Week 5 & 6 Flashcards
(48 cards)
1
Q
Describe the primary role of the nervous system.
A
To maintain homeostasis within the body
2
Q
What is the front lobe responsible for?
A
- Voluntary movement
- Emotions
- Intellect and reason
- Brocha (expressive speech)
3
Q
What is the parietal lobe responsible for?
A
- Tactile/sensations
- Temperature
4
Q
What is the occipital lobe responsible for?
A
- Reading/comprehension
- Visual receptor
5
Q
What is the temporal lobe responsible for?
A
- Wernicke’s Area (speech)
- Receive/interpret impulses
6
Q
What are the main functions of the cerebro-spinal fluid?
A
- Protection - shock absorber for the brain
- Circulation - nutrients to CNS and removal of some waste products
7
Q
Describe Primary Brain Injury
A
Due to the result of an initial insult. Traumatic Primary Brain Injury: - Blow, acceleration, penetrating - Cortical contusions and lacerations - Diffuse axonal injury Non-Traumatic Primary Brain Injury: - Haemorrhage - Thrombus - Tumour - Infection
8
Q
Describe Secondary Brain Injury
A
Consequence of the primary injury.
- Inflammation, swelling and oedema
- Raised intracranial pressure
- Reduction in cerebral blood flow and tissue oxygenation
9
Q
What is intracranial pressure?
A
- Pressure exerted within the skull and meninges by the contents of the skull
10
Q
What is normal intracranial pressure?
A
0-10 mmHg
11
Q
What is considered abnormal intracranial pressure?
A
15 mmHg or above
12
Q
What are some causes of raised intracranial pressure?
A
- CSF drainage: Hydrocepalus
- Trauma
- Infection
- Tumour
13
Q
What is a extradural/epidural haematoma?
A
Commonly arterial bleeds; compression may be rapid
14
Q
Describe a subdural haematoma.
A
Commonly venous so slower to develop (maybe over 24 hours); may be acute or chronic
15
Q
What is a subarachnoid haematoma?
A
Aneurysm rupture in the circle of willis
16
Q
What is an intracerebral haematoma?
A
Severe motion of the brain, or develop from a contusion; elderly, alcoholics more vulnerable
17
Q
List 6 signs and symptoms that may indicate a raised ICP
A
- Vomiting - projectile
- Epileptic fits/seizures
- Bradycardia/decline in pulse
- Decreased respiration rate
- Rise in blood pressure
- Decrease in conscious state
18
Q
What is cushing’s triad and what three things are associated with it?
A
Cushing’s Triad is the body’s physiological response to an increase in intracranial pressure = pressure on the brain stem
- Systolic Hypertension - widening pulse pressure
- Bradycardia
- Irregular respirations
19
Q
How can raised ICP be assessed?
A
- Glascow Coma Scale
- Pupillary Response
- ICP monitoring
20
Q
What nursing care is involved with a patient with a raised ICP?
A
- ABCDE
- Oxygen
- Cluster care - sensitivity as ICP raises when patient is undergoing nursing care
- Observations
- IV Mannitol
- Head elevated >30 degrees - assists venous drainage
- Therapeutic touch can decrease ICP
21
Q
What is a cerebrovascular accident (CVA)?
A
Sudden interference to the brain’s blood supply due to partial or complete occlusion of a cerebral blood vessel.
There are two different forms of CVAs/Strokes
Ischaemic and Haemorrhage
22
Q
Describe the pathophysiology of an ischaemic stroke.
A
Occlusion of a cerebral artery due to:
- Thrombotic (atherosclerosis)
- Embolic (usually cardiac or carotid artery)
- Produces acute ischaemia in the territory served by the artery
- Insufficient blood flow results in oxygen deprivation and rapid cerebral deterioration
23
Q
Describe the pathophysiology of a haemorrhagic stroke
A
Usually occur in the context of severe and longstanding hypertension.
- Mortality is 38% and is higher than for ischaemic strokes
- Bleed can cause brain distortion, midline shift, elevated intracranial pressure (ICP) and herniation
24
Q
What is a transient ischaemic attack?
A
- Obstructing clot may be lysed by the endogenous fibronolytic system before permanent damage occurs
- Associated neurological damage completely resolves
- Usually symptoms last minutes but some up to 24 hours
- Early warning sign of future stroke
25
What early signs and symptoms are associated with TIAs and strokes?
- Slurred speech (dysarthria)
- Loss of speech (aphasia)
- Difficulty understanding speech
- Dimness or loss of vision, usually in one eye
- One sided weakness, numbness or prickling of face, arm or leg
- Severe headache
- Nausea and vomiting
26
Describe the nursing management of TIAs and strokes
- ABCDE
- Oxygen
- Frequent observations including GCS and neurological obs
- IV access and drug therapy
- IDC and fluid balance
- Position changes for pressure area care
27
Describe meningitis.
Inflammation and infection of the pia mater, arachnoid mater, and the CSF filled subarachnoid space.
- Viral = less severe, symptomatic treatment
- Bacterial - invade CSF, endotoxins or cell wall fragments set up inflammatory response
Infarction of surrounding tissue.
