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Test 4 AH > Critically Ill Patients with Neuro Problems (12) > Flashcards

Critically Ill Patients with Neuro Problems (12) Flashcards

1
Q

Brief interruption in cerebral blood flow

A

TIA and RIND

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2
Q

treatment for TIA and RIND

A

neuro assessment
CT scan, lab
possible admission
drug therapy = clopidogrel

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3
Q

what is a stroke (brain attack)

A

change in normal blood supply to brain

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4
Q

causative agents of stroke

A 
hypertension 
arteriovenous malformation (born with it)
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5
Q

types of stroke

A

ischemic (thrombolic and embolic)

hemorrhagic

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6
Q

Types of stroke and onset

A 
thrombotic = gradual onset
embolic = sudden onset
hemorrhagic = sudden onset
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7
Q

what does arteriovenous malformation look like

A

dilated, entangled blood vessels

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8
Q

risk factors for stroke

A 
smoking 
alcohol abuse
obesity
sedentary lifestyle
oral contraceptive use
heavy alcohol use
use of PPA (no longer produced in US)
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9
Q

early intervention for stroke

A 
Face
Arm weakness
Speech difficulty
Time to call 911
Chew 325 mg of aspirin stat!
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10
Q

rtPA eligibility criteria

A

last seen normal less than 3 hours
can extend to 4.5 hours
age

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11
Q

goal of ED door to tx timeframe for stroke

and neuro asessment timeline

A
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12
Q

Damage to right hemisphere (LUDDI)

A 
Loss of depth perception
Unilateral body neglect syndrome
Disorientation
Denial of Illness
Impulsiveness
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13
Q

Damage to left hemisphere (AAARI)

A 
Anger, anxiety, frustration
Aphasia, alexia, dyslexia
Acalculia
Right visual field
Intellectual impairment
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14
Q

when can intra-arterial thrombolysis be done

A

within 6 h of LSN

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15
Q

drug therapy for CVA

A 
thrombolytics 
anticoagulants (ASA, plavix)
lorazepam
CCB
stool softeners
analgesics for pain
antianxiety meds
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16
Q

primary brain tumors originate in ______ and secondary to _________ in other parts of body

A

CNS

mestastasis

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17
Q

med used to decrease fluid in brain

med used to control ICP*

A

mannitol

dexmethasone

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18
Q

why is protonix needed?

A

steroids can cause stomach ulcers

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19
Q

3 things that increases ICP

A

fever
pushing when pooping
N/V

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20
Q

post op care for craniotomy

A 
fluid balance
assess site
monitor ICP
NO FEVER
DVT
helmet for immobolization
high risk aspiration due to altered LOC
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21
Q

removal of pituatary tumor through nasal approach

A

transphenoidal hypophysectomy (TPH)

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22
Q

complications of TPH

A

air embolism
CSF leak
visual disturbances
diabetes inspidus = water imbalance in body

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23
Q

CSF leak can lead to

A

meningitis

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24
Q

post op care

A 
do not blow nose!
HOB elevated
hourly UOP
monitor electrolytes
monitor for visual disturbances
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25
Q

Berry aneurysm occurs where

A

anterior communicating artery of the brain

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26
Q

Fusiform aneurysm occurs where

A

any blood vessel supplying the brain

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27
Q

1st sign of ICP and what happens to eye and pulses

A

decreased LOC
papilledema = “filling up” of the optic cup and dilation of the retinal veins
widened pulse pressure

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28
Q

Cushings triad

A

systolic hypertension
bradycardia
abnormal respirations

29
Q

normal ICP level
borderline = compensating
moderately high

A

5 to 15 mmHg
10-20 mmHg
20-40 mmHg

30
Q

start treatment when ICP > ____ that is sustained over ____

A

20 mmHg

5 minutes

31
Q

Factors of CPP

A 
acidosis = dilation, increased CBF
alkalosis = constriction, decreased CBF
32
Q

CPP calculation

A

CPP=MAP-ICP

33
Q

Normal CPP
hypoperfusion level
brain ischemia level

A

70-95

34
Q

target MAP and what may it induce

A

90

hypertension to increase ICP

35
Q

what two interventions for decreased CPP

A

hyperventilation (only when herniating) and oxygenation

36
Q

when to intubate?

