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Med-Surg > Neurological > Flashcards

Neurological Flashcards

1
Q

A brain insult that results from a mechanical disruption of brain tissue from an external impact or injury to the head refers to

A

traumatic brain injury

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2
Q

4 lobes of the brain

A

frontal, parietal, temporal, occipital

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3
Q

3 points that death occurs at after a TBI?

A

(1) immediately after injury
(2) within 2 hrs of injury
(3) approx. 3 weeks after injury

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4
Q

4 ventricles containing CSF?

A

right cerebral hemisphere, left cerebral hemisphere, midbrain, central canal of the spinal cord

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5
Q

“a change in any one of these components must be accompanied by a reciprocal change in one or both of the other components. If this reciprocal change is not accomplished, the result is an increase in intracranial pressure” this is known as

A

Monroe-Kellie hypothesis

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6
Q

formula for ICP?

A

Brain volume (80%) + cerebral blood volume (12%) + CSF (8%)

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7
Q

Normal ICP

A

0 - 15 mmHg

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8
Q

the pressure gradient associated with cerebral blood flow (CBF) that is necessary to supply adequate amounts of blood to the brain refers to

A

cerebral perfusion pressure (CPP)

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9
Q

CPP must be greater than ____ to ensure adequate cerebral perfusion

A

70 mmHg

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10
Q

CPP formula

A

MAP (mean arterial pressure) - ICP = CPP

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11
Q

A brain insult that results from a mechanical disruption of brain tissue from an external impact or injury to the head refers to

A

TBI

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12
Q

transportation related accidents account for _____ of all TBI’s

A

50%

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13
Q

3 primary mechanisms of injury associated with TBI?

A

(1) acceleration/deceleration
(2) rotational
(3) penetration

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14
Q

acceleration injury occurs when

A

a moving blunt object strikes the head involving transfer of injury along a linear path - causes injury at site of impact

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15
Q

deceleration injury occurs when

A

the head strikes an immovable object and as the skull ceases movement, the brain continues to move until it hits the skull - force of deceleration causes brain injury as it hits the skull

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16
Q

what is coup-countre coup injury?

A

occurs when following the initial acceleration (coup) injury, the brain rebounds and sustains additional decelerations (countre coup) injury

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17
Q

rotational injuries occur when

A

rotational forces cause the brain to twist within the meninges and the skull, resulting in stretching and tearing of blood vessels and shearing of neurons

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18
Q

primary brain injury occurs

A

at the moment of impact as a result of mechanical forces to the head

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19
Q

secondary brain injury occurs

A

at the biochemical and cellular response to the initial trauma that can exacerbate the primary injury and cause loss of brain tissue not originally damaged

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20
Q

skull fractures are caused by

A

substantial force absorbed by the skull with or without underlying brain tissue injury

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21
Q

clinical manifestations associated with a basilar skull fracture

A

CSF coming out of the ears and nose, racoon eyes, Battle’s sign, positive halo sign

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22
Q

what is a positive halo sign

A

a clot in the CSF

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23
Q

what is Battle’s sign

A

bruising / hematoma around the ear

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24
Q

focal brain injuries

A

injuries localized to the area of direct injury in the brain

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25
Q

cerebral hematoma

A
  • result of injury to a cerebral vein or artery
  • a group of focal cerebral injuries associated with the accumulation of blood in the cranial vault
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26
Q

subdural hematoma (SDH)

A

accumulation of blood between the dura and the arachnoid layers of the meninges

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27
Q

Subdural hematoma is usually secondary to

A

venous injury in subdural space leading to slow onset of symptoms often not recognized for days or weeks

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28
Q

acute subdural hematoma is less than __ hrs

A

48

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29
Q

what are the symptoms of acute subdural hematoma

A

drowsiness, headache, confusion, slowed thinking, agitation, unilateral abnormality

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30
Q

chronic subdural hematoma lasts for ___ weeks

A

2

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31
Q

symptoms of chronic subdural hematoma

A

headache, lethargy, absent-mindedness, vomiting, seizures, stiff-neck, pupil changes, hemiparesis

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32
Q

epidural hematoma occurs in

A

the space between the dura mater and the skull

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33
Q

typical sign of epidural hematoma

A

brief loss of consciousness followed by an episode of being alert and orient, and then another episode of loss of consciousness

34
Q

hallmark of epidural hematoma

A

dilated and fixed pupil on the same side as the impacted area

35
Q

intracerebral hematoma (ICH)

A

bleeding directly into the cerebral tissue resulting in destruction of cerebral tissue, cerebral edema and increased ICP

36
Q

clinical manifestations fo intracerebral hematoma

A

headache with reduced LOC, unilateral pupil dilation, hemiplegia

37
Q

contusion

A

bruising of soft tissue
- commonly seen in TBIs

38
Q

diffuse head injuries occur in _______ areas of the brain

A

several

39
Q

diffuse head injuries include

A

concussion, diffuse axonal injury (DAI), subarachnoid hemorrhage (SAH)

40
Q

S&S of concussion

A

amnesia, headache, dizziness, vertigo, n+v, slurred speech, confusion, inability to function at pre-injury level, might lose consciousness

41
Q

diffuse axonal injury occurs as a result of

A

damage to the axons or disruption of axonal transmission to the neural impulses
- stretching and tearing of axons d/t movement of the brain inside the cranium at the time of impact

42
Q

subarachnoid hemorrhage

A

accumulation of blood/hematoma between the arachnoid layer of the meninges and brain

43
Q

complications associated with increased ICP

A

diabetes insipidus, syndrome of inappropriate antidiuretic hormone, cerebral salt wasting, seizure activity, brain herniation, brain death

44
Q

spinal cord injury (SCI)

A

sudden traumatic injury that either results in a bruise, a partial injury or a complete injury to the spinal cord

45
Q

most common neurological level of SCI

A

C5

46
Q

in paraplegia what is the most common level of injury?

