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214 Cards in this Set
- Front
- Back
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What 2 major nutrients does the brain need to remain viable?
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Glucose
Oxygen |
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Resp. center is located where?
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brain stem
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Age related changes with nervous system..
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delayed response to stimui
forgetfullness slower response to changes in balance less readiness to learn easily distracted reflex is slower increased risk for falls |
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How to help with age related changes...
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make lists
use memory games 30 min. teaching at a time and most important done in first 10 min. (thats when you will be most attentive) |
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COmmon neuro asesmnet findings...
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Pain- h/a ad back pain
dizziness- lightheadness v/s room spining sensory problems motor problems (changes in gait and tremors) Alterations in mental status (LOC, just something doesnt seem right) |
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Glasgow Coma scale
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Best score 15
coma 8 or below |
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LOC
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most sensitive indication of changes in neuro status
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GCS
Eye Opening Spontaneous |
4
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GCS
Eye Opening To Speech |
3
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GCS
Eye Opening to pain |
2
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GCS
Eye opening no response |
1
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GCS
Best verbal response Oriented |
5
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GCS
Best verbal responce Confused |
4
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GCS
best verbal response inapporpriate words (mumble) |
3
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GCS
bst verbal response incomprehensible sounds (min. sounds cant tell what they are saying) |
2
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GCS
best verbal response No reponse |
1
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GCS
Best Motor Response Obeys commands |
6
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GCS
Best motor response Localizes pan |
5
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GCS
Best Motor Respose Flexion-withdrawal |
4
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GCS
Best Motor Response Abnormal flexion |
3
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GCS
Best Motor Response Abnormal extension |
2
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GCS
Best Motor Response No response |
1
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Munroe Kellie Hypothesis
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you have an intracranial vault (skull) which holds all the brain contents. It is a rigid container with limited space. Inside the vault you have 3 things... Blood, Brain and CSF. The volume of these three things remain at a constant.
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Cushings triad
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a change in the volume of any of the 3 components of the munroe kellie hypothesis causes an increase ICP.
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What do you give to pull wwater out of ICP?
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Osmotic diutetics
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Autoregulation
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allows the brain to maintian a constant blood flow regardless of changes in systemic blood pressure.
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Blood Brain barrier
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a network of cells/membranes in the brain capillaries.PERMEABLE TO WATER,O2, LIPID SOLUBLE COMPOUNDS and CO2.
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blood volume control is maintained by...
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the blood brain barrier
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Auto regulation will not take place if...
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systemic pressure (MAP) is <50 or >160.
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A compensatory mechanism of either automatic constriction or dilation of cerebral blood vessels in response to changes (reactive only) in systemic arterial pressure or blood levels of CO2 and O2.
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Autoregulation
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When systemic pressure rises...
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the vessels constrict to protect the brain. If they didnt constrict, then the brain would get engorged with blood.
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Autoregulation also protects...
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the brain from the full impact of a sudden rush of blood. LOC and mental function can be affected.
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When autoregulation fails...
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the reverse occurs...Cerebral vessels dilate in an atempt to increase the amount of blood flo to the brain.
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If CO2 is >45 (hypercapnia)...
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vessels usually will dilate
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If CO2 is <35...
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vessels will constrict
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2 types of seizures
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Provoked
Unprovoked |
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Provoked seizure
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identifiable cause (usually secondary to something else)
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Identifiable causes of seizures
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fever
pre-eclampsia sudden or rapid withdrawal hypoxia hypoglycemia (20-30) Na+ imbalance Menegitis, tumor, hemorrhage, trama |
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Identifiable causes after the age of 65 (new onset)
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Infection
CVD Brain trama Alzheimers Chronic ETOH Dementia |
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If provoked seizures continue...
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you can be characterized as a seizure disorder
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Unprovoked seizure
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no identifiable cause, primary or idiopathic seizure. If you have multiple episodes, youre categorized as a seizure disorder.
