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112 Cards in this Set
- Front
- Back
Pituitary tumors may result in: |
Cushing's syndrome
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Primary brain tumors include:
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Gliomas, meningiomas, pituitary adenoma
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Vasospasm is often a complication of cerebral aneurysms
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True
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Spinal injuries from acceleration/deceleration mechanisms can lead to injuries such as:
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Hyper extension
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What is the most common sites for aneurysms to develop
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Anterior circulation
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The type of spinal injury that results from a diving injury is known as what type of injury
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Hyper extension
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An epidural hematoma:
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Is characterized by arterial site bleed into the space above the Dura.
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And intracerebral hematoma:
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Is characterized by bleeding into the brain tissue.
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Widespread and severe shearing of the axos which may show as hemorrhagic lesions by CT scan or MRI are associated with a:
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Difffuse axonal injury
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Preventing conditions that lead to secondary brain injury include management of all except: hypoxemia, systemic hypotension, cerebral hypoperfusion, sepsis.
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Sepsis
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Patient management for meningitis includes administration of antibacterial drugs. The antibacterial drug of choice is determined by culture and sensitivity of the organism
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True
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The most common causes brain abscess is
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Ear infection
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All meningitis patients must be isolated
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False
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Meningitis can be distinguished from encephalitis by the presence of:
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Positive Brudzinski and Kernig sign
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– Are characterized by sporadic jerking movements of limbs
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Myoclonic movements
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Which description of brain involvement is indicative of generalized seizure
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All regions of the brain in both hemispheres are involved
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Nursing interventions aimed at maintaining the safety of the patient having seizure include:
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Having suction available in case Vomiting
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Once diagnosed, treatment of a seizure focuses on:
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Controlling the seizures and providing patient safety
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Your patient has received tPAfor treatment of her stroke. Anticoagulants and antiplatelet's are not given for 24 hours after administration.
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True
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Differentiation of ischemic stroke versus hemorrhagic stroke is vital to ensure the correct treatment. Which of the following diagnostic test is considered the most important initial diagnostic study?
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Noncontrast CT scanning
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Your patient was found unconscious on the floor by his wife. He has no history of hypertension. His only complaint was a dizziness earlier in the day. You anticipate that a – will be done to determine the cause of unconsciousness.
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Noncontrast CT scan
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Which diagnostic test is used to visualize any ischemic regions in the brain within minutes of symptom onset?
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Diffusion weighted imaging MRI
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Ideally the CT scan should be completed within 25 minutes of arrival to the emergency department and read within 45 minutes of arrival
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True
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And occlusion of the posterior cerebral artery results in which of the following symptoms
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Third nerve palsy, weakness, and ataxia
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And occlusion of the superior cerebellar artery results in which of the following symptoms
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Cerebellar ataxia,, partial deafness, nausea, vomiting and loss of pain and temperature sensation
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Patients whonare admitted for hemorrhagic stroke usually present with:
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Headache
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And occlusion of the basilar artery results in which of the following symptoms
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Dizziness or a feeling of lightheadedness
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Antihypertensive treatment is recommended for both prevention of recurrent stroke and prevention of other vascular events in persons who have ischemic stroke.
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True
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What is the most common cause of intracerebral hemorrhage
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Untreated hypertension
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The ischemic penumbra is the region between normally perfused tissue in the evolving infarction
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True
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What presents the highest risk for developing a stroke
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Atrial fibrillation
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Lumbar drains permit nurses to maintain cerebrospinal fluid pressure within normal limits without directly accessing the intracranial compartment
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True
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Clustered nursing care activities will result in increases in intracranial pressure
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True
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As it relates to the use of hyperventilation in managing ICP hyperventilation has no impact on intracranial pressure
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Faults
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When assessing a patient before suctioning you note that the ICP is 17 and the P2 wave is higher than the P1 wave.
you anticipate that suctioning this patient will produce which of the following results |
An increase in ICP from 17 to 27
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While caring for a patient with an intracranial pressure monitoring device in place, the waveform suddenly changes to A waves. The first action will be to:
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Assess the patient for neurological symptoms
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Cerebral autoregulation is best defined as the brains ability to:
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Maintain a constant bloodflow over a wide range of mean arterial pressures
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As arterial carbon dioxide levels rise the cerebral arteries constrict, increasing the volume of blood inside the skull, which can cause an increase in pressure.
