Brain Disorders: A Case Study

Neuro | 47total | | Assessment | 2 1A1ND | #Pt presents w/crossed arms that looks like decorticate-do further neuro assess#CPP if normal (70-100) & brain profused 180/60 B/P, ICP 30 what is body trying to do?-compensate to have adequate profusion. MAP (2xDiastolic) + Systolic/3 CPP=MAP-ICP – MAP 70-110 at least 60#Preliminary ICP findingICP pg15355-10mmHg normal, sustained >10mmHg IICPManifestations * 1st sign is change in level of consciousness: behavior & personality change, irritability & agitation, memory and judgment impaired, change in speech * later: coma & unresponsiveness to pain, etc * Hemiparesis weakness on contralateral side of IICP, hemiplegia, abnormal posturing: decrebrate or decorticate * Altered vision, blurred
s ICP: suctioning, turning, bathing-Do not suction for more than 10 seconds at one time-Elevate HOB, avoid neck flexion or rotation, keep head midline#Visual disturbances originates in occipital lobe of brain-occulomotor nerve exits#If the tongue assess sweet & salty you are assessing cranial nerve?7 facial#glassopharyngeal-posterior
SurgeryHead Injury | 85A3I | #Craniotomy-Select All-include pain meds w/codeine#Craniotomy-position w/HOB increased with specific instructions#Craniotomy-burr holes-removal-sawCraniotomy pg 1571Surgical opening into cranial cavity-series of burr holes-bone between holes is then cut-bone flap returned to openingPost Op Management: * Reducing cerebral edema, pain, seizure precautions, monitor ICP (normal 5-10mmHg), regulate temperature, prevent infection, assure brain profusion, LOC, MAP:70-100mmHg cerebral profusion pressure * Assess for Cushing’s Triad: increased systolic B/P, widening pulse pressure, bradycardia * Positioning: need specific instructionsAssess for s/s of meningitis: fever, chills, HA, +Kernig’s or Brudzinski’s, photophobia#Head injuries require immobilization#Difference b/t subdural & epidural hematoma-subdural=venous & older, epidural=arterial & youngerEpidural Hematoma: Arterial pg 1557 * Develops RAPIDLY in the potential space between the dura & skull, can strip dura away from skull * Momentary loss of consciousness followed by a lucid period from few hours to days * Decrease LOC, HA, vomiting, fixed dilated pupil on same side (ipsilateral) as hematoma or opposite side (contralateral), hemiparesis or hemiplegia, possible seizures, IICP * Can lead to respiratory arrest, burr hole to relieve pressure, drain or remove hematomaSubdural Hematoma: Venous * Mass of blood collects between the dura mater and arachoid * More common, usually