Neurological Dysfunction PDF

Neurological Dysfunction Study online at https://quizlet.com/_c89xkw When is the autoregualtion-maintenance of constant perfusion BP 160 with variation of BP ineffective...

Neurological Dysfunction Study online at https://quizlet.com/_c89xkw When is the autoregualtion-maintenance of constant perfusion BP 160 with variation of BP ineffective increase in volume of one component must be compensated by Monro-Kellie hypothesis a decrease in volume of another because the sum of volumes of brain, CSF, and intracranial blood is constant How is CPP measured? MAP-ICP normal ICP 5-15 mmHg Normal CPP 50-60 mmHg - decreased MAP 2 things that can cause decreased CPP - increased ICP - shunt blood 2 ways the brain compensate for SMALL rises in ICP - displace CSF - tumor - trauma 5 disorders that cause increase in ICP - stroke - postop edema - meningitis How to can hyponatremia cause increased ICP causes cells to expand How can hypotension cause increased ICP cause cerebral vessels to dilate and blood shunting How can hyperthermia cause increased ICP fever can cause vasodilation - LOC - pupils (size/ reaction) - motor strength 5 ways to assess for increased ICP - GCS - cranial nerves (corneals, gag, babinski, pronator drift, facial muscles) When a nurse has a neuro pt what must be done with the oncom- another neuro assessment ing nurse at shift change - eye opening - verbal response 4 categories in the GCS - motor response - posturing - severe: 3-8 scores for severe, moderate, and mild GCS - moderate: 9-12 - mild: 13-15 - nailbed pressure 2 ways to perform noxious stimuli - sternal pinch How should nurse change they way they talk during a neuro exam lower tone - at baseline in the emergency room when should the NIHSS be performed? (3) - in conjunction with tPA/ other therapies - then per policy - pt in coma with spinal cord clear When is doll's eyes performed, define presence/ absence - p: eyes move in opposite direction of head - a: eyes stationary What does an absence of doll's eyes indicate brainstem dysfunction Besides doll's eyes what is another ways to assess brainstem cold calorics function What is herniation of the brain caused by rapid increase in ICP What kind of response can herniation cause cushings response - bradycardia 6 s/s of cushings response - hyperventilation - chainstokes respirations 1/3  Neurological Dysfunction Study online at https://quizlet.com/_c89xkw - periods of apnea - widening pulse pressure - HTN Define widening pulse pressure systolic increases as diastolic decreases - Severe head injury * 4 reasons for ICP monitoring/ which 2 typically also require brain - subarachnoid hemorrhage* drain (IVC) - tumor - stroke Purpose of Intraventricular catheter (IVC) pull fluid off ventricles to relieve pressure on brain If a pt with IVC needs to be supine what should the nurse do with - turn off the drain - bring toward the pt How many people are required for an IVC dressing change at least 2 - below: will drain too much What can happen is the brain drain is not leveled - above: ICP will have to be very high for it to drain - neurological checks 3 things that should be done hourly with IVCs - output of drain checks - ICP monitor True or false: IVC require sterile care false, aseptic True or False: neuro pt should have cluster care to give them false too much stimulus at once can increase ICP longer breaks When is the only time IVCs are zeroed right after insertion - concussion-mild brain injury - coup-acceleration 5 types of traumatic brain injuries - countrecoup-deceleration - skull fracture - bleeding of arteries or veins What resolves a mild concussion rest - epidural hematoma - subdural hematoma* 4 vascular brain injuries from trauma, which is most common - subarachnoid hemorrhage - intracerebral hematoma - quickly When do acute subdural hematomas occur and 2 tx - craniotomy and burr holes How long does it take for subacute subdural hematomas to occur, - 2 days- 2 weeks tx - may or may not have surgery How long does it take for chronic subdural hematomas to occur, days or months 2 tx - surgery or JP drain Who are chronic subdural hematomas common in older adults especially those with a fib on blood thinners What can happen with a chronic subdural hematoma enlarge and form a membrane - high ICP leading to poor perfusion leading to hypotension causes What is the downward spiral of anaerobic metabolism brain in- shunting more blood to the brain that it can't accept the Na/K pump juries failure causing sodium and water to enter cells - Pro: rapid acting, therefore can turn off and do a neruo exam in One pro and con of propofol drip-sedative hypnotic anesthetic 10 min and turn back on - con: eventually have to adjust nutrition due to hyperlipidemia - Pro: decrease ICP One pro and con of mannitol IVPB-osmotic diuretic - con: must be given with filter because will crystalize What type of saline infusion should be given for increase ICP and - hypertonic (2-3%) how - slow Why would dexamethasone IVP be used for brain injuries decrease inflammation How can hyperventilation cause increased ICP because it decreased CO2 which is a vasodilator 2/3  Neurological Dysfunction Study online at https://quizlet.com/_c89xkw - GCS >10 - seizure 24 hours post injury 5 indications anticonvulsants and/or benzo may be initiated for - hematomas seizure management - depressed skull fracture - penetrating head wound How can neurological illnesses result in sodium imbalances ICP affects the hypothalamic pituitary system - diabetes insipidus 2 sodium imbalances caused by increased ICP - SIADH - absence of ADH 3 things that happen in diabetes insipidus - large volume dilute urine - serum Na increases how to treat diabetes insipidus Desmopressin DDAVP - too much ADH 2 things that happen in SIADH - dilutional hyponatremia - fluid restriction 3 tx for SIADH - hypertonic solution - vaptans Why are vaptans not the first choice for SIADH - not always predictable how much h2o will be excreted Why are head injury pt watched closely for aspiration and pneu- typically decreased LOC and can't protect their airway as well monia Define epilepsy 2 seizure w/o cause which seizures do not have a postictal phase pseudoseizure - head injury - electrolyte imbalance 5 causes of seizure due to increased ICP - hyper/hypoglycemia - meningitis - brain tumors - drug/ alcohol intoxication/withdrawal Besides increased ICP what are two other causes of seizures - fever - lip smacking 2 s/s of partial-local seizures - rhythmic hand movements How are seizures diagnosed EEG extension of extremities up to 20 seconds then rhythmic move- Describe tonic clonic seizure ment up to 30 seconds Define status epilepticus seizure lasting more than 5 minutes How do seizures result in anoxic brain injury if cerebral glucose and oxygen demand exceed supply What can be given to stop a seizure and preserve brain function benzo and put into deep coma - Dilantin (phenytoin) - Cerebyx (fosphenytoin) 4 IVP tx for seizure - Valium (diazepam) - Ativan (lorazepam) - can be hard on veins because alkaline 3 things to remember when administering Dilantin (phenytoin) - infuse soon after mixing - if admin to rapid can cause hypotension Because Dilantin is hard on veins, what other drug can be given Cerebyx (fosphenytoin) IVP to stop seizure that is not has hard on veins How to benzos stop a seizure - enhance GABA inhibition to make the neurons less excitable How can the diet be changed to reduce seizures increase fat Urine specific gravity in pt with diabetes insipidus is typically... low 2 things to watch closely with high ICP fluid and electrolyte status 3/3