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243 Cards in this Set
- Front
- Back
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afferent pathway carries impulse from
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point of actiont towards brain
dendrites - DAT |
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efferent pathways carries impulse from
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away from brain to point of action
Axon - AEA |
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what transmit an impulse
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neuron
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parts of neuron 1.2.3.
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1. soma - cell body
2. dendrite - branches - afferent pathways (towards) 3. axon - efferent pathways (away) |
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synapse is
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impulse and is located distal end each axon
purpose to manufacture, store and release transmitter substances |
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myelin sheath is composed of
purpose type of cells |
phospholipid protein of cell membrane
electronic insulation increasing velocity of nerve impulse transmission schwann cells - Peripheral NS oligodendrytes - CNS |
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schwann cells are myleinated/not myelineated?
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myelinated peripheral nerve cells - only 1 cell
clean up perip nervous |
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oligodendrytes cells are myelinated/not myelinated?
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myelinated - groups at once
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neurotransmitters purpose
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enhance or inhibit nerve impulses from that neuron
dopamine serotonin GABA |
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inhibitory neurotransmitters
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serotonin
GABA - gamma anino butyric acid lay back |
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excitatory neurotransmitters
*know* |
stimulates impulse
acetylcholine glutamate |
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*know*
dopamine is what type of neurotransmitter? |
can be both inhib or excit depending on which receptor is stimulated.
CRITICAL TO WAY BRAIN CONTROLS OUR MOVEMENTS ex. parkinson ds |
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astroglial - neuroglial cells
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nurse aid cell
provide physical support, chemical balance, nourishment |
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microglial - neuroglial cell
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nurse aid cell
scavenger responding to CNS infection or trauma |
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oligodendrocytes - neuroglial cells
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nurse aid cell
forms myelin sheath |
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ependymal - neuroglial cell
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nurse aid cell
lining of ventricles and central canal of spinal cord |
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cerebrum aka
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forebrain
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hindbrain aka
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cerebellum
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meninges are
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immediate protective coating of brain and spinal cord
pia mater - internal arachnoid - middle dura mater - external |
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pia mater
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interal meninge
vascular membrane that adheres to brain and spinal cord |
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arachnoid
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middle meninge
circulation of CSF |
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dura mater
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external meninge
one layer adheres to cranium, one layer covers brain |
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DAP
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dura - outer
arachnoid - middle pia - inner |
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cerebrum
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involved with many functions
r/l hemispheres - LEFT DOMINANT corpus collosum: joins r/l hemispheres basal ganglia - regulate body tone and movement -vol muscle activity -part of extrapyramidal system |
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corpus collusum
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joins right and left hemispheres of cerebrum
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cerebrum motor cortex
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controls vol movement
pyramidal tract - begins in the motor cortex and travels to medulla |
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cerebrum basal ganglia
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regulate body tone and movement
vol muscle activity part of extrapyramidal system |
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broca's area
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cerebrum 99% stroke
frontal lobe - speech formation |
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wernicke's area
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cerebrum 99% stroke
higher level brain function processing words into coherent thought recognition of idea thru spoken or written word |
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common abnormalities with speech after stroke********
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broca's area - frontal - cant form speech
wernickes area - cant process words into coherent thoughts |
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function of brainstem
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control cardiac and resp impulses
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3 structures of brain stem
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midbrain
pons medulla RAS - controls awareness and alertness |
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RAS reticular activitating system
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controls alertness and awareness
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cerebellum does what
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receives real time and continous info about conditon of muscles, joints and tendons
control is isplateral - same side |
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cerebellum stroke is ___ lateral meaning ___ side
******************** |
isplateral meaning same side
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cerebrum stroke is ___ lateral meaning ____ side
************************* boards Q |
contralateral meaning opposite side of stroke
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functions of cerebellum
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movement from one type to another
predict distance of approacing object predict speed of approaching object control vol movement maintain equilbrium |
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team work with basal gang and cerebellum - output of bs is ______ and output of cerebellum is _______ ***********************************
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bgang - inhibitory
cerebellum - excitatry the balance btw the 2 allow for smooth coordinated movements --- a disturbance in either system will show up as movement disorders |
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BBB is composed offf
and its function |
endothelial cells of cerebral capilliares
function: protect CSF and brain tissue from invasion of certain subs in plasma |
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intact & healthy BBB will pass what substances
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pass thru: o2, glucose, co2, alchol, anesthetics, water
protection from albumin, most abx ex. meningitis - BBB sick abx will not go thru BBB to treat brain |
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pyramidal tract is **************
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originating in sensory motor areas
transmit motor impulses tha functiona nd control voluntary movement |
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extrapyramidal tract is ************************8
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conduct impulses to release to maintenance of msucle tone and body control
coordination dysfunction : causes abn spontaneous movement |
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dysfunction of extrapyramidal tract will cause
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abnormal spontaenous movement
extrapy- coordination pyram - voluntary |
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12 cranial nerves
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olfactory
optic oculmotor trochlear trigeminal abducens facial vestibulocochlear glossopharyneal vagus accessory hypoglossal |
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nursing care to provide a neuro patient
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1. neuro status -- look for alterations from norm
2. vs 3. education pt and fam |
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neuro assessment tools (3) *********************
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glascow coma scale
assess limb movement assess pupillary size, equlaity and reactivity ??????sleeping or comatose?????? |
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GCS 13-15
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mild brain injury
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GCS below 8
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severe brain injury, coma
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GCS measures 3 categories
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eye opening response
verbal response motor response |
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always monitor ______ in neuro patient and anticipate _________ *******************************************************************
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monitor airway patency
anticipate - difficulty swallowing secretions loss of gag reflex (anesthesia) ALWAYS SUCTION AT BEDSIDE |
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how do u elict a gag response?
