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Unit 10 - Test 4


What are the levels of consciousness? 1. Alert and oriented 2. Confused and disorganized 3 Lethargy 4. Obtundation 5. Stupor 6. Coma
What is an irreversible coma or a persistent vegetative state Cerebral Death
What is the term when a person is absent cerebral function and unable to maintain physiologic homeostasis Brain Dead (or me after this class)
means thinking skills that include awareness, language calculation and memory. Cognition
organic brain degeneration, progressive, untreatable, irreversible decline in mental function Dementia
false belief brought about without appropriate external stimuli (unrelated to reality) Delusion
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. Delirium
Glasgow Coma Score scale helps to gauge the impact of a wide variety of conditions affecting the patient's what? Level of Consciousness
What are the 3 measured parts of the GCS? Eye opening, verbal response, best motor response
GCS: Score 3 to 8 points =____ Score 9 to 12 points =______ Score 13 to 15 points =__________ 1. severe head injury 2. moderate head injury 3. mild head injury
What is called and what does in look like? - posturing indicates that there may be damage to the cerebral hemispheres, and possibly midbrain. Decorticate ( limbs point towards the core)
What is called and what does it look like? - posturing is usually indicative of more severe damage indicating a lesion lower in the brainstem. Decerebrate (hands point away from the body)
This is characterized by limp (floppy) unresponsive muscles. Flaccid Paralysis
The most dangerous outcome of cerebral edema and the most serious complication of a head injury is what? Increased intracranial pressure
Blood-brain barrier damage causes increased capillary permeability. This occurs w/ conditions that impair the function of the blood-brain barrier & allow transfer of water & proteins from the vascular space to interstitial space = swollen brain tissue Vasogenic Edema
The blood–brain barrier remains intact but a disruption in cellular metabolism impairs functioning of the sodium/potassium pump. Cytotoxic Edema
In Cytotoxic Edema active transport failure leads to ___ loss and ____ retention increasing cellular H2O. This leads to ______ of brain tissue and necrosis of brain cells. K+, Na+, ischemia
When treating for cerebral edema how should you position patients. Why? Elevated the head of the bed to 30 degrees because gravity allows for better brain drainage.
What type of medications and IV fluids should be given when treating a cerebral edema patient? Why? 1. Diuretics to increase production of urine 2. Corticosteroids to suppress the inflammatory response and reduce swelling 3. Hypertonic IV Fluids to pull fluid out of the brain ex: mannitol
What is surgical decompression? removing part of the skull allows the brain to swell without being compressed.
What are the early signs of ICP? (6) 1. decreased LOC 2. Pupil changes 3. Vision abnormalities 4. Vomiting 5. Nuchal rigidity (stiff neck)
Vomiting and vision abnormalities are early signs of ICP. Why Vision because brain swelling puts pressure on optic nerve and oculomotor nerve. Vomiting because pressure on the vagal nerve center of the brain controls vomiting.
What are the late signs of ICP? (3) 1. Impaired reflexes (corneal, gag, and swallowing) 2. Papilledema (optic disc swelling) 3. Abnormal posturing - Decorticate/decerebrate
In shock you have the following: increased pulse and respirations decrease BP What do you have with ICP? Decreased pulse and respirations increased BP
When do you see Cushing's Triad vital sign changes? What are the changes Seen when ICP is putting pressure on the brain stem. The vital sign changes are Hypertention, Bradycardia, Hypoventilation
In Cushing's Triad what is widening pulse pressure referring too? Hypertetion - the difference between systolic and diastolic B/P increase
Why is Bradycardia part of Cushing's Triad? reflexive slowing of the heart to compensate for increased B/P
A vital sign of Cushing's Triad is hypoventilation. Respiration slows down (can be irregular and deep). What does this lead to? hypercapnia which cause vasodialation leading to worse cerebral edema and increased ICP.
