CVA and ICP Flashcards
1
Q
Causes of ICP
A
- Head injury: depends where. It’s the bleeding and swelling that cause the problem
- Infxn
- Subarachnoid hermorahage
- Subdural/epidural hematoma (causes pressure)
- Tumor
- Stroke
2
Q
eary Signs and symptoms of ICP
A
- Dec. LOC
- headache, seizures
- anxiety, irratibility, restless, confusion
- inc. BP
- Dec. pulse
- change in resp.
- change in temp (hot, fevers)
- nausea, vomitting
- slurred speech
- not able to follow what you’re saying
- Pupils fixed and dilated d/t dec blood supply to eyes
3
Q
Assessments for ICP:
A
Glasgow coma scale
- The lower the number the worse.
- 15 is best
4
Q
Why are neurological infxn hard to treat?
A
blood brain barrier
5
Q
Causes of neuro infxn?
A
-meningitis
6
Q
signs and symptoms of neuro infxn
A
- changes in mental status
7
Q
S & S for meningitis
A
- severe headache
- rigid neck
- difficulty extending legs at knee
8
Q
Assessment for meningitis
A
- Monitor ICP
9
Q
Intracranial hemorrhage causes
A
- any bleeding in brain
10
Q
when would you not give TPA
A
- when someone has a bleed
11
Q
Hydrocephalous?
A
- increase fluid
12
Q
Causes of stroke (CVA)
A
- blocked (ischemic) or burst (hemorrhagic) blood vessel
13
Q
what are ppl with Hydrocephalous are at risk for?
A
- infxn
14
Q
Who is at risk for CVA (stroke)?
A
non-modifiable: age, male, ethnicity
modifiable: HTN, A-fibb, hyperlipidemia, obesity, smoking, diabetes, periodeontal disease, asymptomatic carotid stenosis, excessive ETOH consumption
15
Q
cushings triad (ICP)?
A
- inc BP
- dec. pulse
- change in resp
16
Q
Ischemic stroke
A
- blood clot or blockage of blood flow to brain tissue
17
Q
Types of ischemic stroke
A
- large artery thrombotic
- small “ “
- cardiogenic embolic
- crypt
18
Q
late Signs and symptoms of ICP
A
- positive babinkski reflec
- fixed dilated pupuo;s
- absent reflexes
- abnormal posturing (decerebrate, decorticate)
- flacidity
19
Q
What are the causes of the symptoms in ICP
A
- decrease cerebral perfusion = further inc. swelling and shifts brain tissue
- herniation through openings in the dura mater
20
Q
What is coning?
A
- herniation through openings in the dura mater
21
Q
Causes of hemorrhagic stroke?
A
- aneurysm
22
Q
AVM?
A
arterial venous malformation - disrupted flow beteen arterial and venous system so as BP inc. as pt gets older, veins and arteries rupture
23
Q
disgnostics for ICP
A
- CT
- MRI
- ICP monitoring
- PET (positive emission tomogrpahy)
- EEG (electroencephalography
24
Q
disgnostics for ICP
A
- CT
- MRI
- ICP monitoring
- PET (positive emission tomogrpahy)
- EEG (electroencephalography)
- xray
25
ICP
- insertion of external ventricular crain (EVD)
- monitor ICP
- dec ICP
26
medical interventions for ICP
- Craniotomy: blood removed
27
Pharmacology for ICP
- mannitol
- vasodilator
- AntiBx
- opioid analgesis
- andrenergic blockers
- corticosteroids
- hypertonic saline
- sedation
- skeletl muscle relfexants
- anti-parkinsons
- anti-convulsants
- calcium channel blocker
- diuretic
- stool softeners ( straining)
28
Osmitrol (Manitol) for ICP
- hypertonic solution for hen they have inc. intracranial pressure = pulls fluid off brain
- blocks reaborption of fluids
= excrete water pot. chloride, Mg, an PO4
- monitor for electrolyte balance
- may have to replace electrolytes
- only given IV
- dose: weight based
- do not give to renal pt, or intracranial bleeding
- VItals
- electrolytes imbalances
- headaches, CHF
- renal fxn (GFR)
Contraindicated:
- pulmonary edema
29
Nursing diagnoses for ICP
- Ineffective airway clearance R/T diminished protective reflexes (cough/gag)
