Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 470 > Cerebral perfusion > Flashcards

Cerebral perfusion Flashcards

1
Q

3 components of neuro assessment

A

level of consciousness
pupillary reaction
vital signs (MAP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

components of pupillary assessment

A

size
equality
shape
degree of reactivity to light

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

apraxia

A

inability to perform learned movement
cerebral cortex injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ataxia

A

lack of coordination
cerebellar injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

dyskinesia

A

impaired voluntary movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

hemiplegia

A

paralysis on 1 side of body
lesion of contralateral cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

nystagmus

A

jerking-bobbing of eyes when trying to track
drugs/ETOH, brainstem injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

anesthesia

A

complete absence of sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

paresthesia

A

alteration of sensation
posterior column

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

cranial nerve 1

A

olfactory
sensory: nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

cranial nerve 2

A

optic
sensory: eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

cranial nerve 3

A

oculomotor
motor: all eye muscles except those supplied by 4 and 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

cranial nerve 4

A

trochlear
motor: superior oblique muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

cranial nerve 5

A

trigeminal
sensory: face, sinuses, teeth, etc
motor: muscles of mastication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

cranial nerve 6

A

abducens
motor: external rectus muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

cranial nerve 7

A

facial
motor: muscles of the face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

cranial nerve 8

A

vestibulocochlear
sensory: inner ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

cranial nerve 9

A

glossopharyngeal
motor: pharyngeal musculature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

cranial nerve 10

A

vagus
motor: heart, lungs, bronchi, GI tract
sensory: heart, lungs, bronchi, trachea, larynx, pharynx, GI tract, inner ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

cranial nerve 11

A

accessory
motor: sternocleidomastoid and trapezius muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

cranial nerve 12

A

hypoglossal
motor: muscles of the tounge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

airway assessment

A

maintain c-spine precautions
loose teeth, vomitus, bleeding
edema, neck swelling
LOC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

breathing assessment

A

skin color
breathing spontaneously
respiratory rate/pulse oximetry/ETCO2
chest rise and fall, symmetry
breath sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

circulation assessment

A

skin color
temp
pulse
blood pressure
obvious bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

components of GCS

A

eye opening
verbal response
motor response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

2 types of traumas for TBI

A

blunt
penetrating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

blunt TBI

A

injury with no opening in the skin or communication with the environment
motor vehicle crash, assault, fall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

penetrating TBI

A

foreign object penetrates the body
gunshot, stabbing, impalement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

types of blunt TBIs

A

skull fracture
concussion
contusion
hematoma: epidural, subdural, intracerebral
diffuse axonal injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

linear skull fracture

A

break in bone but no displacement
usually from low velocity injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

depressed skull fracture

A

inward indentation of the skull, requires a powerful impact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

simple skull fracture

A

can be linear or depresses
no fragmentation or communicating lacerations
from low/moderate impact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

comminuted skull fracture

A

multiple linear fractures with fragmentation of bone into many pieces
from direct, high momentum impact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

compound skull fracture

A

depressed fracture and scalp laceration with communicating pathway into the intracranial cavity, severe injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

two tale tell signs of basilar skull fracture

A

racoon eyes
battle sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

concussion

A

occurs after the blow to the head hard enough to move the brain within the skull

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

contusion

A

occurs after a more severe injury when the brain rebounds against the skull from the force of a blow
injury is directly underneath site of impact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

coup-contracoup injury

A

brains hits both sides of skull, side on injury and opposite side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

diffuse axonal injury

A

shearing damage to the pathways (axons) that connect the different areas of the brain
occurs when there is twisting and turning of the brain tissue at the time of injury
brain messages are slowed or lost
torn axons cannot be repaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

two types of stroke

A

hemorrhagic
ischemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

2 types of ischemic stroke

A

embolic
hemorrhagic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

causes of a ischemic stroke

A

thrombosis (develops in brain)
embolism (travels to brain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

causes of a hemorrhagic stroke

A

subarachnoid hemorrhage
intracerebral hemorrhage
rupture of a stressed cerebral vessel, aneurysm, or vascular malformation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

assessment of stroke

A

decreased consciousness
changing personality
drooping mouth and eyelid
paralysis or weakness on one or both sides
arm drift, possible seizures
pupillary changes
increased BP, HR, RR
nausea and vomiting
pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

