NR 325 Exam 2 what are s/s of head injury? (Answer)- leakage of CSF Ecchymosis Battle's sign/raccoon eyes what is management of head injury? (Answer)- ensure patient airway* priority what is the Monro-Kellie doctrine? (Answer)- If one component increases, another must decrease to maintain ICP.only applicable to closed skull patients* what is normal ICP level? (Answer)- 5-15mmHg >20mmHg needs treatment!!What are key features of increased ICP? (Answer)- CUSHINGS TRIAD lethargy to coma change in speech cranial nerve dysfunction seizures abnormal posturing what is cushings triad? (Answer)- elevated BP, Decreased pulse, and decreased respirations.KEY characteristic of increased ICP how do we manage patients leaking CSF? (Answer)- raise head of bed NO sneezing/blowing nose/bleeding NO NG tube, nasotracheal suctioning How do we place a patient with increased ICP? (Answer)- elevated HOB atleast 30 degrees what is the treatmet for increased ICP? (Answer)- maintain AIRWAY* 1 / 2
Hyperventilate patient to "blow off" CO2 (CO2 dilates blood vessels) Raise HOB Decrease metabolic demands by paralyzing and sedating patient Mannitol- only diuretic given for ICP * corticosteroids Pain management Intracranial monitoring (in ventricle) Craniotomies- removes portion of skull to allow for brain to swell.Decompressive craniectomy what is the ONLY diuretic given for increased ICP? (Answer)- Mannitol what are risk factors of stroke? (Answer)- Obesity Heart disease Diabetes mellitus Hypercholesterolemia Hypercoagulable states Cocaine, illicit drug use Atrial fibrillation- develop into clot, clot causes stroke what type of seizure is this?daydraming seizure- staring off into space (Answer)- absence- petit mal usually occurs in children/young adolecense hyperventilation and flashing lights can precipitate absence seizures what type of seizure is this?muscle stiffening followed by JERKING.patients will fall if they are standing (Answer)- tonic clonic- grand mal
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