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Neuro 2 > Neuro ICU > Flashcards

Neuro ICU Flashcards

1
Q

What should you review prior to seeing a pt in the neuro ICU?

A
  • reason for admission
  • PMHx and relevant interventions
  • HPI and relevant interventions
  • 24-hour plan
  • PRECAUTIONS
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2
Q

Patients are very symptomatically sensitive to changes in _______ after a neurological event

A

Na - sodium
- can lead to cognitive changes

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3
Q

What is hypothyroidism associated with? examples

A

signs of aortic or coronary atherosclerosis
- slowed cognitive function
- ataxia
- weakness
- paresthesias
- edema
- bradycardia
- CHF
- HTN

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4
Q

What is hyperthyroidism associated with? examples

A

atrial fibrillation and cardioembolic stroke
- tremors
- weakness/atrophy
- tachycardia
- arrhythmias
- hypotension

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5
Q

Respiratory alkalosis is a common sequelae of _______

A

CVA
- dissiness
- paresthesias
- chest pain
- confusion
- seizures

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6
Q

Respiratory acidosis is common with what?

A

prolonged vent support and neuromuscular disease (GBS, ALS, muscular dystrophy)
- confusion
- fatigue
- SOB

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7
Q

anti-hypertensives side effects
- diuretics, ACE inhibitors, beta-blockers, calcium channel blockers

A
  • hypotension
  • dizziness
  • lightheadedness
  • weakness
  • fatigue
  • N/V
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8
Q

vasoconstrictors side effects
- Midodrine

A
  • supine HTN
  • headache
  • blurred vision
  • dizziness
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9
Q

Seizure control or prophylaxis side effects
- Keppra

A
  • agitation
  • agressiveness
  • irritability
  • restlessness
  • fatigue
  • apathy
  • depersonalization
  • depression
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10
Q

agitation meds side effects
- Precedex
- Fentanyl
- Propofol

A
  • decreases arousal
  • drowsiness
  • bradycardia
  • hypotension
  • irregular heartbeat
  • edema
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11
Q

decreased arousal meds side effects
- amantadine

A
  • blurred vision
  • nausea
  • loss of appetite
  • drowsiness
  • dizziness
  • lightheadedness
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12
Q

tone management (anti-spasticity) meds side effects
- baclofen
- dantrolene
- tizanidine

A
  • hypotonia
  • weakness
  • drowsiness
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13
Q

pain meds/narcotics side effects
- hydrocodone
- hydromorphone
- codeine

A
  • drowsiness
  • N/V
  • hypoxia
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14
Q

RASS scale and what ranges do PTs work with

A

-5 to + 4 with - numbers = decreased arousal and + numbers = increased arousal

-2 (light sedation) to + 1 (restless) = PT green zone

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15
Q

RASS PT yellow zone

A

-3 = moderate sedation
+2 = agitated

pause but may still be able to work with them with help

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16
Q

T/F: You can work with a pt on propofol.

A

false - not appropriate for PT

17
Q

At what transcranial doppler (TCD) measurement do PT stop treatment? Why?

A

TCD > 120
- higher degree of vasospasm after sub-arachnoid hemorrhage (TBI)

18
Q

typical hemodynamic parameters after ischemic event and hemorrhagic event?

A

Ischemic
- permissive HTN
- BP < 220/110

Hemorrhagic
- BP < 150/90

19
Q

general contraindications for initiation of PT in ICU

A
  • new admin of pressor agent or antiarrhythmic agent
  • multiple pressors being administered
  • change in ventilator setting to provide increased ventilator support
  • non-secured airway
  • active GI bleed
  • elevated ICP
  • agitation requiring increased sedative admin in last 30 min
20
Q

Normal ICP and Abnormal ICP cutoff

A

Normal - 5-10 mmHg

Abnormal - > 20 mmHg

21
Q

What is the gold standard for ICP monitoring?

A

intraventricular catheter

22
Q

___________ is a hard PT stop if a patient has this to monitor ICP

A

ICP Bolt

23
Q

What requires neurosurgery/neurology clearance for PT?

A

intraventricular catheter (IVC)

24
Q

What is the least invasive monitoring device for ICP and is generally not appropriate for mobilization until removed?

A

implantable microtransducer sensor

25
Q

T/F: Pt with extraventricular drain (EVD) can be mobilized

A

true - must be clamped and be able to tolerate 30 minutes of EVD clamped at rest prior to mobilizations
- no mobilization if unclamped

26
Q

steps of the EGRESS test

A

stepwise progression of movement in ICE
- sit to stand x3
- marching x3
- advancing step and return step of each foot

27
Q

FSS-ICU activities and MCID

A
  • rolling
  • supine to sit
  • EOB sitting
  • sit to stand
  • walking

MCID = 3

Neuro 2 (19 decks)

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