Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Role and scope > Exam 3 Neuro: Care of Critically Ill Patients with Neurologic Problems (15 questions) > Flashcards

Exam 3 Neuro: Care of Critically Ill Patients with Neurologic Problems (15 questions) Flashcards

1
Q

Transient Ischemic Attack (TIA)

A
  • “Warning sign”
  • Transient focal neurologic dysfunction
    TIA: minutes to < 24 hours
  • Brief interruption in cerebral blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Stroke types

A
  • Thrombotic
    Gradual onset
    Ischemic
  • Embolic
    Sudden onset
    Ischemic
  • Hemorrhagic
    Sudden onset
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Stroke (brain attack)

A
  • Change in normal blood supply to brain
    Supplies glucose and oxygen
    Removal of metabolic waste
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Stroke risk factors

A
  • Smoking
  • Substance abuse
  • Obesity
  • Sedentary lifestyle
  • Oral contraceptive use
  • Heavy alcohol use
  • Use of phenylpropanolamine (PPA)
    No longer produced in US
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Stroke Symptoms/assessment

A 
- NIH Stroke Scale
Score 0-40
- Cognitive changes 
- Visual changes
- Facial palsy
- Motor changes
- Sensory changes
- Cranial nerve assessment
- CV assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Right Hemisphere stroke symptoms

A
  • Disorientation
  • Loss of depth perception
  • Unilateral body neglect syndrome
  • Denial of illness
  • impulsiveness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Left Hemisphere stroke symptoms

A
  • Aphasia, alexia, dyslexia
  • Acalculia
  • Right visual field deficit
  • Anxiety, anger, frustration
  • Intellectual impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Stroke protocol (general)

A
  • Goal of ED door to treatment:
    < 60 minutes
  • Neuro exam q 15 min for first 2 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Thrombolytic protocol

A
  • IV (systemic) thrombolytic therapy
  • Recombinant tissue plasminogen activator (rtPA) or Retavase
- Eligibility criteria
Last seen normal (LSN) less than 3 hours
Can extend to 4.5 hours
Age < 80 years
No anticoagulant use, INR < or = 1.7
NIH scale < or = 25
NO history of both stroke AND diabetes
Priority of care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Stroke medication

A
  • Thrombolytics
  • Anticoagulants
    ASA, clopidogrel
  • Lorazepam, other antiepileptics
  • Calcium channel blockers
  • Stool softeners
  • Analgesics (for pain)
  • Antianxiety drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Stroke nursing interventions

A 
- Neuro assessments
Post thrombolytic
NIH guidelines
- Monitor ICP
- Safety (unilateral neglect)
- Emotional support
- Education
- Bed at least 30 degrees
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Brain tumor nonsurgical management

A
  • Radiation therapy
  • Chemotherapy
    Orally, IV, intra-arterially or intrathecally
    Direct drug delivery post-surgically
  • Stereotactic radiosurgery
    Gamma knife, CyperKnife
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Brain tumor craniotomy

A
  • Surgical removal of a section of bone (bone flap) from the skull for the purpose of operating on the underlying tissues, usually the brain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Brain tumor medication

A
  • Analgesics
  • Dexamethasone
  • Phenytoin
  • Pantoprazole (protonix)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Craniotomy post-op care

A
  • Fluid balance: Observe for DI/SIADH
  • Incision
    Assess site
    Observe presence or absence of bone flap
    Observe for CSF leak
  • Monitor ICP/Decrease ICP
    Ventriculostomy
  • Avoid activities that increase ICP
    Stool softeners to avoid valsalva
    Antiemetics for N/V
    Antipyretics/cooling blanket for fever
  • DVT prophylaxis
  • Stress ulcers: Cushing Stress Ulcer
  • Pneumonia:
    High risk aspiration altered LOC
  • Proper positioning:
    Avoid body position that increase ICP
  • Eye care
    Washed, gloved hands
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Transsphenoidal hypophysectomy (TPH) nursing interventions

A
  • HOB increase to 35-40°
  • Hourly UOP
  • Monitor electrolytes
  • Avoid any straining
    Antiemetics
    Do NOT blow your nose
  • Monitor for visual disturbances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Transsphenoidal hypophysectomy (TPH) complications

A
  • Air embolism
  • CSF leak
    meningitis
  • Diabetes Insipidus
  • Visual disturbances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Subarachnoid Hemorrhage (SAH) from cerebral aneurysm

A
  • Bleeding in the space between the brain and the tissue covering the brain.
  • Damage to microvessels in the subarachnoid space
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

SAH pre-op nursing care

A 
- BP control (want it low), keep low
To prevent rebleeding
- Bedrest
- Dark, quiet environment
- Stool softeners, no straining
- No restraints, keep calm
- HOB ↑ 35- 45° degrees at all times
- DVT precautions
- Educate family to keep calm environment
20
Q

SAH Post-operative management

A
  • Complications can lead to death
    Cerebral vasospasm
Treatment:
- HHH after clipping
- Hypertensive
 Increase BP and CO with vasoactive drugs  
- Hypervolemic
Volume expanders
- Hemodilution
Fluid
21
Q

