Acute Disorders Of Brain

Question 0

Cushing’s Triad

Answer 0

Reflects pressure on the brain stem; 1) widened pulse pressure
- systolic minus diastolic BP
- resting( sitting) pulse pressure = 40 mm/ hg
2) bradycardia
3) irregular Breathing pattern, these findings should be reported ASAP
Late sign of increased ICP!!!!

Question 1

Ischemia and hypoxia

Answer 1

Is a contributing factor either as the primary insult Or as part of the secondary response to injury.

Ischemia results in the immediate neurologic dysfunction due to the inability of neurons to generate the ATP needed for a energy requiring processes

Question 2

Intracranial pressure (ICP)

Answer 2

With brain injury or insult:

Increased ICP can lead to compression and herniation of the brain!

Question 3

Maintaining cerebral perfusion

Answer 3

Cerebral perfusion pressure =
MAP- ICP
Normal CPP is >60 mm/ hg But is patient specific
Maintenance of CPP reduces mortality in severe head injury.
Hypotension is associated with higher mortality rates in head injury!!!!

Question 4

Brain compression and herniation

Answer 4

With increased intracranial pressure, Nueral tissue and blood vessels are compressed.
!!!!!Herniation; the protrusion of brain tissue through the foreman magnum( the opening through which the spinal cord passes)- This is fatal!!!!!!

Question 5

Some causes of increased intracranial pressure

Answer 5

Tumors, 
hemorrhage,
 infections,
hydrocephalus ( increase in CSF), 
acidosis

Question 6

Nursing care for increased intracranial pressure.

These factors increase ICP:

Answer 6

Hypoxia - vasodilation from increases co2
coughing
 pain
 suctioning 
lying supine 
vomiting 
straining/ valsalva maneuver (ie BM)
Bright light/noise

Question 7

Level of consciousness (LOC)

Answer 7

Change in LOC is an early indicator of altered brain function

Question 8

Glasgow coma scale interpretation

Answer 8

!!!Mild head injury 13 -15
moderate head injury 9 -12
severe head injury- 8 or less!!!

Question 9

Motor response

Answer 9

Abnormal motor response is the most powerful predictor of patient outcome in unconscious patients
!!!Decorticate posturing, abnormal flexor responses
Decerbrate posturing, abnormal extension.!!!!

Question 10

Decerebrate posture results from damage to upper brain stem. Arms are adducted and extended, with wrists probated and fingers flexed. The legs are stiffly extended, with plantar flexion of the feet.

Answer 10

Decorticate posture results From damage to one are both corticospinal tracks. In this posture the arms are adducted and flexes with the wrist and fingers flexed on the chest. The legs are stiffly extended and internally rotated, with plantar flexion of the feet

Question 11

Cerebral concussion

Answer 11

Concussion/mild head injury

• Loss of consciousness for five minutes or less
• Headache, nausea vomiting, dizziness
• Complication post concussion syndrome

Question 12

Cerebral contusion

Answer 12

Major head injury
bruising of brain tissue areas of micro hemorrhages, usually with cerebral edema.
Headache, nausea, vomiting, weakness, cognition problem

Question 13

Epidural hematoma

Answer 13

!!Collection of blood between dura and skull.
Usually involves arterial injury= rapid onset of symptoms!!

Seen often with skull fracture, classic sign alert, then lapses into coma. Usually requires emergency surgery to evacuate blood.

Question 14

Subdural hematoma

Answer 14

Collection of blood between Dura and outer layer of the arachnoid membrane.
Usually involves venous bleeding.
Classified as acute, subacute, chronic

Question 15

Subarachnoid hemorrhage

Answer 15

!!!Usually from leaking our rupture from of cerebral aneurysm or arteriovenous malformations!!’n

Question 16

Secondary injury

Answer 16

Ischemic any hypoxia events, cerebral edema, and other processes that lead to increased ICP and altered vascular regulation.

Question 17

Cerebrovascular disease and stroke

Answer 17

Stroke is a sudden onset of neurologic dysfunction due to cardiovascular disease that results in an area of brain infarction.
Stroke is the third leading cause of death in the United States.
!!Can be ischemic or hemorrhagic.
Most common form of stroke is ischemic.!!!

Question 18

Stroke risk factors

Answer 18

Females affected > males.
most victims >65 or older years of age,
risk factors are similar to those for other after atherosclerotic vascular diseases
Hypertension, DM, hyperlipidemia, smoking

Question 19

Ischemic stroke

Answer 19

A sudden occlusion of cerebral artery due to thrombus formation or Emboli.

Question 20

Hemorrhagic stroke

Answer 20

Usually from severe, chronic Hypertension.!!!
Most occur in basal ganglia or thalamus.
Degree of secondary injury and associated morbidity and mortality rates is much higher in hemorrhagic stroke than ischemic stroke.

Question 21

Management of stroke

Answer 21

Cardiovascular stabilization
Brain CT determines type and location of stroke
Ischemic stroke, treatment aimed at minimizing infarct size and preserving neurological function
Hemorrhagic stroke, blood pressure management, ICP monitoring and management

Question 22

Aphasia/language impairment

Answer 22

Broca’s aphasia, (expressive aphasia). Consist of poor articulation and sparse vocabulary. can comprehend language but cannot express self

Wernicke aphasia- (receptive aphasia) Characterized by impaired auditory comprehension and speech that is fluent but does not make sense

Question 23

Meningitis

Answer 23

Infection of meningeal layers
Bacterial meningitis is an emergency
Fatality rate 12% in US 30% in neonates and elderly.
Those living in close quarters at risk
Survivors had 10 to 30% neurological complications i.e. deafness
In children: seizures and developmental delays

Question 24

Meningitis

Answer 24

Bacteria, viruses are fungi enter into CNS via a bloodstream, ear, sinuses, skull fractures
Respiratory isolation!!!!!
headache, fever, stiff neck,(Michael rigidity) photophobia, rash.