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False
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Common external landmarks for the zero reference point (foramen of Munro) for intraventricular intracranial pressure monitor are the tragus of the ear and –.
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External auditory canal
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Alterations in pituitary function and utilization of osmotic diuretics can lead to inappropriate fluid losses. Which of the following laboratory studies should be monitored?
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Serum osmolality, serum potassium, serum sodium
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Other reflexes used on patients are performed by a nurse practitioner or MD.These test, doll eyes maneuvers and cold calories, test for Intact
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Midbrain and brainstem
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In ICUs, Death is sometimes confirmed by evaluating neurological functioning. This is done using:
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An EEG
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Cushing's triad is seen:
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Less than 40% of the time and it is a late finding
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The gag reflex, which is elicited when something is put near the Uvula and the back of the throat, especially with suctioning in the ICU, is a survival mechanism and prevents choking. The cranial nerves involved are:
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Cranial nerves IX and X
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What symptoms to patients having an acute subdural hematoma typically experience
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Headache, slow Cerebration, muscle weakness and decreased level of Consciousness
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What sign is exhibited by patient when during physical examination, you flexed the patient's neck, causing and involuntary flexion of both knees and hips
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Positive Brudzinski sign
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What is one of the signs of encephalitis
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Fever, headache, and stiff neck
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A central nervous system infection often causes edema within the cranial cavity
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True
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Partial seizures are categorized as simple, complex or evolving
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True
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What are presenting signs and symptoms of the patient with an intracerebral hemorrhage
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Unexplained dizziness unsteadiness or sudden falls and sudden severe headache and loss of consciousness. Severe weakness paralysis or numbness in the face arm and leg on one or both sides of the body. Altered speech or difficulty speaking or understanding speech
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An occlusion of the basilar artery results in which symptoms
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Dizziness or a feeling of lightheadedness
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– Has been found to be a safe and reliable method for monitoring cerebral oxygenation
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Pbt 02
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And uncal lateral herniation is:
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When the third cranial nerve is trapped below the tentorium
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What are the factors that influence compliance in the brain
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Amount and rates of volume increases
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Your patient has cerebral edema. The physician has ordered an osmotic diuretics to be administered. Patient should be monitored for signs of
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Hypovolemia
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When assessing spinal lesions, which muscle group evaluated C-5 and C-6
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Deltoids and biceps
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The variety of tumors that arise from the neural glial cells are categorized as
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Gliomas
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Cushing syndrome gigantism acromegaly or hormonal dysfunctions related to
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Pituitary adenoma
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The anterior cerebral artery supplies which parts of the brain
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Medial area of the Temporel, frontal, and parietal lobes
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The posterior cerebral artery supplies which part of the brain
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Occipital lobe, midbrain, thalamus and the inferior medial temporal low
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Where does the reticular activating system originate
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Medulla
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The temporal lobe is responsible for controlling:
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Speech memory and intellect
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The parietal lobe is primarily responsible for which following functions
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Touch, pain awareness, and spatial awareness of the body in its environment
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– the RAS from the medulla to the midbrain. it relates and controls a portion of respiratory function and is the original origins of cranial nerves V, VI, VII and VIII
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Pons channels
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The right and left cerebral hemispheres are connected by the –
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Corpus collosum
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Compliance is related to how well this structures inside the skull can accommodate the change in pressure
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True
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The brain takes up what percent of skull?
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80
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Which of the following are exclusion criteria for the administration of TPA except: witnessed seizure at stroke onset. Platelet count of 80,000. Blood pressure of 220/140. Cholecystectomy two months ago.
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Cholecystectomy two months ago
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An occlusion of the basilar artery results in which symptoms
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Dizziness or a feeling of lightheadedness
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And occlusion of the superior cerebellar artery results in:
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Cerebellar atasia, partial deafness, nausea, committing, and loss of pain and temperature sensation.
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Embolic strokes are frequently:
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Cardio embolic in origin
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a cingulated herniation is:
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Compression of brain structures
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The purpose of the transducer in any pressure monitoring system is to
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Convert the mechanical pressure wave into an electrical signal
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This reflex indicates upper motor neuron disease. It manifests with hyper reactive reflexes when the patient's ankle is passively pushed upward. The ankle flexes and dorsiflexes repetitively and rhythmically.