Contusions, Hematoma’s, Concussions; Diffuse Axonal Injury; Traumatic Subarachnoid Hemorrhage are all what type of brain injury? Primary brain injury
What type of brain injury? – Causes damage to parts of the brain that were not initially injured – Damage caused by the inflammation process – Swelling --> ICP ---> brain herniation ---> tissue necrosis Secondary brain injury
What are s/s of a Traumatic Brain Injury? Loss of consciousness, headache, vomiting, drowsy, confusion, seizure, drowsiness, restlessness, agitation, LOC changes, contralateral hemiplegia, ICP, signs of herniation.
Ecchymosis around the eyes (“raccoon eyes”) or behind the ears (“battle sign”) are s/s of what? basilar skull fracture
What can indicate a skull fracture and how do you check it? fluid draining from ears and/or nose. Check with a glucometer for the presence of glucose (cerebral spinal fluid)
T or F - 1. H.I. can result from a ground level fall, especially in the elderly True
T or F - You should move a person with any H.I. right away to make sure they are safe and to get their head elevated. F - Always assume C-spine injury will occur with any H.I ( do not move injured person)
What is the condition: Possible transient loss of consciousness. CT scan is normal Concussion
S/S are headaches and memory lapse concussion
Bruising of the brain surface underneath a fracture or at the under-surface of the frontal and temporal lobes, due to shearing forces. Diagnosed on CT scan. Contusion
What is the diagnostic test for a contusion CT scan
Tearing of the brain substance. Diagnosed by CT scan Laceration
how is a brain laceration diagnosed CT SCan
This is localized in the glial cells, myelin sheaths, and intercellular spaces. It causes increased intracranial pressure, which may impair brain circulation, or result in brain herniation. Brain/ Cerebral edema
T or F - Early CT scans are the best way to diagnose Brain/ cerebral edema. False - early CT scans may miss this. Later CT scans or MRI show edema more reliably.
what is displacement of brain tissue towards the other side of the brain which increases pressure on the non-injured side. Herniation
What is coup-contrecoup? What are the results? . Acceleration–deceleration head injury - hitting both front and back of head. Results in brain contusions and hematomas (more than one injury from the same blow).
Focal brain necrosis due to complete and prolonged ischemia that affects all tissue elements (neurons, glia, and vessels). Cerebrovascular infarction
What is an Epidural Hematoma? blood clot that forms between the skull and the top lining of the brain (dura). Usually an ARTERIAL bleed so can expand very quickly.
ipsilateral pupil dilation is an early sign of what? Epidural Hematoma
What test helps determine whether a CT scan is needed in people with suspected concussion? What does it measure Brain Trauma Indicator (BTI) - measures ubiquitin C-terminal hydrolase (UCH-L1) and glial fibrillary acidic protein (GFAP). These are rapidly released by the brain into the blood within 12 hours of serious brain injury.
A blood clot that forms between the dura and the brain tissue. May be either arterial or venous bleed but is usually venous Subdural Hematoma
A blood clot deep in the middle of the brain that is hard to remove. Pressure from this clot may cause damage to the brain. Surgery may be needed to relieve the pressure. Can be either arterial or venous. Intracerebral Hematoma
What are the 3 stages of Alzheimer's disease? 1. Short-term memory loss 2. Confusional stage (Disorientation, lack of insight, impaired hygiene and language use, “sundowner” syndrome) 3. Incontinence; long-term memory loss (inability to recognize family and friends)
What are the risk factors for Alzheimer's disease? Age Heredity (genetic predisposition) Family HX Hispanics and African-Americans are at greater risk (connection btw heart &brain health)
T or F: . There is growing evidence that diabetes, high blood pressure and high cholesterol — may also be risk factors for Alzheimer’s and stroke-related dementia. True
s/s of what: Mental changes begin with “Recent Memory” loss then progress to “Remote Memory” loss. Signs of mental damage precede the physical signs of illness progression. Alzheimer's
What is the most common pathology for CVA/ Stroke. Ischemic (Thrombotic) - Thrombi cause arterial occlusion (narrows blood vessel)
s/s of what: Acute onset (hrs to days), occasional headache, no LOC, + history of TIA’s Ischemic (Thrombotic) brain attack
