Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/86

Click to flip

86 Cards in this Set

  • Front
  • Back
Normal CPP
60-100
-Under 60>inadeq blood supply to brain>neuronal hypoxia and possibly cell death
-Under 40=disruption of autoregulation
CPP requirement in an acutely inured brain
>70
-to maintain adeq CBF
-falls under and autoreg is disrupted leading too???
Fx of increased MAP on CBF
Cerebral vasoconstr
-Cerebral vasoconstr>dec CBF/volume>potential for neuronal hypoxia
-Better then hypo (which inc ICP)tension but potential for inadeq cerebral perfusion exists
Fx of decreased MAP on CBF
Cerebral vasodil>inc CBF/volume>IICP
Fx of increased CO2 on CBF
Cerebral vasodil>inc CBF/volume>IICP
Fx of decreased CO2 on CBF
-Cerebral vasoconstr>dec CBF/volume>potential for neuronal hypoxia
-Implication for Tx i.e. dec blood flow has potential to decrease IICP
Calculating CPP
MAP-ICP
CBF=measure of cerebral oxygenation
-estimated clinically by measurement of CPP

What must CPP remain above for autoreg to remain intact???
40-60
Implication of CPP > 100
Hyperperfusion>IICP
Low compliance
-young people or old?
Stiff brain=young people
-sm volume changes can cause large increases in ICP
High compliance
-young people or old people
Elastic brain=old people d/t atrophy, dementia and also alcoholics
Edema assoc with increased capillary permeability and movement of fluid into extracellular brain matter (white matter)
Vasogenic
Assoc with swelling of indvl neurons and endothelial cells>increases fluid in intracellular space (grey matter)
Cytotoxic
Brain characteristic ensuring constant blood flow to brain
autoregulation
CBF is dependent upon
CPP
-Fx'd by MAP and ICP

