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191 Cards in this Set

  • Front
  • Back
Status epilepticus is defined as...
seizure activity lasting > 5-10 minutes
Status epilepticus is usually with what type of seizure?
grand mall/tonic-clonic
In a patient with epilepsy, what is the leading cause of Status epilepticus?
failure to take anticonvulsants regularly
What is the leading cause of Status epilepticus?
CVA
During which type of seizure will a patient lose conciousness and stop breating?
grand mal/tonic-clonic
What ist he #1 concern during Status epilepticus?
airway/breathing
Why is an NGT placed during Status epilepticus?
to prevent aspiration
What kind of fluids should you run during Status epilepticus?
NS only
What is the drug of choice for Status epilepticus?
ativan IV
What can be given instead of ativan for Status epilepticus?
IV valium
If Status epilepticus continues despite ativan what can be given? (2)
IV phentoin (Dilantin)
Fosphenytoin
How fast can IV phentoin (Dilantin) and
Fosphenytoin be given?
No faster than 50mg/min
What is the last ditch effort in meds for status epilepticus?
IV propofol
What do you need to watch for when giving Propofol?
hypotension
Encephalitis:
inflammation of the brain tissue and often the meninges
What 3 parts of the brain affect?
cerebrum
brainstem
cerebellum
Where do you get Arbovirus from?
mosquito or tick
If a pt has encephalitis secondary to herpes simplex what can be given as treatment?
acyclovere
What is the most common non-epidemic type of encephalitis?
herpes simplex type I
What are the 3 cardinal signs for meningitis?
Fever
HA
Nuchal rigidity
Is there drugs available for arbovirus or enterovirus ensephalitis?
no
Increased ICP is defined as:
sustained increase of ICP of >20 mmHg for > 5 minutes
What is the normal ICP?
0-15 mmHg
In the Monro-Kellie hypothesis, what are the 3 thrings that contribute to ICP?
Volume of blood
Volume of CSF
Volume of Brain
Hypercarbia and hypoxia will ________ circulating blood volume
increase
What may cause an increase in CSF?
hydrocephalus
What may cause an increase in brain volume?
cerebral edema
How do you calculate CPP?
CPP= MAP - ICP
What is the normal CPP?
70-100 mmHg
What is the average CPP?
85 mmHg
If CPP is less than 60 what happens?
cerebral anoxia
ICP is 15 and MAP is 90, what is the CPP?
75
MAP is 80 and ICP is 30, what is the CPP?
50
Compensatory mechanisms for IICP are _________
temporary
With HTN brain vessels will _________ to ______ flow to brain in autoregulation
constrict; decrease
With hypotension brain vessels will _________ to ______ flow to brain in autoregulation
Dilate; increase
With accomadation, the brain will push blood into the _____ _______ to decrease pressure in the brain
venous sinuses
With accomodation, the brain will ________ reabsorption to decrease pressure in the brain
increase
With accomodation, the brain will divert CSF to the ________ ______ to decrease pressure in the brain
subarachnoid space
What 3 things may lead to an increased cerebral blood flow?
hypercapnia
hypoxia (e.g. suctioning)
Fluid overload
What are hte 4 factors which may precipitate IICP?
Increased cerebral blood flow
Jugular drainage obstruction
increased oxygen demand
cerebral edema
Neck flexion adn hyperextension may cause what factor that precipitates IICP?
Jugular drainage obstruction
Valsalva maneuver, PEEP ventilation, vomitting, and coughing are all things that may lead to...
jugular drainage obstruction and IICP
Seizures, hyperthermia, shivering, hyperactivity, and pain all ________ oxygen demand in the brain
increase
an increased oxygen demand in the brain will lead to...
increased cerebral blood flow and IICP
Cytotoxic cerebral edema is characterized by...
