever? | Inflammation of the endocardium, myocardium, and pericardium
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| What are signs and symptoms of rheumatic fever? | Rash, chest discomfort, pericardial effusions, rubs, murmurs
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| What is the treatment for rheumatic fever? | Antibiotics, PCN, steroids
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| What is myocarditis? | Inflammatory disorder of the myocardium
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| What is myocarditis caused by? | Infection (usually viral), burns, poison exposure, autoimmune response
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| What is the treatment for myocarditis? | Steroids, antibiotics, rest
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| What is pericarditis? | Inflammation of the pericardium
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| What are causes of pericardium? | Idiopathic, MI, trauma, post op infection
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| What are the signs and symptoms of pericarditis? | Cough, chest pain, hemoptysis, dyspnea, friction rub, signs and symptoms of tamponade
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| What are the treatments for pericarditis? | Steroids, antibiotics, pericardiectomy or window, pericardiocentesis or tap
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| What is preload? | Volume of blood in the ventricles at end-diastole (stretch)
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| What is afterload? | Amount of force the ventricle must develop to eject the blood into circulation
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| Which is more common: Left-sided or Right-sided heart failure? | Left-sided
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| What are signs and symptoms of left-sided heart failure? | Signs & symptoms of decreased CO, pulmonary congestion, SOB, S3, cyanosis, orthopnea
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| What are causes of left-sided heart failure? | Atherosclerotic heart disease, MI, myocarditis, valvular disease, hypertension, overloading
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| What are causes of right-sided heart failure? | Pulmonary hypertension, COPD, right ventricular MI, PE, left ventricular failure (number one cause)
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| What are signs and symptoms of right-sided heart failure? | Edema, increased venous pressures, hepatic congestion, JVD, ascites, oliguria, anorexia/nausea
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| What is hemodynamic monitoring? | Invasive monitoring to evaluate cardiac function in critical patient. Measures the pressures within the vessel by use of a transducer
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| What is an arterial line used for? | Direct, continuous monitoring of systolic, diastolic, and mean pressures
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| What is a Swan-Ganz catheter? | Balloon tipped catheter threaded through right atria to right ventricle into the pulmonary artery. Assesses left ventricular function, right atrial pressures, pulmonary capillary wedge pressure (PCWP)
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| What is the pulmonary capillary wedge pressure? | It reflects the left ventricular diastolic pressure and is measured with the Swan-Ganz catheter balloon inflated.
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| Where are the AV valves found and what are their purpose? | The AV valves are found between the atria and the ventricles. These valves open and shut to keep blood flowing forward through the heart.
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| What is the purpose of the semilunar valves? | These valves keep blood flowing out to the lungs and the body
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| What is stroke volume? | How much blood the heart pumps out every time it beats (strokes)
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| What is cardiac output? | The amount of blood that the heart pumps out in one minute
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| How is cardiac output calculated? | Stroke volume multiplied by heart rate
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| What is cardiac index? | calculation that uses the CO & body surface area. Much more reflective than cardiac output of whether or not the amount of blood being pumped out of the heart is enough for the client because it takes into consideration the size of the client.
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| What are the four classifications of heart failure? | Systolic or diastolic failure, left ventricular or right ventricular, low-output or high-output, and acute or chronic failure
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| What is systolic heart failure? | When the ventricle fails to contract adequately to eject a sufficient blood volume into the arterial system
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| What is diastolic failure? | When the heart cannot completely relax in diastole, disrupting normal filling.
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| What are common causes of left ventricular (left-sided) heart failure? | Coronary heart diseases and hypertension
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| What are the common causes of right ventricular (right-sided) heart failure? | Conditions that restrict blood flow to the lungs, such as acute or chronic pulmonary disease
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| Clients with which conditions develop low-ouput heart failure? | Heart failure due to coronary heart disease, hypertension, cardiomyopathy, and other primary cardiac disorders
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| Clients with which conditions develop high-output heart failure? | Hypermetabolic states (e.g. hyperthyroidism, infection, anemia, pregnancy) which require increased cardiac output to maintain blood flow and oxygen to the tissues
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| What is acute heart failure? | Abrupt onset of a myocardial injury (such as a massive MI) resulting in suddenly decreased cardiac function and signs of decreased cardiac output.