Also CO2 levels
Abnormal fluid accum resulting in increased tissue volume
cerebral edema
Most common type of cerebral edema
vasogenic
Sensitive and impt indicator of neuro status
LOC
Cushings triad
-Inc SBP with widened pulse pressure
-Bradycardia -Bradypnea
T/F
Changes in vitals are early indic of impaired CBF
F-late
especially cushing triad
Examples of pupillary changes
-Dilation of pupil on side of mass
-Sluggish/doesn't respond to light
-Ptosis
-Diplopia
-Fixed unilateral dilation (oncoming herniation-neuro 911)
Examples of motor changes
-Contralateral hemiparesis/plegia
-response to painful stim
-Decorticate>decerebrate
Decorticate
-Extension of flexion
Flex into core
How do you test abnormal positioning? i.e. decorticate
Noxious stim
Results from disruption of corticospinal pathways
-Decort or decrebrate
Decorticate
Results from dusruption of motor fibers in midbrain and pons
-Decort or decerebrate
Decerebrate
Examples of noxious stim
pain, suction, turn and reposition
T/F
Vomiting is an early Sx of IICP
F-late sign
S&S of brainstem herniation
-Cushings triad
-Fixed unilateral pupil -Decort>decerebrate
-Rapid deterioration
T/F
Brainstem herniation can be reveresed
F-usually fatal
Inadeq ADH
-DI or SIADH
DI
Main complication/worry of DI
Dehydration/hypovolemic shock
Fx of DI on spec gravity
Decreases<1.005
Fx of DI on Na
HyperNa (>145)
-Thus water retention? Serum or urine?
Tx Di
Synthetic ADH
-Aqueous vasopressin (Pitressin)
-Desmopressin acetate (DDAVP)
F&E replacement
Excess ADH
SIADH
main complication/worry of SIADH
Water intox
Fx of SIADH on spec gravity
Inc urine spec gravity (>1.025)
Tx of SIADH
-Fluid restriction
-Na replacement/3% hypertonic saline (shifts fluid out of cells)
Benefits to invasive ICP monitoring device (i.e. intraventricular catheter)
-Helps to improve pt outcomes
-Info on likelihood of herniation
-Calculation of CPP
-Guides potentially harmful Tx
Indications for ICP monitoring device
Stoke/bleed
Head injury
Cranial surgery
C/I to ICP monitoring device
Prone to bleed??
Meningitis/CNS infection
CSF drainage from intraventricular catheter becomes pink. You immediately think???
Intracranial bleed. Should be crystal clear.
Mannitol does what to blood viscosity?
Decreases viscosity>thereby increasing CBF and O2 delivery
Diuretic that moves fluid from tissue to intravascular space
Mannitol
Why must serum osmol be kept under 320 during Mannitol therapy
Potential for renal failure
Labs come back and serum osmol is>320. What action do you taek?
Hold dose
Notify MD
What type of fluid replacement is used in IICP
isotonic (LR, NSS) and hypertonic (3% NS) are OK
-Move fluid out of cells
-Impt for DI and mannitol therpay
What fluid pushes water into cells
Hypotonic (1/2 NS)
Why is it impt to provide fluids with Mannitol
Don't want hypovolemia/hypotension
-Attempting to balance I&O
Diuretic that potentially reduces CSF production
Loop
Tx with hyper or hypo ventilation
Hyper>dec PaCO2>vasoconstrict
Goal for PaCO2 in hypervent therapy
30-35
Risk of hypervent
Dec PaCO2>vasoconstricts>decreased cerebral blood flow>potential for cerebral ischemia
How can you tell if pt is tolerating hypervent therapy
Monitor O2 levels
Why must hypervent therapy be postponed 24 hours post acute brain injury
CBF already reduced
Hypothermia therapy intended to...
reduce O2 and metab dmd of brain
Why must fever be avoided?
Increases metab dmd and O2 req
T/F
Tylenol is fx'ive for neurogenic fever
F
How is temp monitored?
Rectal or Swann
Why is sedation/analgesia impt in Tx
Prevents SNS response which increases ICP
This sedative/analgesic may actually decrease CBF/CPP and ICP
Propofol
Propofol carries risks of??
Pancreatitis b/c its a lipid
-must do cal counts
Infection
-change tubing q12h
You've used tons of sedation and analgesia and ICP still remains>25. What Tx do you expect
Barbit coma
GCS must be<?? for barbit coma
7
ICP must be>?? for barbit coma
25 for 10 minutes when at rest
How is resp fxn supported in barbit coma
MV
How is hypotension avoided in barbit coma
pressor support
Why must pre/intra/post EEG be done with barbit coma
Lose classic neuro signs
Why must d/c of barbit coma be tapered
Withdrawal/seizure
Reasons to d/c barbit coma
-ICP<15 for 2-3 days (it worked!)
-ICP remains elev (didn't work)
-SBP<90 (unctrl hypotension)
This Rx inhibits synthesis of prostaglandins and is fx'ive at reducing vasogenic edema
Corticosteroids
Complications of corticosteroids/decadron
Hyperglycemia (its a steroid)
Infection
Why are ACEI (vasotec) and BB (Labetolol) so good for anti-HTN therapy
Cause systemic vasodil withouth causing cerebral vasodil
Decompressive craniotomy indic when??
All else failed
IICP does what to nute needs
Produced hypermetabloic/hypercatabolic state
-Increased glucose needs
How many suction passes are safe
1-2
Suction for no longer then ?? secs
10
Body positioning to decrease ICP??
-Elev HOB
-Align neck
-Avoid hip flexion
T/F
Nurse should cluster activities
F
provide time for noxious stim to decrease and thus ICP to decrease between care
#1 Rx for seizure prophylaxis
Dilantin-anti-convulsant
? or less GCS score indicates coma
8 or less
arousable with stim. Incosistently follows commands. Limited speech and spontaneous movement
Obtunded
Very hard to arouse
Stuporous
drowsy, follows simple commands
Lethargic
1/2 NS is what type of fluid
Hypotonic=bad