Surgery Neuro Flashcards
How many mL of CSF is taken during lumbar puncture
8-10mL
What position is the pt in during Lumbar puncture
orthopneic position
Post lumbar puncture
lie flat 6-12 hr
drink fluids – replace CSF
leak = serious HA
Used to visualize cerebral artery system
Cerebral angiogram
Post cerebral angiogram (dye)
BedRest for 4-8 hr
pressure on insertion site
monitor distal pulses
watch for s/s bleeding or hematomas
temporary impairment of cerebral circulation
brain temporarily deprived of O2
focal neurological deficits
lasts minutes/hours
(TIA) Transient ischemic attack
infarction/death of brain tissue
disruption of blood flow to brain
focal neurological deficits, specific to brain area involved
urgent medical condition
ischemic (tpa) or hemorrhagic (surgical intervention)
(CVA)
Cerebrovascular accident
CVA caused in younger people is usually due to
drugs
expressive aphasia
cannot express the right words
receptive aphasia
cannot understand language
Normal ICP
10-15
early signs of ICP
agitation confusion irritability drowsiness personality changes blurred vision decreased LOC
Late signs of ICP
increased BP widened pulse pressure = INCREASING SYSTOLIC slow irregular respiration slow pulse dilation of one pupil increased body temp decorticate posturing Decerebrate posturing
portion of brain protrudes through an opening in skull and causes dilation of eye on side of herniation
Cerebral Herniation
Interventions for cerebral Herniation
no narcotics, sedatives/barbiturates (masks s/s of ICP)
HOB elevated
stool softeners
avoid hip flexion
Decadron & Prednisone
reduces inflammation for ICP
Mannitol
osmotic diuretic given post op to reduce ICP
removing a bone, flap of skull for decompression in ICP
Craniotomy
Prevent ICP post cerebral sugery
quiet room
stool softeners
HOB elevated
- leak of serous/Serosanguineous fluid from ear or nose rhinorrhea (nose) otorrhea (ear)
- battle’s signs: ecchymosis behind ear
- raccoon eyes: bilateral ecchymosis under both eyes
appears 3-4 hours after insult S/S OF
skull fracture
temporary neurological dysfunction caused by mechanical force brief loss of consciousness amnesia HA, fatigue concentration problems
Concussion
bruising of brain, areas of hemorrhage is called
Contusion
bleeding btwn skull/dura
arterial – faster bleed
often associated w/ a skull fracture
Epidural hematomas
S/S of Epidural Hematoma
- pt loses consciousness directly after the injury and then regains consciousness and is coherent for a brief period
- dilated pupil and paralyzed extraocular muscles on the side of the hematoma
- seizures or hemiparesis may occur