hypoxia
Vasogenic cerebral edema is characterized by...
breakdown in BBB allowing proteins to penetrate which pulls water into cells
Ischemia from CVA, cardiac arrest, asphyxiation, and SIADH all lead to ________ cerebral edema
cytotoxic
Head injuries, brain tumors, meningitis, and abssess' all lead to ________ cerebral edema
vasogenic
What are the 3 supratentorial herniation syndromes?
cingulate
Central
Uncal
What is the infratentorial herniation syndrome?
cerebellar tonsil
A cingulate herniation is a _________ herniation of ________ hemisphere across the ________
unilateral; cerebral; midline
A cingulate herniation will compress what 2 things?
cerebral blood vessesls and brain tissue
What are 2 s/s of a cingulate herniation?
change in LOC
change in mental status
A central herniation is ________ displacement of _________ hemisphere through the _______ notch
downward; cerebral; tentorial
A central herniation will compress....
brainstem and vital centers
Early or late s/s of central herniation: changes in LOC and respiration
early
Early or late s/s of central herniation: decortecate posturing
late
Early or late s/s of central herniation: motor weakness and increased muscle tone
early
Early or late s/s of central herniation: small pupils
early
Early or late s/s of central herniation: cheyne-stokes respirations
late
Early or late s/s of central herniation: positive babinski reflex
early
WIth decorticate posturing arms....
flex to the core
With decerabate posturings arm.s...
are tight to the sides
With Flaccidity posturing limbs are...
completely limp
A positive babinski is when...and it is (normal/abnormal)
toes flare; abnormal
What is a negative babinski?
toes curl, this is normal
An uncal herniation is a herniation of the ______ portion of the _______ lobe through the _______ notch
Uncal; temporal; tentorial
An uncal herniation will compress...
the midbrain
An uncle herniation presses on the midbrain which causes dysfunction of what cranial nerve?
CN III
What is the cardinal sign of an uncal herniation?
CN III is affected which causes ipsilateral dilated pupil
Contralateral hemiplegia is seen in what kind of herniation?
uncal
Decerabrate posturing is seen in what kind of herniation?
uncal
Decortacate posturing is seen in what kind of herniation?
central
Fixed midposition pupils are seen in what kind of herniation?
worsening Uncal herniation
An Uncal herniation will progress to a __________ if not treated
coma
A cerebellar tonsil herniation causes the cerebellar _________ to be displaced thru the ________ ________ .
Tonsils; foramen magnum
With cerebellar tonsil herniation there is compression on the ____ _____.
brain stem
THe pressure on the brain stem and medulla during a cerebellar tonsil herniation will cause compromised...
Cardiovascular and respiratory function
Flaccidity is a sign of _________ in a patient without a spinal chord injury.
brain death
Vital sign are ______ indications of herniation.
late
Cheyne stokes pattern:
shallow.....deep....shallow....apnea...then repeat
Cluster respirations:
no pattern in respirations then apnea
Central neurogenic respirations:
hyperventilation
Apneusis respirations-
big breath....apnea....big breath
Atoxic breathing
no pattern
What is normal with dolls eyes?
eyes stay fixed or turn in the opposite direction that head is turned
How do you test oculocephalic response?
dolls eyes
How do you test oculovestibular response?
ice water in ear
WHat is a normal oculovestibular response?
eyes turn towards the ice water
papilledema...
swelling inthe optic disk
change in LOC, HA, pupillary changes, N/V, and papilledema are all s/s of...
increased ICP
What is cushings triad?
slow, bounding pulse

