Shared Flashcard Set

Details

Principles III-Exam II-Neuro Slides 115-130
Headz & Spinal Cords
31
Nursing
Graduate
02/26/2010

Additional Nursing Flashcards

 


 

Cards

Term

 

What is the primary approach for infratentorial lesions? Why?

Definition

 

The sitting position

-head up position provides venous drainage

-less facial & conjunctival edema

-better ventilation

 

Term

 

 

What happens if the head is flexed forward in the sitting position? 

Definition
-it cold lead to jugular obstruction and thus facial/tongue swelling
Term

 

 

What distance should you have between the mandible and sternum?

Definition

 

 

2 finger breaths

Term

 

 

What position is used for infratentorial lesions?

Definition

 

 

Lateral, prone or semi-sitting position

Term

 

 

What is the problem postoperatively with infratentorial lesions?

Definition

 

Pts may have apnea due to brainstem manipulation, ischemia, swelling in surgical area.

-Vitals may be labile

Term

 

 

Where are the majority of pituitary tumors located?

Definition

 

 

at the base of the brain (sella turscica)

Term

 

 

What are nonfunctioning tumors?

Definition

 

 

Tumors that impinge on adjacent structures and cause symptoms

Term

 

 

Name five anesthetic implications for pituitary tumors.

Definition

-Normal thyroid function

-Normal blood glucose

-Normal electrolytes

-controlled BP

-Airway assessment and plan

-EKG/CXR

-Steroid replacement

-Vasopressin for diabetes insipidus

Term

 

 

How is pituitary failure treated?

Definition
It is life threatening and treated by removing the gland or the tumor and supplementing with corticosteroids.
Term

 

What is the approach for transphenoidal hypophysectomies?

Definition

 

through the nose/sphenoid bone

-head up position

-Oral rae tube

Term

Name the three problems associated with surgery to remove pituitary tumors?
Definition

1) You working near the internal caroids, cranial nerves, & optic chiasm

2) work around the dura can cause vagal outflow (bradycardia)

3) A skin patch is used to close dura which can easily be torn if the patient coughs or bucks

Term

 

 

What percentage of blood supply is provided by one anterior spinal artery which arises from the vertebral arteries?

Definition

 

 

75%

Term

 

 

What does the anterior spinal artery feed?

Definition

 

 

The anterior cord (motor)

Term

 

 

How is the posterior cord supplied?

Definition

 

 

By two posterior spinal arteries

Term

 

 

What do intercostal (redicular) arteries contribute to?

Definition

 

 

Both the anterior and posterior arteries

Term

 

 

In the lower thoracic/lumbar cord region, the ?????artery is supplied by the artery of ?????

Definition

 

The anterior artery is supplied by the artery of ADAMKIEWICZ

Term

 

 

Where is the location of the artery of Adamkiewicz?

Definition

 

 

its variable T-5 to L-1

*usually arises on the LEFT

Term

 

 

What artery supplies most of the spinal cord?

Definition

 

 

the anterior spinal artery

Term

 

 

Spinal cord perfusion and protection is identical to ????

Definition

 

 

brain perfusion

Term
What are the differences in BP, HR, Fluid response, and Vasopressor response for Spinal & Hemorrhagic Shock?
Definition

Spinal-BP decreases; HR decreases if T 1-4 or above is involved; it does NOT respond to fluids, but DOES respond to pressors.

 

Hemorrhagic-BP decreases; HR increases; it DOES respond to fluids and does NOT respond to pressors.

Term

 

T/F

Hemorrhagic shock responds to Vasopressors

Definition

 

FALSE-Hemorrhagic shock does NOT respond to pressors, but Spinal shock DOES (:

Term

 

 

When should high doses of methylprednisone be initiated? What is the dose?

Definition

 

 

Initiated within 3-8 hours of injury

Dose: 30 mg/kg load over 1 hour followed by drip of 5.4 mg/kg/hr over the next 23 hrs

Term

 

 

An increase in sepsis, pneumonia, and prolonged hospital stay is associated with what?

Definition

 

 

High doses of methylprednisone

Term

 

 

When does hyperrelexia occur?

Definition

 

 

spinal injuries ABOVE T-5

(rarely seen if injury below T-10)

Term

 

 

(Sorry this one sucks) Describe the mechanism of autonomic hyper-reflexia.

Definition
Cutaneous or visceral stimulation below cord injury sends impulses to spinal cord, travel upward until it reach the level of injury. A reflex arc is activated increasing the activity of the smypathetic portion of the ANS. The sympathetic system is not inhibited by the PSNS which would normally come from above.
Term

 

 

What is the result of autonomic hyper reflexia?

Definition

An increased SVR and hypertension

-The baroreceptors detect the elevated pressure and reflexively decrease HR and vasodilate teh vessels ABOVE the injury.

Term

 

 

In autonomic hyper-reflexia, what occurs above the injury?

Definition

Flushing

Sweating

HA/nasal stuffiness

Term

 

 

In autonomic hyper-reflexia, what occurs below the injury?

Definition

Pallor

Pilomotor erection

Muscle contraction/spasm

Term

 

 

If you are going to treat a patients BP that has autonomic hyper-reflexia or dysreflexia, what should you be thinking?

Definition

Direct arterial dilators

(Short acting-Nipride)

Term

 

 

What is the treatment in hyper reflexia or dysreflexia? What is your anesthetic of choice?

Definition

Treatment: removal of stimuli

 

Anesthetic of choice: Spinal

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