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critical care > unit 6 > Flashcards

unit 6 Flashcards

1
Q

adjust the diameter of the blood vessels so the brain is protected

Changes in pressure

Changes in CO2

A

Autoregulation

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2
Q

with Increased Intracranial Pressure

what 3 things should you avoid

A

Avoid clustering of activities

Avoid valsalva situations

external stimuli

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3
Q

Cushing’s Triad (warning of herniation) includes what things

A

systolic BP: increased
diastolyc BP: decreased

bradycardia

respiration: decreased or irregular

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4
Q

This type of injury is associated with disruption of axons in the cerebral hemispheres, diencephalon, and brainstem.

This injury results in vasodilation and increased CBV that precipitates increased ICP. Signs and symptoms are variable, and prognosis is poor.

A

Diffuse Axonal Injury

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5
Q

Brain metabolism

Cerebral glucose < ___ mg/dL = confusion

A

70

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6
Q

with Intracranial Pressure Monitoring

Goal: PaO2 > ____mm Hg

A

80

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7
Q

skull fracture aginst the base of the brain

A

basilar skull fracture

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8
Q

when the CO2 goes up and the blood pressure goes down the blood vessels ______

A

dilate

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9
Q

never insert _____ with a skull fracture

A

NG tube

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10
Q

what 3 things can cause a dangerous increase in ICP

A

Increased Blood Volume

  • Loss of Autoregulation
  • Decreased Oxygenation
  • Hypercapnia
  • Obstruction

Increased Brain Volume
-Cerebral Edema

Increased Cerebrospinal Fluid
-Hydrocephalus

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11
Q

very high pressure within the skull that occurs when a part of the brain is squeezed across structures within the skull

A

Herniation

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12
Q

3 Components of ICP

A

brain tissue, blood, CSF fluid

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13
Q

increases serum osmoality and water in brain cells goes into intravasular system

A

Mannitol

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14
Q

to avoid hypertension with Increased Intracranial Pressure

it is comon to give

A

Nicardipine

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15
Q

when decorticate and decerebrate posturing are present that usually means ______ involvement

A

brain stem

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16
Q

____ is the most reliable factor to tell us about our patients neuro status

A

LOC

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17
Q

2 emergency measures when a patient has Cushing’s Triad

A

HOB 90 degrees

hyperventilate

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18
Q

Normal ICP range

A

0-15 mm Hg

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19
Q

Brain metabolism

Cerebral glucose < ___ mg/dL = damage

A

20

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20
Q

2 things to determine brain death

A

crainal nerve test

apnea testing

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21
Q

posture where The client internally flexes his wrists

A

decorticate

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22
Q

indications for Intracranial Pressure Monitoring

A

severe brain injury

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23
Q

signs of increased ICP

CO2:
WBC:
Coagulation profile:

A

CO2: increased
WBC: increased
Coagulation profile: increased

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24
Q

is the result of coup and contrecoup injuries accompanied by bruising and bleeding into brain tissue.

A

Contusion

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25
Q

If CPP is inadequate, _______ or ______ can occur

A

ischemia or infarction

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26
Q

with Increased Intracranial Pressure

for Sedation you might give what 2 things

A

Benzodiazepines

Analgesia

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27
Q

with Increased Intracranial Pressure

you might give what 2 things for Seizure prophylaxis

A

Phenytoin

Levetiracetam

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28
Q

when the CO2 goes down and the blood pressure goes up the blood vessels ______

A

constrict

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29
Q

Increased Intracranial Pressure

Goal: MAP ___ mm Hg
CPP: at least ____ mm Hg

A

70-90

70

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30
Q

Increased Intracranial Pressure

Goal: serum osmolality less than ___ mOsm/L.

A

320

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31
Q

how to calculate Cerebral Perfusion Pressure (CPP)

A

MAP - ICP = CPP

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32
Q

with Increased Intracranial Pressure

what 3 things should you remember with suctioning

A

Only when necessary
Preoxygenate
Limit suction to 10 seconds

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33
Q

5 Later manifestations of increased ICP

A

Deteriorating LOC (unresponsive)

Cushing’s Triad

Cheyne-Stokes respiration

Dilated pupils

Abnormal posturing

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34
Q

a hemorrhage into brain tissue that creates a mass lesion

can be caused by penetrating injuries, gunshot wounds, deep depressed skull fractures, stab wounds, or extension of a contusion

A

Intracerebral Hematoma

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35
Q

associated with a linear fracture of the temporal bone and results from tearing of the middle meningeal artery

experiences a brief loss of consciousness followed by a lucid period before neurologic deterioration

A

epidural hematoma.

