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Med Surg > Neuro 3/4 > Flashcards

Neuro 3/4 Flashcards

1
Q

ICP manifestations

A

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

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2
Q

LOC scale

A

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

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3
Q

ICP prevention techniques

A 
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
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4
Q

Management of ICP

A

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
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5
Q

All of these increase ICP

A 
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
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6
Q

Complications of ICP

A

DI and SIADH bc herniation of brain causes brain stem to push on pituitary gland- abnormal amounts of ADH

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7
Q

Intracranial hemorrhage

A

Subdural hematoma- venous (takes longer to recognize)
Epidural hematoma - arterial
Intracerebral hematoma- both

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8
Q

Intracranial hemorrhage manifestations

A 
Dizziness
Headache
Seizure
Memory loss
Change in LOC
Confusion
Pupillary changes

Late states is cushings triad- hypertension, bradycardia –> may indicate imminent herniation

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9
Q

TBI meds

A

Osmotic diuretics

Anticonvulsants

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10
Q

Increased ICP meds

A

Corticosteroids
Osmotic diuretics
Anticonvuslants

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11
Q

Brain tumors

A

Increase ICP
Gliomas-within brain tissue. Most common.

Meningiomas, Acoustic neuromas, Pituitary Adenomas-from supporting structures.

Brain Angiomas-composed of abnormal blood vessels.

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12
Q

Brain tumor manifestations

A 
Hemiparesis
Sensory disturbances
Language disturbance
Visual changes
Changes in coordination. 
Headache
Nausea & Vomiting
Papilledema
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13
Q

Organ donation

A

GCS 3- GCS 3 (eye, verbal, motor), apneic, Ø pupil ∆, Ø reflex (corneal, gag, cough, doll’s eye)

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14
Q

FAST

A

Facial
Arm
Speech
Time

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15
Q

Brain Box

A

brain(78%), blood (12%) & CSF (10%).

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16
Q

Transient Ischemic Attack

A

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

17
Q

Two types of ischemic stroke

A

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

18
Q

Ischemic stroke treatment

A

CT scan!!! without contrast dye bc it looks like blood

Interventions
tPA- clot buster
Embolectomy
Stenting

19
Q

Carotid artery stenosis

A

Hear a bruit upon auscultation

20
Q

Two types of hemorrhagic stroke

A

Intracerebral Hemorrhage and Subarachnoid Hemorrhage

21
Q

Intracerebral Hemorrhage (ICH) causes

A

HTN
Vessel rupture
Rapid spikes of BP

22
Q 
Subarachnoid Hemorrhage (SAH) causes
"worst headache of my life"
A 
Aneurysm
Arteriovenous malformation (AVM)
23
Q

Hemorrhagic stroke intervention

A

Medical Management – Allow brain to recover
Prevent or minimize risk for rebleeding.
Prevent or treat complications
Interventions- Drain and Coiling

24
Q

Left hemisphere stroke

A 
(language and math dominant for 80% of pop)
Aphasia
Right visual field deficit
Right motor deficit
Cautious
Anxiety
Depression*
25
Q

Right hemisphere stroke

A 
(outgoing, artistic)
Disorientation
Left visual field deficit
Left motor deficit
Left neglect
Impulsive*
Euphoric
Overconfident
26
Q

tPA

A

Goal is to improve/restore cerebral perfusion
IV fibrinolytic
Administer 3 to 4.5 hours from LastSeenNormal (LSN)
Bleeding is complication

27
Q

Stroke drug therapy

A

Enteric coated ASA (aspirin)
Lorazepam (Ativan) for anxiety
AED for potential brain swelling from stroke
Calcium channel blockers (prevent vasospasm)
Analgesics

28
Q

Goiter

A

Lack of iodine

Seen in hyperthyroidism and sometimes hypo

Med Surg (12 decks)

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