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276 Cards in this Set
- Front
- Back
What is the skull?
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a closed compartment containing brain.
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What is inside skull?
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Tissue, brain make up 75% of skull contents.
Blood makes up 12% of volume. Spinal fluid makes up rest. |
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What is the Monro-Kellie hypothesis?
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if volume added = volume removed, the total volume does not change.
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What is ICP?
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the pressure exerted by tissue, blood, CSF on the cranial walls.
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How is ICP measured?
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manometer or transducer
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What is normal ICP?
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80-180 mm H2O
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Sustained pressure above norms is considered
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abnormal
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dura distensibility
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ability of dura to stretch. The cranial vault limits its distensibility.
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Is pressure more of a problem with closed or open head trauma?
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Closed
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Tissue plasticity
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ability of brain tissue to be molded or compacted depends on amt. of interstitial fluid.
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Can CSF volume be changed?
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Yes, body can produce more or less CSF; can displace out of skull.
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What substance will decrease production of SCF?
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diuretics
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How much of the 135 ml of CSF is in the lateral ventricles?
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25-35 ml
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What is autoregulation in reference to blood volume and ICP?
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the automatic alteration in diameter of the cerebral arteries so that there is a constant blood flow during changes in systemic arterial pressure.
Maintains a constant supply of O2 and glucose to brain and protects from too much fluid. |
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What are the limits of systemic blood pressure within which autoregulation can operate?
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50 to 150 mm HG mean MAP.
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What happens when MAP < 50?
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vasodilatory response is ineffective so that blood flow (CPP) decreases and signs of ischemia occur.
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What happens with MAP > 150?
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Vasoconstriction fails so that flow increases to the point that the blood-brain barrier is disrupted and cerebral edema occurs.
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What is CPP?
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Cerebral perfusion pressure
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How is CPP calculated?
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CPP=MAP - ICP
MAP=Diastolic + 1/3 pulse pressure Pulse pressure=diff. between diastolic/systolic |
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What is normal CPP?
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60-90 mm Hg
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What happens when CPP<30?
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brain death - tissues not perfused.
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What factors affect autoregulation?
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Pressure changes
Cerebral oxygen tension - PO2 decreases, cerebral vessels dilate. Metabolic factors: increased O2 and PCO2(most significant -resp. arrest, pneumonia, diabetic coma. |
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What is the most frequent cause of death with head injuries?
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Increased cause of death with head injuries.
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What is always a part of increase intracranial pressure?
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cerebral edema. sometimes it's a cause, sometimes it's a result.
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What is one of the 1st indicators, clinically, of increased ICP?
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change in LOC that results from decreased blood flow and low O2 to cerebral cortex and RAS. Everything else is a late sign.
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What causes vital sign changes?
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Ischemic brainstem.
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What is Cushings Triad?
What area of the brain is each associated with? |
Elevated BP w/widening pulse-medulla
Bradycardia:full & bounding-pons and medulla Irregular RR - pons |
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Is headache a late sign of inc. ICP?
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Yes, due to stretching of dura - could be due to underlying problem.
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Is vomiting without nausea a late sign of inc. ICP?
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yes, often projectile - hypothalamus houses vomiting center.
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Are pupillary changes a late sign of inc. ICP?
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Yes, pupils react unequally or sluggishly. May have diplopia or blurred vision. EOM - nystagmus
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What does an unequal pupil reaction indicate?
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An abnormality in the side of brain of the abnormal pupil.
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What does fixed, dilated pupil indicate?
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Bad sign of possible herniation. Increased pressure pushes brain down and puts pressure on brainstem down to foramen magnum.
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Is change in motor or sensory function a late sign of inc. ICP?
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Yes
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What is the major complication of IICP?
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Herniation (subtentorial) of cerebellum and brainstem through foramen magnum may cause resp. arrest.
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What is the #1 goal of management of IICP?
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Support brain function
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What is the #2 goal of IICP?
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to identify and treat cause.
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What is the #1 priority?
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Oxygen. Keep PO2 at 100 mm HG or more; keep PCO2 at 25-35 mm HG or more.
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Why should vasodilitation be prevented?
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It will make ICP go up.
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Can diuretics be used to treat IICP?
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Yes. Loop or osmotic. Loop-lasix especially good and decreases the production of CSF. Either helps get rid of interstitial and intracellular fluid.
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What should you watch when giving diuretics?
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K+ and fluid volume
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What are glucocorticoids and why can they be used to treat IICP?
