T4 Blueprint - Care of Critically Ill with Neuro Problems (Josh)

Question 1

Symptoms of Left Hemisphere CVA

Answer 1

Aphasia

Alexia, Dyslexia

Acalculia

Right visual field deficit

Anxiety, Anger, Frustration

Intellectual Impairment

Question 2

Symptoms of Right Hemisphere CVA

Answer 2

Disorientation (left sided motor weakness)

Loss of Depth Perception

Unilateral Body Neglect Syndrome

Denial of Illness

Impulsiveness

Question 3

How often are neuro exams given for CVA?

Answer 3

q 15 mins for 2 hrs

Question 4

What is the eligibility for Thrombolytic Therapy?

Answer 4

LSN 3-4.5 hrs

Less than 80 yo

No anticoagulant use (INR less than or equal to 1.7)

NIH Scale less than or equal to 25

No history of STROKE and DIABETES

Question 5

When can Intra-arterial Thrombolysis be done?

Answer 5

LSN less than 6 hrs

Question 6

Brain Tumor:

Nursing interventions post-Craniotomy

Answer 6

Fluid Balance

Incision care

Monitor ICP

Avoid activities that increase ICP

DVT prophylaxis

Stress Ulcers

Pneumonia

Proper Positioning

Eye Care

Question 7

Craniotomy:

With fluid balance, what are we observing for?

Answer 7

Diabetes Insipidus

**UOP 400 mL per hr

Question 8

Craniotomy:

What is Cushing’s Stress Ulcer?

Answer 8

a gastric ulcer associated with increased ICP

Question 9

TPH:

Complications to watch for?

Answer 9

Air embolism

CSF leak (meningitis)

Diabetes Insipidus

Visual disturbances

Question 10

TPH:

Post op care

Answer 10

HOB increase to 35-40 degrees

Hourly UOP

Monitor electroylytes

Avoid straining

Monitor for vision disturbances

Question 11

Increased ICP:

What do we want to keep SBP?

Answer 11

140-160

Question 12

Increased ICP:

Why do we want to hyperventilate?

Answer 12

CO2 is a vasodilator that increases ICP so we want to keep levels at low normal (35 mmHg) and have high PaO2 levels

Question 13

Increased ICP:

What is normal ICP?

Answer 13

5-15 mmHg

Question 14

Increased ICP:

What is CPP and how do we calculate?

Answer 14

Cerebral Perfusion Pressure

CPP = MAP - ICP

Normal is 70-95 mmHg

Question 15

Increased ICP:

CPP of — indicates hypoperfusion of brain.

CPP of — indicates brain ischemia

Answer 15

less than 60

less than 40

Question 16

Increased ICP:

When would you hyperventilate?

Answer 16

only if herniating

Question 17

Increased ICP:

Why do we increase oxygenation?

Answer 17

because hypoxia along with hypotension has a 75% mortality rate

***give 100% FiO2

Question 18

Increased ICP:

What is our optimal MAP?

Answer 18

greater than 90

Question 19

Increased ICP:

What can we do to increase CPP?

Answer 19

induce HTN with DA or Dobutamine

***monitor UO closely

Question 20

Increased ICP:

What drug can we give to prevent extreme rise in BP?

Answer 20

Nicardipine (CBB)

**Neuroprotective

Question 21

Increased ICP:

What is our goal with PAWP and CVP?

Answer 21

PAWP 5-12 mmHG

CVP 5 mmHg

Question 22

Increased ICP:

What is our goal with serum osmolarity?

Answer 22

keep less than 315

Question 23

Increased ICP:

How often should Na and Osmolarity be measured?

Answer 23

q 6 hrs

Question 24

SAH:

What are signs and symptoms of SAH?

Answer 24

Severe sudden headache

Brief loss of consciousness

NV

Kernig’s and Brudzinskis

Question 25

SAH: When should craniotomy and surgical clipping be performed?

Answer 25

within 48 hrs

Question 26

SAH: Nursing Interventions Preop?

