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intercranial disorders Flashcards

1
Q

CEREBRAL BLOOD FLOW (CBF)

A

The brain needs a constant supply of O2 and glucose. It uses about 20% of the body’s O2 and 25% of its glucose.

CBF = The amount of blood in mL passing through 100 g of brain tissue in 1 minute.

Normal CBF: 50 ml/min

Brain cells begin to die within 3-5 min of O2 deprivation

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2
Q

AUTOREGULATION OF CBF

A

During changes in arterial BP, diameter of the cerebral blood vessels auto adjusts based on metabolic needs to maintain a constant blood flow.
Auto regulation is effective only if the MAP is between 70-150 mmHg

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3
Q

CEREBRAL BLOOD FLOW

A

What affects CBF?
CO2 (ventilation)
O2 (oxygenation)
Hydrogen ions (pH of blood)
Cerebral Metabolic Rate
Temperature, Vasoactive Drugs, and Anesthetic Agents

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4
Q

CEREBRAL BLOOD FLOW- high PaCO2?

A

CO2 is a potent vasodilator
↑ PaCO2 → relaxes smooth muscles, causes cerebral vasodilation, ↓ cerebrovascular resistance → ↑CBF

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5
Q

CEREBRAL PERFUSION PRESSURE (CPP) - number range for normal CPP

A

Pressure needed to perfuse the brain
Normal CPP = 60 – 100 mmHg
CPP=*MAP-ICP

*MAP= Mean Arterial Pressure (The averagearterial pressureduring one cardiac cycle. A better indicator of organ perfusion than systolicblood pressure)
MAP = SBP + 2 (DBP) / 3

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6
Q

WHAT IS INTRACRANIAL PRESSURE - what 3 components? ON TEST

(ICP is BBC)

A

ICP: Is the pressure exerted by three components within the skull:
Brain tissue: 78 %
Blood : 12%
CSF: 10%
An increase in any of these
components results in increased ICP

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7
Q

FACTORS THAT INFLUENCE ICP

A

Arterial pressure
Venous pressure
Intraabdominal and intrathoracic pressure
(coughing, vomiting, bearing down)
Body positioning
Supine ↑ ICP
HOB up ↓ ICP
Temperature
CO2 and O2 levels
Seizures

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8
Q

INTRACRANIAL PRESSURE:
NORMAL COMPENSATION

(we normally pressure monroe)

A

Modified Monro-Kellie doctrine:
The 3 components in the skull must remain at relatively constant volume
If the volume of one increases, the volume of another is displaced

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9
Q

INTRACRANIAL PRESSURE:
MEASUREMENT - what number indicates ICP? (you know this)

A

Measured in the ventricles, subarachnoid, subdural and epidural spaces as well as brain tissue.
Any sustained reading >15mmHg is indicative of ↑ ICP. Sustained reading over 20 mmHg = poor prognosis

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10
Q

INCREASED INTRACRANIAL PRESSURE

A

Significance: ↑ in ICP → ↓CPP (central perfusion pressure) → brain tissue ischemia

Causes of increased ICP:
Head injury (bleeding, hematoma, contusion)
Increased CSF
Infection (abscess, encephalitis, meningitis)
Hydrocephalus
Tumor

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11
Q

INCREASED INTRACRANIAL PRESSURE - what part of the brain is affected with ICP goes up?

(medusa gets squished)

A

With increasing ICP, autoregulation fails, more edema/mass leads to displacement, herniation and compression of the medulla in the brain stem responsible for respiratory control → Respiratory hypoventilation → ↑ CO2 → vasodilation →&raquo_space;> ↑ ICP

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12
Q

TYPES OF CEREBRAL EDEMAS = VASOGENIC: what happens?

(the vase is leaking)

A

Most common
Mainly in the white matter when an insult ↑ permeability of the BBB
Osmotic gradient moves more fluid into the extracellular space

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13
Q

INCREASED ICP:DIAGNOSTICS (the usual)

A

CT
MRI
Cerebral angiography
EEG
Transcranial doppler (TCD)
**Lumbar puncture: usually not done due to risk of downward herniation

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14
Q

INCREASED ICP: MONITORING - what GCS score?

A

ICP monitoring is indicated for a GCS<=8, cerebral hemorrhage, tumor, infection, or TBI

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15
Q

INCREASED ICP: meds - on TEST - steroids

A

Corticosteroids for vasogenic edema: decrease inflammation → ↓ cerebral edema

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16
Q

INCREASED ICP:THERAPY - what number should you keep PaCO2 at?

