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Adult Health I final > 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

(45 cards)

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1
Q

Transient Ischemic Attack (TIA)

A
  • “Warning sign”
  • Transient focal neurologic dysfunction
    TIA: minutes to < 24 hours
  • Brief interruption in cerebral blood flow
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2
Q

Stroke types

A
  • Thrombotic
    Gradual onset
    Ischemic
  • Embolic
    Sudden onset
    Ischemic
  • Hemorrhagic
    Sudden onset
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3
Q

Stroke (brain attack)

A
  • Change in normal blood supply to brain
    Supplies glucose and oxygen
    Removal of metabolic waste
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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
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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
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6
Q

Right Hemisphere stroke symptoms

A
  • Disorientation
  • Loss of depth perception
  • Unilateral body neglect syndrome
  • Denial of illness
  • impulsiveness
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7
Q

Left Hemisphere stroke symptoms

A
  • Aphasia, alexia, dyslexia
  • Acalculia
  • Right visual field deficit
  • Anxiety, anger, frustration
  • Intellectual impairment
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8
Q

Stroke protocol (general)

A
  • Goal of ED door to treatment:
    < 60 minutes
  • Neuro exam q 15 min for first 2 hours
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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
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10
Q

Stroke medication

A
  • Thrombolytics
  • Anticoagulants
    ASA, clopidogrel
  • Lorazepam, other antiepileptics
  • Calcium channel blockers
  • Stool softeners
  • Analgesics (for pain)
  • Antianxiety drugs
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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
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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
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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
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14
Q

Brain tumor medication

A
  • Analgesics
  • Dexamethasone
  • Phenytoin
  • Pantoprazole (protonix)
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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
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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
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17
Q

Transsphenoidal hypophysectomy (TPH) complications

A
  • Air embolism
  • CSF leak
    meningitis
  • Diabetes Insipidus
  • Visual disturbances
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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
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19
Q

SAH pre-op nursing care

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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

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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

Study These Flashcards
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

Study These Flashcards
A

Normal level: 5 – 15 mm Hg

23
Q

Increased ICP

Study These Flashcards
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

Study These Flashcards
A
  • CPP = MAP – ICP
  • Normal/Target 70 – 95 mmHg
  • CPP < 60 = hypoperfusion of brain
  • CPP < 40 = brain ischemia
25
ICP monitors
- Ventriculostomy | - Camino Monitors: Fiberoptic technology
26
Care for Ventriculostomy
- 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
ICP wave forms significance
Can be indicator of neuro change before numbers change
28
ICP nursing interventions
- 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
Increased ICP: Herniation
- 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
Care for Camino Monitors: Fiberoptic technology
- No transducer or anything to level - Heavy cable – secure to patient - ICP and CPP at least hourly - Record waveform every 8 hours
31
Mild traumatic brain injury
- Grade 1 - Altered or LOC <30 min with normal CT &/or MRI - GCS 13-15 - PTA < 24 hrs
32
Moderate traumatic brain injury
- Grade 2 - LOC < 6 hrs with abnormal CT &/or MRI - GCS 9-12 - PTA < 7 days
33
Severe traumatic brain injury
- Grade 3 - LOC > 6 hrs with abnormal CT &/or MRI - GCS <9 - PTA > 7 days
34
Skull fracture signs
- Raccoon eyes (Frontal or orbital fracture) | - Battle sign (Basilar Skull Fracture)
35
Epidural hematoma pathophysiology
- Associated with skull fracture - Damage to dura, veins and arteries - 80% caused by: Arterial bleeding Middle meningeal artery Small percentage: venous bleeding
36
Epidural hematoma symptoms
- *Immediate LOC, followed by lucidity, then rapid deterioration - *Dilated, fixed pupil on the same side of injury
37
Subdural Hematoma pathophysiology
- Small bridging veins torn between the dura and the skull, bleeding into the subdural space
38
Subdural Hematoma symptoms
- 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
Diffuse axonal injury (DAI) pathophysiology
-extensive lesions in white matter tracts occur over a widespread area
40
-Mild DAI:
coma 6-24hrs, follows commands by 24hrs
41
Moderate DAI:
coma lasting > 24hrs, no brainstem signs
42
Severe DAI:
coma prolonged & associated w/ prominent brainstem signs
43
Concussion
- A sudden transient mechanical head injury with disruption of neural activity - Considered benign and resolves spontaneously - May or may not lose consciousness
44
Post Concussive Syndrome
- 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
Epidural/Subdural Bleed: Management Goals
- 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

Adult Health I final (16 decks)

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