Answer 26

Keep BP low (to prevent rebleeding) Bedrest Dark, quiet environment Stool softeners No restraints, keep them calm HOB 35-45 degrees DVT precautions

Question 27

SAH: Nursing Interventions Postop?

Answer 27

prevent VASOSPASM Hypertensive Hypervolemic Hemodilution

Question 28

SAH: We want BP --- before surgery and --- after surgery.

Answer 28

low high

Question 29

SAH: What can we give postop to make vessels Hypervolemic?

Answer 29

Albumin

Question 30

SAH: Complications

Answer 30

Hyponatremia Re-bleeding Hydrocephalus Seizures

Question 31

SAH: What do we give if they become Hyponatremic post op?

Answer 31

isotonic fluids

Question 32

TBI: How long are the uncouncious for a Mild TBI? Moderate TBI? Severe TBI?

Answer 32

less than 30 mins less than 6 hrs greater than 6 hrs

Question 33

TBI: What will CT and MRI look like with Mild TBI? Moderate TBI? Severe TBI?

Answer 33

normal abnormal abnormal

Question 34

TBI: CGS for Mild? GCS for Moderate? GCS for Severe?

Answer 34

13-15 9-12 less than 9

Question 35

TBI: How long do they have Post Trauma Amnesia for Mild TBI? Moderate TBI? Severe TBI?

Answer 35

less than 24 hrs less than 7 days greater than 7 days

Question 36

Concussion: Signs and Symptoms

Answer 36

N/V with drowsiness Persistent HA Lethargy Personality and Behavior Changes Shortened Attention Span Decreased Short Term Memory Changes in Intellectual Ability

Question 37

CTE is a complication from Concussions. Which proteins are released?

Answer 37

tau proteins

Question 38

Concussion: What are complications from repeated concussions?

Answer 38

CTE ALS Second Impact Syndrome

Question 39

CTE: What are the Initial Symptoms?

Answer 39

Disorientation Confusion Dizziness HA Lack of Insight Poor Judgment Overt Dementia Slowed Muscular Movements Staggered Gait Impeded Speech Tremors Vertigo Deafness

Question 40

CTE: What are the Progressive Symptoms?

Answer 40

Social Instability Erratic Behavior Memory Loss Initial Symptoms of Parkinson's Disease

Question 41

Skull Fracture: --- --- are signs of a Frontal or Orbital Fracture. --- --- are a sign of a Basilar Skull Fracture

Answer 41

Racoon Eyes Battle Sign (behind ears)

Question 42

Hematomas: Which type is ARTERIAL bleeding? Which type is VENOUS bleeding?

Answer 42

Epidural Hematoma Subdural Hematoma

Question 43

Hematomas: Which type may not seek treatment initially?

Answer 43

Epidural Hematoma - they have an immediate loss of consciousness BUT have a time of lucidity before rapid deterioration

Question 44

Epidural Hematoma: Dilated, fixed pupil on --- -- of injury.

Answer 44

same side

Question 45

Epidural Hematoma: What do we want to keep the CPP?

Answer 45

at 70 or above

Question 46

Epidural Hematoma: What Sodium level do we want?

Answer 46

145 or greater to decrease cerebral edema

Question 47

Epidural Hematoma: What PaCO2 level are we wanting?

Answer 47

low normal (35 mmHg) ***CO2 is a dilator that increases ICP

Question 48

Subdural Hematoma: What is the patho?

Answer 48

small bridging veins b/t dura and skull are torn, and bleed into the subdural space

Question 49

Subdural Hematoma: What type of deterioration?

Answer 49

PROGRESSIVE deterioration

Question 50

Subdural Hematoma: What is Acute? Subacute? Chronic?

Answer 50

first 48 hrs 2 days to 2 wks 2 wks to several months

Question 51

DIA: What is the patho?

Answer 51

extensive lesions in white matter tracts that occur over a widespread area of brain caused by acceleration type injury