A

GOAL: Identify and treat underlying cause and support brain function

Adequate oxygenation
Hyperventilation to keep PaCO2, 30-35mmHg (book says 35-45)
Surgery: If the cause is a tumor or hematoma (Decompressive craniotomy)
Radiation for non-surgical tumors

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17
Q

INCREASED ICP:
NURSING MANAGMENT - ON TEST - what type of test to give pt?

A

Evaluate mental status, cranial nerve function, motor and sensory functions

ABCs: maintain airway (with loss of consciousness the tongue drops back, occluding the airway)

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18
Q

INCREASED ICP:
NURSING MANAGMENT - how often to do a neuro assessment? HOB?

A

Monitor ICP, minimize sneezing, valsalva, coughing and arousal from sleep except to perform neuro checks
Proper positioning: HOB>30 degrees unless cervical injury, head midline, avoid flexion of neck or hips
Monitor for seizures
Reduce metabolic demands such as fevers, chills, pain
Neuro assessment Q1-2hrs initially
Treat pain and anxiety: analgesics, sedatives and paralytics
Early enteral feeding or other means of nutrition improves outcome

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19
Q

GLASCOW COMA SCALE (GCS) - which is the best predictor of brain function?

A

Quick, easy, standardized method of assessing LOC
Developed in 1974 to standardize assessment of impaired consciousness, to allow all professionals to assess LOC using the same tool (may be subjective)
The 3 areas to assess are:
Eye opening response
Best verbal response
Best motor response
The higher the score, the higher the brain function
A GCS <= 8 generally indicates coma

Motor response is the most predictive for brain function of all the categories of GCS

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20
Q

HEAD TRAUMA

A

Any injury or trauma to scalp, skull or brain
Most common due to falls and MVA
Scalp laceration: relatively minor; a highly vascular area. Concern for blood loss and infection
Skull Fracture
Linear
Depressed
Comminuted (cracked everywhere)
Open vs closed
Basilar

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21
Q

HEAD TRAUMA – Basilar skull fracture - symptoms?

(the racoon in the basil)

A

Involves the base of the skull
Could evolve to review Battle’s sign (bruising around jaw/ear) and Racoon eyes

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22
Q

CATEGORIES OF HEAD TRAUMA - just 2

A

Two Categories of Head Trauma

Diffused (generalized)

Focal (localized)

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23
Q

HEAD TRAUMA: CONCUSSION - hallmark symptoms

A

Diffuse head trauma. Considered a mild TBI
“A trauma induced alteration in mental status that may or may not involve altered LOC” (American Academy of Neurology)
Hallmark symptoms:
Brief interruption to LOC
Retrograde amnesia (can’t remember what happened)
Headache
Persistent headache, lethargy, shorten attention span, behavioral changes, short-term memory affected

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24
Q

HEAD TRAUMA: FOCAL INJURY - brain laceration - and complications?

(lacerations tear)

A

Brain laceration: actual tearing of brain tissue from skull fracture and penetrating injuries
Complications: hemorrhage and hematoma, seizure, cerebral edema
Prevent secondary injuries related to increase ICP

