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73 Cards in this Set
- Front
- Back
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What scan of the head is best to use in emergencies? Why?
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Cat scan
-They are quick and give fast results |
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What brain scan is similar to an EKG of the heart?
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Electroencephalogram EEG
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Which scan of the head is good at catching seizures?
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EEG
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What is considered brain dead?
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2 flat EEG lines in 24 hours
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A cerebral angiogram is most similar to a ____ _____?
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Cardiac catheterization
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What are the complications of a lumbar puncture?
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1. Headache
2. Herniation of cerebral contents 3. Infection 4. Hematoma |
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Where is a lumbar puncture inserted?
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In the subarachnoid space usually between L3 or L4 (below the spinal chord)
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What numbers would be considered high ICP from a lumbar puncture? (mmH2O and mmHG)
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mmH2O: 200 is considered high
mmHg: > 15 is high ICP |
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What is the correct position for a pt to be in to receive a lumbar puncture?
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Pts back all the way at the edge of the bed with legs up to the chest
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What is the best way to prevent a spinal headache?
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have pt on bed rest for 4-6 hours after puncture
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What is the Tx for a spinal headache?
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blood patch
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What are some structural causes of neurological dysfunction?
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1. head injury
2. intracranial hemorrhage 3. encephalitis 4. brain abscess 5. stroke |
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List some possible metabolic reasons for neurological dysfunction.
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1. Sepsis
2. FVD 3. MI 4, Resp arrest 5. hypoglycemia 6. electrolyte imbalance 7. drug/alcohol abuse 8. diabetic ketoacidosis 9. hepatic encephalopathy |
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What are the 3 fixed volumes that reflect ICP?
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1. The brain
2. CSF 3. Blood |
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What is the Munro-Kellie hypothesis?
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Closed box theory of ICP
-any increase in ICP within an intact skull results in a compression or decrease in one of the other compartments. |
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LIst the factors contributing to ICP.
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1. Hypercap: paCO2 > 45
2. hypoxemia: paO2<50 3. Valsalva maneuver 4. Positioning 5. isometric muscle Ctxs 6. coughing, sneezing 7. emotional upset 8. noxious stimuli 9. excessive sensory stimuli |
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What are the nursing assessments for pts with ICP?
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1. Confused
2. Lethargic: sleeps often, speech and thought are slow 3. Obtunded: awake only with constant stimuli, follows commands 4. Stuporous: wakens only to painful stimuli 5. Comatose: NO response |
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What characterizes the early picture of ICP?
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1. Change in LOC or behavior (the one sign you can count on)
2. Pupils 3. Motor function 4. Constant headache 5. VS 6. visual disturbances |
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What are the Late signs of ICP
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1. LOC deteriorates
2. Loss of brain stem reflexes (pupils fixed and dilated) 3. Motor response: flacid 4. VS 5. Projectile vomiting |
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What is decordicate position?
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Fetal position
Muscles come into the core: indicates problem with cerebral hem |
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What is the deseridate position?
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Arms out and feet abducted. Indicative of a midbrain problem
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What is the worst body position for a pt with ICP to have?
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FLACID
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What is the Triad for ICP? What can also been a SxS of ICP?
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1. HTN
2. Bradycardia 3. Abnormal respirations: Cheyne-Stokes widening pulse pressure and Temperature |
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What is the most common drugs given for increased ICP?
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Osmotic diuretics: Mannitol
Corticosteroids |
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If a pt with ICP has a fever, what are the nursing interventions to deal with it?
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Cool them down slowly without letting them shiver
May be Thorazine to stop them from shivering with rapid cooling |
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How can the nursing staff reduce metabolic demands for pts with ICP?
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Give sedatives and maybe paralyzing agents.
Pt must be intubated and on a respirator |
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How can a nurse help reduce CSF and Blood volume for pts with ICP?
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Drain some fluid from the catheter
Hyperventilate pt to have them blow off CO2 |
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How is a pts ICP monitored?
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With a intracranial catheter placed in the lateral ventricles and connected to a transducer.
Also allows for drainage |
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What is the definition of unconsciousness?
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unresponsive, unaware of environmental stimuli. Have EEG activity
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What is a coma?
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unconsciousness for days, months or years
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Describe a persistant vegetative state.
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Wakeful, but no conscious or cognitive mental function
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What are the 3 causes of unconsciousness/coma?
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1. Neurological
2. Toxic 3. Metabolic |
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What should a nurse look for with a comatose pt with normal pupillary light reflex?
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Metabolic signs leading to coma
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What is the Glasgow scale and what is it based on?
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Tracks how a pt is doing neurologically.
-Based on 3 responses: Eye opening, Motor response and verbal response -The higher the score, the better they are doing |
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What is CVD?
