Critically Ill Patients with Neuro Problems (12) Flashcards
(69 cards)
1
Q
Brief interruption in cerebral blood flow
A
TIA and RIND
2
Q
treatment for TIA and RIND
A
neuro assessment
CT scan, lab
possible admission
drug therapy = clopidogrel
3
Q
what is a stroke (brain attack)
A
change in normal blood supply to brain
4
Q
causative agents of stroke
A
hypertension arteriovenous malformation (born with it)
5
Q
types of stroke
A
ischemic (thrombolic and embolic)
hemorrhagic
6
Q
Types of stroke and onset
A
thrombotic = gradual onset embolic = sudden onset hemorrhagic = sudden onset
7
Q
what does arteriovenous malformation look like
A
dilated, entangled blood vessels
8
Q
risk factors for stroke
A
smoking alcohol abuse obesity sedentary lifestyle oral contraceptive use heavy alcohol use use of PPA (no longer produced in US)
9
Q
early intervention for stroke
A
Face Arm weakness Speech difficulty Time to call 911 Chew 325 mg of aspirin stat!
10
Q
rtPA eligibility criteria
A
last seen normal less than 3 hours
can extend to 4.5 hours
age
11
Q
goal of ED door to tx timeframe for stroke
and neuro asessment timeline
A
12
Q
Damage to right hemisphere (LUDDI)
A
Loss of depth perception Unilateral body neglect syndrome Disorientation Denial of Illness Impulsiveness
13
Q
Damage to left hemisphere (AAARI)
A
Anger, anxiety, frustration Aphasia, alexia, dyslexia Acalculia Right visual field Intellectual impairment
14
Q
when can intra-arterial thrombolysis be done
A
within 6 h of LSN
15
Q
drug therapy for CVA
A
thrombolytics anticoagulants (ASA, plavix) lorazepam CCB stool softeners analgesics for pain antianxiety meds
16
Q
primary brain tumors originate in ______ and secondary to _________ in other parts of body
A
CNS
mestastasis
17
Q
med used to decrease fluid in brain
med used to control ICP*
A
mannitol
dexmethasone
18
Q
why is protonix needed?
A
steroids can cause stomach ulcers
19
Q
3 things that increases ICP
A
fever
pushing when pooping
N/V
20
Q
post op care for craniotomy
A
fluid balance assess site monitor ICP NO FEVER DVT helmet for immobolization high risk aspiration due to altered LOC
21
Q
removal of pituatary tumor through nasal approach
A
transphenoidal hypophysectomy (TPH)
22
Q
complications of TPH
A
air embolism
CSF leak
visual disturbances
diabetes inspidus = water imbalance in body
23
Q
CSF leak can lead to
A
meningitis
24
Q
post op care
A
do not blow nose! HOB elevated hourly UOP monitor electrolytes monitor for visual disturbances
25
Berry aneurysm occurs where
anterior communicating artery of the brain
26
Fusiform aneurysm occurs where
any blood vessel supplying the brain
27
1st sign of ICP and what happens to eye and pulses
decreased LOC
papilledema = "filling up" of the optic cup and dilation of the retinal veins
widened pulse pressure
28
Cushings triad
systolic hypertension
bradycardia
abnormal respirations
29
normal ICP level
borderline = compensating
moderately high
5 to 15 mmHg
10-20 mmHg
20-40 mmHg
30
start treatment when ICP > ____ that is sustained over ____
20 mmHg
| 5 minutes
31
Factors of CPP
```
acidosis = dilation, increased CBF
alkalosis = constriction, decreased CBF
```
32
CPP calculation
CPP=MAP-ICP
33
Normal CPP
hypoperfusion level
brain ischemia level
70-95
34
target MAP and what may it induce
90
| hypertension to increase ICP
35
what two interventions for decreased CPP
hyperventilation (only when herniating) and oxygenation
36
when to intubate?
GCS
37
hypoxia and hypotension = ____% mortality
| intervention?
75
| uses 100% FiO2, early resus
38
when do you not give mannitol
serum osmo
39
what is herniation
| where does it occur most often
shifting of tissue from one compartment to another
| cerebrum (supratentorial)
40
which type of herniation is considered a late sign and emergent
tonsillar
| tonsils of cerebrum shift through the foreman magnum and into the spinal canal
41
open vesticuostomy
certain level reached, chamber drains
42
closed vesticuostomy
monitoring only, no drainage
43
where is the zero reference point
foramen of monroe (at ear level)
44
Name ICP waveforms (EVD closed system)
"giving middle finger" = bad
P1 = percussion
P2 = tidal
P3 = dicrotic
45
Cerebral aneurysm SAH symptoms
sudden onset ha
brief LOC
N/V
kernigs sign, brudzinskis sign, photophobia
46
Why is SAH considered an emergency and what must be done
direct effect of hemorrhaging and a craniotomy must be done within 48 hours
47
SAH preop
```
keep calm
dark environment
KEEP BP LOW
bed rest
no straining
DVT precautions
```
48
SAH post op and what can lead to death
```
Triple H
Hemodilution = fluid
Hypertension= increase BP and CO
Hypervolemic= volume expanders
vasospasms can lead to death
```
49
use isotonic fluids to prevent
hyponatremia
50
what other two complications of SAH and interventions
rebleeding - assess for sudden onset ha, increased BP, and resp change
hydrocephalus - ventriculostomy = temporary or shunt = permanant
51
traumatic brain injury is similar to
spinal cord injury
52
primary injury occurs
contact
acceleration - deceleration
rotational
53
secondary injury occurs
cerebral ischemia
54
know this!
| degrees of TBI
mild (grade 1) mod (grade 2) severe(grade 3)
LOC 6h
CT/MRI normal CT/MRI abnormal CT/MRI abnormal
GCS 13-15 GCS 9-13 GCS7d
55
sudden transient mechanical injury with disruption of neural cavity with AMNESIA REGARDING EVENT
concussion
56
post concussive syndrome timeline
2 w to several months
57
progressive brain disease caused by REPEATiTIVE HEAD TRAUMA occurring mostly in sports
CTE or chronic traumatic encephalopathy
58
what is CTE patho
Tau proteins become toxic and start dying
59
what diseases are liked to CTE
parkinsons
dementia
ALS
60
Skull fractures
| FAR and BMB
frontal or orbital fracture - anterior fossa - racoon eyes
| basal fracture - middle fossa- battle sign (behind ear)
61
major complications
CSF leak
rhinorrhea (mucus in nasal cavity)
otorrhea (drainage from ears)
62
what hematoma is associated with skull fractures
epidural hematoma
63
damage occurs where
dura, veins, and arteries
64
symptoms of epidural hematoma
IMMEDIATE LOC, then alert, than rapid decline
| dilated, fixed pupil on same side of injury
65
surgical intervention and when
craniotomy at 72 h (when ICP greatest)
66
what hematoma occurs with MVA, falls, trauma
subdural hematoma
67
timeline for subdural hematoma
```
acute = first 48 h
subacute = 2d to 2w
chronic = 2w to several months
```
68
damage to white matter of brain causing coma
DAI or diffuse axonal injury
69
timeline for severity
```
mild = coma 6-24h, follow commands after 24h
moderate = coma >24h, no brainstem signs
severe = coma prolonged, prominent brainstem signs
```
