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191 Cards in this Set
- Front
- Back
Status epilepticus is defined as...
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seizure activity lasting > 5-10 minutes
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Status epilepticus is usually with what type of seizure?
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grand mall/tonic-clonic
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In a patient with epilepsy, what is the leading cause of Status epilepticus?
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failure to take anticonvulsants regularly
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What is the leading cause of Status epilepticus?
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CVA
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During which type of seizure will a patient lose conciousness and stop breating?
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grand mal/tonic-clonic
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What ist he #1 concern during Status epilepticus?
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airway/breathing
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Why is an NGT placed during Status epilepticus?
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to prevent aspiration
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What kind of fluids should you run during Status epilepticus?
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NS only
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What is the drug of choice for Status epilepticus?
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ativan IV
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What can be given instead of ativan for Status epilepticus?
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IV valium
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If Status epilepticus continues despite ativan what can be given? (2)
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IV phentoin (Dilantin)
Fosphenytoin |
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How fast can IV phentoin (Dilantin) and
Fosphenytoin be given? |
No faster than 50mg/min
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What is the last ditch effort in meds for status epilepticus?
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IV propofol
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What do you need to watch for when giving Propofol?
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hypotension
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Encephalitis:
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inflammation of the brain tissue and often the meninges
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What 3 parts of the brain affect?
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cerebrum
brainstem cerebellum |
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Where do you get Arbovirus from?
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mosquito or tick
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If a pt has encephalitis secondary to herpes simplex what can be given as treatment?
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acyclovere
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What is the most common non-epidemic type of encephalitis?
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herpes simplex type I
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What are the 3 cardinal signs for meningitis?
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Fever
HA Nuchal rigidity |
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Is there drugs available for arbovirus or enterovirus ensephalitis?
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no
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Increased ICP is defined as:
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sustained increase of ICP of >20 mmHg for > 5 minutes
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What is the normal ICP?
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0-15 mmHg
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In the Monro-Kellie hypothesis, what are the 3 thrings that contribute to ICP?
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Volume of blood
Volume of CSF Volume of Brain |
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Hypercarbia and hypoxia will ________ circulating blood volume
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increase
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What may cause an increase in CSF?
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hydrocephalus
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What may cause an increase in brain volume?
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cerebral edema
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How do you calculate CPP?
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CPP= MAP - ICP
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What is the normal CPP?
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70-100 mmHg
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What is the average CPP?
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85 mmHg
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If CPP is less than 60 what happens?
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cerebral anoxia
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ICP is 15 and MAP is 90, what is the CPP?
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75
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MAP is 80 and ICP is 30, what is the CPP?
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50
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Compensatory mechanisms for IICP are _________
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temporary
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With HTN brain vessels will _________ to ______ flow to brain in autoregulation
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constrict; decrease
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With hypotension brain vessels will _________ to ______ flow to brain in autoregulation
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Dilate; increase
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With accomadation, the brain will push blood into the _____ _______ to decrease pressure in the brain
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venous sinuses
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With accomodation, the brain will ________ reabsorption to decrease pressure in the brain
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increase
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With accomodation, the brain will divert CSF to the ________ ______ to decrease pressure in the brain
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subarachnoid space
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What 3 things may lead to an increased cerebral blood flow?
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hypercapnia
hypoxia (e.g. suctioning) Fluid overload |
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What are hte 4 factors which may precipitate IICP?
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Increased cerebral blood flow
Jugular drainage obstruction increased oxygen demand cerebral edema |
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Neck flexion adn hyperextension may cause what factor that precipitates IICP?
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Jugular drainage obstruction
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Valsalva maneuver, PEEP ventilation, vomitting, and coughing are all things that may lead to...
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jugular drainage obstruction and IICP
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Seizures, hyperthermia, shivering, hyperactivity, and pain all ________ oxygen demand in the brain
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increase
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an increased oxygen demand in the brain will lead to...
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increased cerebral blood flow and IICP
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Cytotoxic cerebral edema is characterized by...
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hypoxia
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Vasogenic cerebral edema is characterized by...
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breakdown in BBB allowing proteins to penetrate which pulls water into cells
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Ischemia from CVA, cardiac arrest, asphyxiation, and SIADH all lead to ________ cerebral edema
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cytotoxic
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Head injuries, brain tumors, meningitis, and abssess' all lead to ________ cerebral edema
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vasogenic
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What are the 3 supratentorial herniation syndromes?
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cingulate
Central Uncal |
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What is the infratentorial herniation syndrome?
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cerebellar tonsil
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A cingulate herniation is a _________ herniation of ________ hemisphere across the ________
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unilateral; cerebral; midline
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A cingulate herniation will compress what 2 things?
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cerebral blood vessesls and brain tissue
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What are 2 s/s of a cingulate herniation?
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change in LOC
change in mental status |
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A central herniation is ________ displacement of _________ hemisphere through the _______ notch
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downward; cerebral; tentorial
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A central herniation will compress....
