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Nur 412 Neurological
Neuro flip cards
| Question | Answer |
|---|---|
| What pattern does brain function follow after impairment? | Loss of consciousness from higher functions to lower functions |
| What is the first stage of impairment? | Responds to verbal stimuli; decreased concentration;agitation; confusion;lethargy;disorientation |
| What is the second stage of impairment? | Requires continuous stimulation to arouse |
| What is the third stage of impairment? | Reflexive positioning to pain stimulus |
| What is the final stage of impairment? | No response to stimuli |
| What is decorticate posturing? | Hands pulled to chest and hyper-extended/ |
| What is deceregrate posturing? | Hands pushed to sides and body hyper-extended. |
| What is arousal? | alertness (function of the RAS , duffuse system of neurons in the thalamus and upper brainstem) |
| What is cognition? | activities controlled by cerebral hemispheres including thought processes, memory, perception, problem solving and emotion |
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| What is COMA? | unarousable; will not stir or moan in response to stimulus; may have non-purposeful response to an area stimulated but does not withdraw. Usually due to severe head injury or global anoxia. |
| What is irreversible COMA? | (persistent vegetative state): usually due to severe head injury or global anoxia Death of cerebral hemispheres but intact brainstem and cerebellum Complete unawareness of self and environment |
| What other symptoms of irreversible coma? | Sleep-wake cycles intact Chews, swallows, coughs Eyes wander but cannot track |
| What is a minimally conscious state? | aware of environment and can follow simple commands; may respond (blink or smile) to a stimulus |
| What is locked in syndrome? | alert and fully aware, with motor paralysis of all voluntary muscles; only cranial nerves I-IV intact--can communicate via eye movements and blinking. Usually caused by infarction or hemorrhage in pons that disrupts outgoing nerve tracts but spares RAS |
| What is Brain Death? | irreversibility and loss of all brain functions, including brainstem; no evidence of cerebral or brainstem function for an extended period (6-24hrs) with normal body temperature |
| What is the criteria of Brain Death? | Unresponsive coma with absent motor and reflex movements No spontaneous respirations (apnea) Pupils fixed (unresponsive to light) and dilated |
| What is the prognosis of altered LOCs? | Lowered age and health - better; Consciousness w/in 2 weeks favorable outcome. No pupil reactivity or reflex 6 hours post onset, poor prognosis. |
| Management of COMA or LOC changes: focus | Airway breathing and circulation |
| Management of COMA or LOC changes: Initial Therapy | maintain airway/breathing during acute phase (oral pharyngeal airway; endotracheal intubation with or without mechanical ventilation); support circulation with IV fluids (slightly hypertonic like Lactated Ringers or normal saline) and correct imabalances |
| Management of COMA or LOC changes: Long Term therapy | tracheostomy; G tube; Treatment depends on causation |
| Diagnostic Tests: Blod Glucose | Blood glucose-if hypoglycemia suspected (less than 40-50 mg/dL causes rapid cerebral decline) |
| Diagnostic Tests: Serum electrolytes | (Na, K, Bicarb, Cl, Ca)-to check for metabolic disturbances |
| Diagnostic Tests: Osmolality | hyperosmolality causes brain dehydration; hypoosmolality causes cerebral edema |
| Diagnostic Tests: ABG's | to determine arterial PO2, PCO2 and acid-base status; hypoxemia can alter LOC; high CO2 is toxic to brain and can induce coma especially when acute |
| Diagnostic Tests: Serum creatinine and BUN | to evaluate renal function Liver function tests- bilirubin, AST, ALT, LDH, serum albumin, serum ammonia (can affect LOC) |
| Diagnostic Tests: Toxicology | blood and urine-to check for alcohol and drugs that could affect LOC |
| Diagnostic Tests: CBC with differential | to check for anemia and infection |
| Diagnostic Tests: CT and MRI | to detect hemorrhage, tumors, cysts, edema, brain atrophy, displacement of brain structures |
| Diagnostic Tests: EEG | to detect unrecognized seizure activity; normal EEG may indicate locked |
| Diagnostic Tests: Radioisotope brain scan | to identify abnormal lesions and evaluate cerebral blood flow |
| Diagnostic Tests: Cerebral angiogram | to identify aneurysms, occluded vessels, tumors, lack of blood flow and brain death |
| Diagnostic Tests: Transcranial doppler studies | to assess cerebral blood flow |
