NURS 3000 FINAL EXAM QUESTIONS AND ANSWERS UPDATED (GRADED)

NURS 3000 FINAL EXAM QUESTIONS AND ANSWERS UPDATED (GRADED) What are the normal serum sodium levels? - ANSWER 135-145 mmol/L What are the normal serum potassium levels? - ANSWER 3.5-5 mmol/L what is normal glucose levels? - ANSWER 4-7 What is the normal pH of blood? - ANSWER 7.35-7.45 what is the normal PaCO2 value? - ANSWER 35-45 PaO2 normal range - ANSWER 75-100 mmHg What is the normal HCO3 value? - ANSWER 22-26 what is the normal level of hematocrit? - ANSWER Men- 41%-50% Women- 36%-44% normal blood hemoglobin levels - ANSWER Men- 135-170g/L Women- 120-160g/L what is the normal duration of a P wave? - ANSWER 0.06-0.12 seconds What is the normal duration of the PR interval? - ANSWER 0.12-0.20 seconds what is the normal duration of the QRS depolarizing? - ANSWER 0.06-0.10 What is the normal duration of the QT interval? - ANSWER 0.34-0.43 When are we concerned about the ST segment? - ANSWER if there is greater than 1-2mm elevation in two contiguous leads how long is a stroke patient eligible for tPa? - ANSWER 4 hours What are the percentages of the three essential skull components? - ANSWER CSF- 10% Blood - 12% Brain tissue - 78% what is the total volume in the skull? - ANSWER ~1900mL what is the normal ICP? - ANSWER 5-15 mmHg NURS 3000 FINAL EXAM QUESTIONS AND ANSWERS UPDATED (GRADED) What factors impact ICP? - ANSWER blood pressure cardiac function intra-abdominal and intra-thoracic pressure temperature posture blood gasses What is the modified Monro-Kellie doctrine? - ANSWER if the volume of one component increases within the skull and the volume from another component is displaced the total ICP will not change CSF compensates for extra volume by: - ANSWER being displaced into the spinal sub-arachnoid space and can alter CSF production and absorption rates Blood vessels compensate for extra volume by: - ANSWER decreasing the amount of blood coming into the brain venous outflow can be increased or decreased by dilation or constriction of cerebral vessels Brain tissue compensates for extra volume through: - ANSWER distention of the dura or brain tissue compression what is the formula for MAP? - ANSWER diastolic pressure + ((systolic-diastolic pressure)/3) What is the formula for CPP - ANSWER CPP = MAP - ICP what is a normal CPP? - ANSWER 70-100 what CPP is needed for adequate perfusion? - ANSWER 50-60 what happens if CPP is less than 50? less than 30? - ANSWER 50 causes cellular ischemia 30 is incompatible with life What to do when there is a high CPP - ANSWER medication - osmosis diuretic, crystalloid, 3% normal saline check what is causing high blood pressure check the factors that increase ICP what is CPP? - ANSWER cerebral perfusion pressure/Cerebral flood flow if CO2 is high or O2 is low what does this do? - ANSWER relaxes smooth muscles dilates cerebral blood vessels decreases cerebrovascular resistance INCREASES CBF if CO2 is low what happens? - ANSWER constricts smooth muscles constricts cerebral blood vessels increases cerebrovascular resistance DECREASES CBF solve for MAP 82/48 - ANSWER 59 solve for MAP 192/110 - ANSWER 137 solve for CPP BP 112/50 ICP 10 - ANSWER 61 solve for CPP BP: 172/100, ICP: 20 - ANSWER 104 interpret these ABGs including CBF PH:7.28, PaCO2: 52, HCO3: 25, PaO2: 66 - ANSWER uncompensated respiratory acidosis increased CBF hypoxia what happens if PaO2 levels remain low? - ANSWER 1. anaerobic metabolism 2. accumulation of lactic acid 3. increased H+ concentration (lower PH) 4. cerebral environment acidic 5. acidosis causes vasodilation (fluid levels stop auto regulating what does the Pressure-Volume curve determine - ANSWER the relationship between pressure and volume in the cranial vault as expandability (compliance of the brain) decreases the brain can not compensate for the changes in fluid and pressure stage one of the pressure-volume curve - ANSWER modified Monroe-kellie doctrine is still in place stage two of the pressure volume curve - ANSWER compliance is beginning to decrease, increased risk of IICP if pressure or volume is not decreased stage 3 of the pressure-volume curve - ANSWER compensatory mechanisms are becoming exhausted exhibiting headache. changes in LOC & pupillary response small changes in intracranial volume = large increase of ICP stage 4 of the pressure-volume curve - ANSWER lethal IICP at risk for hypo perfusion, herniation, and death if pressure/volume not decreased What is a head injury? - ANSWER trauma that leads to injury of scalp, skull, and/or brain does head trauma include an alteration in LOC? - ANSWER yes no matter how brief what is the name for a serious form of head injury? - ANSWER traumatic brain injury (TBI) examples of what can cause a TBI - ANSWER MVA Falls Assaults Sports Recreational accidents what does IICP over 20mmHg lead to? - ANSWER decreased CPP risk of brain ischema and infarction poor life prognosis What are the 3 types of cerebral edema - ANSWER vasogenic, cytotoxic, interstitial What changes occur with vasogenic edema? - ANSWER changes in the endothelial lining of cerebral capillaries leaking of macromolecules from the capillaries into extracellular space resulting in osmotic gradient from intra to extravascular disruption of BBB increases permeability and fluid moves to the brain tissues What changes occur with cytotoxic cerebral edema? - ANSWER local disruption of the function/make up of cell membranes develops from destructive brain tissue resulting in cerebral hypoxia or anoxia, sodium depletion, or SIADH impairs sodium-potassium pump in glial cell membranes results as fluid and protein shift from ECF to ICF causing brain cells to swell CVA(stroke) AND TBI timeline of IICP - ANSWER cranial injury - tissue edema - increased ICP - compression of blood vessels - decrease of CBF - decrease O2 (death of brain cells) - edema around necrotic tissue - increased ICP with compression of brainstem and respiratory centre - accumulation of CO2 - vasodilation - increased blood volume- increased ICP - DEATH what is an intracranial catheter? - ANSWER placed in the place of edema to reduce fluid ventricular, subarachnoid, intraparenchymal, epidural, subdural What are early signs of increased ICP? - ANSWER altered LOC (confusion and restlessness) unilateral changes in pupil size, shape, or reactivity altered respiratory pattern unilateral hemiparesis COMPENSATORY MECHANISMS INTACT what are the early variable signs of IICP? - ANSWER speech difficulties, visual disturbances papilledema vomiting headaches