Test 1

Question 1

Apraxia

Answer 1

Verbal apraxia refers to difficulty in forming and organizing intelligible words although the musculature is intact.

Question 2

Anopsia

Answer 2

blindness in one eye resulting from complete lesion of the optic nerve before the optic chiasm

Question 3

Bitemopral hemianopsia

Answer 3

blindness in both lateral visual fields (usually from pituitary tumors or aneurysms)

Question 4

Homonymous hemianopsia

Answer 4

half-blindness involving both eyes with loss of visual field on the same side of each eye

Question 5

Cerebral autoregulation

Answer 5

a protective mechanism that enables the brain to receive a consistent blood flow over a range of systemic blood pressures
- vessel diameter changes in response to the changes in arterial pressure

Question 6

Vasogenic edema

Answer 6

most common type of cerebral edema
characterized by a disruption in the blood-brain barrier and the inability of the cell walls to control movement of water in and out of cells
common processes leading to this are brain tumors, cerebral abscess, stroke, and cerebral trauma

Question 7

Cytotoxic edema

Answer 7

charaterized by swelling of the individual neurons and brain cells
cell membrane cannot maintain an effective barrier so both water and salt enter the cell, causing swelling, loss of function, and cellular death

Question 8

Uncal herniation

Answer 8

herniation of the medial temporal lobe through the tentorium, where it pushes against the brain stem

Question 9

Central herniation (supratentorial)

Answer 9

describes the downward displacement of the diencephalon and parts of the temporal lobes through the tentorium, causing compression of the brain stem

Question 10

Central herniation (infratentorial)

Answer 10

describes a downward displacement of the brain stem into the spinal cord

Question 11

ICP increases with increases in:

Answer 11

Intrathoracic pressure – coughing, sneezing
Intraabdominal pressure – Valsalva maneuver
Metabolic demands – seizures, shivering

Question 12

How the brain compensates

Answer 12

increasing CSF absorption
displacing CSF into spinal subarchnoid space
collapsing the cerebral veins and dural sinuses
Dispensibility of the dura
Increasing venous outflow
Decreasing CSF production
Changing intracranial blood volume through constriction and dilation
Slight compression of brain tissue

Question 13

Cerebral blood flow

Answer 13

the amount of blood in mL passing through 100 g of brain tissue in 1 minute.

Question 14

Akinetic mutism

Answer 14

unresponsiveness to the environment, the patient makes no movement or sound but sometimes opens eyes

Question 15

Locked-in syndrome

Answer 15

patient is unable to move or respond except for eye movements due to a lesion affecting the pons

Question 16

Cerebral Perfusion Pressure

Answer 16

Normal CPP is 70-100 mm Hg

50-60 mmHg needed for adequate perfusion

Question 17

Early signs of ICP

Answer 17

Change in LOC – most sensitive indicator (first)
Ocular signs – ipsilateral pupillary changes
Decrease in motor function - contralateral
Headache – usually worse

Question 18

Cushing’s Triad

Answer 18

Classic sign of increase ICP include an elevated systolic blood pressure in conjunction with a widening pulse pressure, slow bounding pulse, and respiratory irregularities

Question 19

Cheyne-Stokes Breathing

Answer 19

hemispheric disease or metabolic brain dysfunction- Cycles of hyperventilation and apnea – Referred to Death Breath
- Heavy, deep breathing, rate is increased and irregular, hard to get oxygen in apnea

Question 20

Indications for ICP monitoring

Answer 20

stroke
brain tumor
postcardiac arrest
carniotomy
coma
severe brain surgery
hemorrhage
ischemic infarction
hydrocephalus

Question 21

Contraindications for ICP monitoring

Answer 21

Coagulopathy
systemic infection
CNS infection
Infection at the site of device insertion

Question 22

A waves

Answer 22

signifies ischemia (prolonged abnormal ICP)
rapid increases of pressure ranging from 20-50 mm Hg over a period of 20 minutes or more

Question 23

B waves

Answer 23

signifies intracranial herniation (talk to families about stopping life support)
produced by ICPs up to 50 mmHG (between 5 and 20 minutes)

Question 24

Positioning

Answer 24

place head of bed flat or 30-45 degrees elevation to facilitate venous drainage

Question 25

Diabetes insipidus

Answer 25

look at s/s, labs including urine, treatments with meds, expected response to meds

Question 26

SIADH

Answer 26

look at s/s, labs including urine, treatments with meds, expected response to meds

Question 27

Hypoventilation

Answer 27

after cerebral trauma can lead to respiratory acidosis. As the CO2 increases & O2 decreases, cerebral hypoxia & edema can result in secondary brain trauma

Question 28

Hyperventilation

Answer 28

produces respiratory alkalosis with increased O2 and decreased CO2 causing vasoconstriction of cerebral blood vessels

Question 29

Diuresis

Answer 29

Considered a cornerstone in the treatment of increased ICP Osmotic diuresis pulls water out of brain tissue into systemic circulation where it’s removed by the kidneys Mannitol is the agent most commonly used Care must be taken to prevent a drop in CPP Must monitor serum osmolality & lytes, esp. Na Must monitor renal function Other commonly used drugs – Bumex, Lasix

Question 30

Shivering

Answer 30

Avoid shivering Muscle relaxants reduce shivering Most common medications administered: Thorazine – depresses thermoregulation in the hypthalamus and reduces peripheral vasoconstriction, muscle tone and shivering Demerol – relaxes the smooth muscle and reduces shivering

Question 31

Mannitol

Answer 31

hypertonic crystalloid solution that decreases cerebral edema by increasing intravascular osmolality typically administered as a bolus IV infusion immediate plasma-expanding effect of mannitol reduces blood viscocity, increaing cerebral blood flow and cerebral oxygen metabolism it lowers cerebral blood volume and ICP, while maintaining constant cerebral blood flow

Question 32

Propofol

Answer 32

fat-soluble anesthetic administered as a continous infusion to decrease agitation in the critically ill patient patients must be intubated and mechanically ventilated hypotension is common frequent BP monitoring is needed

Question 33

Neuromuscular blockade

Answer 33

last resort decreases the brains demand for oxygen and lowers the ICP necessitates mechanical ventilation with full support complications include tachycardia, hypotension, and dysrhythmias

Question 34

Barbiturate coma

Answer 34

for a patient with severe ICP may be induced to decrease metabolic activity and preserve brain function criteria - GCS less than 7 - ICP greater than 25 mmHg at rest for 10 minutes - failed maximal interventions including CSF drainage, mannitol, analgesia, and sedation Taper over 24-72 hours

Question 35

Decompressive Craniectomy

Answer 35

part of the skull ("bone flap") is removed to relieve brain swelling bone flap is replaced at a later date after the swelling has decreased widely used for patients with malignant cerebral edema after a traumatic brain injury

Question 36

Craniotomy

Answer 36

a section of the skull is removed to facilitate accessing the brain underneath and then replaced performed to remove space-occupying lesion, to evacuate hematomas, or to reverse herniation may also be used to clip an aneurysm Risks include cerebral edema and intracerebral hemorrhage

Question 37

Carotid Endarterectomy

Answer 37

in patients with high-grade carotid stenosis, it may be performed to prevent a stroke the procedure removes atherosclerotic plaque that has accumulated inside the carotid artery to restore blood flow

Question 38

Acceleration injuries

Answer 38

a moving object strikes the stationary head

Question 39

Acceleration-deceleration injuries

Answer 39

the head in motion strikes a stationary object

Question 40

Coup-contrecoup injuries

Answer 40

the brain "bounces" back and forth within the skull, striking both sides of the brain

Question 41

Rotation injuries

Answer 41

the brain twists within the skull, resulting in stretching and tearing of blood vessels and shearing of neurons

Question 42

Penetration injuries

Answer 42

a sharp object disrupts the integrity of the skull and penetrates the brain tissue

Question 43

Contusion

Answer 43

result from laceration of the microvasculature that causes bruising or, or bleeding into, the brain tissue diagnosis with a CT complications of a cerebral contusion include intracerebral hematoma and cerebral edema cerebral edema peaks 24-72 hours after injury increasing the ICP

Question 44

Cerebral brain flow

Answer 44

CBF is the amount of blood in mL passing through 100 g of brain tissue in 1 minute. The maintenance of blood flow to the brain is critical because the brain requires a constant supply of oxygen and glucose. Brain uses 20% of the body’s oxygen and 25% of its glucose.

Question 45

Pinpoint fixed pupils

Answer 45

pons injury or drugs (cocaine)

Question 46

Fixed midposition

Answer 46

midbrain injury

Question 47

Lumbar Puncture

Answer 47

CSF L3-L5 clear no bacteria, glucose

Question 48

Cerebral Perfusion Pressure

Answer 48

Normal is 70-100 mmHg | 50-60 needed for adequate perfusion

Question 49

Shivering medications

Answer 49

thorazine- depresses thermoregulation in the hypothalamus and reduces peripheral vasoconstriction, muscle tone and shivering demerol- relaxes the smooth muscle and reduces shivering

Question 50

Steroid protocol for spinal cord injuries

Answer 50

Methylprednisolone- bolus dose of 30 mg/kg follow by infusion at 5.4 mg/kg/hr for 23 hours initiate within 6-8 hours of injury

Question 51

autonomic dysreflexia

Answer 51

``` uncontrolled hypertension above T6 sweating bradycardia massive headache common cause is full bladder, rectum, or anything sharp that hurts the patient ```

Question 52

Neurogenic shock

Answer 52

due to the loss of function of the autonomic nervous system blood pressure, heart rate decreases (hallmark sign!!!), and cardiac output decreases venous pooling occurs due to peripheral vasodilation paralyzed portions of the body do not perspire may give atropine to speed up heart

Question 53

Spinal Shock

Answer 53

a sudden depression of reflex activity below the level of spinal injury muscular flaccidity and lack of sensation and reflexes usually 24-72 hour period of paralysis, hypotonia, and areflexia development of spasticity indicates recovery

Question 54

Injury above T-1 level

Answer 54

quadriplegia

Question 55

injury below T-1 level

Answer 55

paraplegia