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brainstem and vital centers
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Early or late s/s of central herniation: changes in LOC and respiration
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early
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Early or late s/s of central herniation: decortecate posturing
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late
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Early or late s/s of central herniation: motor weakness and increased muscle tone
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early
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Early or late s/s of central herniation: small pupils
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early
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Early or late s/s of central herniation: cheyne-stokes respirations
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late
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Early or late s/s of central herniation: positive babinski reflex
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early
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WIth decorticate posturing arms....
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flex to the core
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With decerabate posturings arm.s...
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are tight to the sides
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With Flaccidity posturing limbs are...
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completely limp
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A positive babinski is when...and it is (normal/abnormal)
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toes flare; abnormal
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What is a negative babinski?
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toes curl, this is normal
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An uncal herniation is a herniation of the ______ portion of the _______ lobe through the _______ notch
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Uncal; temporal; tentorial
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An uncal herniation will compress...
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the midbrain
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An uncle herniation presses on the midbrain which causes dysfunction of what cranial nerve?
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CN III
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What is the cardinal sign of an uncal herniation?
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CN III is affected which causes ipsilateral dilated pupil
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Contralateral hemiplegia is seen in what kind of herniation?
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uncal
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Decerabrate posturing is seen in what kind of herniation?
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uncal
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Decortacate posturing is seen in what kind of herniation?
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central
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Fixed midposition pupils are seen in what kind of herniation?
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worsening Uncal herniation
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An Uncal herniation will progress to a __________ if not treated
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coma
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A cerebellar tonsil herniation causes the cerebellar _________ to be displaced thru the ________ ________ .
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Tonsils; foramen magnum
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With cerebellar tonsil herniation there is compression on the ____ _____.
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brain stem
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THe pressure on the brain stem and medulla during a cerebellar tonsil herniation will cause compromised...
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Cardiovascular and respiratory function
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Flaccidity is a sign of _________ in a patient without a spinal chord injury.
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brain death
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Vital sign are ______ indications of herniation.
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late
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Cheyne stokes pattern:
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shallow.....deep....shallow....apnea...then repeat
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Cluster respirations:
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no pattern in respirations then apnea
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Central neurogenic respirations:
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hyperventilation
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Apneusis respirations-
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big breath....apnea....big breath
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Atoxic breathing
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no pattern
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What is normal with dolls eyes?
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eyes stay fixed or turn in the opposite direction that head is turned
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How do you test oculocephalic response?
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dolls eyes
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How do you test oculovestibular response?
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ice water in ear
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WHat is a normal oculovestibular response?
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eyes turn towards the ice water
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papilledema...
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swelling inthe optic disk
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change in LOC, HA, pupillary changes, N/V, and papilledema are all s/s of...
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increased ICP
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What is cushings triad?
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slow, bounding pulse
irregular respirations increased systolic pressure c widening pulse pressure |
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Cushings triad is a _______ sign of herniation
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late
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What is the only kind of ICP monitoring that can also drain CSF?
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Ventriculostomy
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how much CSF can be drained per hour?
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20-25 ml/hr
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How often should you record ICP and CPP when monitoring a pt?
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every hour
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What is evoked potential monitoring?
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EEG monitor while you try to illicit a response to stimulation
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CBF studies are used to establish...
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brain death
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What will be found in a normal culture of CSF?
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water, lytes, glucose, and protein
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What is the goal ICP?
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<20 mmHg
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What is the goal CPP?
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at least 70 mmHg
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What is the goal PaO2 with IICP?
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80-100 mmHg
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What is the goal PaCO2 with IICP?
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35-45 mmHg
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When may you want PaCO2 to be 32-35mmHg?
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possibly in the early treatment of IICP, but only for a very short amount of time
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Mannitol (osmotic diuretic) will pull water from _________ tissue
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normal
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How quickly will mannitol work?
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in 20 minutes
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What are the risks with using manitol for IICP?
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rebound cerebral edema
hypotension |
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What does furosemide (loop diuretic) do to CSF?
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decreases the production of CSF
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Furosemide will remove Na and H2O from ________ tissue
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injured
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When giving diuretics for IICP, what should you replace what you pull off with?
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NS
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What corticosteroid is given for IICP?
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dexamethasone (decadron) but its controversial
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What is the goal systolic pressure for IICP?
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<160 mmHg
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What is the goal MAP for IICP?
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70-90 mmHg
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In vasospasms associated with subarachnoid hemorrhage a _______ BP is required
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high
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When is Nicardipine used in IICP?
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to manage vasospasms associated with subarachnoid hemorrhage
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What rate should NS be infused in a patient with IICP?
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75-100 mL/hr
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What is the preferred body temp for pts with IICp?
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controlled hypothermia
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What are 2 disadvantages of sedating a patient with IICP?
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decreased BP
don't know the actual LOC |
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What drug is used to medically induce a coma?
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pentobarbital
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What will pentobarbital do?
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induce a barbiturate coma
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Why would you put a patient into a coma when they have IICP?
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Decrease metabolism
decrease cerebral edema increase cerebral blood flow |
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What is the most common cause of spinal chord injury?
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MVA
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most patients with spinal chord injury die from ________ or __________
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infection or complications of immobility
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A complete spinal chord injury?
