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196 Cards in this Set
- Front
- Back
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True or false, hypoxia maintains blood flow to the brain? |
True |
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What is ischemia? |
Deprivation of oxygen caused by greatly reduced or interrupted blood flow |
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What are the levels of consciousness in order of descending function? |
Alert and oriented Confused Lethargy Obtundation Stupor Coma |
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What does a&o x 3 mean? |
Alert and oriented to person place and time |
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What happens in The lethargy stage level of consciousness? |
Oriented but slow motor and speech |
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What happens in the stupor level of consciousness? |
Vocalization to pain, has decreased motor movement |
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What happens in the coma level of consciousness? |
Does not respond appropriately to stimuli. No verbal response. |
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What happens in the obtundation level of consciousness? |
Needs continuous stimuli to maintain arousal |
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What are the two types of unconsciousness related to death? |
Cerebral death Brain death |
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What is cerebral death? |
A irreversible coma or a persistent vegetative state |
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What is brain death? |
Absent cerebral function and unable to maintain physiologic homeostasis |
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What's the difference between cerebral death and brain death? |
Cerebral death can maintain homeostasis and the rest of the body while brain death cannot. |
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What does cognition mean? |
Thinking skills include awareness, language calculation and memory. |
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What is dementia? |
Organic brain degeneration, Progressive, untreatable, irreversible decline in mental function. |
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What is delusion? |
False belief brought about without appropriate external stimuli (unrelated to reality) |
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What is delirium? |
Acute reversible state of agitated confusion. Disoriented to time and place with hallucinations (usually symptomatic of a disease and is reversible with treatment of the disease.) Can be caused by a high fever. |
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What is GCS? |
Glasgow Coma score |
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What is the purpose of GCS? |
Helps to gauge the impact of a wide variety of conditions affecting the patient's level of Consciousness. |
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What is the lowest possible score a patient could receive for a GCS? |
3 |
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What is the highest score a patient could receive for a GCS? |
15 |
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What is a GCS score of 3-8 points mean? |
Severe head injury |
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What does a GCS score of 9 to 12 points mean? |
Moderate head injury |
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What does a GCS score of 13 to 15 points mean? |
Mild head injury |
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For what type of head injuries is the GCS used? |
Trauma Vascular injuries Infections Hypoxia Metabolic disorders |
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What metabolic disorders is the GCS system used? |
Renal failure Liver failure Hypoglycemia Diabetic ketoacidosis |
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What are the types of pathologic posturing? |
Decorticate Decerebrate Flaccid paralysis |
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What is pathologic posturing? |
Indication of serious brain damage, when an abnormal posture happens from painful stimuli |
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What does decorticate posturing indicate? |
There may be damage to the cerebral hemispheres, and possibly midbrain. |
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What does decerebrate posturing indicate? |
Severe damage indicating a lesion lower in the brainstem. |
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What does flaccid paralysis look like? |
Limp floppy unresponsive muscles |
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What does decerebrate posturing look like? |
Hand went away from body "brain has gone away" |
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What does decorticate posturing look like? |
Limbs point of the core of the body |
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How do we test GCS? |
Peripheral= nailbed Central= pinch trapezius, Superior orbital notch |
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What is the most dangerous outcome of cerebral edema? |
Increase ICP due to brain injury. |
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What does ICP mean |
Intracranial pressure |
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What does IICP mean? |
Increased intracranial pressure |
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What are the types of cerebral edema? |
Vasogenic edema Cytotoxic edema |
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What is vasogenic edema? |
Blood-brain barrier damage causes increased capillary permeability. |
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What does vasogenic edema result in? |
Swollen brain tissue |
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When does vasogenic edema occur? |
With conditions impair the function of the blood-brain barrier and allow transfer of water and proteins from the vascular space into the interstitial space |
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What is cytotoxic edema? |
The blood-brain barrier remains intact But A disruption in cellular metabolism impairs functioning of the sodium and potassium pump |
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What is the result of cytotoxic Edema and why? |
