neuro health deviations

Head CT

Intracranial Hemorrhage Diagnostic Tests

motor dysfunction on right side right visial field aphasia expressive , receptive, global altered intellectual ability ex math slow cautious behavior aware of deficiets

left sided stroke

motory dysfunction left side left visual field deficiet spatial awareness increased distractability poor judgement not aware of deficiets

right sided stroke

Ø Sudden Severe Headache* Ø Numbness or weakness of the face, arm, or leg, especially on one side of the body- not getting blood flow/o2 to the tissue Ø Confusion or change in mental status Ø Emotional Deficits- ex may just start crying Ø Trouble speaking or understanding speech Ø Dysarthria Ø Apraxia Ø Visual disturbances Ø Motor Loss

s+s ischemic stoke

always ABC before neuro focus on airwat patency - compromised cough or resp pattern cardiovascular status gross neurological deficiets

stroke assessment

D. 350 to 375 mL

A potential complication of a hemorrhagic stroke is interference with the ability of the arachnoid villi to absorb CSF. Therefore, fluid in the ventricles increase beyond the amount that is usually absorbed daily, which is: ´ A. 150 to 200 mL ´ B. 200 to 250 mL ´ C. 276 to 325 mL ,D. 350 to 375 mL

´ Large artery thrombosis (20%) ´ Small penetrating artery thrombosis (25%) ´ Lacunar Infarcts ´ Cardiogenic embolic (20%) ´ Originate from the heart and circulate to the cerebral vasculature ´ Afib** ´ Patent foramen ovale (PFO)- may not be found until have a stroke can be 40 ´ Cryptogenic (no known cause)(30%) ´ Valvular Heart Disease ´ Thrombi in the Left Ventricle ´ Other

reasons for ischemic stroke

´ CSF processing must be completed quickly to ensure accurate results because CSF is hypotonic. ´ Cell counts decrease by 32% after 1 hour and 50% after 2hours, and bacteria may not survive long periods in collection tubes. ´ For this reason, CSF is rapidly hand delivered to the lab in some institutions.

CSF analysis must be processed

´ Intracerebral/Subarachnoid Hemorrhage ´ Cerebral Aneurysm- ruptured often will kill you Arteriovenous Malformation (AVM

Causes- intracranial hemorrhage

closed for 1 hr neurotoxicity, menigeal irritation, delirium , confusion, seizures hearing loss removed

EVD Related Ventriculitis- Meningitis nursing management the evd should _____ for how long post antibiotics watch for signs of when infected the EVD should be

Tragus Raising the level of a patient's bed who has an External Ventricular Drainage (EVD) device in place, set at a fixed zero reference and pressure levels can result in a large increase in cerebral spinal fluid drainage. DO NOT RAISE THE HEAD OF BED

External Ventricular Drainage (EVD) Collection System must stay level with the what position should the pt be

best score 15, lowest 3 in acoma less than 8 eye opening spontaneous 4 to voice 3 to pain 2 none1 best verbal response oriented 5 confused 4 inappropriate words 3 incomprehensible sounds2 none1 best motor response obeys comand 6 localizes pain 5 withdraws 4 flexion 3 extension2 none 1

Glascow Coma Scale (GCS)

´ Subjective ´ "Exploding headache" ´ Decreased level of consciousness* ´ Objective ´ ABC's- always assess first ´ Neuro exam - feel for strength bilaterally etc ´ Increased ICP ´ Increased lethargy, confusion, drowsiness, irritability- irrational behavior ´ Changes in ability to communicate and/or appropriateness of thinking and behavior ´ Change in level of consciousness or response to stimuli may be the first sign of increasing ICP- no longer responding to me pinching you Inability to maintain orientation is a sign of deterioration

Intracranial Hemorrhage Assessment signs of increased ICP

´ Persistent and recurrent fever indicates the need to investigate for CSF infection. ´ New or increasing headache, nuchal rigidity, and decreased level of consciousness or cranial nerve signs are reasons to send CSF for infection surveillance. ´ If see frank blood seen in evd that a rebleed not infection- need to get back to surgery!

Nursing Management Patients with EVD- external ventricular drainage device

´ Non-contrast Computed Tomography (CT) ´ Should be performed within 25 minutes or less from the time the patient presents to the ED to determine if the event is ischemic or hemorrhagic

Stroke Diagnostic Tests how quicly shoudl be done looking to identify if its ______ or ______ stroke

C. The stimulation can increase intracranial pressure or trigger a seizure.*

The nurse is caring for a client with a cerebral aneurysm. Why does the nurse limit the interaction of visitors or family members with the client who has an aneurysm? ´ A. The interaction may cause the client to become violent. ´ B. The interaction may cause migraine headache in the client. ´ C. The stimulation can increase intracranial pressure or trigger a seizure. D. The client may become emotional and lose interest in the treatment

hypoxia hypoxia is a potent vasodialtor - must prvent causes • Increased Cerebral Blood Flow • Increased Intracranial Pressure • Reduced Cerebral Perfusion Pressure

Vasodilatory Cascade- triggered by ? causes what

´ A. Respiratory Arrest B. Tetraplegia- diagnosis not a complication ´ C. Spinal Shock- pathy physiology ´ D. Paraplegia- diagnosis ´ E. Autonomic dysreflexia- clinical manifetstaion

