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

T4 - Care of Critically Ill Patients with Neuro Probs (Josh) Flashcards

1
Q

— and — have stroke-like symptoms and serves as a ‘warning sign’ of a possible stroke.

A

TIA (Transient Ischemic Attack)

Reversible Ischemic Neurologic Deficit (RIND)

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2
Q

TIA and RIND:

TIA lasts — to —

RIND lasts — to —

A

minutes to less than 24 hours

less than 24 hours to less than a week

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3
Q

With a TIA and RIND, what is happening?

A

brief interruption in cerebral blood flow

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4
Q

TIA and RIND:

What is the treatment plan?

A

Complete neuro assessment

CT Scan, lab, ECG

Possible admission

Anticoagulant therapy (clopidogrel)

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5
Q

TIA and RIND:

What anticoagulant would we give to treat?

A

Clopidogrel

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6
Q

With — you recover.

With — you have permanent change.

A

TIA and RIND

CVA

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7
Q

Which heart arrhythmia is a concern for CVAs?

A

Afib

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8
Q

A stroke is a change in – – – to the brain.

A

normal blood supply

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9
Q

Stroke (Brain Attack):

What are he causative agents?

A

HTN

Arteriovenous Malformation (AVM)
***Can be congenital
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10
Q

What are the types of Strokes?

A

Ischemic (lack of blood flow)

Hemorrhagic (bleeding in brain)

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11
Q

Stroke:

Thrombus and Emboli are examples of which type of Stroke?

A

Ischemic (lack of blood flow)

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12
Q

Which type of Strokes have SUDDEN onset?

Which type have GRADUAL onset?

A

Sudden:

  • Embolic (ischemic)
  • Hemorrhagic

Gradual:
- Thrombotic (ischemic)

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13
Q

Causes of Hemorrhagic Strokes:

A

Aneurysm

HTN

Arteriovenous Malformation

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14
Q

What is an Arteriovenous Malformation?

A

tight cluster of arteries and veins bundled together

blood passes quickly from artery to vein without going through normal capillary network

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15
Q

Risk factors for Stroke

A

Smoking

Substance abuse

Obesity

Sedantary Lifestyle

Oral contraceptive use

Heavy ETOH use

Use of Phenylpropanolamine (PPA)
***no longer made in US

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16
Q

Stroke in Left Hemisphere will have which symptoms?

A

Aphasia, Alexia, Dyslexia

Acalculia

Right Visual Field Deficit

Anxiety, Anger, Frustration

Intellectual Impairment

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17
Q

Stroke in Right Hemisphere will have which symptoms?

A

Disorientation (left sided motor weakness)

Loss of depth perception

Unilateral body neglect syndrome

Denial of illness

Impulsiveness

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18
Q

Stroke:

What is the eligibility criteria for Thrombolytic Therapy?

A

Last seen normal (LSN) less than 3 hrs- 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 both STROKE and DIABETES

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19
Q

Stroke:

What is the time goal for ED door to treatment?

A

less than 60 mins

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20
Q

Stroke:

How often are neuro exams given?

A

q 15 mins first 2 hrs

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21
Q

Stroke:

What are the Endovascular Interventions?

A

Embolectomy

  • *mechanical clot removal
  • *NOT common

Intra-arterial Thrombolsis

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22
Q

Stroke:

When can an Intra-arterial Thrombolysis be done?

A

with 6 hrs LSN (last seen normal)

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23
Q

Medication classes for Strokes

A

Thrombolytics

Anticoagulants (ASA, Clopidogrel)

Lorazepam (other antiepileptics)

CCBs

Stool softeners

Analgesics

Antianxiety drugs

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24
Q

Stroke:

Which CCB is likely to be given?

