Neurology Quiz (Week 9) Flashcards
A patient sustained a large subdural hematoma subsequent to a motor vehicle collision. The nurses must be alert for signs & symptoms of increased intracranial pressure (ICP). Which manifestation should be reported immediately?
a.) A change in respiratory rate from 18 to 42.
b.) A temperature change from 98.8 F to 98.2 F.
c.) A blood pressure decrease from 122/88 to 110/72.
d.) Glascow Coma Scale (GCS) of 15.
a.) A change in respiratory rate from 18 to 42.
Central neurogenic hyperventilation may be a sign of increasing ICP
A fiberoptic intracranial pressure monitor was placed in a patient who sustained a large subdural hematoma subsequent to a motor vehicle accident. The BP is now 110/50 and the ICP is 25. Calculat the patient’s CPP (Cerebral Perfusion Pressure).
a.) 70 mmHg
b.) 45 mmHg
c.) 25 mmHg
d.) None of the above
b.) 45 mmHg
CPP = MAP - ICP
1.) MAP = ((2 x DBP) + SBP) / 3
* MAP = ((2 x 50) + 110) / 3
* MAP = (100 + 110) / 3
* MAP = 210 / 3
* MAP = 70
2.) CPP = MAP - ICP
* CPP = 70 - 25
* CPP = 45 mmHg
What is the equation to calculate CPP (Cerebral Perfusion Pressure)?
KNOW THIS!!!!!
CPP = MAP - ICP
What is the equation to calculate MAP?
KNOW THIS!!!!!
MAP = ((2 x DBP) + SBP) / 3
A patient is admitted to the ICU with a closed head injury incurred in a motor vehicle accident. Included in the nurse’s plan of care would be:
a.) Report a Glascow Coma Score greater than 12.
b.) Prevent hypothermia by warming blankets.
c.) Assess for rhinorrhea & otorrhea.
d.) Apply soft restraints for the patient.
c.) Assess for rhinorrhea & otorrhea.
Either of these findings should be reported immediately since they are indicative of a CSF leak.
An intubated patient is in the ICU following a craniotomy for a closed head injury. The patient has an intracranial pressure monitoring device in place to monitor their ICP. The nurse monitoring the patient’s ICP finds it to be elevated. Which of the following is an effective nursing intervention to lower the patient’s ICP?
a.) Repositioning the patient on the left side.
b.) Lowering the head of the bed.
c.) Increase suctioning frequency to ensure optimal gas exchange.
d.) Maintain optimal PCO2 in lower range of normal.
d.) Maintain optimal PCO2 in lower range of normal.
Hyperventilation causes a decrease in the PCO2, leading to cerebral vasoconstriction & decreaed blood flow in the brain.
A patient who was found to be unconscious in their home is brought into the emergency room via ambulence. He is a 65-year-old male with a history of a single level fall. The patient is on coumadin for chronic atrial fibrillation. The left pupil is 3mm > than the right & is non-reactive. Patient has a GCS of 7. On admission, several lab tests were performed including arterial blood gases. The CT is pending. The following values are obtained on 4L nasal cannula:
- pH: 7.32
- pO2: 64
- O2 Sat: 92%
- pCO2: 50
- HCO3: 23
How would you interpret the ABG?
a.) Uncontrolled diabetes mellitus.
b.) Respiratory acidosis with hypoxemia.
c.) Chronic respiratory failure with compensation.
d.) Acute hyperventilation with respiratory alkalosis.
b.) Respiratory acidosis with hypoxemia.
- pO2 of 64 reflexcts hypoxemia on supplemental oxygen
- pH of 7.32 = ACIDIC (normal = 7.35 - 7.45)
- pCO2 of 50 = respiratory (normal = 35 - 45)
- HCO is normal (20 - 26)
The physician orders mannitol (Osmitrol) for a patient who has sustained a head injury. What is the purpose of the mannitol?
a.) Reduce blood pressure.
b.) Reduce intracranial pressure.
c.) Prevent seizure activity.
d.) Reduce temperature.
b.) Reduce intracranial pressure
Osmotic diuretics (like mannitol) decrease fluid in the brain by pulling out extracellular water from the brain into the plasma.
Which of the following is the most probable cause of decreased levels of consciousness related to a metabolic disorder?
a.) Hypocalcemia
b.) Increased intracranial pressure
c.) Hyperglycemic hyperosmolar non-ketotic coma or syndrome (HHS)
d.) Blood glucose of 200
c.) Hyperglycemic hyperosmolar non-ketotic coma or syndrome (HHS)
HHS may mimic the signs of stroke as the blood glucose is frequently over 600.
Name the combination of these symptoms: wide pulse pressure, bradycardia, & systolic hypertension.
a.) Epidural bleed
b.) Autonomic dysreflexia
c.) Diffuse axonal injury
d.) Cushing’s Triad
d.) Cushing’s Triad
Match the respiratory pattern with the clinical condition:
1.) Increased intracranial pressure
2.) Congestive heart failure
3.) Transtentorial herniation
4.) Metabolic acidosis
a.) Sudden cessation of breathing
b.) Respiratory alkalosis
c.) Central neurogenic hyperventilation
d.) Cheyne-Stokes
- 1-c.) Increased ICP = Central neurogenic hyperventilation
- 2-d.) Congestive Heart Failure (CHF) = Cheyne-Stokes
- 3-a.) Transtentorial Herniation = Sudden cessation of breathing
- 4-b.) Metabolic acidosis = Respiratory alkalosis
What breathing pattern is associated with increased intracranial pressure?
KNOW THIS!!!!!
Increased ICP = Central neurogenic hyperventilation
What breathing pattern is associated with congestive heart failure (CHF)?
KNOW THIS!!!!
CHF = Cheyne-Stokes
What breathing pattern is associated with Transtentorial herniation?
KNOW THIS!!!!!
Transtentorial herniation = Sudden cessation of breathing
Which criteria should the nurse use to consider calling the Gift of Life Program (organ procurement organization)?
a.) Dependent on mechanical ventilation.
b.) Glascow Coma Scale (GCS) below 5.
c.) Significant intracranial pathology such as hypertensive bleed or trauma.
d.) Change of resuscitation status.
e.) All of the above.
e.) All of the above
