Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
81 Cards in this Set
- Front
- Back
|
Normal ICP is?
|
5-15 mmHg
|
|
|
What does the Monro- Kellie Hypothesis state?
|
That an INCREASE in any of the 3 components will necessitate a DECREASE in one or both of the other components, or there will be an INCREASE ICP.
|
|
|
True or False
Cerebral Blood Flow (CBF) remaind constant even with wide ranges in MAP |
True
|
|
|
Acidosis leads to _______ of cerebral vessels which leads to _______.
|
- dilation
- ICH |
|
|
Alkalosis leads to ________ of cerebral vessels which leads to _______.
|
- constriction
- decreased ICH |
|
|
Hypothermia leads to ________ CBF which leads to _________ ICH.
|
- decreased
- decreased |
|
|
Hyperthermia leads to ________ CBF which leads to _________ ICH.
|
- increased
- increased |
|
|
What are the early s/s of increased ICP?
|
- change in behavior and/ or LOC
- vomiting without nausea - motor changes from weakness, pronator drift to posturing - Cheyne- Stokes respirations |
|
|
How do you assess for pronator drift?
|
Have patient lift both arms up to shoulder height. Have them close their eyes and one arm will drift down with in 30 seconds.
|
|
|
What do you always assess in a person having Cheyne- Stokes respirations?
|
Always time the apnea period
|
|
|
What are the middle s/s of increased ICP?
|
- Headache (not from trauma)
- decrease in visual acuity - diplopia - blurry vision - papilledema |
|
|
What are the late s/s of increased ICP?
|
- Unequal pupil sizes
- Decreased pupillary reaction to light - Cushing's triad |
|
|
What is Cushing's triad?
|
- Bradycardia
- Systolic hypertension with widing pulse pressure - Abnormal breathing patterns |
|
|
What is the usual progression of increased ICP s/s?
|
- LOC change
- Motor change - Respiratory pattern changes - Pupil size changes - Cushing's triad |
|
|
True or False
Sluggish pupils are one of the first signs of increased ICP. |
True
|
|
|
A sustained ICP of greater than 60 is?
|
Fatal
|
|
|
What are the characteristics of CSF?
|
- clear
- colorless - oderless - free of RBCs - contains little protein |
|
|
How much CSF is in the brain at any time? How much is produced a day?
|
- 100-150 mL
- 500 mL |
|
|
How much CSF is produced an hour? Why is this number important to know?
|
- 20 mL/ hr
- Important if patient has a CSF drain |
|
|
With a patient on a ventrics, what must you NEVER do?
|
- Drop down the system and leave it there, you will drain out all the CSF
- leave it to open to air, will cause infection - attach any fluid filled drip system to it - never flush the catheter, MD does it |
|
|
ICP waveform the normal is P1 < or > than P2?
|
>
|
|
|
What does a LICOX monitor?
|
Brain tissue oxygen monitoring
|
|
|
Where is the LICOX probe placed?
|
In the parenchyma (white matter)
|
|
|
What is the normal values for the Licox monitor?
|
20-40 mmHg
|
|
|
What does it usually mean if the Licox reads <20 mmHg, <15 mmHg, 2 mmHg?
|
- Low, do something
- Ischemic - Tissue death |
|
|
What are things to do as a nurse to promote venous drainage for a patient on a vent?
|
- head and neck up 30 degrees at all times
- neutral head position - PEEP should be below 10 - No valsalva maneuvers |
|
|
When do you hyperventilate a patient?
|
ONLY if acutely decompensating and they have to be on a LICOX monitor
|
|
|
If ICP is increased where should CO2 levels be maintained?
|
30-35
|
|
|
What are normal CO2 levels?
|
35-45
|
|
|
What is the longest you should suction a patient for?
|
10 secs
|
|
|
What is the standard H/H for brain injuries?
|
10/30
|
|
|
What level would you want the PaO2 to be at?
|
100 mmHg
|
|
|
Is D5W given to patients with ICP? why?
|
No, D5W is hypotonic which will retain volume causing cerebral edema
|
|
|
What is the formula for CPP?
|
CPP= MAP-ICP
|
|
|
What is normal CPP? what level do we like to maintain it?
|
- 60-100
- 70 |
|
|
What should you watch for in a ICP patient getting fluid resuscitation?
|
DI or SIADH
|
|
|
Inadequate CPP means what for cerebral metabolic needs?
|
Less glucose and oxygen
|
|
|
Each degree Centigrade elevation raises cerebral metabolic rate by?
|
5-7 %
|
|
|
Where do you want to maintain MAP when trying to control blood pressure?
|
High normal range
Normal: 70-100 |
|
|
Increased temp = _____ metabolic rate
|
Increased
|
|
|
Propofol, Lorazepam, Morphine are all examples of what?
