Acute Neuro Flashcards
how soon can brain damage occur because of insufficient blood flow
3-5 min
how does the brain auto regulate insufficient blood flow
adjusts diameter of blood vessels, ensures consistent and constant blood flow to the brain tissue
what are some factors that lead to decrease cerebral perfusion
Carbon dioxide, oxygen and acidosis, Cardiac or respiratory arrest, Systemic hemorrhage, Trauma, tumors, cerebral hemorrhage, or stroke
how do you calculate cerebral perfusion pressure
MAP - ICP
what is normal cerebral perfusion pressure
60-100
what does less then 50 cerebral perfusion pressure mean
associated with ischemia and neuronal death
what is normal ICP
10-15
what is elevated ICP
over 20 for 5-10 mins
what are the components of ICP
CSF, intracranial blood volume, tissue brain volume
what is the monro kelle doctrine
if one component of ICP increases another must decrease to maintain ICP
what are some factors that influence ICP
high arterial pressure, venous pressure cant return blood, high intrabdominal/ intrathoracic pressure, temp, CO2 levels
what are the stages of increased ICP
total compensation, decrease compensation = risk for increased ICP, failing compensation then cushings triad, herniation = immanent death
what is cushings triad
widened pulse pressure, bradycardia, irregular respirations
what are the indications for measuring ICP
glasgow coma scale over 8, abnormal CT scan or MRI
what is the gold standard for measuring ICP
ventriculostomy
how does a ventriculostomy work
catheter inserted into lateral ventricle, coupled with an external transducer, can control ICP by removing CSF (only with ventricular catheter), intermitten or continuous drainage
what are some signs of increased ICP
change in LOC, projectile vomiting w/o nausea, change in VS, cushings triad, change in body temp, decrease in motor function, docorticate/decerbrate posturing, decreasing GCS, h/a, pupillary change
what are some signs of cerebral damage
alteration in LOC, bradycardia, increase BP, cheyne stokes, evidence of extra ocular movement abnormalities, alteration and inequality of pupil size, extensor plantar response
what are the interventions for ICP and CPP
HOB elevated, prevent extreme neck flexion, turn slowly, avoid coughing/straining/valsalva, avoid hip flexion, quiet non stimulating enviornment
how is pain and anxiety managed for ICP and CPP
acetaminopen, propofol, dexmedtomide, neuromuscular blocking agents (vecuronium), benzos
how is fluid and electrolyte balanced for ICP and CPP
monitor IV fluids, daily electrolytes, monitor for DI or SIADH, mannitol, hypertonic saline bolus (3%)
how do you ensure adequate oxygenation for ICP and CPP
PAo2 over 60, PaCO2 30-35, intubation, mech vent, minimize suctioning, minimize abdominal distension
what is cerebral edema
increased extravascular fluid in the brain aka swelling
what are the causes of cerebral edema
brain bleed, tumors, trauma, TBI, stroke, meningitis
what are the 3 types of cerebral edema
vasogenic, cytotoxic, intersitial
what is vasogenic cerebral edema
most common form, from increased permeability of the capillary endothelial cells
what is the tx for vasogenic cerebral edema
corticosteriod
what is cytotoxic cerebral edema
cellular swelling
what is intersitial cerebral edema
seen in hydrocephalus when outflow of CSF is obstructed
what is the tx for intersitial cerebral edema
shunt
what is viral meningitis
inflammatory condition of brain and spinal cord
what is the assessment of viral meningitis
Usually presents as headache, fever, N/V, occasionally accompanied by photophobia and a stiff neck.
what are the risk factors for viral meningitis
most common causes are viral illness, most often spread through direct contact with respiratory secretions
how do you diagnose viral meningitis
lumbar puncture (CSF to show lymphocytosis), PCR to detect viral specific DNA/RNA
what is the tx for viral meningitis
antibiotics after obtaining diagnostic sample but before receiving test results, discontinue if found to be viral in nature
what is the prevention for viral meningitis
symptomatic management, disease is self limiting, full recover expected, isolate and droplet precaution immediately until etiology determined, wash hands, vaccine promotion
what is bacterial meningitis
acute inflammation of meningeal tissue surrounding brain and spinal cord, increased CSF production, purulent secretions spread to other areas of brain through CSF
what is the assessment of bacterial meningitis
fever, nuchal rigidity (stiff neck), altered mental status, severe h/a, N/V, coma, hearing loss, petechiae and palpable purpura
what are the risk factors for bacterial meningitis
usually occurs in fall, winter or early sping , often secondary to viral respiratory disease, close contact
how is bacterial meningitis dx
verified by lumbar puncture and sample CSF (increased neutrophils, increased protein, and decreased glucose), CT scan: prior to LP is suspect to ICP
what are some complications of bacterial meningitis
seizures, bradycardia, hypertensive coma, increased ICP, coagulation disorders, death
what is encephalitis
acute inflammation of the brain, usually by a virus
what is the assessment for encephalitis
ss apear on day 2-3, fever, h/a, n/v, altered mental status
what are the risk factors for encephalitis
Measles, chickenpox, mumps, HSV, CMV, West Nile Virus, Amebae
how is encephalitis diagnosed
CT; MRI; PET; PCR; RNA test
what are the meds used for encephalitis
Acyclovir; Ganciclovir; Anti-Seizure meds
what is the teaching for encephalitis
Mosquito control; Tick control; Vaccines, Avoid pond swimming
what is a glioma
brain turmor
what is a primary brain tumor
originates in the brain
what is a secondary brain tumor
most common brain tumors ordinate from lung or breast
what is the 1st sign of a brain tumor
seizures w/o other symptoms and new onset
what is the assessment of a brain tumor
New Onset: Headache , New Onset:, Seizures, N/V, Mood & personality changes, Muscle weakness; sensory loss; aphasia;visual-spatial dysfunction
what are the lab changes for a brain tumor
DI vs SIADH, Hypernatremia, etc….