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antiinflammatories; Want to decrease inflammatory response and edema.
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What should be monitored when giving glucocorticoids?
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Blood sugar, electrolytes, I&O. Suppress immune system>fever.
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Why are barbituates used to treat IICP?
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They may decrease metabolic rate of brain cells; helps control seizures
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What is used to control seizures caused by IICP?
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Dilantin
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Can antihypertensives and vasopressors be used to treat IICP?
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Yes, depends on what's needed.
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Are fluids restricted with IICP? Why or Why not?
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Yes, restricted to 65%-75% normal (1600-1900 ml/day). Don't want to contribute to edema.
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What kind of fluids are used initially with IICP?
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isotonic - adjust to blood values.
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What complication could occur from fluid restriction?
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Blood becomes thicker, clots possible, can cause strokes > monitor.
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What about nutrition and IICP?
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Serum glucose should remain up and keep up serum albumin -may need feeding tube with protein.
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Why do you initially use isontic fluids with IICP?
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Don't want to shift fluids into cells. Typically give NS unless specific reason to give something else.
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Is surgery an option for IICP?
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Yes, as necessary to treat cause or relieve pressure.
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Is suctioning appropriate nursing care with IICP?
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Yes, but causes IICP, so suction PRN, briefly and hyperventilate before and after to keep oxygen up with 100% O2.
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If suctioning is risky why do it?
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For airway maintenance. Secretion my occlude.
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What position should the bed be in for IICP.
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Keep HOB up 30 degrees - increases venous output from brain through juggular.
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Should abdominal distention be prevented?
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Yes, abd. distention decreases ventilatory volume.
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Are sedatives appropriate with IICP when there is an airway concern?
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No, they should be avoided because they decrease RR and effort and decrease LOC.
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When are sedatives appropriate?
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When pts. are aggitated on vent. they may need sedative to decrease O2 demands, lower ICP, and allow vent to work properly.
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What IICP nursing care applies to circulation?
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whatever it takes to maintain blood flow perfusion to kidneys, liver, brain most important.
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Are neuro checks important?
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Yes, to evaluate progress/
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Is F&E management important?
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Yes. Diabetes Insipidus (decr. ADH)- inc. UOP - specific gravity should be low. SIADH (inc. ADH) - retain fluids. Specific gravity should be high.
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What about pt. postion and IICP?
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HOB 30 degrees. Venous output and helps ventilation.
Avoid flexion - decr. venous return from brain, puts pressure on jugular. |
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Should pt. be turned?
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Yes, q2, carefully since turning can cause IICP.
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Is safety an issue with pt. with IICP?
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Yes, prevent injury. May try to get out of bed. Try not to use restraints.
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What are 3 ways to measure ICP?
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epidural sensor
subarachnoid bolt intraventricular catheter |
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Epidural sensor
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wire that goes through skull, lies between skull and dura mater. Not very invasive, decr. risk of bleeding,infection. Not very accurate.
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Subarachnoid belt
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Screwed down through meninges into subarachnoid space. Bolt must remain in patient. Sometimes develop fibrin clots at bolt. Fairly accurate, great risk of infection.
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Intraventricular catheter
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Places direct pressure. More invasive, great risks. Infection rate is higher. Could have cerebral hemorrhage.
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Which monitor for measuring ICP is most accurate?
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Intraventricular catheter.
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What are factors contributing to IICP?
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High CO2 content; low O2 content; valsalva maneuver; restricting body positions, coughing-sneezing, emotional upsets, REM sleep, arousal from sleep, medications as antihistamines.
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surgery for ICCP is done...
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as necessary to treat cause or relieve pressure.
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Nursing management of airway for IICP...
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Suctioning
Keep hob up to 30 degrees avoid sedatives prevent abdominal distention |
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What special precaustions should be taken when suctioning a pt. with IICP?
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keep brief and hyperventilate with 100% O2 before and after to keep O2 up.
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Why should the HOB be kept at 30 degrees for a pt. with IICP?
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To increase venous output from brain through juggular.
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Why is preventing abdominal distention important for someone with IICP?
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That decreases ventilatory volume.
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Why avoid sedatives?
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They decrease RR and effort, as well as, decreases LOC.
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Is there an exception to avoiding sedatives?
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Yes, patients who are aggitated on ventilator may need these to decrease O2 demands, lower ICP, and allow vent to work properly.