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touch back of throat
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nsg mgmt to maintain appropriate airway status
********************** |
intubation with respirator
trach frequenet suctioning pulse ox assm - need for mechanial vent suppl o2 maintain HOB >30 promotoe pulm hygiene (cheset PT) |
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****************************
monitor vital signs which indicate ICP |
cushing triad
1. increasing sys BP (widening pulse pressure) 2. bradycardia with bounding pulse 3. irregular breathing pattern |
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what usually kills trauma patients?
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post trauma swelling
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neurotransmitters are stored
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in vesicles
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inhibitory neurotransmitters do what?
name some |
lay back
serontonin, gaba |
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exhibitory neurotransmitters do what?
name some |
stimulate
acetylcholine glutamate |
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acetylcholine is?
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excitatory neurotransmitter
in PNS- activate muscles, producing a muscle contraction (muscarinic - inhibits cardiac muscle) and CNS- sensory perception, wake up, sustaining attention, memory deficits assoc with alzheimers |
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The disease myasthenia gravis, characterized by
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muscle weakness and fatigue, occurs when the body inappropriately produces antibodies against acetylcholine nicotinic receptors, and thus inhibits proper acetylcholine signal transmission.
Over time, the motor end plate is destroyed. Drugs that competitively inhibit acetylcholinesterase (e.g., neostigmine, physostigmine, or primarily pyridostigmine) are effective in treating this disorder. They allow endogenously-released acetylcholine more time to interact with its respective receptor before being inactivated by acetylcholinesterase in the gap junction. |
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glutamate is?
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excitatory neurotransmitter
non essential amino acid important for learning and memory cellular metabolism meat poultry fish eggs dairy - sources of glutamate |
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dopamine
inhib or excit? |
catecholamine neurotransmitter
acting on SNS (FORF) can NOT cross BBB - therefore does not affect CNS involved in cognition, voluntary movement, motivation, punishment both inhib and excit depending on which receptor site |
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Ldopa can be given to ___ pt because
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parkinson pt to increase amount of dopamine - it can cross bbb
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order of meninges
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P - pia internal (adhere to brain and spinal cord
A- archnoid middle (circulation of CSF) D dura - outer (one layer to cranium, 1 layer to brain) |
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basal ganglia function
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regulate body tone and movement
extrapyrmaidal system *this is what is going out in parkinson pt** |
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cerebrum has __ hemispheres that are joined by ___ interdispersed with ___ ____
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2 - right and left hemi
corpus collosum basal ganglia (volun muscle activity) |
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brocas area is in what part of brain -- what is function?
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cerebrum - area of communication
frontal lobe cant form speech |
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wernickes area - which part of brain - fucntion?
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cerebrum - cant process words into thoughts
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aphasia is common with ___
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stroke - broca ,wernickes areas
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brainstem controls?
