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N232 > CVA and ICP > Flashcards

CVA and ICP Flashcards

1
Q

Causes of ICP

A
  • Head injury: depends where. It’s the bleeding and swelling that cause the problem
  • Infxn
  • Subarachnoid hermorahage
  • Subdural/epidural hematoma (causes pressure)
  • Tumor
  • Stroke
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2
Q

eary Signs and symptoms of ICP

A
  • Dec. LOC
  • headache, seizures
  • anxiety, irratibility, restless, confusion
  • inc. BP
  • Dec. pulse
  • change in resp.
  • change in temp (hot, fevers)
  • nausea, vomitting
  • slurred speech
  • not able to follow what you’re saying
  • Pupils fixed and dilated d/t dec blood supply to eyes
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3
Q

Assessments for ICP:

A

Glasgow coma scale

  • The lower the number the worse.
  • 15 is best
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4
Q

Why are neurological infxn hard to treat?

A

blood brain barrier

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5
Q

Causes of neuro infxn?

A

-meningitis

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6
Q

signs and symptoms of neuro infxn

A
  • changes in mental status
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7
Q

S & S for meningitis

A
  • severe headache
  • rigid neck
  • difficulty extending legs at knee
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8
Q

Assessment for meningitis

A
  • Monitor ICP
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9
Q

Intracranial hemorrhage causes

A
  • any bleeding in brain
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10
Q

when would you not give TPA

A
  • when someone has a bleed
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11
Q

Hydrocephalous?

A
  • increase fluid
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12
Q

Causes of stroke (CVA)

A
  • blocked (ischemic) or burst (hemorrhagic) blood vessel
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13
Q

what are ppl with Hydrocephalous are at risk for?

A
  • infxn
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14
Q

Who is at risk for CVA (stroke)?

A

non-modifiable: age, male, ethnicity
modifiable: HTN, A-fibb, hyperlipidemia, obesity, smoking, diabetes, periodeontal disease, asymptomatic carotid stenosis, excessive ETOH consumption

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15
Q

cushings triad (ICP)?

A
  • inc BP
  • dec. pulse
  • change in resp
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16
Q

Ischemic stroke

A
  • blood clot or blockage of blood flow to brain tissue
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17
Q

Types of ischemic stroke

A
  • large artery thrombotic
  • small “ “
  • cardiogenic embolic
  • crypt
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18
Q

late Signs and symptoms of ICP

A
  • positive babinkski reflec
  • fixed dilated pupuo;s
  • absent reflexes
  • abnormal posturing (decerebrate, decorticate)
  • flacidity
19
Q

What are the causes of the symptoms in ICP

A
  • decrease cerebral perfusion = further inc. swelling and shifts brain tissue
  • herniation through openings in the dura mater
20
Q

What is coning?

A
  • herniation through openings in the dura mater
21
Q

Causes of hemorrhagic stroke?

A
  • aneurysm
22
Q

AVM?

A

arterial venous malformation - disrupted flow beteen arterial and venous system so as BP inc. as pt gets older, veins and arteries rupture

23
Q

disgnostics for ICP

A
  • CT
  • MRI
  • ICP monitoring
  • PET (positive emission tomogrpahy)
  • EEG (electroencephalography
24
Q

disgnostics for ICP

A
  • CT
  • MRI
  • ICP monitoring
  • PET (positive emission tomogrpahy)
  • EEG (electroencephalography)
  • xray
25
Q

ICP

A
  • insertion of external ventricular crain (EVD)
  • monitor ICP
  • dec ICP
26
Q

medical interventions for ICP

A
  • Craniotomy: blood removed
27
Q

Pharmacology for ICP

A
  • mannitol
  • vasodilator
  • AntiBx
  • opioid analgesis
  • andrenergic blockers
  • corticosteroids
  • hypertonic saline
  • sedation
  • skeletl muscle relfexants
  • anti-parkinsons
  • anti-convulsants
  • calcium channel blocker
  • diuretic
  • stool softeners ( straining)
28
Q

Osmitrol (Manitol) for ICP

A
  • hypertonic solution for hen they have inc. intracranial pressure = pulls fluid off brain
  • blocks reaborption of fluids
    = excrete water pot. chloride, Mg, an PO4
  • monitor for electrolyte balance
  • may have to replace electrolytes
  • only given IV
  • dose: weight based
  • do not give to renal pt, or intracranial bleeding
  • VItals
  • electrolytes imbalances
  • headaches, CHF
  • renal fxn (GFR)

