Neuro dysfunctions Flashcards
(27 cards)
Normal cerebral blood flow rate
750mL/min
How to calculate CPP (Cerebral perfusion pressure)
CPP=MAP-ICP
Normal MAP
70 to 105mmHg
Normal ICP
5 to 15mmHg
Normal CPP
60 to 100mmHg
When does CPP autoregulation (arteriole diameter alteration) not work?
If CPP under 50 or over 150mmHg
Early signs of ICP
LOC change
Restless
worsening HA
small reactive pupils
Rising SBP
Weakness
Late signs of ICP (often indicate irreparable brain ischemia)
Cushing’s triad
Deterioration of LOC
Ipsilateral dilation/fixation(pupil on side of lesion is dilated)
Seizure
Cushing’s triad (indicative of ICP)- very bad
Bradycardia
Irregular respirations
Widening pulse pressures (large difference between SBP and DBP)
muscle strength scale (refresher)
0: No movement
1: flickers or contraction noted
2: Active movement, but not against gravity
3: Active movement full ROM against gravity
4: Weak
5: Strong (relative to pt age)
Cingulate brain herniation syndrome
Lateral shift of one hemisphere (one side shifts to the other)
Often from pressure on one side of brain pushing the brain over- like through the corpus callosum almost
Tentorial brain herniation
Middle of brain moves down towards brain stem
Most often from TBI causing edema- squeezes brain out the Foramen Magnum
Transcalvarial brain herniation
Brain herniates out of duramater
Uncal brain herniation
Uncus of temporal lobe (outer part of the back of the brain, posterior and slightly inferior) pushed MIDLINE and DOWN
Think of pressure from edema on the outside of the bain causing a collapse into the center
Cerebellar brain herniation
Cerebellar tonsils pushed through foramen magnum
Diffuse axonal injury
Widespread inflammation of brain from injury, raises ICP
Battle’s signs are
Basilar skull fractures that show up as bruising behind the ear due to hematoma
Subdural hematoma
Venous bleed (slower)
Can occur spontaneously
Between dural and arachnoid!!
HEADACHES, IRRITABLE, LOWER LOC
Epidural hematoma
Arterial bleed
RAPID
Assoc. w/ linear skull fracture
WATCH FOR loss of consciousness at time of injury–>seem fine–»rapidly deteriorate
Dilated nonreactive ipsilateral pupil
YOU CAN PALPATE THESE since they are EPI (outside) dural (duramater)
Nursing interventions for brain bleeds and ICP
AIRWAY MAINTENANCE and prevent aspiration
Monitor ICP and temp
Prepare pt for surgery (Burr hole, CT/MRI, clot evac.)
Avoid nasal suctioning, anything that will cause pressure to rise (bear down)
Monitor glucose levels: High glucose causes more liquid to be pulled in, increasing pressure. (You want higher osmotic pressures to suck liquid out of brain)
How to posture a patient with brain hematoma
Bed elevated 20-30 degrees (venous drainage)
No pillows- neutral neck angle
Avoid excess hip flexion
Brain tumors (Glimoas) all bad
Astrocytomas
Oligodendrogliomas
Ependymomas
Medullablastomas
Glioblastoma multiforme
Guillian-Barre Sydrome (GBS)
ACUTE Autoimmune disorder
Destruction of myelin which impairs conduction of impulses
DESCENDING: Progress from face down, RESPIRATORY FUNCTION compromised- watch for aspiration, airway
ASCENDING: Most common, ends with brain symptoms last
Can take years to remyelinate
GBS remyelination stages
Initial: 1-4 weeks, symptoms of GB
Plateau period: days to 2 weeks after initial, not much progress on recovery
Recovery period: 6months to 2 years is when remyelinization happens