3 structures of brainstem |
cardiac and resp impulses
midbrain pons medulla RAS - controls awareness and alertness |
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cerebellum does what?
control is ____ side |
recieves real time and continous info about condition of muscles, joints and tendons
allow for movement from one type to anotehr, predict distance of approaching object, predict speed of appr object, controls vol movement maintains equilibrium control is isplateral - same side |
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rt cerebral stroke will have what side deficits
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left side - contralateral
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left side cerebellum stroke will have what side deficit
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left - isplateral
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basal ganglia and ____ work toghether as a tearm
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cerebellum - recieve and send nerve impulses via motor cortex
output of cerebellum is excitatory output of basal ganglia is inhibitory the balance btw these two allow for smooth coordinated movement, a disturbance in either systme will show up as a movement disorder |
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BBB purpose
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to protect CSF circulation and brain tissue from invasion of certain substances in plasma
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Meningitis is inflammation
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of the protective membranes covering the brain and spinal cord, known collectively as the meninges.
a medical emergency characterized by stiff neck, headache, fever, confusion, vomiting, photophobia |
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an intact BBB will allow what to pass thru
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oxygen, glucose, co2, alcohol, anesthestics, water
while providing protection from albumin and most antibiotics (too large) virus however can pass by attaching to immune cells |
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pyramidal tract purpose
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originating sensory motor area of cerebral cortex
transmit motor impulses that function in control of voluntary movement |
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extrapyramidal tract purpose
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conduct impulses r/t maintenence of muscle tone and body control
dysfunction - causes abnormal spontaneous movement |
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assm of neuro client
what 3 things must nurse monitor in neuro pt |
1. vitals
2. neuro status -a&0x3 3. provide pt and family with education |
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neuro pt need to have 3 things evaluated********************
GLP |
gcs
limb movement assess pupillary size, equality, reactivity |
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GCS range
measure what 3 things ***************************** |
3-15
13-15 mild brain injury 9-12 mod brain injury below 8 severe brain injury, coma eye (4-1) verbal (5-1) motor (6-1) EVM |
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neuro pt alway must assume
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no gag reflex until known otherwise
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elict gag response by
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touching back of throat
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neuro pt always have what available at bedside??
************************ |
suction equip
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nsg mgmt of stroke/neuro pt may include
************************ |
intub with respirator
trach tube frequent suctioning pulse ox assm - to assess need for mech vent suppl oxygen maintain hob greater 30 degrees promotoe pulm hygiene - chest pt |
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cushing triad ************
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1. widening pulse pressure with increase in sys BP
2. irregular breathing 3. bradycarida with bounding pulse this indicates ICP - must id early to prevent death of brain cells - damage luggage! |
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what most likely kills trauma patients?
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post trauma swelling in brain
ICP |
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****************************
neuro patients may have trouble maintaing thermoregulation - body temp nurse should anticipate hypo/hyper thermia? |
hyperthermia due to infection, drug reaction, trauma to hypothalamus
must manage aggressively - hyperthermia increases metabolic need of brain increase need oxygen and glucose implement cooling blanket to decrase metabolism, allow chance to heal brain needs oxygen and glucose to heal |
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prompt _____ therapy improves neuro function and BBB integrity
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albumin
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neuro pt need
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familiar voices (family, friends)
family should not be crying or anxious at bedside encourage family to be involved with pt care to their point of comfort |
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neuro pt will alway have ____ precautions
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seizure
turn pt on side, maintain patent iv site, bed low, oxygen setup, oral airway at bedside, suction setup, report activity to physican |
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after a seizure the nurse must assess ______
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reality orientation
name, day, month, year, situation, surroundings |
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monitor for s/s increased ICP
**** |
chg in loc
seisures visual disturbances vomiting/projectile vomiting pressure - effect on brain deficient blood flow |
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neuro pt rountine care
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1.if absent corneal reflex - use artificial tears, placed eyes in closed position, cover eye with gauze
2. mouth care - sux toothbrush, bacteria colonize 3. adequate nutriton - TPN or intubation (use GUT first-- stimulates the immune response) 4. maintain fluid balance 5. prevent complications of mobility - turning pt in bed, protecting against shearing |
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what lab do u want to check with TPN pt
************* |
pre albumin
dx malnutrition or poor nutrition 16-35 |
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purpose of albumin
long term nutritional status |
The main purpose of albumin within blood is to maintain colloidal osmotic pressure, which keeps fluid within the vascular space
This is why patients with very depleted albumin levels may develop edema, ascites, or pulmonary edema norm 4-6 |
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purpose of pre albumin
short term nutritional status |
16-35
determines short term nut status <5 poor prognosis <11 quick intervention |