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What nursing management of circulation of pt. with IICP should be done?
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Whatever it takes to maintain blood flow. Perfussion to kidneys, liver, brain most important.
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Why should nurses to neuro checks regularly?
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To evaluate treatment
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What should be done to manage F&E management?
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Watch for Diabetes Insipidus from decreased ADH.
Watch for SIADH from increased ADH. |
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What are the signs of diabetes insipidus?
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Increased UOP. Specific gravity should be low.
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What are signs of SIADH?
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Retain fluids. UOP decreases, specific gravity will be high.
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What nursing management of pt. position should be done?
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HOB up 30 degrees. Avoid flexion of neck - decreases venous return from brain - put pressure on juggular.
Turn q2 carefully. |
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Why should a pt. with IICP be turned carefully?
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Turning increases ICP.
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What kind of monitoring of ICP can be done?
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Epidural sensor
Subarachnoid belt |
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What is the epidural sensor?
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wire that goes thru skull, lies between skull and dura mater.
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What are the advantages/disadvantages of the epidural sensor?
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Not very invasive
Decreased risk of bleeding Decreased risk of infection Not very accurate |
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What is the subarachnoid belt?
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It is screwed down through the meninges into subarachnoid space. Bolt must remain.
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What are the adv/disadv of subarachnoid belt?
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Pt. sometimes gets fibrin clots at bolt.
Great risk of infection. Fairly accurate. |
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Intraventricular Catheter..
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3rd type of ICP monitor.
Most accurate; more invasive; greater risk of infection; could have cerebral hemorrhage. |
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What are some factors that contribute to IICP?
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High carbon dioxide content
Low oxygen content Valsalva maneuver Restricting body positions Coughing-sneezing Emotional upsets REM sleep Arousal from sleep Medications as antihistamines |
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Types of head injuries?
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Scalp lacerations
Fractures |
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what are the facts about scalp lacerations?
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there is a lot of bleeding; risk of infection; bleeding can usually be controlled with pressure - usually no significant problems.
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What are the different types of fractures?
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Comminuted
Depressed Compound Linear |
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A comminuted fracture...
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crushing injury with breaks in lots of places.
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A depressed fracture...
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portion of bone pressing down into underlying brain tissue.
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A compound fracture...
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open communication to the outside.
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A linear fracture...
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Basilar - Broken bone but no displacement. Simple, usually heels nicely. Problem - can tear blood vessels underneath.
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basilar skull fracture...
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linear fracture in area of frontal or temporal bones
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A basilar skull fracture is associated with CSF leaks because...
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because of tearing of the dura
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Anerior fossa fracture -
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linear fracture that causes periorbital ecchymosis - raccoons eyes. Often get SPF leak from nose.
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Middle fossa fracture
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Linear fracture that causes mastoid ecchymosis - Battles sign, otorrhea, hemotypanium -CSF leak from the ear.
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What are 2 methods of dx CSF leaks.
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Halo sign
Glucose strip will be + if CSF. |
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If pt. is having drainage from the nose what should you do.`
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collect it so it doesn't stay there. No nasal suctioning, no NG tube.
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Why no NG tube?
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An NG tube has a tendency to go up, if there is a tear could go through to brain.
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What are some major complications of basilar skull fracture
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Infection
Hemotoma formation |
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What is a concussion?
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a minor injury in which there is "sudden transient mechanical head injury with disruption of neural activity and change in LOC".
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Are there usually long term effects from concussion?
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NO
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What is a contussion?
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A major injury in which there is bruising of brain tissue that may lead to edema, ischemia, necrosis, hemmorrhage.
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What are some S/S of contussion?
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Altered LOC, possible amnesia, possible neuro dysfunction. Early on can't tell difference between contusion/concussion.
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Is it necessary to prevent pt. from going to sleep?
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No, it is better to let them go to sleep and wake them up periodically.
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What is the coup-contrecoup phenomena?
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an injury with 2 types of trauma.
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Coup injury:
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on side of blow, 2 degree compression. Whipping forward, then backwards, blood vessels get torn.
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Contrecoup injury:
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on opposite side of coup injury and occurs primarily because of pulling and tearing of tissues and vessels with some compression damage.
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What type of injuries which occur with MVA but also with boxers and others?
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Acceleration/deceleration when head moves quickly in one direction and then stops abruptly (deceleration).
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What is the treatment for any of the head injuries?
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Remove boney fragments or depression. Prevent infection with antibiotics and clean dressings. Observe for and treat IICP.