stroke assessment tools

A

BE FAST
NIH Stroke Scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

BE FAST stroke assessment

A

balance
eyes (vision)
facial droop
arm drift
speech difficulty
time to call

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

stroke diagnostic testing

A

CT scans
MRI
lumbar puncture
doppler ultrasound and duplex imaging
echocardiogram
24 hrs of continuous cardiac monitoring
CT angiography
stroke ambulance and portable CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

medical management of a stroke

A

optimize cerebral oxygenation
maintain a patent airway
restore cerebral blood flow with thrombolytic therapy, tPA
manage BP and temp
minimize risk of stroke recurrence with anti-coagulant/platelet meds
prevent aspiration
PT/OT asap
seizure precautions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

medical management of ischemic stroke

A

infusion of rTPA (tissue plasminogen activator)
mechanical thrombectomy
anticoagulant medications
mannitol for cerebral edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

surgical management of ischemic stroke

A

mechanical thrombectomy
catheters to deliver TPA to site of clot and/or deploy a retrieval device

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

types of mechanical clot removal

A

coil retrievers
aspiration devices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

medical management for hemorrhagic stroke and its vasospasm

A

calcium channel blockers: nimodipine, verapamil
triple H therapy: hypertension, hypervolemia, hemodilution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

medical management for hemorrhagic stroke and its obstructive hydrocephalus

A

external ventricular drain (EVD)
aka “ventric”, “ventriculostomy”

54
Q

surgical management of a hemorrhagic stroke

A

craniotomy
craniectomy
aneurysm clipping or coiling
burr holes

55
Q

epidural hematoma location

A

between skull and the outer endosteal layer of the dura mater

56
Q

is an epidural hematoma an arterial or venous bleed

A

arterial

57
Q

source of epidural hematoma

A

temperoparietal locus: middle meningeal artery (most common)
frontal locus: anterior ethmoidal artery
occipital locus: transverse or sigmoid sinuses
vertex locus: superior sagittal sinus

58
Q

why does an epidural hematoma form a biconvex lens

A

the expansion stops at skull’s sutures, where the dura mater is tightly attached to the skull

59
Q

epidural hematoma symptoms

A

changes in level of consciousness
nausea and vomiting
focal deficits

60
Q

treatment for epidural hematoma

A

rapid surgical evacuation of blood and stopping bleed

61
Q

location of subdural hematoma

A

between the dura and the arachnoid layers

62
Q

source of bleed in a subdural hematoma

A

bridging veins

63
Q

what type of lens is present in a subdural hematoma on xray

A

concave, crescent-shaped lens
because bleed crosses suture lines

64
Q

symptoms of a subdural hematoma

A

gradually increasing headache, confusion, and LOC change

65
Q

location of a subarachnoid hemorrhage

A

bleeding into the subarachnoid space

66
Q

diagnostic tests for subarachnoid hemorrhage

A

CT
lumbar puncture
MRU

67
Q

subarachnoid hemorrhage causes

A

smoking, heavy drinking, illicit drugs
genetic
people between 30 and 40 years of age
more common in women than men

68
Q

treatment of a subarachnoid hemorrhage

A

early neurosurgical intervention

69
Q

nursing care for a subarachnoid hemorrhage

A

CLOSE observation
decrease BP
nimodipine for vasospams
drain care
decrease stimulation, do not cluster care

70
Q

what is an intracerebral blled

A

bleeding anywhere in the brain

71
Q

what causes an intracerebral bleed

A

trauma
severe head injury
abnormalities of the blood vessels
aneurysm
angioma
uncontrolled HTN

72
Q

shearing injury in intracerebral hemorrhage

A

shear forces from brain movement commonly cause vessel laceration and hemorrhage into the parenchyma

73
Q

monroe-kellie hypothesis

A

skull is a rigid compartment filled to capacity with essentially non-compressible contents
if volume rises in one compartment, there has to be a decrease in one of the other compartments for pressure to remain unchanged

74
Q

percentages for the contents of the brain in regards to monroe-kellie hypothesis

A

brain 80%
blood 10%
CSF 10%

75
Q

normal ICP

A

0-15 mmHg

76
Q

increased ICP

A

life threatening
persistent increase 20mmHg or more for >5min

77
Q

autoregulation

A

compensatory mechanism to keep cerebral blood flow constant
cerebral blood vessels automatically constrict or dilate to maintain adequate cerebral perfusion pressure (CPP)

