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102 Cards in this Set
- Front
- Back
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Increased intracranial pressure
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pressure placed on the contents of the cranium
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normal intracranial pressure
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0-15 mm hg
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couses of increased ICP
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cerebral edema (most commonn trauma)
tumors increased blood volume increased cebral spinal fluid |
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1st compensation for ICP
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displace & reabsorb CSF
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s/s of 1st compensation of ICP
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subtle drowsiness
slight sluggish pupils |
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s/s of 2nd compensation of ICP
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increasing BP
decreased LOC pupils don't react (sluggish fixed) |
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2nd compensation of PCP
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constrict blood vessels
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worsening s/s of ICP
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widening pulse pressure
papilledema decreased pulse cheyne-stokes respirations increased temp due to inflammation loss of sensory/moter function headache vomiting-projectile unresponsivenss posturing (Decorticate vs Decerbrate) |
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hemiplegia
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1/2 side weakness
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decorticate
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curl up towards core
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decerbrate
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posturing out
Worse |
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widening pulse pressure
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sytolic bp going up & diastolic bp going down
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treatment for ICP
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treat the cause
maintain ventilation diuretics (draw water from brain cells) corticosteroids - to decrease edema |
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cerbral vascular accident (stroke)
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sudden impairments of cerebral activity
usually due to impaired cerebral ciruclation it's either a plug or leak impaired ciruculation can be massive or slight |
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most common durological disability
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CVA/stroke
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#3 cause of death
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stroke / CVA
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FAST
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facial
arms speach time |
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2 types of ischemic strokes (plug/clot)
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thrombosis
embolism |
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most common stroke
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thrombosis
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thrombosis
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most common in elderly
associated with ahterosclerosis narrowing of arterial lumen |
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atherosclerosis
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plaques
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risk factors for thrombosis type strokes
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atherosclerosis - HTN, High cholestrol, smoking
advancing age diabetes FHX |
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Embolism
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often at bifaction (branching)
develops rapidely w/out warning usuay from thrombi formed in heart |
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thrombi formed in heart
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artrial fibrillation
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2nd type of stroke
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intracerebral hemorrahge
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intracerebral hemorrhage especially common with
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HTN and aneurysms
severity depends on age, location, size of hemorrhage most likely to be fatal sudden rupture of cerbral artery compression of brain increased ICP usually no warning |
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patho of CVA
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decreased blood flow leads to ischemia
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s/s of CVA occur within
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one minute of insufficient O2
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tissue softens and discolors within
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6-12 hours
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ncrosis occurs within
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48-72 hours
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treatment for stroke needs to be within
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3 hours for maxium recovery
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warnings for stroke are called
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transient ischemic attacks
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transient ischemic attacks
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focal ischemic deficit lasting less than 24 hours (usally minutes)
the pt. feels "silly" becasue they are "all better" when the ambulance arrives |
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transient ischemic attacks due to
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atherosclerosis and emboli that resolve
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transient ischemic attacks
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WARNING OF IMPENDING STROKE
and are often progressive signs |
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s/s of transient ischemic attacks
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numbness
weakness aphasia foggy vision ets THEY ALL CLEAR UP symptoms vary based on where in the brain it is |
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treatment of transient ischemic attacks
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locate the lesion/embolism
give ASA daily decrease BP seek cause agressively |
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S/S of CVA
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depending on artery effected
CVA on left produced symptoms on the right side of body and vice versa EXCEPT cranial nerve dysfunctjion (same side) |
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most effected artery causing CVA
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middle cerebral artery
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most common s/s ischemic strokes
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vision changes
speech chages headache sided weakness balance changes .......... consciousness OK |
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most common s/s of hemorrhagic stokes
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vision changes
speech changes headache is worse sided weakness balance changes decreased LOC N/V |
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Goals for CVA
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normalize BP
minimize infarct treat ICP preserve neurological function rehab and prevention of recurrence |
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meds for CVA may be
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thromolytic/anticoagulants for a clot
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possible surgery for a _______ stroke
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hemorrhagic stroke
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meningitis
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infection of the meninges (coverings of the brain)
usually pia matter and arachnoid matter lower ones that snug up to brain |
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cause of meningitis
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any way organisms can get in:
ottis media skill fx sinusitis denatl infection immunocompromised or unknown |
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patho of meningitis
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infection causes inflammatory exudate (pus)
thick CSF as exudate forms possible obstruction of pus swollen meninges increased ICP eventually infection can spread to brain itself (encephalitis) |
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s/s of meningitis
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worst headache ever
fever stiff neck (nuccal rigidity) lethargy photophobia decrease in consciousness is rapid +kernig sign +brudzinksi sign cloudy purulent & CSF (exudate) |
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+ kernig sign
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leg will not extend if lying with hip flexed at R angle
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+ brudzinski sign
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forcible flexion of neck
flexion of hip/knee |
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treatment of meningitis
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ICU
antibiotics ICP monitoring HIGH MORTIALITY IF BACTERIA |
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prevention of meningitis
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H. Flu vaccine for kids
meningococal vaccine also available (now routine for teens) |
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seizure
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sudden explosive abnormal electircal impulse in the brain
not a disease but a symptom may have motor, sensory, autonomic or behavioral symptomes |
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seizures may be due to
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elctrolyte imbalance
