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NU 360 > Ch. 36 & 38 > Flashcards

Ch. 36 & 38 Flashcards

1
Q

seizure (defined)

A

abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain; may result in alteration in consciousness, motor or sensory ability, and/or behavior

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2
Q

epilepsy (defined)

A
  • two or more seizures experienced without a known cause (ie fever, tumor)
  • chronic disorder with recurrent, unprovoked seizure activity, may be caused by abnormality in electrical neuronal activity and/or imbalance of neurotransmitters (ie GABA)
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3
Q

how is epilepsy quantified (r/t # of seizures)

A

two or more seizures experienced without a known cause (ie fever, tumor)

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4
Q

types of seizures

A
  • generalized
  • partial
  • unclassified
  • primary or idiopathic epilepsy
  • secondary seizures
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5
Q

generalized seizures

A

tonic-clonic/grand mal
- postictal state ( period of confusion immediately following seizure, then pt is fine)

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6
Q

partial seizures

A

focal/local
- one cerebral hemisphere- complex or single

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7
Q

unclassified seizures

A

seizures that can’t be classified due to lack of information
- not witnessed
- no EEG available

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8
Q

primary aka idiopathic epilepsy

A
  • not associated with any identifiable brain lesion
  • we don’t know why it happens
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9
Q

secondary seizures

A
  • result from an underlying brain lesion, most commonly a tumor or trauma
  • many diseases/disorders associated with s/s of seizure
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10
Q

causes of seizures/ things that increase risk of seizure

A
  • metabolic d/o: liver disease- ammonia goes up, brain swelling
  • acute alcohol withdrawal!*
  • electrolyte disturbances: low sodium
  • heart disease: v-tach
  • high fever: common with kids
  • stroke: from increased ICP with brain swelling
  • substance abuse: need hx of illicit drug use
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11
Q

diagnostics for seizures

A
  • EEG (want to mimic the way pt has a seizure: sleep deprived, no meds, no lotion, clean/clip hair- electrodes to scalp)
  • CT/MRI (looking for tumor)
  • ID underlying causes (labs, PMH)
  • document before and after (want to know how long/length of seizure)
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12
Q

drug therapy “rules” for seizures

A
  • evaluate most current blood level of medication, if appropriate
  • be aware of drug-drug and drug-food interactions
  • maintain therapeutic blood levels for maximal effectiveness
  • do not administer warfarin with phenytoin
  • document and report side/adverse effects: fatigue common
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13
Q

phenytoin special considerations

A
  • cannot mix with sugar, ONLY saline
  • very small window of therapeutic range- check blood levels!
  • no warfarin!
  • causes gum hyperplasia
  • compliance issue b/c need blood levels checked
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14
Q

seizure medication: AEDs (anti epileptic drugs)

A
  • Carbamazepine: maintenance
  • Diazepam: rescue
  • Lorazepam: rescue
  • Divalproex: maintenance
  • Valproic Acid: maintenance
  • Gabapentin: maintenance
  • Lamotrigine: maintenance
  • Levetiracetam: maintenance
  • Phenobarbital: maintenance *
  • Phenytoin (aka dilantin): maintenance; through IV
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15
Q

patient may be prescribed up to __ medications simultaneously for intractable seizures

A

patient may be prescribed up to 3 medications simultaneously for intractable seizures

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16
Q

seizure precautions: patient positioning

A
  • turn patient to side if possible
  • do NOT force patient to move to side
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17
Q

nursing management when seizure occurs (stages)

A
  • observe and document
  • patient safety
  • medications
  • need medical history to ID why seizure is happening
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18
Q

nursing management when seizure occurs: observe and document

A
  • onset of seizure if witnessed
  • behavioral manifestations
  • determine if patient is oriented by asking questions and document responses
  • document end of seizure
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19
Q

nursing management when seizure occurs: patient safety

A
  • position: side lying
  • no restraints
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20
Q

nursing management when seizure occurs: medications

A
  • Lorazepam
  • Diazepam
  • Diastat
  • IV phenytoin
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21
Q

status epilepticus: actions

A
  • establish an airway
  • ABGs
  • IV push lorazepam, diazepam; rectal diazepam (rescue meds)
    -lorazepam is like jelly, insert small amount of NS flush into lorazepam to make easier to draw up
  • loading dose IV phenytoin (maintenance meds)
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22
Q

what is status epilepticus?

