NURS 460_Neuro

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Author:
GerberTri
ID:
23278
Filename:
NURS 460_Neuro
Updated:
2010-06-12 23:17:44
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critical care nursing
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Description:
cc test III Neuro
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  1. Mannitol
    • d/c ICP by drawing water into the vasculature
    • *albumin for the brain
  2. Diprivan (Propogol)
    • sedative for anxiety
    • d/c agitation
  3. nimodipine
    • oral CCB specific to the brain
    • antispasmodic for subarachnoid hemorrhage
  4. Solu-medrol
    IV steroid to d/c inflammation
  5. ICP
    • 0-15
    • i/c: space-occupying lesions, cerebral edema, CSF outflow obstruction, failure of compensatory mechanisms
  6. CPP
    • 60-100
    • < 30 produces neuronal hypoxia, cell death
    • CPP = MAP - ICP
  7. Sodium
    • 135-145
    • i/c with DI
    • d/c with SIADH
  8. Serum osmolaity
    • 285-300
    • high: hypovolemia (DI)
    • Low: hypervolemia (SIADH)
  9. GCS normal range
    • 3-15
    • Coma @ =/< 7
  10. GCS: eye opening
    • 4: spontaneous
    • 3: to speech
    • 2: to pain
    • 1: none
  11. GCS: verbal
    • 5: oriented x3
    • 4: confused
    • 3: inappropriate words
    • 2: incomprehensible sounds
    • 1: none
  12. GCS: Motor
    • 6: obeys commands
    • 5: localizes to pain
    • 4: withdraws from pain
    • 3: abnormal flexion
    • 2: abnormal extension
    • 1: no response
  13. Oculocephalic reflex
    • Dolls eyes
    • Hold eyes open & turn head rapidly side to side
    • Normal: eyes stay centered
    • coma: eyes will move in the opposite direction
    • bad: eyes move with ehad as if painted on
  14. Oculovestibular
    • irigate the auditory canal with iced water (20-50cc)
    • Normal: eyes should slowly move toward the irrigated ear with rapid nytagmus away from the ear within 20-30 seconds
    • Coma:
    • Good (+): slow movement toward the ear & 2-3 minute delay to return to midline
    • Bad (-): no response may indicate brain death
  15. Vital signs: ususlaly late int he course of neurodysfunction
    F°, BP, pulse
    • : side variations especially if hypothalamus injured
    • BP: i/c with i/c ICP
    • Pulse: sinus tach w/ increasing ICP
  16. Cushing's Triad
    • late sign of herniation syndrome d/t pressure on the medulla in response to increasing ICP
    • 1. bradycardia
    • 2. systolic hypertension
    • 3. widening pulse pressure
  17. Cheyne-stokes respirations
    most common respiratory pattern with unconsicous patients
  18. Causes of subarachnoid hemorrhage
    • -Aneurysm: localized dilation of aterial lumen (weak vessel)
    • -AVM: tangled mas of arteries and veins presenting initially as a sz/hemorrhage
  19. Complications of subarachnoid hemorrhage
    Vasospasm (70% of pts 4-14 days after SAH)
  20. Presentation of subarachnoid hemorrhage
    explosive HA
  21. Treatment of subarachnoidhemorrhage
    • Aneurysm: clipping
    • AVM: coiling/embolization
  22. Treatment of vasospasm r/t subarachnoidhemorrhage
    • -Triple H therapy: hypervolemia, hemodilution, hypertension
    • -Nimodipine (antispasmodic)
    • -Cerebral angioplasty (last resort)
  23. Indicators for i/c ICP
    • d/c LOC
    • pupillary changes
    • worsening HA
    • cognitive deficits
    • cushing's triad (late sign)
    • irregular respiratory patterns
    • bradycardia
    • sz
    • aphaseia, dysconjugate gaze
    • hemiparesis/hemiplegia
  24. Factors in i/c ICP
    • venous outflow obstruction (pt positioning--never lay flat!)
    • i/c intrathoracic pressure: anything that i/c BP will d/c venous return (PEEP, coughing)
  25. Diabetes insipidus
    • failure to release ADH (too little)
    • large amount of dilute urine
    • s/s: polyuria, low urine spc gr, polydipsia, high serum osmolarity, hyeprnatremia, hypovolemia
    • tx. fluid replacement & ADH replacement
  26. SIADH
    • i/c secretion of ADH
    • *water retention--scant urine with large amounts of sodium in the urine
    • s/s: d/c UOP, i/c urine spc gr., low serum osmolaity, hyponatremia
    • tx.: fluid restriction, replace sodium, fluorocortisone, hypertonic saline (3%NS), loop diuretics
  27. Pupil abnormalities
    • small: narcotics, damage to pons
    • large: atropine, agitation, darkened room
    • CNIII nerve compression
    • Unequal: pressure in one side
    • dilated & nonreactive pupils

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