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ways to provide sensory stimulation to coma/neuro patients
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explain all procedures to pt as if they were alert and oriented
anticipate pt can hear encourage family to bring objects from home music fav tv shows, fav toys, taped voices write down schedule to bring pt out of coma - follow it as if at home |
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prevent urinary retention
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common problem in neuro pt
often overlooked due to overflow incontinence bladder scan protocol - if needed indwelling cathether should be removed ASAP intermittent cath - condom cath c bladder scan c sterile technique post residual --- avoid uti |
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CSF normally looks
***** |
clear, colorless, free RBCs, contains little protein,
sg 1.007 ph 7.35 |
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LP is contraindicated when
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with Increased ICP
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before LP pt must
entry point |
empty bladder
lateral recumbent position knees flexed up to abdomen flex head to chest entry pooint - 3 lumbar vertabrae |
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during LP
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puncturing spinal cord is NOT possible b/c cord ends btw 1st and 2nd vertabrae
pt may experience pain radiating down leg muscle twitching all symptoms are temporary but scary TEACHING POINTS |
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POST LP
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MUST BE FLAT prone or supine
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complications of LP
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spinal headache
mengineal irriation - nuchal rigidity hematoma at insertion site pain at insertion site |
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cerebral angiography
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done when lesions or tumors are suspected
cath inserted in femoral artery - passed to aortic arch into base of carotid or vertbrael artery xrays taken at regular intervals as dye travels vascular path assist in dx absecess aneursym hematoma av malformation aterial spasm |
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CT scan
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non invasive - iodine based contrast - enhances visulations of blood vessels
identifies disruptions in BBB mri shows better picture |
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MRI
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better than CT
2 fields of magnetism pt in giant magentic field hydrogen and proton alignment produces 3d image |
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PET
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evulate metabolic activity of brain
non invasive of regional areas of metabolism alzheimers seizures disorder parkinsons ds |
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myelography
pre/post care? |
visualizes spinal column and subarachnoid space
done with spinal lesion suspected - herinated disc, tumor injection of contrast medium in subarachnoid space - iodine based xray of spinal column pre-intra-post procedural care same as LP |
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ECG
*** |
electroencephalography
recording electrical activity in cortical section of brain 8-16 electrodes on scalp assist in dx cerebral ds metabolic ds systemic ds pt doesnt not feel electric shock during this test |
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EMG
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electromyography
nerve conduction stuides needle electrodes inserted n muscle sites normal muscle at rest show NO activity electrical activity should exist with activity abn will show 1-3 weeks after muscle lost nerve supply |
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carotid duplex - ultrasound
****************** |
probe on skin - carotid artery
sound wave off moving blood vessle within artery dx stenosis within a vessel - due to decresed blood flow |
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transcranial doppler
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records blood flow in intracranial blood vessels
probe placed in windows of skull - areas of skull thin bony covering dx vasospasm subarachnoid hemorrhage altered blood flow presence of emboli temporal, zygmatic arch/cheekbone |
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adrenergic receptors
**** |
alpha 1
alpha 2 beta 1 - heart cells (constriction, dilation bv -- increased contractility -- increased HR - av and sa node) beta 1 - endocrine -- decreased insulin beta 2 - smooth muscle, resp visceral organs (liver - glycogenolysis -- kidney increased renin secretin -- inc BP) |
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nasal decongestant - alpha __ receptor
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1
sudafed - causes tachycardia and HTN do not give to tachyc pt or htn pt |
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beta 2 receptors adrenergic agents
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bronchodilation - asthma, bronchitis
albuterol, epinephrine, foradil, serevent, xopenex |
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opthalmic indications adrenergic agents
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dilation of pupil mydraisis
stim alpha 2 and/or beta 2 prep eye exam |
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vasoactive indications adrengic agents
***** |
cardioselective pressors
used during cardiac failure or shock dobutamine dopamine norepi (levophed) epi (adrenlin) phenlyphrine mododdrine (proamatine) used to pull someone out of shock - increase BP , increase pulse |
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side effect alpha adrenergic agents
**** |
headache
restlessness excitement insomnia cardiovascular constriction* tachycardia palpatations cardiac dysrhythmias anorexia loss of appetite dry mouth nausea vomiting Increased BP increased HR |
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*****
side effects of beta adrenergic agents |
inc HR
HA nervousness palpatations BP instability sweating n/v muscle cramps |
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cholinergic agents
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parasympathetic ns
rest and digest |
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ach is made and stored where
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in synapses
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direct cholinergic agents do what?
indirect cholinergica gents do what? |
direct - bind to cholinergic
indirect make more ach available at receptor site - stimulating site more |
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cholinesterase inhibitors do what
*********** |
increases amt of ACH
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cholinesterase is an enzyme that
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in synapse that "erases" ach
if u inhibt that enzyme u increase the amt of actechycholine |
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how do indirect cholinergic agents increase the amt of ACH?