Contraindicated:
- pulmonary edema

29
Q

Nursing diagnoses for ICP

A
  • Ineffective airway clearance R/T diminished protective reflexes (cough/gag)
  • Ineffective breathing patterns R/T neurologic dysfunction (brain stem compression, structural displacement)
  • Ineffective cerebral tissue perfusion R/T the effects of increased ICP
  • Risk of hemodynamic disturbance R/T increased ICP
  • Risk for imbalanced body temperature R/T neurologic dysfuntion
  • Deficient fluid volume R/T fluid restriction
  • Risk for fluid overload R/T increased ICP
  • Risk for electrolyte imbalance R/T increased ICP
  • Risk for infection R/T ICP monitoring system
30
Q

Nursing plan/outcome for pt with ICP

A 
Maintenance of a patent airway
Normalization of respiration
Adequate cerebral tissue perfusion through reduction in ICP
Restoration of fluid balance
Absence of infection
Absence of complication
31
Q

Nursing interventions for ICP

A
  • Monitor for changes in LOC and changes in Neuro vital
    signs, regular Neuro vital signs
  • Monitor for changes in BP, HR, pulse pressure increase,
    Temp, RR, O2 sats
  • Airway patency and lung fields assessed regularly,
    Sx with care – coughing discouraged
  • Monitor breathing patterns
  • Head midline, HOB 30-45 degrees (avoid extreme
    rotation of neck and flexion)
  • Avoid extreme hip flexion
  • Administer stool softeners, high fiber diet
  • Administer Pain medications PRN
  • Provide a calm environment
  • Maintain fluid balance (fluid restriction, diuretic, fluid
    resuscitation)
  • Monitor for electrolyte imbalances
  • renal f
32
Q

Rule for remembering S&S of ICP and Schock

A 
ICP:
cushings triad
Inc BP
Dec pulse
Dec resp

*shock is the opposite

33
Q

Assessments for ICP

A
  • complete head to toe
  • Glasgow coma scale
  • fluid balance = excess fluid output
  • electrolytes
34
Q

TIA

A

Transient ischemic attack - brief neurological dysfxn d/t loss of blood flow (ischemia) to brain, spinal cord or retina without tissue death (infarction).

35
Q

S&S of TIA

A
  • same as stroke..
  • paralysis
  • weakness
  • numbness on one side of body
  • dizzy
  • mumble words
36
Q

motor symptoms of stroke

A
  • hemiplegia - half-sided paralysis
  • hemoparesis - half-sided weakness
  • ataxia - unsteady gait
  • dysphagia - difficulty swallowing
37
Q

communication symptoms of stroke

A
  • dysarthia - weakness/paralysis of muscle used to speak
  • dysphasia - difficulty speaking
  • Aphasia - inability form speech or language
  • Apraxia - difficulty performing tasks
38
Q

communication symptoms of stroke

A

Visual perception dysfxn d/t problem with sensory pathways between eye and visual cortex
Homonymous hemianopsia: can only see either left or right

39
Q

sensory symptoms of stroke

A
  • touch impairment

- difficulty interpreting stimuli

40
Q

cognitive impairment symptoms of stroke

A 
- o	Frontal lobe damage can affect learning capacity, memory, and other higher intellectual functions
o	Limited attention span
o	Comprehension difficulty
o	Forgetfulness
o	Apathy
o	Headache
41
Q

emotional deficits of stroke

A 
o	Loss of self-control
o	Emotional liability
o	Depression
o	Withdrawal
o	Fear, hostility, anger
o	Feelings of isolation
42
Q

Stroke assessment

A 
FAST
face
arm
speech
time - 911
43
Q

diagnostics for stroke

A 
Ct scan: bleeding
CT angiography
Carotid U/S: narrowing of artery
MRI: bleeding
Phenytoin level and albumin
PTT, PT-INR(baseline), Hgb, Na and K, renal fxn test
44
Q

Pharmacological for stroke

A

TPA (Tissue plasmin activator): thromboltic. Cannot give if unsure of when stroke happened
Antihypertensive (ACE inhib, beta blocker, Ca blocker): HTN risk factor for developing stroke
Anticoags (aspirin)
Platelet-inhibiting meds: Plavix, coumadin
Anticonvulsants: if at risk for dev. seizures

N232 (15 decks)

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