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What are the types of hematomas?
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Intracerebral hemorrhage
Subarachnoid hemorrhage Epidural hematoma Subdural hematoma |
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Intracerebral hemorrhage:
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as with laceration, HTN (stroke). Bleeding into brain tissue itself or can get with high BP - stroke.
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Subarachnoid hemorrhage:
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ruptured vessels, aneurysms (stroke) - most common cause is ruptured aneurysms of arterial venous anomalities person is born with. Usually in Circle of Willis with bleeding into subarachnoid space.
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Epidural hematoma:
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a medical emergency with 50% mortality due to herniation. Bleeding above the dura and under the skull. Emergency because tends to be due to arterial rupture with hematomas occuring quickly.
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What is a sign of an epidural hematoma?
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At MVA - change in LOC, the pt. seems O.K., then on way to emergency room, person deteriorates with quick progression of injury.
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What are epidural hematomas most often associated with?
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Tears of middle meningeal artery (with linear fracture of temporal bone) and with blunt trauma.
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How long does it take for symptoms of an hematoma to show up after an injury?
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1-12 hours after trauma.
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Subdural Hematoma:
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under dura between dura and brain tissue. Usually venous in nature. Blood collects more slowly. No rapid collection rate - have time to treat.
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S/S of subdural hematoma:
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LOC declines gradually over time
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3 kinds of subdural hematomas:
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Acute: rapid deterioration with symptoms occuring in less than 48 hours.
Subacute: Slower deterioration with symptoms occuring from 48 hours to 2 weeks after injury. Chronic: Progressive decline in LOC with symptoms occuring more than 2 weeks after injury - even 1-2 months. |
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Why does chronic subdural hematoma occur often in older people?
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Cerebral atropthy - larger space to fill.
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What is the #1 management of head injury?
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monitor for and treat IICP
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Management of head injury includes:
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Assume you have a spinal cord injury until proven otherwise.
Logroll to move; keep head in neutral position. Remember ABCs and monitor progression of hematoma. |
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What procedures are usually done?
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CT Scan to see how big hematoma is.
Craniotomy or drill burr holes. |
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What complication do these pts with hematomas often develop?
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Stress Ulcers, are prone to seizures, meningitis or brain abscess, risk for hypo/hyperthermia (hypothalamus), risk for diabetes insipidus and SIADH.
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Intracranial tumors:
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most are primary tumors, some are metastatic with primary source from lungs, breast, kidney, GI tract, prostate, uterus.
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Common Intracranial tumors:
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-Glioma (glioblastoma, astrocytoma)
-Meningioma -Metastatic tumors -vascular tumors |
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Glioma
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From glial cells (cells that hold neurons together). Not defined tumors, hard to find edges. Gliomas are usually malignant and aren't good surgical candidates
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Meningioma
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Benign tumor that arises from meninges - well-encapsulated so can see edges well. Excellent surgical candidates - sometimes getting to them is difficult -curative.
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Metastatic Tumors
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treatment usually not curative because arises elsewhere.
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Vascular Tumors
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AV malformation - present at birth, but not apparent until its grown. Area where you have arterioles connected directly to venules - serves no purpose. Can of worms. Often in Circle of Willis near brainstem. Poor surgical candidates because of location.
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S/S of intracranial tumors
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Focal motor and/or sensory deficits which vary based on location of tumor.
IICP Seizures due to changes in neural activity Endocrine changes due to effects of pituitary and hypothalamus H/A - blood irritating to meninges. |
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Treatment of intracranial tumors
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surgery is treatment of choice if it's accessible.
Chemotherapy Sometimes combination of the 2 |
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Why does chemotherapy work?
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Malignant cells alter the blood brain barrier so chemoagents can get through.
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What is goal of nursing care?
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#1 is prevention of management of IICP, prevent seizures, infection.
Relieve pain and keep pt. as comfortable as possible. |
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Cranial Surgery - Craniotomy:
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Done to repair bleeders, evacuate hematomas, remove boney fragments or foreign bodies, drain abscesses, remove tumors
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What are the primary concerns following a craniotomy?
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Prevention of IICP
Safety (seizures) Prevention of infections prevention of hazards of immobility emotional support |
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What are some inflammatory Conditions of the brain?
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Meningitis
Encephalitis Brain Abscess |
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Meningitis
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acute inflammation of meninges involving both brain and spinal cord.
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When does meningitis usually occur?
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Usually in Fall or Winter because it usually follows something else.
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When does meningitis usually occur?
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Usually in Fall or Winter because it usually follows something else.
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When does meningitis usually occur?
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Usually in Fall or Winter because it usually follows something else.
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When does meningitis usually occur?
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Usually in Fall or Winter because it usually follows something else.
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When does meningitis usually occur?
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Usually in Fall or Winter because it usually follows something else.
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What is the most frequent cause of meningitis?
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virus; can be bacterial, parasitic, or fungus.
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When does meningitis usually occur?
|
Usually in Fall or Winter because it usually follows something else.
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What is the most frequent cause of meningitis?
|
virus; can be bacterial, parasitic, or fungus.
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When does meningitis usually occur?
|
Usually in Fall or Winter because it usually follows something else.
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What is the most frequent cause of meningitis?
|
virus; can be bacterial, parasitic, or fungus.
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Who usually gets meningitis?
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immunocompromised, long-term steroid use.
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What is the most frequent cause of meningitis?
|
virus; can be bacterial, parasitic, or fungus.
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What is the most frequent cause of meningitis?
|
virus; can be bacterial, parasitic, or fungus.
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Who usually gets meningitis?
|
immunocompromised, long-term steroid use.
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What is the most common bacterial cause of meningitis?
|
haemophilus influenza
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Who usually gets meningitis?
|
immunocompromised, long-term steroid use.
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Neisseria meningitis
|
Often results in fulminating disease (rapidly progressing)
6-8 hours death. |
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What is the most common bacterial cause of meningitis?
|
haemophilus influenza
|
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Bacterial Meningitis
|
Mortality highest for this kind. Is a medical emergency due to exudate; 10-20% show fulminating infection with DIC and septicemia and may die within a few hours of onset.
|
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What is the most frequent cause of meningitis?
|
virus; can be bacterial, parasitic, or fungus.
|
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What is the most common bacterial cause of meningitis?
|
haemophilus influenza
|
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Who usually gets meningitis?
|
immunocompromised, long-term steroid use.
|
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Who usually gets meningitis?
|
immunocompromised, long-term steroid use.
|
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What is the most common bacterial cause of meningitis?
|
haemophilus influenza
|
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Neisseria meningitis
|
Often results in fulminating disease (rapidly progressing)
6-8 hours death. |
|
Neisseria meningitis
|
Often results in fulminating disease (rapidly progressing)
6-8 hours death. |
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S/S of Bacterial Meningitis
|
1st - severe H/A (irritation of meninges)
Nuchal rigidity Photophobia Fever Rash and seizures Change in LOC |
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Neisseria meningitis
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Often results in fulminating disease (rapidly progressing)
6-8 hours death. |
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Bacterial Meningitis
|
Mortality highest for this kind. Is a medical emergency due to exudate; 10-20% show fulminating infection with DIC and septicemia and may die within a few hours of onset.
|
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S/S of Bacterial Meningitis
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1st - severe H/A (irritation of meninges)
Nuchal rigidity Photophobia Fever Rash and seizures Change in LOC |
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Kernigs Sign:
|
With thigh flexed on abdomen cannot extend leg with meningeal irritation; + is abnormal, have meningitis; negative is normal
|
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Brudzinski Sign
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Flexing the neck causes flexin of hip and knees with meningeal irritation; + is abnormal, have meningitis, negative is normal.
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How do you dx meningitis?
|
CSF analysis
|
|
Kernigs Sign:
|
With thigh flexed on abdomen cannot extend leg with meningeal irritation; + is abnormal, have meningitis; negative is normal
|
|
What characteristics will the CSF have with bacterial meningitis?
|
Protein elevated
Glucose decreased Purulent - exudate WBC elevated Organisms present |
|
Bacterial Meningitis
|
Mortality highest for this kind. Is a medical emergency due to exudate; 10-20% show fulminating infection with DIC and septicemia and may die within a few hours of onset.
|
|
What are the characteristics of CSF with viral meningitis?
|
protein elevated, but less
Glucose normal, maybe decreased Clear WBC normal No organisms |
|
Who usually gets meningitis?
|
immunocompromised, long-term steroid use.
|
|
Brudzinski Sign
|
Flexing the neck causes flexin of hip and knees with meningeal irritation; + is abnormal, have meningitis, negative is normal.
|
|
What is the most frequent cause of meningitis?
|
virus; can be bacterial, parasitic, or fungus.
