Wk 6

Question 1

The nervous systems role

Answer 1

Maintain homeostasis
Responsible for our perceptions, behaviours and memories
Initiates voluntary movements
Responds rapidly to stimuli using nerve impulses

Question 2

Role of brain

Answer 2

Perception and sensory stimuli
Voluntary motor responses
Homeostatic mechanisms
Only 2% of body weight yet uses 20% O2 in blood
Uses glucose for energy but doesn’t store extra supplies hence needs constant supply of O2 and glucose
Auto regulation: cerebral perfusion, blood flows through cerebral vessels to maintain optimum blood flow

Question 3

The cerebral-spinal fluid

Answer 3

Circulates through subarachnoid space around spinal cord and brain
80-150mls CSF in CNS
Made in choroid plexus and absorbed by arachnoid villi
Protection: acts as shock absorber, buoyancy for brain
Circulation: nutrients to CNSand removal of waste

Question 4

Meninges of the brain

Answer 4

Scalp
Skull
Periosteal dura mater 
Meningeal dura mater 
Arachnoid mater
Subarachnoid space
Pia mater
Cerebral cortex

Question 5

The components within the skull

Answer 5

Brain 80%
CSF 10%
Blood 10%

Sums of volumes of brain, csf and intracranial blood are constant = Monroe kellie doctrine

Question 6

Primary brain injury

Answer 6

Occurs at moment of trauma

Includes contusion, damage to blood vessels, laceration of brain tissue and axonal shearing (shearing of nerve fibers)

Blood brain barrier and meninges damaged

Different regions of brain more sensitive to mechanical damage

Primary leads to secondary injury

Cause: blow to head, penetration, acceleration/deceleration

Question 7

Concussion

Answer 7

Momentary interruption of brain function with or without loss of consciousness

Question 8

Contusion

Answer 8

Bruise to the brain caused by blunt head trauma, results in permanent damage

Question 9

Diffuse axonal injury

Answer 9

Primary injury with widespread microscopic damage: shifting, shearing, rotational, acceleration, deceleration injury, that stretch and or tear nerve cell processes within the brain

Question 10

Haemotoma bleeding in the brain

Answer 10

Extradural/epidural: commonly arterial bleeds. Compression may be rapid

Subdural: commonly venous so slower to develop can be acute or chronic

Subarachnoid: aneurysm rupture in circle of willis

Intracranial: severe motion of the brain or develop from contusion. Eked rely and alcoholics more vulnerable

Question 11

Secondary brain injury

Answer 11

Consequence of primary injury, occurs hours and days after
Plays large role in brain damage and death
Inflammation, swelling, oedema, raised ICP, reduction in cerebral blood flow and tissue oxygenation

Question 12

Altered consciousness and coma

Answer 12

Consciousness: awareness of self and environment, requires arousal and awareness, often first sign of severe illness

Coma: state of unresponsiveness from which a patient can’t be aroused to produce meaningful response, absence of arousal and content, often problem with cerebral cortex or brain stem reticular activating system

Question 13

Skeletal muscle weakness and paralysis may result from lesions in voluntary and sensory nerve pathways (upper and lower)

Answer 13

Upper: corticospinal and corticobulbar tracts, basal ganglia, cerebellar

Lower: peripheral nerves, mixed sensory and motor deficits, decreased muscle tone and flaccid paralysis

Question 14

Intracranial pressure ICP

Answer 14

Pressure exerted within the skull and meninges by the contents of the skull
Normal 0-10mmhg
Above 15mmhg is abnormal

Question 15

Cerebral perfusion pressure cpp

Answer 15

Blood pressure gradient across the brain, an estimate of cerebral blood flow

Cpp = map - icp
Cpp less than 60mmhg neuronal hypoxia and cell death

Question 16

Causes of raised ICP

Answer 16

Trauma: swelling, bleeding and obstruction/ reduced blood flow

Bleeding: CVA, aneurysm, malformation

Infection: meningitis, encephalitis

Tumour: benign or malignant

Csf drainage blocked hydrocephalus: clot, debris, malformation

Question 17

Symptoms of raised ICP

Answer 17

Headache: stretch on vessels
Changes in LOC/cognition: lack of O2 to cerebrum
Altered reaction/size of pupils: optic nerve comp
Projectile vomiting
Bradycardia, irregular pulse, increased BP, decreased RR (cushings triad- widening pulse pressure, increases arterial pressure to overcome increased ICP)
Seizures
Papilloedema swelling of optic disk

