MED SURG II COMPREHENSIVE UPDATED EXAM
QUESTIONS AND ANSWERS RATED A+
✔✔Why would increased CO2 cause increased ICP? - ✔✔Need for oxygen results in
cerebral vasodilation, increasing blood flow thus increasing pressure
✔✔What causes fluctuation of ICP within normal ranges? - ✔✔Body temperature
Oxygenation status
Body position
Arterial and venous pressure
Increased intra-abdominal and thoracic pressure (vomiting, coughing, bearing down)
✔✔What is the formula for total fluid volume replacement? - ✔✔Wt in kg x 30
✔✔What is the normal cerebral perfusion pressure? - ✔✔70-100 (60-70 is adequate)
✔✔What is the formula for cerebral perfusion pressure? - ✔✔MAP-ICP
✔✔What is the formula for MAP? - ✔✔(SBP + (2xDBP))/3
✔✔What is the formula for cardiac output? - ✔✔CO (L)= HR (bpm) x Stroke volume
(mL)
**CONVERT**
✔✔When does cerebral edema peak? - ✔✔24-36 hours
✔✔How do we maintain CPP? - ✔✔Monitor respiratory status
Assess VS and neuro q15 minutes to q hour
Avoid extreme head rotation
Neutral positioning in bed
✔✔Complications of increased ICP - ✔✔Cerebral edema and herniation
Decreased cerebral perfusion pressure
Seizure
Fluid and electrolyte abnormalities
Hyperthermia
Nutrition problems
Brain death
✔✔What is cerebral edema - ✔✔Fluid buildup around the brain
✔✔What does cerebral edema do to ICP and CPP? - ✔✔Increases ICP, less room for
cerebral blood-flow, decreases CPP
, ✔✔What is a subarachnoid hemmorhage? - ✔✔Blood between arachnoid and pia mater
✔✔What is an epidural hematoma? - ✔✔Collection of blood between the dura and the
skull
✔✔What is a subdural hematoma? - ✔✔Collection of blood between the dura and
arachnoid mater
✔✔What is an intracerebral hemorrhage? - ✔✔Bleeding within the brain tissue
✔✔Risk factors for brain hemorrhage? - ✔✔Age >40
Brain injury
Hypertension
Smoking
✔✔Clinical cues for brain hemorrhage early signs: - ✔✔Sudden thunderclap headache
Worst headache of life
Double vision
Altered LOC
N/V
Neck pain
Stiffness
✔✔Clinical cues for brain hemorrhage late signs: - ✔✔Vasospasm
Cerebral ischemia
Coma
Seizures
Rebleeding
Hydroencephalus
✔✔What is hydroencephalus? - ✔✔fluid around the brain
✔✔What type of fracture results in raccoon eyes? - ✔✔Basilar skull fracture, pushes
brain forward
✔✔What is Battle's sign? - ✔✔Ecchymosis behind the ear
✔✔What is the halo sign? - ✔✔Ring of fluid around blood stain from drainage, indicates
CSF leak
✔✔Assessment for patients with a head injury includes: - ✔✔Airway
Breathing
Circulation
Disability- mvmt, sensation, naming objects, serial addition
QUESTIONS AND ANSWERS RATED A+
✔✔Why would increased CO2 cause increased ICP? - ✔✔Need for oxygen results in
cerebral vasodilation, increasing blood flow thus increasing pressure
✔✔What causes fluctuation of ICP within normal ranges? - ✔✔Body temperature
Oxygenation status
Body position
Arterial and venous pressure
Increased intra-abdominal and thoracic pressure (vomiting, coughing, bearing down)
✔✔What is the formula for total fluid volume replacement? - ✔✔Wt in kg x 30
✔✔What is the normal cerebral perfusion pressure? - ✔✔70-100 (60-70 is adequate)
✔✔What is the formula for cerebral perfusion pressure? - ✔✔MAP-ICP
✔✔What is the formula for MAP? - ✔✔(SBP + (2xDBP))/3
✔✔What is the formula for cardiac output? - ✔✔CO (L)= HR (bpm) x Stroke volume
(mL)
**CONVERT**
✔✔When does cerebral edema peak? - ✔✔24-36 hours
✔✔How do we maintain CPP? - ✔✔Monitor respiratory status
Assess VS and neuro q15 minutes to q hour
Avoid extreme head rotation
Neutral positioning in bed
✔✔Complications of increased ICP - ✔✔Cerebral edema and herniation
Decreased cerebral perfusion pressure
Seizure
Fluid and electrolyte abnormalities
Hyperthermia
Nutrition problems
Brain death
✔✔What is cerebral edema - ✔✔Fluid buildup around the brain
✔✔What does cerebral edema do to ICP and CPP? - ✔✔Increases ICP, less room for
cerebral blood-flow, decreases CPP
, ✔✔What is a subarachnoid hemmorhage? - ✔✔Blood between arachnoid and pia mater
✔✔What is an epidural hematoma? - ✔✔Collection of blood between the dura and the
skull
✔✔What is a subdural hematoma? - ✔✔Collection of blood between the dura and
arachnoid mater
✔✔What is an intracerebral hemorrhage? - ✔✔Bleeding within the brain tissue
✔✔Risk factors for brain hemorrhage? - ✔✔Age >40
Brain injury
Hypertension
Smoking
✔✔Clinical cues for brain hemorrhage early signs: - ✔✔Sudden thunderclap headache
Worst headache of life
Double vision
Altered LOC
N/V
Neck pain
Stiffness
✔✔Clinical cues for brain hemorrhage late signs: - ✔✔Vasospasm
Cerebral ischemia
Coma
Seizures
Rebleeding
Hydroencephalus
✔✔What is hydroencephalus? - ✔✔fluid around the brain
✔✔What type of fracture results in raccoon eyes? - ✔✔Basilar skull fracture, pushes
brain forward
✔✔What is Battle's sign? - ✔✔Ecchymosis behind the ear
✔✔What is the halo sign? - ✔✔Ring of fluid around blood stain from drainage, indicates
CSF leak
✔✔Assessment for patients with a head injury includes: - ✔✔Airway
Breathing
Circulation
Disability- mvmt, sensation, naming objects, serial addition