|
|
What is the most common bacterial cause of meningitis?
|
haemophilus influenza
|
|
How do you dx meningitis?
|
CSF analysis
|
|
Neisseria meningitis
|
Often results in fulminating disease (rapidly progressing)
6-8 hours death. |
|
What characteristics will the CSF have with bacterial meningitis?
|
Protein elevated
Glucose decreased Purulent - exudate WBC elevated Organisms present |
|
Who usually gets meningitis?
|
immunocompromised, long-term steroid use.
|
|
What are the characteristics of CSF with viral meningitis?
|
protein elevated, but less
Glucose normal, maybe decreased Clear WBC normal No organisms |
|
What is the most common bacterial cause of meningitis?
|
haemophilus influenza
|
|
What are complications of Meningitis?
|
Residual neurological deficits - blindness, deafness, acute cerebral edema - may leave mentally retarded or physically retarded.
Hydrocephalus - when flow is impended. DIC secondary to bacterial toxins |
|
Bacterial Meningitis
|
Mortality highest for this kind. Is a medical emergency due to exudate; 10-20% show fulminating infection with DIC and septicemia and may die within a few hours of onset.
|
|
Bacterial Meningitis
|
Mortality highest for this kind. Is a medical emergency due to exudate; 10-20% show fulminating infection with DIC and septicemia and may die within a few hours of onset.
|
|
Friedrickson-Waterhouse Syndrome=
|
Petechiae
DIC Adrenal hemorrhage Lose Na+ and water no inflammatory response |
|
S/S of Bacterial Meningitis
|
1st - severe H/A (irritation of meninges)
Nuchal rigidity Photophobia Fever Rash and seizures Change in LOC |
|
Treatment for meningitis:
|
Specimen for culture
antibiotic if bacteria suspected |
|
What are complications of Meningitis?
|
Residual neurological deficits - blindness, deafness, acute cerebral edema - may leave mentally retarded or physically retarded.
Hydrocephalus - when flow is impended. DIC secondary to bacterial toxins |
|
Neisseria meningitis
|
Often results in fulminating disease (rapidly progressing)
6-8 hours death. |
|
Kernigs Sign:
|
With thigh flexed on abdomen cannot extend leg with meningeal irritation; + is abnormal, have meningitis; negative is normal
|
|
S/S of Bacterial Meningitis
|
1st - severe H/A (irritation of meninges)
Nuchal rigidity Photophobia Fever Rash and seizures Change in LOC |
|
Bacterial Meningitis
|
Mortality highest for this kind. Is a medical emergency due to exudate; 10-20% show fulminating infection with DIC and septicemia and may die within a few hours of onset.
|
|
Brudzinski Sign
|
Flexing the neck causes flexin of hip and knees with meningeal irritation; + is abnormal, have meningitis, negative is normal.
|
|
Kernigs Sign:
|
With thigh flexed on abdomen cannot extend leg with meningeal irritation; + is abnormal, have meningitis; negative is normal
|
|
S/S of Bacterial Meningitis
|
1st - severe H/A (irritation of meninges)
Nuchal rigidity Photophobia Fever Rash and seizures Change in LOC |
|
What is the most common bacterial cause of meningitis?
|
haemophilus influenza
|
|
Brudzinski Sign
|
Flexing the neck causes flexin of hip and knees with meningeal irritation; + is abnormal, have meningitis, negative is normal.
|
|
How do you dx meningitis?
|
CSF analysis
|
|
S/S of Bacterial Meningitis
|
1st - severe H/A (irritation of meninges)
Nuchal rigidity Photophobia Fever Rash and seizures Change in LOC |
|
How do you dx meningitis?
|
CSF analysis
|
|
Kernigs Sign:
|
With thigh flexed on abdomen cannot extend leg with meningeal irritation; + is abnormal, have meningitis; negative is normal
|
|
Neisseria meningitis
|
Often results in fulminating disease (rapidly progressing)
6-8 hours death. |
|
What characteristics will the CSF have with bacterial meningitis?
|
Protein elevated
Glucose decreased Purulent - exudate WBC elevated Organisms present |
|
What characteristics will the CSF have with bacterial meningitis?
|
Protein elevated
Glucose decreased Purulent - exudate WBC elevated Organisms present |
|
Bacterial Meningitis
|
Mortality highest for this kind. Is a medical emergency due to exudate; 10-20% show fulminating infection with DIC and septicemia and may die within a few hours of onset.