Ischemia of the brain tissue and necrosis of brain cells. Active transport failure leads to potassium loss and sodium retention increasing cellular water |
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What is the treatment for cerebral edema? |
Positioning patient head elevated 30 degrees Hypertonic IV fluids Diuretics Corticosteroids to suppress the inflammatory response and reduce swelling Surgical decompression removing part of the skull to allow swelling |
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What are the causes of increased ICP? |
1. Rise in cerebrospinal fluid pressure 2. Increase pressure within the brain matter 3. Bleeding into the brain or into the fluid around the brain 4. Swelling within the brain matter itself |
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What are the early signs of ICP? |
Decreased loc Pupil changes: PERRLA Vision abnormalities Headache Vomiting Nuchal rigidity |
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What does PERRLA mean? |
Pupils equal, round, reactive to light, and accommodation |
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What happens if ICP is left untreated? |
Causes brain herniation |
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What are the late signs of ICP? |
Impaired reflexes Papilledema Abnormal posturing |
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True or false, brain herniation is imminent in the late signs of ICP? |
True |
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What is Cushing's Triad? |
Vital sign changes seen in ICP indicating pressure on the brain stem |
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What are the signs and symptoms of ICP? |
Increase blood pressure Decreased pulse Decreased respirations |
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What are the signs and symptoms of shock? |
Decreased blood pressure Increased pulse Increased respiration |
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True or false, you can move an injured person? |
False |
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What could head injuries result from? |
A ground-level fall especially in elderly |
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What should you always assume when there's a head injury? |
There will be a C spine injury |
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What is a brain injury as defined by the national head injury Foundation? |
A traumatic insult to the brain capable of producing physical, intellectual, emotional, social and Vocational changes. |
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What happens in Cushing's Triad? |
Hypertension with a widening pulse pressure Bradycardia Hypoventilation |
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What does a widening pulse pressure mean? |
Difference between systolic and diastolic BP increases |
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What happens in hypoventilation during Cushing's Triad? |
Respiration slow down causing hypercapnia which causes vasodilation leading to worse cerebal edema and increased ICP. |
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What are the warning signs after a head injury in the first 24 hours? |
Changes in loc Seizures Bleeding or water drainage from nose or ears Pupils slow to react or unequal Visual problems Loss of sensation to any extremity Slurred speech Projectile vomiting |
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When do we check fluid from the ears? And what do we check for? |
When there is a head injury and there is presence of fluid from the ear. We check for glucose which indicates a skull fracture |
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When there's glucose coming out of the ear where is this glucose coming from? |
Cerebral spinal fluid |
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What is the nursing care for a head injury? |
Frequent assessment of LOC using GCS. Keep patients head elevated 30 degrees to prevent increased intracranial pressure Protect Airway |
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What are the types of head injury? |
Concussion Contusion Laceration Brain/ cerebral edema Herniation Acceleration-deceleration head injury Cerebrovascular infarction |
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What type of head injury is no gross pathology? |
Concussion |
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What type of head injury is bruising of the brain surface underneath the fracture or at the undersurface of the frontal and temporal lobes, due to shearing forces. |
Contusion |
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What type of head injury has a transient loss of consciousness? |
Concussion |
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What happens in post-concussion syndrome? |
Headaches and memory lapses |
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What type of brain injury is tearing of the brain substance? |
Laceration |
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What type of brain injury has a normal CT scan? |
Concussion |
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What type of brain injury is localized in the glial cells, myelin sheath, and intracellular spaces? |
Brain/cerebral edema |
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What type of brain injury causes increased intracranial pressure, which may impair brain circulation, or result in brain herniation? |
Brain/cerebral edema |
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How is a contusion brain injury diagnosis? |
CT scan |
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How is a laceration head injury diagnosed? |
CT scan |
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How is a brain or cerebral edema head injury diagnosed? |
CT scans or MRI after time has taken place |
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What is a brain herniation? |
Displacement of brain tissue towards the other side of the brain which increases pressure on the non-injured side. |
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What is another term for acceleration deceleration head injury? |
Coup-contrecoup |
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What type of head injury results from hitting both the front and the back of the head and results in brain contusions and hematomas? |
Acceleration deceleration head injury |
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What type of brain injury has focal brain necrosis due to complete and prolonged ischemia that affects all tissue elements (neurons, glia and vessels.)? |