Question 18

Assessment of pt

Answer 18

ABCDE
Early detection of ICP can be lifesaving 
AVPU
Glasgow coma scale
Neuro obs
Decorticate posturing and decerebrate posturing 
Mental status
Pupil changes

Question 19

Avpu

Answer 19

Alert/awake: eyes open and responding
Voice: needs verbal stimulus to open eyes and respond (drowsy)
Pain: needs physical stimuli to elicit response
Unresponsive: no response

Question 20

GCS

Answer 20

3-8: coma/severe injury
9-12: moderate head injury
13-15: mild injury

Question 21

Medical treatment of raise. ICP

Answer 21

ABCDE
Maintain cerebral perfusion (cpp>70mmhg) and oxygen delivery: Fluid resuscitation, map 90mmhg, cool pt
ICP monitoring: GCS 3-8, adverse signs, abnormal CT
ICP above 20-25mmhg

Question 22

Brain injury surgery

Answer 22

Craniotomy: bone flap is temporarily removed from skull to access brain
Decompressive craniectomy: part of skull is removed to allow swelling

Question 23

Nursing care of pt with raised ICP

Answer 23

ABCDE
Oxygen
Cool pt
Breaks between care (10mins)
Accurate measurement of BP, TPR, GCS and fluid balance 
Avoid oropharyngeal suction 
Communicate with patient
Therapeutic touch 
Elevate head >30 degrees for venous drainage 
Neutral alignment
Avoid hip flexion (increases intra thoracic pressure and affects venous drainAge) 
Treat constipation as it raises BP

Question 24

Spinal cord injuries

Answer 24

Described at various levels and degrees of damage
Transient (full recovery)
Incomplete: contusion, laser action and compression of cord substance - range of effects
Transection of cords “complete” injury - total loss of function below site of injury

Cord oedema
Spinal shock

Question 25

Cervical injury sites and their effect

Answer 25

Cervical: tetraplegia or quadriplegia, limited function, c1-3 results in loss of breathing Thoracic: Paraplegia Lumbar/sacral : decreased control of legs and hips, urinary system

Question 26

Nursing management sci

Answer 26

``` ABCDE Treat as being spinal injury until ruled out Pt immobilised Spinks alignment X-ray, cT scan, MRI Airway and breathing are key Respiratory support Fluid resuscitation BP control Hr control Nutrition Skin care Pain relief ```

Question 27

CVA/ cerebrovascular accident stroke

Answer 27

Sudden interference to brains blood supply due to a partial or complete occlusion of a cerebral artery Ischaemia Haemorrhage

Question 28

Early signs and symptoms of TIA and stroke

Answer 28

Fast Face: one sided weakness of face, tingling, headache, dimness of vision Arms: one sided weakness Speech: slurred, loss, difficult to understand Time: call 911

Question 29

Nursing management of stroke

Answer 29

``` ABCDE Oxygen Frequent neuro obvs Iv access and drug therapy Transfer to ct scan MRI IDC and fluid balance Position changes Range of motion exercises ```

Question 30

Meningitis

Answer 30

Inflammation and infection of the Pia mater, arachnoid mater, and the CSF filled subarachnoid space Viral is less severe Bacterial invades CSF and sets up inflammatory response Meninges thicken adhesions form and flow of CSF is affected

Question 31

Signs and symptoms of bacterial meningitis

Answer 31

``` Fever and chills Headache Stiff neck and back Abdominal and extremity pains Nausea and vomiting Seizures Meningococcal meningitis rash Photophobia ```

Question 32

Diagnosis and treatment of bacterial meningitis

Answer 32

``` ABCDE Organ support Antibiotics Corticosteroids Antipyretic X and anticonvulsants IV therapy Obs Vaccines ```

Question 33

Encephalitis

Answer 33

Inflammation of the brain Memory problems, hallucination. Tremors, seizures, headache Antiviral agents, mechanical ventilation, corticosteroids, sedatives

Question 34

Seizures

Answer 34

Transient neurological event of abnormal or excessive electrical discharges Disturbances of motor function and autonomic visceral function, behaviour, consciousness

Question 35

Nursing Management of seizures

Answer 35

``` ABCDE Protect airway Protect from injuries Bloods: glucose important Further investigation Antiepilectic medication ```

Question 36

Myasthenia gravis

Answer 36

Autoimmune neuromuscular disease that causes fluctuation muscle weakness and fatiguability

Question 37

Guillain barre syndrome

Answer 37

Acute inflammatory demyelinating polyneuropathy affecting peripheral nervous system Triggered by acute infection