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NUR2115 Exam 3 latest/ 230 Questions and Answers/ verified and Graded A+

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NUR2115 Exam 3 latest/ 230 Questions and Answers/ verified and Graded A+

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  • August 22, 2023
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NUR2115 Exam 3 latest/ 230 Questions and
Answers/ verified and Graded A+
Cerebral Perfusion Pressure (CPP) - -MAP-ICP

-Normal CPP - -80-100 mmHg

-Mean Arterial Pressure (MAP) - -(SBP + 2DBP)/3

-Normal MAP - ->70-80 mmHG

-Normal Intracranial pressure - -5-15 mmHg

-Intracranial components - -10% blood, 10% CSF, 80% Brain

-Monro-Kellie Hypothesis - -If the volume of any of the intracranial components
changes, it must be compensated for by another component. The total volume of the
intracranial compartment must remain fixed.

-Neurological exam components - -LOC
Pupillary function
Motor function
Respiratory function
Vital signs

-Arousal - -Evaluates lowest level of consciousness

-Alert - -Patient responds to gently calling name

-Lethargic - -Patient must be shouted at to gain attention

-Obtunded - -Patient responds to noxious, painful stimuli such as sternal rub or
trapezius pinch

-Comatose - -Patient responds to NO stimuli

-Awareness - -Evaluates higher level of consciousness

-Orientation - -Determines level of awareness. Evaluate orientation to person, place,
time, and situation

-Motor response - -Use noxious peripheral stimulation if needed to elicit a response

-Spontaneous response - -Obeys commands

-Localizes pain response - -Opposite extremity crosses over midline to remove stimulus

,-Withdrawal response - -Patient presents normal flexion to avoid stimulus

-Decorticate response - -Patient presents abnormal flexion in response to stimulus

-Decerebrate response - -Patient presents abnormal extension in response to noxious
stimuli

-Flaccid response - -Patient does not respond at all to stimuli

-PERRLA - -Pupils Equal Round Reactive to Light and Accommodating

-Pupils oval - -Pupillary sign of increased ICP

-Pupils constricted - -Pupillary sign of brain stem compression or narcotic use

-Pupils dilated - -Indicates ICP = 25-30 mmHG (normal 5-15)

-Pupils unequal - -Indicates impending brain herniation

-Oculocephalic reflex - -Doll's eyes. Normal eye reflex. Patient's eyes move to opposite
side when head is turned

-Abnormal oculocephalic reflex - -Patient's eyes move to same side when head is
turned

-Absent oculocephalic reflex - -Eyes remain fixed when head is turned. Shows
significant brain stem injury

-Central fever - -Due to hypothalamic damage. Will not respond to antipyretics and
patient displays no sweating. Responds to cooling blankets.

-Cushing's Triad - -Bradycardia, Systolic HTN, Widening pulse pressure

-Cushing's Reflex - -Bradycardia, Systolic HTN, Bradypnea. Late sign of increased ICP

-Glasgow Coma Scale - -Most widely used tool to evaluate LOC. Does not provide a
complete neural exam, gives information about LOC only based on eye opening, verbal
response, and motor response. Grades from 1-5. Best score 15. Worst score 3.

-GCS <8 - -Indicates coma

-S/S of increased ICP - -Decreased LOC
Cushing's reflex
Posturing (decreased brain stem reflexes)
Unequal pupils/decreased reaction to light
Altered breathing patterns

, Headache
Projectile vomiting

-ICP Monitoring sites - -Subdural
Epidural
Parenchymal
Intraventricular

-Positions to avoid - -Trendelenburg, prone, hip flexion, neck angulation

-Activities to avoid - -PEEP >20, Coughing, Suctioning, Valsalva maneuver

-Hyperventilation - -Keep PCO2 between 25-30 (low) to induce respiratory alkalosis
and combat cerebral acidosis

-Therapeutic hypothermia - -Reducing patient temperature to between 32-35 C to treat
anoxic brain injury or TBI

-Hypothermia phases - -Induction, Maintenance, Rewarming

-Prophylactic anticonvulsants - -Phenytoin/Phenobarbitol give to prevent post-
traumatic seizures in TBI patients.

-Lorazepam - -Seizure medication given to TBI patients to treat breakthrough seizures

-Hypertension with TBI - -Maintain BP in high normal range. Treat with
antihypertensives but avoid vasodilators unless given concomitantly with beta-blockers

-Minimum SBP - -SBP must be maintained >90 mmHG. Used crystalloids, colloids, or
ionotropic agents to maintain if necessary

-Dopamine, Levophed - -Positive ionotropic agents given to maintain SBP post TBI

-Pain control - -Give TBI patients opioids such as morphine or fentanyl to control pain
and reduce metabolic demands

-Anxiety control - -Give TBI Benzodiazepines such as Ativan or Versed

-IV Hypnotics - -Use propofol to reduce aggitation in TBI patients to reduce metabolic
demands

-NBMA - -Neuromuscular blocking agents such as Vecuronium or Atracurium given to
TBI patients to reduce aggitation and reduce metabolic demands

-Shivering control - -Give TBI patients Demerol or thorazine to treat/prevent shivering
in TBI patients. Especially those undergoing therapeutic hypothermia

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