Neurological Alterations Flashcards
1
Q
Four Major Regions of The brain
A
1- cerebrum
2- diencephalon
3- brainstem
4- cerebellum
2
Q
Functions
1- cerebrum
A
- interprets sensory input
- controls skeletal muscle
- intellect/emotions
- skills memory
3
Q
Functions:
2- Diencephalon
A
- senses and motor
- regulates ANS
- regulates hormones
- mediates emotions
4
Q
Functions
3- Brainstem
A
Serves as a conduction pathway
- controls HR, RR, BP, swallowing
- regulates skeletal
- **CANNOT LIVE WITHOUT THIS
5
Q
Functions
4- Cerebellum
A
- processes information
- provides info for balance, posture, body mvmt
6
Q
Cerebral spinal fluid (CSF)
-function
A
- cushion for the brain
- protects the brain and spinal cord from trauma
- nourishment to brain
- removes waste products from cerebralspinal cellular metabolism
7
Q
Peripheral Nervous System
A
*links CNS with the rest of the body
-
8
Q
PNS
-parts
A
- nerves
- ganglia
- sensory receptors
9
Q
PNS subdivisions
A
sensory or motor
10
Q
PNS two types of nerves
A
Spinal nerves or cranial nerves
11
Q
Autonomic Nervous System
A
regulates the internal environment of the body
12
Q
ANS subdivision
A
1-sympathetic
2- parasympathetic
13
Q
PARASYMPATHETIC EFFECTS
A
Rest & digest:
- constrict pupil
- incr. salvation
- decr. HR
- constrict bronchioles
- incr. digestion
- contract bladder and gallbladder
- relax rectum
14
Q
SYMPATHETIC EFFECTS
A
Flight or Fight:
- dilate pupil
- decr. saliva
- relax bronchi
- incr. HR
- slows digestion
- glucose release from liver
- secrete epinephrine and norepi
- relax bladder
- contract rectum
15
Q
what meds stimulate the sympathetic NS
A
-Levophed-norepi
16
Q
+++++++++++++++++++++++++++5 major components of Physical exam
A
- LOC
- Motor function
- Pupil function
- Respiratory function
- Vitals
- ALL 5 MUST BE PERFORMED
17
Q
Level of Consciousness:
1-alert
A
responds to external stimuli
doesn’t have to be a GCS of 15
18
Q
Level of Consciousness:
2- Confused
A
orientated to person but NOT TO
time and place
-impaired judgement
-decision making and decr. attention span
19
Q
Level of Consciousness :
3- Delirium
A
Disorientated to time, place, and person loss of contact with reality auditory and visual hallucinations -disorientated x3 delirium tremors
20
Q
Level of Consciousness:
4-Lethargic
A
drowsiness
needs a stronger stimuli to wake up
21
Q
Level of Consciousness:
5- obtunded
A
dull indifference to external stimuli
response is minimal
1 word
appear sedated
22
Q
Level of Consciousness:
6- Stupor
A
responds to a vigorous and continuous stimuli
23
Q
Level of Consciousness:
7- Comatose
A
no response-
24
Q
Level of Consciousness:
8- Vegetative State
A
non-purposeful eye movement
25
GCS:
| Eye movement-
4- spontaneous
3- to command
2-to pain
1-no response
26
GCS:
| Best Motor Response
```
6- obeys verbal orders
5- localizes pain
4-withdraws
3- flexion
2-extension
1-no response
```
27
GCS:
| Best Verbal response
```
5-orientated
4-diorientated
3-inappropriate words
2-inappropriate sounds
1-no response
```
28
Motor function:
1-spontaneous
2-localization
1-without external stimuli
| 2-opposite extremity reaches over to relieve pain
29
Motor function
3-withdrawal
4-flaccid
3-extremity receiving the pain moves away from it
| 4-no response
30
Motor function
5-decorticate
6-decerabrate
5-abnormal flexion
| 6- abnormal extension
31
Superficial Reflexes
| ** don't assess if pt follows commands
- corneal
- blink
- gag
- cough
- plantar
* fanning of toes only normal in babies
32
What does fixed, dilated pupils mean
pressure on ocular nerve (tumor, bleed, infarction
33
Respiratory Patterns with neuro probs
