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ICU THEORY EXAM 4; NEURO
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ICU THEORY EXAM 4; NEURO
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ICU THEORY EXAM 4; NEURO___ &___ are the leading causes of bacterial meningitis - ANS-Streptococcus
pneumoniae and Neisseria meningitidis
___ accounts for 85% of all cases of SAH, of this 85%, 19% will die from it -
ANS-Cerebral aneurysm rupture
___ is outpouching of the wall of a blood vessel that results from weakening of the wall
of the vessel - ANS-aneurysm
____used when pharm management has failed; performed only when CT or MRI
provides evidence that an infarct has not occurred; placed under procedural sedation (
in SAH) - ANS-Cerebral angioplasty
•Unequal pupils in increased ICP - ANS-Pressure on third cranial nerve
1. Controlled Hyperventilation - ANS-a. If Paco2 can be reduced from its normal level of
35 to 40 to a range of 25 to 30 in a patient with intracranial hypertension,
vasoconstriction of cerebral arteries, reduction of CBF and increased venous return will
result
1. Physiological changes of SE - ANS-a. Phase 1- increased CBF and catecholamine
b. Phase 2- 30-60 min of SE
1. Positioning for ICP - ANS-a. Head elevated increases venous return
b. Positions that impede venous return and increase ICP include Trendelenburg, prone,
extreme hip flexion, and angulation of the neck
1. Temperature Control - ANS-a. Temperature is proportional to metabolic rate
b. High temperature increase metabolic rate and which causes an increase in blood
volume to brain to meet those metabolic needs, increases ICP
c. Antipyretics and cooling devices ,ust be used when appropriate while the source of
the fever is being determined
2. Sodium is replenished with ____ fluids in patients with SAH - ANS-isotonic
a. Complications of SAH - ANS-vasospasms, seizures, rebleeding, hyponatremia
, a. Meningococcal Sepsis or Meningococcemia - ANS-i. Meningitis that goes horribly
south, can lead to DIC
ii. Fever starts moderate then becomes high
iii. Rash, becoming purpura
iv. Skin: Pale with cyanosis of the extremities due to vasoconstriction
v. Hypotension leads to septic shock (cardiovascular collapse)
a. Nursing Management of ICH or SAH - ANS-i. Monitor for changes in hemodynamic
status
1. BP, heart rhythms
ii. Frequent neurological assessment
1. Neuro checks q 1 hour
iii. Maintain surveillance of complication
iv. Monitor for increased intracranial pressure (increased ICP)
1. First observed by a decreased LOC/confusion
v. Monitor Labs and coagulation
1. Platelets, H and H, INR, PT, PTT, clotting factors, sodium,
vi. DVT precautions
1. SCDs
vii. Monitoring Intracranial pressure
a. Phase 1 of SE
- increased CBF and catecholamine release (epi and norepi) - ANS-i. Elevated temp
ii. Lactic acidosis (anaerobic metabolism)
iii. Cardiac dysrhythmias
iv. Autonomic dysfunction (urinating and pooping on yourself)
a. Waterhouse Friedrichsen syndrome - ANS-adrenal gland failure due to bleeding in
the adrenal gland
i. Complication of meningococcal meningitis
ii. Severe and sudden onset
iii. Overwhelming septic shock
iv. DIC (overactive clotting, lots of clots form in the vessels)
v. Adrenal hemorrhage
vi. Petechiae/Purpura
vii. Circulatory collapse
ABGs
Acidic- - ANS-dilating
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