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| What is chronic heart failure? | Progressive deterioration of the heart muscle due to cardiomyopathies, valvular disease, or coronary heart disease
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| Why is a contusion a more serious injury than a concussion? | Contusions-localized & macroscopic, concussions- widespread & microscopic. Concussions involve temporary axonal disturbances, contusion is a bruise caused by bleeding in the brain & usually results in permanent damage to the injured area
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| How does a contra-coup injury occur? | The brain nearest the point of impact bashes against the inner hard skull producing a contusion. There is a bounce back of the brain within the skull or a suddenly created vacuum that produces a 2nd contra-coup contusion on the opposite pole of the brain
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| How is Doll’s Eyes (oculocephalic) reflex assessed? | The eyes will move opposite the direction the head is turned, thus maintaining a more-or-less steady gaze
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| What does the absence of the oculocephalic reflex indicate? | Its absence suggests damage to the brain stem. It carries a very poor prognosis, possibly indicating brain death
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| What is the advantage of the MRI over the CT scan? | MRI gives much higher detail in the soft tissues and can produce images in any plane
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| How does Mannitol work to reduce ICP? | osmotic diuretic that increases the osmolarity of the blood, thereby drawing water out of the edematous brain tissue and into the vascular system for elimination via the kidneys
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| How do steroids decrease ICP? | They restore cell wall integrity and help in recovery and reduces edema
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| What is the maximum dose of dilantin? | 20 mg/kg max
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| What is the max rate of dilantin? | 50 mg/min
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| What is Nimotop and how does it work? | It is a lipophilic calcium channel blocker that effectively crosses the blood brain barrier. It reduces the incidence and severity of neurological deficits resulting from vasospasm
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| How do you calculate Mean Arterial Pressure (MAP)? | MAP = systolic + (2 x diastolic)/ 3
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| How do you calculate Cerebral Perfusion Pressure (CPP)? | CPP = MAP –ICP
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| What is normal range for CPP? | 70 to 95 mmHg
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| What doctor’s orders should the nurse expect to help lower ICP? | Sedation, bedrest, IV fluids, antipyretics, antiulcers, antihypertensives, vasopressors, stool softeners, HOB elevated at least 30 degrees, knees flat, keep neck neutral
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| Why does a brain herniation occur? | When pressure inside the skull increases and displaces brain tissues
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| What are the primary nursing diagnoses for the neurological client? | Ineffective airway clearance, High risk for fluid volume deficit, altered oral mucous membranes, high risk for impaired skin integrity, ineffective thermoregulation
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| What are nursing interventions for Ineffective airway clearance? | Position in lateral or semi prone position to maintain open airway and facilitate drainage of secretions, suction as necessary to prevent aspiration, Keep HOB up 30 degrees or more, be prepared to intubate if respiratory effort diminishes
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| What are nursing interventions for High risk for fluid volume deficit? | Monitor for side effects of dehydration, NGT placement may be required for feedings, do not give oral fluids until swallowing is assessed, administer IVF and blood slowly so as not to increase ICP
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| What is the difference in an open versus a closed skull fracture? | In an open fracture the dura is torn. In a closed fracture the dura is not torn.
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| Skull fractures are either open or closed and are further classified into what four categories? | Linear, comminuted, depressed, or basilar
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| What is a linear (simple) skull fracture? | Simple, clean break in skull. Occurs with low-velocity injuries. Generally requires bed rest and observation for underlying injury to brain tissue or hematoma formation. No specific treatment is required.
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| What is a comminuted skull fracture? | Bone is crushed into small, fragmented pieces. Usually seen with high-impact injuries.
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| What is a depressed skull fracture? | Inward depression of bone fragments. Usually due to a powerful blow to the skull. The dura may or may not be intact. Bone fragments may penetrate into the brain tissue. Requires surgical intervention, usually within 24 hours of the injury
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| What is a basilar skull fracture? | Occurs at the base of the skull. May be linear, comminuted, or depressed. Does not require surgery unless CSF leakage persists.
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| What are the purpose of Burr holes? | They are used as openings to insert ventricular drains and pressure monitors. The hole may facilitate the evacuation of an extracerebral clot, or a series of holes may be made in preparation of a craniotomy
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| What are the three components that are found inside the rigid, non-flexible, bony structure of the skull according to the Monroe-Kellie Hypothesis? | Brain 80%, cerebrospinal fluid 8%, and blood 12%
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| What is the Monroe-Kellie Hypothesis? | A state of dynamic equilibrium exists; if the volume of any of the three components increases, the volume of the others must decrease to maintain normal pressures within the cranial cavity
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| What is Intracranial pressure (ICP)? | It is sustained elevated pressure (10 mmHg or higher) within the cranial cavity. The normal ICP is 5 to 10 mmHg measured intracranially with a pressure transducer while the client is lying with the HOB elevated 30 degrees
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| What are causes of ICP? | Head injury, stroke, tumor, inflammatory process, intracranial surgery, cough, mechanical ventilation
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| What is a brain tumor called? | Glioma
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| What is a tumor of the brain covering called? | Meningioma
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| What is a tumor of the cranial nerves called? | Neuroma
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| What are terms for a tumor of the blood vessels? | Angioma, hemangioblastoma
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| What are clinical manifestations of brain tumors? | Headache (most common), vomiting, LOC changes, motor & sensory losses, seizures, autonomic & vasomotor changes, visual changes
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| What is an Ommaya reservoir? | An intraventricular method of medication administration. The ommaya reservoir is surgically implanted into a lateral ventricle of the brain.
