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144 Cards in this Set

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