**************** |
cholinesterase inhibitors = increase amt of ach
cholinesterase - erases ach reversible cholinesterase inhibitors - temporary stunt production irreversible cholin inhibitors - permanently make ach |
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muscarinic receptors
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muscle - smooth, cardiac, parasympathetic fibers
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nicotinic receptors
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neuronal dev, cognitive ability, memory, reward
*smoking addictive* instant ahhh |
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cholinergic receptor responses to stimulation
eye |
muscarinic & nicotintic: pupil constriction, decreased accomodation
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cholinergic receptor response to stimulation
skeletal muscle |
muscarinic - no response
nicotintic - increased contraction |
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direct acting cholinergics
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reduction IOP in pt with glaucoma
carbachol pilocarpine succingylcholine bethanechol |
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indirect acting cholinergics
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anecdote for anticholinergic poisioning
ancedote for OD of irreversible cholinesterase inhibitors alzheimers ds |
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The effects of cholinergic stimulation include:
**** |
vasodilattion of blood vessels; slower heart rate; constriction of bronchioles and reduced secretion of mucus in the respiratory tract; intestinal cramps; secretion of salvia; sweat and tears; and constriction of eye pupils
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side effects cholinergic agents
*** |
bradycardia, hypotension, cardiac arrest, ha, dizziness, convulsion, cramps, n/v, increased secretions, bronchospams
lacrimation, sweating, salivation, loss bincocular accomodation -- automatic lens adjustment by both eyes - stimulatenously focusing on distant objects miosis - abnormal constrictiion of pupil of eye |
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miosis
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abnormal constriction of pupil of eye
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seizure disorder vs epilepsy
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sd = periods of abnormal electrical discharges in brain that cause involuntary movement, behavior, sensory alterations
epil= chronic disorder characterized recurrent unprovoked seizures 2nd CNS disorder 1 out 100 ppl have eplipelsy |
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seizure disorders are usually secondary to
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strokes, head trauma
mis firing of synapses |
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phases of seizures
1234 paip |
1. prodromal - before - trigger
signs and activities that proceed seizure (flickering lights) 2. aural (presence of aura) sensation (visual, auditory, taste or motor) that gives warning of impending seizure --- allows pt to take med and move to safe place---- 3. ictal - full seizure activity - nerves stimulated -- going crazy 4. post ictal - period of recovery p seizure - still not right, fatigued, strange brain activity |
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febrile seizure
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occurs in connection in sudden rise in temp usually assoc with illness or infection
usual 3m to 5y peak age 18-24 months carries 30-50% greater chance of having future seizure disorder **********indicates child has a lower convulsive threshold************** phenobarbital |
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phenobarbital is used
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for all seizures except absence seizure
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generalized seizure
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result of diffuse electrical activity in both hemispheres of brain at same time
symptoms bilateral and symmetrical |
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partial (focal) seizure
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abn electrical activity in one hemisphere or specific area
symptoms depend on area of brain affected |
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febrile seizures and brain damage
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no brain damage
reassure parents may increased likeihood for seizures in future |
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types generalized seizures
123 |
tonic clonic (Grand mal)
typical absence seizure (petit mal) akinestic/astatic/atonic |
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tonic clonic seizure
grand mal |
tonic - stiffening body
duration 10-20 seconds clonic - jerking extremities duration 30-40 seconds post ictal - no memory of seizure event normal seizure - 1 minute t- stiff -10-20 s c-jerk 30-40 s |
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p seizure patient may be ____ nurse should be careful
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defensive - come out fighting
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typical absence seizure
petit mal |
occurs rarely in adults
few seconds of staring often goes un-noticed can occur 100 times/day **child not listening** |
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aaa seizure
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akinetic - arrest movement
astatic - loss balance atonic - loss body tone present as drop attacks or falling spells pt regains consciousness b4 hitting ground in fall increased risk for head injury |
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which type seizure does pt have increased risk head injury
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aaa
b/c they just drop to floor akinetic- arrest movement astatic -loss balance atonic - loss body tone |
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partial seizure is ____ a seizure disorder
generalized is ____ a seizure disorder |
partial is NOT
generalized IS A disorder |
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partial seizure - simple
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duration less 1 minute
includes simple motor, autonomic or sensory phenomena *no LOC aka focal motor seizure- finger twitching focal sensory sz - odd sensation, temp in one area jacksonian - pins and needles, tingling |
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complex partial seizure
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duration longer 1 minute
automatisms - repetitive movements that are inappropriate - lip smaking, picking at objects impaired consciousness "cloudy" |
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difference btw simple partial and complex partial seizures
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simple - less 1 min and no loss of cons
complex - more 1 min and cloudy consc |
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complications of seizures ****
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status epilepticus - medical emergency
continous seizure or seizures in rapid succession last greateer 30 minutes most common cause - suddent withdrawl anti seizure medication brain needs more oxygen and glucose |
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most common cause of status epilepticus*****
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sudden withdrawl of anti seizure medication
dilantin - always ask last time taken med |
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why is status epilepticus dangerous
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brains metabolic needs increase during seizure
supplies of oxygen nad glucose are dramatically reduced |
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medication used for seizures - which is quicker
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dilantin
phenobarbital - quicker |
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nsg assm seizure ****
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before - circumstances which occured before seizure -- trigger?
