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69 Cards in this Set
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Apneustic breathing:
Characteristics Type of damage |
Prolonged inspiratory pahse followed by expiratory pause
Pontine level damage |
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Ataxic Breathing:
Characteristics Type of damage |
Very irregular w/ irregularly interspersed pauses
RAS lesions of the medulla |
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Cheynes-Stokes Respirations:
Characteristics Type of damage |
Crescendo-decrescendo w/ periods of apnea
Basal ganglion @ internal capsule |
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Decorticate posturing
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Upper extremeties exhibit flexion
Lower exhibit extension |
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Decerebrate posturing
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Both upper and lower extension
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Opsithotonos:
What is it? What is it r/t? |
head, neck and spinal column enter into a complete "bridging" or "arching" position
Decerebrate posturing |
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Anisocoria:
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Unequally sized pupils
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Oculocephalic reflex:
AKA What happens? |
"doll's eye" response
eyes deviate conjugately in direction opposite to head deviation |
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Oculovestibular response:
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Intermittent conjugate tonic nystagmus deviation of eyes to side of irrigated ear
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COWS
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Normal intracranial pressure:
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15 mmHg
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What is the Monro-Kellie hypothesis?
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Due to lmtd space for expansion within skull, increase in any one component causes change in volume of others
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What is the earliest sign of Increased Intracranial Pressure (IICP)? What are the earliest indicators?
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Lethargy
altered LOC, restlessness, slowing of speech, delay in response to verbal suggestions |
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Pupillary changes in IICP?
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Fixed, dilated, slowed response, anisocoria
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What is the Cushing's triad r/t IICP?
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HTN, bradycardia, respiratory irregularity
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Other S/S of IICP?
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Bradypnea, hyperthermia, HA, N/V, & papilledema
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Meds for IICP?
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Osmotic diuretics (mannitol), corticosteroids, & analgesics
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RN interventions for IICP?
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Mntr neuro status, maintain airway patency, elevate HOB 30-45 deg, keep neck straight, institute seizure precautions
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What changes are involved in seizure precautions?
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Pad side rails, side rails up, w/ a bite block @ bedside
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What is SIADH? What condition is it r/t?
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Syndrome of Inappropriate Anti-diuretic hormone
IICP |
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Which CN is compressed in a transtentorial herniation?
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CN III
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What are the consequences of a Subfalcine (cingulate) herniation?
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Ischemic injury to portions of primary motor and/or sensory cortex
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Tonsillar herniation?
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Displacement of cerebellar tonsils through foramen magnum
LIFE THREATENTING |
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Difference between noncommunicating & communicating hydrocepalus?
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Former: obstruction w/i ventricular system
Latter: obstruction outside ventricular system |
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Most frequent cause of epidural hematomoa?
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rupture of meningeal artery r/t skull fracture
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Course of epidural hematoma?
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First a "lucid interval immediately after injury, followed by progressive loss of consciousness
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Cause of subdural hematoma?
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Disruption of bridging of veins that extend from surface of brain to dural sinuses
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What is a subdural hematoma r/t?
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Any condition with rapid changes in head velocity
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What is Battle's sign?
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Ecchymosis over mastoid bone
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What is raccoon's sign?
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Periorbital ecchymoses
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What are the S/S of a Basal skull fracture (BSF)?
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CSF otorrhea or rhinorrhea
hemotympanum Battle's Sign Raccoon's sign CN injury |
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Common manifestation of BSF?
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Loss of consciousness, ranging from a few minutes to 1 hr or longer
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Two signs of CSF leak r/t BSF?
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Positive glucose reading
Halo sign (blood surrounded by yellowish stain) |
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2 types of CVAs?
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Ischemic & hemmorhagic
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Which type of CVA is the most common, with about 70-80 % of CVAs?
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Ischemic (infarcts)
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What will often precede a CVA?
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TIA; 1/3 of pts w/ TIA develop infarct w/i 5 yrs
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Most common cause of CVA?
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cerebral artherosclerosis
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Manifestations of a TIA?
