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Adult Health 1 - (Josh) > T4 Blueprint - Care of Critically Ill with Neuro Problems (Josh) > Flashcards

T4 Blueprint - Care of Critically Ill with Neuro Problems (Josh) Flashcards

1
Q

Symptoms of Left Hemisphere CVA

A

Aphasia

Alexia, Dyslexia

Acalculia

Right visual field deficit

Anxiety, Anger, Frustration

Intellectual Impairment

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2
Q

Symptoms of Right Hemisphere CVA

A

Disorientation (left sided motor weakness)

Loss of Depth Perception

Unilateral Body Neglect Syndrome

Denial of Illness

Impulsiveness

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3
Q

How often are neuro exams given for CVA?

A

q 15 mins for 2 hrs

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4
Q

What is the eligibility for Thrombolytic Therapy?

A

LSN 3-4.5 hrs

Less than 80 yo

No anticoagulant use (INR less than or equal to 1.7)

NIH Scale less than or equal to 25

No history of STROKE and DIABETES

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5
Q

When can Intra-arterial Thrombolysis be done?

A

LSN less than 6 hrs

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6
Q

Brain Tumor:

Nursing interventions post-Craniotomy

A

Fluid Balance

Incision care

Monitor ICP

Avoid activities that increase ICP

DVT prophylaxis

Stress Ulcers

Pneumonia

Proper Positioning

Eye Care

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7
Q

Craniotomy:

With fluid balance, what are we observing for?

A

Diabetes Insipidus

**UOP 400 mL per hr

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8
Q

Craniotomy:

What is Cushing’s Stress Ulcer?

A

a gastric ulcer associated with increased ICP

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9
Q

TPH:

Complications to watch for?

A

Air embolism

CSF leak (meningitis)

Diabetes Insipidus

Visual disturbances

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10
Q

TPH:

Post op care

A

HOB increase to 35-40 degrees

Hourly UOP

Monitor electroylytes

Avoid straining

Monitor for vision disturbances

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11
Q

Increased ICP:

What do we want to keep SBP?

A

140-160

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12
Q

Increased ICP:

Why do we want to hyperventilate?

A

CO2 is a vasodilator that increases ICP so we want to keep levels at low normal (35 mmHg) and have high PaO2 levels

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13
Q

Increased ICP:

What is normal ICP?

A

5-15 mmHg

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14
Q

Increased ICP:

What is CPP and how do we calculate?

A

Cerebral Perfusion Pressure

CPP = MAP - ICP

Normal is 70-95 mmHg

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15
Q

Increased ICP:

CPP of — indicates hypoperfusion of brain.

CPP of — indicates brain ischemia

A

less than 60

less than 40

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16
Q

Increased ICP:

When would you hyperventilate?

A

only if herniating

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17
Q

Increased ICP:

Why do we increase oxygenation?

A

because hypoxia along with hypotension has a 75% mortality rate

***give 100% FiO2

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18
Q

Increased ICP:

What is our optimal MAP?

A

greater than 90

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19
Q

Increased ICP:

What can we do to increase CPP?

A

induce HTN with DA or Dobutamine

***monitor UO closely

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20
Q

Increased ICP:

What drug can we give to prevent extreme rise in BP?

A

Nicardipine (CBB)

**Neuroprotective

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21
Q

Increased ICP:

What is our goal with PAWP and CVP?

A

PAWP 5-12 mmHG

CVP 5 mmHg

22
Q

Increased ICP:

What is our goal with serum osmolarity?

A

keep less than 315

23
Q

Increased ICP:

How often should Na and Osmolarity be measured?

24
Q

SAH:

What are signs and symptoms of SAH?

A

Severe sudden headache

Brief loss of consciousness

NV

Kernig’s and Brudzinskis

25
Q

SAH:

When should craniotomy and surgical clipping be performed?

A

within 48 hrs

26
Q

SAH:

Nursing Interventions Preop?