| Diagnostic Tests: Lumbar puncture with CSF analysis | to determine if infection or meningitis |
| Medications: Low blood glucose | 50% dextrose IV push |
| Medications: High blood glucose | insulin IV |
| Medications: Narcotic overdose | naloxone (Narcan) IV push |
| Medications: Menigitis | antibiotics IV |
| Medications: Electrolyte imbalances | correct them |
| Nursing diagnosis: Unconscious patient | Ineffective airway clearance (cough reflex may be absent)—suction, ET tube or trach care, turn q2 hrs, side-lying position |
| Risk for aspiration: Unconscious Patient | NPO, side-lying, good oral hygiene, assess lungs, ABGs or pulse oximetry |
| Family care: Unconscious Patient | Education on disorder; Encourage to talk with patient; Provide support ( may be uncertain prognosis); Allow to stay with patient when desired |
| Increased Intracranial Pressure: ICP | ICP is pressure within cranial cavity, measured as pressure in lateral ventricles |
| ICP cranial pressure | Normally increases with coughing, sneezing, straining (Valsalva), bending forward |
| ICP Sustained pressure | Sustained increases lead to ischemia and damage to neural tissue: most frequent cause is cerebral edema; other causes are trauma, tumor, abscess,stroke, inflammation, hemorrhage |
| ICP: sustained pressure values | Sustained elevation (10 mm Hg or higher) |
| ICP: Patho | Interruption of the cerebral blood flow Leads to ischemia Disruption of cellular metabolism |
| ICP: Etilogy | Space-occupying lesion Hydrocephalus Cerebral edema Excess CSF Intracranial hemorrhage |
| ICP: Manifestations | Mental status changes; Decreased LOC; Hemiparesis - Weakness; Hemiplegia - paralysis Posturing |
| ICP Manifestations: Most important | Cushing’s triad (increase SBP, widening pulse pressure, bradycardia) |
| Cerebral Edema | Abnormal Accumulation of Fluid in the Brain |
| Hydrocephalus | Progressive Dilatation of Ventricular System; Abnormal accumulation of CSF and treated with a shunt |
| Brain Herniation: Definition | Displacement of brain tissue; movement is down into the spinal column, affecting all of the vital centers. |
| Brain Herniation: diagnosis | Identifying and treating underlying cause |
| Brain herniation: DO NOT DO | Lumbar puncture is not performed |
| Increased Intracranial Pressure: Diagnostic Testing | CT, MRI;Cerebral angiography, brain scan;Transcranial doppler;Lumbar puncture;Serum glucose, electrolytes, molality;ABGs, liver function tests, toxicology |
| Brain Herniation: Treatments | Careful assessment of ICP Intubation, mechanical ventilation |
| Brain Herniation: Nursing Diagnosis | Ineffective tissue perfusion: cerebral Risk for infection |
| Traumatic Brain Injury | Any injury of the scalp, skull, or brain |
| Traumatic Brain Injury | Leading cause of death and disability in the US |
| Traumatic Brain Injury: Penetrating | Open |
| Traumatic Brain Injury: Closed | Blunt Trauma |
| Traumatic Brain Injury: Accelerated | Head is struck by an object |
| Traumatic Brain Injury: Decelerated | Head hits a stationary object |
| Traumatic Brain Injury: Coup-Contrecoup | Head is flung forward an hits an object then is flung backwards and hits another object (Auto accident where head hits windshield and then hits head rest) |
| Basal Skull Fractures | Base of head fracture, can cause dura matter to be torn. spinal fluid coming out of the nose or ear. When looking in ear, and see blood behind the membrane (hemotempanum), that is a basal fracture; Raccoon eyes; Battle's sign bruising behind the ear. |
| Treatment for spinal fluid loss | Prevent encouragement of further loss: No sneezing, do not blow nose, NO SUCTIONING |
| Antibiotics used in Basal Skull Fracture | Due to risk of infection |
| Head injury: Two types | Primary and secondary |
| Primary head injury | Initial injury to the head |
| Secondary | Swelling of the brain, cerebral edema, hematoma, ischemia, infection |
| Focal Brain Injury | Confined to one area; intracranial hemorrhae, contusion, epidural hematoma, subdural hematoma |
| Epidural hematoma | artery is torn. Initially patient is fine, followed by a rapid decline (Liam Neeson's wife) |
| Mild concussion | Dizzy, visual changes, ante(before the accident) and/or retrograde(After the accident) amnesia. |
| Postconcussion Syndrome | May last several weeks up to a year |
| Postconcussion Syndrome: Manifestations | Persistent headache; Dizziness; Irritability; Insomnia; Impaired memory and concentration; Learning problems |
Created by:
mpabner
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