Cerebrovascular infarction |
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True or false, the ischemia and necrosis is reversible cerebrovascular infarction? |
Flase it is irreversible |
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What are the types of hematomas of the brain? |
Epidural hematoma Subdural hematoma Intracerebral hematoma |
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What is an early sign of epidural hematoma? |
Ipsilateral pupil dilation |
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What does ipsilateral pupil dilation mean? |
Dilation of pupil on the same side as the brain hematoma |
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Where does an epidural hematoma form? |
Between the skull and the top lining of the brain (dura). |
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What type of bleed is an epidural hematoma? |
Arterial bleed |
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True or false, arterial bleeds are usually worse than Venous bleeds? |
True |
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Where does a subdural hematoma form? |
Between the dura and the brain tissue. |
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If a subdural hematoma occurs quickly it is called a what? |
Acute subdural hematoma |
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If a subdural hematoma occurs over several weeks it is called a what? |
Chronic subdural hematoma |
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What type of bleed is a subdural hematoma? |
Maybe either arterial or venous bleed but is usually Venous so the rate of blood flow is slower and the hematoma develops slower |
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Where does an intracerebral hematoma form? |
In the middle of the brain |
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What type of bleed is an intracerebral hematoma? |
Can be either arterial or venous |
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How long does a person with Alzheimer's live on average after their symptoms become noticeable to others? |
8 to 10 years |
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How long can a person live with Alzheimer's? |
4 to 20 years |
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What is the sixth leading cause of death in the United States? |
Alzheimer's |
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How does Alzheimer's disease happen? |
Clumps of protein grow in the brain 2. Protein strands twist, damaging brain cells 3. Brain cells die, certain areas of brain shrink |
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What are the stages of Alzheimer's disease? |
First: short term memory loss Second: confusional stage Third: incontinence, long term memory loss |
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What stage of Alzheimer's is also known as The Sundowner stage? |
Second stage |
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What are the risk factors of Alzheimer's disease? |
Age Heredity Hispanic African-American Diabetes High blood pressure High cholesterol |
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Why are Hispanics and African-Americans at a greater risk for Alzheimer's disease? |
Because there is a connection between heart health and brain health. |
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What is the pathophysiology of Alzheimer's disease? |
Neuronal proteins develop into neurofibrillary tangles causing areas of degenerative tissue called senile plaques. These plaques impair transmission of neural impulses. |
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True or false there is a cure for Alzheimer's? |
False |
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What is the treatment for Alzheimer's? |
Supportive care to maintain function. Medication is sometimes helpful to slow the rate of metal loss, but will not cure or prevent ongoing decline in either mental or physical symptoms |
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What memory loss happens first in Alzheimer's? |
Recent memory loss and progresses to remote memory loss |
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What are some signs and symptoms of Alzheimer's disease? |
Cognitive Behavioral Mood Psychological Restlessness Loss of appetite Inability to combine muscle movements or jumbled speech |
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Does mental or physical damage show first in Alzheimer's disease? |
Signs of mental damage preceed the physical signs of illness progression |
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Is poor judgment and decision-making with the inability to problem solve simple tasks a sign of Alzheimer's or typical age-related change? |
Alzheimer's |
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Is making a bad decision once in a while a sign of Alzheimer's or a typical age-related change? |
Typical age-related change |
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Is missing a monthly payment a sign of Alzheimer's disease or a typical age-related change? |
Typical age-related change |
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Is the inability to manage a budget a sign of Alzheimer's or a typical age-related change? |
Alzheimer's |
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Is losing track of the date or the season a sign of Alzheimer's or a typical age-related change? |
Alzheimer's |
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Is forgetting which day it is and remembering it later a sign of Alzheimer's or a typical age-related change? |
Typical age-related change |
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Is sometimes forgetting which word to use a sign of Alzheimer's or a typical age-related change? |
Typical age-related change |
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Is difficulty having a conversation a sign of Alzheimer's or a typical age-related change? |
Alzheimer's |
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Is misplacing things and being unable to retrace steps to find them a sign of Alzheimer's or a typical age-related change? |
Alzheimer's |
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Is losing things from time to time a sign of Alzheimer's or a typical age-related change? |
Typical age-related change |