|
|
Brudzinski Sign
|
Flexing the neck causes flexin of hip and knees with meningeal irritation; + is abnormal, have meningitis, negative is normal.
|
|
S/S of Bacterial Meningitis
|
1st - severe H/A (irritation of meninges)
Nuchal rigidity Photophobia Fever Rash and seizures Change in LOC |
|
Friedrickson-Waterhouse Syndrome=
|
Petechiae
DIC Adrenal hemorrhage Lose Na+ and water no inflammatory response |
|
How do you dx meningitis?
|
CSF analysis
|
|
What are the characteristics of CSF with viral meningitis?
|
protein elevated, but less
Glucose normal, maybe decreased Clear WBC normal No organisms |
|
Treatment for meningitis:
|
Specimen for culture
antibiotic if bacteria suspected |
|
Kernigs Sign:
|
With thigh flexed on abdomen cannot extend leg with meningeal irritation; + is abnormal, have meningitis; negative is normal
|
|
Kernigs Sign:
|
With thigh flexed on abdomen cannot extend leg with meningeal irritation; + is abnormal, have meningitis; negative is normal
|
|
Brudzinski Sign
|
Flexing the neck causes flexin of hip and knees with meningeal irritation; + is abnormal, have meningitis, negative is normal.
|
|
Brudzinski Sign
|
Flexing the neck causes flexin of hip and knees with meningeal irritation; + is abnormal, have meningitis, negative is normal.
|
|
How do you dx meningitis?
|
CSF analysis
|
|
What are the characteristics of CSF with viral meningitis?
|
protein elevated, but less
Glucose normal, maybe decreased Clear WBC normal No organisms |
|
What are complications of Meningitis?
|
Residual neurological deficits - blindness, deafness, acute cerebral edema - may leave mentally retarded or physically retarded.
Hydrocephalus - when flow is impended. DIC secondary to bacterial toxins |
|
What characteristics will the CSF have with bacterial meningitis?
|
Protein elevated
Glucose decreased Purulent - exudate WBC elevated Organisms present |
|
What are complications of Meningitis?
|
Residual neurological deficits - blindness, deafness, acute cerebral edema - may leave mentally retarded or physically retarded.
Hydrocephalus - when flow is impended. DIC secondary to bacterial toxins |
|
What are the characteristics of CSF with viral meningitis?
|
protein elevated, but less
Glucose normal, maybe decreased Clear WBC normal No organisms |
|
How do you dx meningitis?
|
CSF analysis
|
|
Friedrickson-Waterhouse Syndrome=
|
Petechiae
DIC Adrenal hemorrhage Lose Na+ and water no inflammatory response |
|
What are complications of Meningitis?
|
Residual neurological deficits - blindness, deafness, acute cerebral edema - may leave mentally retarded or physically retarded.
Hydrocephalus - when flow is impended. DIC secondary to bacterial toxins |
|
What characteristics will the CSF have with bacterial meningitis?
|
Protein elevated
Glucose decreased Purulent - exudate WBC elevated Organisms present |
|
Friedrickson-Waterhouse Syndrome=
|
Petechiae
DIC Adrenal hemorrhage Lose Na+ and water no inflammatory response |
|
Treatment for meningitis:
|
Specimen for culture
antibiotic if bacteria suspected |
|
What characteristics will the CSF have with bacterial meningitis?
|
Protein elevated
Glucose decreased Purulent - exudate WBC elevated Organisms present |
|
What are the characteristics of CSF with viral meningitis?
|
protein elevated, but less
Glucose normal, maybe decreased Clear WBC normal No organisms |
|
What are the characteristics of CSF with viral meningitis?
|
protein elevated, but less
Glucose normal, maybe decreased Clear WBC normal No organisms |
|
What are complications of Meningitis?
|
Residual neurological deficits - blindness, deafness, acute cerebral edema - may leave mentally retarded or physically retarded.
Hydrocephalus - when flow is impended. DIC secondary to bacterial toxins |
|
Friedrickson-Waterhouse Syndrome=
|
Petechiae
DIC Adrenal hemorrhage Lose Na+ and water no inflammatory response |
|
Treatment for meningitis:
|
Specimen for culture
antibiotic if bacteria suspected |
|
Friedrickson-Waterhouse Syndrome=
|
Petechiae
DIC Adrenal hemorrhage Lose Na+ and water no inflammatory response |
|
Treatment for meningitis:
|
Specimen for culture
antibiotic if bacteria suspected |
|
Treatment for meningitis:
|
Specimen for culture
antibiotic if bacteria suspected |
|
What are complications of Meningitis?
|
Residual neurological deficits - blindness, deafness, acute cerebral edema - may leave mentally retarded or physically retarded.