irregular respirations

increased systolic pressure c widening pulse pressure
Cushings triad is a _______ sign of herniation
late
What is the only kind of ICP monitoring that can also drain CSF?
Ventriculostomy
how much CSF can be drained per hour?
20-25 ml/hr
How often should you record ICP and CPP when monitoring a pt?
every hour
What is evoked potential monitoring?
EEG monitor while you try to illicit a response to stimulation
CBF studies are used to establish...
brain death
What will be found in a normal culture of CSF?
water, lytes, glucose, and protein
What is the goal ICP?
<20 mmHg
What is the goal CPP?
at least 70 mmHg
What is the goal PaO2 with IICP?
80-100 mmHg
What is the goal PaCO2 with IICP?
35-45 mmHg
When may you want PaCO2 to be 32-35mmHg?
possibly in the early treatment of IICP, but only for a very short amount of time
Mannitol (osmotic diuretic) will pull water from _________ tissue
normal
How quickly will mannitol work?
in 20 minutes
What are the risks with using manitol for IICP?
rebound cerebral edema
hypotension
What does furosemide (loop diuretic) do to CSF?
decreases the production of CSF
Furosemide will remove Na and H2O from ________ tissue
injured
When giving diuretics for IICP, what should you replace what you pull off with?
NS
What corticosteroid is given for IICP?
dexamethasone (decadron) but its controversial
What is the goal systolic pressure for IICP?
<160 mmHg
What is the goal MAP for IICP?
70-90 mmHg
In vasospasms associated with subarachnoid hemorrhage a _______ BP is required
high
When is Nicardipine used in IICP?
to manage vasospasms associated with subarachnoid hemorrhage
What rate should NS be infused in a patient with IICP?
75-100 mL/hr
What is the preferred body temp for pts with IICp?
controlled hypothermia
What are 2 disadvantages of sedating a patient with IICP?
decreased BP
don't know the actual LOC
What drug is used to medically induce a coma?
pentobarbital
What will pentobarbital do?
induce a barbiturate coma
Why would you put a patient into a coma when they have IICP?
Decrease metabolism
decrease cerebral edema
increase cerebral blood flow
What is the most common cause of spinal chord injury?
MVA
most patients with spinal chord injury die from ________ or __________
infection or complications of immobility
A complete spinal chord injury?
spinal chord is completely cut through
a partial spinal chord injury?
spinal chord is only partially cut
What is spinal shock?
temporary loss of autonomic, sensory and motor function below the level of injury
What are the 3 function lost in spinal shock?
autonomic
sensory
motor
Spinal shock mostly often occurs with ______ lesions
complete
How do you know when spinal shock has resolved?
return of simple reflexes below the level of the lesion
During spinal shock HR is...
bradycardia
During spinal shock blood vessels...
vasodilate/lose tone
Durding spinal shock thermoregulation is...
impaired
During spinal shock Bowel and bladder function are...
lost
What is the priority with a new spinal chord injury?
airway
Injuries below _____ leave a patient with intact diaphragmatic breathing.
C 5
How do assess the motor neuro s/s of a patient with spinal chord injury?
resp rate, rhythm, depth
movement/strength of ext, head
How do you assess the sensory s/s of a patient with spinal chord injury?
Pinprick
position sense
temperature
Vasodilation that occurs with a spinal chord injury will ______ BP, HR, and venous return
decrease
Venous stasis that occurs in pts with spinal chord injury leads to an increased risk for...
clots
poikolothermy:
pt with spinal chord injury assumes the ambient temperature
How long post spinal chord injury does a pt have an NGT?
at least 72 hours
Will you hear bowel sounds in a pt will a spinal chord injury?
no, paralytic illeus
What is given to prevent stress ulcers in pts with spinal chord injury?
h2 blockers or proton pump inhibitors
If you are giving corticosteroids to a new spinal chord injury pt, when must they be given?
within 8 hours of injury
WHat type of bed should be used with a spinal chord injury pt?
kinetic
WHen does autonomic dysreflexia ocur?
with spinal chord injuries at T6 or above after resolution of spinal shock
WHat cuases autonomic dysreflexia
an intense sympathetic response to stimuli
ex. kinked catheter or fecal impaction
What is the biggest concern with Autonomic dysreflexia?
malignant HTN
A patient with Autonomic dysreflexia will complain of what?
severe headache, congestions, swetting above level of lesion
When will lymphocytes appear in the CSF in a pt with GBS?
in 1-2 weeks
Why is immunoglobulin given to a pt with GBS?
decrease inflammation
WHat is the antidote for Tensilon testing in MG?
Atropine sulfate
WHen is atropine sulfate used for a pt with MG?
as an antidote for tensilon testing
1. Head injury is the leading cause of trauma-related deaths in persons younger than______ and occurs____times as often in males.
45; 1.5
decceleration
Head hits a stationary object.
linear fracture
Simple, clean break in the skull
laceration
cortical surface is torn
Aceleration
Head is in motion
depressed fracture
Bone presses inward into brain tissue
Basilar skull fracture
CSF leaks from nose and/or ears
open fracture
There is a direct opening to brain tissue
cominuted fracture
Fragments of bone are in brain tissue
List the specific signs related to basilar skull fracture
Battles’ sign- bruising behind ear

Raccoon’s eyes- bruising around eyes

Rhinorrhea and otorrhea
What is the specific infectious complication of basilar skull fracture?
Meningitis
What is the nursing care specific to otorrhea/rhinorrhea?
Let it flow freely- do not blow nose.