A

MEDICAL EMERGENCY- loss of neurons may occur (no oxygen to the brain)
- prolonged seizures lasting more than 5 minutes or repeated seizures over the course of 30 minutes

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23
Q

surgical management of seizures

A
  • vagal nerve stimulation (VNS)
  • conventional surgical procedures
  • anterior temporal lobe resection
  • partial corpus callosotomy
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24
Q

surgical management of seizures: VNS

A

implanted medical device to send electrical impulses to vagus nerve

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25
Q

surgical management of seizures: anterior temporal lobe resection

A

a neurosurgical procedure that removes the front part of the temporal lobe of the brain to treat drug-resistant epilepsy

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26
Q

surgical management of seizures: partial corpus callosotomy

A

a surgical procedure that separates the front two-thirds of the corpus callosum, the bundle of nerve fibers that connects the two hemispheres of the brain

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27
Q

patient/family education regarding seizures

A
  • 30% of persons with epilepsy have intractable seizures.
  • Alternative employment may be needed.
  • No driving if seizure activity within 6 months.
  • Vocational rehabilitation may be subsidized.
  • Antiepileptic drugs (AEDs) may not be stopped, even if seizures stop.**!!
  • Refer limited-income patients to social services.
  • All states prohibit discrimination against people who have epilepsy.
  • Some persons with seizures develop pseudoseizures
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28
Q

what % of people with epilepsy have intractable seizures?

A

30%

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29
Q

no driving for a person who had seizure activity within the last ___ (time period)

A

no driving for a person who had seizure activity within the last 6 months

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30
Q

what is a stroke?

A

a stroke or CVA occurs when the blood flow to the brain is obstructed, causing deprivation of oxygen and nutrients, which are essential for functioning
- the obstruction may be caused by a clot (ischemic) or a hemorrhage (bleeding)
- need to know which type of stroke (ischemic or hemorrhagic)
- ischemic stroke is more common, more nursing interventions
- lack of blood flow leads to cell death

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31
Q

risk factors for stroke: modifiable

A
  • smoking
  • obesity
  • hypertension (higher risk for hemorrhagic stroke)
  • diabetes mellitus
  • elevated cholesterol
  • blacks 2x higher than whites- access to healthcare, psychosocial reasons
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32
Q

risk factors for stroke: non-modifiable

A
  • familial: first degree relative with history of hypertension, atherosclerosis disease, aneurysm (anywhere in the body)
  • if fam member has hx of aneurysm, the patient should get a head CT just incase
  • women (more prevalent post-menopausal; the idea is that women live longer than men)
  • hispanic, native american, african ancestory
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33
Q

transient ischemic attack (TIA) definition

A

transient episode of reversible ischemia in the CNS typically <1hr, up to 24hr
- “mini stroke”
- little blockage, blood isnt getting through, then all of a sudden the blood gets through
- if patient has multiple TIAs- red flag that they need to change lifestyle or will experience a stroke
- pt shows stroke sx, we rule out CVA, then back track to TIA
- difference between CVA and TIA: TIA symptoms resolve- function back, speaking clearly

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34
Q

TIA symptoms

A
  • depend on region- affected by emboli
  • hemiplegia
  • difficulty with speak
  • weakness
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35
Q

ischemic stroke is when

A

a clot blocks blood flow to an area of the brain

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36
Q

hemorrhagic stroke is when

A

bleeding occurs inside or around brain tissue
- ie aneursym bursts

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37
Q

types of hemorrhagic stroke

A

radiologist is the one that diagnoses the region
- intracerebral hemorrhage (ICH)
- subarachnoid hemorrhage (SAH)
- aneurysm
- arteriovenous malformation (AVM)

