CVA/Hemorrhage
This test rapidly differentiates between ischemic or hemorrhagic stoke.
CT without contrast
This structure regulates respiratory and cardiovascular functions and can become compromised during herniation.
Brainstem
This is the primary medication class utilized in alcohol withdrawal treatment.
Benzodiazepines
A patient in DKA may display this breathing pattern.
Kussmaul respirations
Define Cushing's triad.
hypertension, bradycardia,
irregular respirations
This term refers to the region of ischemic brain tissue surrounding the infarction that may be salvaged with timely intervention.
Penumbra
Why does increased PaCO2 worsen ICP?
Hypercapnia causes vasodilation, leading to increased CBF and ICP
This non-opioid medication may be used in opioid withdrawal treatment to reduce sympathetic symptoms.
Clonidine
This is the priority intervention in treatment of HHS.
IV fluids
Define the Monro-Kelly Doctrine
Principle that says due to limited space for expansion within the skull, an increase in any one of the cranial contents—brain tissue, blood, or cerebrospinal fluid (CSF)—causes a change in the volume of the others
The nurse is educating a patient on some stroke factors unique to women - list one.
Oral contraceptive use, pregnancy, HRT, history of migraines with aura
List 3 early signs of increased ICP.
Headache, restlessness, anxiety, subtle
changes in level of consciousness, slowed
cognition
This is why it is especially important to monitor magnesium levels in withdrawal patients.
low Mg increases seizure risk
These are lab results that would support a diagnosis of DKA.
Glucose >/= 250 (typically)
UA positive for ketones
ABG results reflect metabolic acidosis
Elevated anion gap
Other than blood glucose, this should be evaluated before starting an insulin drip.
Potassium!
If K⁺ <3.3 → hold insulin and replace K⁺
If K⁺ ≥3.3 → start insulin
Ensure modified diet texture to order (pureed, mechanical soft, thickened liquids), sit patient upright (≥90°) for feeding and for at least 30–45 minutes after meals, monitor for aspiration signs: coughing, choking, wet voice, recurrent pneumonia
Describe why a provider may choose to utilize propofol in a patient with TBI.
Short-acting sedative that decreases cerebral metabolic rate and lowers intracranial pressure. It has a major advantage of being titratable to its desired clinical effect but still provides the opportunity for an accurate neurologic assessment.
At what point of opioid withdrawal treatment should buprenorphine / Suboxone be started?
Must start when moderate withdrawal begins
This is why it is important not to lower glucose levels too fast during treatment with IV insulin.
Lowering glucose too fast can drop serum osmolality → water shifts into brain cells → cerebral edema / increased ICP (especially in kids).
This should be administered in alcohol withdrawal to prevent development of Wernicke's encephalopathy.
Thiamine / vitamin B1
A patient appears increasingly confused and displays new speech difficulties 3 days after development of a SAH. What complication does the nurse suspect is occurring?
Cerebral vasospasm - most frequently occurs 7 to 8 days after initial hemorrhage, but can also occur 3-14 days post hemorrhage. When the clot undergoes lysis + the chance of rebleeding is increased. It leads to increased vascular resistance, which impedes cerebral blood flow and causes brain ischemia (delayed cerebral ischemia) and infarction. Often heralded by a worsening headache, a decrease in level of consciousness (confusion, lethargy, and disorientation), or a new focal neurologic deficit (aphasia, hemiparesis).
Following a head injury, a patient may develop this complication which results in dilutional hyponatremia.
syndrome of inappropriate antidiuretic hormone (SIADH)
List some signs that would cause the nurse to suspect development of hepatic encephalopathy.
Mild confusion/disorientation (early)
Altered mood
Personality changes
Drowsiness
Difficulty concentrating
Severe confusion (late)
A family member asks what may have caused the patient's DKA. List some potential causes of this condition.
"4 S'": Skipped insulin (including new diagnosis), sepsis, stress, substances
Describe hepatorenal syndrome.
Liver failure leads to renal vasoconstriction and decreased renal blood flow, resulting in renal injury.
Decreased U/O, Increased BUN & Creatinine, Edema