Assessment
Upon feeling dizzy, confused, and slurring speech, would you expect her GCS to become lower or higher?
Lower
What is the first scan you should anticipate your patient will be receiving?
CT Head/neck
What is the most important question to ask the patient before they are taken to get a cerebral angiogram?
Are you allergic to contrast?
The patient complains of headache, and is asking if she can take some aspirin for it. What education would you give your patient if she has not yet been diagnosed with a brain bleed?
many answers
What education would you give the spouse if he asks, "What is a craniotomy? Why does she need that?"
many answers
The patient is now diagnosed with an intracranial hemorrhage. What is one hallmark compliant/symptom of this diagnosis?
Thunderclap Headache
What potential complication could occur if the patient's sodium came back at 110 (135-145)
fluid shift and brain swelling- increased ICP
The patient becomes dizzy, confused, and is slurring speech. Besides the brain bleed, what could be another cause of these symptoms, given her history?
low blood sugar
Name a medication class that can help lower the patient's blood pressure and reduce risk of further unnecessary bleeding.
ACE Inhibitors, ARBs, Calcium Channel Blockers, Diuretics (may be contraindicated in this case), Beta Blockers
After reversal of warfarin, the provider still is not comfortable with how fast the patient is bleeding. What is another intervention the provider may order for the nurse to administer?
Platelet transfusion
Perform a focused neuro assessment on your teammate (sorry lol)
Yay you did it
What test can detect the source of a brain bleed?
cerebral angiogram
Now that we have slowed down the bleeding, she is at risk for abnormal clotting. Name two interventions we can do to prevent this.
SCDs, compression stockings, early ambulation/mobility (as soon as it's safe)
The patient's husband states the patient took her warfarin right before the fall. What is the reversal agent for warfarin (Coumadin)?
Vitamin K (and clotting factor replacement)
The patient states "I don't understand why ICP matters, what even is that?!"
Many answers lol
What is the term for unequal pupil size?
anisocoria
The provider orders an X-ray of her ankle after all braIN-TERVENTIONS are done (see what I did there hehe). Name 3 types of fractures we learned about in MedSurg and explain what each of the 3 are.
Fissure, impacted, transverse, segmental, oblique, comminuted, greenstick, longitudinal, spiral, compound
After interventions, the patient will remain in the hospital for monitoring until she is equipped to leave. What complication may arise that requires a certain safety protocol to be adhered to?
seizures
Why may diuretics be contraindicated in this case, even though we want to keep blood pressure, ICP, and other fluid buildup under control?
It can deplete sodium, which may cause brain swelling
What intervention can be done to measure ICP levels as well as help drain any fluid or blood buildup in the brain?
EVD (External Ventricular Drain)