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Neuro_Critical care

test 2

what is the normal intracranial pressure? 5-15 mmHg
3 Risk factors for increased ICP Increased Brain volume (tumors) Increased CSF (hydrocephalus, obstruction, ext CSF Increased Blood (loss of autoreg, hemorrhage, vasodialation)
secondary causes of increased ICP? Extracranial, high level of PEEP, straining.
Brain herniation after compensation of CSF means? maxed out
Because of the rigid skull, an increase in one component (brain, CSF, or blood) must be compensated by a decrease in another component This compensation is weak and short-lived so if the risk factor continues then ICP increases dramatically
when should you watch out for cerebral herniation? if there was head trauma
A constant cerebral blood flow over a wide range of blood pressures is maintained through autoregulation
MAP over the range of 50-150 mm Hg does not alter Cerebral blood flow CBF
Increased ICP reduces CPP and brain is less well-perfused (CBF decreases)
MAP = MAP = SBP + (2xDB) / 3
what are the indication for Intracranial Pressure Monitoring? Glascow coma score of 3-8
what is the most reliable ICP monitoring device? INTER VENTRICULAR cathether
What functions are we able to perform with inter ventricular catheter drain CSF test CSF for infection Entrathecal medication access.
less than 60 ICP blood flow is diminished and compromised
vasoconstriction increased ICP
assessment of lvl of consciousness is done q 1 hr. and if they are on TPA q 15min
Altered LOC Papilledema (eyes are swollen) Unilateral pupil dilation (blown pupil) Headache Vomiting Early response to increased ICP
Cushing’s triad: systolic hypertension, widening pulse pressure, bradycardia, hyperventilation (Cheyne stokes) Paralysis/paresthesia Late response to increased ICP
Major complication of increased ICP is brainstem herniation (responsible for breathing)
Negative Oculocephalic/ oculovestibular reflex means damage to pons or medulla.
what drug is used for Increased ICP treatment? osmotic diuretic Mannitol, acts w in 20 min. Use filter needle.
loss of consciossness, prolonged coma abnormal posturing increased ICP hypertensive hyperthermic are S/S of... Diffuse axonal injury
what is the worst skull fracture? Depressed, bony indentation at least the thickness of the skull. Pt is at risk for infection
Battle’s sign: bruising of mastoid process Raccoon’s eyes: periorbital bruising Conjunctival hemorrhage Leaking CSF: halo sign, dextrose; report of salty taste Basilar fractures: occurs at base of skull
bleeding from artery. Bad, worse type of bleed a pt can have. Pt will have initial loss of concsioussness, wake up and deteriorate. This will clue you in that the hematoma is Epidural hematoma
bleeding from a vein Acute – needs to be treated w in 4 hrs. worried about it expanding Subacute – monitor 48hr – 2 weeks, watching the progression of the bleed. CT scans Subdural hematoma
signs of a Subarachnoid hemorrhage noise in the head, and have the WORSE head ache of their life, ever! and neuchal rigidity.
why do we do Lumbar Puncture? to see if there is blood in it which will indicate there is a suburachnoid hemorrhage is occuring.
what happens to sodium with Diabetes Incipdis goes up
what happens to sodium with SIADH sodium goes down
General Symptoms HA Vomiting Changes in visual acuity and fields, diplopia Hemiparesis and hemiplegia Paresthesias Seizures Aphasia Cerebral (Supratentorial)
Focal Symtoms Hearing loss Facial pain and weakness Dysphagia, decreased gag reflex Nystagmus Hoarseness Ataxia and dysarthria Brainstem (Infratentorial)
meds used for decreasing cerebral edema Dexamethasone (Decadron)
(NIH) National Institute of health Tells us how bad the stroke is
gold standard for diagnosis of CVA CT scan. will tell us if stroke is hemorrhagic or ischemic.
Ichemic stroke less than 3 hr give TPA, if more than 3 hr, give supportive RN measures
symptoms of meningitis triad of headache, stiff neck and fever kernings and brudzinski and nuchal rigidity
2 high risk groups for meningitis are prisoners and college students.
Consecutive seizures for 20–30 minutes without return of consciousness Status Epilepticus
treatment of Status Epilepticus ativan and valuim. test dilanting lvl to make sure they are taking their medications.
Autoimmune attack on peripheral nervous system Guillain-Barre Syndrome
Starts with weakness or tingling sensations in the legs, Can spread upward resulting in complete paralysis Guillain-Barre Syndrome
Created by: sputnik775