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M/S 3 > Exam 3 - Neuro > Flashcards

Exam 3 - Neuro Flashcards

1
Q

3 essential components of the skull

A

brain tissue
blood
CSF

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2
Q

factors that influence ICP

A

arterial pressure
venous pressure
intaabdominal, intrathoracic pressure
posture
temperature
blood gas (CO2 level)

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3
Q

normal ICP is __ to __ mmHg

A

5-15 mmHg

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4
Q

when is ICP considered elevated

A

sustained >20 mmHg

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5
Q

cerebral blood flow is what

A

amount of blood in mL passing through 100 G of brain tissue in 1 minute

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6
Q

what is the average cerebral brain flow

A

50 mL/100 G of brain tissue

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7
Q

what occurs during auto-regulation of cerebral blood flow

A

adjusts diameter of blood vessels
ensures consistant CBF
only effective if MAP is 70-150 mmHg

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8
Q

how to calculate cerebral perfusion pressure (CPP)

A

MAP - ICP = CPP

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9
Q

what is considered a normal CPP

A

60-100 mmHg

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10
Q

CPP < __ mmH is associated with ischemia and neuronal death

A

< 50 mmHg

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11
Q

there are __ stages of increased ICP

A

4

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12
Q

stage 1: increase ICP

A

total compensation

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13
Q

stage 2: increased ICP

A

decrease compensation
RISK for increase ICP

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14
Q

stage 3: increased ICP

A

failing compensation
clinical s/sx of increase ICP (Cushing’s Triad)

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15
Q

stage 4: increased ICP

A

herniation imminent = death

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16
Q

increase ICP can occur when there’s an increase of any of these 3 components

A

brain tissue
blood
CSF

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17
Q

what is cerebral edema

A

increase extravascular fluid in the brain

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18
Q

what are the 3 types of cerebral edema

A

vasogenic
cytotoxic
interstitial

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19
Q

what is the most common type of cerebral edema

A

vasogenic

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20
Q

where does vasogenic cerebral edema occur

A

mainly in white matter

21
Q

what occurs during vasogenic cerebral edema

A

fluid leaks from intravascular to extravascular space

22
Q

what is the cause of cytotoxic cerebral edema

A

secondary to destructive lesions or trauma to brain tissue

23
Q

what occurs during cytotoxic cerebral edema

A

fluid shifts from extracellular to intracellular

24
Q

what is the cause of interstitial cerebral edema

A

usually a result of hydrocephalus

25
Q

how is interstitial cerebral edema treated

A

ventriculostomy or shunt

26
Q

what is Cushing’s Triad

A

increase SBP
decrease HR
decrease RR

**remember CT s/sx are opposite of shock

27
Q

s/sx of cerebral edema

A

change in LOC (flat affect, coma)
Cushing’s Triad
diplopia, ptosis
change in body temp
inability to move eye upward
unilateral pupil dilation
vomiting (not preceded by nausea)
HA (often worse in the AM)
decrease motor function

28
Q

decorticate vs. decerebrate vs. opisthotonic posturing

A

decort: flexion towards the core

decere: hyperpronation away from the body

opist: hyperflexion of the back

29
Q

what are com complications of cerebral edema

A

inadequate cerebral perfusion
cerebral herniation

30
Q

how to dx cerebral edema

A

CT**
MRI
PET
EEG
angiography
ICP, brain tissue oxygenation (LICOX catheter)
doppler
ABG
CBC, Coag, CMP
serum osmolality

31
Q

what is NOT performed to dx cerebral edema

A

lumbar puncture

32
Q

what must be assessed on a pt who needs sent for radiographic testing with suspected cerebral edema

A

airway

33
Q

what is a normal serum osmolality

A

280-300

34
Q

what will serum osmolality be with increased ICP

A

maintained >325

35
Q

GSC measures which 3 areas

A

eye opening response
verbal response
motor response

36
Q

what are some causes of inaccurate ICP readings

A

CSF leak
obstruction/kink in cath
bubbles, air in tubing*
incorrect height of drainage system
difference in height of bolt/transducer

37
Q

what 2 things does LICOX catheter measure

A

brain oxygenation
temperature

38
Q

nursing interventions for increased ICP

A

keep CPP > 70 mmHg
neurological exams
HOB no more than 30 degrees
neutral head positioning
VS (HTN is common; CT is a LATE sign)
GSC
seizure precautions
space activities
assess pt response to family members

39
Q

what are some things to avoid with increase ICP

A

coughing
blowing nose
straining for BM
pushing against bedrail/footboard
isometric muscle exercises

40
Q

serum osmolarity is kept between __ to __

A

310-325 to draw extracellular fluid into the vascular system

41
Q

what kind of IVF is preferred for increased ICP

A

1/2 NS
NS

42
Q

what kind of IVF should NOT be administered with increased ICP

A

NO hypertonic (3%)
NO hypotonic (D5W)

43
Q

decadron and solumedrol are only effective for ___ and ___; it is NOT effective if r/t ___

A

effective: meningitis, tumors

not: trauma

44
Q

HTN drug of choice with increased ICP

A

nicardipine

45
Q

what must you turn off prior to assessing pupillary response

A

the room light

46
Q

what occurs during oculocephalic reflex (dolls eye reflex)

A

eyes move when the head moves

47
Q

what occurs during oculovestbular (caloric stimulation) test

A

cold water injected into ear, eyes should gaze towards that ear

normal: both eyes
asymmetrical: one eye
negative: no eye movement

48
Q

must know the cranial nerves

A

must know the cranial nerves

M/S 3 (17 decks)

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