With what glascow coma scale would you intubate a patient?
GCS less than or equal to 8
What are the criteria for glascow coma scale for infants?
Eye opening: Spontaneously, To speech, To pain, No reponse
Best Verbal Response: Coos, babbles, Irritable, cries, Cries to pain, Moans, grunts, No response
Best Montor Response: Spontaneous, Localizes pain, withdraws from pain, flexion (decorticate), extension, decerebrate), no response
What are the criteria for the glascow coma scale for a child/adult?
Eye opening: spontaneously, to command, to pain, no response
Best verbal response: oriented, confused, inappropriate words, incomprehensible, no response
Best motor response: obeys commands, localizes pain, withdraws from pain, flexion (decorticate), extension (decerebrate), no response)
What is a normal GCS score?
What is the progression of deteriorating brain function?
Level of consciousness deteriorates and improves in a perdictable pattern (except in direct and massive brain damage). Progressive loss of the higher levels of function occurs initially then the more primitive levels, and finally the life-sustaining functions. A diminished level of consciousness and behavior changes are early manifestations of cerebral involvement. The midbrain and brainstem functions are affected sequentially with characteristic changes in motor function, pupillary response and breathing patterns.
What is the progression of level of consciousness?
- Alert, oriented to time, place, and person
- Responds to verbal stimuli, decreased concentration, agitation, confusion, lethargy, disoriented
- Requires continuous stimulation to rouse
- Reflexive positioning to pain stimulus
- No response to stimuli
What is the progression of pupillary response?
- Brisk and equal; pupils regular
- Small and reactive
- Pupils fixed (nonreacive) in midposition
- Pupils fixed in midposition
What is the progression of motor response?
- Purposeful movement; responds to commands
- Decorticate positioning with upper extremity flexion (flexion positioning)
- Decerebrate positioning with adduction and rigid extension of upper and lower extremities
- Extension of upper extremities with flexion of lower extremities or flaccidity
What is the progression of breathing?
- Regular pattern with normal rate and depth
- Yawning, sighing respirations
- Cheyne-Stokes respirations with cresscendo-decrescendo pattern in rate and depth followed by periods of apnea
- Central neurologic hyperventilation with rapid, regular, and deep respirations; apneustic breathing with prolonged inspiration and pauses at full inspiration and following expiration
- Cluster or ataxic breathing with irregular pattern and depth of respirations; gasping respirations or apnea
What are gerontological considerations?
- Reduction in total brain weight
- Loss of neurons and changes in neurotransmitters
- Decrease in blood flow to the cerebrum (20%)
- Decreased CSF production
- Decrease in cerebellar function can lead to impaired balance/coordination
- Decreased sensory fibers can lead to altered perception of touch and pain
- Decrease in thermal sensitvity (hot-cold)
- Nerve conduction slows
- Decreased reaction time
- Pupil size diminishes, pupils react more slwoly to light and dark
What are the brain fast facts?
- Only 1-2% of body weight
- Receives 15% of rest cardiac output
- Accounts for 20% of total body oxygen consumption
- Cerebral blood flow (50ml/100gm of tissue) remains constant over a wide range of BP and intracranial pressure due to autoregulation of cascular resistance
What is the central nervous system?
Made up of the brain and spinal cord
What is the spinal cord?
A bundle of neurons that transmit information in ascending and descending tracts
What is the brain?
One function is expression of language VIA broca's area
What is the brainstem?
Contains the midbrain, pons, medulla, and reticular formation, where the respiratory and vasomotor centers are located
What is the cerebrospinal fluid?
Circulates within the subarachnoid space and provides a fluid cushion for the brain and spinal cord
What is a neurotransmitter?
A chemical agent involved in the transmission of an impulse across the synaptic cleft
What is the peripheral nervous system?
Includes all neuronal structures that lie outside the CNS
What are the spinal nerves?
Each one contains motor and sensory nerve fibers
What are the cranial nerves?
12 pairs of nerves that may be motor, sensory, or both
What is the autonomic nervous system?
Controls involuntary functions of cardiac and smooth muscle and glands
What is the blood brain barrier?
Protects the brain from foreign substances in the blood that may injure the brain
What is the function of the frontal lobes?
- Memory retnetion
- Higher cognitive functions
- Voluntary eye movements
- Voluntary motor movement
What is the function of the parietal lobes?
What is the function of the temporal lobes?
- Receptive speech
- Integration of somatic, visual, and auditory data
What is the function of the occipital lobe?
- Visual image interpretation
What is the function of the cerebellum?
- Coordinate voluntary movement
- Controls balance and coordination
What is the function of the brainstem?
- Regulation of basic body function
- Vasomotor center (BP)
- Respiratory center
Why should the RN have some knowledge about the location of different brain functions?
Injury or disease to a specific area (eg temporal lobe on left) will cause a specific symptoms (expressive aphasia (anterior temporal) or receptive aphasia
What is the oculomotor nerve function and nursing assessment?
Pupil reaction (parasympathetic)
Eye movements (motor)
Check pupil reaction to light. Have patient follow your finger with their eyes up, down, side to side.