Neuro ICU Flashcards
What should you review prior to seeing a pt in the neuro ICU?
- reason for admission
- PMHx and relevant interventions
- HPI and relevant interventions
- 24-hour plan
- PRECAUTIONS
Patients are very symptomatically sensitive to changes in _______ after a neurological event
Na - sodium
- can lead to cognitive changes
What is hypothyroidism associated with? examples
signs of aortic or coronary atherosclerosis
- slowed cognitive function
- ataxia
- weakness
- paresthesias
- edema
- bradycardia
- CHF
- HTN
What is hyperthyroidism associated with? examples
atrial fibrillation and cardioembolic stroke
- tremors
- weakness/atrophy
- tachycardia
- arrhythmias
- hypotension
Respiratory alkalosis is a common sequelae of _______
CVA
- dissiness
- paresthesias
- chest pain
- confusion
- seizures
Respiratory acidosis is common with what?
prolonged vent support and neuromuscular disease (GBS, ALS, muscular dystrophy)
- confusion
- fatigue
- SOB
anti-hypertensives side effects
- diuretics, ACE inhibitors, beta-blockers, calcium channel blockers
- hypotension
- dizziness
- lightheadedness
- weakness
- fatigue
- N/V
vasoconstrictors side effects
- Midodrine
- supine HTN
- headache
- blurred vision
- dizziness
Seizure control or prophylaxis side effects
- Keppra
- agitation
- agressiveness
- irritability
- restlessness
- fatigue
- apathy
- depersonalization
- depression
agitation meds side effects
- Precedex
- Fentanyl
- Propofol
- decreases arousal
- drowsiness
- bradycardia
- hypotension
- irregular heartbeat
- edema
decreased arousal meds side effects
- amantadine
- blurred vision
- nausea
- loss of appetite
- drowsiness
- dizziness
- lightheadedness
tone management (anti-spasticity) meds side effects
- baclofen
- dantrolene
- tizanidine
- hypotonia
- weakness
- drowsiness
pain meds/narcotics side effects
- hydrocodone
- hydromorphone
- codeine
- drowsiness
- N/V
- hypoxia
RASS scale and what ranges do PTs work with
-5 to + 4 with - numbers = decreased arousal and + numbers = increased arousal
-2 (light sedation) to + 1 (restless) = PT green zone
RASS PT yellow zone
-3 = moderate sedation
+2 = agitated
pause but may still be able to work with them with help
T/F: You can work with a pt on propofol.
false - not appropriate for PT
At what transcranial doppler (TCD) measurement do PT stop treatment? Why?
TCD > 120
- higher degree of vasospasm after sub-arachnoid hemorrhage (TBI)
typical hemodynamic parameters after ischemic event and hemorrhagic event?
Ischemic
- permissive HTN
- BP < 220/110
Hemorrhagic
- BP < 150/90
general contraindications for initiation of PT in ICU
- 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
Normal ICP and Abnormal ICP cutoff
Normal - 5-10 mmHg
Abnormal - > 20 mmHg
What is the gold standard for ICP monitoring?
intraventricular catheter
___________ is a hard PT stop if a patient has this to monitor ICP
ICP Bolt
What requires neurosurgery/neurology clearance for PT?
intraventricular catheter (IVC)
What is the least invasive monitoring device for ICP and is generally not appropriate for mobilization until removed?
implantable microtransducer sensor
