CVA and ICP

Question 1

Causes of ICP

Answer 1

• Head injury: depends where. It’s the bleeding and swelling that cause the problem
• Infxn
• Subarachnoid hermorahage
• Subdural/epidural hematoma (causes pressure)
• Tumor
• Stroke

Question 2

eary Signs and symptoms of ICP

Answer 2

• Dec. LOC
• headache, seizures
• anxiety, irratibility, restless, confusion
• inc. BP
• Dec. pulse
• change in resp.
• change in temp (hot, fevers)
• nausea, vomitting
• slurred speech
• not able to follow what you’re saying
• Pupils fixed and dilated d/t dec blood supply to eyes

Question 3

Assessments for ICP:

Answer 3

Glasgow coma scale

• The lower the number the worse.
• 15 is best

Question 4

Why are neurological infxn hard to treat?

Answer 4

blood brain barrier

Question 5

Causes of neuro infxn?

Answer 5

-meningitis

Question 6

signs and symptoms of neuro infxn

Answer 6

• changes in mental status

Question 7

S & S for meningitis

Answer 7

• severe headache
• rigid neck
• difficulty extending legs at knee

Question 8

Assessment for meningitis

Answer 8

• Monitor ICP

Question 9

Intracranial hemorrhage causes

Answer 9

• any bleeding in brain

Question 10

when would you not give TPA

Answer 10

• when someone has a bleed

Question 11

Hydrocephalous?

Answer 11

• increase fluid

Question 12

Causes of stroke (CVA)

Answer 12

• blocked (ischemic) or burst (hemorrhagic) blood vessel

Question 13

what are ppl with Hydrocephalous are at risk for?

Answer 13

• infxn

Question 14

Who is at risk for CVA (stroke)?

Answer 14

non-modifiable: age, male, ethnicity
modifiable: HTN, A-fibb, hyperlipidemia, obesity, smoking, diabetes, periodeontal disease, asymptomatic carotid stenosis, excessive ETOH consumption

Question 15

cushings triad (ICP)?

Answer 15

• inc BP
• dec. pulse
• change in resp

Question 16

Ischemic stroke

Answer 16

• blood clot or blockage of blood flow to brain tissue

Question 17

Types of ischemic stroke

Answer 17

• large artery thrombotic
• small “ “
• cardiogenic embolic
• crypt

Question 18

late Signs and symptoms of ICP

Answer 18

• positive babinkski reflec
• fixed dilated pupuo;s
• absent reflexes
• abnormal posturing (decerebrate, decorticate)
• flacidity

Question 19

What are the causes of the symptoms in ICP

Answer 19

• decrease cerebral perfusion = further inc. swelling and shifts brain tissue
• herniation through openings in the dura mater

Question 20

What is coning?

Answer 20

• herniation through openings in the dura mater

Question 21

Causes of hemorrhagic stroke?

Answer 21

• aneurysm

Question 22

AVM?

Answer 22

arterial venous malformation - disrupted flow beteen arterial and venous system so as BP inc. as pt gets older, veins and arteries rupture

Question 23

disgnostics for ICP

Answer 23

• CT
• MRI
• ICP monitoring
• PET (positive emission tomogrpahy)
• EEG (electroencephalography

Question 24

disgnostics for ICP

Answer 24

• CT
• MRI
• ICP monitoring
• PET (positive emission tomogrpahy)
• EEG (electroencephalography)
• xray

Question 25

ICP

Answer 25

- insertion of external ventricular crain (EVD) - monitor ICP - dec ICP

Question 26

medical interventions for ICP

Answer 26

- Craniotomy: blood removed

Question 27

Pharmacology for ICP

Answer 27

- mannitol - vasodilator - AntiBx - opioid analgesis - andrenergic blockers - corticosteroids - hypertonic saline - sedation - skeletl muscle relfexants - anti-parkinsons - anti-convulsants - calcium channel blocker - diuretic - stool softeners ( straining)

Question 28

Osmitrol (Manitol) for ICP

Answer 28

- hypertonic solution for hen they have inc. intracranial pressure = pulls fluid off brain - blocks reaborption of fluids = excrete water pot. chloride, Mg, an PO4 - monitor for electrolyte balance - may have to replace electrolytes - only given IV - dose: weight based - do not give to renal pt, or intracranial bleeding - VItals - electrolytes imbalances - headaches, CHF - renal fxn (GFR) Contraindicated: - pulmonary edema

