unit 6 Flashcards
adjust the diameter of the blood vessels so the brain is protected
Changes in pressure
Changes in CO2
Autoregulation
with Increased Intracranial Pressure
what 3 things should you avoid
Avoid clustering of activities
Avoid valsalva situations
external stimuli
Cushing’s Triad (warning of herniation) includes what things
systolic BP: increased
diastolyc BP: decreased
bradycardia
respiration: decreased or irregular
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
Brain metabolism
Cerebral glucose < ___ mg/dL = confusion
70
with Intracranial Pressure Monitoring
Goal: PaO2 > ____mm Hg
80
skull fracture aginst the base of the brain
basilar skull fracture
when the CO2 goes up and the blood pressure goes down the blood vessels ______
dilate
never insert _____ with a skull fracture
NG tube
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
very high pressure within the skull that occurs when a part of the brain is squeezed across structures within the skull
Herniation
3 Components of ICP
brain tissue, blood, CSF fluid
increases serum osmoality and water in brain cells goes into intravasular system
Mannitol
to avoid hypertension with Increased Intracranial Pressure
it is comon to give
Nicardipine
when decorticate and decerebrate posturing are present that usually means ______ involvement
brain stem
____ is the most reliable factor to tell us about our patients neuro status
LOC
2 emergency measures when a patient has Cushing’s Triad
HOB 90 degrees
hyperventilate
Normal ICP range
0-15 mm Hg
Brain metabolism
Cerebral glucose < ___ mg/dL = damage
20
2 things to determine brain death
crainal nerve test
apnea testing
posture where The client internally flexes his wrists
decorticate
indications for Intracranial Pressure Monitoring
severe brain injury
signs of increased ICP
CO2:
WBC:
Coagulation profile:
CO2: increased
WBC: increased
Coagulation profile: increased
is the result of coup and contrecoup injuries accompanied by bruising and bleeding into brain tissue.
Contusion
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
70
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
8
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 ___
CT
____ 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