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Critical Care Med Surg > Acute Intracranial Problems - Modified SG > Flashcards

Acute Intracranial Problems - Modified SG Flashcards

1
Q

Calculate CPP

A 
CPP = MAP - ICP
CPP = Flow x Resistance
MAP = ((SBP-DBP)1/3) + DBP
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2
Q

Clinical Manifestations of Increased ICP

A

Changes in LOC - most reliable
Cushing’s Triad
Changes in Pupils
Decrease in Motor Functions
Nocturnal Headache or Morning headache that’s worsened with straining, agitation, and movement
Projectile vomiting or Vomiting with no nausea

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3
Q

Cushing’s Triad

A

MEDICAL EMERGENCY
Systolic HTN with widening pulse pressure
Bradycardia with bounding pulses
Irregular respirations

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4
Q

How does Compression of cranial Nerve III look like?

A

Dilated pupils on same side as mass lesion (ipsilateral)
Sluggish or no response to light
Inability to move eye upward and adduct
Ptosis (eye drooping)

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5
Q

Neurologic emergency for eyes

A

Fixed, unilateral, dilated pupil

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6
Q

Clinical Manifestations of CN II (optic), CN IV (trochlear,), CN VI (abducens) damage

A

Blurred vision
Diplopia
Changes in extraocular eye movements

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7
Q

Clinical Manifestations Central Herniation

A

Sluggish but equal pupil response

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8
Q

Clinical Manifestations Uncal Herniation

A

Dilated unilateral pupil

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9
Q

Clinical Manifestations Papilledema

A

Edematous optic disc on retinal examination

Nonspecific signs but always with increased ICP

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10
Q

Decrease in Motor functions

A

Contralateral hemiparesis or hemiplegia
Decorticate posture
Decerebrate posture

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11
Q

Decorticate posture

A

Internal rotation and adduction of the arms with flexion of elbows, wrist and fingers.
Extension, internal rotation and plantar flexion of lower extremities

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12
Q

Decerebrate posture

A

Arms are stiffly extended, adducted and hyperpronated.

Hyperextension of the legs with plantar flexion of the feet.

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13
Q

Important Nursing Assessment of increased ICP (and Head Injury)

A 
Glasgow Coma Scale
Neuro Assessment:
Comparing pupils with one another
Test pupils with light reaction
Assess eye movements
Test motor strength for awake and cooperative pts. 
Assess for motor response with unconscious or unresponsive pts. 
Record v/s
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14
Q

GCS

A 
Lowest score: 3, Highest score: 15
Eyes Open (4 total)
Verbal Response (5 total)
Motor Response (6 total)
If any category is unstable, they get a U
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15
Q

GCS Eyes Open

A 
Eyes Open (4 total)
Spontaneous response- 4
Opening eyes to name or command - 3
Lack of eye opening to previous stimuli but opens to pain - 2
Does not open eyes to any stimulus - 1
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16
Q

GCS Verbal Response

A

Verbal Response (5 total)
AOx 4 and appropriate conversation- 5
Confused, conversant but disoriented in 1 or more spheres - 4
Inappropriate or disorganized word choices or lack of sustained conversation - 3
Incomprehensible words or sounds - 2
Lack of sound with painful stimuli - 1

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17
Q

GCS Motor Response

A

Motor Response (6 total)
Obedience of command - 6
Localization of pain, lack of obedience but presence of attempts to remove offending stimulus - 5
Flexion withdrawal, Arms flexed with pain but not abnormally - 4
Abnormal flexion, making a fist, flexing of arm at elbow and pronation - 3
Abnormal extension, extension of arm at elbow usually with adduction and internal rotation of arm at shoulder - 2
Lack of response - 1

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18
Q

Nursing Management of increased ICP

A 
Maintain ABCs, esp, respiratory function
Sedate pt to deal with pain 
Monitor fluid and electrolyte balance
Monitor ICP
Maintain proper body position
Protect pt from injury with surroundings
Assess psychologic considerations
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19
Q

How do you promote respiratory function?