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36
Q

you want the CPP to be __ or greater

A

70

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37
Q

Increase in any one component requires a reduction in one or both of other components to sustain normal ICP

A

Monro-Kellie doctrine

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38
Q

2 secondary injury after primary brain injury

A

added leeding after initial injury

swelling

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39
Q

3 Earlier manifestations of increased ICP

A

Change in LOC
Headache (unrelieved)
Vomiting without nausea

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40
Q

occurs when a mechanical force of short duration is applied to the skull

Patients may lose consciousness for a few seconds at the time of injury, but lasting effects are not common.

A

Concussion

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41
Q

3 things assessed in the glasgow coma scale

the ___ the number the better off the patient

A

eyes
motor response
verbal response

higher the number

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42
Q

crainal nerve 5 & 6 together test

A

cornial reflex

43
Q

every patient who has signs of a stroke you should check which cranial nerves

A

9 and 10 for gag reflex

44
Q

Collection of blood in the potential space between the inner table of the skull and the dura causes an _________

A

epidural hematoma.

45
Q

posture where The client rigidly extends his arms

A

decerebrate

46
Q

with Increased Intracranial Pressure

wht 3 positions should you initiate

A

HOB elevation 30 degrees

Neutral head position

Turn side to side
-Watch for return to baseline CPP

47
Q

with Increased Intracranial Pressure

to Avoid hypotension it is common to give

A

Vasopressors

48
Q

with a glasgow scale __ or below is when someone is near or in a coma

A

8

49
Q

how can you tell mannitol is effective

A

increased LOC

50
Q

Collection of blood in the subdural space causes a ________

occurs when a surface vein is torn around the cerebral cortex

A

subdural hematoma

51
Q

Intracranial Pressure Monitoring is measured at ____

A

level of the 3rd ventricle

52
Q

7 potential complications from neuro surgery

A 
Infection 
Cerebral hemorrhage
Increased ICP
Diabetes Insipidus
Seizures
SIADH
hydrocephalus
53
Q

2 signs of basilar skull fracture

A

ecchymosis around both eyes

ecchymosis underneath the ear

54
Q

2 main meds for Increased Intracranial Pressure

A

Mannitol

Dexamethasone (meningitis)

55
Q

type of stroke where result of stenosis in the large arteries of the head and neck; it is caused by a cholesterol plaque or a thrombus superimposed on plaque.

A

Large Artery Atherosclerosis

Ischemic Stroke

56
Q

type of stroke whrere An embolism occurs when a blood clot or plaque fractures, breaks off, and travels to the brain

A

cardioembolic strok

Ischemic Stroke

57
Q

The most common causes of cardioembolic stroke are what 4 things

A

atrial fibrillation
rheumatic heart disease
acute myocardial infarction
endocarditis

58
Q

Hallmark is the sudden onset of focal neurological symptoms

Deficit that lasts 24 hours or more

A

stroke

59
Q

type of stroke where primary intraparenchymal hemorrhage and ruptured vascular malformations, such as cerebral aneurysms or arteriovenous malformations

A

Hemorrhagic

60
Q

if suspect of a stroke patient will have a ___

A

CT

61
Q

____ can mimmic a stroke

A

hypoglycemia

check a blood sugar

62
Q

2 things you should do if you suspect a stroke

A

check blood sugar - hypoglycemia could mimmic stroke

suction equipment

63
Q

4 clinical manifestations in a right sided stroke

A

left sided weakness
overestimate limitations
neglect- forget about lleft side of body
hemiopsia

64
Q

6 clinical manifestations in a left sided stroke

A

right sided weakness

espressive aphasia

recetpitve aphasia

cautious

depressed

agnosia - cannot remember common objects

65
Q

is defined as the sudden onset of a temporary focal neurologic deficit caused by a vascular event