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38
Q

ischemic stroke types

A

(blocked vessels- most commonly carotid- do a carotid ultrasound)
- embolic stroke (“moving clot” clot breaks off in the body somewhere and travels to the brain where it gets stuck)
- thrombotic stroke (clot forms and blocks vessel)

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39
Q

stroke incidence and prevalence

A
  • 5th leading cause of death in US
  • women have higher prevalence than men post-menopause
    -onset of symptoms may be slightly different
  • stroke belt: a section of states that are at a higher risk mostly due to modifiable risk factors (lifestyle factors. limited access to healthcare, etc.)
  • 4+ million stroke survivors in the US
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40
Q

in a stroke, “act F.A.S.T.”

A

face: one-sided droop, ask pt to smile
arms: one arm weak or numb, ask pt to raise both arms, one arm drift downward
speech: slurred, ask pt to repeat simple sentence- repeated correctly?
time: if person shows any sx, call 911 or get to hospital immediately

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41
Q

stroke: pt history

A
  • onset of sx: time, type of sx (HA, weakness)
  • when was patient’s last known well (last time they were definitively known to be well/at baseline- need to know to give t-PA)
  • use of medications, OTC (current use)
  • medical hx: a-fib (huge clot risk), including recent events (MI, stroke or TIA, trauma, surgery, GI bleed or any bleed in the body)
  • know if pt is diabetic- sx of low blood sugar are similar to stroke- make sure to get a blood sugar before doing anything else
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42
Q

stroke diagnostics: labs

A
  • blood glucose (check this first!!)
  • PT, INR, aPTT (going down the road of if going to give thrombolytic or anticoagulant- need to check these levels before giving meds)
  • elevated H&H, WBC
  • hemoglobin A1C (can do later)

*note blood levels do not diagnose stroke

43
Q

stroke diagnostics: imaging

A
  • CTP and/or CTA using contrast dye (CT is definitive dx stool)- think working IV, allergy to iodine/dye?, impact on kidneys d/t contrast dye (monitor kidney function), stop metformin for 48hr give IVFs for DM pt
  • MRA (similar to MRI- usually do it down the road, facility specific)
  • ultrasound (used to view carotid arteries/vessels, NOT the brain)

*initially will not see blockage on CT, will only see bleed on CT (white spot in brain): this is how we dx type of stroke
- see nothing on CT: ischemic stroke
- see bleed on CT: hemorrhagic stroke

44
Q

“time is brain” meaning

A

with a stroke,
- up to 1 million brain cells may die each minute without treatment
- 3 hour window from beginning of symptoms to administration of thrombolytic

45
Q

nursing priorities with stroke

A
  • activate stroke team/call stroke alert
  • 3 hr window time for tPA
  • may rule in for intra-arterial interventions up to 6 hours
  • anticipate stat orders and prepare patient
    -brain CT (non-contrast) or MRI
    -labs: glucose, PT/INR/aPTT
    -EKG: looking for a-fib, new-onset
    -vitals
  • GCS (need to know baseline as well, any change from baseline is worrisome): goal is to have HIGH number
  • NIH stroke scale (NIHSS): goal is to have LOW number
46
Q

target time with stroke: “door to needle time”

A

latest goal is 45 minutes (no more than 3 hours from onset of sx)
- time patient arrives at hospital to time thrombolytic (activase (t-PA)) is given to patient
<10 min: neuro assessment *last known well, when did the sx start, document everything
<15 min: stroke team notified, heart monitor, start IV
<25 min: CT initiated
<45 min: CT and labs interpreted, patient comfortable in bed
<60 min: t-PA given to patient if eligible

47
Q

stroke medication: thrombolytic therapy

A

to loosen clots/”cause” bleeding- for ischemic stroke only (clot strokes)
- activase (t-PA) *blood pressure must be <180/105 to give t-PA
-labetalol may be administered to reduce BP
- need to know patients PMH including recent surgeries because we may not be able to give with thrombolytic depending on how recent the surgery was

