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Med Surg 3 Exam 3 > Acute Neuro > Flashcards

Acute Neuro Flashcards

1
Q

how soon can brain damage occur because of insufficient blood flow

A

3-5 min

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2
Q

how does the brain auto regulate insufficient blood flow

A

adjusts diameter of blood vessels, ensures consistent and constant blood flow to the brain tissue

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3
Q

what are some factors that lead to decrease cerebral perfusion

A

Carbon dioxide, oxygen and acidosis, Cardiac or respiratory arrest, Systemic hemorrhage, Trauma, tumors, cerebral hemorrhage, or stroke

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4
Q

how do you calculate cerebral perfusion pressure

A

MAP - ICP

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5
Q

what is normal cerebral perfusion pressure

A

60-100

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6
Q

what does less then 50 cerebral perfusion pressure mean

A

associated with ischemia and neuronal death

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7
Q

what is normal ICP

A

10-15

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8
Q

what is elevated ICP

A

over 20 for 5-10 mins

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9
Q

what are the components of ICP

A

CSF, intracranial blood volume, tissue brain volume

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10
Q

what is the monro kelle doctrine

A

if one component of ICP increases another must decrease to maintain ICP

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11
Q

what are some factors that influence ICP

A

high arterial pressure, venous pressure cant return blood, high intrabdominal/ intrathoracic pressure, temp, CO2 levels

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12
Q

what are the stages of increased ICP

A

total compensation, decrease compensation = risk for increased ICP, failing compensation then cushings triad, herniation = immanent death

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13
Q

what is cushings triad

A

widened pulse pressure, bradycardia, irregular respirations

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14
Q

what are the indications for measuring ICP

A

glasgow coma scale over 8, abnormal CT scan or MRI

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15
Q

what is the gold standard for measuring ICP

A

ventriculostomy

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16
Q

how does a ventriculostomy work

A

catheter inserted into lateral ventricle, coupled with an external transducer, can control ICP by removing CSF (only with ventricular catheter), intermitten or continuous drainage

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17
Q

what are some signs of increased ICP

A

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

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18
Q

what are some signs of cerebral damage

A

alteration in LOC, bradycardia, increase BP, cheyne stokes, evidence of extra ocular movement abnormalities, alteration and inequality of pupil size, extensor plantar response

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19
Q

what are the interventions for ICP and CPP

A

HOB elevated, prevent extreme neck flexion, turn slowly, avoid coughing/straining/valsalva, avoid hip flexion, quiet non stimulating enviornment

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20
Q

how is pain and anxiety managed for ICP and CPP

A

acetaminopen, propofol, dexmedtomide, neuromuscular blocking agents (vecuronium), benzos

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21
Q

how is fluid and electrolyte balanced for ICP and CPP

A

monitor IV fluids, daily electrolytes, monitor for DI or SIADH, mannitol, hypertonic saline bolus (3%)

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22
Q

how do you ensure adequate oxygenation for ICP and CPP

A

PAo2 over 60, PaCO2 30-35, intubation, mech vent, minimize suctioning, minimize abdominal distension