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Temp loss of consc., double vision, unilateral blindness, ataxic gait, unilateral parasthesias, dizziness, garbled speech
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What causes most intracranial hemorrhages?
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Rupture of small vessel
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Most common etiology of intracranial hemorrhages?
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HTN
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What context do parenchymal hemorrhages occur in?
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Infarct
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Findings for an intracranial hemorrhage?
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Onset almost always abrupt
Motor loss (hemiplegia & hemiparesis) Communication loss (aphasia & dysarthria) Perceptual disturbances (visual-perceptual dysfunction, visual-spatial relations, sensory loss) Unilateral neglect Bladder impairment |
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What is dysarthria?
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Slurred speech
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What is hemianopsia?
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Loss of vision in one side r/t CVA
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Manifestations of non-ruptured cerebral aneurysm?
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Asymptomatic
Nonspecific symptoms (HA, blurred vision) |
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Manifestations of ruptured cerebral aneurysm?
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S/S of IICP
Severe HA, vomiting, loss of consc. Meningeal signs Photophobia Irritability & restlessness Slight temp |
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What are meningeal signs?
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Nuchal rigidity & pain on neck mvmt
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Septic meningitis course? Etiology?
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Important cause of morbidity & mortality at all ages
Almost all caused by bacteria which reach CNS via blood after colonizing nasopharynx Most implicated pathogen is S. penumoniae |
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Neisseria meinigidites route & epidemiology?
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Transx via secretions or aerosol contamination
Denses community groups most at risk (such as college campuses) |
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LP results for meningitis?
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CSF cloudy, turbid, or clear
CSF predominantly Neutrophils (if bacterial) or lymphocytes (if viral) Nrml or increased protein Nrml or decreased glucose |
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Assessment findings for meningitis?
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Fever, chills, altered LOC/mental status, S/S of IICP
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Signs of meningeal irritation?
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Severe HA, nuchal rigidity, positive Brudzinski sign, positive Kernig sign, photophobia
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What is areflexia?
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spinal shock
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Spinal cord injury below C4 =
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loss of M&S from neck down (incl resp func)
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Spinal injury below T12 =
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loss of M&S below waist
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S/S of autonomic dysreflexia?
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Severe pounding HA w/ paroxysmal HTN, profuse diaphoresis, nasal congestion, & bradycardia
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Trigger of autonomic dysreflexia?
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distended bladder or bowel, pain stimulation
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Immediate intervention for autonomic dysreflexia?
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Place pt in sitting position, empty bladder, fecal impaction, other triggers
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What to do to maintain joint mobility in pt w/ spinal cord injury?
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Passive ROM exercises
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Epidemiology of MS?
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Most common demyelinating disease
Most common in temperate climates, females |
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Age of presentation?
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Young adults
20-40 yo |
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Best dx test for MS? Findings?
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MRI
Presence of demyelinating plaques |
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Common manifestations of MS:
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visual disturbances, parasthesias, spasticity of 1 or more extremity, speech disturbances, gait abnormalities, fatigue, bladder/bowel incontinence
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Emotional disturbances r/t MS:
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depression, mood lability, inappropriate euphoria
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Tx for MS:
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Corticosteroids, muscle relaxants, & immunosupressants
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Epidemiology of alzheimer's:
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Adults over 50
Most common cause of dementia in the old Incidence increases progressively w/ age |
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Two known mechanisms of Alzheimer's:
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Beta amyloid, prominent component of senile plaques
Hyperphosphorlation of protein tau increases neurofibrillary tangles |
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Primary Tx for underlying cause of Alzheimer's:
Pharm txs for S/S of Alzheimer's: |
Anticholinesterase agts
Antipsychotics & benzos |
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What is myasthenia gravis?
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Progressive disorder of the voluntary muscles r/t an autoimmune response of anti-bodies to the ACH receptors
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Difference between myasthenic & cholinergic crisis?
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Former is a result of diseases exacerbation, often a result of respiratory infx
Latter is the result of overmedication of cholinesterase inhibitors |
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