test 2
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| what is the normal intracranial pressure? | 5-15 mmHg
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| 3 Risk factors for increased ICP | Increased Brain volume (tumors)
Increased CSF (hydrocephalus, obstruction, ext CSF
Increased Blood (loss of autoreg, hemorrhage, vasodialation)
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| secondary causes of increased ICP? | Extracranial, high level of PEEP, straining.
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| Brain herniation after compensation of CSF means? | maxed out
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| 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
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| when should you watch out for cerebral herniation? | if there was head trauma
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| A constant cerebral blood flow over a wide range of blood pressures is maintained through | autoregulation
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| MAP over the range of 50-150 mm Hg | does not alter Cerebral blood flow CBF
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| CPP = | MAP - ICP
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| NORMAL CPP IS | 60-100
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| Increased ICP reduces CPP and | brain is less well-perfused (CBF decreases)
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| MAP = |
MAP = SBP + (2xDB) / 3
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| what are the indication for Intracranial Pressure Monitoring? | Glascow coma score of 3-8
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| what is the most reliable ICP monitoring device? | INTER VENTRICULAR cathether
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| What functions are we able to perform with inter ventricular catheter | drain CSF
test CSF for infection
Entrathecal medication access.
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| less than 60 ICP | blood flow is diminished and compromised
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| vasoconstriction | increased ICP
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| assessment of lvl of consciousness is done q 1 hr. and if they are on TPA | q 15min
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| Altered LOC Papilledema (eyes are swollen) Unilateral pupil dilation (blown pupil) Headache Vomiting | Early response to increased ICP
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| Cushing’s triad: systolic hypertension, widening pulse pressure, bradycardia, hyperventilation (Cheyne stokes) Paralysis/paresthesia | Late response to increased ICP
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| Major complication of increased ICP is | brainstem herniation (responsible for breathing)
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| Negative Oculocephalic/ oculovestibular reflex means | damage to pons or medulla.
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| what drug is used for Increased ICP treatment? | osmotic diuretic Mannitol, acts w in 20 min. Use filter needle.
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| loss of consciossness, prolonged coma abnormal posturing increased ICP hypertensive hyperthermic are S/S of... | Diffuse axonal injury
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| what is the worst skull fracture? | Depressed, bony indentation at least the thickness of the skull. Pt is at risk for infection
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| 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
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| 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
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| 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
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| signs of a Subarachnoid hemorrhage | noise in the head, and have the WORSE head ache of their life, ever! and neuchal rigidity.
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| why do we do Lumbar Puncture? | to see if there is blood in it which will indicate there is a suburachnoid hemorrhage is occuring.
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| what happens to sodium with Diabetes Incipdis | goes up
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| what happens to sodium with SIADH | sodium goes down
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| General Symptoms HA Vomiting Changes in visual acuity and fields, diplopia Hemiparesis and hemiplegia Paresthesias Seizures Aphasia | Cerebral (Supratentorial)
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| Focal Symtoms Hearing loss Facial pain and weakness Dysphagia, decreased gag reflex Nystagmus Hoarseness Ataxia and dysarthria | Brainstem
(Infratentorial)
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| meds used for decreasing cerebral edema | Dexamethasone (Decadron)
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| (NIH) National Institute of health | Tells us how bad the stroke is
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| gold standard for diagnosis of CVA | CT scan. will tell us if stroke is hemorrhagic or ischemic.
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| Ichemic stroke less than 3 hr | give TPA, if more than 3 hr, give supportive RN measures
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| symptoms of meningitis | triad of headache, stiff neck and fever
kernings and brudzinski and nuchal rigidity
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| 2 high risk groups for meningitis are | prisoners and college students.
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| Consecutive seizures for 20–30 minutes without return of consciousness | Status Epilepticus
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| treatment of Status Epilepticus | ativan and valuim. test dilanting lvl to make sure they are taking their medications.
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| Autoimmune attack on peripheral nervous system | Guillain-Barre Syndrome
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| Starts with weakness or tingling sensations in the legs, Can spread upward resulting in complete paralysis | Guillain-Barre Syndrome
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