head injury increased intracranial pressure · *define and state the components of the monro-kellie...

* IMPORTANT INFORMATION – you will be tested!

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LEVELS OF KNOWLEDGE: Increased ICP

• Complete after NCCU increased ICP Class.

HEAD INJURY

1. *Differentiate the pathophysiology, seriousness, outcome, and clinical

presentation of a concussion & contusion, and between an epidural & subdural

hematoma.

2. *Differentiate between rhinorrhea and otorrhea in terms of definition,

characteristics.

3. *State principles of care for a patient with a CSF leak.

INCREASED INTRACRANIAL PRESSURE

1. *Define and state the components of the Monro-Kellie Doctrine.

2. *Define compliance, then draw and explain the compliance curve based on the

Monro-Kellie Doctrine.

3. *Identify the clinical picture of a compensated and on-compensated increase in

intracranial pressure (supratentorial lesion).

4. *Identify the clinical picture of a compensated and non-compensated increase in

intracranial pressure (lesion in the posterior fossa).

5. *List factors influencing the extent of the increase in the ICP.

6. *Define Herniation:

7. *Explain the rational for the following treatment measures:

a. Hyperventilation

b. Osmotic diuretics

c. Loop diuretics

d. Steroid therapy

e. Barbiturate therapy

f. Positioning

g. Normotherima

h. Ventriculostomy

i. Hyperosmolar therapy

j. Lidocaine

k. Seizure prevention


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8. *Define auto regulation.

9. *Define, state the normal, and calculate in a given situation the cerebral

perfusion pressure.

10. *Explain the effects of hyper and hypotension on a patient with increased ICP.

11. *State the normal intracranial pressure in mmHg (high and low range).

12. *List factors that impact on cerebral blood flow in to the brain (arterial) and

out of the brain (venous).

13. *Differentiate uncal from tonsillar herniation.

14. *Differentiate between the intraventricular catheter, sudarachnoid bolt, and

lumbar drain in terms of:

a. Advantages/disadvantages

b. Procedure

c. Criteria to use

d. Location for leveling

BRAIN DEATH

1. *Identify the criteria and time frame for declaring a patient brain dead at

JHH.

2. *State two tests for cessation of cortical function, and four tests for cessation

of brain stem function.

3. *Describe the Coronna method for apnea testing.

4. *Describe the preparation, stimulus, and response for both Dolls eyes and cold

calorics for:

a. The normal patient

b. The patient without a cortex (vegetative)

c. The brain dead patient


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LEVELS OF KNOWLEDGE: Cardiac

• Complete after cardiac emergencies class at the latest.

• Use ECCO, ECG materials. ACLS review book and Cardiac emergencies class book as

references.

CARDIAC A & P

1. Trace the electrical impulse through the heart’s condition system. Be sure to

know the locations of SA node, AV node and bundle branches.

2. *Know the intrinsic rate generated from:

a. SA node:

b. AV node/Bundle of HIS:

c. Bundle branches/Purkinje fibers:

3. Trace the flow of blood through the heart.

4. *List the five basic steps used to interpret EKG strips.

5. *Identify what the following deflections of an EG represent:

a. P wave

b. QRS

c. T wave

6. *State the normal intervals values for the PR interval and QRS complex.

DYSRHYTHMIA

1. *Be able to recognize and identify the following rhythms, their defining criteria,

causes, treatment and indication for treatment: This does not require a

written answer

a. NSR

b. Sinus bradycardia

c. Sinus arrhythmia

d. Sinus tachycardia

e. PAC-premature atrial contraction

f. SVT and PSVT

g. Atrial flutter

h. Atrial Fibrillation

i. PVC-premature ventricular contraction


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j. V tach

k. V Fib

l. Torsades de point

m. Heart blocks: 1st degree, 2nd degree (type 1 & 2), and 3rd degree block

n. Placed rhythm: atrial, ventricular, AV sequential; failure to pace and

failure to sense

o. Asystole

CHEST PAIN AND ACUTE MI

1. *Know the assessment for chest pain: OLD CARS

2. *Identify the appropriate action for the patient with complaint of chest pain.

3. *Know the acronym MONA for MI intervention.

4. *List the phases of myocardial infarction event with the EKG change.

ACLS

1. *Know the first line of drugs/interventions for the following ACLS algorithms:

This does not require a written answer

a. Asytole/PEA

b. V fib/pulseless V Tach

c. Bradycardia

DEFIBRILLATOR SKILLS

1. Demonstrate procedure for: This does not require a written answer

a. Defibrillate patient by using paddles and pads. Know the placement of

pads for defibrillation, synchronized cardioversion and pacing.

b. Know how to select joules for defibrillation by using the manual and AED

mode.

c. Know the sequence joule’s selection for both defibrillation and

synchronized cardioversion for different dysrythmias, using either

monophasic or biphasic defibrillator.

d. Know how to synchronized cardiovert patient by selecting the “synch”

mode on the defibrillator. Know the preparation for synchronized

cardioversion.


