Shock
How long does spinal shock last?
7-10 days
Days to months
Within what time frame can we give tPA to a patient with a suspected ischemic stroke?
3-4.5 hours of symptom onset
Which precautions are patients with increased ICP on?
Aspiration and seizure
A change in how many points is significant?
2
Spinal precautions include
Bedrest
No neck flexion
No thoracic flexion
Manual control of cervical spine anytime rigid collar is removed
Using log roll to reposition patient
What are the major clinical features of neurogenic shock? (there are 3)
Bradycardia
Hypotension
Poikilothermia
Describe albumin and loop diuretic use for pre-renal AKI
The fluid is in the interstitial space so we give albumin first and give furosemide IMMEDIATELY after
What are symptoms of increased ICP?
Decreased LOCBehavior changes
Headahce
N/V
Change in speech
Seizures
HTN
Bradycardia
Abnormal posturing
A patient has no eye opening, has incomprehensible sounds/speech, and is in decerebrate posture. What is the GCS?
5
What is the equation to calculate cerebral perfusion pressure (CPP) AND what is a normal CPP?
CPP = MAP - ICP
MAP = SBP + 2(DBP)/3
Normal CPP = 60-80
What are the clinical features of spinal shock?
Absence of all voluntary and reflex neurologic activity below level of injury:
Decreased reflexes
Loss of sensation
Flaccid paralysis below injury
How do we treat hyperkalemia in AKI patients
Insulin and glucose
Loss of reaction to light
Unilateral or bilateral dilated pupils
Change in size, shape
Loss of vision
Papilledema
A patient with a moderate brain injury will have a score ranging from?
9-12 points
How does acute tubular necrosis affect the kidneys?
Damage to nephron
Prevents normal concentration of urine
Prevents normal filtration of urine
Prevents normal regulatory functions
Neurogenic shock occurs within ___ minutes of a spinal cord injury at level ____ or above
30 minutes, T5
24 hours, T6 (in class notes)
For a patient with a dissecting aortic aneurysm, which BP medications (classes) are given after patient is stabilized?
Beta blockers
Calcium channel blockers
What are late signs of increased ICP?
Severe headache
N/V
Sezisures
A patients eyes open to pain, has no verbal response, and withdrawals from pain. GCS?
7
What are contraindications of hemodialysis?
Hemodynamic instability
Inability to coagulate
Lack of vascular access
Management of neurogenic shock includes
Airways support
Fluids
Atropine (bradycardia)
Vasopressors
Temperature management
Aspirin 325 mg within 24-48 hrs after stroke onset, but not within 24 hrs of tPA
Heparin or warfarin
Nimodipine to prevent cerebral vasospasms after hemorrhage
Stool softeners
Analgesics
Antianxiety meds
What are nursing interventions to decreased ICP?
Head in midline/neutral position
HOB between 25-30 (for improving CPP and oxygenation)
Avoid hip/neck flexion
Avoid clustering care
Stool softeners
Pain management
Reduce noise
A patient opens eyes spontaneously, is confused in conversation but able to answer, and obeys command for movement. GCS?
14
What are the 8 core measures for Ischemic Stroke Care? (name at least 4)
VTE prophylaxis
D/c with antithrombotic therapy
D/c with anticoagulation therapy for a/fib
Thrombotic therapy as indicated
Antithrombotic therapy re-evaluated by end of hospital day 2
D/c on statin mediation
Stroke education provided
Assessment for rehab