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ICP
Nursing
| Question | Answer |
|---|---|
| Causes of ICP | Brain tumors Infectious and inflammatory disorders |
| Pathophysiology of ICP | Dilation or constriction of cerebral blood vessels in response to changes in blood pressure leafs to ICP |
| Assessment findings for ICP | Decreasing LOC, lethargic, stuperous, semi comatose, confusion, restlessness, periodic distortion. Headache that's worse in the morning |
| Cushing ' s triad | A pulse rate that increases initially but then decreases. Systolic BP that rises with a widening pulse pressure, And a respiratory rate that is irregular. |
| Other signs of ICP | Vomiting without nausea Decorticate or decerbrate posturing Cheyne stokes breathing |
| Goals for tx of ICP | Maintain Bp,prevent hypoxia, and ensure cerebral perfusion |
| Avoid IV Solutions containing | Glucose |
| Medical Mgmt For ICP bed should be: | Midline HOB elevated to 30 degrees |
| Drug given for ICP | Mannitol Which is an osmotic diuretic |
| Other med surg Mgmt for ICP | Avoid hypothermia/hyperthermia Control seizures Versed for restlessness indwelling cathader monitor I/O NG tube Stool softener Pepcid to prevent stress ulcers |
| Meningitis | Caused by infectious bacteria, viruses, fungi,or parasites Damages CN responsible for seeing and hearing |
| Assessment findings for meningitis | Headache, fever, nuchal rigidity, N/V,photophobia, restlessness, irritability, seizures, purpura on face and hands |
| Meningitis diagnostics | Cloudy LP CT scan shows inflammation CBC shows an increase in WBC'S |
| Encephalitis | Inflammation of white and gray matter 48 to 72 hours after being infected from vector |
| Assessment findings for encephalitis | Sudden fever, headache, stiff neck, vomiting, drowsiness, tremors, seizures, spastic or flaccid paralysis, irritability, lethargy, delirium, coma, incontinence, visual disturbances |
| Medical Mgmt For encephalitis | Antipyretic, anticonvulsant, anti inflammatory, and analgesic Monitor VS and LOC frequently I/O Bowels (eenema or stool softener) |
| Guillain Barre synd | Antibodies attack the Schwann cells that make up the mylin sheath surrounding the axon nerves |
| Assessment findings for guillain Barre synd | Weakness, numbness, tingling in the arms and legs progressive weakness that starts at feet and goes to hands Difficulty chewing, swallowing, and talking. May need iv or tpn feedings Increased protein levels in LP |
| Tx for guillain Barre synd | If resp muscles are involved mechanical vent Plasmapheresis shortens the course of the disease Assess signs of respiratory distress Skin care change positions every 2 hours ROM exercises to prevent atrophy |
| Brain abscess | infection in nearby structure Bacterial endocarditis Pulmonary or abdominal Infection |
| Assessment findings for brain abscess | Increased ICP Fever Headache Paralysis, seizures, muscle weakness Lethargy |
| Diagnostic findings for brain abscess | Neuro changes depending on location Increase in WBC'S Mri or xray to determine the location |
| Ms | Causes permanent destruction of the myelin sheath Made worse by infection, stress, and emotional upset |
| Assessment findings for ms | Blurred vision, diplopia, nystagmus, weakness, clumsiness, and numbness and tingling of arms and legs, intention tremor, and slurred hesitant speech,and mood swings |
| Nursing management for ms | Assess emotional status Identify vision problems Adaptive services needed Ambulatory devices Skin care |
| Ms can cause difficulty breathing what are some interventions | Fowler position support the arms Encourage client to deep breathe Provide rest between activities |
| Pathophysiology of myasthenia gravis | Antibodies bind to and degrade the acetylcholine receptor on the surface of skeletal muscles |
| Assessment findings for myasthenia gravis | Ptosis of the eyelids Difficulty chewing or swallowing Diplopia Voice weakness mask like facial expressions weakness of the extremities and respiratory system |
| Diagnostic findings for myasthenia gravis | Acetylcholine receptor antibody titer Chest xray may show an enlargement of the thymus IV tensilon may make better for a few minutes but only lasts a few minutes |
| Nursing Mgmt for myasthenia gravis | Must administer meds at the exact time to maintain a therapeutic level in the blood |
| Pathophysiology of ALS | Degeneration of the motor neurons of the spinal cord or brain stem Results in muscle weakness and wasting Cause is unknown |
| ALS | Wasting of arms legs and trunk development Difficulty speaking and swallowing Episodes of muscle twitching periods of inappropriate laughter and crying respiratory failure and total paralysis |
| ALS treatment | Relutex protects nerves from glutamate thought to be the cause of the disease this drug is metabolizes in the liver and kidneys so frequent function tests are necessary |
| Tic douloureux | Involves the trigeminal nerve Cause is unknown causes sudden severe burning pain Pain begins and ends quickly multiple times a day |
| Tic douloureux patients | Eating can trigger the pain so they may not eat as much. Small frequent meals Figure out how often the pain is and how frequent also what activities are associated with the pain |
| Surgical management of tic douloureux | Severe the root of the trigeminal nerve it can cause a lot of complications |
| Bells palsy | Inflammation occurs around one of the paired facial nerves Cause is unknown but viral link is suspected Improvement may begin in a few weeks but if hasn't begun to heal in 3 months may be permanent |
| Bells palsy carries a risk of | Eye infection Lubricant may be necessary |
| Question to ask someone with bells palsy | Any recent viral infections? |
| Parkinsons disease | Onset begins after age 50 |
| Symptoms of parkinsons | Stiffness Tremors Bradykinesia Mask like expression stooped posture Low volume of speech Shuffling gait |
| Parkinsons triad | Pill rolling Cogwell rigidity Bradykinesia |
| Management for parkinsons | Lots of patient and family education on safety rom exercises Assistance with adls Thickened liquids Small Frequent Meals |
| Huntington disease | Inherited High risk of suicide develops between 30 and 50 Difficulty chewing and swallowing Uncontrolled twisting mmovements |
| Seizures and brain tumors | Still need flashcards can't make any more without dying |
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