A

GCS

37
Q

hypoxia and hypotension = ____% mortality

intervention?

A

75

uses 100% FiO2, early resus

38
Q

when do you not give mannitol

A

serum osmo

39
Q

what is herniation

where does it occur most often

A

shifting of tissue from one compartment to another

cerebrum (supratentorial)

40
Q

which type of herniation is considered a late sign and emergent

A

tonsillar

tonsils of cerebrum shift through the foreman magnum and into the spinal canal

41
Q

open vesticuostomy

A

certain level reached, chamber drains

42
Q

closed vesticuostomy

A

monitoring only, no drainage

43
Q

where is the zero reference point

A

foramen of monroe (at ear level)

44
Q

Name ICP waveforms (EVD closed system)

A

“giving middle finger” = bad
P1 = percussion
P2 = tidal
P3 = dicrotic

45
Q

Cerebral aneurysm SAH symptoms

A

sudden onset ha
brief LOC
N/V
kernigs sign, brudzinskis sign, photophobia

46
Q

Why is SAH considered an emergency and what must be done

A

direct effect of hemorrhaging and a craniotomy must be done within 48 hours

47
Q

SAH preop

A 
keep calm 
dark environment 
KEEP BP LOW
bed rest
no straining
DVT precautions
48
Q

SAH post op and what can lead to death

A 
Triple H
Hemodilution = fluid
Hypertension= increase BP and CO
Hypervolemic= volume expanders
vasospasms can lead to death
49
Q

use isotonic fluids to prevent

A

hyponatremia

50
Q

what other two complications of SAH and interventions

A

rebleeding - assess for sudden onset ha, increased BP, and resp change
hydrocephalus - ventriculostomy = temporary or shunt = permanant

51
Q

traumatic brain injury is similar to

A

spinal cord injury

52
Q

primary injury occurs

A

contact
acceleration - deceleration
rotational

53
Q

secondary injury occurs

A

cerebral ischemia

54
Q

know this!

degrees of TBI

A

mild (grade 1) mod (grade 2) severe(grade 3)

LOC 6h
CT/MRI normal CT/MRI abnormal CT/MRI abnormal

GCS 13-15 GCS 9-13 GCS7d

55
Q

sudden transient mechanical injury with disruption of neural cavity with AMNESIA REGARDING EVENT

A

concussion

56
Q

post concussive syndrome timeline

A

2 w to several months

57
Q

progressive brain disease caused by REPEATiTIVE HEAD TRAUMA occurring mostly in sports

A

CTE or chronic traumatic encephalopathy

58
Q

what is CTE patho

A

Tau proteins become toxic and start dying

59
Q

what diseases are liked to CTE

A

parkinsons
dementia
ALS

60
Q

Skull fractures

FAR and BMB

A

frontal or orbital fracture - anterior fossa - racoon eyes

basal fracture - middle fossa- battle sign (behind ear)

61
Q

major complications

A

CSF leak
rhinorrhea (mucus in nasal cavity)
otorrhea (drainage from ears)

62
Q

what hematoma is associated with skull fractures

A

epidural hematoma

63
Q

damage occurs where

A

dura, veins, and arteries

64
Q

symptoms of epidural hematoma

A

IMMEDIATE LOC, then alert, than rapid decline

dilated, fixed pupil on same side of injury

65
Q

surgical intervention and when

A

craniotomy at 72 h (when ICP greatest)

66
Q

what hematoma occurs with MVA, falls, trauma

A

subdural hematoma

67
Q

timeline for subdural hematoma

A 
acute = first 48 h
subacute = 2d to 2w
chronic = 2w to several months
68
Q

damage to white matter of brain causing coma

A

DAI or diffuse axonal injury

69
Q

timeline for severity

A 
mild = coma 6-24h, follow commands after 24h
moderate = coma >24h, no brainstem signs
severe = coma prolonged, prominent brainstem signs

Test 4 AH (7 decks)

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