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ch 47 critically ill neurological
ch 47 critically ill neurological
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10/30/2013

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Term
what will you be monitroing the pt with an aneurysm or arteriovenus malformation s/s of
Definition
hjydrocephalus and vasospasms
Term
hydrocephalus where is the increased fluid
Definition
within the ventricular or subarachnoid space
Term
what are the s/s of hydrocephalus
Definition
headach
change in loc
poor coordination
gait
Term
rebleeding is common in those with aneurysm when can it occur
Definition
24 hours yo 7 days later
Term
what may be given as drug therapies after a stroke 3
Definition
asprin within 24 hours but then after that there shouldnt be asprin given if there is rtPA therapy.
lorazapan to prevent vasospams
stool softeners to prevent valsalva maneuver
Term
distal embolic protection device
Definition
this catches clots that breaks off during a CAS procedure
Term
if a person is recieving an embolic protecting device what s/s are a complication called hyperperfusion
Definition
headache
seizures
Term
carotid endarectomy
Definition
remove arthscerosis plaque from inner lining of the carodit artery
Term
extracranial intracranial bypass
Definition
bypasses the blocker artery to establish blood flow around the blocked arery
Term
what is the best thing to do for a person after they had a stroke for swallowing
Definition
npo until swallowing is evaluated
Term
dysarthria
Definition
slurred speech
Term
what is slurred speech often from
Definition
slurred speech may be from a facial weakness or muscle disfunction rather then a side of the brain
Term
expressive brocas aphasia
Definition
damge in the brocas area of the frontal lobe the pt can understand whats being said but can not communicate verbally
Term
receptive wernicks aphasia
Definition
injury to the wernickes area in the tempproal area the pt can not understand or the written word but can talk
Term
what stroke pt will often use neologism
Definition
the one with wernickes apashia
Term
what are 5 ways of communicating with a pt with aphasia
Definition
idea in one scentence
simple commands
speak slowly
use yes and no questions
use communicaiton board if needed
Term
how do we begin a bladder training program
Definition
toilet every 2 hours
Term
pt with right hemisphere problems will typically have problems with visual and perception so how can we help them 4
Definition
approach from unaffected side
put a patch on effected eye
reoreient
establish a consistant routine
Term
unilateral neglect who typically has it and what are two teaching techniques
Definition
common in those with right sided stroke
teach to use both sides of the body
remind them to dress with the affected side first
Term
direct injury to the head/ indirect
Definition
force produced o the head/
force applied to another par of the body that affects the head
Term
primary brain injury
Definition
occurs at the time of injury from physical stress within the tissue from open or closed head trauma
Term
open head/ closed head trauma
Definition
when skull is fractured or peirced by object/
from blunt force to the head
Term
glawscow coma scale score of 13 to 15 and a loc up to 15 minutes relect a ____tbi
Definition
mild
Term
sever head injury is a score
Definition
3 to 8 and loc for longer then 6 hours
Term
s/s TBI
Definition
amnesia
headache seizure
dilopia
Term
linear fracture
Definition
clean simple break when the bone bends inward and bends outward
Term
depressed fracture
Definition
bone is pressed into the brain tissue of the skull
Term
open fracture
Definition
scalp is lacerated with an opening to the brain tissue
Term
comminuted fracute
Definition
fragments of bone with bone into the brain tissue
Term
basilar skull fracture
Definition
base of the skull extends into the fossa and results in csf with leakage into the ears and nose
Term
a basilar skull fracute has the potential to hemorrhage and cause damage to what cranial nerves
Definition
I, II, VII, VIII
Term
contusion
Definition
bruising into the tissue
Term
concussion
Definition
shakey movement in the brain
Term
diffuse axonal injury what is it and what damge ocurs
Definition
from high speed acceleration deceleration crashes
damage in the white matter
Term
icp level
Definition
10 to 15
Term
what is the first response to ICP within the three compnents
Definition
the csf is shunted or displaced from the cranial components into the spinal subachranoid space or the csf absorption rate is increased
Term
an increase in ICP can decrease tissue perfusion, and decrease ph with increased co2 what happens if left untreasted
Definition
the brain may herinate downward
Term
what are the 2 types of ICP
Definition
vasogenic edema and cytotoxic edema
Term
vasogenic edmea is seen
Definition
icp in the adult it increases in the voume of brain tissue from abnormal permability of the cerbral vessles
Term
when does cytotoxic edema occur
Definition
from hypoxic edema that causes a disturbance in the na/k potassium pump / the brain is is depleated of o2 and gluclose
Term
interstitial edema occur when
Definition
acute brain swelling and ia associated with elevated bp
Term
cerebral perfusion pressure what is it and what influences it by
Definition
graident over the brain is perfused it is influenced by o2 bp, edema
Term
three major types of hemorrhage after TBI
Definition
epidural
subdural
intracerbral hemorrhage
Term
epidural hematoma what is it and what does the pt have
Definition
from arterial bleeding into the space between the dura and the inner skull the pt has Lucid intervals
Term
subdural heamtoma
Definition
results from venous bleeding into the space beneath the dura and above the arachnoid space it occurs from tearing of the laceration of the brain tissue
Term
what could be a potential cause of hydrocephalus from imparied reabsorption and what is this known as
Definition
impaired absorption in the arachnoid villi called communicating hydrocephalus
Term
uncus brain herniation what is it and what cranial nerve is involved
Definition
shift and downward herniation that can cause the third cranial nerve
Term
what is a clinical finding in herniation f the brain
Definition
chenye stokes respiration and pinpoint and nonreactive pupils
Term
cushings triad in ICP
Definition
hypertension
widened pulse pressure
bradycardia
Term
pinpoint and nonreactive pupils are a signs of brainstem dysfunction where
Definition
pons
Term
blown pupils
Definition
those who have fixed nonreactive pupils
Term
what is a loss of vision due to with brain injuries
Definition
injury to the occipital lobe
Term
papilledema
Definition
edema and hyperemia of the optic disk
Term
many of those admitted with a head injury have an increased temp why is this
Definition
hypothalamic damge
Term
co2 is a ____ in the brain
Definition
vasodialator
Term
what are some drug therapies with ICP
Definition
osmoid diuretics
lasix
fentynl
Term
what is a drug that is not used
Definition
glucosteroids
Term
barbituate coma how does it work
Definition
decrease the metabolic demands on the brain and cerebral blood flow, also decreases the vasogenic edema
Term
what are two thing a pt with ICP are at risk for becuase of fluid and electrolyte imbalances
Definition
diabetes and syndrome of inappropriate antidiuretic horomone
Term
burrhole
Definition
this can be made into the brain to place a elevtronic device to see what the pt electronic impulses in the brain are
Term
what are some self management techniques in minor head injury for the pt 4
Definition
wake every 2 hours
acetaminophen for headache
do not give seditives or depressants
do not engage in strenous activites
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