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2 classifications of seizures
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Partial
Generalized |
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Aura
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sense of Deja Vu or an unusual smell, or sense of emotion. Usually will get right before you have a seizure.
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Partial seizure
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effecting only one portion of the brain. how it manifests depends on the area (focal/local)
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2 types of partial seizures
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Simple partial
complex partial |
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Simple partial seizure
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no effects on the consciousness, motor portion of the cortex
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Jacksonian
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aka Simple partial...recurrent contralateral muscle contraction in a particular part of the body (hand, leg, face) Abnormal sensations, hallucinations, sensory alterations.
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contralateral
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opposite sides
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Espilateral
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same side of the body
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Comples partial seizure
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temporal region of the brain
-consciousness is impaired in some way (blackout 1-3 min) -usually have an aura -automatisms |
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Automatisms
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repetitive, non-purposeful types of activities (smack thier lips, aimless walking in circles, pick at their clothing)
-Usually amnesia follows -we may think thye are having a psychotic episode |
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Generalized seizure
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effects multiple parts, both hemispheres of the brain...goes deeper into the tissues.
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2 types of generalized seizures
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Petit mal
Grand mal |
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Petit Mal (absence)
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zone out
-Sudden Loss of Motor Activity |
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S/S of petit mal seizure
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Blank stare, unresponsive
they smack thier lips, eyes flutter lasts seconds to minutes Can go undetected for long periods of time b/c of the short duration (they think people zone out) Can have several hundred per day Mainly in children and tend to go away with adolescence |
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If S/S of petit mal seizure are seen after the age of 20..;
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they have identifiable causes of tumors or infections
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grand mal (tonic clonic) seiure
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-occurs in adults
-typpical pattern=may/may not have an aura -occur w/out warning (no aura) -very sudden LOC (fall down) -Intense muscle contraction (this period is divided into 2 phases) |
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the 2 phases of a Grand Mal seizure
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Tonic phase (1st phase)
Clonic Phase (2nd phase) |
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Tonic Phase of grand mal seizure
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Loss of Postural Control
-fall to the floor -epileptic cry -muscles become rigid (jaw clenched and breathing will stop) -they almost alwas become incontinent: always urine, some times bowel -pupils become dilated |
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Epileptic cry
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Air forced from lungs in sudden intense muscle contraction. Sound made when the person falls
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Tonic phase lasts...
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15-20 seconds but can go up to a minute.
--very scary phase--nothing moves |
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Clonic phase of grand mal seizure...
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Alternating contraction/relaxtion of muscles in all extremeties.
-pt tends to HYPERVENTILATE -eyes roll back -frothing --Abruptly stops-- |
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Clonic phases lasts...
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typically 30-40 seconds, but can last up to 1.5 minutes
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Post-ictal phase
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when you stop seizing
-unconcious, unresponsive to stimuli -body relaxes -breathing is quiet -gradually regain consciousness -disoriented -tired -achy, might have h/a (sore from muscle activity) -done for the day...will sleep for several hours -electrolyte imbalances occur (ACIDOTIC) -amnesia very common *increased risk for injury* |
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Status Epilepticus
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intractable (back to back) seizure...EMERGENCY
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S/S of status epilepticus
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-interferes with resp. (hypoxic)
-acidotic (lactic acid from muscle contractions) -hypoglycemic (burning glucose) -exhaustion |
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Status Epilepticus is life threatening if uncontrolled...
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no time to reverse acidosis: metabolic b/c of hypoglycemic
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1st drug of choice for status epi.
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Ativan
-must have a good IV (very thick) -2mg per min. push slow, can repeat if seizure reoccurs within 10-15 min. |
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Other meds given for status Epi...
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--Valium (if ativan does not work)
-Dilantin (not used as immediate) -Phenobarbitol -D50 to reverse hypoglycemia |
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Nursing Interventions after administering meds for Status epi..