How would you treat an ischemic brain attack? Decrease edema and ICP
s/s of what: Acute onset, often moderate Head ache, occasional brief LOC, no history of TIA’s Embolic brain attack
How would you treat an embolic brain attack? anticoagulants and eliminate cause
s/s of what: Acute onset, severe head ache, + stiff neck, + LOC, + blood in Cerebral Spinal Fluid Hemorrhagic brain attack
how would you treat a hemorrhagic brain attack? Stop bleed, decrease ICP & vasospasm (NO ANTICOAGS)
What are the non modifiable risk factors for brain attacks/ stroke? (5) 1.Genetics (family history) 2. Age (>55) 3. Gender ( men more than women) 4. Race (Black and Hispanic) 5. Medical history. Having had a prior stroke, Transient Ischemic Attack or heart attack
Overconsumption of alcohol, Use of cocaine or amphetamines, Vasculitis (inflamed blood vessels) and Birth control pills are some modifiable risk factors for brain attacks/ stroke. What are the other modifiable risk factors. (8) 1.High blood pressure 2. smoking 3, Atherosclerosis narrowing /stiffening of the arteries from plaque 4. Diabetes 5. Atrial fibrillation 6, High cholesterol levels 7, Overweight-especially abdominal fa 8. Lack of exercise
loss of comprehension or production of language that impairs the patient’s ability to communicate. Aphasia
What are the two type of aphasia? How are they different? 1-Expressive Aphasia: Patient understands what is being said to them but cannot speak (or “express” themselves) coherently. 2-Receptive Aphasia: Patient can speak coherently but does not understand (is not “receiving”) what is being said to them.
In stroke treatment what is vital in for saving brain tissue? Time
Thrombolytic (clot busters) medicine generally must be given in the first 3 hours and can be given for ________ or ______ stokes but can not be given for ________ strokes because it will cause more bleeding in the brain. (Ischemic strokes) thrombolytic or Embolic ----- Not Hemorrhagic
This considered "angina of the brain" or a ministroke Transient Ischemic Attack (TIA)
Brief episodes of neurologic dysfunction. Can have all the S/S of a stroke but reverses before infarction occurs. They are temporary and resolve without treatment. No Permanent damage. TIA
TIA’s are a warning sign for a ____ since they frequently precede ________brain attack. About 1 in 3 people who have a TIA will eventually have a stroke, with about half occurring within a year after the transient ischemic attack. stroke, Thrombotic
What part of the spine is damaged: quadriplegia (paralysis that results in the partial or total loss of use of all limbs and torso). Cervical spine
What part of the spine is damaged: paraplegia (impairment in motor or sensory function of the lower extremities). Thoracic Spine (T1- T7)
What part of the spine is damaged: : Requires mechanical ventilation of the patient C1 - C3
all reflexes including somatic (voluntary) and autonomic involuntary) are temporary lost below level of injury. Average 1-3 weeks but may be up to 3 months. Resolves as edema/injury resolves. Spinal Shock
What could a spinal shock patient have for up to a year after sensations returns? hyperreflexia (spacisity)
Spinal cord remains intact but could be contused (“bruised”) and swollen, thereby preventing conduction of nerve signals below the point of injury. Compressed
Spinal cord is completely severed. Transected
What could it indicated if Involuntary Anal Reflex (anal wink) is present in a person who is paralyzed after a spinal cord injury? The spinal injury may be incomplete and chances of recovery are higher.
Some function (either motor, sensory or both) is preserved. Only a portion of the spinal cord may be injured (i.e., Central Cord Syndrome and Anterior Cord Syndrome). Incomplete Spinal injury
All function (motor, sensory, reflex, and autonomic function) is lost below the damaged spinal cord. Complete spinal injury
A condition common in patients with spinal cord injuries. Dangerously high blood pressure (high enough to cause a stroke or seizures) Autonomic Dysreflexia
Autonomic dysreflexia is often triggered by a _______ stimulus below the spinal cord injury such as a________ _____. “noxious", full bladder
What are some triggers for autonomic dysreflexia other than noxious stimulus? UTIs; overfull bowel; GI problems; pressure sores; sexual activity; tight clothing; temperature extremes or quick temperature changes; skin problems or even ingrown nails.
