exam 4 study guide Flashcards
What causes an increased intracranial pressure?
- Changes to the components of the brain ( CSF, intravascular blood, brain tissue
- Monro-Kelli Doctrine
• sum of the volumes of the brain tissues, CSF and intracranial pressure
• Changes lead to compensatory efforts to stay in homeostasis
• Inability to compensate leads to increased ICP - Pressure itself…any pressure changes in the body ( INCREASED BP, intrathoracic and abdominal pressure )
What are some of the key characteristic symptoms of an increased intracranial hemorrhage?
- Changes in LOC (first sign)
- Changes in motor function (loss of strength, loss of coordination)
- Stroke like symptoms (vague for ex: like headache, vomiting)
What are some of the late clinical manifestations of increased intracranial pressure?
- Decerebrate (extension) and Decorticate (flexion) positioning
- Herniation of the brain stem or contents
- Cushing triad
o Widen pulse pressure (systolic HTN)
o Bradycardia (bounding, very loud)
o Irregular respirations (irregular tachycardia)
- Changes in oculus o Dilation o Symmetry o Reaction o Coma or unconscious
What are some treatment and intervention options for increased intracranial pressure?
- Assess neuro function
- Diagnostic studies
o CT o MIR o PETS o Doppler o Angiography o Labs o Measuring ICP (using ventriculostomy to measure and drain ICP and using spiral drain for the same thing) o NO LUMBAR PUNCTURES
- Surgical interventions
o Craniotomy - Drugs
o Anti-seizure
o Antipyretics
o Sedatives
o Analgesics
o Barbiturates
o Mannitol (plasma expansion, osmotic effect, monitor fluid and electrolytes)
o Hypertonic saline (moves H2O out of the cells and into the blood, monitor b/p and serum Na+ levels)
o Nimodipine (CCB—hypertensive management of ICP)
Ischemic strokes ( thombolic, embolic)
most common = inadequate blood flow to brain from partial or complete occlusion of an artery
CAUSES o Occurs from injury to a blood vessel wall and formation of a blood clot o Results in narrowing of blood vessel o Often associated with HTN & DM o Can be proceeded by TIA
Thrombotic ischemic strokes
clot formation narrowing of the lumen blocks the passage of blood through the artery.
CAUSES
o Occurs when an embolism lodges in and occludes a cerebral artery
o Results in infarction and edema of area supplied by involved vessel
Embolic ischemic stroke
blood clot or other debris circulating in the blood reaches an artery in the brain that is too narrow to pass through lodges and block blood flow.
Hemorrhagic strokes ( intracerebral, subarachnoid, cerebella )
most dangerous = burst blood vessel allow blood to seep into and damage brain tissues until clotting shuts off the leak.
Intracerebral hemorrhagic stroke
bleeding within the brain tissue itself caused by a ruptured vessel
CAUSE: hypertension is the most common cause
Subarachnoid hemorrhagic stroke
Intracranial bleeding into CSF-filled space between arachnoid and pia mater
CAUSE: Commonly cause by rupture of a cerebral aneurysm, trauma, drug abuse
Hemorrhagic stroke manifestations
o Neurological deficits o Severe headache o Nausea and vomiting o Deceased LOC o Hypertension
- Sudden onset with progression over mins to hours
- Extent of Sx varies and depends on amount, location and duration of bleeding
- Loss of consciousness may or may not occur
- Survivor suffer complications & deficits
Ischemic stroke manifestations
o Numbness or weakness of the face, arm or leg, esp. on 1 side of the body
o Confusion and change in mental status
o Trouble speaking or understanding speech
o Visual disturbances
o Difficulty walking, dizziness, loss of balance or coordination
o Sudden severe headache
- Warning signs are less common
- Patient usually remain conscious
What are some appropriate nursing interventions for taking care of stroke patients?
- Assessments
o Neurological system
o Skeletal, cardiovascular, respiratory
o NIH stroke scale
- Diagnostics o Early diagnosis is the key o CTA o MRA o MRI o CT’s early diagnosis of a stroke ▪ CT Angiography ▪ CT Perfusion o Doppler o Lumbar punctures o Lab studies
What are some drug therapy interventions for stroke patients?
- Anticoagulants o For ischemic patients only o Aspirin, antiplatelet - All strokes o Antihypertensive ▪ Nomodipine o Anti-seizures o Cholesterol medications
Tissue Plasminogen Activator (tPA). What is this for?
- Clot buster
o Converts plasminogen to plasmin
o Must screen patient prior to use, frequently monitor, assess for bleeding
o Cut off time is 3-4.5 hours for medications to be effective
What are the criteria for this clot busters (TPA)?
- Inclusion
o Age 18 and older
o Onset of symptoms <3 hours
o Ischemic stroke causing neurological deficits
o Patient and family verbalize understanding risk vs benefits of IV tPA - contraindicated
o Elevated b/p systolic >185 or diastolic >110
o Patients with a bleed or taking anticoagulants, history of bleed or brain injury
What are risk factors for the development of a stroke?
- Non-modifiable o Age ▪ Risk doubles each decade after 55 o Gender ▪ More common in men ▪ More women die o Ethnicity/race ▪ Higher in African Americans o Hereditary and family Hx
- Modifiable o HTN o Heart disease o DM o Cholesterol o Smoking o Obesity and lack of exercise o Sleep apnea o Metabolic syndrome o Drug and alcohol abuse o Poor diet
What are some factors that triggers or worsen strokes?
- Worsen hemorrhagic stroke o Active bleeding o Use of anticoagulants, antiplatelet, aspirin o Blood thinners - Hypertension makes all strokes worst - Buildup of plaques - Deoxygenation
What are some diagnostic tests for strokes? What diagnostic test is most important to order first?
- All as mentioned previously
- CT’s and MRI are the most important—order CT first
Scalp Lacerations (head injury)
- External head trauma
- Scalp is highly vascular à profuse bleeding
- Blood loss and infection are major complications
head fractures
- Linear fracture
- Depressed fracture
- Diastatic fracture
- Basilar fracture
• Infection, hematoma, and tissue damage are complications
Focal injuries localized
- Contusions
- Hematomas
Diffuse injuries generalized
- Concussions
- DAI