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25
COMPLICATIONS OF FOCAL HEAD TRAUMAS (focused epidural)
Epidural hematoma: bleeding between dura and skull Neurological emergency (develops rapidly if involves a major artery such as the middle meningeal artery) Requires immediate surgical evacuation of hematoma Venous epidural hematomas develop slowly
26
COMPLICATIONS OF FOCAL HEAD TRAUMAS - Subdural hematoma (it's in the name)
Subdural hematoma: bleeding between dura and arachnoid Damage to brain tissue and its blood vessels Usually venous and tends to develop slowly (can be acute, subacute and chronic)
27
INFLAMMATORY CONDITIONS OF THE BRAIN
Most common inflammatory conditions of the brain and spinal cord: Meningitis Encephalitis Brain abscess: accumulation of pus within brain tissue usually direct extension from ear, tooth, sinus infections. Aggressive treatment with antibiotics. Staph and strep: primary infective organisms. These conditions can be caused by bacteria, viruses, fungi, chemicals (contaminated contrast media)
28
MENINGITIS
Acute inflammation of the meningeal tissue of the brain and spinal cord Infection may spread to other parts of the brain → encephalitis Viral or bacterial Usually occurs in Fall, Winter or early Spring secondary to viral respiratory infection Bacterial meningitis is a medical emergency and carries a 100% mortality if not treated early
29
BACTERIAL MENINGITIS: CLINICAL MANIFESTATION (and one that is specific to bacterial)
Key signs Fever Severe headache n/v Nuchal rigidity Photophobia Decreased LOC + signs of increased ICP
30
MENINGITIS: COMPLICATIONS
Increase ICP: main cause of altered mental status Many cranial nerves may be affected: Papilledema, ptosis, diplopia, vision loss, facial paresis, tinnitus, vertigo. (Resolves within few wks if treated). Hearing loss may be permanent w/bacterial meningitis Hemiparesis, dysphasia, hemianopsia (loss of half of vision field) Hydrocephalus if exudate causes adhesions blocking normal flow of CSF from ventricles
31
VIRAL MENINGITIS - is it in the brain? (virus not in my brain)
Not as contagious compared to bacterial type Managed symptomatically: self limiting, usually with full recovery Symptoms: Fevers, headaches, photophobia, stiff neck Seldom brain involvement
32
MENINGITIS: DIAGNOSIS (Don had a lumbar puncture)
Blood culture CT Lumbar puncture to analyze CSF to confirm organism Neutrophils often found in bacterial meningitis (LP should only be done after CT to confirm r/o obstruction in foramen magnum) X-ray may indicate infected sinus
33
meningitis - treatment - what type of precaution is it?
If meningitis suspected, antibiotics started right after cultures even before confirmation of dx Common abx: Ampicillin, PCN, Ceftriaxone, vancomycin Dexamethasone with 1st dose abx: associated with lower mortality & reduced hearing loss in bacterial meningitis. ** Droplet precaution until confirmed negative
34
ENCEPHALITIS - SYMPTOMS - on test
Acute inflammation of the brain Usually caused by a virus Symptoms: Headache Fever seizures Change in LOC
35
ENCEPHALITIS: Epidemic (ticks are an epidemic)
Epidemic Ticks and mosquitos: West Nile virus Typically seen from May to September
36
CEREBROVASCULAR ACCIDENT (CVA)
aka stroke, brain attack Occurs when there is ischemia (decreased blood flow) to a part of the brain or hemorrhage (bleeding) into the brain death of brain cells If blood flow is interrupted >2-3 minutes, metabolism stops and cellular death occurs in five minutes
37
CEREBROVASCULAR ACCIDENT (CVA) - risk factors
Risk factors: Non-modifiable: age (risk doubles each decade after 55), gender (more common in men but more women die from stroke), race (African Americans 2x the risk) Modifiable: HTN (if managed, CVA can be reduced by 50%), smoking, Etoh use, obesity, heart disease, DM, hx of TIA 90% of strokes result of modifiable risk factors 5th Most common cause of death in the U.S.
38
CVA : ISCHEMIC STROKE (ischemic TIE)
Ischemic (partial or complete occlusion to artery): 80% of all strokes Thrombotic (blood clot formation after vessel wall injury): most common 60% Embolic (embolus in circulation blocks artery in brain): 2nd most common Other etiologies: MI, endocarditis, rheumatic heart disease, heart valve prosthesis
39
CVA: CLINICAL MANIFESTATIONS
Sudden loss of focal brain function is the core feature of the onset of acute ischemic stroke Function affected related to artery involved: Motor function: mobility, respiratory, speech, swallowing, gag reflex, Bladder and bowel elimination Spatial and perceptual alteration (neglect) Personality and affect Cognition
