OH NO IT'S ICP!
increased CSF, increased blood flow, increased tissue pressure
What is the definition of thrombolytic (ischemic), hemorrhagic, and TIA. What are risk factors/causes for each?
Thrombolytic- anything that narrows the blood vessel (diabetes, CAD, Afib, clotting disorders).
Hemorrhagic- ruptured clot (uncontrolled HTN)
TIA- mini stroke, warning sign, but it resolves.
Signs and Symptoms of Meningitis and Encephalitis?
S/S? of Meningitis- severe HA, nuchal rigidity, photophobia, high fever, rash
S/S of Encephalitis- hallucinations, confusion, HA, seizures, loss of coordination
Types of seizures: tonic/clonic, status epilepticus, focal, absent, atonic
tonic/clonic- stiff and jerking, status epilepticus- longer than 5 mins, focal- a specific part of the brain, absent- daydreaming, atonic- (drop attack) falling to the floor seizure
Autonomic Dysreflexia
causes: tight clothes, something wrong with urinary catheter, FIND THE STIMULI FIRST
S/S: HTN, bradycardia, severe HA, nasal stuffiness, flushing, goose bumps,
TX: remove stimuli, loosen gown, bladder scanner, reposition, disimpact pt
What are Early and Late signs of ICP?
Early: change in LOC (restlessness, drowsiness, confusion)
Late: dolls eyes, decerebrate, decorticate, projectile vomiting, loss of brain stem reflexes, low pulse, low RR
Left sided vs. Right sided Stroke
Left (language and logic)- impaired math, depression, anger, aphasia, dysphasia, read/writing problems, right hemiparesis
Right (reckless/really creative)- lack of impulse, behavioral changes, confusion on date/time/place, unilateral neglect.
What are risk factors for Meningitis and Encephalitis?
Risk factors for Meningitis- older age, HR greater than 120, low GCS, cranial nerve palsies, positive Gram stain.
Risk factors for Encephalitis- herpes simplex virus type 1, fungi, arboviruses, enteroviruses
Risk factor of seizures
CNS infections, metabolic conditions, hypoglycemic, alcohol withdrawal, ischemic stroke,
Complications of SCI?
orthostatic hypotension, DVT, muscle weakness, autonomic dysreflexia
What are signs and symptoms of increased ICP for peds?
high pitch cry, bulging fontanelles
What are the s/s of stroke?
F- facial drooping
A-arm draft
S- speech impairment
T- time to call (golden hour)
What are the interventions for Meningitis? (list in priority)
1) droplet precautions 2) labs/ blood cultures/ LP
3) antibiotics (order from DR)
4) low noise, low light, low pressure (no bending, no coughing, no sneezing)
* if they go into shock= give oxygen and IV fluids FIRST
EEG diagnostic test education
hold seizure meds before and give after, they can eat but no caffeine, hair clean
Interventions
log roll- minimum of 3 people, stabilize neck midline, maintain airway, prevent skin breakdown, bowel retraining, baclofen for muscle spasms, ROM to prevent muscle spasticity/contractures,
Halo- inspect for infection- call surgeon if major problems
How to determine CPP? Normal range of ICP and CPP?
CPP= MAP-ICP
Normal Range of ICP= 0-15
Normal Range of CPP= 70-100
What is treatment for hemorrhagic stroke?
fresh frozen plasma, stool softeners, vitamin K, platelets, take antihypertensive meds as ordered, seizure precautions.
NO aspirin, no thrombolytics
Meningitis- Kernig sign vs Brudsinki sign
Kernig sign- extending the leg straight up while having pain.
Brudsinki sign- felxing the neck and knees/hips come up
Before, During, and After a Seizure
After- 1) HOB, 2) turn pt on side , 3) oxygen, 4) respirations and pulse ox 5) call DR 6) document
What is spinal shock? How long does it last?
Due to acute spinal cord injury. Absence of all voluntary and reflex neurogenic activity below level of injury. flaccid paralysis and decreased reflexes.
Days to months
Name 7 nursing interventions for ICP?
Name 5 meds for ICP
1) elevated HOB 2)maintain hydration 3) avoid coughing, sneezing, flexion 4) seizure precautions. 5) glascow coma scale 6) maintain temperature 7) control CO2
Meds: 1) mannitol 2)furosemide 3) steroids 4) anticonvulsants 5) IV fluids
Order of giving t-PA.
1) CT Scan/ Neuro assessment
2) Contraindications/labs/ meds given/ time of onset. 3) Plug the holes 4) Stroke scale assessment
5) call Dr 6) give TPA
Medications for Meningitis and Encephalitis
Meningitis- Antibiotics: penicillin G plus cephalosporin, anticonvulsants (phenytoin, levetiracetam), steroids (dexamethasone). Prophylactic for anyone exposed.
Encephalitis- antiviral A: acyclovir (zovirax),
fungal- amphotericin)- give Tylenol and Benadryl 20mins before
Medication education for seizures
Benzos: lorazepam-stops seizure, liver precautions and antidote is flumazenil. Keppra (levetiracetam)- is cheap and prevents seizures. Dilantin (phenytoin)- avoid calcium foods, drug reactions-antacids. hold for tub feedings 1 hr before med and hr after. Therapeutic level (10-20). Dental vistis. Phenobarbital- side effects are drowsy and ataxia, theurapeutic level is 15-40. Monitor resp depression and hypotension.
What is neurogenic shock: s/s, when does it occur, and treatment?
s/s: bradycardia and hypotension. cardiac ouput decreased. poikilothermia- unable to regulate temp.
occurs: 30 mins of injury and lasts for 6 weeks
TX: airway support, fluids,
atropine= increase HR, methylpredisone, Dextran is volume expander.