unit 6 Flashcards by britt rank

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

Changes in pressure

Changes in CO2

Autoregulation

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with Increased Intracranial Pressure

what 3 things should you avoid

Avoid clustering of activities

Avoid valsalva situations

external stimuli

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

systolic BP: increased
diastolyc BP: decreased

bradycardia

respiration: decreased or irregular

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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.

Diffuse Axonal Injury

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Brain metabolism

Cerebral glucose < ___ mg/dL = confusion

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with Intracranial Pressure Monitoring

Goal: PaO2 > ____mm Hg

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skull fracture aginst the base of the brain

basilar skull fracture

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

dilate

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never insert _____ with a skull fracture

NG tube

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what 3 things can cause a dangerous increase in ICP

Increased Blood Volume

Loss of Autoregulation
Decreased Oxygenation
Hypercapnia
Obstruction

Increased Brain Volume
-Cerebral Edema

Increased Cerebrospinal Fluid
-Hydrocephalus

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

Herniation

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3 Components of ICP

brain tissue, blood, CSF fluid

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

Mannitol

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to avoid hypertension with Increased Intracranial Pressure

it is comon to give

Nicardipine

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

brain stem

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

LOC

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2 emergency measures when a patient has Cushing’s Triad

HOB 90 degrees

hyperventilate

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Normal ICP range

0-15 mm Hg

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Brain metabolism

Cerebral glucose < ___ mg/dL = damage

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2 things to determine brain death

crainal nerve test

apnea testing

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posture where The client internally flexes his wrists

decorticate

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indications for Intracranial Pressure Monitoring

severe brain injury

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signs of increased ICP

CO2:
WBC:
Coagulation profile:

CO2: increased
WBC: increased
Coagulation profile: increased

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

Contusion

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If CPP is inadequate, _______ or ______ can occur

ischemia or infarction

with Increased Intracranial Pressure for Sedation you might give what 2 things

Benzodiazepines | Analgesia

with Increased Intracranial Pressure you might give what 2 things for Seizure prophylaxis

Phenytoin | Levetiracetam

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

constrict

Increased Intracranial Pressure Goal: MAP ___ mm Hg CPP: at least ____ mm Hg

70-90 70

Increased Intracranial Pressure Goal: serum osmolality less than ___ mOsm/L.

320

how to calculate Cerebral Perfusion Pressure (CPP)

MAP - ICP = CPP

with Increased Intracranial Pressure what 3 things should you remember with suctioning

Only when necessary Preoxygenate Limit suction to 10 seconds

5 Later manifestations of increased ICP

Deteriorating LOC (unresponsive) Cushing’s Triad Cheyne-Stokes respiration Dilated pupils Abnormal posturing

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

Intracerebral Hematoma

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

epidural hematoma.

you want the CPP to be __ or greater

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

Monro-Kellie doctrine

2 secondary injury after primary brain injury

added leeding after initial injury | swelling

3 Earlier manifestations of increased ICP

Change in LOC Headache (unrelieved) Vomiting without nausea

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.

Concussion

3 things assessed in the glasgow coma scale the ___ the number the better off the patient

eyes motor response verbal response higher the number

crainal nerve 5 & 6 together test

cornial reflex

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

9 and 10 for gag reflex

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

epidural hematoma.

posture where The client rigidly extends his arms

decerebrate

with Increased Intracranial Pressure wht 3 positions should you initiate

HOB elevation 30 degrees Neutral head position Turn side to side -Watch for return to baseline CPP

with Increased Intracranial Pressure to Avoid hypotension it is common to give

Vasopressors

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

how can you tell mannitol is effective

increased LOC

Collection of blood in the subdural space causes a ________ occurs when a surface vein is torn around the cerebral cortex

subdural hematoma

Intracranial Pressure Monitoring is measured at ____

level of the 3rd ventricle

7 potential complications from neuro surgery

``` Infection Cerebral hemorrhage Increased ICP Diabetes Insipidus Seizures SIADH hydrocephalus ```

2 signs of basilar skull fracture

ecchymosis around both eyes | ecchymosis underneath the ear

2 main meds for Increased Intracranial Pressure

Mannitol | Dexamethasone (meningitis)

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.

Large Artery Atherosclerosis Ischemic Stroke

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

cardioembolic strok Ischemic Stroke

The most common causes of cardioembolic stroke are what 4 things

atrial fibrillation rheumatic heart disease acute myocardial infarction endocarditis

Hallmark is the sudden onset of focal neurological symptoms Deficit that lasts 24 hours or more

stroke

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

Hemorrhagic

if suspect of a stroke patient will have a ___

____ can mimmic a stroke

hypoglycemia | check a blood sugar

2 things you should do if you suspect a stroke

check blood sugar - hypoglycemia could mimmic stroke suction equipment

4 clinical manifestations in a right sided stroke

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

6 clinical manifestations in a left sided stroke

right sided weakness espressive aphasia recetpitve aphasia cautious depressed agnosia - cannot remember common objects

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

TIA

the hihger ther number the worse in this stroke scale

NIH stroke scale

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

Hemorrhagic stroke

with stroke patients the BP is _____

elevated

adequate BP for stroke patients

180/100

2 meds used to lower BP with stroke patients

nitroglycerin drip | calcium channel blocker

3 interventions with stroke patients

Hourly neuro assessments Monitor for vasospasm (for hemorrhagic strokes) Glycemic management

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

nicardipine

clot busting drug that is given to ischemic stroke

rt-PA -ateplase given too fast can cause hemorrhage

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

3 -4

with Hemorrhagic stroke what med do you give

Osmotic diuretics (mannitol)

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

status epilepticus

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

seizure

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

Generalized

can an airway be affected with a seizure

yes

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

Partial

4 interventions with seizures

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

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

Benzodiazepines | medazolam or lorazepam

6 precautions for seizure patients

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

sensory warning that seizure is coming

aura

phase of active seizure

ichtal

post seizure phase

postichtal

2 meds to help control or prevent seizures

Anticonvulsants Dilantin -phenytoin Cerebyx

A neurological emergency Infection of the pia and arachnoid layers and CSF

Bacterial Meningitis

5 clinical manifestations of Bacterial Meningitis

``` severe Headache Fever Photophobia Rash Nuchal Rigidity ```

2 tests with positive signs of Bacterial Meningitis

kernigs - pain in leg when extended brudzinskis -pain with tilt neck

2 inerventsions for spinal headache from lumbar puncture

keep flat | oral fluids

4 interventions for Bacterial Meningitis

Antibiotics Droplet Precautions Seizure Precautions Monitor for ↑ ICP

5 common causes for Spinal Cord Injury

``` MVC’s Falls GSW Sport Injuries Diving Accidents ```

spinal cord injury where | Total loss below the level of Injury

Complete Lesion

spinal cord injury where | Sparing of some function below the injury

Incomplete Lesion

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

Spinal shock

vasodilitary shock because the parasymatheic and sympathetic systems are working correcty

Neurogenic shock

3 symptoms of Neurogenic shock

vasodilation hypotenion bradycardia

diaphragm is still working with spinal injury with ___ or lower

c5 or lower

syndrome in which there is a sudden onset of excessively high blood pressure Occurs T6 or above after resolution of spinal shock

Autonomic Dysreflexia

3 things that can trigger Autonomic Dysreflexia

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

4 clinical manifestations of Autonomic Dysreflexia

Severe hypertension headache bradycardia flushing of face and neck

used to immobilize and protect cervical spine

Halo Traction