Neuro 3

Question 1

how does the brain initially compensate for pressure changes

Answer 1

by pushing on the tumor/mass (constricts blood flow, and decreases CSF it is making)

Question 2

when does the brain typically show a problem is going on

Answer 2

brain does not show obvious s/s of tumor/mass/bleed/problem until it starts to decompensating and know you even have it

Question 3

what does herniation/compensation start

Answer 3

Attempts to compensate until at 100 change in volume (herniation starts)

Question 4

once compensatory system is exhausted…

Answer 4

a small additional volume causes a greater increase in pressure

Question 5

normal ICP

Answer 5

<15

Question 6

signs of increased ICP

Answer 6

1) Change in LOC (agitated to become sleepy, lose sensorium, eventually become obtunded and cannot arouse)
2) Change in Pupils (dilated, double vision, nystagmus)
3) Motor response (weakness)
4) VS Change: increased systolic BP, widening pulse pressure, bradycardia, and abnormal RR (Cushing’s triad*)

Question 7

what is important to remember about all neuro conditions

Answer 7

have very similar symptoms

Question 8

posturing related to brain herniation

Answer 8

Decerebrate away (extension posturing)
Decorticate toward (abnormal flexion)

Question 9

describe extraventricular drains (EVD)

Answer 9

• Shave head, get drill to create opening for drain

- Drain goes through skull and dura matter to right above ventricle (drains blood and CSF)

Question 10

describe care of a becker drain

Answer 10

• needs to be leveled with tragus of ear (adjust to cm of water, how high you want it)
• set to what cm of water you want ie/ once ICP gets above 15, will drain

Question 11

hourly care of EVD

Answer 11

-At the end of each hour, turn off drain, open line to monitor, read pressure within tubing to determine what the ICP level is, and dump

Question 12

imperative to remember about EVD!!!!

Answer 12

***Turn it off to head drain if moving to prevent/sitting them up (will lose entire CSF fluid in brain, ie/ 110)

Question 13

things to remember about EVD

Answer 13

• Remember, never irrigate the drain or allow too much fluid to drain at a time
• Only have 125 ml of CSF, usually open and drain, then close
• It must be closed if the patient is moved, transferred or up in the chair
• Level it to the tragus of the ear

Question 14

how can you monitor ICP

Answer 14

can use manometer or transduced waveform

Question 15

treatment of neuro disorders

Answer 15

• treat symptoms and possibly have surgery
• CT/ MRI (first part of treatment)
• Surgery to evacuate blood
• Ventilation, sedation
• Neuro checks q hour
• ICP monitoring q hour
• BP to maintain MAP at 85-90.
• Monitor oxygenation

Question 16

describe CPP

Answer 16

-Cerebral Perfusion Pressure
CPP=MAP-ICP
-Normal ICP is 10-15 mmHg
-Want CPP at least 70 for oxygenation to the brain, so MAP should be 85-90

Question 17

to keep systolic at 135-145 in neuro emergency what should be given

Answer 17

dopamine to vasoconstrict

Question 18

this is the one diuretic that will cross the BBB

Answer 18

• *Mannitol
• decreases cerebral edema- first line
• Must have a foley in and monitor if renal failure