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Neuro_Critical care
test 2
| Question | Answer |
|---|---|
| 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 |
| CPP = | MAP - ICP |
| NORMAL CPP IS | 60-100 |
| 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
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