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| What is Parkinson’s disease? | Progressive, degenerative neurologic disease characterized by tremor, muscle rigidity, and bradykinesia (slowness of movement)
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| What is the only definitive method of diagnosis Alzheimer’s disease? | Postmortem examination of the brain tissue
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| What is the most common degenerative neurologic disorder and the most common cause of cognitive impairment in older adults? | Alzheimer’s disease
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| What is usually the first sign of Alzheimer’s disease? | Memory loss
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| What is the frequent cause of death with Alzheimer clients? | The cause of death is often aspiration pneumonia because of the loss of the ability to swallow late in the disease. Usually live about 7 years after diagnosis.
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| What are the risk factors for Alzheimer’s disease? | Older age, family history, and female gender
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| What are the three stages of Alzheimer’s disease? | Early, Confusional, Terminal
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| What is the cure for Alzheimer’s disease? | There is no cure, but some medications are effective in slowing the progression of the disease (Cognex, Aricept, Exelon, Reminyl)
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| What is Multiple sclerosis (MS)? | A chronic demyelinating neurological disease of the CNS, associated with abnormal immune response to an environmental factor
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| What causes multiple sclerosis? | It is believed to occur as a result of an autoimmune response to a prior viral infection in a genetically susceptible person, associated with a deficit in T-Lymphocytes
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| When is the usual onset of MS? | Usually between 20 and 50 years of age, with a peak age of 30.
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| What is Huntington’s disease? | A progressive, degenerative, inherited disease that is characterized by increasing dementia and chorea (jerky, rapid, involuntary movements)
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| What causes Huntington’s disease? | Single gene autosomal dominant. Child has a 50/50 chance of inheriting the disease if the parent has the disease
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| What are the manifestations of Huntington’s disease? | Usually asymptomatic until age 30 to 40, primarily affects movement and posture, swallowing and speech, cognition and personality, symptoms progress as condition deteriorates. Progression is slow, usually 15 to 20 years
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| What is the treatment of Huntington’s disease? | Symptom driven as there is no cure, antipsychotics and antidepressants for palliative care
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| What is Amyotrophic Lateral Sclerosis—ALS (Lou Gerhig’s Disease)? | A degenerative disease affecting upper and lower motor neurons. The cells die and the muscles atrophy. There is no sensory or cognitive changes; weakness begins as loss of fine motor in hands.
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| What is the etiology for ALS? | Nutritional deficiency r/t problem with enzyme metabolism, vitamin E deficiency, autoimmune disorder
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| How do they diagnose ALS? | EMG and muscle biopsy show muscle fibrillation at rest and muscle fiber loss
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| Is ALS fatal? | Yes. They usually die within 3-5 years of diagnosis r/t aspiration pneumonia
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| What is Guillain-Barre? | Acute infectious neuronitis where the immune system overreacts to an infection destroying the myelin sheath. Cognition and LOC not affected. Severe muscle pain. May follow upper respiratory infection or gastroenteritis
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| How does Guillain-Barre progress? | Weakness begins in lower extremities and progresses symmetrically to upper extremities, may result in respiratory failure.
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| What is Myasthenia Gravis? | Autoimmune disease that destroys acetylcholine receptor sites, affects skeletal muscles
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| What are manifestations of Myasthenia Gravis? | 75% have hyperactive thymus gland, muscle weakness involving eyes (ptosis), face (difficulty smiling, closing mouth), and oropharynx (impaired speech, swallowing, chewing), respiratory paralysis and failure
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| How do they diagnose Myasthenia Gravis? | Tensilon test results in increased muscle strength within five minutes of injection of medication.
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| What is Myathenic Crisis? | Exacerbation of Myasthenia Gravis r/t missed dose, undermedication, infection
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| What is Cholinergic Crisis? | Overdosage of anticholinesterase medicine. Treat with atropine
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| How are spinal cord tumors classified? | By anatomic location
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| What are the two classifications of spinal tumors? | Intramedullary (makes up about 10%) and extramedullary
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| Where are intramedullary spinal tumors located? | They arise within the neural tissues of the spinal cord
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| Where are extramedullary spinal tumors located? | They arise from tissues outside the spinal cord
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| What is often the first manifestation of a spinal cord tumor? | Pain
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| What are manifestations of cervical cord tumors? | Paresis of arms and legs, stiffness of neck, paraplegia, pain in the shoulders and arms, hyperactive reflexes
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| What are manifestations of thoracic cord tumors? | Pain in the back and chest, positive babinski reflex, bowel and bladder dysfunction, sexual dysfunction
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| What are manifestations of lumbosacral cord tumors? | Pain in the lower back radiating to the legs and perineal area, loss of sensation in the legs, bowel and bladder dysfunction, sexual dysfunction, decreased or absent ankle and knee reflexes
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| What tests are used to diagnose a spinal cord tumor? | x-rays, CT scans, MRI, myelogram, and lumbar puncture
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| A lumbar puncture of the client with a spinal cord tumor will demonstrate CSF that is xanthochromic (having a yellow color), has increased protein, has few to no cells, and clots immediately. This cluster of findings is known as what? | Froin’s syndrome
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| What are treatment options for spinal cord tumors? | Medications (narcotics for pain, steroids for edema), surgery, radiation therapy
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| What is encephalitis? | An acute inflammation of the parenchyma of the brain or spinal cord
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| Encephalitis is almost always caused by what? | A virus
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| What is meningitis? | Inflammation of the pia mater, the arachnoid, and the subarachnoid space (can be bacterial, viral, fungal or parasitic in origin)
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| What are manifestations of bacterial meningitis? | Restlessness, agitation, irritability, severe headache, chills and high fever, confusion or altered LOC, photophobia, seizures, signs of increased ICP, petechial rash, positive brudzinski’s sign, positive kernig’s sign, nuchal rigidity
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| What are manifestations of viral meningitis? | Similar to those of bacterial meningitis, although usually milder
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| What is a brain abscess? | An infection with a collection of purulent material within the brain tissue. (approximately 80% are found in the cerebrum and 20% are cerebellar)
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| What are the nursing diagnosis for a client with bacterial meningitis? | Hyperthermia r/t infection and abnormal temperature regulation by the hypothalamus, disturbed thought processes r/t intracranial infection, ineffective protection r/t progression of the illness
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| What age group has the highest incidence of brain tumors? | Although brain tumors can occur in any age group, the highest incidence is in those ages 50 to 70
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| What are manifestations of frontal lobe tumors? | Inappropriate behavior, personality changes, inability to concentrate, impaired judgment, recent memory loss, headache, expressive aphasia, motor dysfunctions
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| What are manifestations of parietal lobe tumors? | Sensory deficits, paresthesia, loss of two-point discrimination, visual field deficits
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| What are manifestations of temporal lobe tumors? | Psychomotor seizures
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| What are manifestations of occipital lobe tumors? | Visual disturbances
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| What are manifestations of cerebellum tumors? | Disturbances in coordination and equilibrium
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| What are manifestations of pituitary tumors? | Endocrine dysfunction, visual deficits, headache
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| What are treatment options for brain tumors? | Treatment may involve chemotherapy, radiation therapy, surgery, or any combination of these
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| What are nursing diagnoses for client with brain tumors? | Anxiety, risk for infection, acute pain, disturbed body image
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| If a client has had intracranial surgery you must monitor for a CSF leak. If they may have a CSF leak from the nose what do you do? | Keep HOB elevated 20 degrees unless contraindicated, do not suction nasally, do not clean nose, tell client not to put finger in nose, do not insert packing
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| What if your client has a CSF leak from the ear? | Position client on side of leakage unless contraindicated, do not clean ear, tell client not to put finger in ear, do not insert packing. Place a sterile dressing over the area of drainage and change as soon as it becomes damp.
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| What is a migraine? | A recurring vascular headache lasting from 4 to 72 hours, often initiated by triggering event and usually accompanied by a neurologic dysfunction
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| What are the two types of migraine headaches? | Common migraine (without an aura) and classic migraine (with an aura; most often experienced as a visual disturbance prior to the pain)
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| Which type of migraines are more prevalent? | Common migraines are most common and occur in 80% of the people who are affected by the disorder
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| What are the risk factors for migraine headaches? | Female, family history of migraine headaches
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| What are cluster headaches? | Extremely severe, unilateral, burning pain located behind or around the eyes. The headaches occur in “clusters” of one to eight each day for several weeks or months, followed by remission lasting months to years.
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| What are risk factors for cluster headaches? | Male, use of alcohol or nitrates, may begin in early childhood
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| What is a tension headache? | Characterized by bilateral pain, with a sensation of a band of tightness or pressure around the head.
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| What are risk factors for tension headaches? | Related to tension and anxiety, no family history, often begins in adolescence
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| What is the primary nursing diagnosis for client with headaches? | Acute pain
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| What is a chronic disorder of abnormal recurring, excessive, and self-terminating electrical discharge from neurons? This disorder is characterized by recurring seizures accompanied by some type of change in behavior. | Epilepsy
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| What is a single event of abnormal electrical discharge in the brain resulting in an abrupt and temporary altered state of cerebral function? | Seizure
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| What is the most common cause of epilepsy in older adults? | Arteriosclerosis of the cerebrovascular system
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Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
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You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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lhawthorne
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