Hemodynamics
What is the MAP calculation and goal for a neuro pt vs regular?
Systolic BP + (2x Diastolic BP)/3
65 vs 85
What is SIADH?
urinary sodium loss without corresponding loss of water, leading to a decrease in plasma osmolality in the presence of hypertonic urine
What is the Monroe-Kellie theory?
Increase in one of the 3 volumes is at the expense of one of the constant components
What are the anti-epileptic medications of choice per the CPG?
Keppra*, vimpat, phenytoin
What position is best for a patient that has suffered a brain injury?
30 degress or reverse T with their neck positioned midline
What is increased ICP considered? *numerical value range
20-25
What is cerebral salt wasting syndrome?
Polyuria and sodium excretion; Renal loss of sodium due to intracranial disease leading to hyponatremia and hypovolemia
What is herniation?
mechanical displacement of brain tissue past its normal meningeal boundaries
What triggers hyperosmolar therapy?
•Cushing’s Triad
•Unilateral dilated or unreactive pupil
•rapid neuro deterioration
•known large mass lesion with deterioration
The patient has an ICP of 26 what nursing interventions can you implement?
Pain management, Appropriate Sedation, Positioning
What is CPP and the goal?
-Cerebral Perfusion Pressure 60 or >
-MAP-ICP = CPP
What is DI?
inability to concentrate urine and the passage of a large volume of inappropriately dilute urine with a consequent rise is plasma osmolality due to disproportionate loss of water over sodium, and progressive dehydration
What is cushing's triad?
Increased systolic blood pressure, bradycardia, and irregular respiration
The patient has just arrived from the OR to the ICU with a SBP of 89, what nursing interventions can you implement?
check what the cause of hypotension is and correct it:
is the pt hypovolemic? is it sedation related? did they give something in the OR that may have dropped it?
The patient with an ICP of 26 has been provided every possible intervention available yet continues to be dysnchronus with the vent, what can you recommend to the physician?
Paralytic
What is goal End Tidal Carbon Dioxide for a neuro pt? When is hyperventilating appropriate?
35-45
ONLY PHYSICIAN PROMPTED-MAX 15 MIN IN ATTEMPT TO PREVENT HERNIATION
What are the signs and symptoms of hypernatremia?
Lethargy, thirst, irritability, hyperreflexia, seizures
What are the signs and symptoms of herniation?
unarousable, posturing,motor weakness, unilateral dilated and fixed pupil, cushings triad
What is the 3% protocol?
250cc bolus over 10-15minutes; followed by 50cc/hr infusion; check sodium every hour until Na is between 155-160
The patient is fevering despite being given tylenol what can you do and what are you concerned about?
ice packs, cooling blanket, A/C,
seizure
what are the signs and symptoms of hyponatremia?
Lethargy, nausea, vomiting, irritability, muscle weakness, cramps, depressed reflexed, seizures
How does hypotension impact a patient that has suffered a brain injury?
increased ICP related to vasodilation or cerebral ischemia related to decreased CBF impacting perfusion
What is the main concern with Mannitol?
Hypotension
What should your Q1H assessment include?
VS, pupills, GCS, Neurovascular, temperature,RASS, I/O