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LEVELS OF KNOWLEDGE: Respiratory

• Complete after Critical Care Core Day 1.

• Use Respiratory outlines, self learning packets and applicable protocols as

references.

RESPIRATORY

1. *State the indications for intubation. State who is allowed to incubate patient

at JHH. State the nursing responsibilities for a patient who has been

intubated.

2. *Describe the ventilator pattern of Cheyne-Stokes respirations.

3. Differentiate the advantages and disadvantages of the following tubes:

a. Oropharyngeal airway (oral airway)

b. Nasopharyngeal airway (nasal trumpet)

c. Endotracheal tube (oral and nasal)

d. Tracheostomy tube

4. *List aspects of care used to maintain a safe airway for the intubated patient.

5. Discuss the adverse effects of over-inflation or under-inflation of cuffed tubes

and describe the consequences of a ruptured cuff.

6. *Define the following ventilator settings: Assist Control, SIMV, Pressure

Support, PEEP, and CPAP.

7. *State the indications for PEEP.

8. Explain a reason for the following ventilator alarms: low exhaled volume, high

pressure limit, apnea alarm.

9. List three potential problems with mechanical ventilation and include

predisposing factors and preventative action.

10. List criteria for weaning a patient from the ventilator.

11. *State criteria for extubation. Who may extubate a patient in the NCCU?

State the nursing responsibilities post extubation.

12. *Identify the normal ABG values for pH, PaO2,PaCO2 bi-carb.

13. *Interpret ABC’s and be able to describe compensated/uncompensated,

respiratory/metabolic, alkalosis/acidosis.


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14. *Briefly define:

a. Tidal volume (VT)

b. Forced vital capacity (FVC)

c. Negative inspiratory force (NIF)

15. *State the emergency interventions that a nurse will do if a tracheostomy tube

is dislodged from the airway.

16. Identify who may change the first trach and state when the first trach change

should occur.

17. State what equipment must be kept in a patient’s room if they have a

tracheostomy?


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LEVELS OF KNOWLEDGE: Shock

• Complete after Critical Care Core Day 3.

• Use shock class outline as a reference.

SHOCK

1. *Define shock in one sentence.

2. List the initiating event of the shock syndrome.

3. *State the mechanism, purpose, and clinical response of “Nature’s First Aid” or

the body’s own compensatory mechanism (auto-transfusion, baroreceptors,

“SAM” epinephrine and norepinephrine, glucocorticoids, mineral corticords and

ADH).

4. *Describe the difference between compensated and uncompensated shock. (i.e.,

SBP, DBP, LOC, heart rate, urinary output)

5. Briefly identify why trendelenburg position is often contraindicated.

6. Define the three broad categories of shock and list differentiating

characteristics of each.

CARDIAC OUTPUT

1. *State the three components of peripheral circulation and their alternate

names.

2. *State the formula for cardiac output.

3. *Review and know the following: This does not require a written answer

a. Cardiac output

b. Cardiac index

c. Preload

d. After-load

e. Contractility

f. Stroke volume

g. Systemic vascular resistance

h. LVSWI

4. *List the three determinants of stroke volume.

5. *State the measurements for the preload and after-load for both right side

and the left side of the heart.

6. *List two generic causes of increased and decreased preload and indentify

suggested treatments.


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7. *List two generic causes of increased and decreased after-load with suggested

treatments.

8. *List two causes of increased and decreased contractility with suggested

treatments.

9. *List two drugs under each category of inotrope, chronotrope, vasoconstrictor,

and vasodilator.

10. *Explain the atrial contractions contribution to CO and name one clinical

condition in which “atrial kick” is impaired.

PHARMACOLOGY

1. *Review and know the nursing considerations and administrations rate for the

following drugs:

Adenosine Amiodarone Lorazepam

Atropine Sodium Bicarbonate Calcium Chloride

Calcium Gluconate Dexamethasone Digoxin

Dilantin Diltiazem Dobutamine

Dopamine Epinephrine Esmolol

Fentanyl Heparin Insulin

Labetolol Furosemide Lidocaine

Magnesium Sulfate Mannitol Metacolopramide

Morphine Naloxone Neostigmine

Nicardipine Nimodipine Nitroglycerine

Nitroprusside Norepiniphrine Pancuronium

Pentobarbital Pentobarbial Phenobarbital

Phenylephrine Potassium Chloride Procainamide

Propofol Ranitidine Methylprenisolone

Succinylchlorine Diazepam Vascopressin

Vecuronium Verapamil Midazolam

ELECTROLYTE REPLACEMENT

1. *State the dosage and rate of administration for potassium, magnesium,

calcium, and phosphate supplements delivered via peripheral line, central line,

and PO per the NCCU protocol.

2. *State the interpretation and consequences of a low and high potassium,

magnesium, calcium, and phosphate level.

3. *State he situations that might predispose a patient to have a low potassium,

magnesium, calcium, and phosphate.

4. *State the interpretation and follow up for “hemolyzed” specimen.

head injury increased intracranial pressure · *define and state the components of the monro-kellie...

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