Question 29

Nursing diagnoses for ICP

Answer 29

- Ineffective airway clearance R/T diminished protective reflexes (cough/gag) - Ineffective breathing patterns R/T neurologic dysfunction (brain stem compression, structural displacement) - Ineffective cerebral tissue perfusion R/T the effects of increased ICP - Risk of hemodynamic disturbance R/T increased ICP - Risk for imbalanced body temperature R/T neurologic dysfuntion - Deficient fluid volume R/T fluid restriction - Risk for fluid overload R/T increased ICP - Risk for electrolyte imbalance R/T increased ICP - Risk for infection R/T ICP monitoring system

Question 30

Nursing plan/outcome for pt with ICP

Answer 30

``` Maintenance of a patent airway Normalization of respiration Adequate cerebral tissue perfusion through reduction in ICP Restoration of fluid balance Absence of infection Absence of complication ```

Question 31

Nursing interventions for ICP

Answer 31

- Monitor for changes in LOC and changes in Neuro vital signs, regular Neuro vital signs - Monitor for changes in BP, HR, pulse pressure increase, Temp, RR, O2 sats - Airway patency and lung fields assessed regularly, Sx with care – coughing discouraged - Monitor breathing patterns - Head midline, HOB 30-45 degrees (avoid extreme rotation of neck and flexion) - Avoid extreme hip flexion - Administer stool softeners, high fiber diet - Administer Pain medications PRN - Provide a calm environment - Maintain fluid balance (fluid restriction, diuretic, fluid resuscitation) - Monitor for electrolyte imbalances - renal f

Question 32

Rule for remembering S&S of ICP and Schock

Answer 32

``` ICP: cushings triad Inc BP Dec pulse Dec resp ``` *shock is the opposite

Question 33

Assessments for ICP

Answer 33

- complete head to toe - Glasgow coma scale - fluid balance = excess fluid output - electrolytes

Question 34

TIA

Answer 34

Transient ischemic attack - brief neurological dysfxn d/t loss of blood flow (ischemia) to brain, spinal cord or retina without tissue death (infarction).

Question 35

S&S of TIA

Answer 35

- same as stroke.. - paralysis - weakness - numbness on one side of body - dizzy - mumble words

Question 36

motor symptoms of stroke

Answer 36

- hemiplegia - half-sided paralysis - hemoparesis - half-sided weakness - ataxia - unsteady gait - dysphagia - difficulty swallowing

Question 37

communication symptoms of stroke

Answer 37

- dysarthia - weakness/paralysis of muscle used to speak - dysphasia - difficulty speaking - Aphasia - inability form speech or language - Apraxia - difficulty performing tasks

Question 38

communication symptoms of stroke

Answer 38

Visual perception dysfxn d/t problem with sensory pathways between eye and visual cortex Homonymous hemianopsia: can only see either left or right

Question 39

sensory symptoms of stroke

Answer 39

- touch impairment | - difficulty interpreting stimuli

Question 40

cognitive impairment symptoms of stroke

Answer 40

``` - o Frontal lobe damage can affect learning capacity, memory, and other higher intellectual functions o Limited attention span o Comprehension difficulty o Forgetfulness o Apathy o Headache ```

Question 41

emotional deficits of stroke

Answer 41

``` o Loss of self-control o Emotional liability o Depression o Withdrawal o Fear, hostility, anger o Feelings of isolation ```

Question 42

Stroke assessment

Answer 42

``` FAST face arm speech time - 911 ```

Question 43

diagnostics for stroke

Answer 43

``` Ct scan: bleeding CT angiography Carotid U/S: narrowing of artery MRI: bleeding Phenytoin level and albumin PTT, PT-INR(baseline), Hgb, Na and K, renal fxn test ```

Question 44

Pharmacological for stroke

Answer 44

TPA (Tissue plasmin activator): thromboltic. Cannot give if unsure of when stroke happened Antihypertensive (ACE inhib, beta blocker, Ca blocker): HTN risk factor for developing stroke Anticoags (aspirin) Platelet-inhibiting meds: Plavix, coumadin Anticonvulsants: if at risk for dev. seizures