LOC & Neuro Assessment
This is the MOST important indicator of neurologic status.
What is level of consciousness (LOC)?
Normal ICP range is this.
What is 10–20 mmHg?
This device is the gold standard for ICP monitoring and can drain CSF.
What is an EVD (intraventricular catheter)?
This complication occurs when patients cannot protect their airway.
What is aspiration?
The head of bed should be elevated to this degree to reduce ICP.
What is 30–45 degrees?
LOC progresses from alert to this most severe state.
What is coma?
This hypothesis explains pressure changes in brain, blood, and CSF.
What is the Monro-Kellie hypothesis?
This landmark is used to level the ICP system.
What is the tragus (Foramen of Monro reference)?
Immobility increases risk for this clotting condition.
What is DVT?
This maneuver should be avoided because it increases ICP.
What is Valsalva maneuver?
This condition involves awareness but inability to move except eyes.
What is locked-in syndrome?
CPP is calculated using this formula
What is CPP = MAP – ICP?
These waves indicate severe ICP elevation and impending herniation.
What are A waves?
This triad includes bradycardia, hypertension, and bradypnea.
What is Cushing’s triad?
This positioning helps prevent aspiration.
What is lateral or semiprone position?
Arms flexed toward chest in response to pain is called this.
What is decorticate posturing?
A CPP below this level leads to permanent damage.
What is 50 mmHg?
These waves are early warning signs of worsening ICP.
What are B waves?
This condition results from too much ADH and causes hyponatremia.
What is SIADH?
This must be done before repositioning a patient with an EVD.
What is clamping the drain?
This is the earliest sign of increased ICP.
What is a change in LOC?
Increased CO₂ causes this effect on cerebral vessels.
What is vasodilation (increasing ICP)?
Lowering the drainage system will cause this effect.
What is increased CSF drainage?
This life-threatening complication occurs when brain tissue shifts.
What is brain herniation?
This is the priority nursing goal for LOC patients.
What is maintaining a patent airway?