NeuroAdult1

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Author:
madelynlee
ID:
69062
Filename:
NeuroAdult1
Updated:
2011-02-27 22:48:12
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neuro neurological nursing
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Description:
Neurological Alterations Across the Lifespan - Acute Adult Neuro
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  1. Acute neuro topics
    • TBI
    • cranial surgeries
    • SC injury
  2. TBI stats/facts
    • 1.4 million per yr treated in USA
    • 50,000 die immediately
    • 250,000 hospitalized each year
    • high chance for residual deficits
  3. norm vs elevated ICP
    • norm = 0-15 mmHg
    • elevated = 15+ mmHg
  4. measure ICP if GCS is what
    8 or below
  5. skull contains what
    • brain
    • blood
    • CSF
  6. you treat ICP for how much pressure
    20 mmHg or more
  7. epidural transducer
    • not really used anymore
    • device to measure ICP that doesn't enter skull/dura
  8. probe directly into brain measures
    • brain tissue oxygen
    • temperature
  9. microdialysis
    • w/ catheter into brain tissue
    • samples are take periodically
    • analyze glucose, lactate, pyruvate, glutamate
    • determine changes in cellular nrg metabolism to help understand mechanisms of secondary injury
  10. what is hypothermia treatment for brain trauma
    • controversial
    • stabilizes BBB
    • decreases metabolic rate, which decreases CO2 and lactate)
  11. NIs for head trauma and increased ICP
    • fluid balance
    • stimulation/activity
    • positioning
    • temp ctrl
    • pain ctrl
    • valsalva's maneuver
    • CSF drainage
    • BP
    • ABGs (CO2)
    • medications
    • barbiturate coma
    • assessment
  12. with head trauma and ICP pt, be careful not to what re: fluid balance
    overhydrate
  13. what solutions would you hang for a ICP pt
    • hypertonic, i.e.
    • D5NS
    • D5LR
    • D5.45NS
  14. osmolalities of hyper vs. hypo-tonic solutions
    • hypotonic = less than 240
    • hypertonic = greater than 340
  15. when is peak swelling for ICP/head trauma pt.
    • 1-3 days
    • after 3 days usually peak is over
  16. why is temp ctrl impt for ICP/head trauma pts
    increased temp means increased metabolism, which increases CO2, which potently vasodilates, which increases swelling
  17. what is a potent vasodilator
    CO2, and it will lead to cerebral edema
  18. do you want high or low BP re: ICP pt
    • high, to assure perfusion
    • body will attempt to do this on its own via cushings triad
  19. what do you do if BP is not high enough and you have an ICP pt
    put them on pressors
  20. why would an ICP pt need a ventilator
    to ctrl CO2 levels
  21. what ABG level would you want CO2 at for a ICP pt
    nearer to the 35 end (low CO2 to decrease risk for edema)
  22. osmotic diuretics are for what
    • fluid shifts from tissues to BVs via osmosis
    • reduced ICP
  23. name an osmotic diuretic for ICP ctrl
    • mannitol (osmitrol)
    • hyperosmotic diuretic
    • causes fluid to move from brain tissue to BVs
    • give KCl w/ it to replace K+ lost in urine
  24. name ALL osmotic diuretics
    • mannitol (osmitrol)
    • 3% saline drip (titrate per Na lvl sliding scale)
    • 23% saline for severely high ICP
  25. if you have severely high ICP, hang what
    23% saline
  26. what do you need to know re: 3% saline drip
    • titrate per Na lvl sliding scale
    • osmotic diuretic to help ctrl ICP
  27. what do you need to know re: mannitol?
    • lose lots of water in urine, esp K+
    • give lots of KCl w/ mannitol to replace
  28. what two med types give ICP pt
    • osmotic diuretic
    • corticosteroids
  29. what need to know re: corticosteroids for ICP pts
    • must be tapered off; can't stop them abruptly
    • causes BG to go up; sometimes give insulin w/ it
  30. name 2 corticosteroids you give for ICP pt
    • dexamethasone (decadron)
    • medrol packs -- ctrls edema for cranial surgeries but not as helpful for TBI
  31. why put sb in barbiturate coma w/ phenobarbital
    deeper coma causes person to shut down more metabolically, so decreases CO2 -- good!
  32. best indicator for neuro status changes
    change in lvl of consciousness
  33. what does "changes in lvl of consciousness" look like
    person may just be restless, confused, sleepy, or agitated
  34. cushing triad
    • increase in systolic BP
    • widened pluse pressure
    • decrease in pulse
  35. symptoms of increased ICP
    • changes in lvl of consciousness
    • headache
    • visual disturbances
    • vomitting
    • resp changes (cheyne-stokes, hypervent., cluster, ataxic)
    • VS changes
    • cushing triad
    • papiledema
    • motor/sensory dysfunction
    • CN dysfunction
    • cerebellar signs: imbalance, unsteady, incoord.
    • changes in reflexes
  36. factors influencing outcome of ICP pt
    • extent/type of injury
    • increased age - elderly do worse
    • abn motor response
    • absent eye mvmt or pupil light reflexes
    • early hypotension, hypoxemia, hypercapnia
    • medical and nursing care
  37. most common nrain injury deficits
    • motor/sensory changes
    • cog. impairment
    • headaches
    • cranial nerve involvement
    • tiredness
    • memory problems
    • difficulty walking
    • poor back to work/school
  38. reasons for cranial surgery
    brain tumors
    evacuation of bleeding/hematomas
    aneurysm clipping
    drainage of brain abscesses
    shunt insertions
    insertion of PD/depression devices
  39. name 5 cranial surgeries
    • Burr hole
    • craniotomy
    • cranioplasty
    • stereotaxis
    • shunt procedure (VP or VA)
  40. burr hole def and why
    • remove blood beneath dura
    • open into cranium with a drill
  41. craniotomy def and why
    • open into cranium w/ removal of bone flap to excise tumor, abscess, clot, lesion, or to relieve ICP
    • drains may be placed, ICU until stable
  42. cranioplasty def and why
    • repair of cranial defect r/t trauma
    • artificial material may replace lost bone
  43. stereotaxis - why do
    used for biopsy or radiosurgery
  44. shunt procedure (VP or VA shunt) does what
    redirects CSF via a tube from ventricle to abdomen (or heart)
  45. main complication of cranial surgery
    increased ICP
  46. NIs post-op cranial surgery
    • freq neuro assess
    • freq VS
    • prevent ICP/positioning
    • monitor dressing/incision
    • pain mgmt
  47. what is the most critical factor for spinal cord injuries
    edema, b/c it can make the condt worse than the original problem
  48. how to spinal cord injuries happen (4 mechanisms of injury)
    • flexion
    • compression
    • hyperextension
    • flexion-rotation
  49. how do you classify the level of injury for spinal cord injuries
    • skeletal - damage to vertebral bones and ligaments
    • neurological - cervical, thoracic, lumbar
  50. cervical (neck) injuries result in what for pt
    • quadriplegia
    • above C4 may require ventilator
    • loss of resp/chest muscles
    • motor/sensory loss of upper and lower extremities
  51. thoracic/lumbar level injuries result in what for pt
    • paraplegia
    • poor trunk ctrl as result of lack of abd muscles
    • motor/sensory loss of lower extremities

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