|
Sedatives
|
|
|
Pavulon and Tracrium induces? what does the patient need in addition to these meds?
|
- Paralysis
- Sedation/analgesics |
|
|
True or False
Propofol is mostly given to patients that are intubated |
True
|
|
|
Mannitol is classified as?
|
Osmotic diuretic
|
|
|
Does Mannitol have to be filtered? Why?
|
Yes, forms crystals at room temp
|
|
|
Are steriods used for trauma patients?
|
No, only tumors
|
|
|
Diamox (Acetazolamide) is classified as?
|
Carbonic Anhydrase Inhibitor
|
|
|
What does Diamox (Acetazolamide) do?
|
- Decreases production of CSF
- weak diuretic |
|
|
Dilantin and Cerebyx are used for?
|
Seizure control
|
|
|
What is the therapeutic levels for Cerebyx?
|
10-20 ng/mL
|
|
|
What meds are used to control BP in a neuro patient?
|
- Beta- blockers
- ACE inhibitors - Ca Channel blockers - Cardene infusion |
|
|
What meds are NOT used to control BP in neuro patients? Why?
|
- Nipride, NTG
- Vasodilates brain blood vessels |
|
|
True or False
Malnutrition promotes cerebral edema |
True
|
|
|
What happens with herniation syndromes?
|
Shifting or escaping of tissue from one brain compartment to the other. Pressure is placed on cerebral vessels and vital function centers.
|
|
|
What are the four types of supratentorial herniations?
|
- Cingulate
- Uncal - Central - Transcalvarial |
|
|
Name the infratentorial herination
|
Cerebellar tonsillar herniation
|
|
|
What is a cingulate herniation?
|
Lateral displacement beneath falx cerebri
|
|
|
What is an uncal herniation? what is usually the first sign?
|
- Lateral and downward displacement
- Ipsilateral pupil change |
|
|
What is a central herniation?
|
Downward shift of both cerebral hemispheres and the brainstem through the tentorium
|
|
|
What else is a central herniation called? What are the early signs?
|
- Classic herniation
- Decreased or change in LOC, bilateral pupil change |
|
|
What is a transcalvarial herniation? When is this sometimes done?
|
- Occurs with skull fracture and protrusion of brain matter outside of skull
- Surgically as a last effort to control ICH |
|
|
What is cerebellar tonsillar herniation?
|
One or both points of the cerebellum push through the foramen magnum
|
|
|
What are the s/s of cerebellar tonsillar herniation?
|
- Stiff neck (early sign)
- Ataxic respirations - HR and BP changes |
|
|
Cerebellum coordinates? maintains?
|
- Coordinates: muscle tone, movement, balance
- Maintains: equlibrium, posture, and coordination |
|
|
Oculocephalic reflex is also called?
|
Doll's eyes test
|
|
|
What is a positive response for the Doll's eye test? What does it mean?
|
- Eyes move in opposite direction that head is turned
- Means reflexes are intact |
|
|
What cranial nerves is Doll's eye testing?
|
Cranial nerve III, VI, VIII
|
|
|
What does a negative response indicate in a Doll's eye test?
|
- Indicates brainstem involvement and should follow with caloric test
- Usually means brain dead |
|
|
What does the caloric test (oculovestibular reflex) test for?
|
- 8th cranial nerve in awake patients
- Brainstem integrity in comatose |
|
|
What is the caloric test contraindicated with?
|
- Cervical neck injury
- Ruptured eardrum |
|
|
What are the four lobes of the brain?
|
- Frontal
- Temporal - Occipital - Parietal |
|
|
What is the frontal lobe in charge of?
|
- Personality
- Judgement - Affect - Higher Intellectual function - Broca's area (expressive speech) - Voluntary motor movement |
|
|
What is the temporal lobe in charge of?
|
- Hearing
- Wernicke's area (receptive speech) - Taste - Smell |
|
|
What is the parietal lobe in charge of?
|
- Pain
- Touch - Pressure - Proprioception (aware of space) |
|
|
What is the occipital lobe in charge of?
|
- Vision
- Meaning of written words |
|
|
What are contraindications for a MRI?
|
- Pacemakers
- anything metal |
|
|
What is an MRA?
|
- Magnetic Resonance angiography
- like an MRI but looks at blood flow |
|
|
If there is a bleed on the right side of the brain, which eye would have pupil change and which side of the body might have affects?
|
- Right side pupil change
- Left side body change |
|
|
What is the difference between decorticate and decerebrate?
|
- Decorticate arms are flexed onto chest
- Decerebrate arms and legs are extended |
|
|
What could it possibly mean if someone is decorticate posturing?
|
Indicates that there may be damage to the cerebral hemispheres, the internal capsule, the thalamus, and the midbrain.
|
|
|
What could it possibly mean if someone is decerebrate posturing?
|
Indicates brainstem damage
|