A

Maintain airway patency
Monitor breathing patterns - Snoring sounds indicate obstruction and need immediate intervention
Intubate PRN,
Suctioning should only be done when necessary because it can increase ICP
Monitor and evaluate ABGs
NG tube to prevent abd distention but not with facial or skull fractures

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20
Q

Opioids

A

Fast response with minimal effect on CBF and O2 metabolism

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21
Q

Propofol (Diprivan)

A

Opioid used to manage anxiety and agitation

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22
Q

Dexmedetomidine (Precedex)

A

Alpha2- adrenergic agonist used for continuous IV sedation of intubated and mechanically ventilated pts in ICU for 24 hours
Hypotension - lowers CPP

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23
Q

Nondepolorizing neuromuscular blocking agents

A

Used for complete ventilatory control in treatment of refractory intracranial HTN.

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24
Q

Benzodiazepine

A

Avoided due to hypotensive effect and long half-life

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25
Q

How do you monitor fluid and electrolyte balance in pts with increased ICP?

A

Record I&O and daily weights
Monitor serum electrolytes
Monitor urine output for DI and SIADH
DI- increased urine output and hypernatremia
SIADH- decreased urine output and dilutional hyponatremia

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26
Q

What should the pt with increased ICP should avoid doing?

A

Coughing, sneezing and Valsalva maneuver.

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27
Q

Proper positioning in pts with increased ICP

A

Head-up position with head in midline position.
Elevate HOB to promote drainage from head
Turn the pts with slow, gentle movements
Avoid extreme hip flexion

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28
Q

How do you protect pt with increased ICP from injury?

A

Quiet, nonstimulating environment with calm, reassuring approach.
Use restraints PRN
Antisz precautions

29
Q

Types of Head Injuries

A

Scalp Lacerations
Skull fractures
Head trauma

30
Q

Scalp Lacerations

A

External head trauma with profuse bleeding

31
Q

Skull fractures

A

Linear or depressed
Simple, comminuted or compound
Closed or opening

32
Q

Rhinorrhea and Otorrhea

A

CSF Leakage from nose and ear, respectively
Both indicate high risk of meningitis
Give anti-bx as preventative measure

33
Q

How to test for CSF leak?

A

Dextrostix and Tes-Tape for present glucose

If blood is present, look for yellowish halo ring in a gauze pad.

34
Q

Diffuse Injury

A

Damage to the brain not localized in one area.

35
Q

Focal Injury

A

Damage is localized to specific brain area.

36
Q

Concussion

A

Sudden, transient mechanical head injury with disruption of neural activity and change in LOC.
Benign and solves spontaneously
Discharge if no loss of consciousness or if loss of consciousness = <5 min.
Notify HCP if behavioral changes or symptoms persist

37
Q

Postconcussion Syndrome

A

Develops 2 weeks to 2 months after injury.

Affects pt’s ADLs

38
Q

Diffuse Axonal Injury (DAI)

A

widespread axonal damage occurring after mild, moderate or severe TBI.
Takes 12-24 hrs to develop and may persist longer
Monitor for increased ICP

39
Q

Lacerations

A

Tearing of the brain tissue

Antibiotics and preventing secondary injury = main goal of treatment

40
Q

Contusion

A

Bruising of brain tissue within a focal area.
Associated with close head injury and occurs at fracture site.
Coup-contrecoup injury
CT scan shows bleeding or “blossom”

41
Q

Traumatic Brain Injury (TBI)

A

Severe form of head trauma

42
Q

Complications of Head Trauma

A

Epidural hematoma
Subdural Hematoma
Intracerebral Hematoma

43
Q

Epidural Hematoma

A

NEUROLOGIC EMERGENCY
Bleeding between dura and inner surface of the skull.
Classic Signs: Initial period of unconsciousness at scene, lucid interval followed by decreased LOC.

44
Q

Subdural Hematoma

A

Bleeding from between the dura mater and arachnoid layer of the meninges
Manifests within 24 to 48 hours
Signs and Symptoms: Decreased LOC and Headache

45
Q

Subacute Subdural Hematoma

A

Occurs within 2-14 days of the injury.

46
Q

Chronic Subdural Hematoma

A

Develops over weeks or months after seemingly minor head injury.

47
Q

Intracerebral Hematoma

A

Occurs from bleeding within the brain tissue.

48
Q

Diagnostic Studies and Interprofessional Care

A

CT scan - best diagnostic test to evaluate for head trauma
MRI scan - detects small lesion
Transcranial Doppler Studies - measures cerebral blood flow (CBF) velocity.
Cervical Spine X-ray

49
Q

Craniotomy

A

Elevate the depressed bone and remove the free fragments.