drugs ETOH (alcohol) fever trauma infection CVA |
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epilepsy
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recurring seizures without a reversible cause
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epilepsy due to
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birth injury
rapid development of nervous system structural damage, trauma, tumor, stroke OR UNKNOWN/IDIOPATHIC |
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types of seizures
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partial seizures
generalized seizures status epilepticus |
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partial seizures
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only 1/2 brain effected
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simple partial seizure
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no loss oc consciousness
pt. may have a deja-vu event queasy stomach numbness tingling sense of fear can begin with aura & progress to complex partial |
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compex parital sz
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some alteration in consciousness
automatisms are common last about 60-90 sec followed by confusion and no recall of episode can progress to a generalized tonic-clonic seizure |
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automatisms
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lip smacking
rapid eye blicking etc |
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s/s of partial seizures
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motor symptoms
sensory symptoms autonomic symptoms |
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autonomic symptoms of partial
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flushing
tachcardia pupil dilation |
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sensory symptoms of partial sz
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numbness
bad taste odd smell flashing lights |
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motor symptoms of partial sz
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often limited to one part of the body
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generalized sz
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entire brain is involved
usually causes unconsciousness |
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3 generalized sz
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absence (petit mal)
atonic (drop attack) tonic-clonic (grand mal) |
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absence sz
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most common in kids
impaired responsiveness (stares in space) no decreased consciousness last less than 30 seconds tacher thinks child has lack of focus |
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atonic sz
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sudden loss of all mussle tone
could lead to injury |
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tonic-clonic sz
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starts w/ vague warning (aura)
sudden unconscious jerking of whole body often yells or bits tongue no breathing during sz sleep afterward (brain nds to reboot) |
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status epileptieus
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one sz right after another
usually due to skipping meds can cause brain damage and/or death from ischemia if goes more than 30-40 minutes |
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tx for sz
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keep pt safe
maintain airway don't restrain correct cause if possible aticonvulsant drugs surgery or Zap |
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dementia
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focus on alzheimers disease 60-70% of dementia pt
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alzheimers
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progressive decrease in intellectural function
dure to corical atrophy and loss of neurons |
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cause of alzheimers
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unknown
some genetic mutation |
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risk factor for alzheimers
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age
family history |
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patho for alzheimers
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neurofibrillary tangles form in the brain (fibrous proteins from the neurons are wound together)
senile plaques form in areas of degenearting nerve terminals increased # of degenerating neve impulses in hippocampus |
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alzheimers may be due to
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loss of neurotramsmitter choline acetyltransferase which helps synthesize acethycholine
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an important neurotransmitter
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choline acetyltransferase
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s/s of alzheimers
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gradual onset
starts with forgetfulness memory loss lack of insight forget words aware they r forgetful at first progress to decrease problem solving impaired language can't care for self often leads to wandering eventually unable to communicate incontinence unable to recognize family |
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conductive hearing loss
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anythng that disrupts passage of sound from outside of body
disrupts air conduction of sound would not reach CN #8 |
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conductive hearing loss - what can disrupt
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ear wax
hole fluid/pus in the middle ear ossicles fused together w/age |
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treatment of conductive hearing loss
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correct the cause
surgery can help ostosclerosis |
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sensorineural hearing loss
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CN#8, organ of corti or the auditory pathway to the brain is the problem
birth trauma (rubella) nerve dead loud noise - damage organ of Corti vascular disorders in the brain or vessels of the inner ear meningitis DM drug toxicity |
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treatment of sensorineural hearing loss
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not much - hearing aids don't hlep
imbedded neural hearing aid, surgical attached to brain |
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otitis media
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infection of the middle ear (ossicles r air filled space)
most common in child |
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otitis media due to
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shorter horizontal wide eustachian tube
bottle fed babies are fed lying doing, milk comes to fast and less meternal antibodies |
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s/s of otitis media
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ear ache
fever 101 decreased hearing (fluid there) tugging on ear fluid behind the TM (serous) chronic lasting over 12weeks |
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dx for otitis media
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otoscopic exam
tm looks red bulging toward u dull color can't see land marks can't see cone of light not mobile (yawn) |
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treatment for otitis media
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antibiotics
myringotomy/tmpanostomey tubes keep child out of water tubes to drain serous |
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complications of otitis media
Their uncommon |
conductive hearing loss (rupture)
perforated ear drum meningitis |
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cataracts
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cloudy of lens of eye
congenital - materanal exposure traumatic - foreigh body, heat tradiation exposure senile - old fibers become compressed & dehydrated & ineral concentrate in lens metabolic - drug side effects, diabetes |
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s/s of cataracts
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gradual decrease in visual acuity
need more light visual blurry severe pupil appears white |
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treatment for cataracts
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surgery
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open angle glaucoma (mystery)
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wide open canal schlem
unknown cause drainage not occluded pressure is just high more common than closed angle starts about age 40 |
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dx for open angle glaucoma
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push of air (tonometry)
IOP should be less than 20mm Hg |
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treatment for open angle glaucoma
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antiglaucoma drugs that decrease producion of aqueous humor and increase outflow
constrict pupil |
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glaucoma
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increased intraocular pressure
enough to cause degeneration of the optic nerve vision loss |
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normal IOP
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12-20 mm Hg
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closed angle glaucoma (narrow angle)
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inherited narrow anterior chamber of eye from forward placement of iris
leads to decrease outflow through the canal of schlem because lack of space occurs suddenly due to dilation of the eye (darkenss to lightness) FFF leads to bunching of iris |
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s/s of closed angle glaucoma
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ocular pain
blurred vision halos around things red eye severe headache |
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treatment for closed angle glaucoma
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laser surger
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