48
Q

stroke medication: anticoagulants

A

to prevent clots
- Warfarin, apixaban, dabigatran, edoxaban and rivaroxaban
*not to be used within 24 hours of t-PA

49
Q

stroke medication: lorazepam and antiepileptics (phenytoin) are used for ___

A
  • May be used for seizure prophylaxis
50
Q

stroke medication: statins

A
  • Atorvastatin (Lipitor), Lovastatin (Altoprev), Pravastatin (Pravachol), Rosuvastatin (Crestor, Ezallor), Simvastatin (Zocor)
51
Q

stroke medication: CCBs

A
  • Amlodipine (Norvasc), Diltiazem (Cardizem), Nicardipine, Nifedipine (Procardia), Verapamil (Calan SR, Verelan)
52
Q

stroke medications

A
  • stool softeners: to prevent straining and prevent increased ICP
  • analgesics for pain: as needed for hemorrhagic stroke
  • anti-anxiety meds: benzos also cover anxiety
  • statins: long-term management; d/c pt on this
  • CCBs: gets BP down
  • lorazepam and other antiepileptics
    -“pams” are rescue meds for seizures to stop; benzos
    -antiepileptics are maintenance to prevent seizures
  • anticoagulants
  • thrombolytic therapy* for clot stroke only
53
Q

activase (T-PA)

A
  • <3 hrs of onset of symptoms!
  • 4.5 hours for some patients
  • May require Patient or Family Consent
  • Bolus for 1 min then drip for 60 minutes
  • need to know patients weight
  • very expensive- dont drop it, even if you spike it but dont use it, return it to save hospital some money
  • Prior to Administering – Nursing!
  • Post t-PA infusion care – Nursing! (looking for improvement of sx, looking for bleeding)
  • ICU 24 hrs
  • Neuro checks/vs every 15 minute protocol
54
Q

contraindications of activase (t-PA)

A
  • Onset of symptoms unclear (i.e. wake-up stroke)
  • Bleeding (recent surgery/known active/labs/meds-on blood thinners)
  • outside of the 3 hour window (in rare cases, neurology may choose to give it)
  • blood pressure 180/105 or higher (need to give antihypertensive to lower BP then reassess)
    (*note -permissive HTN: 140s/150s systolic is okay, want BP a little high to increase pressure in brain d/t lack of blood flow to brain)
  • Already improving; symptoms got better
55
Q

interventional management for ischemic stroke

A
  • medical management: tPA
  • surgical:
    -merci device (mechanical embolus retrieval in cerebral ischemia)
  • carotid artery angioplasty with stenting
    -endarectomy: scraping out the crud
56
Q

hemorrhagic stroke: medical treatment

A
  • Medications used to treat acute stroke
    anticonvulsants, antihypertensives, osmotic diuretics (ie. mannitol- causes polyuria, edema, CHF, full of fluid- think lung sounds important)
  • Reversal of anti-platelet or anticoagulant therapy: vit K, cryo, FFP
  • Surgical intervention: craniotomy with clot evacuation
  • Endovascular surgery with aneurysm clipping (think clamp on either end of vessel to prevent blood flow through the vessel)
57
Q

hemorrhagic stroke: nursing measures

A
  • Frequent monitoring of neuro status
  • Low stimulation environment
  • Blood pressure management
  • Arrythmia detection
  • Post operative care
  • Dysphasia screening
58
Q

s/sx of increased intracranial pressure (ICP)

A
  • changes in LOC
  • HA

seizures:
- impaired sensory and motor function
changes in VS:
- cushings triad: increased systolic BP, decreased pulse, irreg resp pattern

  • vomiting
  • changes in speech

posturing: (ominous sign to do something!)
- decorticare, decerebrate, flaccid
eyes:
- papilledema, pupillary changes, impaired eye movement
infants:
- bulging fontantels, cranial suture separation, increased head circumference, high pitched cry