In Autonomic Dysreflexia a strong sensory input travels up the spinal cord and evokes a massive reflex sympathetic surge from the thoracolumbar sympathetic nerves, causing widespread ________. vasoconstriction
In Autonomic Dysreflexia the sympathetic nerves prevail _____ the level of neurologic injury, and the parasympathetic nerves prevail ______ the level of injury. below, above
The sympathetic response causes _______ Below the injury; parasympathetic nerves _____Above the injury. The vasoconstriction below the injury causes HYPERTENSION, bradycardia, pounding headache, visual changes, anxiety; pallor; & goose bumps below injury Vasoconstriction, Vasodialation
S/s for Autonomic Dysreflexia included Hypertention (due to vasoconstriction); pounding headache. and A slow heart rate (bradycardia)-to compensate for Hypertention. What are the s/s above and below the sight of injury? ABOVE: - A flushed face and/or red blotches on the skin above the spinal injury (due to vasodilation) and Sweating above the level of injury. BELOW - Pale, cold, clammy skin below the level of injury. - Goose bumps below the level of spinal injury.
What are the three types of meningitis? Which one has a higher mortality rate? What is the most common Viral, Bacterial and fungal - Bacteria is the most sever but Viral is the most common
What type of precautions do you take with Meningitis? Droplet - regular mask minimum
What disease is this: Cerebral Spinal Fluid (CSF) and ventricles become inflamed leading to obstruction of CSF flow, edema of infected tissues, and potential ischemia due to increased ICP. Meningitis
S/S of what: Throbbing headache, Nuchal rigidity (stiff neck), Fever, Photophobia, Projectile vomiting, Altered LOC, Increased ICP, Red purpuric or blotchy rashes that do not blanch when applying pressure, • Kernig’s sign and/or Brudzinski's sign may be s/s of meningitis
Bacterial, viral or fungal meningitis: usually infected by direct exposure. Most serious form of meningitis- can cause long term and or permanent brain damage/death. Bacterial
Bacterial, viral or fungal meningitis: usually from upper respiratory infection – most common cause of meningitis and usually the least severe. Often resolves in 2 weeks without treatment. Viral
Bacterial, viral or fungal meningitis: usually found in immunosuppressed individuals. Fungal
the term used for a group of s/s that are commonly present (but not always) when the meninges is irritated, as in infection [meningitis], subarachnoid hemorrhages, or other diseases. Meningism
intolerance of bright light photophobia
is the inability to flex the neck forward due to rigidity of the neck muscles Nuchal Rigidity
A type of spasm of the whole body that leads to legs and head being bent back and body bowed backwards. Can occur in some types of meningitis, tetanus, strychnine poisoning. Opisthotonus
___________ is positive when the thigh is bent at the hip and knee at 90-degree angles, and subsequent extension in the knee is painful (leading to resistance). Kernig's
Kernig's can indicate what? subarachnoid hemorrhage or meningitis
Need continuous stimuli to maintain arousal Obtundation
Indicates a lesion in the brainstem Decerebrate Posturing
One side of the brain moves towards the other side due to swelling Herniation
Possible transient loss of consciousness Concussion
indicates a lession in the cerbral hemispheres/ midbrain Decorticate Posturing
Limp (floppy) unresponsive muscles Flaccid Paralysis
Occurs when integrity of the blood brain barrier is disrupted Aneurysm
Inability to comprehend, integrate and express language Aphasia
Deprivation of oxygen with maintained blood flow Hypoxia
Deprivation of oxygen with reduced or interrupted blood flow Ischemia
orientated but slowed motor and speech skills Lethargy
vocalization of pain but has decreased motor movement stupor
does not respond appropriately to stimuli. No verbal response Coma
Paralysis of one side of the body hemiplegia
Results form the destruction of pyramidal upper motor neurons innervation resulting in paralysis restricted to one limb or region of the body. Monoplegia
Paralysis of corresponding parts on both side of the body. (upper or lower limbs) Dipplegia/ Paraplegia
Paralysis of all 4 limbs tetraplegia/ quadriplegia
_______ is the appearance of involuntary lifting of the legs when lifting a patient's head while the patient is lying supine. Brudzinski's neck sign
Created by: sbertelsen



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