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Critical Care > Diagnostics > Flashcards

Diagnostics Flashcards

1
Q

Non contrast or plain
Looks at brain tissue and brain
Present with focal/neurologic sx
Rule out patho process in intracranial vault involving brain
Quick image to develop

A

CT

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2
Q

Contrast injected
Looking at arteries in the head rather than brain tissue
3D CT angiogram
Contrast - can point out ischemic stroke
Iodine based - check allergies!

A

CT angiogram

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3
Q

More detailed images of brain
Start with CT scan
Takes 1hr 15min
Nursing responsibility
Screen pt for metals: sheet where check off
Claustrophobia
Any hospital provided things (SCDS, IV pumps) leave
Let MRI suite know if cannot leave MRI pump - sits in MRI suite and 15 feet of tubing

A

MRI

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4
Q

Non-iodine based dye injected to visualize arteries in head and neck
More detailed than CTA
Nursing responsibility
Screen pt for metals: sheet where check off
Claustrophobia
Any hospital provided things (SCDS, IV pumps) leave
Let MRI suite know if cannot leave MRI pump - sits in MRI suite and 15 feet of tubing

A

MRA

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5
Q

Done in IR under fluoroscopy; insert need between two lumbar vertebral bodies and hand injects IV contrast - not into spinal column - contrast goes into subarachnoid space (spinal canal around SC) and spinal root nerves are imaged

A

Myelogram

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6
Q

Records electrical activity of brain
Electrodes adhered to head and forehead
Waveforms get bigger - onset of seizure
Nurses primary role - educate; tell fam and pt - noninvasive procedure; just lay there; no shaving or IV access; see what electrical activity is; video EEG - see seizure happen - subclin seizure - no outward seizure activity but in brain are electrical activity present

A

Electroencephalogram (EEG)

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7
Q

Performed get sample of CSF
Pts in sitting position or on side and knees tucked up
Need spine curved to open vertebral columns - needle between vertebral bodies
After LP, nurse to label and sent to lab to get diagnostic testing done
Clear: normal
Straw yellow but clear: little blood - subarachnoid hemorrhage
More yellow to red gets - more blood
Cloudy = bacteria = meningitis
Presence/absence of bacteria. Diagnosis: bacterial meningitis
Presence/absence of blood. Diagnosis: subarachnoid hemorrhage

A

Lumbar puncture

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8
Q

treat or Prevent seizures - after craniotomy or blood in brain - very irritating and cause seizures - dx of epilepsy can have these meds in hospital
Phenytoin
Fosphenytoin

A

Anticonvulsants

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9
Q

CNS depression
Phenobarbital – reduces spread of epileptic focus (given pentodiazepines to stop seizure, propofol to stop seizures and if break through seizures do drip of this)
Pentobarbital - barbiturate coma; not seen as common; very sick and need decrease all metabolic demand; given in status epilepticus - brain time to rest and stop seizure

A

Barbiturates –

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10
Q

Mannitol - Treats cerebral edema
Pull edema from intracellular to extracellular - takes up less space in intracranial space - pee it off

A

Osmotic Diuretics

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11
Q

Nimodipine – Decreases cerebral vasospasm in pt.’s with subarachnoid hemorrhage (SAH); oral; subarachnoid hemorrhage - originates from arteries in head - ruptured anyreursm - until blood out of head - artery irritable and get spasm - narrows - affects blood flow in head leading to ischemic event

A

Calcium Channel Blockers

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12
Q

Maintain euvolemia in pt.’s with ICP & CPP within defined limits.
Everything is normal after surgery and out on dry side; ICP and MAP and CPP fine - NS given still

A

0.9% Sodium Chloride/NS

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13
Q

Dependent on what used
ICP - most common
CPP - most common
Brain Oxygenation
CBF - cerebral blood flow
Cerebral metabolism
Brain function

A

What is being monitored? - ICP monitoring devices

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14
Q

Issues with increased ICP or increased metabolism in brain; device placement dependent on pt presentation

A

What patient populations require intracranial pressure monitoring? - ICP monitoring devices

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15
Q

Transcranial cranial dopplers (TCD), CT/MRI, pupillometry

A

Noninvasive intracranial monitoring - ICP monitoring devices

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16
Q

Transcranial cranial dopplers (TCD), CT/MRI, pupillometry

A

Noninvasive intracranial monitoring - ICP monitoring devices

17
Q

Intracranial monitoring devices - neurosurgeon present - intraventricular catheter, subarachnoid screw, intraparechymal sensor, subdural bolt
intraventricular catheter - distal tip in ventricle of the brain
subarachnoid screw - screwed in subarachnoid space - indirectly get pressure of brain based on pressure pushed against tip screw
intraparechymal sensor - distal tip catheter in brain tissue - direct measurement of ICP
Subdural bolt - distal tip in subdural space

A

Invasive - ICP monitoring devices

18
Q

Intracranial Pressure: Normal 5-15 mmHg

A

Normal range for ICP? - ICP monitoring devices

19
Q

Intraventricular catheter with EVD - common set up
Intraventricular catheter - into head - feed catheter until in ventricles - get CSF flashback - out to EVD set up
Most used at SLH: External ventricular drain (EVD) AKA Intraventricular monitoring, intraventricular catheter device.
Continuously draining CSF to achieve a prescribed amount (usually 5, 10, or 15 ml/hour). - Drain off CSF to decrease ICP - done slowly
Do not drain the CSF too quickly.

A

External ventricular drain (EVD)

20
Q

Normal range for Intracranial Pressure (ICP): 5 -15 mmHg
Know perfect wave form looks like (on slide)

A

Intracranial pressure waves

21
Q

Not waveform
How is CPP calculated?
MAP - ICP
Normal: 50 - 70 mmHg = need for pressure gradient for blood to get from arteries into brain tissue

A

Cerebral perfusion pressure (CPP) (pg 570)

22
Q

Depends on the numbers
MAP: 64 mmHg
ICP: 15
CPP: 49 mmHg
Consider giving phenoefran - raise BP to raise MAP or something decrease ICP - decrease external stimuli and metabolic demand of brain, increase head of bed, consider sedation (valium or ativan PRN orders), Sats low - give O2, mannitol to decrease cerebral edema
How does the nurse know if the intervention is effective?
Decrease ICP or raise MAP

A

The nurse is taking care of a patient who has a low CPP. What intervention(s) should be done to get the CPP in the normal range?

23
Q

No because if MAP stays constant and ICP goes up the CPP goes down; MAP - ICP = CPP

A

The nurse is caring for a patient who’s ICP is trending up. Should the nurse expect the CPP to go up as well?

24
Q

Objectively measures Pupil size and reactivity
Able Trend pupil size and reactivity based on device; take guesswork out
Takes away guesswork from pen light

A

Pupillometry

25
Q

Measure velocity of cerebral blood flow
Measured through thinnest part of skull: windows - temple and eye socket and transoccipital

A

What is measured? - Transcranial doppler (TCD)

26
Q

Velocities measured and trended to monitor for vasospasm - vessel narrowed at pt decreasing blood distal to spasm causing neuro decline

A

What information does the TCD monitoring collect?

27
Q

Ordered for pts with a subarachnoid hemorrhage - caused by trauma/ruptured aneurysm - by intracerebral artery

A

What is the patient’s most likely diagnosis?

Critical Care (41 decks)

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