Brain things
What causes vasodilation in the brain and therefore increased CBF?
Decrease of O2 causes vascular dilation
Increase of CO2 causes vascular dilation
What is the diagnostic test for meningitis?
Bonus 100: Name four s/s that present with meningitis.
Lumbar puncture to check for WBCs in CSF
fever, headache, photophobia, nuchal rigidity (can't flex head forward), petechial rash, abnormal behavior, LOC changes, kernig's sign (cant straighten leg completely when the hip is flexed at 90 degrees), Brudzinkis neck sign (flex knees when the head is moved forward)
what movement commonly used for maintaining an airway is contraindicated with a suspected SCI?
head tilt-chin-lift
A patient is admitted with a suspected C6 spinal cord injury. Which of the following clinical findings would the nurse expect to observe?
A. Loss of motor and sensory function in all four extremities
B. Loss of proprioception below the injury level
C. Intact motor function but loss of temperature sensation below the level of the injury
D. Impaired motor function and burning pain in the upper extremities
Answer: A
Rationale: A complete C6 spinal cord injury results in tetraplegia (paralysis in all four extremities). This level of injury disrupts both motor and sensory pathways below the level of the injury.
What criteria are needed to call the organ transplantation nurse?
Bonus 100: When can you as a nurse approach the family to discuss organ donation?
Within ONE HOUR of GCS being under 5, absence of 1+ brainstem reflexes, and anticipated end of life discussions.
Bonus: Never. You are not trained in that aspect - the organ donation nurse must be the one who speaks to the family first.
What is a normal ICP?
Bonus 100: What is a normal Cerebral perfusion pressure (CPP)?
Bonus 100 pt 2: What level of CPP is incompatible with life?
5-15. anything over 20 must be treated
Bonus 100: calculated by MAP-ICP. Normal is 60-100.
Bonus 100: Under 30
when do secondary spinal injuries usually occur?
Bonus 100: when can you determine the extent of permanent damage after the secondary injury starts?
within 24 hours of the initial damage
Bonus: after 72 hours
With a spinal cord injury above T6, what should be at the bedside?
Bonus 100: what can cause vagal responses that would further hypotension with a SCI above T6?
atropine to reverse bradycardia.
it doesn't say in the slides but I would assume airway equipment as well.
Bonus: excessive suctioning or position changes, bearing down when going to the bathroom
A patient with increased ICP exhibits Cushing's triad. What findings would the nurse expect?
A. Tachycardia, narrowed pulse pressure, and irregular breathing.
B. Bradycardia, widened pulse pressure, and irregular breathing.
C. Tachycardia, hypotension, and shallow breathing.
D. Hypertension, bradycardia, and rapid respirations.
B. Bradycardia, widened pulse pressure, and irregular breathing.
Cushing's triad is a late sign of increased ICP indicating brainstem compression and impending herniation.
What conditions can mimic brain death?
Bonus 100: Name three reflexes used to test brain death.
High spinal cord injuries, Drug intoxication, Hypothermia, Shock, Metabolic impairment, Out of range labs
Bonus: Light, blink, cornea, cough, occulovestibular, grimacing
What are late signs of inc ICP?
Cushing’s triad from cerebral ischemia
Increased SBP, widening pulse pressure, bradycardia, and irregular breathing pattern
Posturing
Name the symptoms of spinal shock.
Absence of all reflexes, flaccidity, and loss of sensation below the injury
why do patients need a foley catheter with a SCI?
Patients lose the sensation to urinate when the bladder is full. Cannot empty bladder as the muscle may be flaccid.
Dangerous if there is more than 500 ml in the bladder (do frequent bladder scans)
Which symptom is classic for a subarachnoid hemorrhage?
A. Sudden, severe headache described as the “worst headache of my life.”
B. Gradual onset of confusion and lethargy.
C. Loss of consciousness followed by a lucid interval.
D. Hemiparesis with progressive worsening over days.
A. Sudden, severe headache described as the “worst headache of my life.”
This is a hallmark symptom of a subarachnoid hemorrhage, often caused by a ruptured aneurysm.
Name five interventions needed to preserve organ function when a patient is declared brain-dead and is going to donate their organs.
Optimize Fluid Balance, treat hypotension, Maintain SPO2 >95%, Normalize PH (7.35-7.45), Prevent Pulmonary Edema, Maintain Normothermia (36.5-37.5), Monitor CBC/Coagulation panel daily to prevent coagulopathies, Blood products/factors if indicated, tx DI, keep normal glucose lvls, F/E replacements to tx imbalances, tx infection with abx
What are signs of basillar skull fractures
Halo sign – sign of CSF leakage
otorrhea & rhinorrhea
“Raccoon eyes”- periorbital ecchymosis
“Battle sign” – mastoid ecchymosis
Name five manifestations of a SCI.
Any injury above T6 leads to dysfunction of the SNS: neurogenic shock risk causing vasodilation, bradycardia, and hypotension. neurogenic bladder (urinary retention), decreased gastric emptying, paralytic ileus, poikilothermia (inability to regulate body temp), VTE, pain, spacisity
An assessment of a patient’s GCS was E2, V3, M5, How would you interpret this?
The patient’s eyes open to pain, they can utter some inappropriate words but do not form sentences, and they are able to localise to a painful stimulus.
A patient presents with sudden headache, blurred vision, and sweating. The nurse suspects autonomic dysreflexia. What is the initial intervention?
A. Place the patient in a supine position
B. Administer IV antihypertensive medication
C. Identify and alleviate the trigger
D. Notify the healthcare provider immediately
Answer: C
Rationale: The initial action is to identify and remove the trigger (e.g., bladder distension, tight clothing). This can quickly resolve autonomic dysreflexia.
If a patient who was classified as a donor after circulatory death, how long would death be expected after the pt was extubated?
Bonus: when does organ recovery begin in a patient who is a donor after circulatory death?
120 minutes after extubation.
Bonus: 5 min after cardiopulmonary arrest
What symptoms present with a subdural hematoma?
Bonus 100: What symptoms present with an epidural hematoma?
Typically present with “worst headache of life” or as “Thunderclap” headache, altered LOC, diplopia, meningeal signs or seizures
Bonus: initial LOC, followed by a lucid period, followed by another LOC.
When can a C-spine be cleared?
Patient is AOx4, sober, provider places an order, and radiologic and physical assessments are done to ensure that the collar can be removed.
Name the symptoms of cauda equina syndrome.
Bonus 100: what usually causes cauda equina?
Asymmetrical distal weakness, patchy sensation in lower extremities, may cause flaccid paralysis of lower extremities, complete loss of sensation in saddle area, flaccid bladder and bowel, severe, radicular, asymmetric pain
Bonus: herniated disc
Which medication would the nurse anticipate for a patient with neuropathic pain due to a spinal cord injury?
A. Dantrolene
B. Gabapentin
C. Diazepam
D. Atropine
Answer: B
Rationale: Gabapentin is commonly used to treat neuropathic pain in spinal cord injury patients.
How long is the heart, lungs, liver, and kidney good for after being extracted from the patient's body?
Heart and lungs: 4-6hrs, liver 8-12 hrs, kidney 24-36 hrs