NURS 487 EXAM 2 QUESTIONS WITH COMPLETE ANSWERS

Depressed Skull Fx


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- May be visible and palpable
- May tear meninges and extend into brain tissue
- High probability of cerebral injury
- Medical interventions: surgical repair of fracture, evacuation of any
hematoma
- Nursing Interventions: frequent neuro assessments, pain mgmt




Cerebral Spinal Fluid


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, - Clear fluid that circulates in subarachnoid spaces and spinal cord and is
reabsorbed into venous system
- 8% of intracranial volume (150 mL)
- Normal adult CSF pressure: 5-13 mmHg
- Too much production leads to hydrocephalus (need drain)
- Functions of CSF include acting as a cushion and support brain and spinal
cord, maintaining stable chemical environment for CNS, and excreting toxic
wastes (carbon dioxide, lactate, hydrogen ion)
- Should not contain RBC or WBC and should not be cloudy
- CSF usually obtained from doing a Lumbar Puncture (needle inserted b/w
3rd and 4th lumbar vertebrae, also done to measure pressure)




Subarachnoid Hemorrhage (SAH)


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- Bleeding btw arachnoid layer of the meninges and the brain; blood may
leak into CSF
- S/S: Nuchal rigidity (chin to chest)
- Medical Interventions: Surgical evacuation, placement of an
intraventricular catheter
- Nursing Interventions: frequent neuro checks, monitoring quantity and
color of CSF drainage from IVC




Predisposing RF/Causes of Seizures


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- Hypernatremia > 145/hyponatremia <135
- Hyperglycemia>250/hypoglycemia<70
- Hypercalcemia>11/hypocalcemia<9
- Hypomagnesemia<1.5
- Hypophosphatemia<1.7
- Meningitis, hypoxia, fever, head injury, brain tumors
- Toxins: pertussis, salmonella, Shigella

, - Drug or alcohol intoxication (amphetamines, cocaine, meperidine,
penicillins, tricyclic antidepressants) or withdrawal (barbituates,
benzodiazepines, ethanol, opiates)




Diffuse Axonal Injury


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- Widespread shearing of axons and blood vessels in the white matter
(rotational injury or high speed accel/decel injury (MVA))
- Usually comatose: Mild (lasts hrs to days) OR Severe (poor prognosis:
death or persistent vegetative state)
- Difficult to assess on a CT scan (usually see multiple small hemorrhages);
Need MRI
- Medical and Nsg Interventions: Lower ICP, Increase CPP, Stabalize VS




Blood Brain Barrier


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- Controls brain volume (mainly water found intracellularly) and contents
by controlling permeability
- Most drugs do not cross the BBB
- Disruption results in increased brain volume
- Permeable to: water, oxygen, lipid-soluble compounds, and carbon
dioxide (slightly permeable to electrolytes)




Coma


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, - Persistent state of unresponsiveness from which a person cannot be
aroused lasting for more than 6 hours
- A major goal in the early management of a comatose patient is to identify
the underlying cause in effort to prevent deterioration of neurological
function and reverse the coma
- Use the GCS scale (7)




When ICP rises to the level of the MAP, brain perfusion ceases and brain death
results. T or F?


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TRUE




CBIGs


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- Maintain Temp between 36 & 37.5°C with warming blanket and/or warm
fluids
- Treat hypotension in order to maintain organ function and perfusion
(vasopressors, maintain MAP >65, fluid bolus if fluid responsive)
- Treat DI (Administer DDAVP 1-2mcg IV q12hr; or Vasopressin gtt 0.1 u/hr
and titrate to maintain UOP 200-400 ml/hr)
- IV fluids: maintence fluids D5W with 20mEq KCl at 100ml/hr; UO
replacement 1/2NS to match urine output cc/cc




Manifestations of Increased ICP


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