Neuro 3/4 Flashcards
ICP manifestations
Decreased LOC
Restlessness, Confusion
Headache
N/V
Seizures
Posturing: decerebrate (Extension posturing), decorticate –corticospinal tract (abnormal flexion)
Decerbebrate is worse bc it is brain stem- patient won’t recover from it
LOC scale
Alert- 15
Lethargic- patient is drowsy but awakens easily with touch or sound
Stuporous- arousable only to noxious stimuli
Comatose- unable to arouse 7 and below
ICP prevention techniques
HOB 30° Head in neutral, midline position Avoid extreme neck or hip flexion Avoid clustering care – allow rest, perform mouth care Maintain normothermia Hyperoxygenate prior to suction
Management of ICP
Osmotic diuretics
↓ Volume of CSF
↓ Blood volume
↓ Edema
ABC Assess, neuro Control environment Prevent further injury Manage pain Drain CSF as ordered Control fever Monitor Vitals/02 Position
All of these increase ICP
Increased C02 Endotracheal suctioning Coughing Blowing nose Extreme neck or hip flexion Head of the bed > 60° Valsalva – bearing down for BM Give them stool softeners
Complications of ICP
DI and SIADH bc herniation of brain causes brain stem to push on pituitary gland- abnormal amounts of ADH
Intracranial hemorrhage
Subdural hematoma- venous (takes longer to recognize)
Epidural hematoma - arterial
Intracerebral hematoma- both
Intracranial hemorrhage manifestations
Dizziness Headache Seizure Memory loss Change in LOC Confusion Pupillary changes
Late states is cushings triad- hypertension, bradycardia –> may indicate imminent herniation
TBI meds
Osmotic diuretics
Anticonvulsants
Increased ICP meds
Corticosteroids
Osmotic diuretics
Anticonvuslants
Brain tumors
Increase ICP
Gliomas-within brain tissue. Most common.
Meningiomas, Acoustic neuromas, Pituitary Adenomas-from supporting structures.
Brain Angiomas-composed of abnormal blood vessels.
Brain tumor manifestations
Hemiparesis Sensory disturbances Language disturbance Visual changes Changes in coordination. Headache Nausea & Vomiting Papilledema
Organ donation
GCS 3- GCS 3 (eye, verbal, motor), apneic, Ø pupil ∆, Ø reflex (corneal, gag, cough, doll’s eye)
FAST
Facial
Arm
Speech
Time
Brain Box
brain(78%), blood (12%) & CSF (10%).
Transient Ischemic Attack
Warning sign of a stroke in the future
Temporary neurologic manifestations
Visual disturbances
Extremity weakness, numbness
Speech difficulty
ER : CT, EKG, Labs
Nursing
Neuro assessment
Reinforcement of need for follow up care
Two types of ischemic stroke
Thrombotic- clot forms in brain
Embolic- clot form outside of brain
Caused by from sepsis or atherosclerosis or from a fib can shoot up into the brain
Ischemic stroke treatment
CT scan!!! without contrast dye bc it looks like blood
Interventions
tPA- clot buster
Embolectomy
Stenting
Carotid artery stenosis
Hear a bruit upon auscultation
Two types of hemorrhagic stroke
Intracerebral Hemorrhage and Subarachnoid Hemorrhage
Intracerebral Hemorrhage (ICH) causes
HTN
Vessel rupture
Rapid spikes of BP
Subarachnoid Hemorrhage (SAH) causes "worst headache of my life"
Aneurysm Arteriovenous malformation (AVM)
Hemorrhagic stroke intervention
Medical Management – Allow brain to recover
Prevent or minimize risk for rebleeding.
Prevent or treat complications
Interventions- Drain and Coiling
Left hemisphere stroke
(language and math dominant for 80% of pop) Aphasia Right visual field deficit Right motor deficit Cautious Anxiety Depression*
Right hemisphere stroke
(outgoing, artistic) Disorientation Left visual field deficit Left motor deficit Left neglect Impulsive* Euphoric Overconfident
tPA
Goal is to improve/restore cerebral perfusion
IV fibrinolytic
Administer 3 to 4.5 hours from LastSeenNormal (LSN)
Bleeding is complication
Stroke drug therapy
Enteric coated ASA (aspirin)
Lorazepam (Ativan) for anxiety
AED for potential brain swelling from stroke
Calcium channel blockers (prevent vasospasm)
Analgesics
Goiter
Lack of iodine
Seen in hyperthyroidism and sometimes hypo
