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Sx ICP Mgt

Neuro Exam

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
Created by: mreedy
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