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Clonus reflex
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A head CT with angiography
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Evaluates vascular structures of the brain
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What is the term for the ability of the blood vessels to change diameter in order to maintain constant flow and pressure
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Autoregulation
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Contents of brain
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Brain matter 80%. CSF 10%. Blood 10%.
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Components of frontal lobe
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Reasoning, broca's area area ,memory, Eye movement
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Components of parietal lobe
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Sensory strip, interpretation of pain, temperature, light touch vibration.
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Components of temporal lobe
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Wernecke's area, auditory Association,
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components of cerebellum
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Controls find movement, maintains balance through feedback loops
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Components of Occipital obe
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Primary visual cortex, visual perception
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Cerebrospinal fluid
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10% of cranial vault content, secreted from choroid plexus in ventricles. Secreted at rate of 25 mL per hour.
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Brain uses
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20% of cardiac output. 20% of total body oxygen. Consumes 65% of total body glucose. The brain has no glucose stores. The brain can use glucose without insulin.
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You can get a withdrawal from pain from someone who is brain-dead
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True
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Is the response purposeful
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Considered purposeful if crosses midline
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Ischemic stroke blood pressure parameters
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Only treat if SBP greater than 220 or DBP greater than 120 in less candidate for thrombolytics
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Blood pressure parameter for administration of thrombolytic
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SBP less than 185 Or DBP less than 110
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ICH. Intraparenchymal stroke
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Bleeding into the brain tissue
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ICH. Subarachnoid hemorrhage
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Bleeding into subarachnoid space by aneurysm/AVM
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Management of ICH
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uvolemia BP control SBP 120 to 150.Labetalol or cardine administration. Nimitop:3 calcium channel blocker shown to enhance collateral bloodflow. Anticonvulsants. Stool softeners
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Management post coiling
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SBP greater than 180 for CPP, and prevention of vasospasm – Levophed. TCD daily – to monitor for vasospasm. EVD placement – for hydrocephalus
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Signs and symptoms of tumor
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Headache, nausea and vommiting, changes in LOC, seizures,
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Primary versus metastatic tumor
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Primary rarely metastasize; secondary are metastasis from lung, breast, melanomas
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Diagnosis tumor
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CT MRI
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Treatment tumor
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Corticosteroids, radiation, biopsy, resection, chemotherapy
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Partial simple seizure
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Consciousness not impaired
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Partial complex seizures
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Consciousness is impaired
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Evolving seizure
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Evolves into generalized
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Types of generalized seizure
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Absence. Myoclonic. Clonic. Tonic. Tonic – clonic. Atonic.
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Treatment of seizure
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Treatment of underlying condition. Avoidance of precipitating factor. Anti-epileptic drugs: Dilantin. Fosphenytoin, Carbamazepine, Valproic acid. Phenobarbital
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Encephalitis
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inflammation of the brain; caused by: viruses, bacteria, fungi, parasite; S/S: headache, fever, aching muscle or joint, fatigue or weakness, altered LOC, seizure
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Meningitis
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Inflammation of the protective membranes covering the brain and spinal cord; causes: bacterial most severe, virus, fungal, parasitic; symptoms: nausea vomiting, photophobia, altered mental status
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Brain death – triggers for translife
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GCS five or less, withdrawal of life support being considered by physician or family, absent two or more brainstem reflexes including pupillary response, cough, gag, response to stimuli; family mentions organ donation
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Brain death test
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Apnea test, nuclear perfusion scan, EEG, cranial angiography
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Target MAP
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Greater than or equal to 80 – 90
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Causes other than
Neuro problems that lead to a change in NEURO assessment |
Hypoxia/Hypercarbia ,; hyponatremia/hypernatremia; hypotension/hypertension; hypoglycemia/hyperglycemia
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Delirium
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Acute confusionaI state; clouding of consciousness; dulling of cognitive processes, and a general impairment of awareness; agitated or lethargic
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Dementia
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Progressive and irreversible general decline in global cognitive functions without a reduction in arousal
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GCS scale is based on best
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Eye-opening. Verbal responses. Motor responses. A change in score of two or more is significant and needs to be reported to dr
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GCS measures cognition and strength
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False
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Pupillary changes are a late finding
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True
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