Exam 3 NR 328 Study guide Questions
Fully Answered.
Nursing measures for a lumbar puncture - Answer Requires consent, sterile fashion
Dealing with the tubes for a lumbar puncture - Answer three different tubes sometime more, make
sure you LABEL which is the first specimen and so on
Position for lumbar puncture - Answer Side lying
Position for babies and lumbar puncture - Answer do not hyperflex or extend the neck, be sure they
have an open airway, put more pressure on the back or butt
Lumbar punctures show - Answer Inceased WBC, decreased glucose, elevated protein, increased ICP,
and positive culture for menengitis
Lumbar puncture? - Answer Bacteria is made of protein and it eats the glucose
Always wear? - Answer A mask you never know what youre in contact with
Older children and signs of increased ICP - Answer Change in LOC, irritability, vomiting, headache,
motor dysfunction, unequal pupil response, seizures, decline in academics, personality changes
Infants s/s of Increased ICP - Answer Irritability, lethargy, increased head circumference, bulging
fontanels, widened suture lines, sunset eyes, high pitched cry scalp veins
Early sign of ICP increase - Answer Tachycardia
Late sign of increased ICP - Answer bradycardia, failure to follow command
, Fixed and dilated pupils - Answer what med are they on? or brain death impending
cushing reflex - Answer when the pulse pressures are widened (ex: 200/68)
What is an early most important indicator of change in neuro status? - Answer LOC
Parent can detect change - Answer Mom states baby has blank stair and doesnt get excited over
favorite toy exc
Priorities with MVA - Answer A= airway c-spine mobilization
B=breathing
C= circulation
D= disability
E= environment/exposure
F= full set of vitals , five interventions, family presence
G- Give comfort measure
H- head to toe exam
I Inspect
Circulation - Answer carotid artery, 2 ivs, any bleeding
Disability - Answer LOC and pupils
Enviorment/exposure - Answer warm the room up expose them
Five interventions - Answer EKG, pulse ox, foley, blood work, NG tube or oral gastric
NOTHING IN NOSE TILL CT COMES BACK
Inspect - Answer look at back
Fully Answered.
Nursing measures for a lumbar puncture - Answer Requires consent, sterile fashion
Dealing with the tubes for a lumbar puncture - Answer three different tubes sometime more, make
sure you LABEL which is the first specimen and so on
Position for lumbar puncture - Answer Side lying
Position for babies and lumbar puncture - Answer do not hyperflex or extend the neck, be sure they
have an open airway, put more pressure on the back or butt
Lumbar punctures show - Answer Inceased WBC, decreased glucose, elevated protein, increased ICP,
and positive culture for menengitis
Lumbar puncture? - Answer Bacteria is made of protein and it eats the glucose
Always wear? - Answer A mask you never know what youre in contact with
Older children and signs of increased ICP - Answer Change in LOC, irritability, vomiting, headache,
motor dysfunction, unequal pupil response, seizures, decline in academics, personality changes
Infants s/s of Increased ICP - Answer Irritability, lethargy, increased head circumference, bulging
fontanels, widened suture lines, sunset eyes, high pitched cry scalp veins
Early sign of ICP increase - Answer Tachycardia
Late sign of increased ICP - Answer bradycardia, failure to follow command
, Fixed and dilated pupils - Answer what med are they on? or brain death impending
cushing reflex - Answer when the pulse pressures are widened (ex: 200/68)
What is an early most important indicator of change in neuro status? - Answer LOC
Parent can detect change - Answer Mom states baby has blank stair and doesnt get excited over
favorite toy exc
Priorities with MVA - Answer A= airway c-spine mobilization
B=breathing
C= circulation
D= disability
E= environment/exposure
F= full set of vitals , five interventions, family presence
G- Give comfort measure
H- head to toe exam
I Inspect
Circulation - Answer carotid artery, 2 ivs, any bleeding
Disability - Answer LOC and pupils
Enviorment/exposure - Answer warm the room up expose them
Five interventions - Answer EKG, pulse ox, foley, blood work, NG tube or oral gastric
NOTHING IN NOSE TILL CT COMES BACK
Inspect - Answer look at back
