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144 Cards in this Set
- Front
- Back
why should IV tubing be converted the night before an MRI
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to make tubing long enough and make sure dose it appropriate
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narrow xray beams scan body parts in successive layers-variation in tissue density
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CT scan
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important to check before given contrast
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shellfish allergy due to iodine
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may be required with CT scan due to claustrophobic
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sedation
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what type of procudure can pick up chemical changes in the cell
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MRI
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how are images created with MRI's
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through combination of radiofrequency pulses and powerful magnetic fields
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important with MRI's
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remove all metal objects
IV pumps oxygen patches |
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why are MRI's often used over CT
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picks up earlier changes
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what should be done if pt needs an MRI and is on the vent
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bag them
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done if bleeding and brain shifting is expected
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CT scan
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if ICP is increased and LP is performed what will happen
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rapid gush and drop of ICP
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what is a LP
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removal of CSF for dx and pressure measurement
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where is the needle for LP inserted
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3-5th lumbar vertebrae into subarachnoid space
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LP is contraindicated with what
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increased ICP
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position for LP
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side lying
legs flexed to chest and head flexed |
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position for LP post procedure
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prone for 2-3 hours
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can result from positioning of LP
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airway obstruction
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what are the complications of LP (4)
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-HA (frontal/occipital)
-throbbing d/t CSF leak - infection -hematoma |
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can be done for correction of HA after LP
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blood patch
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what is a blood patch
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removing blood from AC and injecting into epidural space
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can be given after LP (2)
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fluid replacement
analgesics |
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helps to decrease HA from LP
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laying flat
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what does brain need
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constant supply of 02
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% of CO that brain req's
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15-20
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% of glucose that the brain uses
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15
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needed to deliver nutrients to brain
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blood flow
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hard to fix
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intracellular edema
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first thing to go upon neuro assessment
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LOC
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included with neuro assessment (5)
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- LOC
- motor response/strength - pupillary response - reflexes - VS |
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why does motor response get delayed
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increased ICP
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what is epsilateral
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same pupil/side
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contralateral
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diff side
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right sided stroke would affect what
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r eye and L side
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eye opening responses for glasgoq coma scale
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4- spont
3- to speech 2- to pain 1- none |
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verbal response scale for glasgow
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5- oriented
4- confused 3- inappropriate 2- incomprehensible 1- none |
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motor response scale for glasgow
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6- obeys commands
5- localizes to pain 4- withdraws from pain 3-flexion to pain 2- extension to pain 1- none |
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min and max scores for glasgow
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3= bad
15=good |
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when is one often intubated based on glasgow score
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8
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mild coma
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13-15
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moderate disability
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9-12
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severe disability
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3-8
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vegetative state score
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less than 3
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brain death state (2)
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- no brain function
- specific criteria needed for this dx |
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what is persistant vegetative state
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when it last longer than 1 month
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vegetative state characteristics (3)
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- sleep wake cycles
- arousal w/no interaction - no localized response to pain |
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severe disability characteristics (4)
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- coma
-unconscious state - no meaningful response - no voluntary activities |
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moderate disability characteristics (3)
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- LOC for >30min
- Px or cognitive impairment - benefit from rehab |
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anasocoria
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unequal pupils
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important to assess with pupils (4)
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- size
-shape -reactivity to light - comparison of one pupil to the other |
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sluggish pupils
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compression of 3rd cranial nerve
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cause of sluggish pupils (2)
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- cerebral edema
- herniation |
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causes of nonreactive or fixed pupils (3)
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- herniation
- severe hypoxia - ischemia |
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due to compression of the 3rd cranial nerve
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nonreactive or fixed pupils
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occurs with brain death
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loss of light reflex
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computer with LCD and digital camera
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pupillometer
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characteristics of pupilometer (5)
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- quantifies pupillary size and response
- noninvasive - 0-5 scale -0-3 abnormal - 4-5 normal |
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what are dolls eyes
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normal response with deviation of the eyes to the opposite side of head turning
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brain death dolls eyes =
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oculocephalic reflexes absent (no movement)
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absence of corneal relex =
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brainstem dysfunction
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what is the corneal reflex
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sensory -V
motor - VII |
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how is corneal reflex tested
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wisp of cotton touched to cornea causing pt to blink
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small amt of cold water delivered into innner ear canal
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cold calorics
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what does cold calorics doe
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stimulate inner ear nerves
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what does cold calorics cause
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nystagmas
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no movement with cold calorics means what
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brainstem injury/death
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what should happen with cold calorics
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eye should move away from cold water and slowly back
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should be considered with motor function (4)
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- focus on arm and leg movement
- symmetry is most important movement - consider strength and tone - comparison to baseline is key |
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with decordicate posturing the ICP can rise and go to what
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deceribate
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no cognitive function but has sleep wake cycles
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persistent vegetative state
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pt is unable to move or respond except for eye movement due to a lesion affecting the pons
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locked in syndrome
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unconsciousness, unresponsiveness, and inability to arouse
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coma
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hypothermia causes this to increase with brain head injury
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metabolic demands
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refers to the brains ability to change the diameter of blood vessels to maintain cerebral blood flow