59
Q

increased intracranial pressure (ICP): management

A
  • osmotic diuretics
  • mannitol IV: use 0.22 micron filter
  • hypertonic saline (2% or 3%)
  • drainage of CSF
60
Q

Joint Commission of Measures of Stroke Care

A
  • Dysphasia screening
  • DVT prophylaxis
  • Consider thrombolytic therapy
  • Antithrombotic therapy by end of day 2
  • Stroke education
  • Assess for rehabilitation
  • Anticoagulation therapy for atrial fibrillation/flutter
  • Discharge on statin medication
61
Q

other tests and monitoring for stroke

A
  • carotid ultrasound
  • dysrhythmias monitoring
  • nursing bedside swallow eval***
62
Q

stroke: patient intensive care management

A
  • cooling (normothermia)
  • internal cooling, external cooling devices
    -nursing: bedside shivering assessment scale
  • neuroprotective drugs
  • carotid artery angioplasty with stenting
  • consider endarterectomy
63
Q

AV malformation (definition)

A
  • something a person is born with; congenital malformation
  • usually incidental finding on CT
  • can live normally, but increased risk of brain bleed
  • weird collection of vessels without capillary bed
  • type of hemorrhagic stroke cause
64
Q

management of cerebral aneurysms

A
  • minimally invasive techniques
  • open craniotomy
    -clipping
  • interventional radiology
    -coiling
  • type of hemorrhagic stroke cause
  • types: saccular, fusiform, ruptured
  • will leave if not burst or small enough to not worry about/cause harm
65
Q

clipping: post-op care

A
  • position
  • normal expectations
66
Q

coiling (definition)

A

insert tiny platinum coils into aneurysm
- no skull incision, minimally invasive, quicker recovery
- go through groin

67
Q

craniotomy: nursing post-op care

A
  • Monitoring for ICP and Neuro deficits
    -GCS/Pupils
  • Normal Findings: periorbital edema and ecchymosis
  • Positioning: midline, HOB elevated 30°
  • Dressing
  • Lab
  • Meds: seizure, anxiety, pain, etc.
  • NPO for 1st 24 hrs
  • Potential Complications: bleeding more, infection (monitor temp, give prescribed ABT)
68
Q

potential complications from a craniotomy

A
  • impaired physical mobility & self-care deficit
  • disturbed sensory perception
  • unilateral neglect
  • impaired verbal communication
69
Q

interventions for impaired physical mobility and self-care deficit

A
  • Range-of-motion exercises for the involved extremities
  • Change of patient’s position frequently
  • Prevention of deep vein thrombosis
  • Therapy focused on patient performance of ADLs
70
Q

disturbed sensory perception: right hemisphere damage

A
  • visual-perceptual or spatial-perceptual tasks (not aware of one side of body): approach and tap from side that she is not aware of to reorient and retrain the brain
  • ADLs difficult
  • Ambulation: fall risk, bed alarm, scheduled toileting
  • Personality changes (impulsivity- laughing/crying/swearing)
71
Q

disturbed sensory perception: left hemisphere damage

A
  • memory deficits
  • difficulty with carrying out simple tasks
  • speech, language (aphasias)
72
Q

unilateral neglect is most commonly seen with (stroke type)

A

right cerebral stroke

73
Q

interventions for unilateral neglect

A
  • Observe safety measures* (explain to family)
  • Touch and use both sides of the body
  • Use scanning technique of turning the head from side to side to expand the visual field
74
Q

impaired verbal communication includes

A
  • language or speech problems
  • expressive aphasia, Broca’s area (have a hard time finding their words and expressing themself)
  • receptive aphasia, Wernicke’s or sensory (have a hard time understanding what other people are expressing to them)
75
Q

symptoms of dysphagia (difficulty swallowing)