what is a Diffuse intrinsic pontine glioma(DIPG)
a brain tumor that is highly aggressive and difficult to treat. It occurs in an area of the brainstem
how are brain tumor diagnosed
Neuro exam, CT Scan, MRI – may be more informative than PET Scan
what should you avoid for a brain tumor
Lumbar puncture for risk of herniation
unless tx what do brain tumors cause
death from increased ICP and cerebral edema
what are the goals of a brain tumor
id tumor, remove vs decrease tumor mass, prevent vs manage ICP
what is a diffuse injury
Concussion & Diffuse Nerve Axonal Injury
what is a focal injury
Contusion & Hematoma
what is the TBI GCS score range
Minor (GCS 13-15) <30min LOC
Moderate (GCS 9-12) 30min-6hrs LOC
Severe (GCS 3-8) >6hrs LOC
what are the signs for Basilar Skull Fracture
Battle’s sign (postauricular ecchymosis) & Racoon Eyes (periorbital ecchymosis)
what are the ss of Concussion: <5min +LOC = d/c home
Brief disruption in LOC, Retrograde amnesia, Headache, Short duration, May result inpost concussionsyndrome
what are the ss of Post concussionSyndrome: occurs 2wks-2mth later
Persistent headache, Lethargy, Personality and behavior changes, Shortened attention span, decreased short-term memory, Changes in intellectual ability
what are the ss of Diffuse Axonal Injury (DAI)
12-24hrs after injury, Decreased LOC, Increased ICP, Cerebral edema, Decortication or Decerebration, 90% in a persistent vegetative state
what is Diffuse Axonal Injury
widespread axonal damage following a TBI (rotation on brainstem)
what is a laceration
severe tearing of brain tissue and may result in an intracerebral hemorrhage: prognosis poor as unable to evacuate or repair
what is a contusion
bruising of the brain in a closed head injury; minor to severe
what is a epidural hematoma
bleeding between dura and skull
what is a subdural hematoma
Bleeding between Dura and Arachnoid layer
what is the assessment for laceration
+LOC; contralateral hemiplegia; dilated pupil ipsilateral
what is the tx for laceration
Antibioticsand ICPmanagement
what is the assessment for contusion
Can rebleed, Focal and generalized manifestations, Monitor for seizures, Potential for increased hemorrhage if onanticoagulants, Coup & Contercoup
what is the assessment/interventions for epidural hematoma
Initial period of unconsciousness, Brief lucid interval followed by decrease in LOC, Headache, nausea, vomiting, Focal findings, Requires rapid evacuation to prevent herniation, Medical Emergency: usually arterial bleed
what is the assessment/interventions for subdural hematoma
Venous, Presents within 24 to 48 hours of theinjury, Symptoms related to increasedICP, ↓ LOC,headache, Ipsilateral pupil dilated and fixed ifsevere, Highest mortality as often goes unrecognized
what is the best diagnostic for head injury
CT
how often are neuro assessments after crainotomy
every 15-30 mins for 6 hrs -> every hr for 24hrs.
what level of saturation should you report after craniotomy
Report saturation or >50ml in 8hrs
what are the nursing interventions for head injury
Patentairway, Stabilize cervicalspine, Oxygen, IVaccess, Intubate if GCS <8, Control externalbleeding, Remove patient’sclothing to make sure you’re not missing anything, Maintain patientwarmth, Administer fluids cautiously, Pao2 >80 mm Hg, MAP >70 mm Hg.
what are the spinal precautions for head injury
Rigid cervical collar, Bedrest, Avoid neck flexion, Avoid HOB elevation (may do reverse Trendelenburg), Log roll
what are the omnious signs for a head injury
Cushing’s Triad, Change in LOC and/or GCS by 2 pts, Pinpoint or dilated pupils, Worsening motor response, Cheyne-Stokes Respirations
