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Critical Care > Neuro > Flashcards

Neuro Flashcards

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1
Q

Meninges

A

protects CNS
* Dura
* Arachnoid
Pia

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2
Q

Where is the epideral space

A

between skull bone and dura

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3
Q

Where is the subdural space

A

between dura and arachnoid

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4
Q

Where is the subarachnoid space

A

between the arachoid and pia

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5
Q

Compare the two ruptures in the dura mater

A
  1. Epidural hematoma (Arterial)
  2. Subdural hematoma (Venous)
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6
Q

What are the components of the arachnoid?

A
  • CSF circulates here
  • cerebral vasculature
    if ruptured –> subarachnoid hemmorhage
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7
Q

What is the purpose of arachnoid villi?

A

Absorb CSF for removal

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8
Q

What happens if you block the arachnoid villi?

A

communicating hydrocephalus

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9
Q

What is the pia mater responsible for?

A

production of CSF

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10
Q

Cerebrospinal fluid (CSF)

Characteristics

A
  • clear, colorless
  • flows through subarachnoid
  • shock absorber / brain tissue protector
    * contains glucose
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11
Q

What does the circle of willis do?

A

circulates blood anterior to posterior

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12
Q

What are the three components of intracranial pressure?

A
  1. Blood
  2. CSF
  3. Brain tissue
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13
Q

Monro-Kellie Doctrine

Define

A
  • ability for brain to self regulate
  • increase in one, other one or two should compensate by decreasing
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14
Q

Cerebral Blood Flow

Autoregulation

A

changes the diameter of blood vessels
* vasocontriction = less blood flow
* vasodilation = more blood flow

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15
Q

What activities can cause impaired autoregulation?

A

coughing, suctioning, restlessness

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16
Q

Cerebral perfusion pressure

Define; Values (formula)

A

represents adequacy to delievering oxygen to the brain
60-100mh normal
50-70 adequate with injury**
MAP-ICP = CPP

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17
Q

Pressure autoregulation

A

MAP 50-150
* increase in MAP = constriction
* decrease in MAP = dilation

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18
Q

Metabolic autoregulation

A
  • increase CO2+Lactic = vasodilation
  • decrease CO2 = vasoconstriction
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19
Q

CSF regulation

A

increase ICP –>
CSF will be displaced into spinal canal –>
aarachnoid will increase absorption

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20
Q

Cerebral edema

A

water in cells cause swelling
* cause by brain trauma, CNS infection, tumors, CVA
* impairs circulation leading to hypoxia

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21
Q

Central Herniation

Define

A

Displacement of brain tissue
* leads to ischemia/anoxic injury

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22
Q

Central Herniation

Symptoms

A

Bilateral pupil dilation
Cushings triad
Flaccid paralysis

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23
Q

Cushings triad

A
  1. increased pulse pressure
  2. bradycardia
  3. abnormal respiration
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24
Q

When are intracranial pressure monitoring devices contraindicated?

A

GSC 9-15
(mild to moderate brain injury)

