Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
127 Cards in this Set
- Front
- Back
|
What area of the brain is responsible for temperature control?
|
Diencephalon (thalamus & hypothalamus)
|
|
|
What is the major function of the medulla oblongata?
|
cardiac regulation
respiratory center |
|
|
What area of the brain is responsible for equilibrium?
|
cerebellum
|
|
|
How long can the brain go without oxygen?
|
5 minutes
|
|
|
Which brain matter is made up of neurons?
|
grey matter
|
|
|
What is the white matter made up of?
|
axons
|
|
|
Where does the Circle of Willis originate?
|
carotid artery
vertebral artery |
|
|
Where do the anterior and middle cerebral arteries originate?
|
internal carotid artery
|
|
|
Where do the posterior cerebral arteries originate?
|
vertebral arteries
|
|
|
Where is CSF produced?
|
choroid plexus
|
|
|
What are the three volume components of intra-cranial pressure?
|
brain tissue
blood cerebrospinal fluid |
|
|
List the brain's 3 types of compensation used to maintain a stable ICP:
|
Autoregulation
Metabolic regulation CSF regulation |
|
|
What is autoregulation?
|
The system that maintains constant cerebral perfusion despite chantes in systemic arterial pressure; blood flow to the brain remains fairly constant
|
|
|
What is metabolic regulation?
|
Changes to o2 & co2 that affect cerebral blood flow
|
|
|
How does co2 affect the arteries in the brain
|
vasoconstriction
|
|
|
What causes increased intracranial pressure?
|
Anything that causes an increase in production of CSF
OR Anything that causes a decrease in reabsorption of CSF |
|
|
What is meant by the term "hydrocephalus?"
|
increased intracranial pressure
|
|
|
What happens if the brain's system for regulating ICP fails?
|
Hypoxia and brain cell death
|
|
|
When does IICP occur?
|
When the brain cannot accomodate the increase in volume of one of the components (failure to compensate)
|
|
|
What areas of the brain are in danger with uncal herniation?
|
Pons
Medulla |
|
|
What is the pupil response when uncal herniation is present?
|
fixed and dilated
|
|
|
True or False: the damage caused by uncal herniation is temporary if treated quickly
|
false; the damage is irreversible
|
|
|
What respiratory pattern is sometimes seen with increased ICP?
|
Cheyne-Stokes
|
|
|
What pupillary response is an EARLY sign of increased ICP?
|
Unequal pupils
Sluggish response |
|
|
What pupillary response is a LATE sign of increased ICP?
|
fixed and dilated
|
|
|
List the late signs and symptoms of increased ICP:
|
*Fixed dilated pupils
*Decorticate/decerebrate posturing *Loss of gag reflex *Bradycardia *Cushings Triad |
|
|
What is Cushing's triad?
|
*Severe HTN
*Wide pulse pressure *Bradycardia |
|
|
List interventions for IICP:
|
*Administer diuretics
*Administer sedation as ordered *Establish euvolemia *Avoid valsalva (inc. suctioning) *Establish eucapnia *Elevate head of bed to 45 degrees *Maintain the patient's head in a midline position *Maintain normal body temperature *Decrease environmental stimuli |
|
|
What is euvolemia?
|
balanced fluid volume
|
|
|
What is eucapnia?
|
balanced o2
|
|
|
Regarding traumatic brain injuries, the extent of the injury depends on what?
|
the amount of force
|
|
|
Traumatic brain injury is a major cause of death for what age group?
|
children younger than age 5
|
|
|
What event causes the most traumatic brain injuries?
|
Motor vehicle accidents
|
|
|
What is the GCS in a mild head injury?
|
13-15
|
|
|
What is the GCS in a moderate head injury?
|
9-12
|
|
|
What is the GCS in a severe head injury?
|
3-8
|
|
|
80% of all skull fractures are what type of fracture?
|
Linear skull fracture
|
|
|
What is a common nursing assessment to determine whether fluid leaking from the ear or nose is CSF?
|
the "Halo" test: fluid forms a yellow ring when blotted with a tissue
|
|
|
What severe damage can result from a basilar skull fracture?
|
Severe cranial nerve damage
|
|
|
What are the signs/symptoms of a concussion?
|
*Headache
*Nausea/vomiting *Diplopia *Possible loss of consciousness (usually brief) |
|
|
What is vasogenic edema?
|
abnormal permeability of the cerebral vessel wall; plasma filters to ECS causing an increase in brain tissue volume
|
|
|
What is cytotoxic edema?
|
cellular edema; a result of hypoxic insult to the brain cells
|
|
|
Of what is the brain depleted in cytotoxic edema?
|
*O2
*glucose *glycogen |
|
|
What can cause vasogenic edema, resulting in further IICP?
|
cytotoxic edema
|
|
|
What is low when cytotoxic edema is present?
|
serum Na
|
|
|
When does interstitial brain edema occur?
|
in the presence of acute brain swelling
|
|
|
Interstitial brain edema is associated with an increase in what?
|
*Blood Pressure
OR *CSF pressure |
|
|
How is Cerebral Perfusion Pressure (CPP) calculated?