Don’t place anything in nose or ear.
Why are nasogastric tubes avoided with basilar skull fractures
to avoid penetrating the brain
Which statement about Guillain Barre’ Syndrome (GBS) is correct?
a. Clients with GBS usually present with an acute respiratory illness or injury.
b.Males are affected twice as often as females.
c.Most evidence points to a cell-mediated immunologic reactions as the cause.
d.The major problem in GBS is the destruction of the muscle receptor site.
c. most evidence points to a cell-mediated immunolog reaction as the cause
2.Which of the following would the nurse report to the physician immediately for a client with GBS?
a. Increasing loss of motor function
b. Ineffective cough
c.Dyspnea and confusion
d.Analgesia following administration of opoids
c. dyspnea and confusion---indicates oncoming respiratory failure
Which of the following statements about treatment for GBS is correct?
a.Immunoglobins are curative.
b.Second treatments with plasmapheresis have increased risk of side effects.
c. Treatment is supportive because this disease is usually self-limiting.
d.Immunoglobins have no major side effects.
c. treatment is supportive because this disease is usually self-limiting
Which should be included in health care teaching for the GBS client?
a.Always include a family member or significant other.
b.Instructions given in oral form only.
c. Always include information on range-of-motion exercises.
d.Include information on the need for continued plasmaphersis.
a. always include family member or significant other
Which of the following statements about Tensilon testing is correct?
a. A false-positive test may occur if the muscle is extremely weak.
b.The drug has a long duration of action.
c. The test can be used to distinguish between a cholinergic crisis and a myasthenic crisis.
d.A false-negative test can result from increases effort by the client.
c. the test can be used to distinguish between a cholinergic crisis and a myatsthenic crisis
Which of the following symptoms of an MG client should the nurse report to the physician immediately?
a. Diarrhea
b.Blurry vision
c.Inability to swallow
d.Tinnitus
C. inability to swallow
Indicates aspiration risk and impaired airway risk
In planning activities for the client with MG, the nurse should use which of the following parameters?
a. Time of day
b.Severity of symptoms
c.Medication times
d.Sleep schedule
c. medication schedule- bc that is when they are the strongest
Which of the following is important information about MG drug therapy?
a. If a dose of cholinesterase is missed, a double dose is taken the next day.
b. Antibiotics such as neomycin and kanamycin have a synergistic effect with cholinesterase inhibitors.
c.Medications must be taken on an empty stomach.
d.Drugs containing morphine or sedatives can increase muscle weakness.
D. drugs containing morphine or sedatives can increase muscle weaknes
What are the most life htreatening complications of Guillain Barre Syndrome?
Respiratory failure and PE
What is the role of plasmaphersesis in the client with GBS?
Cleans blood of circulating antibodies believed to cause myelin destruction
penetrating injury
caused by deep laceration of brain tissue; may include GSW or stab wound
Concussion
temporary loss of consciousness; neuro deficits generally mild and short-term
Diffuse axonal injury
global damage to brain tissue and neurons; poor prognosis with severe neuro
deficits
Contussion
result of coup & contrecoup injuries; see bruising & hemorrhage into brain
tissue; signs & symptoms vary
caused by tearing of small vessels within brain tissue
Intracranial hemorrhage
occurs between skull and dura; arterial bleed
epideral hematoma
may present as acute, subacute, or chronic; venous bleed
Subdural hematoma
develops over minutes to hours; temporary loss of Consciousness followed by
lucid period followed by neuro decline
epideral hematoma
subdural hematoma
later signs may include ipsilateral dilated pupil, contralateral hemiparesis,
Decerebrate posturing
epideral hematoma
can occur from birth trauma or fall in the elderly
subdural hematoma
requires surgical evacuation through a burr hole.
subdural hematoma and epideral hematoma
What is the proper position for a patient with a craniotomy?
Supratentorial- HOB 30o

Nonoperative side for tumor

Infratentorial- flat; side to side x 24-48o
If your patient with a craniotomy had 30 ml drainage for the surgical drain at the end of 8 hours, what should the nurse do?

a.document the amount
b.report to the physician
c.tell the charge nurse
d.ignore it
a. document the amoung. If greater than 50 then you would call the physician
List 4 types of drugs that might be given to the post-op craniotomy pt.
1.Anticonvulsants
2.H2 blockers
3.Steroids
4.Analgesics