SAH Complications

A 
- Hyponatremia
Isotonic fluids (N.S.)
  • Rebleeding
    Sudden onset HA, N&V,
    Increased BP
    Respiratory changes
  • Hydrocephalus
    Ventriculostomy – temporary measure
    Shunt – permanent measure
  • Seizures
    Prophylactic anticonvulsant medication
22
Q

ICP normal value

A

Normal level: 5 – 15 mm Hg

23
Q

Increased ICP

A
  • Typically treat ICP > 20 mm Hg that is sustained for 5 minutes
  • An ICP level of 10-20, means the brain is borderline – it’s compensating
24
Q

CPP – cerebral perfusion pressure calculation

A
  • CPP = MAP – ICP
  • Normal/Target 70 – 95 mmHg
  • CPP < 60 = hypoperfusion of brain
  • CPP < 40 = brain ischemia
25
Q

ICP monitors

A
  • Ventriculostomy

- Camino Monitors: Fiberoptic technology

26
Q

Care for Ventriculostomy

A
  • Open Vs Closed
  • Open: stopcock at zero point is open to drainage. When pressure in brain exceeds level of drip chamber, CSF will drain out.
  • Closed: Monitoring only – no drainage
27
Q

ICP wave forms significance

A

Can be indicator of neuro change before numbers change

28
Q

ICP nursing interventions

A
  • Monitor serum electrolytes
  • Monitor serum Dilantin/Phenobarbitol levels
  • CVP monitoring: Avoid volume depletion
  • Diuretics
  • Keep systolic BP 140 –160
  • Hyperventilation
  • Antiseizure meds: Phenytoin, Phenobarbitol
  • Antipyretics/cooling blanket
  • Pt positioning: Maintain HOB 30-45 degrees
  • Head in neutral plane
  • Avoid activities that increase ICP
29
Q

Increased ICP: Herniation

A
  • Shifting of tissue from one compartment in the brain to another
    Uncal herniation most common (Supratentorial herniation)
    Lateral displacement uncus over edge tentorium
  • Leads to coma, loss of reflexes, posturing, loss brain stem function, and death.
30
Q

Care for Camino Monitors: Fiberoptic technology

A
  • No transducer or anything to level
  • Heavy cable – secure to patient
  • ICP and CPP at least hourly
  • Record waveform every 8 hours
31
Q

Mild traumatic brain injury

A
  • Grade 1
  • Altered or LOC <30 min with normal CT &/or MRI
  • GCS 13-15
  • PTA < 24 hrs
32
Q

Moderate traumatic brain injury

A
  • Grade 2
  • LOC < 6 hrs
    with abnormal CT &/or MRI
  • GCS 9-12
  • PTA < 7 days
33
Q

Severe traumatic brain injury

A
  • Grade 3
  • LOC > 6 hrs with abnormal CT &/or MRI
  • GCS <9
  • PTA > 7 days
34
Q

Skull fracture signs

A
  • Raccoon eyes (Frontal or orbital fracture)

- Battle sign (Basilar Skull Fracture)

35
Q

Epidural hematoma pathophysiology

A
  • Associated with skull fracture
  • Damage to dura, veins and arteries
  • 80% caused by: Arterial bleeding
    Middle meningeal artery
    Small percentage: venous bleeding
36
Q

Epidural hematoma symptoms

A
  • *Immediate LOC, followed by lucidity, then rapid deterioration
  • *Dilated, fixed pupil on the same side of injury
37
Q

Subdural Hematoma pathophysiology

A
  • Small bridging veins torn between the dura and the skull, bleeding into the subdural space
38
Q

Subdural Hematoma symptoms

A
  • Venous
  • *Neuro altered from time impact (drowsy, confused)
  • Progressive deterioration
    Acute: first 48 hours
    Subacute: 2 days to 2 weeks
    Chronic: 2 weeks to several months
39
Q

Diffuse axonal injury (DAI) pathophysiology

A

-extensive lesions in white matter tracts occur over a widespread area

40
Q

-Mild DAI:

A

coma 6-24hrs, follows commands by 24hrs

41
Q

Moderate DAI:

A

coma lasting > 24hrs, no brainstem signs

42
Q

Severe DAI:

A

coma prolonged & associated w/ prominent brainstem signs

43
Q

Concussion

A
  • A sudden transient mechanical head injury with disruption of neural activity
  • Considered benign and resolves spontaneously
  • May or may not lose consciousness
44
Q

Post Concussive Syndrome

A
  • Symptoms 2 weeks to 2 months after concussion CM:
  • N & V, drowsiness
  • Persistent HA
  • Lethargy
  • Personality and behavior changes
  • Shortened attention span
  • Decreased short term memory
  • Changes in intellectual ability
45
Q

Epidural/Subdural Bleed: Management Goals

A
  • Surgical intervention
    Craniotomy
    Decompression: Evacuate clot, control bleeding
- Decrease ICP 
CSF drain (post op edema expected to peak 48-72 hours after surgery)
  • CPP 70 or above
  • Euthermia
  • Analgesics & Sedatives
  • Sodium level 145 or greater
  • HCT level (The more it is diluted the better it flows)
  • PaCO2 level

Role and scope (58 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions