Neurology Flashcards by Stephanie Richards

Causes of increased ICP

tumor
bleeding
hydorcephalus
edema

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early signs of ICP

change in LOC (as subtle as a change in attention span or pronounced as a coma
slurred or slow speach
delay in response to verbal suggestion
increase in drowsiness
restlessness with no apparent reason
confusion

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late signs of ICP

marked changed in LOC progressing to stupor and coma
cushings triad
decerebrate
decorticate

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what is causing triad

systolic hypertension with widening pulse pressure
slow full and bounding pulse
irregular respirations (cheyne stokes or ataxic)

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what is decorticate posturing

arms flexed inward and bent in toward the body and legs extended mid brain damage

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what is decerebrate posturing

all 4 extremities in rigid extension, deep brain damage (worst)
will be rigid, tight and burning more calories

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miscellaneous ICP signs

headache
change in pupil response
if in profound coma, fixed and dialated
projectile vomiting

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complications of increased ICP

brain herniation
DI and SIADH

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what does brain herniation do

obstructs the blood flow to the brain leading to anoxia and then brain death

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treatment for Increased ICP

reduce cerebral edema
reduce the amount of cerebral spinal fluid or
reduce the blood volume in the brain
maintain oxygenation
maintain adequate cerebral perfusion
keep temperature below 100.4
elevate HOB
keep head midline so the jugular veins can drain
watch the ICP monitor with turning
avoid restraints, bowel/bladder distention, hip flexion , valsalva, and isometrics
no sneezing or nose blowing
limit suctioning and coughing
space nursing interventions

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why must you keep temperature below 100.4 with increased ICP

increased temperature will increase cerebral metabolism and cerebral edema which increases ICP

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what is the first cranial nerve

olfactory (smell)

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what is the second cranial nerve

optic (vision)

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what is the 3rd cranial nerve

oculomotor (pupil constriction)

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what is the 4th cranial nerve

trochlear (downward movement of eyes)

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what is the 5th cranial nerve

trigeminal (jaw movement, sensation of face and neck)

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what is the 6th cranial nerve

abducens (lateral movement of eyes)

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what is the 7th cranial nerve

facial (facial movement on anterior 2/3 of tongue)

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what is the 8th cranial nerve

vestibulocochlear (hearing balance)

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what is the 9th cranial nerve

glossopharyngeal (swallowing, taste on posterior 3rd of tongue)

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what is the 10th cranial nerve

vagus (swallowing, speaking)

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what is the 11th cranial nerve

spinal/accesory (flexion and rotation of head

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what is the 12th cranial nerve

hypoglossal (tongue movements)

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how does oxygenation effect ICP

decreased o2 levels and high CO2 levels cause cerebral vasodilation in the brain increasing ICP

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why do you want to avoid hypotension and bradycardia with increased ICP

it decreases brain profusion

what fluids can you give with ICP

isotonic saline and inotropic agents: dobutamine and norepinephrine (emergency short term)

signs of a basilar skull fracture

Battle's sign (bruising over the mastoid) raccoon eyes ( periorbital bruising) cerebrospinal rhinorrhea

how do you check for cerebrospinal rhinorrhea

test drainage for CSF halo test glucose

what is an open skull fracture

torn dura

what is a closed skull fracture

intact dura

characteristics of an epidural hematoma

rupture to the middle meningeal artery fast bleed high pressure

symptoms of an epidural hematoma

loss of consciousness recovery period bleeding into head with compensation loss of compensation neuro changes

treatment of epidural hematoma

burr holes

questions to ask for assessing head injury

did you pass out and stay out? did they pass out and wake up and pass out again did they just see stars

what is a subdural hematoma

venous bleed between dura and brain slower and less jpressure commonly seen in chronic geriatric clients imitates other conditions

treatment of subdural hematoma

craniotomy

What is hydrocephalus

increased accumulation of cerebral spinal fluid that increases ICP

causes of hydrocephalus

tumor hemorrhage infection congenital

What is meningitis

inflammation of the spinal cord of brain

what causes meningitis

bacterial or biral infection primarily transmitted through respiratory system

which meningitis is worse

bacterial

signs of meningitis

chills and high fever severe headache disorientation that can progress to coma nausea and vomiting nuchal rigidity stiff neck photophobia seizures kern and brudinski signs

what is kerning sign

severe stiffness of the hamstrings, inability to straighten leg when hips flexed at 90 degrees

what is brudinski sign

severe neck stiffness causes hips and knees to flex when neck is flexed

treatment for meningitis

steroids analgesics antibiotics (bacterial)

what precautions do you use for menengitis

viral (contact) bacterial (droplet) Medical emergency

how do you prevent menengitis

Hib vaccine

What do you monitor for spinal injuries above T6

autonomic dysreflexia

symptoms of autonomic dysreflexia

sudden severe hypertension bradycardia headache nasal stuffiness flushing sweating blurred vision anxiety

Trigger of autonomic dyreflexia

stimulus below t6 blister restrictive clothing dehydration fecal inpaction broken bones full bladder or UTI anxiety pressure areas

treatment of autonomic dyreflexia

antihypertensives-hydralazine treat cause

what are focal injuries

contusions and hematomas

when are contusions seen

blunt trauma or acceleration-deceleration injureis

What are the two types of stroke

hemorrhagic ischemic

what are the two types of ischemic strokes

embolic thrombotic

What happens in a hemorrhagic stroke

vessel ruptures and bleeds in the brain as it accumulates there is increased ICP

what can a hemorrhagic stroke Be caused by

a weakened vessel such as an aneurysm

What causes a ischemic stroke

blood flow to the brain is blocked by a blood clot causing a loss of circulation to the brain causing ischemia and damage

what is a thrombotic ischemic stroke

a blood clot in an artery going to he brain

what is an embolic ischemic stroke

a clot that's formed elsewhere and travels in the blood stream and clogs a vessel in or leading to the brain (sudden onset)

Signs of a stroke

Balance- dizzy loss of balance eyes- blurry vision abnormal pupil response emianopia facial droop- unilateral arms drift or weakness speech- aphasia, dysphagia, alter loc/ confusion

treatment of ischemic stroke

permissive hypertension antithrombotics- tPA, MUST BE DONE WITHIN AN HOUR percutaneous thrombectomy- surgical removal of clot done in IR

treatment for hemorrhagic stroke

get bleeding under control if caused by aneurysm coiling (IR) clipping (OR) craniotomy EVD

Neurology Flashcards

(63 cards)