week 1: neuro/ TBI Flashcards
what are prodromes
aura; experiences that are precursor of a symptom; early symptom
what are the diet triggers of migraines
chocolate, aged cheese and meat, wine and beer, and citrus fruits
other triggers: lack of sleep, noise, light
what class of medications do not work for migraines
opiates
what are preventative medications for migraines
beta blockers**, CCB, antidepressants, anticonvulsants
drug of choice due to rapid onset of action and long duration of action
lorazepam (Ativan)
what is the main class of medication used for treatment of status epilepticus
benzodiazepine (-azepam)*
The earlier the seizure terminates the…
better!
why: benzodiazepines will be fast acting
what are anti-epileptic drugs
Keppra (levetiracetam), Dilantin (phenytoin), Valium (diazepam) for status epilepticus*
tegretol neurotin (partial seizure), lamictal
what do we do to avoid toxicity and under-dosing for anti-epileptics?
monitor therapeutic lab levels for medication
tertiary prevention for seizures
patent airway
- turn head to side, loosen collar
protect from injury
- remove objects, lower to floor, block from from furniture, nothing in mouth, watch for bony prominences
ensure adequate oxygenation
- O2, suctioning
remain calm and reassuring, stay with patient
seizure precautions
6 with stars
- suction - always make sure set is working in pt room
- side rails up and padded
- loosen restrictive clothing
- time the seizure
- do no force anything in mouth
- do not hold pt down or restrain
stay w pt, O2, IV access, bed low, turn pt to side, neuro check
what is secondary injury
related to pathophysiology of TBI
delayed injury from hypoxia, ischemia, and release of neurtoxins
cause cerebral swelling and neuronal death, increased ICP cause hypoxia
When do we not use CT on head with TBI?
- age: greater than 55 or less than 2
- witnessed LOC
- coagulopathy: blood is thinned by meds or disease
GCS<15, intoxicated, amnesia, vomit, basilar skull frac, penetrating HI
first sign for high ICP
change in LOC
what medication should a patient post-concussion not use
- ibuprofen
- naproxen
- ASA
ICP management
4 with stars
- HOB 30
- drugs for sedation (propofol, ketamine, precedex)
- maintain normothehrmia (fever increase ICP, acetaminophen PR)
- seizure control
monitor ICP, drain CSF from ventricle or lumbar drain, pace activities
signs of epidural hematoma
brief unconciousness, lucid interval awake, alert, then rapid decline of LOC
main nursing intervention with TBI
seizure prophylaxis
what are the three volumes inside the skull
brain, blood, CSF
if volume of any fluid increase, pressure will …, unless…..
if volume of any fluid increase, pressure will increase, unless volume of otehrs go down
what is the normal ICP
5-15 HHmg
most common caused of elevated ICP
*** TBI **
* cerebral edema
* mass, lesion, tumor
* hydrocepalus
* brain inflammation
* CVA
* ventricular shunt malfunctions
progressive symptoms of high ICP
beware of vomiting (projectile!) *
* motor deficit
* pupil changes, abnormal PERRLA
* headache
what are three main evidence based medical guidelines for TBI nursing management
- neuro exam
- antiseizure PPX
- analgesic/ sedatives
avoid too frequent of suctioning as it will …
increase ICP
only prn and still not often
drugs to control ICP
movement will increase ICP
pentobarbital/ propofol/ versed for burst suppression
what is somthing to consider during evaluation
TBI and depression
not starred
tension type headache
- most common type of HA
- patho myofacial (tension by the jaw)
characteristics
* bilateral, pressing, bandlike pressure
* can occur intermittently over wks, mos, yrs
* no prodrone, no n/v
* common at the end of the day
treatment
* nonopioid analgesics
* sedatives, muscle relaxants
not starred
cluster headaches
- rare and severe
- primary neurovascular pathophhysiology
- seasonal, same time of day
- ~1hr severe stabbing, sharp unilateral pain around the eye, temple, forehead, cheeks, nose, gums
treatment
* 100%O2 for 15-20
* sumatriptan
* B-blocker for prophylactic
not starred
migraines
- patho: vasoconstrict -> dilate
not starred
what are some auras of migraines
- scotoma
- fortification
- sxintilla
- unilateral paresthesia
- hallucination
- hemianopsia