aura? ------------------------------------- during event id first motion of pt during seizure - where movement or stiffness starts gives clues to location of seizure orgin areas of body in movement size pupils eyes open or closed 2. length seizure (airway) 3. prescense automatisms 4. incontinence urine/stool 5. duration each phase 6. level of consc ------------------------ after event 1. presence of paralysis or weakness, ability to speak 2. describe movements at end of seizure 3. id if pt fell asleep p seizure -- ok to sleep- 4. describe cognitive state - level of confusion p seizure confused? combative? |
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goals nsg mgmt of seizure pt
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prevent complications
safety - injury aspiration loss pt personal dignity metabolic complications |
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during seizure nurse must
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pulll down sheets - assist in determining body involvement
stay with patient - focus on critical areas of concern (airway, safety) after - document and communicate with phsyican |
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biggest concern with seizure pt
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safety
if aura gives warning - lower pt to floor in bed remove pillows and raise side rails protect head by placnig padding over hard areas looseen constrictive clothing |
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what should u NEVER do to a pt having a seizure
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restrain
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p seizure the nurse should anticipate
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confusion, agitation, and to re orient pt upon wakening
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nurse should prevent aspiration during seizure -- nsg interventions
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suction at bedside
maintain available oxygen pt on side with head flexed forward - during - do not attempt to open airway do not restrain in anyway after - keep pt on side attain patent airway - assess need for artifical ariway assessneed for suctioning anticpate short episode of apnea |
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what is common after seizure with pt breathing
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apnea spells
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ways to prevent metabolic complications after seizure
*** |
before -- assess pulse ox, oxygen and accucheck
after -- immed assessment pulse ox saturation!! immed assessment accucheck supplemental oxygen |
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ketogenic diet
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common tx in children
high fat, low protein and low carb duration 2-3 years must monitor urine for ketones |
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cluster headache
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unilateral radiating from temporal region or around eye
deep and penetrating abrupt onset pain peak 10 minutes duration 90 mins commonly nocturnal 2-3 attacks/day over period of weeks months btw attack periods |
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migraine headache
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unilateral and anterior
throbbing and PULSATING (inflam of meniges) triggers - stress excitement bright lights, menses, alcohol food combo neuro, vascular and chemical components |
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which nerve is triggered in migraine - the pathophysiology?
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trigemnial nerve
decreased serontonin levels dilation and inflammation of blood vessels feeding meninges |
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most common stages of migraine
123 |
aura - experienced only by 10% - allows for pre medication (vasodilator)
headache resolution |
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aura stage migraine
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flashing lights in 1 quad of visual field
a symptom of reversible brain dysfunction -dizziness -confusion -numbness or burning -motor dysfunction crossed eyes, nasal function |
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the headache stage will occure within ___ minutes of aura
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60 minutes
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headache stage migraine
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unilateral
pulsating pain moderate to severe intensity worsens with activity n/v photophobia light phonophonbia sound **must be 2 of preceeding** |
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tension headache
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bilateral band of pressure around head
constant pressure sporadic, associated with contraction of muscles of neck and skull triggers - neck shoulder muscle contraction |
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pathophysiology of headache
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triggers stimulate trigeminal nerve
pt has decreased serontonin -- which causes vasodilatoin (serontonin is vasoconstrictor) dilation and inflammation of blood vessels within meninges create a pain response |
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alpha adrenergic blockers
**** |
block FORF - block dinosaur
promotes vasoconstriction of dilated blood vessels ergomar sansert |
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serotonin receptor agonist
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promotes vasoconstriction in cranial vessels
reduces inflammation wthin cerebral blood vessels |
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treatment of headache is to vaso______ the cause is vaso ______
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constrict
cause is vaso dilation |
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beta blockers can be given in ____ phase to help prevent headache
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aura phase before headache starts -- promotes vasodilation
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midrine
fiorinal/fioricet butalbital treat what? |
headaches
midrine - acetaminophen butalbital c aspirin - fiorinal butalbital c acetaminophne fioricet fiorinal/fioricet are addictive and not commonly used anymore |
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nutritional mgmt of headaches
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instruct pt to keep dietary journal - including time period when headaches occured - assm of foods commonly ingested prior to headach
attempt food elimination trial triggers: MSG aged cheese - chemical caffeine -vc- stimulant chocolate - decreased serotonin pathophysiology vc with rebound vd -- causing headache |
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common triggers headaches - nutritional
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nitrites - hotdogs
nitrates - proccessed meats with MSG red wine |
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most important indicator of neurological status is
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decrease in consciousness
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consciousness means
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ability of mind to respond to stimuli
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delirum means
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expression of confusion accompanied by fear, agitation or hyperactivity or anxiety
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confusion means pt is
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disoriented to place time or person
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Whats the prevalence of bulimia?