A

Keep BP low (to prevent rebleeding)

Bedrest

Dark, quiet environment

Stool softeners

No restraints, keep them calm

HOB 35-45 degrees

DVT precautions

27
Q

SAH:

Nursing Interventions Postop?

A

prevent VASOSPASM

Hypertensive

Hypervolemic

Hemodilution

28
Q

SAH:

We want BP — before surgery and — after surgery.

29
Q

SAH:

What can we give postop to make vessels Hypervolemic?

30
Q

SAH:

Complications

A

Hyponatremia

Re-bleeding

Hydrocephalus

Seizures

31
Q

SAH:

What do we give if they become Hyponatremic post op?

A

isotonic fluids

32
Q

TBI:

How long are the uncouncious for a Mild TBI?

Moderate TBI?

Severe TBI?

A

less than 30 mins

less than 6 hrs

greater than 6 hrs

33
Q

TBI:

What will CT and MRI look like with Mild TBI?

Moderate TBI?

Severe TBI?

A

normal

abnormal

abnormal

34
Q

TBI:

CGS for Mild?

GCS for Moderate?

GCS for Severe?

A

13-15

9-12

less than 9

35
Q

TBI:

How long do they have Post Trauma Amnesia for Mild TBI?

Moderate TBI?

Severe TBI?

A

less than 24 hrs

less than 7 days

greater than 7 days

36
Q

Concussion:

Signs and Symptoms

A

N/V with drowsiness

Persistent HA

Lethargy

Personality and Behavior Changes

Shortened Attention Span

Decreased Short Term Memory

Changes in Intellectual Ability

37
Q

CTE is a complication from Concussions.

Which proteins are released?

A

tau proteins

38
Q

Concussion:

What are complications from repeated concussions?

A

CTE

ALS

Second Impact Syndrome

39
Q

CTE:

What are the Initial Symptoms?

A

Disorientation

Confusion

Dizziness

HA

Lack of Insight

Poor Judgment

Overt Dementia

Slowed Muscular Movements

Staggered Gait

Impeded Speech

Tremors

Vertigo

Deafness

40
Q

CTE:

What are the Progressive Symptoms?

A

Social Instability

Erratic Behavior

Memory Loss

Initial Symptoms of Parkinson’s Disease

41
Q

Skull Fracture:

— — are signs of a Frontal or Orbital Fracture.

— — are a sign of a Basilar Skull Fracture

A

Racoon Eyes

Battle Sign (behind ears)

42
Q

Hematomas:

Which type is ARTERIAL bleeding?

Which type is VENOUS bleeding?

A

Epidural Hematoma

Subdural Hematoma

43
Q

Hematomas:

Which type may not seek treatment initially?

A

Epidural Hematoma

  • they have an immediate loss of consciousness BUT have a time of lucidity before rapid deterioration
44
Q

Epidural Hematoma:

Dilated, fixed pupil on — – of injury.

45
Q

Epidural Hematoma:

What do we want to keep the CPP?

A

at 70 or above

46
Q

Epidural Hematoma:

What Sodium level do we want?

A

145 or greater to decrease cerebral edema

47
Q

Epidural Hematoma:

What PaCO2 level are we wanting?

A

low normal (35 mmHg)

***CO2 is a dilator that increases ICP

48
Q

Subdural Hematoma:

What is the patho?

A

small bridging veins b/t dura and skull are torn, and bleed into the subdural space

49
Q

Subdural Hematoma:

What type of deterioration?

A

PROGRESSIVE deterioration

50
Q

Subdural Hematoma:

What is Acute?

Subacute?

Chronic?

A

first 48 hrs

2 days to 2 wks

2 wks to several months

51
Q

DIA:

What is the patho?

A

extensive lesions in white matter tracts that occur over a widespread area of brain

caused by acceleration type injury

Adult Health 1 - (Josh) (26 decks)

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