- Ineffective breathing patterns R/T neurologic dysfunction (brain stem compression, structural displacement)
- Ineffective cerebral tissue perfusion R/T the effects of increased ICP
- Risk of hemodynamic disturbance R/T increased ICP
- Risk for imbalanced body temperature R/T neurologic dysfuntion
- Deficient fluid volume R/T fluid restriction
- Risk for fluid overload R/T increased ICP
- Risk for electrolyte imbalance R/T increased ICP
- Risk for infection R/T ICP monitoring system
30
Nursing plan/outcome for pt with ICP
```
Maintenance of a patent airway
Normalization of respiration
Adequate cerebral tissue perfusion through reduction in ICP
Restoration of fluid balance
Absence of infection
Absence of complication
```
31
Nursing interventions for ICP
- Monitor for changes in LOC and changes in Neuro vital
signs, regular Neuro vital signs
- Monitor for changes in BP, HR, pulse pressure increase,
Temp, RR, O2 sats
- Airway patency and lung fields assessed regularly,
Sx with care – coughing discouraged
- Monitor breathing patterns
- Head midline, HOB 30-45 degrees (avoid extreme
rotation of neck and flexion)
- Avoid extreme hip flexion
- Administer stool softeners, high fiber diet
- Administer Pain medications PRN
- Provide a calm environment
- Maintain fluid balance (fluid restriction, diuretic, fluid
resuscitation)
- Monitor for electrolyte imbalances
- renal f
32
Rule for remembering S&S of ICP and Schock
```
ICP:
cushings triad
Inc BP
Dec pulse
Dec resp
```
*shock is the opposite
33
Assessments for ICP
- complete head to toe
- Glasgow coma scale
- fluid balance = excess fluid output
- electrolytes
34
TIA
Transient ischemic attack - brief neurological dysfxn d/t loss of blood flow (ischemia) to brain, spinal cord or retina without tissue death (infarction).
35
S&S of TIA
- same as stroke..
- paralysis
- weakness
- numbness on one side of body
- dizzy
- mumble words
36
motor symptoms of stroke
- hemiplegia - half-sided paralysis
- hemoparesis - half-sided weakness
- ataxia - unsteady gait
- dysphagia - difficulty swallowing
37
communication symptoms of stroke
- dysarthia - weakness/paralysis of muscle used to speak
- dysphasia - difficulty speaking
- Aphasia - inability form speech or language
- Apraxia - difficulty performing tasks
38
communication symptoms of stroke
Visual perception dysfxn d/t problem with sensory pathways between eye and visual cortex
Homonymous hemianopsia: can only see either left or right
39
sensory symptoms of stroke
- touch impairment
| - difficulty interpreting stimuli
40
cognitive impairment symptoms of stroke
```
- o Frontal lobe damage can affect learning capacity, memory, and other higher intellectual functions
o Limited attention span
o Comprehension difficulty
o Forgetfulness
o Apathy
o Headache
```
41
emotional deficits of stroke
```
o Loss of self-control
o Emotional liability
o Depression
o Withdrawal
o Fear, hostility, anger
o Feelings of isolation
```
42
Stroke assessment
```
FAST
face
arm
speech
time - 911
```
43
diagnostics for stroke
```
Ct scan: bleeding
CT angiography
Carotid U/S: narrowing of artery
MRI: bleeding
Phenytoin level and albumin
PTT, PT-INR(baseline), Hgb, Na and K, renal fxn test
```
44
Pharmacological for stroke
TPA (Tissue plasmin activator): thromboltic. Cannot give if unsure of when stroke happened
Antihypertensive (ACE inhib, beta blocker, Ca blocker): HTN risk factor for developing stroke
Anticoags (aspirin)
Platelet-inhibiting meds: Plavix, coumadin
Anticonvulsants: if at risk for dev. seizures
