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NURS 2220 Neuro#1
neuro Exam #1
| Question | Answer |
|---|---|
| aneurysm | abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel |
| Babinski reflex | positive (abnormal) Babinski reflex is dorsiflexion of the big toe and fanning of the other toes when a pen is run firmly up the sole of the foot |
| gaze preference | only moves eyes in one direction |
| corneal reflex | blink when something lightly touches the cornea |
| consensual reflex | reaction of both pupils when only one pupil is exposed to a change |
| delirium | transient loss of intellectual function, usually due to systemic problems |
| doll's eyes | Eyes remain fixed when head is turned side to side. |
| dysconjugate | eyes don't move together. could be cross-eyed or lazy eye |
| flaccid | lacking muscle tone, limp, floppy |
| foramen magnum | hole at the base of the skull through which the spinal cord exits |
| hemiplegia | paralysis of one side of the body |
| hemianopsia | loss of vision in one half of the visual field |
| neuralgia | sharp shocking pain that follows the path of a nerve due to damage or irritation to the nerve |
| nuchal rigidity | stiffness of the neck, often seen in patients with meningitis |
| nystagmus | involuntary shaking type of movement of the eyeballs. May be seen with MS, cerebellar CVA and with some drugs |
| obtunded | dulled response. May be confused once aroused. |
| otorrhea | discharge from the ear |
| paraplegia | paralysis of the lower extremities |
| quadriplegia | paralysis of all four extremities |
| rhinorrhea | discharge from the nose |
| spasticity | sustained increase in tension of a muscle when it is passively lengthened or stretched |
| stupor | generally unresponsive state. May be aroused by repeated stimuli but incoherent. Moves spontaneously. |
| neurogenic bladder | bladder dysfunction that results from a disorder or dysfunction of the nervous system; may result in urinary retention or bladder overactivity |
| decorticate posture | for a coma patient, arms contract over core of body after painful stimulus |
| decerebrate | for a coma patient, arms extend and externally rotate after painful stimulus |
| skull fracture | crack or break in one of the bones of the cranium |
| cerebral edema | swelling. abnormal accumulation of water of fluid in the intracellular spaces, extracellular spaces, or both |
| cerebral bleeding | bleeding within the brain itself |
| concussion | temporary loss of neurological function |
| contusion | bruising of the brain accompanied by small, diffuse venous hemorrhages. |
| spinal cord injury | damage or severing of the spinal cord, resulting in loss of function to areas below the point of injury |
| carotid endarterectomy | surgical procedure used to prevent stroke, corrects stenosis in the carotid artery |
| subdural hematoma | most common complication of head injury. Bleeding is usually venous in origin. |
| epidural hematoma | caused by a meningeal artery rupturing between the dura and the cranium after a blow to the head |
| ventricular shunting | used when the flow of CSF becomes obstructed. A synthetic tube is placed into the brain ventricles, tunneled under the skin from the scalp to the abdomen and inserted into the peritoneum to drain. |
| tentorial herniation | pushing of the brain downward through the tentorial notch. Can compress the brain stem and the third cranial nerve |
| subarachnoid hemmorhage | bleeding in the subarachnoid space |
| benign brain tumor | noncancerous, about 50% |
| malignant brain tumor | cancerous, about 50%. 10-15% of all malignant disease. |
| Ativan (lorazepam) | Sedative. May help control restlessness and agitation. |
| Decadron (dexamethasone) | Corticosteroid. Decreases inflammation within brain tissue. Reduces vasogenic edema caused by brain tumors, craniocerebral trauma, abscesses, infarctions and hemorrhage. |
| Dilantin (phenytoin) | Antiseizure drug. Doesn't decrease ICP, but does prevent seizures. Seizures can decrease PaO2 and increase Co2 which results in cerebral vasodilation and edema. |
| Lasix (furosemide) | Loop diuretic. Reduces overall body water. |
| Mannitol (osmitrol) | osmotic diuretic. Elevates osmolarity of blood plasma and increases water flow from tissue to plasma. Fluid is eliminated via kidneys. |
| Zantac (ranitidine) | To treat gastric ulcers caused by steroids. |
| Gliomas | arise from brain cells and spinal cord cells. 60% of all primary tumors. Difficult to remove and rarely curable. |
| Meningiomas | Arise from the meninges. Slow growing and benign. |
| Acoustic Neuromas | Arises from cranial nerves. Slow growing, bening. Compress trigeminal and facia nerves. Removed surgically through the hear and cause deafness. |
| Pituitary tumors | 10% of brain tumors. Can be hormone secreting tumors. Treated with transphenoidal microsurgery. |
| Interventions that decrease ICP | elevate HOB 30-45 deg. Avoid flexion of head and neck. Log roll to turn. Monitor ABG, keep PaCO2 slightly low (hyperventilate). Manage constipation. Discourage coughing. Restrict fluids. Monitor ICP. Diuretics, corticosteroids. Limit activity. |
| Primary intracranial tumor | originates in the brain |
| Secondary intracranial tumor | originates elsewhere in the body, metastisizes to the brain from another area. |
| Types of skull fractures | linear, depressed, basilar, comminuted |
| spinal shock | total sensory and motor loss and loss of all reflexes for a period of 24 hours - several weeks following a spinal injury. Reflexes return gradually. Severity of the injury determines whether damage is permanent. |