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Watch closely afterwards
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Nursing diagnosis for seizures
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-Ineffective breathing pattern
-Risk for injury -Ineffective Coping -Risk for ineffective therapeutic regiment (med adm.) |
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nursing implications safety with seizures
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-PROTECT FROM NJURY-
-help thier head if possible(pad side rails, pillow) -help assist to floorr to prevent fracture -Do not restrain pt (can cause fracture or dislocation) -**DO NOT FORCE ANYTHING INTO MOUTH(especially fingers) -suction what is on outside of mouth |
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Privacy and Dignity with seizures...
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b/c they lose alot of bodily functions: shut the door, pull the curtin, have people turn thier backs to sheild pt. from public.
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Observe and document with a seizure..
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-Note time of onset
-Note behavior prior to onset (epileptic cry) -Note how long post Ictal phase lasts and behavior during. -Doc. what int. you did to protect the pt. form injury -side rails up and padded -note when the seizure stopped |
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If pt is on telemetry when they seize...
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there will be alot of artifact.
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if pt has hx. of sizures when admitted to hospital make sure...
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you have suction setup and O2 in room
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interventions during the post ictal phase...
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-Do not bother them
-It is normal for them to be unresponsive -Roll to the side during the phase |
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Cure for epilepsy..
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no known cure
Meds dont cure, but can help |
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Meds that help control epilepsy
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Dilantin
Tegatrol Depakote Phenobarbitol (these all have narrow therapeutic window) |
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Dilantin given for epilepsy..
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-can only be given with N.S.
-Range 10-20 min. -Given at bedtime b/c it makes people very sleepy and tired. |
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With long term Dilantin Use...
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frequent dental visits due to side effects of GINGIVAL HYPERPLASIA (red, edemtatous gums that cause tooth loss) at least q3months to dentist.
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Increase Vitamin D intake when taking...
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Dilantin
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Dilantin can cause....
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a patechial rash on chest similar to sunburn
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If Dilantin is given with tubefeeding...
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turn off 2 hours before and 2 hours after and flush with sterile water.
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Meds with wider therp. range on them that do not require alot of level monitoring on ....
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Topamax
Kepra Neurontin Gabitril lamictil (does not make them sleepy) *Used more because they help control without impairing normal CNS function* |
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When on meds for seizures...
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we need to document LOC and alertness.
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trt. for seizures...
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-Doc. CNS side effects (visual changes, slurred speech, confusion)
-long term med. therapy requires increased vit. D in the diet because bones will become brittle. -Vagus Nerve Stimulator |
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Vagus Nerve Stimulator
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implanted like a pacemaker in chest. Lead wire through back of neck, wound around Vagas nerve. It sends regular small electrical impulses into vein to interrupt seizures every few minutes. Very successful.
--it si used in conjunction seizure meds to increase the usage of seizure meds. |
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Side Effects of the Vagus Nerve Stimulator
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Hoarsness
throat discomfort |
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Teaching with seizures..
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-Adhere to medicastion schedule (DONT MISS A DOSE, DONT DOUBLE UP ON DOSES)
-Avoid hazardous activity until dosage is regulated -Good oral hygiene (especially if on dilantin)--and watch for rash on trunk -Med alert bracelet -Neurontin 1 hour before you eat or a little less that 2 hours after antacid. |
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to keep blood levels in normal range...
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take meds at same time every day
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What kills people the most with spinal cord injuries?
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-pneumonia
-PE -Sepsis |
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2 types of spinal cord injuries
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tramatic
nontramatic |
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tramatic SCI
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some kind of injury
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non tramatic SCI
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occur over time
-arthritis -CA -infection -bloodvessels -bleeding -inflammation |
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the most spinal cord injuries
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-C5&C6 (most common) cervicaal area
T12 and L1 |
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patho of SCI
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Damage ranges from transient concussion to contusion, laceration, compression to complete transection
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C5 & C6 location
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at the base of neck
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T12 and L1 location
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level of the pubic bone
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C4 injury causes
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quadriplegia
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C6 injury causes
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quadraplegia
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T6 and L1 injury cause
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paraplegia
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2 types of SCI
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Incomplete
Complete |
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there are 2 types of complete SCI
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-complete paraplegia
-complete tetraplegia |
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complete paraplegia
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-permanent loss of nerve function at T1 and below. Loss of movement in legs, bowel, bladder and sexual region.