A

TIA

66
Q

the hihger ther number the worse in this stroke scale

A

NIH stroke scale

67
Q

Localized or worst headache, nuchal rigidity, restlessness/irritability, photophobia are all signs of

A

Hemorrhagic stroke

68
Q

with stroke patients the BP is _____

A

elevated

69
Q

adequate BP for stroke patients

A

180/100

70
Q

2 meds used to lower BP with stroke patients

A

nitroglycerin drip

calcium channel blocker

71
Q

3 interventions with stroke patients

A

Hourly neuro assessments

Monitor for vasospasm (for hemorrhagic strokes)

Glycemic management

72
Q

if vasospasm does occur give what med do you give to help control it

A

nicardipine

73
Q

clot busting drug that is given to ischemic stroke

A

rt-PA -ateplase

given too fast can cause hemorrhage

74
Q

rt-PA -ateplase only effective if given within the first - hours

A

3 -4

75
Q

with Hemorrhagic stroke what med do you give

A

Osmotic diuretics (mannitol)

76
Q

When seizures occur in close proximity to each other, they have the potential to lead to a life-threatening medical emergency known as ______

A

status epilepticus

77
Q

is an abnormal electrical discharge in the brain that can be caused by a variety of neurologic disorders, systemic diseases, and metabolic disorders

A

seizure

78
Q

seizures involve both cerebral hemispheres and cause altered consciousness and bilateral motor manifestations

A

Generalized

79
Q

can an airway be affected with a seizure

A

yes

80
Q

seizures usually begin in one cerebral hemisphere and cause motor activity to be localized to one area of the body

A

Partial

81
Q

4 interventions with seizures

A

turn patient on side
suction outside of mouth
nasal canula
protect head

82
Q

med that is given if cyanotic seizure patient to help airways and prepare for intubation

A

Benzodiazepines

medazolam or lorazepam

83
Q

6 precautions for seizure patients

A 
seizure pads 
lower bed 
side rails up 
suction at bedside 
oxygen at bedside 
dont restrain or put anything in mouth
84
Q

sensory warning that seizure is coming

A

aura

85
Q

phase of active seizure

A

ichtal

86
Q

post seizure phase

A

postichtal

87
Q

2 meds to help control or prevent seizures

A

Anticonvulsants

Dilantin -phenytoin
Cerebyx

88
Q

A neurological emergency

Infection of the pia and arachnoid layers and CSF

A

Bacterial Meningitis

89
Q

5 clinical manifestations of Bacterial Meningitis

A 
severe Headache
Fever
Photophobia
Rash
Nuchal Rigidity
90
Q

2 tests with positive signs of Bacterial Meningitis

A

kernigs - pain in leg when extended

brudzinskis -pain with tilt neck

91
Q

2 inerventsions for spinal headache from lumbar puncture

A

keep flat

oral fluids

92
Q

4 interventions for Bacterial Meningitis

A

Antibiotics
Droplet Precautions
Seizure Precautions
Monitor for ↑ ICP

93
Q

5 common causes for Spinal Cord Injury

A 
MVC’s
Falls
GSW
Sport Injuries
Diving Accidents
94
Q

spinal cord injury where

Total loss below the level of Injury

A

Complete Lesion

95
Q

spinal cord injury where

Sparing of some function below the injury

A

Incomplete Lesion

96
Q

below the level of lesion there may not be any reflex or sensation for 4-6 weels

A

Spinal shock

97
Q

vasodilitary shock because the parasymatheic and sympathetic systems are working correcty

A

Neurogenic shock

98
Q

3 symptoms of Neurogenic shock

A

vasodilation
hypotenion
bradycardia

99
Q

diaphragm is still working with spinal injury with ___ or lower

A

c5 or lower

100
Q

syndrome in which there is a sudden onset of excessively high blood pressure

Occurs T6 or above after resolution of spinal shock

A

Autonomic Dysreflexia

101
Q

3 things that can trigger Autonomic Dysreflexia

A

Bladder - straight cath
Bowel - fecal impaction
Skin - clothing too tight

102
Q

4 clinical manifestations of Autonomic Dysreflexia

A

Severe hypertension
headache
bradycardia
flushing of face and neck

103
Q

used to immobilize and protect cervical spine

A

Halo Traction

critical care (6 decks)

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