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Medical-Surgical Nursing, 9th Ed., Ignatavicius & Workman, 2018 Nursing (RN) School Study Aid


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45 - Care of Critically Ill Patients With Neurologic Problems
35 Picmonics to Learn | 58 mins

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Types of Strokes
Warning Signs
Transient Ischemic Attack (TIA)
Reversible Ischemic Neurologic Deficit (RIND)
Types
Ischemic
Thrombotic
Atherosclerosis
Embolic
Atrial Fibrillation
Hemorrhagic
Severe Hypertension
2 mins
Level of Consciousness: Descriptive guide for Glasgow Coma Scale
Conscious
Confused
Delirious
Somnolent
Obtunded
Stuporous
Comatose
2 mins
Native American Culture
No Direct Eye Contact
No Organ Donation
No Blood Donation
Strong Handshakes Offensive
Tribal Shaman
Navajo Mother Massage Newborn
1 min
Middle Cerebral Artery
Contralateral paralysis upper limb and face
Contralateral loss of sensation of upper limb and face
Affects Wernicke's area and Broca's area
Aphasia if Lesion in Dominant (Left) Hemisphere
Hemineglect if lesion in nondominant (right) hemisphere
1 min
Anterior Cerebral Artery
Contralateral paralysis of lower limb
Contralateral loss of sensation in lower limb
1 min
Right Hemisphere Stroke Assessment
Opposite Side Weakness (Hemiplegia)
Poor Proprioception
Disoriented to Person, Place, Time
Can't Recognize Faces (Prosopagnosia)
Loss of Judgement and Awareness
Impulsiveness
Personality Changes
Tonal Hearing Loss
1 min
Left Hemisphere Stroke Assessment
Opposite Side Weakness (Hemiplegia)
Side to Side Discrimination
Aphasia
Agraphia
Slow Performance
Aware of Deficits
Anxiety
Depression
1 min
CN V
Trigeminal Nerve
Sensory
Facial Sensation
Motor
Mastication Muscles
1 min
CN VII
Facial Nerve
Lacrimation
Salivation
Sensory
Taste from Anterior 2/3 of Tongue
Motor
Facial Movement
Stapedius Muscle
Eyelid Closing
1 min
CN IX
Glossopharyngeal Nerve
Sensory
Taste from Posterior 1/3 of Tongue
Monitoring Carotid Body and Sinus
Motor
Stylopharyngeus
Swallowing
Salivation
1 min
CN X
Vagus Nerve
Sensory
Aortic Arch Chemoreceptors and Baroreceptors
Taste from Epiglottic Region
Motor
Swallowing
Palate Elevation
Talking
Coughing
Midline Uvula
1 min
CN XII
Hypoglossal Nerve
Motor
Tongue Movement
34 secs
Cranial Nerve Function
Sensory
CN I
CN II
CN VIII
Motor
CN III
CN IV
CN VI
CN XI
CN XII
Both
CN V
CN VII
CN IX
CN X
1 min
Alteplase
Mechanism
Tissue Plasminogen Activator
Indications
Thrombosis
Side Effects
Bleeding
Contraindications
Intracranial Hemorrhage
Internal Hemorrhaging
Considerations
Minimize Bleeding
Monitor for Shock
Antidote
Aminocaproic Acid
1 min
Vital Signs - Adult
Temperature (96.8-100.4 Degrees F) (36-38 Degrees C)
Rectal - Remove 1 Degree
Axillary - Add 1 Degree
Respiration (12-20)
Oxygen Saturation (94%-100%)
Pulse (60-100)
Blood Pressure (<120/80)
Pain
1 min
Increased Intracranial Pressure (ICP) Assessment
Change in LOC
Headache
Cushings Triad
Irregular Respirations
Widening Pulse Pressure
Bradycardia
Projectile Vomiting
Abnormal Pupils
Papilledema
Posturing
1 min
Increased Intracranial Pressure (ICP) Interventions
Interventions
Elevate Head Of Bed
Foley Catheter
Mannitol (Osmitrol)
Dexamethasone
High Dose Barbiturates
Passive Hyperventilation
Considerations
Neuro Assessment
Maintain Normal Temperature
Avoid Activities That Increase ICP
Intracranial Monitoring System
2 mins
Hydrocephalus
Cause
Increased CSF in Ventricles of Brain
Assessment
Signs of Increased ICP
Infant Assessment
High Pitched Cry
Irritability
Opisthotonus
Increased Head Circumference
Bulging Fontanel
Setting Sun Sign
Interventions
Seizure Precautions
Elevate HOB
CSF Shunt
2 mins
Clopidogrel (Plavix)
Mechanism
ADP Receptor Antagonist
