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CEN - Neurology

Emergency Nursing Certification Review

QuestionAnswer
What 3 items make up the contents of the cranial vault? brain, cerebral spinal fluid, blood
What are normal intracranial pressures? 0 - 15 mm Hg
What is considered an increased intracranial pressure? 20 mm Hg
EARLY SIGNS of ICP in Older children and Adults: level of conscious (restless, confusion, drowsiness),headache, nausea, vomiting, pupil changes
EARLY SIGNS of ICP in Infants: Drowsiness, Separated sutures on the skull, Bulging of the soft spot on top of the head (bulging fontanelle), Vomiting
LATE SIGNS of ICP in Older Children and Adults: Bradycardia, Hypertension, and Bradypnea (Cushing's triad)
What is Cushings Response? Profound bradycardia, Abnormal respirations, Increased systolic pressure (widened pulse pressure)
What is the focus of treatment of ICP? Removal of the cause,Elevate HOB above 30 degrees,Protect the airway (possibly intubation),Diuretics (Mannitol)
What is a HYPOtonic solution? A solution in which the concentration of solute outside the cell is lower than the concentration of solute inside the cell. Water molecules from inside the cell moves into the cell by osmosis to dilute the higher concentration of solute inside the cell.
What is an ISOtonic solution? A solution in which the concentration of solute outside the cell is equal with the concentration of solute inside the cell. Water molecules move into and out of a cell via osmosis at the same rate and the cell retains its normal shape.
What measures are used to reduce the contents of the skull when Blood is the causative factor of ICP. Patient position, Maintain normothermis, prevent/treat seizures, reduce noxious stimuli, suctioning
What measures are used to reduce the contents of the skull when CSF fluid is the causative factor of ICP. Surgical decompresion, CSF dainage catheter
Definition: Concussion Traumatic reversible neurological deficit that results in a temporary loss of consciousness and some degeee of retrograde amnesia
Treatment: Concussion Assure pt. safety, non-narcotic analgesic for pain
Definition: Diffuse axonal injury disruption of axons in the cerebrum which leads to a disconnection of the cortex and the brain-stem reticular formation
Treatment: Diffuse axonal injury decrease ICP and support patient
Sign/symptoms: Diffuse axonal injury Decordicate or decerebrate posturing, loss of brain stem reflexes, hypertension, hyperthermia, excessive sweating
Definition: Intracerebral bleeds Bleeding between the skull and the dura mater, usually from the middle meningeal artery
Sign/symptoms: Intracerebral bleeds Behavior changes,Decreased consciousness, Headache,Lethargy,Neurological symptoms, including weakness, numbness, eye movement problems, and double vision,Seizures, Behavior changes,Decreased consciousness, Headache, Lethargy, Neurological symptoms, in
Common causes of ICP: Aneurysm, Brain tumor, Encephalitis, Head injury, Hydrocephalus, Meningitis, Subdural hematoma, Status epilepticus, Stroke
Hypertonic solution examples: Dextrose 5% in 0.45% saline Dextrose 5% in saline 0.9% Dextrose 10% in saline 0.9% Dextrose 5% in lactated Ringer's Hyperosmolar saline 3% and 5% NaCl
Hypotonic solution examples: 0.45%NS
Isotonic solution examples: Dextrose 2.5% in 0.45% saline Dextrose 5% in 0.2% saline Dextrose 5% in water (D5W) Ringer's lactate Normal saline (NS) 0.9% Dextran 40 10% in NS (0.9%) Dextran 70% in NS
crystolloid
Created by: Vandkvinde