40
CVA: HEMORRHAGIC STROKE - is it sudden?
Hemorrhagic stroke (bleeding into brain): 15 % of all strokes High mortality rate: 50% die within 48 hrs 40—80% mortality within 30 days Sudden onset of symptoms with progression within minutes to hrs
41
BRAIN ANEURYMS
A bulging or enlargement of blood vessels in the brain Walls of vessels weaken leading to leakage or rupture → hemorrhage
42
ARTERIOVENOUS MALFORMATION (AVM) (malformed AV tangle)
A tangle of abnormal blood vessels connecting arteries and veins in the brain Disrupts normal oxygen exchange between arteries and veins AVMs have higher risk of bleeding
43
CVA: CLINICAL MANIFESTATIONS - what is the key word?
Symptoms: Sudden numbness of face, arm, extremity, especially on one side Sudden confusion or trouble speaking or understanding speech Sudden trouble seeing or blurred vision Sudden severe headache with no known cause Sudden mobility deficit **Key word is ”sudden”
44
CVA: MANAGEMENT
Most important: Time of onset of first symptom Goal is preserving brain tissue → preserving life and reducing deficits If unconscious: maintain patent airway and adequate ventilation Stroke center admission preferred
45
ISCHEMIC STROKE MANAGEMENT - IV tpa - when to give? (tap the ischemia)
Prepare to give IV tpa (plasminogen activator): IV tpa: must be administered within 3 to 4.5 hrs of onset
46
CVA: STROKE CENTER GOAL
In hospital timeline goals for all patients with acute ischemic strokes who are eligible for IV tPA: Evaluation by a physician within: 10 min Stroke team contacted within: 15 min Head CT scan within : 25 min Interpretation of neuro-imaging scan within: 45 min Goal : start time of tPA infusion should be < 60 min from time of arrival at the emergency department
47
CVA: MANAGEMENT - don't need to memorize the dose- - IV tPA - where is it inserted?
IV tPA: 0.9 mg/kg of body weight with a maximum dose of 90 mg 10% given IV bolus and 90% over 1 hr Intra-arterial tPA Catheter inserted in femoral artery and directly to area of clot Benefit: less tPA needed leading to less risk of intracranial bleed
48
CVA: Post acute phase = For hemorrhagic stroke- don't give what meds, and what should bp be? (hemmorhaging at 160 mph)
For hemorrhagic stroke: NO anticoagulation Management of hypertension (goal SBP <160 mmHg) Prophylactic anti-seizure during acute period should be discussed with care team Surgical decompression (clot evacuation, craniotomy)
49
CVA - In the acute phase: neuro checks how often?
Maintain patent airway and adequate ventilation Screen for tPA contraindication Monitor VS (manage hypertension) neuro checks every 1-2 hrs Monitor for increasing ICP Fluid and electrolyte balance
50
CVA: NURSING MANAGEMENT - after 48 hours - feeding?
After 48hrs of initial stroke and patient is stable: Initiate feeding; check gag and swallow reflex
51
National Institute of Health Stroke Scale (NIHSS) - not on test - ignore this
Primary assessment tool to evaluate and document neurological status in acute stroke patient Also used as a predictor of both short and long term outcome of stroke patients
52
central herniation - ON TEST (hernia down the middle)
 Both temporal lobes herniate through the tentorial notch because of bilateral mass effects or diffuse brain edema.
53
uncal hernation - ON TEST (uncle's brain stem is not working)
brain stem (life threatening)
54
Cerebral blood flow - Below 70:
Below 70: ischemia and neuro damage may occur
55
Cerebral blood flow - Above 150
Above 150: cerebral vessels are maximally constricted, and auto-regulation fails Responsive to tissue PCO2, and tissue PH, very slightly to tissue PO2
56
cerebral perfusion pressure - A pressure below 50
results in ischemia and brain tissue death
57
normal ICP numbers
Normal ICP 5-15 mmHg
58
ICP - supine?
Supine ↑ ICP
59
ICP - HOB up?
HOB up ↓ ICP
60
intercranial pressure - CSF displacement - goes where?
The body can adapt to volume changes within the skull up to a limit: CSF can be displaced to spinal subarachnoid space or alter absorption and production
61
intercranial pressure - displacement - brain tissue goes where?
Brain tissue vol. compensate via distention of dura or compression of brain tissue
62
intercranial pressure - displacement - blood goes where?
Blood vol. can be decreased via collapse of cerebral vein or dura sinuses, regional vasoconstriction
63
types of cerebral edema = CYTOTOXIC (cyto cell)
Mainly gray matter Lesions or trauma to brain tissue itself disrupts cell membrane →
64
types of cerebral edema = INTERSTITIAL (interstitial hydro)