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90% are women, more men in sports where weight significant and gay men
1-2%, males one-tenth |
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coma means
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severely diminished response
do not react unaware of self or environment for prolonged period of time auditory is thought to be still intact |
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common causes of altered states of consciousness
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hypoxia - tissue starved from oxygen
trauma tumor formation edema decrease in blood flow increase in blood flow - icp - coma alteration in flow of csf - icp - coma |
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skull is a box with 3 seperate components
123 |
brain tissue
blood csf |
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if volume in any of the 3 components of skull increases the other compartments must
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decrease on increased icp
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factors that influence icp
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arterial pressure
venous pressure intra abd and intra thoraic pressure posture temperature blood gases (carbon dioxide levels) inc co2 = inc icp |
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normal icp
**** |
0-15 mm hg
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compensatory mechanisms to maintain icp
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changes in volume of csf - flow
displacement of csf into subarachnoid space alteration in intracranial blood volume collapse of cerebral veins and dural sinuses change in venous outflow displacment of brain tissue thru compression into dura -- blow out brainstem -- instant death |
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critical assm findings in icp
*********************** |
change in loc
change in vitals due to increasing pressure on thalamus, hypothalmus, pons and medulla cushing triad increasing systolic BP (widening pulse pressure) bradycardia with bounding pulse irregular breathing pattern |
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clinical manifestations of icp
************************ |
vomiting
decrease motor function hemiparesis or hemiplegia to side of injury decreased ability to react to painful stimuli ocular signs***** due to compression of ocular motor nerve -dilation of pupil isplateral (same side as insult) -sluggish or no response to light -inability to move eye upward -ptosis of eyelid (Drooping) -fixed and dilated pupil (neuro emergency!!!) -headache |
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complications of increased icp
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life threatning
diminished cerebral blood perfusion pressure and places brain at risk for -ischemia -infarction -- many injuries further complicate by causing -hypoxia (co2 = inc icp) -acid/base imbalance |
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decorticate vs decerebrate
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core - into core, arms flexed
cerebrate - more serious - involves all 4 extremities in rigid extension |
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drug therapy for icp
*** |
mannitol - isomotic diuretic (brain injury pt)
lasix - loop diuretic dilantin - anti seizure med decadron - corticosteroids (deccrease swelling) h2 receptor antagonist - proton pump inhibitors - protonix - long term physiological stress from hospitalization |
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first ___ hours is most critical in brain injury
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36 hr
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diffuse axonal injury occurs in a ____ injury
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brain injury - axonal swelling develops 12-24 hrs p injury
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cerebral contusions
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bruise on brain tissue
closed head injury |
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cerebral laceration
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closed head injury
cut in tissue |
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coup contrecoup injury
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contusions occuring as result of mass movement inside skull <----->
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laceration of brain tissue
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as result of gsw, violent acts, tissue damage is severe, focal and general neuro defects
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epidural hematoma
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bleeding btw dura and inner surface of skull
generally arterial bleed, develops rapidly rapid onset clin manif -decresed neuro integrity -decreased loc -n/v -unconsciousness |
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subdural hematoma
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gradual onset
s/s within 48 hrs injury -drowsiness -confusion -pupillary changes -headache -dec loc |
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intracerebral hematoma
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inj frontal and/or temporal lobes
rupture intracerbral vessels subarachnoid bleed not caught early |
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brain injury treatment
************** |
ensure airway
stabilize cervical spine oxygen nc or nrb estab iv acess while still perfusing control external bleeding assess for ear/nose (csf) drainage remove clothing maintain pt warmth (warm ivf, blanket, warm hum oxy) assess vs assess neuro status **anticipate absent gag reflex adm fluids cautiously with attention to icp valium induced coma |
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corneal reflex loss - periorbital ecchymosis (black eye) treatments
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corneal - adm lub eye drops, secure eyes closed to prevent abrasions - gauze
ecchy-initial cold compress (1st 24 hrs) warm compress |
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hyperthermia common in brain injury pt - best course of action
|
due to injury or inflam of thalamus
