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50 Cards in this Set
- Front
- Back
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Which alteration in level of consciousness is lethargic, somnolent, responsive to tactile stimuli but quickly drifts back to sleep?
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obtundation
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What is the difference between semicomatose and coma?
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semicomatose: unresponsive to stimuli, although may respond to vigorous painful stimuli
Coma: will not stir or moan for any stimuli; makes no attempt to withdraw |
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How do you apply painful stimuli?
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supraorbital pressure, trapezius squeeze, mandibular pressure, sternal rub
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How do you apply peripheral painful stimuli?
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nail bed pressure
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What are visual abnormalities in a neuro assessment?
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blurred vision, diploplia
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How can you test for brain death in a patient in a coma?
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dolls eyes, caloric testing
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What are the components of the GCS?
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motor, eye opening, verbal
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How is brain death ultimately determined?
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cerebral blood flow study, flat EEG
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How long might an altered consciousness last in a concussion?
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seconds or persist for several hours
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What is a contusion?
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bruising of the brain tissue
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Where is a contusion commonly found?
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at the site of impact or opposite the site of impact (Contrecoup)
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What are the types of force?
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acceleration injury: external force contacting the head
deceleration injury: moving head is suddenly stopped |
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This is a simple clean break in which the impacted area of the bone bends inward and the area around it bends outward.
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Linear skull fracture
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In a basilar skull fracture, if the dura is disrupted CSF may lead through the tear. What is this called?
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rhinnorrhea or otorrhea
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Where might blood be noted in a basilar skull fracture?
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mastoid process (Battle's sign) or bilateral periorbital ecchymosis (racoon's eyes)
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An ____ ____ results from arterial bleeding into the space between the dura and the inner table of the skull.
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epidural hematoma
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What happens to the LOC in a epidural hematoma?
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declines rapidly from drowsiness to coma
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What are the s/s of epidural hematoma?
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severe HA, vomiting, fixed dilated pupil on same side as hematoma, seizures, rapid deterioration
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A ___ ___ results most often from venous bleeding into the space beneath the dura and above the arachnoid.
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subdural hematoma
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True or false. Bleeding occurs more slowly in a subdural hematoma.
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True
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What are the 3 categories of a subdural hematoma?
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acute: 48 hours after impact
sub-acute: 48 hours- 2 weeks chronic: 2 weeks to several months |
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____ ____ have the highest mortality rate.
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subdural hematomas
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This is an accumulation of blood within the brain tissue caused by the tearing of small arteries and veins in the subcortical white matter.
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intracerebral hemorrhage
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Where does CSF circulate?
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between the arachnoid and the brain
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What is a subarachnoid hemorrhage?
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blood vessels located along the surface of the brain rupture (aneurysm) and combine with the CSF along the surface of the brain below the arachnoid
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What are the s/s of SAH?
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worse ever HA (thunderclap), vomiting, neck stiffness,
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How do you diagnose a SAH?
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MRI, MRA
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What causes a SAH?
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aneurysm trauma
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What is a big problem with SAH?
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vasospasms--> can cause ischemia
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Which drug is used to prevent spasms in SAH?
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CCB--> Nimotop
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What is important to monitor when caring for a patient with SAH taking CCBs?
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BP: <130-150 to prevent aneurysm from rupturing
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What is a normal ICP reading?
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10-15 mmHg
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How do you calculate cerebral perfusion pressure?
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MAP-ICP=CPP
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If CPP is <50 what does it indicate?
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ischemia
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What are the 3 components of the intracranial compartment?
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brain, blood, CSF
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What is the Monroe-Kellie hypothesis?
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a change in the volume of one compartment must be offset by a reciprocal change in the volume of another compartment
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What are early signs of increased ICP?
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decreased LOC, pupillary dysfunction, HA. changes in vision
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What are late signs of increased ICP?
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continued decrease in LOC, no reaction to light, HTN, bradycardia, hyperthermia, Cushing's triad
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What are the signs of Cushing's triad?
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severe HTN, bradycardia, irreg. respirations
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What is the treatment of choice for ICP?
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Mannitol: osmotic diuretic (pulls fluid back into vasculature)
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What are considerations when administering Mannitol?
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it should be filtered, serum and urine osmolarity, and electrolytes should be monitored (I & Os)
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How are loop diuretics helpful when treating increased ICP?
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decrease blood volume which may mobilize cerebral edema
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What is Phenobarbital?
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decreases cerebral metabolism ad O2 requirements,; leads to a decrease in cerebral blood flow and in blood volume
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What is important to monitor when administering Phenobarbital?
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resp. depression, be ready to intubate
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What does hyperventilation help in decreasing ICP?
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titrates CO2 to cause vasoconstriction
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At which level should the intraventricular drain be placed?
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Foramen of Monroe
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What position should a pt. be placed in to decrease ICP?
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HOB elevated 25-30 degrees; neck neutral and head midline
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What is the cause of meningitis?
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viruses or bacteria that infect the tissues and sometimes the fluid that surrounds the brain
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What is bacterial meningitis often caused by?
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streptococcus pneumoniae
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What are the s/s of bacterial meningitis?
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severe HA, Nuchal rigidity (stiff neck), Positive Brudzinski's sign (irritation in meninges), Positive Kernig's sign (knees up to chest irritating to neck), petechial rash
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