A

Nicardipine

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25
Stroke: Which surgeries are used to treat?
Carotid Artery Angioplasty with Stenting Endarterectcomy Extracranial-Intracranial Bypass
26
Stroke: Nursing interventions
Neuro Assessments Monitor ICP Safety Emotional Support Education
27
Brain Tumors: Where do primary tumors originate? Where do secondary tumors originate?
within CNS metastasis from other parts of body
28
Brain Tumors: What are the classifications?
Benign or Malignant Location Cellular Origin Anatomic Location
29
Brain Tumors: What is non-surgical management?
Radiation Chemo Analgesics Dexamethasone Phenytoin Pantoprazole Steriotactic Radiosurgery
30
Brain Tumors: Why is Dexamethasone given?
to decrease size of brain tumors
31
Brain Tumors: Nursing interventions post-Craniotomy.
Fluid Balance Incision site Monitor ICP changes Avoid activities that decrease ICP DVT prophylaxis Stress ulcers Pneumonia Proper positioning ***HOB 30 degrees or more Eye care
32
Brain Tumors: Post-craniotomy, what activities can be done to avoid increase in ICP?
Stool softeners to avoid valsalva Antiemetics for N/V Antipyretics/cooling blankets for fever
33
Brain Tumors: Which procedure goes through the nose? Which tumor is it used specifically for?
Transphenoidal Hypophysectomy (TPH) Pituitary Tumor
34
Brain Tumors: What are complications from surgery?
Air embolism CSF Leak (meningitis) Diabetes Insipidus (messing with hypothalamus) Visual Disturbances
35
Brain Tumors: Post op care
HOB increase to 35-40 degrees Hourly UOP Monitor electrolytes Avoid straining Monitor for visual disturbances
36
Brain Tumors: We are concerned about Diabetes Insipidus. What UOP will this have?
400 mL/hr ***normal is 0.5-1 mL/kg/hr
37
Brain Tumors: Post-op, why do we want them to avoid blowing their nose?
avoid any straining to prevent rise in ICP
38
Cerebral Aneurysms: Which type is behind the eye? Which type is in the Circle of Willis?
Fusiform Berry
39
Subarachnoid Hemorrage (SAH) from Cerebral Aneurysm: What are physical assessments of SAH?
Severe, sudden Headache Brief loss of consciousness N/V Kernig's Sign, Brudzinskis Sign, Photophobia
40
Cerebral Aneurysm: What do we suspect if client presents and says, 'I'm having the worst headache of my life.'
Subarachnoid Hemorrhage (SAH)
41
Cerebral Aneurysm: Why have positive Kernig's and Brudzinskis with a SAH?
blood in meninges irritates them, giving meningitis symptoms
42
Cerebral Aneurysm: What will a Lumbar Puncture reveal with SAH?
blood inCSF
43
Cerebral Aneurysm: What is gold standard for diagnosing SAH?
Cerebral Angiogram
44
Cerebral Aneuysm: What is treatment plan for SAH?
craniotomy with aneurysm clipping within 48 hours post bleed ***SAH is an emergency
45
Cerebral Aneurysm: What is treatment after clipping the SAH?
HHH - Hypertensive (increase BP and CO) - Hypervolemic (volume expanders -- albumin) - Hemodilution (fluids)
46
Cerebral Aneurysm: Post op from SAH clipping, what is our concern?
not bleeding, since they're stable our biggest concern is VASOSPASM, so we keep BP HIGH
47
Cerebral Aneurysm: What is Endovascular Coiling?
filling the aneurysm with thin coil that will close it off
48
Brain Abscess: What causes a BA? Which areas of brain are most common?
purulent infection of brain frontal and temporal most common
49
Stroke: S/S of Left Hemisphere Stroke
Inability to discriminate words and letters Intellectual Impairment Deficits in right visual field
50
Stroke: S/S of Right Hemisphere Stroke
Disorientation Constant smiling Deficits in left visual field
51
What is earliest indicator of increased ICP?
agitation and confusion
52
ICP: What is the Monroe-Kellie Hypothesis?
due to the fact that the brain is closed system with tissue (brain) and fluids (blood and CSF)... ...an increase in any one MUST be compensated with a decrease in one or more of the other components
53
ICP: Bran takes up --- us space Blood takes up --- of space CSF takes up --- of space
80 percent 10 percent 10 percent ***any change in one must be compensated by changes in others
54
ICP: What is normal ICP?
5-15 mmHg
55
ICP: When would you treat increases in ICP?
ICP greater than 20 mmHg that is sustained for 5 mins
56
ICP: What does an ICP of 10-20 mmHg indicate?
borderline.. it is compensating over 20mmHg you start treating it
57
ICP: What is severely high ICP?
greater than 40 mmHg
58
Cerebral Blood Flow (CBF): What is the name of the pressure gradient that drives CBF?
CPP (Cerebral Perfusion Pressure)
59
CBF: What is Autoregulation?
the ability of cerebral blood vessels to contract of dilate to deliver just the right amount of blood flow to the brain tissues
60
CBF: What four factors can we controle to improve autoregulation?
Hypoxia Hypercapia (CO2 is a vasodilator) Hypotension Hypovolemia
61
CBF: What factors influence Autoregulation of blood flow?
Acidosis (dilates) Alkalosis (constricts) Metabolic Rate
62
CBF: If Metabolic rate increases, what happens to CBF? If Metabolic rate decreases, what happens to CBF?
increases decreases
63
CBF: Since Acidosis dilates vessels, what doe it do to cerebral blood volume?
increases ***in same manner, Alkalosis decreases cerebral blood vol
64
CBF: How is Cerebral Perfusion Pressure (CPP) calculated?
CPP = MAP - ICP
65
CBF: What CPP levels are we looking for?
Normal = 70-95 mmHg ***CPP less than 60 = hypoperfusion of brain ***CPP less than 40 = brain ischemia
66
ICP: Why does increased CO2 cause an increase in ICP?
it's a vasodilator
67
What is mortality rate for someone with both Hypoxia and Hypotension?
greater than 75%
68
What is treatment for Hypoxia and Hypotension?
Early resuscitation using 100% FiO2
69
MAP: What is target MAP?
greater than 90
70
Optimize MAP: How do you treat hypotension?
DA or Dobutamine ***target MAP is 90 or more
71
Optimize MAP: How do you prevent HTN?
Nicardipine 25 mg in 250 mL **CCB
72
Fluid Balance: What do we want to keep the serum osmalirity level at?
less than 315
73
Mannitol: How much can be given in 24 hrs?
do not exceed 200 G in 24 hrs ***hold if serum osmolarity is greater than 315
74
Increased ICP: What is first s/s of increased ICP?
decreased LOC
75
Increased ICP: What is Herniation?
complication of increased ICP where tissue from one compartment of brain shifts to another ***leads to coma, loss of reflexes, posturing, loss of brainstem function, and death
76
ICP: Nursing interventions
Monitor serum electrolytes Monitor serum Dilantin/Phenobarbitol levels CVP monitoring Diuretics Keep SBP 140-160 Hyperventilation Antiseizure meds Antipyretics/Cooling blanket HOB 30-45 degrees Avoid activities that increase ICP
77
Traumatic Brain Injury (TBI): Contact, Accel-Deceleration, or Rotational injuries are examples of --- TBI Cerebral Ischemia is an example of --- TBI
Primary Secondary
78
TBI: What is Mild TBI?
Altered or Loss of Consciousness less than 30 mins with normal CT or MRI GCS of 13-15 Post Traumatic Amnesia less than 24 hrs
79
TBI: What is Moderate TBI?
Altered or Loss of Consciousness less than 6 hrs with abnormal CT or MRI GCS of 9-12 Post Traumatic Amnesia less than 7 days
80
TBI: What is Severe TBI?
Altered or Loss of Consciousness greater than 6 hrs with normal CT or MRI GCS of less than 9 Post Traumatic Amnesia greater than 7 days
81
Skull Fracture: Racoon Eyes are a sign of a fracture of which area?
Frontal or Orbital Fracture
82
Skull Fracture: Battle Sign (bruising behind ears) are a sign of fracture where?
Basilar Skull Fracture
83
Contusions: What are clinical manifestations of Contusion?
Focal findings Disturbance in LOC Seizures common
84
Lacerations: With a brain laceration, which will we see on opposite side of body as lesion? What will we see on same side of body lesion?
Hemiplegia (paralysis on side of body) Dilated pupil
85
Subdural Hematoma time-frame: Acute SDH is --- Subacute SDH is --- Chronic SDH is ---
first 48 hrs 2 days to 2 wks 2 wks to several months
86
Subdural Hematoma: Which type of vessel is ruptured/torn?
venous
87
Epidural Hematoma: Which type of vessel is ruptured/torn?
artery ***middle meningeal artery
88
Epidural Hematoma: Why might they not seek help?
LOC changes quickly, then they recover lucidity so they think they're ok Afterwards, there is rapid deterioration ***Epidural Hematoma is arterial bleeding!!
89
Epidiural Hematoma: What will eyes look like?
dilated, fixed pupil on same side of injury
90
Which hemorrhage is often associated with Cerebral Contusions?
Subarachnoid Hemorrhage
91
Which hemorrhage results from a brain laceration?
Intracerebral Hemorrhage ***most often in Frontal and Temporal areas
92
Diffuse Axonal Injury (DAI): What is DAI?
brain injury in which damage in the form of extensive lesions in white matter tracts occurs over a widespread area.
93
Diffuse Axonal Injury: What is Mild? Moderate? Severe?
Mild = coma 6-24 hrs (follows commands by 24 hrs) Moderate = coma greater than 24 hours with NO brainstem signs Severe = prolonged coma with prominent brainstem signs

Adult Health 1 - (Josh) (26 decks)

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