-But will have upper movements -they can have trunk movement *will use a self propelled wheel chair* |
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complete tetraplegia
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aka quadraplegia\
-loss of hand and arm movements along with legs, bowel, bladder and sexual region. |
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Incomplete SCI
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some movement or little or no feeling or sensation.
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5 classes of Incomplete SCI
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1. Anterior cord syndrome
2. central cord syndrome 3. post cord syndrome 4. Brown-Sequard syndrome 5. Caude Equina lesion |
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anterior cord syndrome
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damage to front of the SC (problems with body temp, impairment in touch and pain sensation below injury)
-can regain some movement |
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central cord syndrome
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loss of function in arms but some leg movement
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posterior cord syndrome
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back of SC
-good muscle strength -feel pain -differentiate between temp -poor coordination |
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Brown-Sequard syndrome
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damage to one side of the SC
-loss of movement on one side but can feel it -preserved movement on other side but no sensation -lower back problems |
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Caude Aquina lesion
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first and second injury to the nerves
-partial or complete loss of sensation -no movement in lower extremity -bowel and bladder problems -nerves can regrow and function can be recovered |
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ASIA scale
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describes a person’s functional impairment as a result of their spinal cord injury
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most cervical injuries result in paralysis in..
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arms and legs
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most thoracic injuries results in pralysis of...
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chest and leg
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Most lumbar and sacral injuries results in paralysis....
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in hip and legs
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lesions at/above C4 generaly result in...
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respiratory arrest
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lesions at/above C7 usually result in...
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quadraplegia
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below the SCI that lasts more than 24 hours...
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carries a poor pprognosis of recovery because association of immediate loss of all sensationand complete loss of movement.
--Blood flow and BP increase. Inflammaion settles in nerve cells and start to die at the distant of the site. |
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Assessment data & prognosis depends on type & level of injury...
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-Paresthesias
-Paralysis -Loss of bowel or bladder control -Hypotension, bradycardia, asystole (neurognic shock) -Acute pain -Respiratory problems |
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2 compications SCI
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-Spinal shock
-Autonomic dyseflexia |
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Spinal Shock
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state of temporary reflex suppresion below the level of the lesion. Ocurs immediately or up to one hour after the cord injury.
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areflexia
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temporary reflex supression
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S/S of spinal shock
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-BP, HR fall
- no sensation below lesion -decreased CO -venous pooling in extremities -peripheral vasodilation -Muscles of resp affected in cervical & thoracic cavity (Decreased VC, secretions; increased pCO2) -Neurogenic blader -bowel distention - paralytic ileus -No perspiration on paralyzed portion of body |
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recovery from spinal shock...
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must be gradual
-return of reflexes -muscle spasms and few reflexes -reflex emptying of bowel/bladder -active rehab only when spinal shock is resolved |
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nursinf considerations with spinal shock..
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Be diligent ato support and protect all thier body functions and defense mechanisms. Once shock resolves, start to let them self care n rehab.
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autonomic dysreflexia
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-Lesions above T6, after spinal shock resolves
-Neurogenic emergency |
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S/S of autonomic dysreflexia
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-Severe pounding HA,
-paroxysmal HTN -Profuse diaphoresis above lesion; -pale, cold, dry skin below lesion -Anxiety -Nausea -Nasal congestion -Bradycardia |
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untreated autonomic dysreflexia leads to...