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25
ICP monitoring | Complications
infection obstruction hemorrhage misplacement
26
Three themes of caring for neuro patients
1. Neuro exam (baseline AxO) 2. ICP with its factors 3. Interventions/meds
27
Space occupying lesion
* tumor * abscesses * bleeds (hemmorrhage)
28
Subarachnoid Hemmorhage | Cause?
caused by ruputured aneurysm | BLOOD IS NOW MIXING WITH CSF IN SUBA
29
Subarachnoid Hemorrhage | Clinical Manifestations
*** worst headache of my life*** * decreased LOC * stiff neck, photophobia * Positive Kernig's/Brudzinski's
30
Kernig
painful knee extension
31
Brudzinski
neck flexion --> knee flexion
32
Subarachnoid Hemorrhage | Diagnostics
CT scan * If negative --> LBP * LBP + if bloody CSF * Angio then needed for location
33
Subarachnoid Hemorrhage | Clinical management Pre-op
Prevent rupture * prevent valsalva (miralax) * antihypertensives * antipyretics * minimal simulation
34
Subarachnoid Hemorrhage | surgical management
clipping is gold standard coiling
35
Subarachnoid Hemorrhage | Post-op
Prevent vasospasms (AEB) change mental, blurred vision decreases in CBF --> decrease o2 --> increase lactic acid
36
Subarachnoid Hemorrhage | Management of vasospasms
**Nimodipine** --> watch for hypotension Triple H therapy (hypervolemic, hemodilution, HTN)
37
Levophed triple H parameters
BP >20mm over baseline (under 200)
38
Subarachnoid Hemorrhage | Hydrochepalus
blood clot in sub A obstructs villi reabsorption communication hydrocephalus SHUNT!!!!
39
Tramatic Brain Injury | Primary vs Secondary
Primary --> direct force Secondary --> biochem changes, inadequate perfusion, hypoxia
40
With all head injuries, what should also be assessed?
cervical spine
41
An increased GSC is indicative of?
Improvement
42
Secondary injury | Cause
ischemia hypercapnia cerebral edema sustained hypertension
43
Secondary Injury | Increase brain tissue
Ischemic cells swell increasing tissue mass
44
Secondary Injury | Increase CBF
Vasodilation occurs to supply oxygen to cells Hypercapnia from hypoventilation of unconscious patient (CO2 potent cerebral vasodilator) HTN increases intracranial blood volume
45
Nursing interventions to prevent secondary injury | DO
* minimal stimulation * head / neck neutral position * maintain o2
46
Nursing interventions to prevent secondary injury | DO NOT
* do not cluster care * no tendelenburg * no valsalva
47
Compound fracture
open
48
Displaced fracture
closed
49
Linear fracture
depressed-bone fragments
50
Basilar Skull Fracture | Define
linear or displaced
51
Basilar Skull Fracture | Assessment/intervention
* assess extraocular movement * Assess CSF drainage * Avoid nasogastic/trach suctioning
52
Basilar Skull Fracture | Clinical manifestations
* otorrhea (CSF in ear) * * Rhinorrhea (CSF in nose) * Ecchymosis --> battle's sign(bruising behind ear) * * Ecchymosis --> raccoon eyes (raccoon)
53
Halo sign
CsF leakage, yellow fluid with blood inside assess glucose assess beta 2 transferrin
54
Basilar Skull Fracture | Treatment
spontaenous healing loose gauze dressing cranial/neuro assessment
55
Concussion | Definition
alteration in mental status resulting from trauma high school football
56
Concussion | Clinical manifestations
* Loss of conciousness * Retrograde amnesia(before) * Anterograde amnesia (after) * sluggish * concentration issues
57
Concussion | treatment
rest the brain (avoid stimulus)
58
Concussion | Post concussion sundrome
6mo-5yr
59
Contusion
Brain bruise coup-contrecoup complication --> expansion of hematoma, cerebral edema
60
Epidural hematoma | Definition
collection of blood between dura/skull resulting from laceration of meningeal artery low or high impact injuries
61
Epidural hematoma | Clinical manifestations
* temporary skull fracture * rapid decrease in conciousness (talk and die) * uncal herniation *** IPSILATERAL PUPIL DILATION**
62
Epidural hematoma | Treatment
Burr holes
63
Subdural hematoma | Define
accumulate venous blood below dura Elderly/ETOH abusers
64
Subdural hematoma | Clinical manifestations
* headache * lethargy * confusion * seizure
65
Compression of CNIII causes | increased ICP
dilated pupils
66
Compression of visual pathways | Increased ICP
* decreased acuity * blurring * diplopia
67
Increased ICP | interventions to decrease brain tissue volume
**Mannitol** draws fluid from brain serum osmo goal <320 Watch for hypovolemia
68
What fluid do you NEVER give neuro patients?
hypotonic
69
Increased ICP | decrease cerebra blood flow
* hyperventilation * hypothermia * Barbiturate coma
70
Increased ICP | decrease CSF
* Furosemide * Ventriculostomy (EVD)
71
Level of conciousness
awareness/arousal
72
Posturing | Decorticate
hands to chest
73
Posturing | Decerebrate
hands straight out
74
Increased ICP | Doll's eye Test
- cervical spine first oculocephalic relflex
75
Increased ICP | Cold calorics
oculovestibular confirm tympanic membrane intact
76
Determination of brain death
* CTA, EEG * exclude endocrine imbalance * exclude drug intoxication * core body temp > 32 or 90f for apnea test * Absence of motor response * Absent reflexes * loss of centrally controlled beathing
77
Cranial nerve III
corneal reflex
78
Cranial nerve IX/X
no cough/gag

Critical Care (9 decks)

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