|
Subtract CSF pressure from the mean arterial pressure
|
|
|
What are hematomas?
|
Space occupying lesions
|
|
|
What is involved in an epidural hematoma?
|
Middle meningeal artery
|
|
|
Where does an epidural hematoma occur?
|
around the temporal lobe
|
|
|
With an epidural hematoma, how soon do signs & symptoms occur?
|
Very rapidly
|
|
|
What is the treatment for an artery that is injured by an epidural hematoma?
|
suture the artery
|
|
|
What is the treatment for a subdural hematoma?
|
remove the hematoma
|
|
|
What causes a subdural hematoma?
|
ruptured veins
|
|
|
When do signs/symptoms occur with a subdural hematoma?
|
days to weeks
|
|
|
Is there more or less bleeding with a subdural hematoma?
|
less
|
|
|
True or false: clot formation is slower with subdural hematomas
|
true
|
|
|
What is an intracerebral hemorrhage?
|
Accumulation of blood within the brain tissue
|
|
|
Which type of brain herniation causes compression of the medulla?
|
cerebellar
|
|
|
What are the long-term effects of head injuries?
|
*Motor deficits
*Perceptual deficits *Speech/language deficits *Cognitive deficits *Difficulty with bowel/bladder function *Traumatic epilepsy |
|
|
If your client has CSF drainage from the ear, what should the nurse assess?
|
nuchal rigidity
|
|
|
What does nuchal rigidity indicate in head injury patients?
|
infection or blood in CSF
|
|
|
What should the nurse rule out BEFORE assessing for nuchal rigidity
|
spinal cord injury
|
|
|
What should ALWAYS be assessed in head injury patients?
|
*IICP
*Systemic hypotension *Hypoxia or hypercapnea |
|
|
What are some nursing measures to decrease ICP?
|
*Elevate HOB 15-30 degrees
*Avoid flexion of hips, waist & knees *Logroll patient to transfer *Avoid rotation/extreme flexion/extension of the head *Space out nursing activities *Avoid Valsalva type of activities: cough/vomit/strain *Suction ONLY as necessary *Provide O2 before & after suctioning *O2 via mask or nasal cannula *Possible ET tube to control pO2 & pCO2 *Prophylactic hyperventilation (only if on ventilator) |
|
|
What is significant about prophylactic hyperventilation?
|
It has a mild vasoconstricting effect when done properly.
|
|
|
When is prophylactic hyperventilation contraindicated?
|
In the first 20 hours after injury
|
|
|
When is prophylactic hyperventilation indicated?
|
*Acute neurologic deterioration (for brief periods)
*Intracranial HTN that does not respond to standard treatment |
|
|
When should ABG's be checked if using prophylactic hyperventilation?
|
Twice daily
|
|
|
What is involved in a craniotomy?
|
Removal of hematoma or parts of brain to reduce pressure
|
|
|
What is normal ICP?
|
10-15 mmHg
|
|
|
What should you remember when preparing your patient for cranial surgery?
|
*NO enemas
*Shampoo hair |
|
|
Into what position should a craniotomy patient be placed immediately after surgery?
|
side-lying
|
|
|
What is supratentorial positioning?
|
*HOB 30-45 degrees
*large pillow under head & shoulders |
|
|
What is infratentorial positioning?
|
*HOB flat with small pillow
*log roll with draw sheet *NO neck flexion |
|
|
Regarding positioning, what is important to remember when a patient has had a craniectomy?
|
Do not place on affected side
|
|
|
What is the 3rd cause of death in the US?
|
Stroke
|
|
|
What is significant about an ISCHEMIC stroke?
|
caused by a thrombus or emboli (occluding the cerebral artery)
|
|
|
What are the two types of ischemic stroke?
|
*Thrombotic
*Embolic |
|
|
What causes a thrombotic stroke?
|
atherosclerosis of arteries
|
|
|
What is an embolic stroke?
|
Embolus or emboli break off from other parts of the body and enter cerebral circulation via the carotid artery
|
|
|
What are the warning signs of ischemic stroke?
|
*TIA
*Reversible ischemic neurological deficit (RIND) |
|
|
What is a hemorrhagic stroke?
|
Vessel breaks down; occurence of bleeding into brain tissue, subarachnoid space, or ventricles
|
|
|
What are the causes of hemorrhagic stroke?
|
*HTN
*Aneurysm *AV malformation |
|
|
Cocaine use causes what two side effects which increase the risk of stroke?
|
*Hypercoagulability
*HTN |
|
|
What is dysarthria?
|
nerve dysfunction
|
|
|
What are the classic symptoms of CVA?
|
*Contralateral weakness
*Hemianopsia *Aphasia (expressive/receptive/global) *Dysarthria *Facial weakness/paralysis *Dysphagia *Transient loss of bowel/bladder control *Seizures *Diminished or loss of consciousness |
|
|
Which cranial nerve affects the ability to chew?
|
5th
|
|
|
Which cranial nerve affects swallowing and the gag reflex?
|
9th
|
|
|
Which cranial nerve affects tongue movement?
