2 avoid valsalva situations avoid straining to poop

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2. Avoid valsalva situations: avoid straining to poop; put them on stool softeners. 3. Avoid coughing & vomiting (anti-emetics or place NG tube). Avoid sneezing/hiccups. 4. Minimize external stimuli: don’t have a lot of family in room. Keep room dark. Keep TV soft. Keep it quiet.
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Critical Care Test 3 (4) Increased ICP Nursing Management: Key: MAINTAIN NORMAL CARBON DIOXIDE AND OXYGEN LEVELS Adequate Oxygenation 1. Goal: PaO 2 > 80mm Hg 2. Airway vigilance 3. Mechanical ventilation Use PEEP with caution: peep decreases venous return so if blood is not in heart, could be in brain (increases ICP) 4. Adequate hematocrit & hemoglobin Normal hemoglobin is 12-18 Hematocrit is 3x Hgb Carbon Dioxide Management 1. PaCO 2 35-45 mm Hg 2. Avoid hyperventilation: decreases blood to brain pts do worse. Exception is Cushing’s Triad (sit them up or hyperventilate) IF THE PATIENT IS ON THE VENTILATOR THEN THIS IS EASY BECAUSE IT CAN INCREASE RATE WHEN YOU PUSH A BUTTON, BUT IF THEY ARE NOT ON A VENTILATOR THEN YOU HAVE TO GRAB AN AMBU BAG AND DO IT MANUALLY (THIS IS THE ONLY TIME THAT YOU CAN HYPERVENTILATE A NEURO PATIENT! Diuretics Osmotic and Loop diuretics: Reduce brain tissue volume Mannitol: Drug of Choice . Crosses blood brain barrier. Pulls sodium (thus fluid) out of cells. You pee it out. Given q6 hrs; not a continuous infusion. Expect urine output to drastically increase after med is given. Hypertonic saline: patient has to have central line. Monitor sodium closely. Steroids Dexamethasone (Decadron): drug of choice. Methylprednisolone Fluid Administration You can give someone fluids but you do NOT want to push fluids unless the pt had a bad hemorrhage, but then you will probably give them blood Want pt at euvolemic state Optimized fluid administration with isotonic solutions Strict intake/output Goal: serum osmolality less than 320 mOsm/L. Colloids or blood products to restore volume Crystalloids = sterile water with electrolytes in it (either in hypertonic, isotonic, or hypotonic state) Examples = 0.9% NS, LR, etc. Colloids = mixture similar to crystalloids but the contents can NOT cross through a semi-permeable membrane due to the high molecular weight Examples: Albumin, dextran, gelatin solutions, etc. Blood Pressure Goal: MAP 70-90 mm Hg (so CPP is at least 70 too) CPP: at least 70 mm Hg Avoid hypertension Increases cerebral blood volume Nicardipine Avoid hypotension Ischemia Vasopressors (Levophed) Metabolic Demands 1. Temperature control Induced hypothermia: bc fever increases metabolic demands Goal: 34 o 35 o C 2. Sedation: used cautiously bc masks neuro changes. Benzodiazepines Propofol: drug of choice. Short half-life. Analgesia 3. Seizure prophylaxis: increases ICP.
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  • Fall '18
  • Traumatic brain injury

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