MISC.
What does a GCS of 3 mean?
How many points are dropped to equal a bad outcome?-patient could be dead, severely brain injured or sedated and paralyzed on a ventilator
-2 points (anything less than an 8 is comatose)
What is the normal range for cerebral perfusion pressure?
55-95
What is the difference between intracerebral and subarachnoid hemorrhagic strokes?
Intracerebral: bleeding in the brain tissue, severe or uncontrolled HTN, cocaine use
Subarachnoid: bleeding between arachnoid and pia matter (often includes CSF), aneurysm (rupture or leak), AVM (looks like spaghetti)What is rhinorrhea?
What is otorrhea?CSF leaking from nose.
CSF leaking from ears.
Inserted into the right lateral ventricle to not interfere with language.
Must level transducer at the tragus of the ear.
Ventriculostomy
How do physicians declare brain death?
-coma
-cause of coma
-normal body temperature
-perfusing blood pressure (systolic over 100)
-at least one documented neuro exam by a provider (apnea testing)
MAP
What is an out pouching of a cerebral artery (most common location is the circle of willis)?
Intracranial aneurysm
Where is an epidural hematoma?
Is it arterial or venous?
Blood in the space between the skull and dura mater
Arterial bleed typicallyEarly and Late signs/symptoms of increased ICP.
Early: decreased LOC, headache (photophobia), N/V
Late: pupillary changes, posturing, cushing triad (bradycardia, increased systolic BP, irregular respiratory rate
What are the 5 reflexes to test cranial nerves and brainstem function?
How do they test them?-corneal (cornea touched, causining blinking)
-oculocephalic (dolls eyes) (when the head is turned, the eyes should turn the opposite way)
-oculovestibular (cold calories) (ice cold water is used to irrigate the ear- should look towards the ear)
-gag/cough (absence=brain death)
-babinski (curling of all toes inward/outward)
What are the late signs of ICP (cushings triad)?
-increased BP (widening pulse pressure)
-decreased HR
-irregular respirations
What type of blunt trauma in a closed brain injury is like getting hit in the head with a baseball bat?
Acceleration (in motion)
Where is a subdural hematoma located?
Is it venous or arterial?
Blood in the space between dura and arachnoid
Venous bleed typically
What is the treatment for SIADH?
-fluid restriction
-slow replacement of sodium (can cause cerebral edema from fluid shift and worsening in ICP)
-decorticate: abnormal flexion
-decerebrate: arms move to the core (worse= leads to no motor response at all)
What are some collaborative interventions and nursing care for carotid stenosis?
-Carotid endarterectomy
-Endovascular interventions (occludes artery)
-antiplatelet drugs (aspirin, clopidegrel)
-BP control (prevents further stroke)
-glucose control
-lifestyle modifications (drugs and alcohol)
What is the first rule with a penetrating injury?
NEVER PULL ANYTHING OUT
What is it called when there is blood in brain tissue from tearing of small arteries and veins in white matter?
Intracerebral hematoma
What is the treatment for DI?
-replace fluids (PO,IV)
-sodium restriction
-replace ADH (vasopressin)
What is the normal value for intracranial pressure?
10-15 (increased ICP is >20)
What is the difference between ischemic and hemorrhagic stroke?
Ischemic: thrombotic (grows there), embolic (flows there), birth control, tPA within 6 hours, a fib, HTN
Hemorrhagic: leak, cocaine, heredity, AVM, HTN
How can you test if there is CSF leaking without invasive testing if you suspect it at the bedside?
-blood glucose monitoring the fluid for glucose
-Halo sign
What is the difference between a craniotomy and craniectomy?
Craniotomy is the removal of tumor/blood clot and bone flap and ultimate replacement.
Craniectomy is the removal of tumor/blood clot and bone flap is removed and kept off to allow room for swelling (kept in deep freezer for later).
What is the treatment for hydrocephalus?
Ventriculostomy