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seizures
strokes heart attack |
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trt for autonomic dysreflexia
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-Elevate thier head
-take off scd's to decrease BP (decreases venous return) -loosen restrictive clothing -assess for cause (if they have a foley, look for kinks in the tubing, palpate the bladdder. If it is not distended and no kinks in the tubing, check for fecal impaction. It is usually one of those 2 things -monitor BP q15 minutes -give nitrates or apresoline for HTN **once you find the cause...it is over** |
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nursing diagnosis with SCI
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-ineffective breathing pattern r/t interruption in spinal cord stimulation
-Risk for ineffective airway clearance r/t stasis of thick secretion-Ineffective coping (probably the most impacting of all) psych will be called in. |
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Nursing interventions with SCI
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-Airway, ventilation
-Immobilization --keep the neck in a neutral position (dont turn the head: put on backboard with a collar) --maintain patent airway, especially a C level type injury. (alot of Cervical injuries will end up ona ventilator) --Acutely , there may be so many bone fragments surgery will be perfrmed within a couple of days, but right away they will put them in a traction --Gardner Well tongs or a halo traction: to help stabilize the neck. -Supplemental O2 -Monitor VS -ROM -Turn q2h -Catheter/bladder retraining -NG tube -Prevent DVT\ -high calorie, high protein and hig fiber once bowel sounds return and |
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Gardner Well tongs
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ice picks into temples
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Sx for SCI
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-Functional Electrical Stimulation (FES)
-Omentum SX |
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Functional Electrical Stimulation
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doesnt cure paralysis but placing an electrode at site of nerve damage to provoke increased movement, particularly in arms and legs. An implant wit a small generator.
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Omentum Sx
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(experimental)
Fat pad on front of the abdomen that is very vascualr. Omentum is detached and tunneled into injury site to supply damaged nerves with O2 and blood supply to stimulate nerve growth. It secretes chemicals that stimulate nerve growth. Must be done with in 3 hours of the injury. |
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Almost and all SCI will get...
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paralytic ileus
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Methylprednisolone (solu med rol)
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Must be given in high doses within 8 hours of SCI
*main drug* |
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Freedeox
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(steroid)
has to be administered a couple hours after the come in with SCI, given with methylprednisolone to cut down side effects of paralysis. |
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Sygen
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Given within 72 hours of SCI and its continued over a 32 day period (has long half life). Pts are getting alot of functional recovery from this drug!! Hasnt beeen FDA approved yet
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Dopamine
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given to SCI for blood pressure
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Dobutamine
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given to SCI for cardiac support
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Atropine
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given to SCI for symptomatic bradycardia
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Baclofen and Valium or Flexerall
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(antispasmotics)
given SCI for the prevention of spacticity (beware of resp. depression with valium) |
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Protonix or Nexium
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PPI to prevent gastric ulcers due to proteins being given
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NSIADS or narcotis
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given to SCI for pain
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Anticoagulants
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given to SCI to prevent DVT's like Lovenox
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herniated intervertebral disk
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aka ruptured disk
neuropathic pain |
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ruptured disks occur where...
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C6, C7, L4, L5 or S1
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causes of rupture disk
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spontaneous (weakness in that area)
trauma (fall or pick up something heavy) |
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Pain location with the C5 and C6 injury
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neck
shoulder arms radial forearm and thumb (numbness and tingling) |
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Pain location with L4 and L5 injury
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lower back and radiates to the hip and thigh and anterior portion of leg and dorsal aspect o foot and great toe
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Pain location with L5 and S1 injury
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idgluteal pain and posterior pain calf to heel, to plantar aspect of foot.
--Pt. may be aggrevated by sitting, sneezing, coughing, standing climbing stairs or sitting in a car. |
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medications for a ruptured disc
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NSAIDS
muscle relaxants (Rovaaxin) sedatives anti-anxietals (Ativan, Elavil, Ametryptaline) Lyrica Neurontin Cotecosteroids Epidural steroid inj. |
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nursing interventions with rupture disks
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-padded braces
-cervical traction -massage -hot moist compress ---decreases spasms ---increase blood flow to muscles |
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post op nursing interventionss with a anterior cervical diskectomy
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-check voice
-check swaalowing -can they lift thier arms above their heads -can they make a muscle , squeeze your hands equally |
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anterior cervical disketomy
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can cause hemmorahge
carotid injury airway obstruction |
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posterior cervical diskectomy
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weakness of muscles
cant hold neck up |
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Nurse Int. with a post. cerv. diskectomy
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-look for excessive neck pressure and pain at teh incision.
