Exam 3 Study guide
Neuro Nursing
Early and late signs of ICP
Early signs of ICP
oDecreased level of consciousness, irritability, restlessness, headache, N/V,
High signs of ICP
oBlown pupils, pupillary changes, posturing (decorticate (to the core indicates it
has been affected by the cortex of the brain), and decerebrate – this one has a
worse outcome because the brain stem has been affected.), and Cushing's Triad
– (Systolic hypertension, with widening pulse pressure and bradycardia).
Bradycardia is actually a reflexive thing because the heart is responding the that
massive hypertension.
Things we can do to promote the further reduction of ICP
oKeep the head of the bed at 30 degrees.
oNo straining or lifting of heavy objects.
oQuiet environment and dark.
Minimize sensory, do not cluster care, don’t allow them to shiver, keep
the room quite, minimize visitors or send visitors home, keep the tv
turned down low.
oKeep the head in the midline position allowing the dura sinus to drain away all of
the CSF which will further normalize their ICP.
Medication that can be given to reduce Intracranial hypertension.
oMannitol – on Exam and NCLEX but in practice it is not used because it
precipitates. It is really hard to manage.
oSuper hypertonic Saline 23.5% - 1st line of choice.
What other drugs than osmotic diuretics are used in a TBI or ICP?
Anti-seizure drugs if they have a seizure risk.
Furosemide
Why do we want to keep the cervical collar in place for a cervical injury?
So you don’t further damage the spine.
Further ways to stabilize the spine is to Logroll when moving the patient.
Signs of a mild traumatic brain injury
, Headache, amnesia, photophobia, balance or gate problems, brief LOC, confusion,
dizziness, mental fog.
What are the risks for the development of TBI? Younger men playing contact sports, sensory
difÏculty, glaucoma, Parkinson’s. If it increases their risk of a fall, it will increase their risk for a
TBI.
Educate the patient about discharge with TBI:
Monitor for worsening of the neuro status. If they start having increased restlessness,
increasing agitation, worsening headache, or blurred vision, you need to report back to
the emergency room.
Activity restrictions. Avoid activities that could lead to another concussion. Brain rest,
no video games, playing on the phone, or TV, no contact sports or lifting.
Monitor for changes in neuro status, they are allowed to sleep, and they do not have to
stay up. They need more rest.
The only medicine you can take for a headache is Tylenol. Because it causes no sedation
or bleeding risk like aspirin and Ibuprofen. If they had a bleed that was not detected this
would put them at a higher risk for bleeding complications. “Intracranial hemorrhage”
Are you going to expect to find a patient with a mild head injury to have drainage from their
nose? No. That is always a concern and you need to inspect that for CSF.
Myasthenia Gravis
Drugs: Cholinesterase Inhibitors – The thing you have to remember about it is that
acetylcholinesterase is the inactivator for acetylcholine. So if you block the inactivator,
you keep acetylcholine.
Neostigmine is one of our Cholinesterase inhibitors. But why are we going to be giving
this patient this cholinesterase inhibitor? What is myasthenia gravis?
They don’t have muscle contraction. They are weak due to the Cholinesterase inhibitors.
The patient has improved muscle strength and lessened their fatigue.
Related to the increase of acetylcholine, monitor for muscular cramping, tetany
(muscular pain), twitching, difÏculty swallowing, excess salivation, and coughing. It is
possible to give TOO much of the Cholinesterase inhibitors. = Cholinergic crises.
What to do if they go into a Cholinergic crisis?
oAtropine. Because if they are in a full-blown Cholinergic crisis, they are going to
become bradycardic.
oBrod Spectrum antibiotics because we almost always have to assume that it’s
bacterial unless otherwise proven.
Neuro Nursing
Early and late signs of ICP
Early signs of ICP
oDecreased level of consciousness, irritability, restlessness, headache, N/V,
High signs of ICP
oBlown pupils, pupillary changes, posturing (decorticate (to the core indicates it
has been affected by the cortex of the brain), and decerebrate – this one has a
worse outcome because the brain stem has been affected.), and Cushing's Triad
– (Systolic hypertension, with widening pulse pressure and bradycardia).
Bradycardia is actually a reflexive thing because the heart is responding the that
massive hypertension.
Things we can do to promote the further reduction of ICP
oKeep the head of the bed at 30 degrees.
oNo straining or lifting of heavy objects.
oQuiet environment and dark.
Minimize sensory, do not cluster care, don’t allow them to shiver, keep
the room quite, minimize visitors or send visitors home, keep the tv
turned down low.
oKeep the head in the midline position allowing the dura sinus to drain away all of
the CSF which will further normalize their ICP.
Medication that can be given to reduce Intracranial hypertension.
oMannitol – on Exam and NCLEX but in practice it is not used because it
precipitates. It is really hard to manage.
oSuper hypertonic Saline 23.5% - 1st line of choice.
What other drugs than osmotic diuretics are used in a TBI or ICP?
Anti-seizure drugs if they have a seizure risk.
Furosemide
Why do we want to keep the cervical collar in place for a cervical injury?
So you don’t further damage the spine.
Further ways to stabilize the spine is to Logroll when moving the patient.
Signs of a mild traumatic brain injury
, Headache, amnesia, photophobia, balance or gate problems, brief LOC, confusion,
dizziness, mental fog.
What are the risks for the development of TBI? Younger men playing contact sports, sensory
difÏculty, glaucoma, Parkinson’s. If it increases their risk of a fall, it will increase their risk for a
TBI.
Educate the patient about discharge with TBI:
Monitor for worsening of the neuro status. If they start having increased restlessness,
increasing agitation, worsening headache, or blurred vision, you need to report back to
the emergency room.
Activity restrictions. Avoid activities that could lead to another concussion. Brain rest,
no video games, playing on the phone, or TV, no contact sports or lifting.
Monitor for changes in neuro status, they are allowed to sleep, and they do not have to
stay up. They need more rest.
The only medicine you can take for a headache is Tylenol. Because it causes no sedation
or bleeding risk like aspirin and Ibuprofen. If they had a bleed that was not detected this
would put them at a higher risk for bleeding complications. “Intracranial hemorrhage”
Are you going to expect to find a patient with a mild head injury to have drainage from their
nose? No. That is always a concern and you need to inspect that for CSF.
Myasthenia Gravis
Drugs: Cholinesterase Inhibitors – The thing you have to remember about it is that
acetylcholinesterase is the inactivator for acetylcholine. So if you block the inactivator,
you keep acetylcholine.
Neostigmine is one of our Cholinesterase inhibitors. But why are we going to be giving
this patient this cholinesterase inhibitor? What is myasthenia gravis?
They don’t have muscle contraction. They are weak due to the Cholinesterase inhibitors.
The patient has improved muscle strength and lessened their fatigue.
Related to the increase of acetylcholine, monitor for muscular cramping, tetany
(muscular pain), twitching, difÏculty swallowing, excess salivation, and coughing. It is
possible to give TOO much of the Cholinesterase inhibitors. = Cholinergic crises.
What to do if they go into a Cholinergic crisis?
oAtropine. Because if they are in a full-blown Cholinergic crisis, they are going to
become bradycardic.
oBrod Spectrum antibiotics because we almost always have to assume that it’s
bacterial unless otherwise proven.
