CEN Neurological Emergencies UPDATED
ACTUAL Exam Questions and CORRECT
Answers
normal ICP - CORRECT ANSWER - 8-12
greater than 20 mmhg is increased ICP
early increased ICP s/s - CORRECT ANSWER - - declining LOC
- confusion
- agitation
- combativeness
- HA
- slowed/slurred speech
- N/V
- blurred vision
- unilateral delay/sluggish pupils
- ovoid-shaped pupils
- decreased motor strength and sensation
- HTN with widening pulse pressure
Late increased ICP s/s - CORRECT ANSWER - - progressive decline in LOC to coma
- speech impairment (may only groan)
- projectile vomiting w/o vomiting
- pupil becomes fixed and dilated
,- flexion (decorticate) and extension (decerebrate) posturing
- cardiac dysrhythmias
- cushing's triad: HTN w/ widened pulse pressure, bradycardia, abnormal respiratory patterns
peds increased ICP - CORRECT ANSWER - - bulging fontanelles
- sun-setting eyes
- vomiting, anorexia, poor feeding
- high pitched cry
- biot's respirations (deep rapid respirations interrupted with long apneic pauses)
Cerebral perfusion pressure - CORRECT ANSWER - measurement of the amount of
oxygen being delivered to the brain. calculated by subtracting the ICP from the mean arterial
pressure.
tx for increased ICP - CORRECT ANSWER - focus on maintaining a CPP above 70 mm
Hg
to keep it above 70 by either increasing the mean arterial pressure (vasopressors) or reducing
ICP.
- keep SPO2 above 95
- systolic BP above 100 mmhg
- ICP < 15 mmhg
- CPP < 60 mmhg
- temp between 36-38
- glucose between 80-100
- Na between 135-145
, - hgb greater than 7
nursing interventions for increased ICP - CORRECT ANSWER - - diuretics (mannitol)
- hypertonic saline to reduce brain volume
- elevate HOB to 30-45 degrees
- midline head/neck position
- avoid hip flexion
- prevent and treat sz
anterior fossa basilar skull fx - CORRECT ANSWER - most common - bleeding/CSF leak
will cause:
- bleeding or CSF leak
- epistaxis
- rhinorrhea
- subconjunctival hemorrhage
- hemorrhage in the periorbital spaces (raccoon eyes)
front
middle fossa basilar skull fx - CORRECT ANSWER - bleeding/CSF leak will cause:
- otorrhea
- hemotympanum
- this fx can cause nerve injury leading to deafness and vertigo
middle
posterior fossa basilar skull fx - CORRECT ANSWER - Rare
bleeding will cause:
ACTUAL Exam Questions and CORRECT
Answers
normal ICP - CORRECT ANSWER - 8-12
greater than 20 mmhg is increased ICP
early increased ICP s/s - CORRECT ANSWER - - declining LOC
- confusion
- agitation
- combativeness
- HA
- slowed/slurred speech
- N/V
- blurred vision
- unilateral delay/sluggish pupils
- ovoid-shaped pupils
- decreased motor strength and sensation
- HTN with widening pulse pressure
Late increased ICP s/s - CORRECT ANSWER - - progressive decline in LOC to coma
- speech impairment (may only groan)
- projectile vomiting w/o vomiting
- pupil becomes fixed and dilated
,- flexion (decorticate) and extension (decerebrate) posturing
- cardiac dysrhythmias
- cushing's triad: HTN w/ widened pulse pressure, bradycardia, abnormal respiratory patterns
peds increased ICP - CORRECT ANSWER - - bulging fontanelles
- sun-setting eyes
- vomiting, anorexia, poor feeding
- high pitched cry
- biot's respirations (deep rapid respirations interrupted with long apneic pauses)
Cerebral perfusion pressure - CORRECT ANSWER - measurement of the amount of
oxygen being delivered to the brain. calculated by subtracting the ICP from the mean arterial
pressure.
tx for increased ICP - CORRECT ANSWER - focus on maintaining a CPP above 70 mm
Hg
to keep it above 70 by either increasing the mean arterial pressure (vasopressors) or reducing
ICP.
- keep SPO2 above 95
- systolic BP above 100 mmhg
- ICP < 15 mmhg
- CPP < 60 mmhg
- temp between 36-38
- glucose between 80-100
- Na between 135-145
, - hgb greater than 7
nursing interventions for increased ICP - CORRECT ANSWER - - diuretics (mannitol)
- hypertonic saline to reduce brain volume
- elevate HOB to 30-45 degrees
- midline head/neck position
- avoid hip flexion
- prevent and treat sz
anterior fossa basilar skull fx - CORRECT ANSWER - most common - bleeding/CSF leak
will cause:
- bleeding or CSF leak
- epistaxis
- rhinorrhea
- subconjunctival hemorrhage
- hemorrhage in the periorbital spaces (raccoon eyes)
front
middle fossa basilar skull fx - CORRECT ANSWER - bleeding/CSF leak will cause:
- otorrhea
- hemotympanum
- this fx can cause nerve injury leading to deafness and vertigo
middle
posterior fossa basilar skull fx - CORRECT ANSWER - Rare
bleeding will cause:
