Rhode Island
What diagnostic test is monitored for cerebral aneurysms?
Cerebral angiogram
True/False: TPA can be administered without consent.
True.
How should hair be removed pre operatively for a craniotomy patient?
Hair removed with clippers
What is autonomic dysreflexia?
What is the first action to do for a patient experiencing autonomic dysreflexia?
Life threatening HTN following an SCI
Sit them up 90 degrees (legs off bed to decrease BP)
What is the main subjective assessment for autonomic dysreflexia?
Metallic taste in the mouth
What is the first sign of increasing ICP?
Change in LOC/response to stimuli
Ateplase
Where does autonomic dysreflexia occur on the body?What does this area look like?
Below the SCI
Pallor
Where do cerebral aneurysms often times occur?
Bifurcations of large arteries at the Circle of Willis
What type of stroke is TPA used for?
Ischemic
Why is it important to maintain respiratory status?
TIME is BRAIN
Want to prevent secondary brain injury
What needs to be done before receiving TPA? How is this done?
Rule out hemorrhagic stroke
CT scan
Can you give TPA on a medsurg floor? Explain.
Yes, but you need to be moved to the ICU
What labs need to be monitored with a high alert osmotic diuretic?
Electrolytes, specifically Na+ & K+
What are 4 signs/symptoms of a blood transfusion?
fever, low back pain, tachycardia, chest pain, hypotension, feelings of doom, jaundice
What are 2 important requirements before receiving TPA?
Stroke onset within 3 - 4.5 hrs
BP < 185/110 mmHg
What are 3 clinical manifestations of hemorrhagic stroke?
What is the first sign?
Severe headache, possible seizures, pain & rigidity of the back of the neck & spine, photophobia, N/V, hemiparesis
Change in LOC
What is the name of an osmotic diuretic used for ICP?
What does it do?
Mannitol
Treats acute TBI with increased ICP
Shrinks brain cells down to decrease swelling
What are 3 clinical manifestations of an ischemic stroke?
sudden severe headache, numbness/weakness of face/arm/leg, confusion, trouble speaking, dysarthria, apraxia, visual disturbances, motor loss
What is a normal ICP level?
What are 3 assessment findings for increased ICP?
7 - 15 mmHg
Increased lethargy, drowsiness, irritability, restlessness, change in communication, bradycardia, rapid resp, slower pulse, increased systolic BP
What are 7 interventions used for aneurysm precautions?
Bed rest, non-stimulating environment, dim lighting, non-stress environment, restrict visitors, HOB 30 -45 degrees, avoid any activity that increases BP, avoid straining, avoid forceful sneezing, avoid pushing up in bed, provide stool softeners to prevent bearing down, unfractionated heparin
What is the main cause of a subdural hematoma?
Who is especially at risk?
What needs to be done with a subdural hematoma?
What do you do with this intervention?
Falls
Individuals on a blood thinner like Warfarin. Scans & neuro checks every 15 mins for 8 hrs
IMMEDIATE craniotomy
Skull is inserted in abdomen for later use
A patient is using inappropriate words, is withdrawn, and their eyes respond to pain. What is their score according to the Glasgow coma scale?
What does a 3 represent on the GCS?
What does a 15 represent on the GCS?
The score is 9.
3 = deep coma
15 = normal
What pain medications are administered post craniotomy? And why?
Acetaminophen - temp & pain
Dexamethasone - decrease swelling
Phenytoin, Carbamazepine - antiseizure meds
A patient has external ventricular drainage.
What should you do when this occurs?
What sx indicate intervention?
DO NOT touch bed position, want 0 pressure
Fever, headache (new or persistent), nuchal rigidity, decrease LOC, CSF sample