-look for CSF drainage (dural leak) -they will come back with a hemovac drain |
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nursing int. with diskectomy;s
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-Log Roll
-Back pts. need to do most the work themselves. -no sitting longer than 20 minutes -PT for gait ** may take weeks to heal** |
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Ant. Lumbar Interbody fusion then post lumbar interbody fusion
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-remove fragments or old disc
-jack up old vertebrae -come back in next week and do stabilization |
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Biggest problem with ant. lumbar interbody fusion and post lumbar interbody fusion...
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Abdominal problems
Paralytic ileus |
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assessment with a lumbar interbody infusion
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assess
-wound -bowel sounds and movemnets -n/v and pain -abd distention -urinary retention (narcotic use) -can they lift and reaise thier legs -infections |
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myasthenia Gravis
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Myasthenia gravis is a type of autoimmune disorders. An autoimmune disorder occurs when the immune system mistakenly attacks healthy tissue. In people with myasthemia gravis, the body produces antibodies that block the muscle cells from receiving messages (neurotransmitters) from the nerve cell
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S/S of Myasthenia gravis
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-Breathing difficulty because of weakness of the chest wall muscles
-Chewing or swallowing difficulty, causing frequent gagging, choking, or drooling -Difficulty climbing stairs, lifting objects, or rising from a seated position -Difficulty talking -Drooping head -Facial paralysis or weakness of the facial muscles -Fatigue -Hoarseness or changing voice -Double vision -Difficulty maintaining steady gaze -Eyelid drooping |
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First signs to seee with mysthenia gravis
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Ocular symptoms
-drooping eyelid -diplopia -blurred vision -reduced eye clsure |
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Late sign in Mysthenia gravis
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muscle weakness in the limbs
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Drug therapy for mysthenia gravis
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Anticholinesterase meds
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Anticholinesterase meds
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inhibit neuromuscular junction by maintaining acetycholine to promote muscle contraction
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Examples of anticholinesterase meds
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Mestinon
Prostigmine Mytelase |
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Important facts about anticholinesterase meds
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-No fixed dose
-they do not cure...but there is improvement in swallowing and breathing -Timing of the med is critical to keep a good serum level. -take 30 minutes before meals |
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Meds that can antagonize anticholinesterase meds
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acetycholine
antihistimines antidepressives atropine haldol |
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What helps decrease fatigue?
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P.O. potassium supplements
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Tensilon test
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Improves muscle contractility just after dosing...If pt has MG right after it is given they will have immmediate improvement in symptoms.
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What test is given to Mysthenia gravis pts?
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Tensilon test
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Antagonist for Tensilon
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Atropine
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Myasthenic Crisis
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severe generalized weakness and respiratory failure
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what can bring on a myasthenic crisis
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-an upper resp. infection
-after you have a baby -newly diagnosed pt. in which meds arent working as well -the challenge is to figure out whether the pt is having a Myasthenic crisis or a cholinergic crisis. |
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S/s of myasthenic crisis
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disease is progressing from one of the stressors that brought it on
-missed dose of meds -infection or under medication |
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Cholinergic crisis
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d/t an anticholernergic overdose...too much medicine/overdose
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how to manage a Myasthenic crisis
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-Recognition of resp. failure
-Manage secretions (hoB @ 30, suction, yaunker/ballard, ambubag, NPO, may need NG tube) -Maintain gas exchange (intubation 3 days to a week) |
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Once thept is improving with Myasthenia crisis...
