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Sx ICP Mgt
Neuro Exam
Question | Answer |
---|---|
Procedure which portion of skull (bone flap) removed to allow room for swollen brain to expand, lessening risk for brain damage. Bone flap replaced when? | Hemicraniectomy; 2-4 months when pt has stabilized |
What osmotic diuretic is indicated to decrease cerebral edema? | Mannitol |
What corticosteroid is given to pt with cerebral edema? | Dexamethasone |
What are the main nursing interventions for a pt with cerebral edema? | Decrease edema, Maintain cerebral perfusion, Control fever and infection, Maintain oxygenation, Maintain F&E balance |
What position should head be in to promote drainage? | Midline/neutral position, cervical collar if needed, elevation |
Avoid _____ and ______ of neck as this could cause compression or distortion of jugular veins and increase in ICP | rotation, flexion |
Pt should avoid Valsalva maneuver and straining with bowel movement. Give what? | Stool softeners |
Preoxygenate and hyperventilate before _______ pt. | Suctioning |
ICP should not rise above ______ and should return to baseline within _____ minutes. | 25; 5 |
Cardiac output must provide adequate perfusion to the brain. What two intervention? | Fluids and Dopamine |
Has positive inotropic effect on myocardium and increased CO. Will increase SBP and renal circulation | Dopamine |
Increased temp can increase cerebral __________ and increase rate of what? | Metabolism, cerebral edema formation |
What interventions for increase temp? Avoid what? | Tylenol and cooling blanket; shivering |
Fever, chills, nuchal rigidity, and increased or persistent H/A are sym of what? | Meningitis |
Abdominal distention can interfere with RR function and should be prevented. What intervention? | NG tube |
Procedure which opens skull to gain access to intracranial structures. Multiple purposes: remove tumor, CNS abscess, vascular abnormalities, relieve elevated ICP, evacuate blood clot, control hemorrhage. May do a bone flap and position when? | Intracranial surgery; after surgery |
What drugs given post-op cranial sx to reduce cerebral edema? | Manitol, Dexamethasone (Decadron), Lasix, Bumex |
What drugs given post-op cranial sx to prevent seizures? | Valium, dilantin |
What are three important things to remember about Dilatin? | Rapid IV admin can cause arrhythmias; Compatible with NS only; Do not infuse through small vessels- IVP through large cath or central line; Patent IV a MUST (Purple Glove Syndrome) |
Procedure: Tumor- sella turcica and sm adenomas of pituitary gland. Incision made upper lip, through nasal cavity, sphenoidal sinus to sella turcica | Transphenoidal Surgery |
Minimal risk of ______ and ______ with Transphenoidal Sx | Trauma and hemorrhage |
What are three complications of Transphenoidal Sx? | Transient DI and SIADH, CSF leakage, Meningitis |
Post-op Transphenoidal Sx management includes preventing ______ and promoting healing. What three drugs given? | Antimicrobial agents, corticosteroids, analgesics |
What two things to teach pt Transphenoidal Sx? | Do not blow nose, No straining or coughing |
Oral care should be provided q ____ hours; do not ______. Saline rinse only. | 4; brush teeth |
Head of bed should be elevated at least 30 degrees at least ____ weeks | 2 |
__________ for lips unless on O2. Those on O2 would have what instead of NC? | Petroleum jelly; mask with humidity |