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Adult Health 1 Review > 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
Q

Stroke:

Which surgeries are used to treat?

A

Carotid Artery Angioplasty with Stenting

Endarterectcomy

Extracranial-Intracranial Bypass

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26
Q

Stroke:

Nursing interventions

A

Neuro Assessments

Monitor ICP

Safety

Emotional Support

Education

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27
Q

Brain Tumors:

Where do primary tumors originate?

Where do secondary tumors originate?

A

within CNS

metastasis from other parts of body

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28
Q

Brain Tumors:

What are the classifications?

A

Benign or Malignant

Location

Cellular Origin

Anatomic Location

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29
Q

Brain Tumors:

What is non-surgical management?

A

Radiation

Chemo

Analgesics

Dexamethasone

Phenytoin

Pantoprazole

Steriotactic Radiosurgery

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30
Q

Brain Tumors:

Why is Dexamethasone given?

A

to decrease size of brain tumors

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31
Q

Brain Tumors:

Nursing interventions post-Craniotomy.

A

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

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32
Q

Brain Tumors:

Post-craniotomy, what activities can be done to avoid increase in ICP?

A

Stool softeners to avoid valsalva

Antiemetics for N/V

Antipyretics/cooling blankets for fever

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33
Q

Brain Tumors:

Which procedure goes through the nose?

Which tumor is it used specifically for?

A

Transphenoidal Hypophysectomy (TPH)

Pituitary Tumor

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34
Q

Brain Tumors:

What are complications from surgery?

A

Air embolism

CSF Leak (meningitis)

Diabetes Insipidus (messing with hypothalamus)

Visual Disturbances

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35
Q

Brain Tumors:

Post op care

A

HOB increase to 35-40 degrees

Hourly UOP

Monitor electrolytes

Avoid straining

Monitor for visual disturbances

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36
Q

Brain Tumors:

We are concerned about Diabetes Insipidus. What UOP will this have?

A

400 mL/hr

***normal is 0.5-1 mL/kg/hr

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37
Q

Brain Tumors:

Post-op, why do we want them to avoid blowing their nose?

A

avoid any straining to prevent rise in ICP

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38
Q

Cerebral Aneurysms:

Which type is behind the eye?

Which type is in the Circle of Willis?

A

Fusiform

Berry

39
Q

Subarachnoid Hemorrage (SAH) from Cerebral Aneurysm:

What are physical assessments of SAH?

A

Severe, sudden Headache

Brief loss of consciousness

N/V

Kernig’s Sign, Brudzinskis Sign, Photophobia

40
Q

Cerebral Aneurysm:

What do we suspect if client presents and says, ‘I’m having the worst headache of my life.’

A

Subarachnoid Hemorrhage (SAH)

41
Q

Cerebral Aneurysm:

Why have positive Kernig’s and Brudzinskis with a SAH?

A

blood in meninges irritates them, giving meningitis symptoms

42
Q

Cerebral Aneurysm:

What will a Lumbar Puncture reveal with SAH?

A

blood inCSF

43
Q

Cerebral Aneurysm:

What is gold standard for diagnosing SAH?

A

Cerebral Angiogram

44
Q

Cerebral Aneuysm:

What is treatment plan for SAH?

A

craniotomy with aneurysm clipping within 48 hours post bleed

***SAH is an emergency

45
Q

Cerebral Aneurysm:

What is treatment after clipping the SAH?

A

HHH

  • Hypertensive (increase BP and CO)
  • Hypervolemic (volume expanders – albumin)
  • Hemodilution (fluids)
46
Q

Cerebral Aneurysm:

Post op from SAH clipping, what is our concern?

A

not bleeding, since they’re stable

our biggest concern is VASOSPASM, so we keep BP HIGH

47
Q

Cerebral Aneurysm:

What is Endovascular Coiling?

A

filling the aneurysm with thin coil that will close it off

48
Q

Brain Abscess:

What causes a BA?

Which areas of brain are most common?

A

purulent infection of brain

frontal and temporal most common

49
Q

Stroke:

S/S of Left Hemisphere Stroke

A

Inability to discriminate words and letters

Intellectual Impairment

Deficits in right visual field

50
Q

Stroke:

S/S of Right Hemisphere Stroke

A

Disorientation

Constant smiling

Deficits in left visual field

51
Q

What is earliest indicator of increased ICP?

A

agitation and confusion

52
Q

ICP:

What is the Monroe-Kellie Hypothesis?

A

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
Q

ICP:

Bran takes up — us space

Blood takes up — of space

CSF takes up — of space

A

80 percent

10 percent

10 percent

***any change in one must be compensated by changes in others

54
Q

ICP:

What is normal ICP?

A

5-15 mmHg

55
Q

ICP:

When would you treat increases in ICP?