|
12th
|
|
|
Damage to which cranial nerve causes facial paresis or paralysis?
|
7th
|
|
|
Which abnormal heart rhythm results in an increased risk for stroke?
|
atrial fibrillation
|
|
|
How often should the GCS and vital signs be checked in stroke patients?
|
q 4 hours
|
|
|
When is the risk for IICP highest in stroke patients?
|
first 72 hours following injury
|
|
|
When are anticoagulants contraindicated?
|
*Ulcer
*Uremia *Hepatic failure |
|
|
What is very important to monitor after a patient has had a carotid endarterectomy?
|
swelling of the neck or complaints of dysphagia
|
|
|
When is embolization indicated?
|
arteriovenous malformation
|
|
|
What are the causes of aneurysm?
|
*Atherosclerosis
|
|
|
What are the symptoms of an aneurysm rupture?
|
*Sudden explosive headache
*photophobia *neck rigidity (due to blood in CSF) *nausea/vomiting *loss of consciousness *brain ischemia *increased ICP *seizures *respiratory distress *shock |
|
|
What is meningitis?
|
inflammation of teh meninges of the brain & spinal cord
|
|
|
What can cause meningitis?
|
*Bacteria
*Viruses *Chemical inflammation *Fungi *Parasites |
|
|
Which type of meningitis is usually not life-threatening?
|
Viral
|
|
|
How is meningitis transmitted?
|
droplet
|
|
|
What type of isolation is indicated for meningitis patients?
|
droplet isolation
|
|
|
List some predisposing conditions for meningitis:
|
*Otitis media
*Acute sinusitis *Fractured base of skull w/CSF leak *Procedures like LP or surgery *Anatomic abnormalities like spina bifida *Foreign objects like ventricular shunts *Can occur from a focal infection via blood |
|
|
What is SIADH?
|
Syndrome of Inappropriate Antidiuretic Hormone (too much adh = retain fluid)
|
|
|
What is Kernig's sign?
|
Pain in hamstring when hip & knee are flexed by examiner
|
|
|
What is Brudzinski's sign?
|
examiner elevates head of patient; knees bend involuntarily
|
|
|
What is opisthotonus?
|
severe spasm of back muscles (bends backward)
|
|
|
What lab findings are consistent in meningitis?
|
*CSF changes: appearance, WBC, glucose & protein
*Culture & sensitivity of CSF *Elevated serum WBC *Low serum Na |
|
|
What is a partial or focal seizure?
|
Epileptogenic focus limited to one region of one cerebral cortex; one hemisphere
|
|
|
What is significant of a simple partial seizure?
|
*Patient remains conscious
*Experiences aura *A "deja vu" phenomenon *Unilateral movement of extremity *Changes in heart rate *Skin flushing *Psychic symptoms |
|
|
What is significant of a complex partial seizure?
|
*black out 1-3 minutes
*automatism (lip smacking/patting/pulling on clothes, etc.) *Amnesia may follow immediately after |
|
|
What is significant of a tonic-clonic seizure?
|
*lasts 2-5 minutes
*tonic: rigidity of arm or leg muscles *immediate loss of consciousness *Clonic: rhythmic jerking of all extremities *May bite tongue *Incontinence of urine or feces *Postictal fatigue, lethargy, confusion (usually lasts an hour) |
|
|
What is significant of a petit mal seizure?
|
*More common in children
*Brief LOC *Blank staring, like daydreaming *Return to baseline immediately after |
|
|
What is significant of a myoclonic seizure?
|
*brief jerking or stiffening of extremities; single or group
*lasts only a few seconds |
|
|
What is significant of an atonic seizure?
|
*Sudden loss of muscle tone
*Patient may fall *Postictal confusion |
|
|
What is the first-hand treatment for acute seizure?
|
Lorazepam or Diazepam rectal gel
|
|
|
What is the treatment goal for acute seizure?
|
to stop clusters and prevent status epilepticus
|
|
|
What is status epilepticus?
|
*Continuous or recurrent generalized seizures, in rapid succession
|
|
|
What is significant of status epilepticus?
|
*Does not regain full consciousness between seizures
*Repeated seizures lasting over 30 minutes, or one seizure lasting over 10 minutes *More intense then regular seizures *A potential complication for all types of epilepsy *MEDICAL EMERGENCY |
|
|
What can cause death or brain damage in status epilepticus?
|
*hypoxia
*cardiac dysrhythmia *lactic acidosis |
|
|
What are teh usual causes for status epilepticus?
|
*Sudden withdrawal from anticonvulsants
*Infection *Head trauma *Cerebral edema |
|
|
During status epilepticus, what is important to know regarding the administration of ativan or diazepam?
|
No more than 50 mg/minute via IV push
|
|
|
List some nursing care measures during status epilepticus:
|
*Maintain ABC's
*O2 via nasal cannula *Inform physician (intubation may be needed) *Access vein/start IV NS *Medications: ativan or diazepam followed by dilantin *Never leave person alone |
|
|
What are typical fluid restrictions for neuro patients?
|
1500-2500 cc/day
|