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spinal chord is completely cut through
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a partial spinal chord injury?
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spinal chord is only partially cut
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What is spinal shock?
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temporary loss of autonomic, sensory and motor function below the level of injury
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What are the 3 function lost in spinal shock?
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autonomic
sensory motor |
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Spinal shock mostly often occurs with ______ lesions
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complete
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How do you know when spinal shock has resolved?
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return of simple reflexes below the level of the lesion
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During spinal shock HR is...
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bradycardia
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During spinal shock blood vessels...
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vasodilate/lose tone
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Durding spinal shock thermoregulation is...
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impaired
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During spinal shock Bowel and bladder function are...
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lost
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What is the priority with a new spinal chord injury?
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airway
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Injuries below _____ leave a patient with intact diaphragmatic breathing.
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C 5
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How do assess the motor neuro s/s of a patient with spinal chord injury?
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resp rate, rhythm, depth
movement/strength of ext, head |
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How do you assess the sensory s/s of a patient with spinal chord injury?
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Pinprick
position sense temperature |
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Vasodilation that occurs with a spinal chord injury will ______ BP, HR, and venous return
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decrease
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Venous stasis that occurs in pts with spinal chord injury leads to an increased risk for...
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clots
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poikolothermy:
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pt with spinal chord injury assumes the ambient temperature
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How long post spinal chord injury does a pt have an NGT?
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at least 72 hours
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Will you hear bowel sounds in a pt will a spinal chord injury?
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no, paralytic illeus
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What is given to prevent stress ulcers in pts with spinal chord injury?
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h2 blockers or proton pump inhibitors
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If you are giving corticosteroids to a new spinal chord injury pt, when must they be given?
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within 8 hours of injury
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WHat type of bed should be used with a spinal chord injury pt?
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kinetic
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WHen does autonomic dysreflexia ocur?
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with spinal chord injuries at T6 or above after resolution of spinal shock
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WHat cuases autonomic dysreflexia
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an intense sympathetic response to stimuli
ex. kinked catheter or fecal impaction |
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What is the biggest concern with Autonomic dysreflexia?
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malignant HTN
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A patient with Autonomic dysreflexia will complain of what?
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severe headache, congestions, swetting above level of lesion
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When will lymphocytes appear in the CSF in a pt with GBS?
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in 1-2 weeks
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Why is immunoglobulin given to a pt with GBS?
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decrease inflammation
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WHat is the antidote for Tensilon testing in MG?
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Atropine sulfate
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WHen is atropine sulfate used for a pt with MG?
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as an antidote for tensilon testing
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1. Head injury is the leading cause of trauma-related deaths in persons younger than______ and occurs____times as often in males.
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45; 1.5
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decceleration
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Head hits a stationary object.
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linear fracture
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Simple, clean break in the skull
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laceration
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cortical surface is torn
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Aceleration
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Head is in motion
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depressed fracture
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Bone presses inward into brain tissue
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Basilar skull fracture
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CSF leaks from nose and/or ears
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open fracture
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There is a direct opening to brain tissue
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cominuted fracture
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Fragments of bone are in brain tissue
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List the specific signs related to basilar skull fracture
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Battles’ sign- bruising behind ear
Raccoon’s eyes- bruising around eyes Rhinorrhea and otorrhea |
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What is the specific infectious complication of basilar skull fracture?
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Meningitis
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What is the nursing care specific to otorrhea/rhinorrhea?
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Let it flow freely- do not blow nose.
Don’t place anything in nose or ear. |
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Why are nasogastric tubes avoided with basilar skull fractures
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to avoid penetrating the brain
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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
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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
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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
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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
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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
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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 |
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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
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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
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What are the most life htreatening complications of Guillain Barre Syndrome?
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Respiratory failure and PE
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What is the role of plasmaphersesis in the client with GBS?
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Cleans blood of circulating antibodies believed to cause myelin destruction
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penetrating injury
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caused by deep laceration of brain tissue; may include GSW or stab wound
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Concussion
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temporary loss of consciousness; neuro deficits generally mild and short-term
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Diffuse axonal injury
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global damage to brain tissue and neurons; poor prognosis with severe neuro
deficits |
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Contussion
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result of coup & contrecoup injuries; see bruising & hemorrhage into brain
tissue; signs & symptoms vary |
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caused by tearing of small vessels within brain tissue
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Intracranial hemorrhage
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occurs between skull and dura; arterial bleed
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epideral hematoma
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may present as acute, subacute, or chronic; venous bleed
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Subdural hematoma
|
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develops over minutes to hours; temporary loss of Consciousness followed by
lucid period followed by neuro decline |
epideral hematoma
subdural hematoma |
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later signs may include ipsilateral dilated pupil, contralateral hemiparesis,
Decerebrate posturing |
epideral hematoma
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can occur from birth trauma or fall in the elderly
|
subdural hematoma
|
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requires surgical evacuation through a burr hole.
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subdural hematoma and epideral hematoma
|
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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 |
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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
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List 4 types of drugs that might be given to the post-op craniotomy pt.
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1.Anticonvulsants
2.H2 blockers 3.Steroids 4.Analgesics |