- cheyne-stokes
- central neurogenic hyperventilation
- cluster
- ataxic
34
Cheyne-stokes
change of rate and depth with periods of apnea
35
Central Neurogenic
very deep, rapid with no apnea
36
Cluster
irregular gasping, long periods apnea
37
Ataxic
irregular, random, deep and shallow
| irregular apnea
38
Vital Signs:
| CUSHINGS TRIAD
- bradycardia
- Systolic HTN
- Abn, RR
39
Cerebral Hemodynamics
| -normal ICP
0-15
| >20 for 10 min = emergency
40
Cerebral perfusion
| -normal CPP
80-100
41
Formula for CPP
CPP= MAP-ICP
42
ICP monitoring devices:
```
ventriculostomy
bolt/screw
subdural catheter
intraparenchymal catheter
fiber optic cath
```
43
which device is the only one that drains CSF
ventriculostomy
| *risk infection
44
Things that raise ICP
```
IV colloids (blood)
vasopressors
Trendelenburg position
warming measures
shivering and fever
coughing
agitation
pain
hypoventilation (incr. CO2 and blood flow)
```
45
Interventions to decrease ICP
-diuretics
-hyperventilate
-incr. HOB
-cooling measures
-rest/ sedate
-hypertonic saline : pulls fluids out
-BP control
CSF drainage
46
Hypertonic saline:
| what to do about Na
increases parameters to 150-155
47
Stroke:
| two types
1-ischemic
| 2- hemorrhagic
48
Ischemic stroke types
- atherothrobotic
- embolic
- hypoxic
49
Hemorrhagic stroke types
- subarachnoid
| - intracerebral
50
Hemmorrhagic
| 1-subarachnoid
-caused by a ruptured cerebral aneurysm (AVM)
51
Hemorrhagic
| 2- intracerebral
caused by HTN or trauma
52
Arteriovenous Malformationd & Aneurysm
| -AVM
lack of bridge between arterial pressure and venous pressure
53
aneurysm
dilation of walls of cerebral artery
54
Types of aneuryms
| 1- Berry or SAccular
most common!
| at the base of the brain or the circle of willis
55
Types of aneuryms
| 2-fusiform or giant
irregular shape and greater than 2.5 cm
- internal carotid artery
- rarely ruptures
- like a lesion in the brain
56
Treatment for ruptured aneuryms
- surgical clip
- blood pressure control- ICP raises to same as MAP
- ventriculostomy
57
Intracerebral hemorrhage
bleeding directly into the brain tissue
| -leads to edema and increased ICP
58
what is the most common cause of inctracerebral hemorrhage
HTN
59
statistics of intracerebral hemorrhage
only 20% will return to baseline functions
60
S/S stroke
- numbness
- confusion
- trouble speaking
- trouble seeing
- trouble walking
- dizzy
- severe headache
61
ACT FASTG stroke
Face, Arm, Speech, Time, Glucose check (hypo/hyper)
62
Time of events after stroke in ER
- general assessment
- Neuro function
- CT
- CT results
- Fibrinolytic therapy
- admission to hospital bed
- 10 min
- 25 min
- 25 min
- 45 min
- 60 min - 3 hr (cant have a brain bleed)
- 3 hours
63
BP level for those ON FIBRINOLYTICS
less than 185/110
64
BP level for those NOT ON FIBRINOLYTICS
less than 220/120
65
BP for those with hemorrhagic stroke
SBP
66
Herniation: worst kind
Uncal herniation b.c puts pressure on brainstem
67
S/S herniation
| -cingulate
-NO S/S but if not corrected can turn to uncal
68
S/S herniation
| -central
small reactive pupils
- progress to fixed dilated
- resp changes
- affects brainstem later on
69
S/S herniation
| -uncal
- pupis dilated
- decreased LOC
- resp Changed
- decorticate or decerebrate posturing
- flaccid
70
BRAIN DEATH TEST (3)
OCULOVESTIBULAR reflex- normal is slow, tonic, nystagmus deviating toward the irrigated ear
DOLL'S eyes
APNEA CHALLENGE
71
2
PaO2 in the 200s
keep stable then disconnect them from vent for 8 min. Draw ABGs
if Co2 >60= BRAIN DEATH!!
72
who to call if pt declared brain dead?
One Legacy- you don't ask about donation!