INTERSTITIAL Usually the result of hydrocephalus d/t ↑ CSF production, obstruction to flow or inability to reabsorb CSF → enlarged ventricles Regardless of type, cerebral edema increases brain volume
65
gold standard for measuring ICP? (ice in the vents)
ON TEST - Gold standard: Ventriculostomy*** catheter inserted into the lateral ventricle to directly measure ICP Ability to sample CSF, med administration, and CSF removal to control ICP Risks: CSF leak and infection especially if monitoring more than 5 days
66
head trauma - Diffused - ex.
Diffused (generalized) i.e. Concussion – cannot be localized to one area
67
head trauma - Focal - ex. (think cut)
Focal (localized) i.e. lacerations, contusion, hematoma - can be localized
68
how long do concussions last? (concussed at 22)
Post-concussion syndrome (persists 2 weeks to 2 months)
69
focal injury - contusion (brusin for a contusion)
Contusion: bruising of brain tissue. Associated with close head trauma Phenomenon of coup-contrecoup : related to high velocity impact Bleeding and re-bleeding may occur Seizures are a common complication
70
hallmark sign of epidural hematoma (epi is conscious for a second)
Hallmark signs: initial period of unconsciousness at the scene with brief lucid interval followed by decrease in LOC, HA, n/v
71
focal head trauma complication - Intracerebral: (intra bleeding)
Intracerebral: bleeding within the brain Commonly occurs in the frontal and temporal lobes from ruptured intracranial vessels (HTN, AV malformation, head trauma)
72
what happens with CSF when someone has menningitis?
Increases CSF production= ↑ ICP
73
mennengitis - Main bacterial culprits
Main bacterial culprits: Strep Pneumoniae and Neisseria meningitis
74
bacterial menningitis - + Kernig’s (Don kernig's hamstring has bacteria)
+ Kernig’s : extension of leg causes contraction or pain in hamstring
75
bacterial menningitis - + Brudzinsk (bru, don's head is flexing)
+ Brudzinski: forward flexion of the head and neck causes flexion at hip and knee
76
encephalitis - Non-epidemic (chicken pox is not an epidemic)
Non-epidemic Complication of chicken pox, measles, mumps, HSV cytomegalovirus
77
encephalitis - Diagnosis (think xray)
Diagnosis: LP, CT, MRI, PET
78
encephalitis - treatment (just management)
Management: symptomatic and supportive, prevention of increase ICP Acyclovir for HSV
79
what causes embolic strokes? (gabrielle had an emoblism)
Embolic strokes usually develop as a complication of Atrial fibrillation
80
hemmorhagic stroke - causes - most common
Uncontrolled HTN most common Ruptured aneurysms, vascular malformation, coagulation disorders, anticoagulants, trauma Manifestations based on area of brain affected
81
Subarachnoid hemorrhage - caused by what? (arachnoid in the circle)
Subarachnoid hemorrhage (SAH)-bleeding between the pia mater and arachnoid space Commonly caused by ruptured aneurysm in the Circle of Willis Vasospasm is a common complication. When clots break down, metabolites cause irritation to endothelium →vasoconstriction Vasospasm peaks at 6-10 days after initial bleed
82
CVA - what type of test do you do immediately? (CVA, C, you need a test)
Non contrast CT to determine ischemic vs hemorrhagic Monitor VS, neuro checks and observe for ↑ ICP
83
IV TPA - screen for what before giving? (think bleeding)
Must screen for: coagulation disorder, GIB (gastro intestinal bleed) within 22 days, stroke, or head trauma within the last 3 months and any major surgery within 2 weeks
84
IV tpa - bp?
BP must be < 185/110 at initiation and 24hrs following tPA
85
CVA - post acute - For ischemic strokes (think, what do they prescribe to prevent strokes?)
For ischemic strokes: tPA ASA 325mg may be initiated 24-48hrs after tPA Plavix Warfarin, Xarelto, Eliquis for afib to prevent future ischemic stroke Statins
86
CVA - acute phase - HOB? and affected side?
Proper positioning of HOB: 30-40 degrees position on the affected side no more than 20-30 minutes Seizure precaution
87
CVA - after 48 hours - have pt do what? (scanning for 48 hours)
Have patient scan room left and right if patient has neglect to one side. Place food by the unaffected side, soft foods, mouth care Prevent constipation. Bowel regimen to prevent straining Urine incontinence – foley or external urinary collection device With communication deficit, speak in normal tone and volume. Simple questions and allow extra time to process. PT Emotional support as some degree of deficit common
88
cerebral edema - CYTOTOXIC - where do fluids and protein go?
Fluid and proteins shifts from extracellular space into the brain cells →cerebral edema BBB stays intact
89
cytotic - BBB?