78
Q

factors that impact autoregulation

A

MAP, CO2, O2 levels

79
Q

autoregulation response to increase in MAP

A

cerebral blood vessels constrict so the brain doesn’t get too much blood

80
Q

autoregulation response to decreased MAP

A

cerebral blood vessels dilate to increase blood flow

81
Q

autoregulation response to increase in CO2 or O2 decreases

A

cerebral blood vessels dilate

82
Q

equation for cerebral perfusion pressure

A

CPP = MAP - ICP

83
Q

normal CPP

A

80-100mHg

84
Q

an increase in ICP does what to CPP

A

decreased CPP

85
Q

what happens with a CPP less than 70

A

ischemia and death

86
Q

what happens when MAP gets too high or too low

A

autoregulation does not work :(

87
Q

primary injury

A

damage to the brain from the bio-mechanical effects of the trauma

88
Q

secondary injury

A

the result of the hypotension, hypoxia, and elevated ICP

89
Q

pathophysiology of secondary brain injury

A

primary brain injury ->
inflammatory response triggered by damaged cells ->
increased vascular permeability and vasodilation -> vasogenic edema -> cerebral ischemia and impaired autoregulation -> decreased ATP production and increased lactic acidosis -> increased intracellular influx of Na, Cl, Ca, H2O -> cytotoxic edema -> and repeat at cerebral ischemia

90
Q

neurogenic fever

A

damage to the hypothalamus
core, rectal, and brain temperatures all differ, with brain temp the higheste

91
Q

effects of a fever

A

increased cerebral blood flow and cerebral metabolic rate
increased ICP
increases O2 consumption

92
Q

neurogenic fever nursing implications

A

targeted temp management
antipyretics
cooling devices: washcloths, blankets, fans
prevent shivering (increases O2 demand)
induced hypothermia

93
Q

effects of seizures on the brain

A

increased cerebral metabolic rate and increased ICP

94
Q

indications for dilantin

A

intracranial hemorrhage
witnessed seizure activity
depressed skull fracture
penetrating head wound

95
Q

lorazepam indication

A

seizures

96
Q

lorazepam + seizure nursing implications

A

maintain airway
monitor VS
note timing of seizure (onset + termination)

97
Q

barbiturate coma (BI)

A

reduces cerebral blood flow and O2 consumption
effects of noxious stimuli are blunted thus stopping increases in ICP

98
Q

care of the brain injured patient

A

oxygen delivery!
keep CPP 80-100mmHg

99
Q

what to do in the event of decreased CPP

A

increase MAP with fluids, vasopressors (dopamine)
decrease ICP with CSF drainage, surgery, nursing interventions, osmotic diuretics

100
Q

early symptoms of increased ICP

A

decreased level of consciousness
irritabilty, restlessness, lethargy, confusion, “goofy”
headache
pupillary changes: ipsilateral changes in size, shape, or reactivity
visual abnormalities: blurred or double vision

101
Q

later symptoms of increased ICP

A

marked changes in LOC
pupils: ipsilateral pupil becomes fixed and dilated (CN III)
motor function changes
abnormal flexion: decorticate posturing
abnormal extension: decerebrate posturing

102
Q

last symptoms of increased ICP

A

cushing’s triad
hyperthermia
loss of cranial nerve function
death

103
Q

Cushing’s triad

A

increased SBP (widened pulse pressure)
bradycardia
altered respiratory pattern

104
Q

respiratory variations associated w/ Cushing’s triad

A

Cheyne-Stokes
Central neurogenic hyperventilation
Apneustic breathing
Cluster breathing
Ataxic breathing

105
Q

epidural catheter

A

least invasive
can’t recalibrate or zero after placement
can’t drain CSF fluid
indirect method of ICP measurement

106
Q

subdural catheter and subarachnoid screw or bolt

A

subdural drain
screw or bolt into the SAS
may or may not have access for CSF drainage & sampling
direct method of ICP measurement

107
Q

parenchymal fiberoptic catheter

A

placed directly in to brain tissue just below subarachnoid space
useful for patients with compressed or dislocated ventricles
very accurate
does not require fluid-filled transducer
no CSF can be withdrawn

