Neuro

Question 1

What is increased ICP?

Created by?

Normal ICP

Factors that Influence ICP

Causes of increased ICP

Compensatory mechanisms when there is a head injury and increased ICP

Symptoms - MIND CRUSHED

Interventions - PRESSURE

Answer 1

• dramatic increase of pressure the brain, created by alterations in blood volume, CSF, and brain tissue within the skull
• Medical emergency
• Normal: 5-15 mmHg, if greater than 20 needs immediate tmt
Factors:
◦ Body temp (hyperthermia),
- CO2 high and O2 (hypoxia) - cause vasodilation
◦ Body position like lying flat
◦ Arterial and venous pressure
◦ Anythig that increaes intra abdominal / thoracic pressure - e.g. vomitting, bearing down (valsalva)

• Causes
	◦ Head injury
	◦ Anything that increases CSF
	◦ Bleeding/hemorrhage/hematoma
	◦ Hydrocephalus
	◦ Tumor
	◦ Encephalitis or meningitis

Patho
◦ Head injury -> high ICP —> vasoconstrict to decrease cerebral blood flow —> ischemia to brain—> body tries to compensate by
‣ increasing SBP to increase blood flow but pressure continues —> overtime eventually cause more increase of ICP, swelling/edema in brain, irregular breathing like cheyne stokes which retain CO2 —> dilate BV, limit venous flow —> more swelling, more increased ICP
◦ Overtime causes hernia or displacement of brain tissue which compresses brain stem —> affect neuro resp death

MIND CRUSHED

◦ Mental status changes (early signs)
◦ Irregular breathing (cheyne stokes - hyperventilate then apnea) - late sign
◦ Nerve changes to optic and occular (double vision, papilledema sweeling of optic nerve, changes in pupils, abdnormal doll’s eyes
◦ Decerebate (feet flex, arms EEEExtended) - worst or Decorticate (arms flexed to core of body)
◦ Cushing’s Triad
	‣ Increased SBP, widening pulse pressure
	‣ Decreased HR, RR (coz of brain stem compression and response to increase SBP
◦ Reflex  Babinski - toes fan out
◦ Unconcious - late
◦ Seizures
◦ Headache
◦ Emesis without nausea
◦ Deterioratio of motor function like hemiplegia

Symptoms
M - mental status change
I - irregular breathing (cheyne stokes - hyperventilate then apnea) - late
N - nerve (optic, occular) changes - papiledema, d vision, dolls eyes
D - decerebate (Eeeeeextend) decorticate (arms flexed to CORe)

C - cushing’s triad (increased SBP with wide pulse pressure, dec HR, RR coz of brain stem compression and response to SBP increase
R - reflex babinski toes fan out
U - unconsious - late sign
S - seizures
H - headache
E - emesis without nausea
D - deterioration of motor function like hemiplegia

Interventions
P- position 30-45 degrees
R - respiration - prevent hypoxia and hypercapnia
E - elevated temp prevent
S - systems monitor - neuro, gcs, icp
S- straining activities
U - unconsious pt care
- avoid sedating
- check lung sounds
- immobility risks (kidney stones, constipation, skin issues, contractures, nutrition, eye care, blood clots, GI tubes)
R - rx barbituates (cns depressant) to decrease brain metabolism and BP, vasopressors, iv fluids, antihypertensives
E - edema management with mannitol (watch for fluid and electrolyte balance)

Question 2

What is TBI

What is basilar skull injury. What needs to be monitored

Symptoms

Answer 2

• calcium gluconate - for those with ecg changes (peaked T waves). Not meant to decrease potassium. Only Stsblizes myocardium by raising threshold for dysrrythmia occurrence. I.e. to prevent life threatening dysrhrythmia
• Decrease potassium thru iv regular insulin with dextrose (shifts potassium to cells), sodium polystyrene sulfomate (exchanges potassium with sodium in bowel. Then k is excreted in stool. , hemodialysis

Question 3

gcs

Gcs values and meaning

When to call MD

Answer 3

Eye opening
Spontaneous - 4
To sound - 3
To pain - 2
Never - 1

Verbal response
Orinted 5
Confuse 4
Inapp words 3
Incomprehensible sounds 2
None 1

Motr response
Obeys commands 6
Localized pain 5
Normal flexion withdrawal 4
Abnormal flexion 3
Extension 2
None 1

Gcs scores
15 highest
3 poor prognosis, high mortality
2 or more points decreas is significant, call MD
7 of less coma

Question 4

Which medication for anti seizure cannot be mixed with other meds and why

Answer 4

• phenytoin (dilantin) coz forms precipitate. Flush before and after

Question 5

Tubing to use for mannitol admin

Answer 5

• filter to prevent particulate from getting into blood

Question 6

Subdural hematoma

Types

Tmt

Answer 6

• venous bleed below dura matter of the brain following a head injruy
• Acute - within 48 hours
• Sub acute up to 2 weeks after
• Chronic 2 weeks to 2 months after
• Slow to develop unlikd Epidural hematoma usually arterial bleed
• Tmt: evacuation thru burr holds or if lafhe or chronic — craniotomy

Question 7

Meningitis symtoms

Complication

Safety concern

Answer 7

• fever, headache, nuchal rigidity (pain with flexion of neck)
• Irritability, photophobia, rash
• Bacterial meningitis is a med emergency, an cause increased icp

Safety concern for pts wih meningitis
• risk for injury coz possiblity of having seizures