nurse most control hyperthermia - hypothermia in 1st 24 hrs following injury may decrease long term complications 1. airway, breathing, circulation good 2. then hypothermia -12-24 hrs |
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cranial surgery done to
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remove fluid collection
blood collection lesion-tumor damaged area of tissue relieve icp |
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burr hole
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done to relieve icp - small localized area
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crainiotomy
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opening into cranium with removal of bone flap
remove bone fragments remove blood resulting from hem visualize bleeding vessels usually put part back |
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craniectomy
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excision into cranium to cut away bone flap - keep out piece of skull
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cranioplasty
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cranium repair - repair defect from trauma, malformation or previous surgery
artifical bone used to replace damaged or lost bone mass |
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stereotaxis
|
immobilze brain tumor excision
precision localization of specific area of brain utliizes frame or frameless aparatus to immoblize head to maintain set coordinates |
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ineffective airway r/t decreased level of consciousness immobility
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maintain pt side lying
suction frequently perform chest pt |
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ineff cerebral tissue perfusion r/t cerebral edema
|
monitor neuro status
monitor icp limit activities that inc icp provide comfort measure to dec agititaton elev hob 30 degrees monitor all rxn to med |
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impaired skin integrity r/t nutritional deficit, self care deficit, immobility
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assess skin frequently
turn and reposition q 2 hr use low loss air beds cleanse all abrasions and lacs |
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self care deficit r/t altered level of consciousness
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assess level of motor and sensory ability
bathe pt daily perform rom begin bowel program provide urinary cath care |
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interrupted family processes r/t comatase family member
|
assess effect of illness on all family members
teach and assist family members to provide care et tube burr hole eyes closedtaped facilitate family communication facilitate realistic family planning provide accurate info to family |
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stroke
|
neuro changes caused by interruption blood supply to part of brain
ischemic - blockage blood hemorrhagic - bleeding into brain tissue |
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ischemic stroke more/less common
cause |
more common
macrovascular - lg vessels cholesterol - damage vessel - hook rbcs homocystine levels - indicate inflammation |
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brain needs lots of
|
oxygen - it cannot resort to anaerobic metabolism if low oxygen levels exist
body will perfuse brain at expense of other organs hypoxia (low ox levels) will cause cerebral ischemia (lack of perfusion) |
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stroke = macrovascular = ischemia
|
dec oxygen
inc carbon dioxide increase icp = cerebral ischemia |
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Who are included in a Command level CDB?
|
CMC,CCC,ESO, Augmented by department as directed.
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|
tia
|
ischemia happens but clot moves and body fixes - no deaden tissue
recovery is complete within 24 hrs duration 5-20 minutes if untreated could lead to stroke within 5 years |
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ischemia 3 types
|
thrombolic - clots
embolic - moving clots hemorrhagic |
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ischemia
|
blood supply to brain is interrupted or totally occulded
lg vessel - anterior middle posterior or vertabral small - vessels that branch off regions of brain |
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survival of ischemia depends of
|
amount of brain tissue affected, length of time brain is deprived of blood supply and degree of altered brain metabolism
|
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Thrombosis
|
starts with damage to endothelial lining of cerebrovascular vessel - hook
atherosclerosis allows fatty deposits to form plaque on damaged wall plaque enlarges and causes stenosis of vessel platelets adhere to plaque deposits forming thrombus vessel lumen becomes obstructed |
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|
if pt has dvt will they be a risk for stroke?
|
no - clot will not get that far - will be pe
|
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embolism
|
occulsion of cerebral artery by embolism
forms outside brain detaches and travels |
|
|
common causes of embolic stroke
|
a fib - pt will take coumadin, plavix, baby asa
mechanical prosthetic heart valves - rougher surface than endocardium and cause increased risk of clot formation detached thrombus, bacteria, tumor, fat and air |
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|
hemorrhagic stroke process
|
results from bleeding into brain
-intracerebral -subarachnoid |
|
|
intracerebral hemorrhage
|
common after age 50
most common risk - hyperternsion mortality rate - 50% most have decreased quality of life 6months after incident - poor quality life |
|
|
subarachnoid hemorrhage
|
bleeding into space btw arachnoid and piamater membranes
*most common risk factor* cerebral aneursym |
|
|
aneursym
|
weakening or balloooning of vessel
picked up on mri - can catch before it blows |
|
|
thrombolic stroke
|
onset gradual
most common during or after sleep will increase in severity after 72 hrs as ischemia and cerebral edema develops morning stroke |
|
|
embolic stroke
|
rapid onset with severe neuro deficits
- may resolve as clot breaks up and blood flow is restored assoc with headache |
