Acute Intracranial Problems

Question 1

3 Compartments of total volume of ICP

Answer 1

brain tissue, blood, cerebrospinal fluid (CSF)

Question 2

Increased ICP clinical manifestations

Answer 2

changes in level of consciousness

vital signs - HTN, bradycardia, full bounding pulse, irregular respirations

Ocular Signs - pupil dilation

Motor Function - hemiparesis or hemiplagia

headache/vomiting

Question 3

Spontaneous abnormal motor function

Answer 3

occurs without regard to external stimuli and may not occur by request

Question 4

Localization abnormal motor function

Answer 4

occurs when the extremity opposite the extremity receiving pain crosses middling of the body in an attempt to remove the noxious stimulus from the affected limb

Question 5

withdrawal abnormal motor function

Answer 5

occurs when the extremity receiving the painful stimulus flexes normally in an attempt to avoid the noxious stimulus

Question 6

Decortication abnormal motor function

Answer 6

abnormal flexion response that may occur spontaneously or in response to noxious stimuli

Question 7

Flaccid abnormal motor function

Answer 7

no response to painful stimuli

Question 8

Decerebrate posture

Answer 8

results from damage to the upper brain stem

the arms are adducted and extended with the wrists pronated and the fingers flexed. The legs are stiffly extended with plantar flexion of the feet

Question 9

Decorticate posture

Answer 9

Results from damage to 1 or both corticospinal tracts

the arms are adducted and flexed, with the writs and fingers flexed on the chest. The legs are stiffly extended and internally rotated, with plantar flexion of the feet

Question 10

Increased ICP dx studies

Answer 10

MRI, CT scan, cerebral angiography, EEG, ICP measurement

Question 11

Increased ICP - nursing intervention

Answer 11

respiratory function - maintain airway

Fluid/electrolyte balance - daily weights, monitor BS, Na, K, Mg

Monitoring ICP - early s/s of intracranial HTN

Body position - HOB elevated

Protection from injury - confusion, agitation, possible seizures

Psychological considerations

Question 12

Primary brain tumors

Answer 12

benign or malignant

gliomas - most common (astrocytoma, Glioblastoma multiforme)

More than half are malignant

Question 13

Secondary brain tumors

Answer 13

metastasis from a malignant neoplasm (tumor)

Question 14

brain tumor clinical manifestations

Answer 14

headache - common
seizures (common in gliomas and brain metastasis)
N/V
cognitive dysfunction (including memory problems and mood or personality changes)
Muscle weakness
Sensory Loss
Aphasia

Question 15

Brain tumor complications

Answer 15

cerebral edema/inflammation
increased ICP
neurological deficiets
hydrocephalus
pituitary dysfunction

Question 16

brain tumor dx studies

Answer 16

MRI, PET scan, CT scan

Question 17

brain tumor collaborative tx

Answer 17

identifying the tumor type and location

removing or decreasing tumor mass

preventing or managing ICP

Surgical tx - preferred
Radiation/Chemo
Shunt

Question 18

Stereotactic surgery

Answer 18

used with greater frequency to perform a biopsy and remove small brain tumors

Question 19

bacterial meningitis

Answer 19

acute inflammation of the pia mater and arachnoid membrane surrounding the brain and spinal cord

Leading causes: Streptococcus pneumoniae and Neisseria meningitidis

Question 20

bacterial meningitis clinical manifestations

Answer 20

fever, severe headache,
N/V, nuchal rigidity
photophobia, decreased LOC,
s/s of increased ICP may be present
Seizures in 1/3 of cases

Question 21

Kernig’s Sign

Answer 21

physical symptom of meningitis

severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed at 90 degrees

Question 22

Brudzinski’s Sign

Answer 22

physical symptom of meningitis

Severe neck stiffness causes a patient’s hip and knees to flex when the neck is flexed

Question 23

Bacterial Meningitis Complications

Answer 23

Increased ICP - most common
meningoccemia
disseminated intravascular coagulation (DIC)

Residual neurological dysfunction: hemiparesis, dysphasia, hemianopais

cranial nerve dysfunction: CN lll, CN lV, CN Vl, CN Vll, CN Vlll

Question 24

Cranial Nerve lll

Answer 24

oculomotor

Question 25

Cranial Nerve lV

Answer 25

trochlear

Question 26

Cranial Nerve Vl

Answer 26

Abducens

Question 27

Cranial Nerve Vll

Answer 27

Facial

Question 28

Cranial Nerve Vlll

Answer 28

vestibulocochlear

Question 29

Hemianopsia

Answer 29

blindness in half of the visual field

Question 30

Bacterial Meningitis Dx studies

Answer 30

blood culture, CT scan, lumbar puncture, CBC, sputum/throat/nasal culture Skull x-rays

Question 31

bacterial meningitis collaborative care

Answer 31

IV fluids, codeine, acetaminophen, Dexamethasone (decadron), Mannitol (osmitrol) Antibiotics: penetrate blood-brain barrier: PCN, Cephalosporin

Question 32

Bacterial Meningitis Nursing Dx

Answer 32

``` Acute confusion Disturbed sensory perception Acute Pain Hyperthermia Ineffective tissue perfusion (Cerebral) ```

Question 33

Bacterial Meningitis Health Promotion

Answer 33

meningitis vaccine pneumococcal vaccine influenza vaccine vigorous treatment of respiratory illness

Question 34

Bacterial Meningitis acute interventions

Answer 34

``` pain relief position tx for photophobia seizure precautions tx of fever fluid replacement droplet precautions ```

Question 35

Viral Meningitis

Answer 35

spread through direct contact w/ resp. secretions Enteroviruses/arboviruses Human immunodeficiency virus (HIV), Herpes Simplex Virus (HSV) Prognosis: self-limiting

Question 36

viral meningitis clinical manifestations

Answer 36

headache, fever, photophobia, stiff neck

Question 37

viral meningitis dx studies

Answer 37

lumbar puncture

Question 38

viral encephalitis

Answer 38

acute inflammation of the brain usually cause by viruses transmitted through ticks, mosquitoes, west nile virus

Question 39

Viral encephalitis clinical manifestations

Answer 39

fever, headache, N/V alteration in mental status symptoms of increased ICP focal neurological deficits

Question 40

viral encephalitis Dx studies

Answer 40

MRI, PET scan, Lumbar puncture

Question 41

Viral encephalitis collaborative care

Answer 41

``` prevention mosquito control diuretics corticosteroids antiviral meds antiseizure meds ```

Question 42

Brain Abscess

Answer 42

Accumulation of pus within the brain tissue by: streptococci staphylococcus aureus

Question 43

Brain Abscess clinical manifestations

Answer 43

Headache N/V signs of increased ICP focal symptoms

Question 44

Brain Abscess Dx studies

Answer 44

CT scan, MRI

Question 45

Brain Abscess collaborative tx

Answer 45

antimicrobial therapy Surgical drainage Surgical removal