A
  • difficulty swallowing
  • choking or coughing
  • weight loss from eating less
  • taking a long time to eat
  • food left in mouth after swallowing (pocketing)
  • frequent chest infection
76
Q

interventions for impaired swallowing

A
  • dysphagia screen (nursing)**
  • swallow evaluation (speech-language pathology)
  • patient positioning to facilitate the process of swallowing before feeding
  • appropriate diet for the patient, including semisoft foods and fluids (thick-it- can manage liquids better with this powder, makes fluids like a honey texture)
  • aspiration precautions
77
Q

urinary and bowel incontinence includes

A
  • Altered level of consciousness may cause incontinence or impaired innervation or an inability to communicate.
  • Sexual dysfunction

types:
- stress
- urge
- reflex
- overflow

78
Q

interventions for bowel and bladder incontinence

A
  • develop a bladder and bowel training program
  • frequent toileting
  • stool softeners, laxatives
  • urology consult for sexual dysfunction
79
Q

traumatic brain injury (TBI) definition

A

head injury occurs as a result of blow or jolt to the head or as a result of penetration of the head by a foreign object
- such as a bullet

80
Q

open head injury definition

A

occurs when there is a skull fracture or when the skull is pierced by a penetrating object
- the integrity of the brain and the dura is violated, and exposure to outside contaminants occurs
- there is a hole in the brain
- infection risk!!

81
Q

closed head injury definition

A

the result of blunt trauma
- the integrity of the skull is not violated

82
Q

s/sx of a TBI

A
  • amnesia
  • seizure *very concerned if pt with TBI has a seizure
  • LOC/lethargy
  • behavioral changes
  • visual
  • ataxia
  • CHECK THE PUPILS AND GCS
83
Q

basilar skull fracture occurs at the (location)

A

base of the skull
- break in the skull at base (very thin bone!)
- Usually extends into the anterior, middle, or posterior fossa and results in cerebrospinal fluid leakage from the nose or ears (halo on gauze=CSF)
- huge risk of infection!

84
Q

a basilar skull fracture has the potential for (complications)

A
  • hemorrhage
  • damage to cranial nerves
  • infection
85
Q

nursing assessment of a basilar skull fracture: expected sx

A
  • Battle’s signs: bruising behind the ears (bruising over the mastoid process)
  • raccoon eyes
86
Q

types of closed head injuries

A
  • Mild concussion
  • Diffuse axonal injury: all parts of the brain were knocked around and damage, poor neuro sx, CT is clean
  • Contusion (coup and contrecoup injury): more areas of brain are affected
  • Laceration: hit your head so hard that the vessels in the brain tear
87
Q

concussion: patients who have sustained a minor head injury are more likely to deteriorate if: (what circumstances occur)

A
  • Loss of consciousness lasting more than 5 minutes
  • Post-traumatic amnesia
  • Persisting neurologic signs or symptoms
  • Impaired consciousness
  • Skull fracture
  • More than one episode of head trauma (ie, the patient is knocked out, recovers, and returns to the game, where he is again traumatized)
88
Q

warning signs of a head injury in the first 24 hours

A
  • changes in LOC**(#1 flag): increased drowsiness, confusion, difficult to arouse
  • seizures
  • bleeding or water drainage (CSF) from nose or ears
  • pupils slow to react or unequal
  • visual problems
  • loss of sensation in any extremity
  • slurred speach
  • projectile vomiting out of the blue
89
Q

coup and contrecoup injury

A

coup: bruise or other damage at site of impact
contrecoup: bruise or other damage at opposite side of impact site

ie. hit dash board and then go back and hit back of seat

90
Q

acceleration-deceleration injury

A

when head moves suddenly and violently, unrestricted

ie. high speed MVA, whiplash

91
Q

secondary injuries to head injuries

A
  • increased ICP
  • hemorrhage: epidural, subdural, intracerebral
  • hematoma development, hydrocephalus
  • brain herniation
92
Q

epidural hematoma

A

epi=above, above the dura mater, between skull and dura mater
- Neurologic emergencies with potentially catastrophic ICP elevation
- ARTERIAL BLEEDING into space between the dura and inner table of skull
- Temporal bone fractures, middle meningeal artery
- Momentary unconsciousness follows LUCID INTERVAL within minutes of injury, decline pretty rapidly after that
- often young, sporty person, traumatic injury
- people think they are fine because of the lucid interval so they don’t seek medical attention

93
Q

subdural hematoma

A

sub= under, under the dura mater, between dura mater and arachnoid
- VENOUS BLEEDING into the space beneath dura and above arachnoid
- Most commonly from a tearing of the bridging veins within the cerebral hemispheres or from a laceration of brain tissue
- Bleeding occurs more SLOWLY, and symptoms mirror those of epidural hematoma
- commonly seen in older patients, get hx, commonly associated/confused (?) with alcohol use d/o

94
Q

complications of subdural hematoma

A
  • hydrocephalus
  • brain herniation
95
Q

brain herniation definition

A
  • bad thing- ominous sign that there is so much pressure in the brain, its getting squished
  • will be seen in CT
  • neurologist will talk with pt family regarding organ donation
  • most likely pt will not survive this

sx:
- pupil unilateral dilated and nonreactive
- rapidly deteriorating LOC
- seizures/posturing
- VS: cushings triad- decreased HR, RR, increased BP

96
Q

medical management of a head injury (non-surgical)

A
  • ABCs
  • Assessment of vital signs to prevent and detect increased ICP **
  • Positioning
  • Pulmonary ventilation and management of oxygen and carbon dioxide levels
  • Suctioning
  • Chest physiotherapy and frequent turning
97
Q

medication therapy for head injuries

A
  • steroids: Glucocorticoids
  • strong diuretics: Mannitol, furosemide, lasix
  • Opioids, naloxone (for comfort, will affect pupils, mental status)
  • Neuromuscular blocking agents: propofol if sedated and on vent
  • Antiepileptic drugs
  • Acetaminophen and aspirin
  • Barbiturate coma: phenobarbital (old fashioned)
98
Q

surgical management for head injuries

A
  • ICP monitoring device
  • craniotomy may be performed in extreme instances of elevated ICP
99
Q

ICP monitoring devices

A
  • Intraventricular catheter (IVC)
  • Subarachnoid screw or bolt (in head)
  • Epidural catheter (window to swell out of)
  • Subdural catheter (window to swell out of)
100
Q

criteria to declare brain death (nice to know)

A

note: brain death = patient is dead; has to meet certain criteria; 2 neurologists declare; very strict rules
- support family
- advocate for patient and family

nice to know:
- Glasgow coma scale <3 (lowest score possible)
- Apnea (off ventilator don’t try to breathe at all)
- No pupillary response (with light shine)
- No cough and gag reflex
- No oculovestibular reflex (squirt cold water into ear, no eye reaction)
- No corneal reflex (touch cornea with gauze, absent corneal reflex
- No oculocephalic reflex (dolls head, eyes flop with head rotation side to side)

101
Q

neuro assessment for stroke (expected sx of stroke)

A

3 or more 80% risk of stroke
1 of 3 70% risk of stroke
- aphasia (speech)
- ataxia (poor coordination, tripping)
- cranial nerve palsy: assess CN7: scrunch face
- diplopia (double vision)
- dysphagia (swallowing)
- dysarthria
- hemianopia
- hemiparesis
- loss of sensation
- visual field disturbance (cant see one field)
- sudden confusion
- dizziness
- sudden severe HA: typically seen in hemorrhagic
- cincinnati prehospital stroke scale (face-droop, arms- pronating drift, speech- slurred, time- when did it start: 911 or hospital)

102
Q

seizure precautions

A
  • oxygen
  • suction equipment**
  • airway: turn to side
  • IV access**
  • side rails up
  • protect from environment (dont let pt fall out of bed, environment is not cluttered)
  • turn on side
  • don’t force anything into mouth (no tongue blade!)
103
Q

post-ictal sate

A

right after seizure
- confusion, period of altered consciousness
- then return to normal

104
Q

rescue seizure meds

A

benzos: “-pams”

rectal valium if not IV access possible

NU 360 (12 decks)

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