Visualizes and allow control of bleeding vessel

50
Q

Craniectomy

A

Removal of bone

51
Q

Burr-hole openings

A

Used in extreme emergency for rapid decompression after craniotomy.
Drain will be placed to prevent blood accumulation.

52
Q

Major Causes of TBI or head injuries

A

Falls

Motor Vehicular Crashes

53
Q

Emergency Management of Head Trauma

A

Assess and Maintain ABCs
Assume neck injury and stabilize cervical spine
Apply O2
Establish IV access
Intubate if GCS <8 or no gag reflex
Control external bleeding with sterile pressure dressing
Remove pt’s clothes
Maintain normothermia using blankets, warm IV fluids
Monitor v/s, LOC, pupil size and reactivity, GCS score
Assess for rhinorrhea, otorrhea and scalp wounds
Give fluids cautiously to prevent fluid overload and increase ICP

54
Q

Nursing Management of Head Trauma

A

Monitor for changes in neurologic status - LOC, GCS, Behavior, Pupil reaction, etc.
Loss of corneal reflex needs eye drops or taping eyes shut
Avoid fever with goal temperature 96.8-98.6F
Inform HCP of rhinorrhea and otorrhea - no sneezing or blowing nose, no NG tubes and no nasotracheal suctioning
Burrhole or Craniectomy for severe cases or pt deteriorates.
Seizures may occur and need to be treated with anti-seizure medication.
Mental and Emotional consequences - not realized they have brain injury, loss of memory, mood swings, lack of awareness, etc.
Provide appropriate guidance and referrals.
Follow No policies

55
Q

No Policies

A 
No drinking alcoholic beverages
No driving
No use of firearms
No working with hazardous machinery 
No unsupervised smoking
56
Q

Meningitis

A

Inflammation of the meningeal tissues surrounding brain and spinal cord
Can be Bacterial or Viral

57
Q

Bacterial Meningitis

A

MEDICAL EMERGENCY
Streptococcus pneumoniae and Neisseria meningitidis = leading cause
Enters through respiratory tract or bloodstream and can spread to other areas of the brain.

58
Q

Bacterial Meningitis Clinical Manifestations

A 
High Fever
Severe Headache
N/V
Nuchal rigidity 
Possible skin rash - Petechiae
59
Q

Bacterial Meningitis Complications

A

Increased ICP
Residual Neurologic Dysfunction
Hydrocephalus
Waterhouse-Friderichsen syndrome

60
Q

Waterhouse-Friderichsen syndrome

A

Petechiae
DIC
Adrenal hemorrhage
Circulatory collapse

61
Q

Nursing Assessment of Bacterial Meningitis

A 
v/s - High Fever 
Neurologic assessment - Severe headache
Fluid I&O
Evaluation of lungs and skin
Vaccine History - Meningococcal Vaccines
62
Q

Nursing Care of Bacterial Meningitis

A 
Respiratory Isolation
Give Antibiotics
Give antipyretics
GIve pain medication PRN
Slightly elevated HOB 
Darkened Room with cool cloth over eyes
Provide fluids adequately
High protein, High calorie in small frequent feedings
Promote ROM and warm baths
63
Q

Meningitis Diagnostic Assessment

A

History and Physical Examination
Analysis of CSF - protein, WBC and glucose, culture
CBC, Coagulation profile, electrolyte levels, platelet count,
CT scan. MRI, PET scan,
Skull x-ray studies

64
Q

Viral Meningitis Clinical Manifestation

A

Moderate to High Fever
Headache
Photophobia
Stiff Neck

65
Q

Viral Meningitis Diagnostic Test

A

Xpert EV test to test for enterovirus

Polymerase chain reaction (PCR)

66
Q

Encephalitis

A

Acute inflammation of the brain
Caused by different viruses
Spread by ticks and mosquitoes

67
Q

Encephalitis Clinical Manifestation

A

Nonspecific that appears within 2-3 days
Fever
Headache
N/v

68
Q

Encephalitis Diagnosis

A

Brain images - CT, MRI, and PET
PCR - HSV and West Nile encephalitis
Blood tests that detect viral RNA - West Nile virus

69
Q

Nursing Care for Encephalitis

A

Mosquito Control
Symptomatic and supportive treatment
Acyclovir (Zovirax) - treatment for HSV infection.

Critical Care Med Surg (17 decks)

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