A

T12

47
Q

a secondary SCI occurs as a result of

A

vascular injury to the cord

48
Q

primary SCI

A

neurological damage that occurs at the moment of impact

49
Q

what are the goals of nursing care for SCI

A
  • Maximize potential for neurological recovery
  • Prevent or minimize complications
  • Regain life skills and independence
50
Q

neurogenic shock occurs with

A

SCI above T6

51
Q

spinal shock usually occurs ______ mins after injury

A

30 - 60 mins

52
Q

clinical manifestations of acute SCI

A

muscle weakness, loss of voluntary muscle movement and/or feeling in chest/arms/legs, breathing problems, loss of bowel and bladder function, changes in fertility (more in men than women), inability to regulate BP effectively, reduced control of body temperature, inability to sweat below level of injury, chronic pain

53
Q

signs of autonomic dysreflexia

A

increased BP (vasoconstriction), increased blood sugar, decreased elimination, flushing (vasodilation), bradycardia (below 40)

54
Q

brain volume remains constant through the blood brain barrier unless

A

disrupted by trauma or metabolic abnormalities (should be 80% of ICP)

55
Q

epidural hematoma is common with high impact to

A

temporal area

56
Q

unstable SCI

A

damage to two or more spinal columns

57
Q

cerebral blood volume is maintained at a

A

constant level through cerebral blood flow (should be 12% of ICP)

58
Q

classifications of diffuse axonal injuries

A

mild - coma less than 24 hrs
moderate - coma more than 24 hrs with transient flexor or extensor posturing
severe - coma prolonged, fever, diaphoresis, severe extensor posturing

59
Q

3 types of subdural hematoma

A

acute - symptoms within 24-48 hrs of injury
subacute - symptoms within 2-14 days of injury
chronic - symptoms after 2+ weeks after injury

60
Q

___% of SCI pts develop persistent neuropathic pain

A

40%

61
Q

sympathetic nervous system responses in autonomic dysreflexia

A

increased perfusion and ventilation - increases BP, increased blood sugar, decreased elimination and digestion

62
Q

how do you assess cerebral tissue perfusion

A

LOC, PERRLA, oculomotor responses, vitals, CN reflexes, ICP monitoring, cerebral oxygenation monitoring, CT, MRI, EEG, cerebral angiography, lumbar puncture, transcranial doppler

63
Q

what are the parasympathetic nervous system responses in autonomic dysreflexia

A

massive vasodilation - causes flushing, bradycardia - below 40

64
Q

management of subdural hematoma

A

surgical evacuation of hematoma, possible placement of subdural drain, monitoring LOC and neurological assessments

65
Q

upper motor neurons of the _______ and lower motor neurons of _______ in the central horn of the spinal cord carry impulses that affect _______________

A

brain
cell bodies
movement

66
Q

intracranial pressure is the pressure exerted by:

A

the CSF within the ventricles

67
Q

CSF should make up how much of the ICP

A

8%

68
Q

motor neurons regulate

A

visceral organs, innervate smooth and cardiac muscles, and glands

69
Q

peripheral sensory nerves transmit stimulation from

A

sensory receptors in the skin, muscles, sensory organs, and viscera to the dorsal horn of the spinal cord

70
Q

auto regulation of blood flow

A

constant supply of blood to the brain regardless of systemic BP changes (matching CBF with metabolic needs leads to auto regulation)

71
Q

S&S of subarachnoid hemorrhage

A

severe headache, intracranial hypotension, neck stiffness (nuchal rigidity)

72
Q

management of epidural hematoma

A
  • surgical evacuation of the hematoma
  • possible placement of ICP monitor
  • admission to ICU for neurological checks and ICP monitoring
  • observe for sudden changes in LOC or a unilateral, fixed, and dilated pupil
73
Q

what is considered a first-line treatment for neuropathic pain?

A

gabapentin

74
Q

management of diffuse head injuries

A
  • not localized to a particular area so it is difficult to diagnose and treat
  • recovery depends on severity of injury
  • neurological assessments and pain management
  • in moderate to severe injury you want to decreased ICP, increase CPP, and stabilize VS
  • rehabilitation may be required
75
Q

the brain attempts to meet metabolic demands by increasing or decreasing ____________________________ as required

A

cerebral blood flow

76
Q

functions of CSF

A
  • cushioning and supporting the brain/ spinal cord
  • nourishing brain tissue
  • removal of wastes
  • monitoring carbon dioxide levels
77
Q

management of intracerebral hematoma

A
  • manage cerebral edema
    -promote adequate cerebral perfusion
  • hemorrhage may be reabsorbed over a period of time
  • surgical evacuation usually not possible due to location
78
Q

CSF is produced by

A

the choroid plexus

79
Q

what arteries are included in the circle of willis?

A
  1. Anterior Cerebral
  2. Anterior Communicating
  3. Posterior Communicating
  4. Posterior Cerebral
80
Q

autonomic dysreflexia occurs more often if injury is

A

T6 and above

81
Q

CSF is comprised of what

A

mainly water in addition to protein, sodium, chloride, potassium, bicarbonate & glucose

82
Q

CSF should not contain

A

RBC

Med-Surg (15 decks)

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