complex #2 - neuro

the 3 components of the brain must stay at a relatively constant volume within the closed skull; if the volume of one increases then the volume of another will decrease

what idea does the Monro-Kellie doctrine rely on?

what is normal ICP?

ICP is completely compensated; an increase in one component does not affect ICP

compensation starts to decline; there is an increased risk for increased ICP

failing compensation; small increases in volume cause big increases in ICP; clinical manifestations increased ICP (i.e. Cushing’s triad)

herniation imminent → leads to death

amount of blood in mL passing through 100g of brain tissue in 1 minute

what is the normal cerebral blood flow

when is autoregulation effective?

automatic adjustment in diameter of cerebral blood vessels

cerebral perfusion pressure =

what is normal CPP?

what CPP is associated with ischemia and neuronal death?

what CPP is incompatible with life

what factors affect cerebral blood vessel tone?

extracellular accumulation of fluid resulting from disruption of the blood-brain barrier (BBB) and extravasations of serum proteins

extracellular water passes into cells resulting in swelling

outflow of cerebrospinal fluid from the intraventricular space to the interstitial areas of the brain

what is a hallmark sign of increased ICP?

what are the three s/s associated with Cushing’s triad?

what posturing indicates more serious damage?

patient begins to have ipsilateral pupil dilation, eyelid ptosis, and is unable to move their eyelid upwards - what do you suspect is happening?

your patient suddenly has a fixed, unilateral, dilated pupil - what neurologic emergency do you suspect?

what kind of headache would you associated with increased ICP?

how is vomiting with increased ICP unique?

occurs when mass lesion forces brain to herniate downward

lateral and downward herniation

lateral displacement of brain tissue beneath falx cerebri

what diagnostic study would you not perform on someone you suspect has increased ICP?

what is the preferred way of monitoring ICP?

directly measures pressure within the ventricles; facilitates removal and/or sampling of CSF; allows for intraventricular drug administration

catheter containing a sensor transducer is placed within the ventricle

air-filled pouch at catheter tip; senses pressure changes within the cranium

what can you remove from the brain to treat increased ICP?

measures jugular venous oxygen saturation (SjvO2)

what does an patient with increase ICP need an increase of nutritionally?

when are the 3 points following a head injury when death is most likely to happen?

GCS of 13 to 15 following a head injury would indicate?

GCS of 9 to 12 following a head injury would indicate?

a GCS of 3 to 8 would most likely indicate?

bleeding between the dura and inner surface of the skull

a venous epidural hematoma would develop -

an arterial epidural hematoma will develop -

bleeding between the dura mater and arachnoid

bleeding below the arachnoid membrane into the subarachnoid space

what are the most common causes of a subarachnoid hemorrhage?

bleeding within brain tissue; usually in the temporal and frontal lobes

what are the two factors that determine a patients outcome with an intracranial hematoma?

what is the best way to evaluate for head trauma?

what are indications for intubation of an individual with a hematoma?

what are nursing interventions for hematomas?

what are some goals when treating individuals with head trauma?

what are common clinical manifestations of brain tumors?

initial disruption of axons due to stretch or laceration

ongoing, progressive damage to the spinal cord

patient comes to the ER after hitting there head on the bottom of the pool. they present with decreased reflexes, loss of sensation, and paralysis - what do you suspect?

what a patient has a cervical or high thoracic injury, what complication would you look out for?

loss of vasomotor tone and loss of sympathetic innervation

what are some signs of loss of vasomotor tone?

which are some signs of a loss of sympathetic innervation?

total loss of sensory/motor function below the level of injury

mixed loss of motor/sensation; some tracts intact

what patient is more likely to develop a complete central cord syndrome?

loss of sensation and motor movements; worse in the upper extremities than the lower extremities; may feel some sensations of pain/tingling

patient has a spinal cord injury and complains of motor paralysis, loss of sensation, and loss of temperature sensation below the level of the injury - what kind of incomplete SCI is suspected?

what sensations does a patient with anterior cord syndrome still feel?

patient presents with ipsilateral loss of motor function, position and vibratory sense, and vasomotor paralysis - what do you suspect?

what symptoms would a person with a Brown-Sequard spinal injury experience on the same side of the injury?

what symptoms would a patient with a Brown-Sequard SCI have on the opposite (contralateral) side of the injury?

in a SCI above C-4, what in the priority intervention?

in a patient with a injury below C-4, what respiratory issues are you worried about?

what is a possible respiratory complication of a SCI that we should monitoring for?

how do we treat bradycardia associated with neurogenic shock?

how do we treat the decreased cardiac output associated with neurogenic shock?

what individual will need an indwelling catheter to remain?

how often should an individual self-catheterize/be catharized?

what patient teaching should you give to a patient with a SCI pertaining to their urinary system?

at would level would an individual have hypomobility of the GI tract?

what are the expected interventions for an individual who develops paralytic ileus/gastric distention following a SCI?

term to describe the lack of voluntary control over the GI tract following a SCI

medication given a day or two after a SCI in order to regain GI motility -

what should you plan on beginning a bowel program for an individual with a SCI?

what is some patient teaching to give a SCI patient about developing a bowel program?

what is am important thing to remember patients with SCI loose when planning nursing care?

what acid/base issue are we monitoring for in a patient with continuous or intermediate NGT suctioning following a SCI?

what are some nursing considerations associated with eating in the acute phase of a SCI?

what is a big issue with eating in the later stages of a SCI?

what is a priority we want to monitor for in patients with immobility following a SCI?

what medication is given prophlactively to prevent DVTs in SCI patients?

what are some nursing interventions that can be done to prevent DVTs?

when would a nurse need to hold a dose of Lovenox for an SCI patient?

your patient suddenly no longer has a gag reflex following a SCI - what is your priority intervention?

what is the appropriate way to open the airway of an individual with a suspected SCI?

what medication do you give as soon as possible to a SCI patient to help prevent the side effect of aggressive swelling and inflammation?

you just administered methylprednisolone to a patient with a SCI - what should you be monitoring for in the hours following?

what medications can be given to prevent the development of stress ulcers in the first 6-14 days following a SCI?

your patient’s spinal shock was resolved yesterday afternoon. during your morning assessment, you notice their reflexes are hyperactive and exaggerated. what do you communicate to your patient and and their family about this reaction?

what medication do you plan on giving to a patient having hyperreflexia following spinal shock resolution?

massive uncompensated cardiovascular reaction of the sympatric nervous system