Meninges thicken, adhesions form; flow of CSF may be impaired
28
What are the signs and symptoms of bacterial meningitis?
- Fever and chills
- Headache
- Stiff neck and back
- Nausea and vomiting
- Seizures
- Photophobia - bright light is uncomfortable or distressing
29
What is the diagnosis for meningitis?
CT or lumbar puncture
30
What treatment and nursing care is needed for someone with meningitis?
- ABCDE
- Antibiotics and corticosteroids
- Antipyretics and anticonvulsant drugs
- IV therapy
- Observations including GCS
31
Describe seizures.
A transient neurological event of paroxysmal abnormal or excessive cortical electric discharges.
A symptom/component of many diseases.
Can be divided into:
- Unprovoked/primary seizures e.g. epileptic seizures
- Provoked/secondary seizures e.g. febrile convulsions
32
What is epilepsy?
Refers to the disorder of recurrent seizures
33
Describe the pathophysiology of a seizure.
- Results from a sudden explosive disorderly discharge of cerebral neurons and is characterised by rapid transient alteration in brain function
34
What is the nursing involved with seizure management?
- Protect airway - administer oxygen
- Protect patient from injury - safe environment
- Bloods to exclude metabolic causes - blood glucose important
- Further investigations - CT, MRI, Electroencephalogram (EEG)
- Antiepileptic medication
35
Describe an absent (petit mal) seizure
- Brief, repetitive, non-convulsive event, usually occurring in the young
- Awareness and responsiveness is impaired - simply stare, eyes might roll back and their eyelids flutter
- Starts suddenly, lasts a few seconds then stops - person doesn't recall the seizure or what happened during that time
- Can occur many times a day and thus be disruptive to learning
36
Describe an atonic seizure
- Generalised seizures that affect muscle tone causing the person to collapse on the ground. The person usually remains conscious
- Often called drop attacks, these seizures can cause head or facial injuries
37
Describe myoclonic seizures
- Brief, shock-like jerks of a muscle or group of muscles, usually lasting no more than a second or two
- Can be just one, but sometimes many will occur within a short time
38
Describe a tonic clonic seizure
- Generally lasts 1-3 minutes
- Body stiffens and person falls to ground
- Air forced past the vocal cords causes a cry or groan
- Tongue or cheek may be bitten
- Limbs then begin to jerk in strong, symmetrical, rhythmic movements
- Loss of bladder or bowel control
- As consciousness returns, the person may be confused, drowsy, agitated or depressed. They may have a headache and want to sleep, the drowsiness can last a number of hours [post ictal phase]
39
What is Parkinsons Disease?
- A progressive degenerative neurological disorder that affects control of body movement
40
Describe the pathophysiology of Parkinsons Disease.
- Degeneration of the dopamine-producing neurons
| - Results in a deficiency of dopamine
41
What are the signs and symptoms of Parkinsons Disease
- Tremor
- Bradykinesia
- Muscle rigidity or stiffness
- Postural instability - shuffling gait
- Mask-like facial expression
- Slow speech
- Difficulty swallowing
- Late in disease, some develop dementia
42
How is Parkinsons diagnosed?
- No specific test yet
- If three of the four main symptoms are present, a diagnosis is made
- MRI and CT to rule out other conditions
43
Describe Alzheimer's Disease
Dementia = intellectual deterioration severe enough to interfere with social performance
- Alzheimer's is a form of dementia
Cortical atrophy and loss of neurons. Formation of neuritic plaques and neurofibrillary tangles arise from improper breakdown of amyloid proteins in the brain.
Exact cause is unknown
44
Signs and symptoms of Alzheimer's Disease
Loss of short term memory: denial
Disorientation, change in personality and affect
- Stage 1 = 2-4 years, short term memory loss
- Stage 2 = several years, confusion, disorientation, lack of insight, inability to carry out ADLs
- Stage 3 = terminal stage, person becomes incontinent, apathetic, unable to recognise family or friends, usually need institutional care
45
How is Alzheimer's diagnosed?
Brain imaging to exclude other causes - no real test to diagnose
46
What treatment is involved with Alzheimer's Disease?
- Cholinsterase inhibitors - to increase acetylcholine and slow loss of memory, improve cognition
- Donepezil - prevent breakdown of acetylcholine
- Antipsychotic drugs - control agitation
- SSRIs = manage depression
47
What is Multiple Sclerosis?
- Results from progressive demyelination of the white matter of the brain and spinal cord - affecting the function of the nerves involved.
- Exact cause is unknown
- Structures involved are the optic and oculomotor nerves - the disorder does not affect the peripheral nervous system
48
What is Guillain-Barre Syndrome?
- An autoimmune disease whereby the myelin surrounding the neuronal axons in the PNS are destroyed by the person's own immune system
- Usually caused by bacterial or viral infection - the antibodies from the infection begin to destroy the myelin as well
- Lack of myelination = fewer action potentials reach the skeletal muscles without receiving the signal from the neurons
- Leads to muscles not contracting = eventually paralysis
