2.9 Neurological, Sensory-Motor Flashcards
Describe the following reflexes and their significance
REFLEXS CORNEAL
CN V & VII
When the cornea is touched there should be a brainstem reflex leading to blinking or bilateral eyes and tearing
Absence means something is affecting the nerves such as a tumor, brain stem CVA or brain death
Describe the following reflexes and their significance
OCULOCEPHALIC “DOLL’S EYES”
Positive reflex: when the head is turned the eyes should turn with opposite
Negative reflex: when the head is turned the eyes become fixed straight ahead
Describe the following reflexes and their significance
OCULOVESTIBULAR “COLD CALORICS”
When ice cold water is used to irrigate the EAR. The brainstem reflex should trigger the eyes to look toward the direction of the irrigated ear
Absence of the reflex indicate brain death
Describe the following reflexes and their significance
GAG
CN IX & X
There should be contraction of posterior pharynx muscles when stimulated
Absence can mean over sedation or brain death
Describe the following reflexes and their significance
BABINSKI
Planter response to movement of a hard object up the bottom of the food. Normal response is curling of all toes inward (negative Babinski)
Dorsiflexion or fanning of the toes indicates presence of Babinski (abnormal) and can indicate spinal cord or brain injury. (positive Babinski)
This is a primitive response in infants and can also occur with ETOH intoxication or seizure activity
Neuro assessment abnormal findings and their significance
RESPIRATORY CONSIDERATIONS
Damage to pons/medulla leads to inability to regulate breathing patterns based on oxygen and carbon dioxide. As a result, you have irregular patterns of breathing depending on the area of injury
Excessive yawning or sighing: first sign of deterioration
Cheyne-stokes: altered deep and rapid breathing with periods of apnea
Hyperventilation: 40 breaths/min or higher
Apneustic: long inhalation and long exhalation
Ataxic/Apneic: uncoordinated or irregular breathing, pt no longer responding to carbon dioxide
What is the Glasgow Coma Scale
Measure a person’s level of consciousness after a brain injury. The GCS assesses a person based on their ability to perform eye movements, speak, and move their body
3 PARTS
Components of the Glasgow Coma Scale
EYE OPENING
Eye Opening: Spontaneously 4 To sound 3 To pain/pressure 2 No response 1
Components of the Glasgow Coma Scale
VERBAL RESPONSES
Verbal responses: Oriented 5 Confused 4 Single words 3 Incomprehensible sounds 2 No response 1
Components of the Glasgow Coma Scale
BEST MOTOR RESPONSE
Best motor response: Obeys commands 6 Localizes pain 5 Flexion-withdrawal 4 Abnormal flexion (decorticate) 3 Abnormal extension (decerebrate) 2 No response (flaccid) 1
What does a GCS of 3 mean?
Could mean patient is dead
OR
Severe neurological injury
Describe the following head injury
BLUNT
No break in skin:
Acceleration (hit in head with bat)
Deceleration (fall)
Acceleration/decelerations (combination of two), Rotation, usually not good outcome, (brain rotating within skull, MVA, shaking baby)
Describe the following head injury
PENETRATING
Break in skin: gunshot, knives, metal object, rocks/objects of nature.
NI:
Never pull out object, secure and held in place
Control bleeding
High infection risk
Domestic: CPS, APS
Describe the following head injury
COUP-CONTRECOOUP
Acceleration and Deceleration head injury
ie: MVA with the head being forced forward and then back with anterior and posterior injury. Think “whiplash”
Pathophysiology and assessment finding of the following hematomas
EPIDURAL
Focal (localized) injury
Hematoma/Hemorrhage
Epidural:
Blood in space between the skull and dura mater, typically from an arterial bleed. Common with skull fractures
Findings:
Loss of consciousness then regain consciousness
ICP
Emergent surgical
Pathophysiology and assessment finding of the following hematomas
SUBDURAL
Focal (localized) injury
Hematoma/Hemorrhage
Subdural:
Blood in space between dura and arachnoid typically from a venous bleeding
Findings: Acute: s/s during time of injury or few days later Pupil changes HA Resp changes Chronic: s/s can be weeks to months Fall is common Mimic dementia Slow changes to complete loss of consciousness
Pathophysiology and assessment finding of the following hematomas
INTRACEREBRAL
Focal (localized) injury
Hematoma/Hemorrhage
Intracerebral:
Blood deep in brain tissue, most common with contusions, penetrating trauma, depressed skull fractures
Findings: HA Vomiting Seizures Reduced level of consciousness Hemiparesis Surgical need Drain placed
Identify the complication of a traumatic brain injury
HERNIATION
Herniation Syndrome:
Shifting of the brain tissue into another part of the brain due to blood or edema.
Shifting shears/tears the vasculature causing decreased brain perfusion and ultimately brainstem compression and herniation
Supratentorial (3 types):
Cingulate: highest up in brain, increased ICP
Central: compression of midbrain, rapid decline of level of consciousness or coma
Uncal/lateral: pressing brain centrally, CNIII trapped, pupil dilation, decreased level of consciousness, respiratory arrest
Infratentorial:
Upward or downward displacement through foramen magnum altering vital functioning. May have altered respirations, fixed pupils, posturing, eventually resp or cardiac arrest
Identify the complication of a traumatic brain injury
BRAIN DEATH
Non reversable loss of brain function Must maintain normothermia Absent of all reflexes No depressant drug/ETOH poisoning Institutional policy may include EEG, brain flow study, apnea test Notify Gift of Life
Identify the complication of a traumatic brain injury
SIADH
Posterior pituitary can alter release of ADH
SIADH: syndrome of inappropriate antidiuretic hormone)
TOO much ADH causing retention of water
Urine: low volume, very concentrated, high specific gravity
Serum: low serum osmolality
Treatment:
Restrict fluid
Slowly replace Na+