Prevent Platelet Aggregation
Indications
Acute Coronary Syndrome (ACS)
Prevention of Thrombotic Events
Side Effects
Bleeding
Thrombotic Thrombocytopenic Purpura (TTP)
Pancytopenia
Abdominal Pain
Considerations
Withhold Before Surgery
2 mins
Warfarin (Coumadin)
Mechanism of Action
Inhibits Clotting Factors
Indications
Atrial Fibrillation
Venous Thrombosis
Pulmonary Embolism
Assessment
PT/INR Levels
Observe for Bleeding
Contraindications
Pregnancy
Nursing Considerations
Vitamin K and Fresh Frozen Plasma
Prolonged Therapeutic Onset
Maintain Same Diet
1 min
Aspirin (Acetylsalicylic Acid)
Mechanism
Inhibits Platelet Aggregation
NSAID
Indications
Thrombotic Event Prevention
General Pain
Inflammatory Conditions
Fever
Side Effects
Pancytopenia
GI Ulcers
Bleeding
Considerations
Withhold Before Surgery 7-10 Days
Reye's Syndrome
2 mins
Depression Assessment
Physical Changes
Anergia
Self Neglect
Decreased Libido
Vegetative Signs
Mood
Sad Affect
Worthlessness
Guilt
Anger and Irritability
Cognitive
Ineffective Problem Solving
Slowed Thinking
1 min
Types of Head Injuries
Open Head Injury
Linear Fracture
Comminuted Fracture
Depressed Fracture
Open Fracture
Basilar Skull Fracture
Closed Head Injury
Coup and Contrecoup
Brain Contusion
Concussion
1 min
Hypoxia (Early Symptoms)
Diaphoresis
Restlessness
Tachypnea
Dyspnea on Exertion
Tachycardia
Hypertension
Arrhythmias
Decreased Urine Output
Unexplained Fatigue
1 min
Hypoxia (Late Symptoms)
Cyanosis
Cool, Clammy Skin
Use of Accessory Muscles
Retractions
Hypotension
Arrhythmias
1 min
Traumatic Brain Injury Assessment
Assessment
Change in LOC
Personality Changes
Amnesia
Increased Intracranial Pressure
Diplopia
Posturing
Location of Injury
Basilar Skull Fracture
Halo or Ring Sign
Considerations
Intracranial Bleeding
1 min
CSF Lab Values: Normal
Pressure: < 20 cm H2O
Color/Appearance: Clear or Colorless
Proteins: < 40 mg/dL
Lactate Dehydrogenase: 10% of Serum Level
Cells: 0-5 Small Lymphocytes
Glucose: 40-70 mg/dL
1 min
Eye
Characteristics
Sclera
Cornea
Iris
Lens
Ciliary Muscles
Optic Nerve
Rods
Cones
Retina
1 min
Magnetic Resonance Imaging (MRI)
Procedure
Internal Body Images
Detects Variations of Soft Tissues
Considerations
No Metal Objects
No Pacemakers
Contrast is Non-Iodine
Safe During Pregnancy
Long Procedure
Antianxiety Medications
2 mins
Mannitol (Osmitrol)
Mechanism
Osmotic Diuresis
Indications
Reducing Intracranial Pressure
Reducing Intraocular Pressure
Renal Failure Prophylaxis
Side Effects
Edema
Fluid and Electrolyte Imbalance
Considerations
Avoid Use in Cardiac Patients
IV Administration
2 mins
Phenytoin (Dilantin)
Mechanism
Blocks Na+ Channels
Indications
Tonic-clonic Seizures
Side Effects
Ataxia
Nystagmus
Sedation
Gingival Hyperplasia
Purple Glove Syndrome
Hirsutism
Rash
Anemia
Considerations
Individualized Dosing
1 min
Hypernatremia
Assessment
> 145 mEq/L Na+
Change in LOC
Extreme Thirst
Orthostatic Hypotension
Dry Flushed Skin
Muscle Twitching
Seizures
Priority Interventions
Prevent Dehydration
Hypotonic Solutions (0.225% or 0.45% NaCl)
Sodium Restriction
Diuretics
1 min
Meningitis Assessment
Assessment
Nausea and Vomiting
Fever
Nuchal Rigidity
Severe Headache
Purpura
Seizures
Photophobia
Infants and Young Children
Opisthotonus Position
High Pitched Cry
Bulging Fontanel
1 min
Syndrome Of Inappropriate Antidiuretic Hormone (SIADH)
Pathophysiology
Hypersecretion of ADH
Increased Sensitivity to ADH
Signs & Symptoms
Serum Hypoosmolality
Coma and Seizure
Dilutional Hyponatremia
Cramps and Tremors
Euvolemia
Change in LOC
1 min
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Pharmacologic Interventions
Diuretics
Hypertonic IV Fluids
Demeclocycline
Tolvaptan and Conivaptan
1 min

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