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-mechanical soft diet with thick liquids
-Assist with ALD's - Prevent complications with immobility -Talk to the pts to keep them oriented. |
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2 types of brain injusry
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Open
closed |
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Open brain injury
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due to skull freacture or skull pierced by a penetrating object --exposes the brain
-gunshot wound -knife stabbing |
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The worst open brain injury is...
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Basilar fracture
--CSF coming out of nose/ears |
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Raccoons mask
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Bilateral bruising around the eyes
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Battles sign
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unilateral bruising behind the ears
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Rhinorrhea
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spinal fluid leak
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With a spinal fluid leak...
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can do a dextrose stick or if its blood tinged, you can obtain a drop on a kleenex or guaze. LOOKING FOR A HALO SIGN. A yellow halo sign around the blood: +halo sign for CSF
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Laceration
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tearing of the breain tissue that occurs with depressed compund fractures or penetrating injuries of the skull.
Cause:: --intra cerebral hemmorhage --unconscious --hamaplegia (contalateral side) |
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Closed head injusry
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MOST SERIOUS
--due to blunt trauma of the skull --no skull fracture |
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concussion
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minor head injury
-brief loss of consciousness up to 30 min. -GCS 13-15 -Disorientation adn confusion |
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Classic concussion
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LOC up to 6 hours accompanied by some types of amnesia.
-N/V -H/A -Foggy -seeing stars -dizziness -ringinging in the ears - slurred speech -fatigue |
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contusion
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major head injury
-bruising the brain |
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Coup-Contrecoup
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injury at site of impact (coup) and also get injury on opposite of brain (Contrecoup)
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S/S of a Coup- Coutrecoup
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-generalized disturbance in LOC
-stupor -seizure -most severe type of seizure: violates Monroe kellie hypothesis = inc'd ICP |
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Normal ICP
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5-10 mm
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Increased ICP
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leading cause of death in head trauma pts. that reach the hospital alive.
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What happens with Increased ICP
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decreased cerebral perfusion that leads to tissue hypoxia leading to decreased serum pH leading to increased PCO2 leading to cerebral vasodilation.
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Epidural Hemorrhage
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neurosurigical emergency b/c it is an ARTERIAL bleed. Breif period of lucidity. you see bleeding between dura and inner surface of the skull
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subdural hemorrhage
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develops slowly.
they are mainly VENOUS bleeds between dura and arachnoid space. usually occur gradually. |
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Chronic subdural hemmorages are often found in...
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the elderly and chronic ETOH users
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Intracerebral bleeds
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front/temporal lobes most effected
-gun shot wounds -depressed skull fractures -stabbing -contusions -long standing hx of HTN |
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Hydrocephalus
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abnormal increase of CSF in brain resulting in Increased ICP: a shunt can be implanted for drainage
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brain hemorrhage
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brain tissue shifts downwardand forces the brainstem into the spinal column= DEATH
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2 complications of head injury
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Diabetes Insipidous
SIADH |
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Nursing DX with Head Injuries
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Ineffective tissure perfusion
Hyperthermia Acute Pain Anviety |
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Medications for head injuries
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Porpofol
Dilanatin Dexamethasone tylenol |
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Propofol
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neuromuscular blocking agents to decrease agitation. They have no analgesic or sedative effects. They arae paralytic. NO ANTIDOTE
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Drig of choice with head injuries
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Dilantin....if they start having seizures within 7 days of the trauma
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Dexmethasone
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Corticosteroid...stabilizing effect on the cell membrane which inhibits prostagladin synthessis leading to decreased inflammatory response: helps neurons get increased blood flow
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tylenol use with head injuries
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to reduce fever and hyperthermia
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ICP monitoring
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Drill a hole into the skull, put device into the brainto monitor the pressure and can be used to drain fluid. Not painful because brainskull have no pain receptors. Most common/best kind to have is INTROVENTRICULAR cattherter, b/c it bests reflects ICP>
Risks: infection, Increased swelling, ventricle collapse, over draining, and hemorrhage. **also watch for occlusion in the catheter** |
