Medicalsurgical same as increased intracranial

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Medical/Surgical Same as increased intracranial pressure Several surgical procedures Craniotomy (go in, removed something, put bone back) -Bone fragments -Evacuation hematoma -Foreign body removal (Cranioectomy: take skull off & put it somewhere else)
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Critical Care Test 3 (6) Acute Stroke: Acute Stroke Nursing Management Post-Operative Neurosurgical Care 1. Frequent and ongoing hemodynamic, neurological, respiratory, and metabolic assessment 2. Position of head of bed: After pt has had brain surgery, position of HOB is MD specific MD specific If physician tells you not to elevate HOB, do not elevate HOB 3. Prevent complications: Infection: everytime we open up skull, we increase risk Cerebral hemorrhage Increased ICP: inflammation Hydrocephalus Seizures: bleeding in brain are increased risk for seizure because irritating to brain tissue. On seizure prophylaxis. Blood supply to brain disrupted by (2 types): Occlusion (ischemic) Hemorrhage Definition is a deficit that lasts 24 hours or more Hallmark is the sudden onset of focal neurological symptoms lasting 24 hours or more Types: 1. Hemorrhagic Stroke Intraparenchymal hemorrhage Ruptured Cerebral Aneurysm Subarachnoid Hemorrhage Arteriovenous Malformation: abnormal communication between veins and arteries. Problem is that they are high risk for rupture. 2. Ischemic Stroke Large Artery Atherosclerosis Cardioembolic Events: afib & aflutter. Small artery occlusion (Lacunar Stroke) Cryptogenic: don’t know cause. Checked everything but don’t know why they have had stroke. Other Ischemic Events TIA: Symptoms lasts less than 24 hours. Symptoms look like they are having stroke but symptoms go away. Warning sign that pt will have full stroke in future. Prevention: most pts don’t know the s/s of stroke Public education regarding signs/symptoms FAST: face, arms, speech, time (or tongue; have pt stick out tongue. If they are having stroke, tongue will go left or right and not midline). Want to know onset of symptoms (time) for TPA (used within 3 hours; clot buster). Assessment 1. History: Time of onset of symptoms 2. Neurological exam -Mental status, cranial nerve function, motor strength, sensory function, neglect, coordination -NIH Stroke Scale (table 13-10): tool to evaluate pt’s stroke. Used countrywide. Higher the number, the worst the patient is . 3. Airway, breathing, circulation 4. Hemorrhagic Variations: may have slightly different manifestations -Localized or worst headache of life (cardinal sign), nuchal rigidity, restlessness/irritability, photophobia Hemorrhagic Stroke: Keep BP on LOWER side. Higher BP = higher bleed. Goal: MAP < 130 mm Hg Glycemic management Diagnostic exams CT evaluation Laboratory tests Medications IV antihypertensives Manage ICP: Osmotic diuretics Monitoring for signs of vasospasm : blood gets irritating in brain and causes blood vessels in brain to vasospasm close. This decreases blood supply to certain part of brain. If pt has had hemorrhagic stroke & having neuro changes, they are probably having vasospasm.
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  • Fall '18
  • Traumatic brain injury

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