BBB stays intact
90
causes of cytotoxic edema (Sia is cytotoxic)
cerebral hypoxia/anoxia and SIADH
91
causes of vasogenic edema (that vase is a tumor)
(brain tumors, abscesses, toxins)
92
cerebral blood flow - ↓LOW!!!!!! PaCO2
↓ PaCO2 has the opposite effect → ↓CBF
93
cerebral blood flow - PaO2 ↓ (the same)
Acute hypoxia (↓ PaO2) → ↑CBF Cerebral PaO2 ↓ 50mmHg →cerebral vasodilation → ↓ cerebrovascular resistance, ↑ CBF
94
cerebral blood flow -- if paO2 remains low for extended time,
anaerobic metabolism → acidosis → >>> vasodilation and loss of autoregulation
95
ICP - meds - on test (Barb on ice slows down)
High dose barbiturates, pentobarbital (Nembutal), to decrease brain metabolism and lower ICP
96
ICP - meds - on test (Manni on ice)
Osmotic diuretic: ****on TEST Mannitol or hypertonic solution (must infuse slowly) Mannitol*** Acts by plasma expansion (reduces Hct and blood viscosity → ↑CBF and cerebral O2 delivery) Osmotic effect (pulls fluid from brain tissue into blood vessels → ↓ ICP)
97
ICP - meds - on test - hypertonic (same mechanism as manni)
Hypertonic solution (produces massive movement of water from edematous brain cells into blood vessels) ***make sure to monitor pt's electrolytes bc you're pulling the fluid off quickly
98
ICP meds - on test (Ice causes seizures)
Anti-seizures: i.e Dilantin prophylaxis
99
mannitol precautions - and how to infuse? (Manni is not full-time)
Requires normal renal function*** Intermittent IV infusion (not continuous) ***Works quickly: decreases ICP within minutes Ensure adequate fluid resuscitation and monitor electrolytes
100
basilar skull fracture - test for what? (leaking basil)
Test rhinorrhea or otorrhea for CSF leak (Glucose >40mg/dL or halo sign) Facial paralysis and and impaired hearing
101
ICP - nursing management - on test - suctioning?
***ON TEST***Suctioning increases ICP: Suction PRN < 10 secs and pre-oxygenate with 100% O2 before and after Limit to 2 passes per suction procedure***
102
viral meningitis - causes (think viruses)
Commonly caused by enteroviruses, HIV, HSV
103
ICP - nursing management - basically just neuro assessment
reflexes, GCS, pupil checks, VS,
104
ICP - nursing management - triad (BPH triad)
monitor for Cushing’s triad (HTN, bradycardia, wide pulse pressure)
105
expressive aphasia. (brock is expressive)
broca
106
receptive aphasia - what area?
Wernicke's area
107
Wernicke's area - part of brain
temporal
108
hall mark sign of epidural hematoma (the epidural made me unconscious for a sec)
initial period of unconsciousness at the scene of injury , followed by a brief period of lucid interval , followed by a decrease in LOC
109
CN 3, 4, 6 - how to test? (3 follows my finger)
hold head steady and follow movement of finger
110
CN 7 (7 faces)
raise eyebrows, closes eyes, frown, smile
111
broca's area - what part of brain
frontal lobe
112
brain stem controls 3 things
cardiac, respiratory, vasomotor
113
layers of the brain (pie on the inside)
pia, arachnoid, dura mater
114
CSF is
colorless, clear, orderless no RBCS, and little protein
115
temporal (tempora is my language)
Ability to understand written and oral language
116
When a brain-injured patient responds to nail bed pressure with internal rotation, adduction, and flexion of the arms, how should the nurse report the response?
Decorticate posturing
117
Which action will the emergency department nurse anticipate for a patient diagnosed with a concussion who did not lose consciousness?
Provide discharge instructions about monitoring neurologic status.
118
The nurse is admitting a patient with a basal skull fracture. The nurse notes ecchymoses around both eyes and clear drainage from the patient’s nose. Which admission order should the nurse question?
Apply cold packs intermittently to face.
119
A patient being admitted with a stroke has right-sided facial drooping and right-sided arm and leg paralysis. Which finding should the nurse expect?
Difficulty comprehending instructions
120
tPA - for how long after can you administer it? (tapped for 6 hours)
May be administered up to 6 hrs after onset of symptoms
121
cingulate or subfalcine  herniation - ON TEST (singular frontal)
the most common type, the innermost part of the frontal lobe is scraped under part of the falx cerebri, the dura mater at the top of the head between the two hemispheres of the brain
122
EMG for what? ON TEST (OMG gillian)
GUILLAIN BARRE SYNDROME
123
test to find origin of seizures (eggs find seizures)
EEG
124
tPA for what?
stroke
125
mannitol for what?
ICP

XIO (400 decks)

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