Hydrocephalus - when flow is impended. DIC secondary to bacterial toxins |
|
Friedrickson-Waterhouse Syndrome=
|
Petechiae
DIC Adrenal hemorrhage Lose Na+ and water no inflammatory response |
|
Treatment for meningitis:
|
Specimen for culture
antibiotic if bacteria suspected |
|
What should be done if cultures come back HIV or Neisseria Men?
|
Isolation - spreads rapidly in closed environment
|
|
What should be done if culture comes back viral men?
|
Treat symptomatically; usually no severe problems.
|
|
What nursing care should be done for pt. with meningtitis?
|
Dark, quiet, cool room for H/A and photophobia - low dose Lortabs, Codeine, no morphine - need to be able to assess LOC.
Fever - aspirin, cooling blanket Fluids - lose fluids with fever so at least IV access, oral fluids; Safety - seizures, Dilantin Nutrition - High protein, high caloric Isolation- only with meningococcal meningitis, HIV |
|
Encephalitis
|
acute inflammation of the brain; usually caused by virus - most often herpes simplex and equine virus (West Nile, bird flu)
|
|
S/S of encephalitis
|
similar to bacterial meningitis but onset is more gradual and cerebral edema is more severe.
|
|
Treatment of encephalitis:
|
antiviral meds
steroids hypertonic fluids for cerebral edema |
|
Brain Abscess:
|
fairly uncommon; chronic sinus infections, mastoiditis, chronic ear infections. Abscess with puss puts pressure on surrounding tissue.
|
|
Brain abscess usually associated with
|
trauma or another infection
|
|
What problems show up with encephalitis?
|
focal deficits and IICP - high mortality rate.
|
|
Care is to:
|
treat IICP; antibiotics; surgical drainage of abscess.
|
|
Treatment:
|
Antibiotics; possible surgery to clean out abscess - craniotomy, burr holes.
|
|
S/S of Encephalitis:
|
HA, fever, change in LOC, symptoms progress more slowly with enceph than meningitis, but because more serious - cerebral edema. Usually has some sort of permanent brain damage.
|
|
When does meningitis usually occur?
|
Usually in Fall or Winter because it usually follows something else.
|
|
What is the most frequent cause of meningitis?
|
virus; can be bacterial, parasitic, or fungus.
|
|
Who usually gets meningitis?
|
immunocompromised, long-term steroid use.
|
|
What is the most common bacterial cause of meningitis?
|
haemophilus influenza
|
|
Neisseria meningitis
|
Often results in fulminating disease (rapidly progressing)
6-8 hours death. |
|
Bacterial Meningitis
|
Mortality highest for this kind. Is a medical emergency due to exudate; 10-20% show fulminating infection with DIC and septicemia and may die within a few hours of onset.
|
|
S/S of Bacterial Meningitis
|
1st - severe H/A (irritation of meninges)
Nuchal rigidity Photophobia Fever Rash and seizures Change in LOC |
|
Kernigs Sign:
|
With thigh flexed on abdomen cannot extend leg with meningeal irritation; + is abnormal, have meningitis; negative is normal
|
|
Brudzinski Sign
|
Flexing the neck causes flexin of hip and knees with meningeal irritation; + is abnormal, have meningitis, negative is normal.
|
|
How do you dx meningitis?
|
CSF analysis
|
|
What characteristics will the CSF have with bacterial meningitis?
|
Protein elevated
Glucose decreased Purulent - exudate WBC elevated Organisms present |
|
What are the characteristics of CSF with viral meningitis?
|
protein elevated, but less
Glucose normal, maybe decreased Clear WBC normal No organisms |
|
What are complications of Meningitis?
|
Residual neurological deficits - blindness, deafness, acute cerebral edema - may leave mentally retarded or physically retarded.
Hydrocephalus - when flow is impended. DIC secondary to bacterial toxins |
|
Friedrickson-Waterhouse Syndrome=
|
Petechiae
DIC Adrenal hemorrhage Lose Na+ and water no inflammatory response |
|
Treatment for meningitis:
|
Specimen for culture
antibiotic if bacteria suspected |