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Cerebrovascular Disease: partial or complete occlusion of a cerebral BV or if they hemorrhage in a cerebral BV
Includes CVA and TIA |
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What are the Risk factors for Cerebrovascular Disease (CVD)?
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1. CV disease
2. HTN 3. DM 4. Smoking 5. Fam Hx 6. Alcoholism or drugs 7. obesity 8. BCPs 9. Sedentary lifestyle 10. Hx of TIA |
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What is a TIA?
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Temporary episode of neurological dysfunction manifested by a sudden loss of motor, sensory or visual function
With no lasting neurological dysfunction |
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What % of pts with TIA go on to have a stroke?
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20%
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Where is the most common place for a TIA and how should it be assessed?
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Carotid arteries
-Auscultate, carotid doppler study, carotid angiogram |
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What are the management options for TIA?
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1. Carotid angioplasty w/ or w/o stent placement
2. Surgical: endarterectomy: removal of clot 3. Anticoagulation Tx |
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What is the most common cause of chronic disability?
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CVA
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What acronym is being used to help people recognize the SxS of a stroke?
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FAST
F: Face= ask the person to smile, does one side droop? A: Arms= ask person to raise both arms, does one drift? S: Speech: ask person to repeat a simple phrase, is it slurred or strange T: Time= call 911 fast! |
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what are the 2 types of CVA?
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1. Ischemic
2. Hemorrhagiv |
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What are the risk factors for ischemic CVAs?
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1. Arteriosclerosis
2. atrial fib 3. disease of heart valves |
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Which CVA is most common?
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Ischemic: seen in 80-90%
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What are the common complaints of pts with an Ischemic CVA?
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numbness or weakness on 1 side of the body
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What are the risk factors for hemorrhagic CVA?
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1. arteriovenous malformation
2. intracranial aneurysm 3. Meds 4. HTN 5. Trauma |
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What is the #1 most common cause of hemorrhagic CVA?
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HTN
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when is arteriovenous malformation common?
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post partum
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In a CVA pt, what visual field manifestations will be seen on assessment?
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1. Hemianopsia
2. Loss of peripheral vision 3. Diplopia |
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What is hemiparesis?
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weakness on one side of body
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What is paralysis on one side of the body called?
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Hemiplegia
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If a pt has ataxia, they have ____?
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unsteady gait
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What is the medical term for difficulty forming words?
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Dysarthria
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What is dysphagia?
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difficulty swallowing
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What sensory changes are seen in pts with CVA?
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Paresthesias: numbness
Difficulty with proprioception |
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What is expressive aphasia?
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cannot express what is going on with them
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What is receptive aphasia?
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Pt does not understand what is being said to them
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IF a pt with CVA cannot express themselves or understand what is being said to them they are said to have ______ aphasia.
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Global
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What side has a CVA occurred on with a pt experiencing Aphasia, altered intellectual ability and slow, cautious behavior?
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Left sided CVA
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If a CVA pt is very distractible, has impulsive behavior and poor judgement and a lack of awareness of their deficits, they are thought to have a ____ Sided CVA.
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Right
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Most right handed people have their Broca's Center where?
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on the left sided of their brain.
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How do you treat an ischemic stroke?
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1. Thrombolytics
2. Anticoagulants |
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What is the time frame for thrombolytic use with CVA pts?
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< 3 hours from onset of symptoms
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What is the management for hemorrhagic strokes?
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1. Manage ICP
2. Surgery |
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Why is proper positioning important for post CVA pts?
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Because contractions will set in and you may not be able to release them.
Do PT 4-5x/day |
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What can a nurse do to help a CVA pt with dysphagia?
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give them thickening substance to help them eat their food
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How should a nurse approach a pt following a CVA?
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From their side of sight
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What are the important nursing interventions for CVA pts to prevent complications?
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1. Watch for cerebral hypoxia: O2 sats, ABGs, keep H/H WNL
2. Watch for Decrease cerebral blood flow: keep normotensive, have adequate hydration 3. Prevent extension of the area of injury: avoid hypo or hypertension |
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What preoperative care should be done before a craniotomy?
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1. Baseline Neuro assessment
2. Prepare client and family for appearance 3. Preop teaching 4. Allow pt and fam to ask questions 5. Consent must include consent for hair removal |
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What usually occurs preoperatively on the morning of the craniotomy?
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-Antiseptic shampoo
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What meds are often given preoperatively for craniotomies and why?
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1. Dilantin: antiseizure
2. Mannitol and steroids: to decrease ICP 3. antibiotics: prophylactic for infection |
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What are the most important complications to assess for and avoid post craniotomy?
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1. ICP
2. Bleeding 3. Fluid and electrolyte imbalances 4. Infection 5. Seizures |