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What are the types of stroke? |
Ischemic (thrombotic) Embolic Hemorrhagic |
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What is the cause of a CVA or stroke? |
Thrombi, emboli and hemorrhage |
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When should you give thrombolytics for a stroke? |
Within 3 hours of the onset of symptoms |
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What can cure a stroke? |
Fast recognition |
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What does fast recognition of a stroke include? |
Face: are both sides equal and is smile equal Arms: can the client raise both arms equally Speech: is speech slurred, can they form a sentence Time: get help now small window of opportunity |
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What is the most common type of stroke? |
Ischemic |
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What type of stroke occurs when a thrombi causes arterial occlusion and Narrows the blood vessel? |
Ischemic |
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What type of stroke occurs when an emboli breaks off from the thrombi in the aorta or carotid? |
Embolic |
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What type of stroke occurs when there is hypertension, aneurysm, or ruptured vessels? |
Hemorrhagic |
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What is the treatment for ischemic Strokes? |
Decrease edema and ICP |
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What is the treatment for embolic strokes? |
Anticoagulants Eliminate the cause |
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What is the treatment for a hemorrhagic stroke? |
Stop bleed, decrease ICP and vasospasm no anticoagulants!! |
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Should you use anticoagulants in a hemorrhagic stroke? |
No |
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What are the signs and symptoms of an ischemic stroke? |
Occasional HA, no LOC, history of TIAs |
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Are there a history of TIAs in embolic strokes? |
No |
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What are the non-modifiable risk factors of a stroke? |
Genetics Age 55+ Gender male Race: Black and Hispanic Medical history: prior stroke, TIA, or HA |
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What does TIA stand for? |
Transient ischemic attack |
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What are the modifiable risk factors of a stroke? |
High blood pressure Smoking Atherosclerosis Diabetes Arterial fibrillation Overweight Lack of exercise Over consumption of alcohol |
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True or false, people with excess belly fat are four times more likely to have a stroke? |
True |
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What is aphasia caused by? |
Caused by a CVA |
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What is a CVA? |
Cerebrovascular accident |
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What is aphasia? |
Loss of comprehension or production of language that impairs the patient's ability to communicate |
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What are the two types of aphasia? |
Expressive Aphasia Receptive aphasia |
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What is expressive aphasia? |
Patient understands what is being said to them but cannot speak coherently |
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What is receptive aphasia? |
Paging and speak coherently but does not understand what is being said to them |
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What is hemiplegia? |
Total or partial paralysis of one side of the body |
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What is considered angina of the brain? |
TIA |
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What is a TIA? |
Brief episodes of neurologic dysfunction. Can have all the signs and symptoms of a stroke but reverses before infarction occurs. They are temporary and resolve without treatment and causes no permanent damage |
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True or false, transient ischemic attacks cause permanent damage? |
False |
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What are TIAs a warning sign for? And why? |
Warning sign of a stroke since they frequently proceed thrombotic Brain Attack. |
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How many people who have TIAs will eventually have a stroke? |
One in three people |
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What does SCI stand for? |
Spinal cord injury |
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What type of spinal cord injury results in quadriplegia? |
Cervical spine injury |
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What type of spine injury results in paraplegia? |
Thoracic spine injury T1 to T7 |
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What type of spinal cord injury requires mechanical ventilation of the patient? |
C1 to C3 injury |
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How long does spinal shock last? |
Average 1 to 3 weeks but maybe up to 3 months. |
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Is spinal shock permanent or temporary? |
Temporary |
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What type of injury results in spinal cord remaining intact but could be contused and swollen, thereby preventing conduction of nerve signals below the point of injury? |
Compressed cord injury |
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What type of injury results from the spinal cord being completely severed? |
Transected cord injury |
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What type of spinal injury has some function? |
Incomplete spinal injury |
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What type of spinal injury results in all function lost below the damaged spinal cord? |
Complete spinal injury |
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What does complete spinal injury result in? |
Flaccid paralysis. Loss of vasomotor tone can result in severe low blood pressure or bradycardia depending on the level of injury. |
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If there is an involuntary anal reflex what type of spinal injury is it? |
Incomplete spinal injury |
