BRAIN

Question 1

What does cerebrum contains

Answer 1

1. Frontal Lobe
2. Temporal Lobe
3. Parietal Lobe
4. Occipital Lobe

Question 2

Frontal lobe

Answer 2

Eye and voluntary movement

Question 3

Temporal lobe

Answer 3

Long term memory formation

recognition of faces, scenes and speech

Wernicke’s area: understanding spoken and written language

Question 4

Parietal lobe

Answer 4

Sensory perception

Question 5

Occipital lobe

Answer 5

Visual processing

Question 6

Cerebellum

Answer 6

Muscle coordination and balance

Question 7

Where is the CSF located at

Answer 7

Subarachnoid space

Question 7

Surgical management of complication of SAH:

Answer 7

EVD for:
Hydrocephalus
Reduce ICP due to brain swelling
Intracranial pressure monitoring

Secondary prevention of re-bleeding
Clipping of aneurysm
Coiling of aneurysm

Question 8

Ventilation and oxygenation

Answer 8

Keep airway clear

Hyperoxygenation before suctioning

Monitor: Ventilator setting, blood ABG, SPO2

Question 9

Monitor cerebral metabolism

Answer 9

Reduce brain’s need for oxygen and glucose: Sedate patient adequately

Avoid clustering of nursing activities

Ensure rest period between procedure

Increase temperature cause an increase in cerebral metabolism

Maintain normothermia

Control fever:

-Administer antipyretics
-Prevent HAI ( VAP, CAUTI, CLABSI)

Question 10

CSF drainage:

Answer 10

Insertion of EVD

Question 11

Osmolar therapy:

Answer 11

Hypertonic solution
Administer Hyperosmolar fluid (IV mannitol)

Monitor for AE: Fluid and electrolyte imbalance, look out for hyponatremia, hypotension, PE, CHF)

Monitor serum osmolality below 320 osm

Question 12

Venous drainage:

Answer 12

HOB 30’C, head and neck in neutral position

Question 13

Aim normovolemia:

Answer 13

Administer IV fluid NS 0.9%

Monitor for fluid and electrolytes imbalance

Question 14

Maintain BP

Answer 14

To prevent hypotension, administer anti-hypertensive

Keep SBP 140-160mmHg

Question 15

Nursing role: Medical Management of Increased ICP

Answer 15

Head position neutral, Head of Bed 30’c: To maximise venous outflow

Osmotic diuretics (Mannitol 20%): Achieve plasma osmolarity to draw water out of the brain , Monitor renal function

Hypertonic saline therapy if sodium is normal

Maintain normothermia

Analgesics for headache

Hyperventilation: Keep PCO2 around 25-30 mmHG

Barbiturate coma if needed- reduce brain metabolism

Question 16

ICH: Maintain SBP

Answer 16

< 160mmhg or > 120 mmhg

Question 17

SAH: Maintain MAP

Answer 17

<130 mmhg or > 80 mmhg

Question 18

Medical management of Haemorrhagic stroke:

Answer 18

Stop antiplatelet & anticoagulation
Reverse the antithrombotic effect and correct coagulation

ICH: Maintain SBP < 160mmhg or > 120 mmhg
SAH: Maintain MAP <130 mmhg or > 80 mmhg

Monitor neurological condition
Control ICP (CPP= MAP - ICP)
Keep BSL 6-10 mmol/L
Consider surgical interventions

Question 19

Surgical management of complication of SAH:

Answer 19

EVD for:

Hydrocephalus
Reduce ICP due to brain swelling
Intracranial pressure monitoring

Secondary prevention of re-bleeding
Clipping of aneurysm
Coiling of aneurysm

Question 20

Post surgical management:

Answer 20

Reduce risk of re-bleeding: Maintain SBP 120-140 mmhg

Prevent vasospasm (post-operation): Nimodipine

Prevent seizure: Phenytoin/ valproate

Control ICP/ BSL/ fever

Intraparenchymal hemorrhage

Question 21

Signs of meningitis

Answer 21

indicate presence of nerve irritation

Neck stiffness - patient may feel pain; chin does not touch the sternum

Kernig’s sign- trying to extend the flexed knee while the hip is flexed - causes spasm of the hamstring muscles

• Brudzinski sign - Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.

Question 22

Investigation of meningitis

Answer 22

• CT scan to exclude mass lesion in drowsy or unconscious patient
• Lumbar puncture – CSF contains:
• Neutrophils > 5000 cells/mm3 (lymphocytes in viral & tuberculous meningitis)
• Protein elevated
• Glucose reduced
• Gram stain may show organism
• Blood culture