| cranial volumes | 78% intracellular and extracellular fluids 12% arterial, venous and capillary network 10% CSF |
| Normal ICP | 0 to 15 mmHg |
| Increased ICP | due to increase in CSF pressure or increased pressure within the brain matter because of lesions, tumors or traumatic injury |
| Factors that influence ICP/CBF | systemic BP, metabolic demands (ie, exercise), intracranial pressure, blood viscosity, pH, PaCO2, hypoxemia, posture/positioning |
| Autoregulation | ability of the cerebrovascular system to regulate itself in response to varying pressures and metabolic needs of the brain. Includes arterial pressure, venous pressure, intrathoracic/intra-abdominal pressure, temperature |
| Arterioles dilate to increase cerebral blood flow | metabolic needs of the brain increase; systemic blood pressure decreases (shunting); ICP increases |
| arterioles constrict to decrease cerebral blood flow | metabolic needs of the brain decrease; systemic blood pressure increases |
| Effect of blood viscosity on CBF | arterioles dilate when blood viscosity increases; arterioles construct when blood viscosity decreases |
| How CO2 affects CBF | Hypercapnia causes arterioles to dilate. Hypocapnia causes arterioles to constrict. Effect is dependent on changes in pH. |
| How position and posturing affects ICP | increased venous congestion can increase ICP; extreme hip flexion increases intra-abdominal pressures which can ultimately increase ICP; neutral neck alignment and elevated HOB promotes venous drainage |
| Situations where ICP temporarily increases | coughing, sneezing, straining to move the bowels, etc. |
| Physiologic response to ICP | 1) CSF system - can increase absorption of CSF and displace into subarachnoid space; 2) Cerebrovascular system - veins collapse, arterioles constrict; 3) Paremchyma - dura can compress slightly to handle additional pressure |
| Cascade of events related to ICP | ICP increases -> blood flow decreases -> tissue hypoxia/decrease in pH/increase in CO2 -> cerebral vasodilation from too much CO2 -> edema -> greater increase in ICP |
| Causes of increased ICP | CNS trauma, hemorrhage, infection, hypoxemia/ischemia of tissues, hydrocephalus, space occupying lesions |
| Signs and symptoms of ICP | decreased LOC, changes in behavior, vomiting, headache, neuro defecits, seizures, change in pupil size/reaction, rising systolic BP, respiratory changes, slowing pulse |
| Cushing's triad | bradycardia, rising systolic BP, dypnea |
| drugs that decrease ICP | osmotic diuretics, loop diuretics, corticosteroids, antiseizure medications, barbiturates, neuromuscular blocking agents, sedatives, calcium channel blockers |
| complications related to intracranial tumors | cerebral edema, cerebral blood vessel compression, ruptured blood vessels, seizures (33%), hydrocephalus, severe fluid and electrolyte imbalances |
| how tumors are classified | malignant or benign, then location, then origin |
| open head injury | skull fracture that exposes the dura to the outside |
| closed head injury | no open wound, integrity of the skull is not violated |
| linear skull fracture | crack in one of the bones of the cranium, no bone movement involved |
| basilar skull fracture | fracture at the base of the skull. Hallmark signs include rhinorrhea, otorrhea, raccoon eyes, redness |
| depressed skull fracture | bones of the skull forcefully displaced downward and are embedded into the brain tissue |
| Comminuted skull fracture | multiple fractures, fragmentation of bone tissue |
| compound skull fracture | bone break that also pierces the skin and allows contaminants to reach the brain |
| signs of dural tear or CSF leak | rhinorrhea, otorrhea, "halo" sign with blood tinged discharge, post-nasal drip of CSF |
| tests to determine whether leakage is CSF | "halo" sign, glucose test (present in CSF), beta 2 interferon test (more accurate) |
| Diffuse axonal injury | widespread shearing and rotations forces axonal damage throughout the brain tissue. Prolonged coma, poor prognosis. |
| coup-contra-coupe pattern | brain hits the skull, then recoils and hits the opposite side. |
| Craniotomy | surgical procedure that involves entry into the skull |
| causes of spinal cord injuries | diving, MVA, GSW, falls |
| Complete vs. incomplete | complete - severing of the cord, total loss of function below the level of injury; incomplete - damage to the cord, may allow some function or movement below the level of the injury |
| primary spinal cord injury | initial insult or trauma |
| secondary spinal cord injury | results from metabolic and cellular events that occur due to the primary injury that lead to spinal cord ischemia. If treated within 4-6 hours, usually reversible. |
| semicomatose | state in which one does not move spontaneously. Unresponsive, though painful stimuli might result in stirring or moaning without arousal |
| comatose | state in which one has no verbal or motor response to any sort of stimuli |
| receptive aphasia | inability to understand speech |
| expressive aphasia | inability to speak and form words |
| Glasgow coma scale | Measures eye movement, verbal response, motor response. Scale is 3-15, the lower the number the greater the impairment |
| Cushing's response | increase in arterial pressure that results from increased ICP. Results in hypertension, bradycardia and bradypnea. |
| burr holes | holes drilled into the skull to allow for removal of hematoma or abscess, or accessing the brain |
| neurogenic shock | complication of spinal cord injury caused when there is loss of ANS function below the level of injury. |
Created by:
pinklrt98
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