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autoregulation
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decreased CO results in
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vasoconstriction
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increased CO results in
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vasodilation
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C02 decreases what (3)
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vasoconstriction
bloodflow ICP |
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S&S of increased ICP (14)
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- HA
- N/V - decreasing LOC - change in pupil size/reaction - papilledema - unilater motor loss - slowed/changed resp pattern - rise in pulse pressure - elevated body temp - loss of temp control - rise in systolic BP w/ widening pulse pressure - restlessness - szs - posturing |
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what is papilledema
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edema of optic nerve
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earliest sign of increasing ICP
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decreasing LOC
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late S&S of increasing ICP (7)
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- tachycardia---> bradycardia
-apnea - cushings triad - decorticate/decerebrate - alteration in pupil size and reactivity - Szs - papilledema |
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what is the cushings triad (3)
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- increased systolic pressure with widening pulse pressure
- bradycarida - decreased resp rate or change in pattern |
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what is the first impulse to compensate with increased ICp
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tachycardia
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when is cushings triad seen
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terminal stages of acute head injury
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how to mtr for declining neuro function (8)
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- initial assessment
- neuro checks q 1hr -LOC mtr q 1hr - GCS q 1 hr - pupil assessment - speech assessment - motor function - evaluate VS data and patterns |
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where is ICP mtr placed
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opposite side of injury
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what can help determine how much to drive the BP
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- CPP
- Pbt02 |
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how is CPP figured
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MAP-ICP
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normal CPP
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70-100
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CPP of less than 50 results in what
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permanent neurological damage
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brain tissue oxygen level
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20-40
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these ppl have poor outcomes
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CPP <60
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mngt of increased ICP (3)
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- reduce volume of CSF
- preserve cerebral metabolic function - avoid situations which increase ICP |
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how can CSF volume be reduced (2)
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-venticulostomy/EVD
- VP shunt |
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how can one preserve cerebral metabolic function
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- oxygenation
- perfusion - ICP/CPP monitoring |
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normal ICP
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<20
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what are situations to avoid that increase ICP (3)
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- suctioning/bathing/turning
-head flexion/extension - valsalvas |
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what is a VP shunt
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permanent and reabsorbs to atrium or peritineum
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very hard on ICP
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constipation
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shunts that are used for adults and why
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VA bc they have no more growth
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why VP in peds
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absorption and longer tube for growth bc tube moves up
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surgical placement of tube into the vent of the brain.
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ventriculostomy
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why are ventriculostmies done
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to mtr ICP and relieve pressure through the drainage of CSF
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how can the amt of CSF drainage be controlled
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by elevating or lowering the CSF collection device
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how can one drain CSF
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open the mtr
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ventriculostomy/EVD nsg responsibilities (6)
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- level at the ear (zero)
- correct pressure set - tubing/clamps/stopcock open - mtr drainage - check dsg and insertion site - caution sign on door to not move pt |
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should be done if moving the pt
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relevel drain
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help relieve pressure by hooking to EVD of other type of drain set up
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lumbar drains
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characteristics of lumbar drains (3)
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- drain CSF
- no leveling reference point - drain by gravity |
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if the ICP rises what happens to the CPP
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falls
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cannot be given til adequate volume
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vasopressors
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how can one drive CPP
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through manipulation of ICP and MAP
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can help manipulate ICP and MAP (3)
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- vasopressors
- fluids - CSF drain |
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help minimize ICP (5)
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- sedation (opiates/barbs/prop)
- osmotic agents (mannitol&3) -ventriculostomy - position - parlytic agents |
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should be assessed with paralytic agents
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train of four (need 3 or 2)
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decrease brain 02 (4)
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- hypoxia
- increased ICP - increased temp - decreased CPP/MAP |
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increases brain 02 (4)
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- draining CSF
- increasing CPP/MAP - decrease temp -barbituates |
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why should increased PIP and PEEP levels be avoided
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causes pressure increase ICP and CO impairment
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dop >3 causes what
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alpha effects
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what does alpha do
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stops brain perfusion
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ADH constrictor
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vasopresson
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dose of dopamine in renal pts
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<3mcg
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helps to decrease sepsis
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early gut feedings
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why should positioning of pts be less than 30degrees
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bc 90 cuts off femoral flexion circulation
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best route for cranial surgery
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transphenoidal
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should not elevate HOB bc it pushes brain down and causes pressure with this type of surg
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infratentorial cranial surg
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opening of the skull
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craniotomy
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excision of a portion of the skull
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craniectomy
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repair of a cranial defect using a plastic or metal plate
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cranioplasty
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circular openings
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burr holes
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req's education with learning and emotions
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supratentorial cranial surgery
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increases in temp does what
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increases brain 02 consumption
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meds for shivering protocol (6)
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-tylenol (IV)
- buspirone - mag sulfate - demoral - sedation - neuromuscular blockade |
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what is ofirmec
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IV tylenol
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how long is the tylenol infusion
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15 min
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should be corrected slowly to prevent cellular edema
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SIADH
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too wet
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SIADH
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too dry
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DI
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characteristics of SIADH (6)
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- decreased urine output
-NA <135 - serum osmo <280 - wt gain - confusion - increased BP |
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characteristics of DI (6)
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- compression of PP
- lack of ASH release - excessive urine -dehydration - decreased urine spec gravity - increased serum osmo |
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potent cerebral vasodilator
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carbon dioxide
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results in acidosis
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hypoxia
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cerebral vasodilator
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Low PH
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promotes venous return
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HOB up to 60
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should be started within 48 hrs
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gut feedings
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