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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
Q

what are the 3 types of cerebral edema

A

vasogenic, cytotoxic, intersitial

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26
Q

what is vasogenic cerebral edema

A

most common form, from increased permeability of the capillary endothelial cells

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27
Q

what is the tx for vasogenic cerebral edema

A

corticosteriod

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28
Q

what is cytotoxic cerebral edema

A

cellular swelling

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29
Q

what is intersitial cerebral edema

A

seen in hydrocephalus when outflow of CSF is obstructed

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30
Q

what is the tx for intersitial cerebral edema

A

shunt

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31
Q

what is viral meningitis

A

inflammatory condition of brain and spinal cord

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32
Q

what is the assessment of viral meningitis

A

Usually presents as headache, fever, N/V, occasionally accompanied by photophobia and a stiff neck.

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33
Q

what are the risk factors for viral meningitis

A

most common causes are viral illness, most often spread through direct contact with respiratory secretions

34
Q

how do you diagnose viral meningitis

A

lumbar puncture (CSF to show lymphocytosis), PCR to detect viral specific DNA/RNA

35
Q

what is the tx for viral meningitis

A

antibiotics after obtaining diagnostic sample but before receiving test results, discontinue if found to be viral in nature

36
Q

what is the prevention for viral meningitis

A

symptomatic management, disease is self limiting, full recover expected, isolate and droplet precaution immediately until etiology determined, wash hands, vaccine promotion

37
Q

what is bacterial meningitis

A

acute inflammation of meningeal tissue surrounding brain and spinal cord, increased CSF production, purulent secretions spread to other areas of brain through CSF

38
Q

what is the assessment of bacterial meningitis

A

fever, nuchal rigidity (stiff neck), altered mental status, severe h/a, N/V, coma, hearing loss, petechiae and palpable purpura

39
Q

what are the risk factors for bacterial meningitis

A

usually occurs in fall, winter or early sping , often secondary to viral respiratory disease, close contact

40
Q

how is bacterial meningitis dx

A

verified by lumbar puncture and sample CSF (increased neutrophils, increased protein, and decreased glucose), CT scan: prior to LP is suspect to ICP

41
Q

what are some complications of bacterial meningitis

A

seizures, bradycardia, hypertensive coma, increased ICP, coagulation disorders, death

42
Q

what is encephalitis

A

acute inflammation of the brain, usually by a virus

43
Q

what is the assessment for encephalitis

A

ss apear on day 2-3, fever, h/a, n/v, altered mental status

44
Q

what are the risk factors for encephalitis

A

Measles, chickenpox, mumps, HSV, CMV, West Nile Virus, Amebae

45
Q

how is encephalitis diagnosed

A

CT; MRI; PET; PCR; RNA test

46
Q

what are the meds used for encephalitis

A

Acyclovir; Ganciclovir; Anti-Seizure meds

47
Q

what is the teaching for encephalitis

A

Mosquito control; Tick control; Vaccines, Avoid pond swimming

48
Q

what is a glioma

A

brain turmor

49
Q

what is a primary brain tumor

A

originates in the brain

50
Q

what is a secondary brain tumor

A

most common brain tumors ordinate from lung or breast

51
Q

what is the 1st sign of a brain tumor

A

seizures w/o other symptoms and new onset

52
Q

what is the assessment of a brain tumor

A

New Onset: Headache , New Onset:, Seizures, N/V, Mood & personality changes, Muscle weakness; sensory loss; aphasia;visual-spatial dysfunction

53
Q

what are the lab changes for a brain tumor

A

DI vs SIADH, Hypernatremia, etc….

54
Q

what is a Diffuse intrinsic pontine glioma(DIPG)

A

a brain tumor that is highly aggressive and difficult to treat. It occurs in an area of the brainstem

55
Q

how are brain tumor diagnosed

A

Neuro exam, CT Scan, MRI – may be more informative than PET Scan

56
Q

what should you avoid for a brain tumor

A

Lumbar puncture for risk of herniation

57
Q

unless tx what do brain tumors cause

A

death from increased ICP and cerebral edema

58
Q

what are the goals of a brain tumor

A

id tumor, remove vs decrease tumor mass, prevent vs manage ICP

59
Q

what is a diffuse injury

A

Concussion & Diffuse Nerve Axonal Injury

60
Q

what is a focal injury

A

Contusion & Hematoma

61
Q

what is the TBI GCS score range

A

Minor (GCS 13-15) <30min LOC
Moderate (GCS 9-12) 30min-6hrs LOC
Severe (GCS 3-8) >6hrs LOC

62
Q

what are the signs for Basilar Skull Fracture

A

Battle’s sign (postauricular ecchymosis) & Racoon Eyes (periorbital ecchymosis)

63
Q

what are the ss of Concussion: <5min +LOC = d/c home

A

Brief disruption in LOC, Retrograde amnesia, Headache, Short duration, May result inpost concussionsyndrome

64
Q

what are the ss of Post concussionSyndrome: occurs 2wks-2mth later

A

Persistent headache, Lethargy, Personality and behavior changes, Shortened attention span, decreased short-term memory, Changes in intellectual ability

65
Q

what are the ss of Diffuse Axonal Injury (DAI)

A

12-24hrs after injury, Decreased LOC, Increased ICP, Cerebral edema, Decortication or Decerebration, 90% in a persistent vegetative state

66
Q

what is Diffuse Axonal Injury

A

widespread axonal damage following a TBI (rotation on brainstem)

67
Q

what is a laceration

A

severe tearing of brain tissue and may result in an intracerebral hemorrhage: prognosis poor as unable to evacuate or repair

68
Q

what is a contusion

A

bruising of the brain in a closed head injury; minor to severe

69
Q

what is a epidural hematoma

A

bleeding between dura and skull

70
Q

what is a subdural hematoma

A

Bleeding between Dura and Arachnoid layer

71
Q

what is the assessment for laceration

A

+LOC; contralateral hemiplegia; dilated pupil ipsilateral

72
Q

what is the tx for laceration

A

Antibioticsand ICPmanagement

73
Q

what is the assessment for contusion

A

Can rebleed, Focal and generalized manifestations, Monitor for seizures, Potential for increased hemorrhage if onanticoagulants, Coup & Contercoup

74
Q

what is the assessment/interventions for epidural hematoma

A

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
Q

what is the assessment/interventions for subdural hematoma

A

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

76
Q

what is the best diagnostic for head injury

A

CT

77
Q

how often are neuro assessments after crainotomy

A

every 15-30 mins for 6 hrs -> every hr for 24hrs.

78
Q

what level of saturation should you report after craniotomy

A

Report saturation or >50ml in 8hrs

79
Q

what are the nursing interventions for head injury

A

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.

80
Q

what are the spinal precautions for head injury

A

Rigid cervical collar, Bedrest, Avoid neck flexion, Avoid HOB elevation (may do reverse Trendelenburg), Log roll

81
Q

what are the omnious signs for a head injury

A

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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