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Brain InjuriesMedical-Surgical Nursing-7th edition

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No _______ intubation if basilar fracture. No _______ intubation if C-spine injury.
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no NT for basilar (or NG); no ET for C-spine
_______ is given to prevent seizures. Monitor gums for hypertrophy.
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Dilantin
Sedation is only given if a brain injured patient is at risk for...
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injury
For increased ICP, HOB should be _______. Seizures; patient should be _______.
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30 degrees; side-lying
_______ are used to increase BP and blood perfusion to the brain. They aren't given if increased ICP.
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Vasopressors
CO2 should be more than _______ or less than 2 to prevent vasoconstriction in patients with increased ICP.
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35
CSF tests: Halo = collect _______ look for... Glucose = collect _______ look for...
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collect fluid with blood (yellow ring) = positive; glucose: no blood can be present
_______ is the pressure needed to ensure blood flow to the brain.
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Cerebral Perfusion Pressure (CPP) CPP = MAP - ICP
What is a normal CPP?
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60-100
PaCO2 _______ when high and _______ when low.
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high = vasodilates (relaxes smooth muscle); low = vasoconstriction (increases resistance)
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Secondary head trauma is _______ and includes injuries from ischemia or infection.
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preventable
_______ fractures are a break in bone continuity without displacement.
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Linear
_______ decreases cerebral metabolism and therefore ICP.
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Barbiturates: pentobarbital or thiopental
_______ strokes present as worst headache, (+) Brudzinski, (+) Kernig's, diplopia, n/v, photophobia. Related to aneurysms, tumors, cocaine, AVMs, hypertension.
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Hemorrhagic
Rebleed risk from a hemorrhagic stroke is increased within _______ hours. Vasospasm risk is increased around _______.
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rebleed 24-48 hours, keep systolic under 150; vasospasm 4-12 days
_______ fractures are characterized by inward displacement of skull fragments.
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Depressed
_______ fractures present with periorbital ecchymosis, post-auricular ecchymosis (Battle's sign) and injury to base of skull.
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Basilar
BP Guidelines: Hemorrhagic stroke _______ and Ischemic stroke _______
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Hemorrhagic stroke: Keep low (less than 150) and Ischemic stroke: Keep high (above 130), but below 220/120. If Tap, under 180/105. *Withhold BP medication.
What is the minimum arterial pressure at which autoregulation of ICP is effective?
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MAP of 50.
How is vasospasm risk decreased?
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Hypertensive/Hypervolemic/ Hemodilution. Nimotop to increase BP: 60 mg every 4 hours for 21 days.
A normal CPP is _______. The formula is _______.
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CPP = 60-100; MAP - ICP = CPP
  
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