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23
Q

what is cerebral edema

A

increased extravascular fluid in the brain aka swelling

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24
Q

what are the causes of cerebral edema

A

brain bleed, tumors, trauma, TBI, stroke, meningitis

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25
what are the 3 types of cerebral edema
vasogenic, cytotoxic, intersitial
26
what is vasogenic cerebral edema
most common form, from increased permeability of the capillary endothelial cells
27
what is the tx for vasogenic cerebral edema
corticosteriod
28
what is cytotoxic cerebral edema
cellular swelling
29
what is intersitial cerebral edema
seen in hydrocephalus when outflow of CSF is obstructed
30
what is the tx for intersitial cerebral edema
shunt
31
what is viral meningitis
inflammatory condition of brain and spinal cord
32
what is the assessment of viral meningitis
Usually presents as headache, fever, N/V, occasionally accompanied by photophobia and a stiff neck.
33
what are the risk factors for viral meningitis
most common causes are viral illness, most often spread through direct contact with respiratory secretions
34
how do you diagnose viral meningitis
lumbar puncture (CSF to show lymphocytosis), PCR to detect viral specific DNA/RNA
35
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
36
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
37
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
38
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
39
what are the risk factors for bacterial meningitis
usually occurs in fall, winter or early sping , often secondary to viral respiratory disease, close contact
40
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
41
what are some complications of bacterial meningitis
seizures, bradycardia, hypertensive coma, increased ICP, coagulation disorders, death
42
what is encephalitis
acute inflammation of the brain, usually by a virus
43
what is the assessment for encephalitis
ss apear on day 2-3, fever, h/a, n/v, altered mental status
44
what are the risk factors for encephalitis
Measles, chickenpox, mumps, HSV, CMV, West Nile Virus, Amebae
45
how is encephalitis diagnosed
CT; MRI; PET; PCR; RNA test
46
what are the meds used for encephalitis
Acyclovir; Ganciclovir; Anti-Seizure meds 
47
what is the teaching for encephalitis
Mosquito control; Tick control; Vaccines, Avoid pond swimming
48
what is a glioma
brain turmor
49
what is a primary brain tumor
originates in the brain
50
what is a secondary brain tumor
most common brain tumors ordinate from lung or breast
51
what is the 1st sign of a brain tumor
seizures w/o other symptoms and new onset
52
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
53
what are the lab changes for a brain tumor
DI vs SIADH, Hypernatremia, etc….
54
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
55
how are brain tumor diagnosed
Neuro exam, CT Scan, MRI – may be more informative than PET Scan
56
what should you avoid for a brain tumor
Lumbar puncture for risk of herniation
57
unless tx what do brain tumors cause
death from increased ICP and cerebral edema
58
what are the goals of a brain tumor
id tumor, remove vs decrease tumor mass, prevent vs manage ICP
59
what is a diffuse injury
Concussion & Diffuse Nerve Axonal Injury
60
what is a focal injury
Contusion & Hematoma
61
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
62
what are the signs for Basilar Skull Fracture
Battle's sign (postauricular ecchymosis) &  Racoon Eyes (periorbital ecchymosis)
63
what are the ss of Concussion: <5min +LOC = d/c home
Brief disruption in LOC, Retrograde amnesia, Headache, Short duration, May result in post concussion syndrome
64
what are the ss of Post concussion Syndrome: occurs 2wks-2mth later
Persistent headache, Lethargy, Personality and behavior changes , Shortened attention span, decreased short-term memory, Changes in intellectual ability
65
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
66
what is Diffuse Axonal Injury
widespread axonal damage following a TBI (rotation on brainstem)
67
what is a laceration
severe tearing of brain tissue and may result in an intracerebral hemorrhage: prognosis poor as unable to evacuate or repair
68
what is a contusion
bruising of the brain in a closed head injury; minor to severe
69
what is a epidural hematoma
bleeding between dura and skull
70
what is a subdural hematoma
Bleeding between Dura and Arachnoid layer
71
what is the assessment for laceration
+LOC; contralateral  hemiplegia; dilated pupil ipsilateral
72
what is the tx for laceration
Antibiotics and ICP management
73
what is the assessment for contusion
Can rebleed, Focal and generalized manifestations, Monitor for seizures, Potential for increased hemorrhage if on anticoagulants, Coup & Contercoup
74
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
75
what is the assessment/interventions for subdural hematoma
Venous, Presents within 24 to 48 hours of the injury, Symptoms related to increased ICP, ↓ LOC, headache, Ipsilateral pupil dilated and fixed if severe, Highest mortality as often goes unrecognized
76
what is the best diagnostic for head injury
CT
77
how often are neuro assessments after crainotomy
every 15-30 mins for 6 hrs -> every hr for 24hrs.
78
what level of saturation should you report after craniotomy
Report saturation or >50ml in 8hrs
79
what are the nursing interventions for head injury
Patent airway, Stabilize cervical spine, Oxygen, IV access, Intubate if GCS <8, Control external bleeding, Remove patient’s clothing to make sure you're not missing anything, Maintain patient warmth, Administer fluids cautiously, Pao2 >80 mm Hg, MAP >70 mm Hg.
80
what are the spinal precautions for head injury
Rigid cervical collar, Bedrest, Avoid neck flexion, Avoid HOB elevation (may do reverse Trendelenburg), Log roll
81
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

Med Surg 3 Exam 3 (6 decks)

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