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What are the signs and symptoms of autonomic dysreflexia? |
Hypertension due to vasoconstriction with a pounding headache Bradycardia Flushed face Sweating above the spinal injury Pale, cold, clammy skin below the level of injury Goosebumps below the level of spinal injury |
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What condition is common in patients with a spinal cord injury at T6 or higher? |
Autonomic dysreflexia |
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What does autonomic dysreflexia cause? |
Dangerously high blood pressure can be high enough to cause a stroke or seizures, skin pallor, gooseflesh associated with piloerector response. |
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What is autonomic dysreflexia often triggered by? |
A noxious stimulus below the spinal cord injury such as a full bladder |
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What are the most common noxious stimuli for autonomic dysreflexia? |
Bladder and bowel needing empty |
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What are the steps of autonomic dysreflexia? |
1. A noxious stimulus initiate the process 2. Spinal reflexes stimulates fight or flight response below injury causing vasoconstriction causing high blood pressure 3. Bradycardia 4. Parasympathetic response cannot reach the motor neuron to turn off the fight or flight response |
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Does the sympathetic or parasympathetic nerves Prevail below the spinal injury? |
Sympathetic nerves Prevail below the level of neurologic injury |
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Does sympathetic or parasympathetic nerves Prevail above the level of injury? |
Parasympathetic nerves Prevail above the level of injury |
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What does the sympathetic response in a neurologic injury cause? |
Vasoconstriction below the injury |
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What does the parasympathetic response cause in a spinal injury? |
Vasodilation above the injury |
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What does vasoconstriction below the spinal injury cause? |
Hypertension, bradycardia, pounding headache, visual changes, anxiety, pallor, Goosebumps below the level of injury |
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Are the types of meningitis? |
Bacterial Viral Fungal |
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What is the most serious form of meningitis? |
Bacterial |
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What can bacterial meningitis cause? |
Long-term and or permanent brain damage and death |
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What is bacterial meningitis usually caused by? |
From direct exposure or systemic bacteremia |
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What type of meningitis has a high mortality rate? |
Bacterial meningitis |
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What does viral meningitis usually occur from? |
Upper respiratory infection |
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What is the least severe type of meningitis? |
Viral meningitis |
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What type of meningitis often results in 2 weeks without treatment? |
Viral meningitis |
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What type of meningitis is usually found in immunosuppressed individuals? |
Fungal meningitis |
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What is the most common type of meningitis? |
Viral meningitis |
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What are the signs and symptoms of meningitis? |
Vomiting Headache Altered LOC Increased ICP Fever Joint aching pain Stiff neck Dislike of light Rashes that do not blanch when applying pressure |
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How is meningitis spread? |
Spread by social contact such as handshakes or sneezes. |
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What is the treatment of meningitis? |
Treatment as related to the pathogen (antibiotic or antifungal meds) Vaccinations available against some pathogens |
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What type of precaution is meningitis? |
Droplet precaution |
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What is the pathophysiology of meningitis? |
Infection of the meninges/ spinal fluid/ ventricles Cerebral spinal fluid and ventricles become inflamed leading to obstruction of CSF flow, edema of infected tissues, and potential ischemia due to increased ICP. |
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What is the term used for a group of signs and symptoms that are commonly present (but not always) when the meninges are irritated, as in infection, subarachnoid hemorrhages, or other diseases? |
Meningism |
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What are the signs of meningeal irritation? |
Kerrigs sign Brudzinskis sign Opisthotones |
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What does photophobia mean? |
Intolerance of bright light |
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What does nuchal rigidity mean? |
Inability to flex the neck forward due to rigidity of the neck muscles. |
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True or false, if flexion of the neck is painful but full range of motion is present nuchal rigidity is present? |
False |
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True or false, if flexion of the neck is painful but full range of motion is present nuchal rigidity is absent? |
True |
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What is opisthotonus? |
Type of spasm of the whole body that leads to legs and head being bent back and body bowed backwards. |
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When does opisthotonus occur? |
In some types of meningitis, tetanus, strychnine poisoning |
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What is kerrigs sign? |
Thigh is been at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful leading to resistance. |
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What can kerrigs sign indicate? |
Subarachnoid hemorrhage or meningitis |
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What is brzezinski's neck sign? |
Appearance of involuntary lifting of the legs when lifting a patient's head while the patient is lying supine |
