Neuro: Altered LOC

Question 1

Responds slowly to external stimulation, needs repeated stimulation to maintain attn and respond

Answer 1

Obtunded

Question 2

Responds only minimally with vigorous stimulation, may only mutter or moan as verbal response

Answer 2

Stuporous

Question 3

No observable reponse to any external stimulation

Answer 3

Comatose

Question 4

How many physicians must determine someone brain dead?

Answer 4

2

Question 5

What do you do if someone that may be “brain dead” has an electrolyte imbalance?

Answer 5

Electrolyte imbalance must be fixed before can be considered brain dead

Question 6

What are the structural causes of LOC?

Answer 6

Trauma, vascular, infection, neoplasms

Question 7

What are the metabolic causes of LOC?

Answer 7

Hypoxic encephalopathy, toxins, body temperature extremes, seizures

Question 8

What are the three parts of the Glascow coma scale?

Answer 8

Eye, Verbal, Motor

Question 9

What are the three score types for the Glascow coma scale?

Answer 9

Mild (13-15), Moderate (9-12), Severe (<9)

Question 10

What three things are included in intracranial volume?

Answer 10

Brain tissue (80%), CSF (10%), Blood (10%)

Question 11

What is the Monroe-Kellie Doctrine?

Answer 11

Increase of one must decrease other 2 or will hemorrhage

Question 12

What is normal ICP?

Answer 12

0-15 mmHg

Question 13

What are causes of increased ICP?

Answer 13

Head injury, CVA, lesions, brain tumors, intracranial surgery, CO2

Question 14

What is nursing care for someone suspected to have increased ICP?

Answer 14

DONT sneeze, cough, valsalva, turn, deep breath

Want bed at 30 degrees, NOT flat

Question 15

What 3 things increase brain matter?

Answer 15

cerebral edema, tumor, hemorrhage

Question 16

What increases cerebral blood flow?

Answer 16

hypoxemia, hypercapnia, anesthetics, histamines,acidosis, antihypertensives

Question 17

What factors increase CSF?

Answer 17

CSF, Hydrocephalus, Obstruction of CSF pathways, some lesions cause inflammation & produce more CSF

Question 18

What are causes of transient increased ICP?

Answer 18

Valsalva, Isometric muscle cx, shivering, decerebration, coughing, sneezing, REM sleep, noxious stimuli

Question 19

What is the formula to figure cerebral perfusion pressure?

Answer 19

ICP-MAP= CPP

Question 20

Where do you want CPP in a pt with increased ICP?

Answer 20

Above 70 mmHG to prevent cerebral ischemia

Question 21

What is normal CPP?

Answer 21

50-100

Question 22

How do you treat increased ICP?

Answer 22

Fluid restriction,
Drugs (Osmotic (Mannitol)/Loop Diuretics (Lasix), Corticosteroids (Decadron),Anti-seizure (Dilantin),stool softener)
Raise HOB to decrease ICP

Question 23

What is the Gold Standard for monitoring ICP?

Answer 23

Ventriculostomy catheter

Question 24

What is management of increased ICP?

Answer 24

Drainage of CSF, Hypervenilation, Control fever, Reduce metabolic demand, fluid restriction

Question 25

What do you do to take care of a pt with increased ICP?

Answer 25

``` Avoid hypotension/hypoxia Elevate HOB 30 degrees NG tube to prevent distention Avoid JV outflow obstruction (prevent extreme neck flexion) Prevent coughing/PEEP/sneezing Prevent/Treat agitation QUIET, non stimulating environment ```

Question 26

What are the early symptoms of increased ICP?

Answer 26

Change in LOC: Confusion, Lethargy, Restlessness Change in pupillary: Ipsilateral, Contralateral Decreased Visual acuity Motor weakness Headache

Question 27

What do you do if corneal reflex isn't intact?

Answer 27

Tape eyes shut, lubricate eyes

Question 28

What are the late stages of increased ICP?

Answer 28

Decreased LOC, vomiting, hemiplegia/hemiparesis, posturing, vital signs change (Cushings triage), papilledema (long increase ICP)

Question 29

What is Cushings Triage?

Answer 29

Increase in systolic BP, widened pulse pressure, bradycardia

Question 30

What is a migraine with an aura?

Answer 30

Classic migraine

Question 31

What is a migraine without an aura?

Answer 31

Common migraine (weekend/holiday)

Question 32

What is a migraine that loses vision?

Answer 32

Hemiplegic/opthalmoplegic

Question 33

What medications are used to treat a classic migraine?

Answer 33

ASA, acetaminophen, Ergomar, Triptans, Imitrex, Maxalt

Question 34

What meds are used to treat a common migraine?

Answer 34

caffeine, imitrex, relpax

Question 35

What type of migraine occurs with young females before menstrual periods with vomiting, partial vision loss, vertigo,tinnitus

Answer 35

Basilar Artery migraine

Question 36

What is treatment for a cluster headache?

Answer 36

prophylactic- SUMATRIPTAIN-Verapamil, lithium, ergomar, NSAIDS

Question 37

What is ACUTE treatment for a cluster headache?

Answer 37

100% O2 delivered at 7-9 L per minute for 15-20 mins (causes vasoconstriction)

Question 38

What are symptoms of a cerebral aneurysm?

Answer 38

sudden severe headache, n/v, LOC, preceded by activity, nuchal rigidity, fever, restlessness, irritability,blurred vision, seizure

Question 39

What do you watch for with symptoms of cerebral aneurysm?

Answer 39

re-bleeding, cerebral vasospasm, hydrocephalus

Question 40

When do you notify MD with pt with cerebral aneurysm?

Answer 40

Systolic BP increases

Question 41

What is treatment for a cerebral aneurysm?

Answer 41

O2, venilation, surgical intervention, no stimulants, BR 4-6 weeks, codeine/analgesia PRN, antiHTN,corticosteroids (decrease cerebral edema), phenobarbital, CCB (decrease vasospasm)

Question 42

What do you do for a pt who has a cerebral aneurysm but surgery is delayed?

Answer 42

Pt flat or <30 degrees, decrease stimuli, watch for s/s enlarging aneurysm, watch for re-bleed,intracranial clot, vasospasm, assess LOC, look for unequal pupils, new or worse headache, increase in systolic BP (notify MD)

Question 43

What is Pre-Post Operative care for aneurysms?

Answer 43

Avoid over hydration, turn, monitor VS,LOC, ABG's, assess gag reflex, stool softeners, artificial tears