Which of the following are the immediate complications of spinal cord injury? ´ A. Respiratory Arrest ´ B. Tetraplegia- ´ C. Spinal Shock ´ D. Paraplegia- ´ E. Autonomic dysreflexia

1 Falling # 2 MVA #3 Flying objects #4 Assault men CTE -> suicide

causes of TBI more likley to happen in ______ tbi can lead to _____ and high risk for _____

Everyone get speech PT, OT/ a artery cleaning(if 80% or less is blocked)

everyone who has a stroke has what other health care providers in volved

´ Carotid Ultrasound ´ CT Angiography or CT Perfusion tests ´ Magnetic Resonance Imaging (MRI)/Magnetic Resonance Angiography (MRA) ´ Transthoracic or Transesophageal Echocardiography ´ when see diagnostic test- find educatial info and let pt know what they are about to get into ´ conscious anesthesia - must sedate when going past gagrelfex ´ topical anestetic on throat- should know when applied so know about when gag reflex returns- NPO until know they can swallow

how to identify sorce of thrombi

coumadin appt 1.5 -2 X normal (60-70s) INR2-3 asprin anithypertensives ace inhibitors, diuretics or both

if have a fib at risj for _____ stroke will be on_____ INR needs to be_______ if cant be on antiplatlets _______ is the next best option ______ may be given even is LDL is below 100 after acute stroke period ______ may be given for 2ndary stroke prevention prefered meds_____

• Immediately notify the neurosurgical or neurointensivist team if bright red blood suddenly appears in the EVD tubing and drip chamber. • Continuous nicardipine infusion- Don't worry about for exam • Intravenous labetalol as needed

in the vent of Aneurysmal Re-bleeding what to do what to give

electrolyte imbalance ´ Used in treatment of acute TBI with increasing Intracranial Pressure ´ Watch out! High Alert Drug! ´ Intense diuretic effect, mannitol can increase excretion of important psych meds (lithium), imipramineTricyclic anti dep., salicylates, barbiturates, and K+ supplements. ´ Reduction in the amount and pressure of CSF can occur as quickly as 15 minutes after initiating infusion ´ Adverse Effects ´ Electrolyte Imbalances

manitol can causes severe______ and increase excretion of ______ used for

´ Thrombolytic Agents- ase= clot busting ´ Alteplase ´ Reteplase- often put into picc line to save the line ´ Tenecteplase ´ Urokinase ´ Contraindicated with any condition that could be worsened by the dissolution of clots

medication for ischemic stroke

´ Osmotic Diuretics ´ Mannitol ´ Anticonvulsants ´ Fosphenytoin/Phenytoin sodium ´ Carbamazepine ´ Valproic Acid/Valproate Sodium - Depakote ´ Levetiracetam- Keppra ´ Topiramate ´ Steroids ´ Dexamethasone

meds for TBI

´ Approach patient from the unaffected side during acute phase ´ Orient to environment as often as needed and ensure adequate lighting ´ Monitor affected body parts for positioning and anatomical alignment, pressure points, skin irritation or injury, and dependent edema ´ Help patient to learn to assume responsibility for safety measures.

nursing interventions unilateral neglect

´ Nursing Management ´ Diagnostics/Labs/Consults ´ Assist with resuscitation efforts and spinal cord injury assessment, as appropriate; maintain patient safety (e.g., airway, circulation, and prevention of further injury) ´ Monitor for respiratory and cardiovascular complications immediately report if present and treat, as ordered. ´ Monitor vital signs, assess all physiologic systems (especially respiratory, cardiovascular, and neurologic), and review laboratory/other diagnostic test results ´ Administer methylprednisolone, as ordered; frequently assess for pain and other discomfort and administer prescribed analgesia and other symptomatic relief Surgical Management ´ Spinal Fusion ´ Decompressive Laminectomy ´ Medication Management ´ Corticosteroids- goal is to decrease inflammation ´ Methylprednisolone ´ Skeletal Muscle Relaxants ´ Antispasmodics- Baclofen ´ Bowel Regimen Meds- don't want Valsalva from being bound increased icp ´ Prophylactic VTE management- often get a vena cava filter -stocking's SCD's ´ Prophylactic UTI Medications- because cant evacuate etc...

nursing management spinal cord injury surgical management medication management work to avoid clots valasalva

´ Acetaminophen ´ Increased Temp and/or Pain ´ Steroids ´ Dexamethasone ´ Antiseizure Medications ´ Phenytoin ´ Carbamazepine ´ Serum levels of Antiseizure medications are monitored for therapeutic ranges

post op medication management craniotomy

´ Evaluate LOC and responsiveness to stimuli. ´ Identify neurological deficits such as paralysis, visual dysfunction, alterations in personality or speech, and bladder and bowel disorders. ´ Distal and proximal motor strength in both upper and lower extremities is recorded on a 3 or 5-point scale (depending on assessment tool). ´ Hair removed with clippers surgical site prepared immediately before surgery (usually in the OR.) ´ Central and arterial line placement.

preoperative management for craniotomy

´ Steroids ´ Dexamethasone ´ Osmotic Diuretics ´ Mannitol ´ Antiseizure medications ´ Phenytoin ´ Carbamazepine

preoperative management for craniotomy medication management