108
Q

ventriculostomy

A

most invasive
most accurate
higher risk of infection
direct method of ICP measurement
frequent calibration is required
catheter can become occluded with blood or brain tissue and cause false readings
inserted on right side of brain to not affect speech and language center

109
Q

ICP monitoring

A

monitor ICP
drain CSF
watch for infection
some systems require zeroing

110
Q

ventricular drainage

A

quick way to decrease ICP and increase CPP transiently
“closed” system
“zero” and calibrate system qs and prn
document amount drained
assess color and clarity of CSF
assess ventriculostomy site

111
Q

P1 wave on an intracranial pressure waveforms

A

P1: percussion (systolic) wave
produced by systolic pressure

112
Q

P2 wave on an intracranial pressure waveform

A

elastance (tidal) wave
produced by the restriction of ventricular expansion from rigid dura and skull
measures compliance of brain

113
Q

P3 wave on intracranial pressure waveform

A

dicrotic wave
produced by closure of the aortic valve

114
Q

on normal intracranial pressure waveforms should p1 or p2 be higher

A

p1

115
Q

jugular venous oxygen saturation (SjvO2) monitoring

A

normal 55-75%
measures supply and demand of cerebral O2
indicator of cerebral metabolism
place on side of injury

116
Q

electroencephalogram (EEG) monitoring

A

can detect seizure activity

117
Q

transcranial doppler

A

assess cerebral blood flow noninvasively

118
Q

neuro nursing care

A

treat primary injury
prevent or minimize secondary injury
treat the patient and don’t forget the family and/or significant others
serial assessment is vital
positioning
fluid volume status
ICP management
ventilation & Oxygenation
temperature management
glucose control
seizure prevention
barbiturate coma

119
Q

ICP management nursing care

A

ventricular drainage
sedatives, analgesics, paralytics
reduce noxious stimuli
mannitol

120
Q

positioning

A

elevate HOB
usually avoid supine position because it can increase ICP
HOB is individualized to pt response
prevent jugular venous drainage obstruction
individualize to patient response

121
Q

how to prevent jugular venous drainage obstruction

A

keep head/neck in neutral position
avoid tight cervical collars
avoid tight ETT taping
avoid raising HOB with hips flexed

122
Q

why is monitoring glucose so important

A

brain injury releases glutamate (molecule that increases metabolic activity and increases breakdown of glucose) -> glycolysis produces lactic acid -> acidosis increases capillary membrane permeability -> increases cerebral edema

123
Q

benefits of sedative, analgesics, and paralytics

A

reduce agitation and discomfort
decrease ICP
decrease cerebral O2 consumption
facilitate mechanical ventilation
reduce response to noxious stimuli (suctioning)

124
Q

cons of sedatives, analgesics, and paralytics

A

limits ability to follow neuro exam
some drugs can cause hypotension and decrease CPP

125
Q

how to reduce noxious stimuli

A

avoid hyperinflation pre-suctioning (still hyperoxygenate though!)
avoid bundling of nursing activities
reduce environmental stimuli (dim lights, quiet)
family at bedside may decrease ICP

126
Q

mannitol

A

osmotic diuretic of choice
hyperosmolar fluid pulls fluid from cells to vascular space
decreases blood viscosity
decrease ICP
reduced edema

127
Q

mannitol nursing implications

A

monitor serum osmolality to prevent renal failure
maintain euvolemia (BP, CVP, PAWP)
monitor urine output
REALLY watch blood pressure
monitor electrolytes

128
Q

ventilation/oxygenation considerations

A

hyperventilating is no longer recommended
maintain PaCO2 35-45 mmHg
PEEP can raise ICP and should be used cautiously
maintain PaO2 > 70 mmHg

129
Q

corticosteroids

A

NOT helpful in TBI
effective with brain and spinal cord tumors in reducing vasogenic edema

130
Q

goals in the care of the brain injured patient

A

keep CPP >70mmHg
keep ICP <15 mmHg
keep PaO2 >80mmHg
keep PaCO2 between 35-40mmHg
keep other lab indices WNL
provide adequate analgesia and sedation
provide sufficient nutrition
prevent iatrogenic injury
provide information & support to patient and family

131
Q

priorities of care

A

ineffective cerebral tissue perfusion
ineffective breathing patterns
ineffective airway clearance
body image disturbance
ineffective coping

NURS 470 (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions