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Critical Care Med Surg > Acute Intracranial Problems - Modified SG > Flashcards

Acute Intracranial Problems - Modified SG Flashcards

1
Q

Calculate CPP

A 
CPP = MAP - ICP
CPP = Flow x Resistance
MAP = ((SBP-DBP)1/3) + DBP
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2
Q

Clinical Manifestations of Increased ICP

A

Changes in LOC - most reliable
Cushing’s Triad
Changes in Pupils
Decrease in Motor Functions
Nocturnal Headache or Morning headache that’s worsened with straining, agitation, and movement
Projectile vomiting or Vomiting with no nausea

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3
Q

Cushing’s Triad

A

MEDICAL EMERGENCY
Systolic HTN with widening pulse pressure
Bradycardia with bounding pulses
Irregular respirations

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4
Q

How does Compression of cranial Nerve III look like?

A

Dilated pupils on same side as mass lesion (ipsilateral)
Sluggish or no response to light
Inability to move eye upward and adduct
Ptosis (eye drooping)

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5
Q

Neurologic emergency for eyes

A

Fixed, unilateral, dilated pupil

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6
Q

Clinical Manifestations of CN II (optic), CN IV (trochlear,), CN VI (abducens) damage

A

Blurred vision
Diplopia
Changes in extraocular eye movements

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7
Q

Clinical Manifestations Central Herniation

A

Sluggish but equal pupil response

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8
Q

Clinical Manifestations Uncal Herniation

A

Dilated unilateral pupil

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9
Q

Clinical Manifestations Papilledema

A

Edematous optic disc on retinal examination

Nonspecific signs but always with increased ICP

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10
Q

Decrease in Motor functions

A

Contralateral hemiparesis or hemiplegia
Decorticate posture
Decerebrate posture

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11
Q

Decorticate posture

A

Internal rotation and adduction of the arms with flexion of elbows, wrist and fingers.
Extension, internal rotation and plantar flexion of lower extremities

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12
Q

Decerebrate posture

A

Arms are stiffly extended, adducted and hyperpronated.

Hyperextension of the legs with plantar flexion of the feet.

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13
Q

Important Nursing Assessment of increased ICP (and Head Injury)

A 
Glasgow Coma Scale
Neuro Assessment:
Comparing pupils with one another
Test pupils with light reaction
Assess eye movements
Test motor strength for awake and cooperative pts. 
Assess for motor response with unconscious or unresponsive pts. 
Record v/s
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14
Q

GCS

A 
Lowest score: 3, Highest score: 15
Eyes Open (4 total)
Verbal Response (5 total)
Motor Response (6 total)
If any category is unstable, they get a U
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15
Q

GCS Eyes Open

A 
Eyes Open (4 total)
Spontaneous response- 4
Opening eyes to name or command - 3
Lack of eye opening to previous stimuli but opens to pain - 2
Does not open eyes to any stimulus - 1
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16
Q

GCS Verbal Response

A

Verbal Response (5 total)
AOx 4 and appropriate conversation- 5
Confused, conversant but disoriented in 1 or more spheres - 4
Inappropriate or disorganized word choices or lack of sustained conversation - 3
Incomprehensible words or sounds - 2
Lack of sound with painful stimuli - 1

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17
Q

GCS Motor Response

A

Motor Response (6 total)
Obedience of command - 6
Localization of pain, lack of obedience but presence of attempts to remove offending stimulus - 5
Flexion withdrawal, Arms flexed with pain but not abnormally - 4
Abnormal flexion, making a fist, flexing of arm at elbow and pronation - 3
Abnormal extension, extension of arm at elbow usually with adduction and internal rotation of arm at shoulder - 2
Lack of response - 1

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18
Q

Nursing Management of increased ICP

A 
Maintain ABCs, esp, respiratory function
Sedate pt to deal with pain 
Monitor fluid and electrolyte balance
Monitor ICP
Maintain proper body position
Protect pt from injury with surroundings
Assess psychologic considerations
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19
Q

How do you promote respiratory function?

A

Maintain airway patency
Monitor breathing patterns - Snoring sounds indicate obstruction and need immediate intervention
Intubate PRN,
Suctioning should only be done when necessary because it can increase ICP
Monitor and evaluate ABGs
NG tube to prevent abd distention but not with facial or skull fractures

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20
Q

Opioids

A

Fast response with minimal effect on CBF and O2 metabolism

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21
Q

Propofol (Diprivan)

A

Opioid used to manage anxiety and agitation

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22
Q

Dexmedetomidine (Precedex)

A

Alpha2- adrenergic agonist used for continuous IV sedation of intubated and mechanically ventilated pts in ICU for 24 hours
Hypotension - lowers CPP

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23
Q

Nondepolorizing neuromuscular blocking agents

A

Used for complete ventilatory control in treatment of refractory intracranial HTN.

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24
Q

Benzodiazepine

A

Avoided due to hypotensive effect and long half-life

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25
How do you monitor fluid and electrolyte balance in pts with increased ICP?
Record I&O and daily weights Monitor serum electrolytes Monitor urine output for DI and SIADH DI- increased urine output and hypernatremia SIADH- decreased urine output and dilutional hyponatremia
26
What should the pt with increased ICP should avoid doing?
Coughing, sneezing and Valsalva maneuver.
27
Proper positioning in pts with increased ICP
Head-up position with head in midline position. Elevate HOB to promote drainage from head Turn the pts with slow, gentle movements Avoid extreme hip flexion
28
How do you protect pt with increased ICP from injury?
Quiet, nonstimulating environment with calm, reassuring approach. Use restraints PRN Antisz precautions
29
Types of Head Injuries
Scalp Lacerations Skull fractures Head trauma
30
Scalp Lacerations
External head trauma with profuse bleeding
31
Skull fractures
Linear or depressed Simple, comminuted or compound Closed or opening
32
Rhinorrhea and Otorrhea
CSF Leakage from nose and ear, respectively Both indicate high risk of meningitis Give anti-bx as preventative measure
33
How to test for CSF leak?
Dextrostix and Tes-Tape for present glucose | If blood is present, look for yellowish halo ring in a gauze pad.
34
Diffuse Injury
Damage to the brain not localized in one area.
35
Focal Injury
Damage is localized to specific brain area.
36
Concussion
Sudden, transient mechanical head injury with disruption of neural activity and change in LOC. Benign and solves spontaneously Discharge if no loss of consciousness or if loss of consciousness = <5 min. Notify HCP if behavioral changes or symptoms persist
37
Postconcussion Syndrome
Develops 2 weeks to 2 months after injury. | Affects pt's ADLs
38
Diffuse Axonal Injury (DAI)
widespread axonal damage occurring after mild, moderate or severe TBI. Takes 12-24 hrs to develop and may persist longer Monitor for increased ICP
39
Lacerations
Tearing of the brain tissue | Antibiotics and preventing secondary injury = main goal of treatment
40
Contusion
Bruising of brain tissue within a focal area. Associated with close head injury and occurs at fracture site. Coup-contrecoup injury CT scan shows bleeding or "blossom"
41
Traumatic Brain Injury (TBI)
Severe form of head trauma
42
Complications of Head Trauma
Epidural hematoma Subdural Hematoma Intracerebral Hematoma
43
Epidural Hematoma
NEUROLOGIC EMERGENCY Bleeding between dura and inner surface of the skull. Classic Signs: Initial period of unconsciousness at scene, lucid interval followed by decreased LOC.
44
Subdural Hematoma
Bleeding from between the dura mater and arachnoid layer of the meninges Manifests within 24 to 48 hours Signs and Symptoms: Decreased LOC and Headache
45
Subacute Subdural Hematoma
Occurs within 2-14 days of the injury.
46
Chronic Subdural Hematoma
Develops over weeks or months after seemingly minor head injury.
47
Intracerebral Hematoma
Occurs from bleeding within the brain tissue.
48
Diagnostic Studies and Interprofessional Care
CT scan - best diagnostic test to evaluate for head trauma MRI scan - detects small lesion Transcranial Doppler Studies - measures cerebral blood flow (CBF) velocity. Cervical Spine X-ray
49
Craniotomy
Elevate the depressed bone and remove the free fragments. | Visualizes and allow control of bleeding vessel
50
Craniectomy
Removal of bone
51
Burr-hole openings
Used in extreme emergency for rapid decompression after craniotomy. Drain will be placed to prevent blood accumulation.
52
Major Causes of TBI or head injuries
Falls | Motor Vehicular Crashes
53
Emergency Management of Head Trauma
Assess and Maintain ABCs Assume neck injury and stabilize cervical spine Apply O2 Establish IV access Intubate if GCS <8 or no gag reflex Control external bleeding with sterile pressure dressing Remove pt's clothes Maintain normothermia using blankets, warm IV fluids Monitor v/s, LOC, pupil size and reactivity, GCS score Assess for rhinorrhea, otorrhea and scalp wounds Give fluids cautiously to prevent fluid overload and increase ICP
54
Nursing Management of Head Trauma
Monitor for changes in neurologic status - LOC, GCS, Behavior, Pupil reaction, etc. Loss of corneal reflex needs eye drops or taping eyes shut Avoid fever with goal temperature 96.8-98.6F Inform HCP of rhinorrhea and otorrhea - no sneezing or blowing nose, no NG tubes and no nasotracheal suctioning Burrhole or Craniectomy for severe cases or pt deteriorates. Seizures may occur and need to be treated with anti-seizure medication. Mental and Emotional consequences - not realized they have brain injury, loss of memory, mood swings, lack of awareness, etc. Provide appropriate guidance and referrals. Follow No policies
55
No Policies
``` No drinking alcoholic beverages No driving No use of firearms No working with hazardous machinery No unsupervised smoking ```
56
Meningitis
Inflammation of the meningeal tissues surrounding brain and spinal cord Can be Bacterial or Viral
57
Bacterial Meningitis
MEDICAL EMERGENCY Streptococcus pneumoniae and Neisseria meningitidis = leading cause Enters through respiratory tract or bloodstream and can spread to other areas of the brain.
58
Bacterial Meningitis Clinical Manifestations
``` High Fever Severe Headache N/V Nuchal rigidity Possible skin rash - Petechiae ```
59
Bacterial Meningitis Complications
Increased ICP Residual Neurologic Dysfunction Hydrocephalus Waterhouse-Friderichsen syndrome
60
Waterhouse-Friderichsen syndrome
Petechiae DIC Adrenal hemorrhage Circulatory collapse
61
Nursing Assessment of Bacterial Meningitis
``` v/s - High Fever Neurologic assessment - Severe headache Fluid I&O Evaluation of lungs and skin Vaccine History - Meningococcal Vaccines ```
62
Nursing Care of Bacterial Meningitis
``` Respiratory Isolation Give Antibiotics Give antipyretics GIve pain medication PRN Slightly elevated HOB Darkened Room with cool cloth over eyes Provide fluids adequately High protein, High calorie in small frequent feedings Promote ROM and warm baths ```
63
Meningitis Diagnostic Assessment
History and Physical Examination Analysis of CSF - protein, WBC and glucose, culture CBC, Coagulation profile, electrolyte levels, platelet count, CT scan. MRI, PET scan, Skull x-ray studies
64
Viral Meningitis Clinical Manifestation
Moderate to High Fever Headache Photophobia Stiff Neck
65
Viral Meningitis Diagnostic Test
Xpert EV test to test for enterovirus | Polymerase chain reaction (PCR)
66
Encephalitis
Acute inflammation of the brain Caused by different viruses Spread by ticks and mosquitoes
67
Encephalitis Clinical Manifestation
Nonspecific that appears within 2-3 days Fever Headache N/v
68
Encephalitis Diagnosis
Brain images - CT, MRI, and PET PCR - HSV and West Nile encephalitis Blood tests that detect viral RNA - West Nile virus
69
Nursing Care for Encephalitis
Mosquito Control Symptomatic and supportive treatment Acyclovir (Zovirax) - treatment for HSV infection.

Critical Care Med Surg (17 decks)

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