A

ICP greater than 20 mmHg that is sustained for 5 mins

56
Q

ICP:

What does an ICP of 10-20 mmHg indicate?

A

borderline.. it is compensating

over 20mmHg you start treating it

57
Q

ICP:

What is severely high ICP?

A

greater than 40 mmHg

58
Q

Cerebral Blood Flow (CBF):

What is the name of the pressure gradient that drives CBF?

A

CPP (Cerebral Perfusion Pressure)

59
Q

CBF:

What is Autoregulation?

A

the ability of cerebral blood vessels to contract of dilate to deliver just the right amount of blood flow to the brain tissues

60
Q

CBF:

What four factors can we controle to improve autoregulation?

A

Hypoxia

Hypercapia (CO2 is a vasodilator)

Hypotension

Hypovolemia

61
Q

CBF:

What factors influence Autoregulation of blood flow?

A

Acidosis (dilates)

Alkalosis (constricts)

Metabolic Rate

62
Q

CBF:

If Metabolic rate increases, what happens to CBF?

If Metabolic rate decreases, what happens to CBF?

A

increases

decreases

63
Q

CBF:

Since Acidosis dilates vessels, what doe it do to cerebral blood volume?

A

increases

***in same manner, Alkalosis decreases cerebral blood vol

64
Q

CBF:

How is Cerebral Perfusion Pressure (CPP) calculated?

A

CPP = MAP - ICP

65
Q

CBF:

What CPP levels are we looking for?

A

Normal = 70-95 mmHg

***CPP less than 60 = hypoperfusion of brain

***CPP less than 40 = brain ischemia

66
Q

ICP:

Why does increased CO2 cause an increase in ICP?

A

it’s a vasodilator

67
Q

What is mortality rate for someone with both Hypoxia and Hypotension?

A

greater than 75%

68
Q

What is treatment for Hypoxia and Hypotension?

A

Early resuscitation using 100% FiO2

69
Q

MAP:

What is target MAP?

A

greater than 90

70
Q

Optimize MAP:

How do you treat hypotension?

A

DA or Dobutamine

***target MAP is 90 or more

71
Q

Optimize MAP:

How do you prevent HTN?

A

Nicardipine 25 mg in 250 mL

**CCB

72
Q

Fluid Balance:

What do we want to keep the serum osmalirity level at?

A

less than 315

73
Q

Mannitol:

How much can be given in 24 hrs?

A

do not exceed 200 G in 24 hrs

***hold if serum osmolarity is greater than 315

74
Q

Increased ICP:

What is first s/s of increased ICP?

A

decreased LOC

75
Q

Increased ICP:

What is Herniation?

A

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
Q

ICP:

Nursing interventions

A

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
Q

Traumatic Brain Injury (TBI):

Contact, Accel-Deceleration, or Rotational injuries are examples of — TBI

Cerebral Ischemia is an example of — TBI

A

Primary

Secondary

78
Q

TBI:

What is Mild TBI?

A

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
Q

TBI:

What is Moderate TBI?

A

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
Q

TBI:

What is Severe TBI?

A

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
Q

Skull Fracture:

Racoon Eyes are a sign of a fracture of which area?

A

Frontal or Orbital Fracture

82
Q

Skull Fracture:

Battle Sign (bruising behind ears) are a sign of fracture where?

A

Basilar Skull Fracture

83
Q

Contusions:

What are clinical manifestations of Contusion?

A

Focal findings

Disturbance in LOC

Seizures common

84
Q

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?

A

Hemiplegia (paralysis on side of body)

Dilated pupil

85
Q

Subdural Hematoma time-frame:

Acute SDH is —

Subacute SDH is —

Chronic SDH is —

A

first 48 hrs

2 days to 2 wks

2 wks to several months

86
Q

Subdural Hematoma:

Which type of vessel is ruptured/torn?

A

venous

87
Q

Epidural Hematoma:

Which type of vessel is ruptured/torn?

A

artery

***middle meningeal artery

88
Q

Epidural Hematoma:

Why might they not seek help?

A

LOC changes quickly, then they recover lucidity so they think they’re ok

Afterwards, there is rapid deterioration

***Epidural Hematoma is arterial bleeding!!

89
Q

Epidiural Hematoma:

What will eyes look like?

A

dilated, fixed pupil on same side of injury

90
Q

Which hemorrhage is often associated with Cerebral Contusions?

A

Subarachnoid Hemorrhage

91
Q

Which hemorrhage results from a brain laceration?

A

Intracerebral Hemorrhage

***most often in Frontal and Temporal areas

92
Q

Diffuse Axonal Injury (DAI):

What is DAI?

A

brain injury in which damage in the form of extensive lesions in white matter tracts occurs over a widespread area.

93
Q

Diffuse Axonal Injury:

What is Mild?

Moderate?

Severe?

A

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 Review (26 decks)

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