Cerebral Dysfunction Flashcards
cranial nerves
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Trigeminal
- Abducens
- Facial
- Vestibulocochlear
- Glossopharyngeal
- Vagus
- Accessory
- Hypoglossal
cranial nerve 1
olfactory
close eyes and inhale, do each nostril
cranial nerve 2
optic
central and peripheral vision
cranial nerve 3
oculomotor
pupillary constriction
cranial nerve 4
trochlear
follow my finger as i move down towards tip of pts nose
cranial nerve 5
trigeminal
assess jaw strength
cranial nerve 6
abducens
eye movement to sides, assess six cardinal directions
cranial never 7
facial
facial expressions
cranial nerve 8
vestibulocochlear
rub fingers together by each ear
cranial nerve 9
glossopharyngeal
say ahhh, gag reflex
cranial nerve 10
vagus
swallow and speak
cranial nerve 11
accessory
neck and shoulder
cranial nerve 12
hypoglossal
stick out tongue and move side to side
normal PERRLA
pupils…
equal
round (2-3mm)
reactive to light (brisk)
movements are parallel
abnormal PERRLA
pupils…
sluggish (slow constriction)
pinpoint (overdose)
sudden fixed and dilated (neuro emergency)
levels of consciousness
full consciousness
confusion
disorientation
lethargy
obtunded (arousable only to stimulation)
stupor (arousable only to vigorous stimulation/sternal rub/pinch fingernail bed)
coma
persistent vegetative state
red flag LOC
lack of response to painful stimuli
can start assessing extremity strength at…
toddler / preschool age
decorticate posturing
cerebral cortex damage
flexion
arms held tightly to body
feet plantar
decerebrate posturing
brainstem damage
extension
hands pronated
back is arched
pediatric glasgow coma scale
eyes (1-5)
verbal response (1-5)
motor response (1-5)
15= unaltered
less than 8= coma
less than 3= extreme
normal ICP for children
1-10 mmHg
early signs of increased ICP for infants
tense and bulging fontanels!!
irritability
poor feeding
distended scalp veins
separated cranial sutures
early signs of increased ICP for children
diplopia (double vision)
HA
nausea w or w/out vomit
late signs of increased ICP
bradycardia
decreased LOC
alterations in pupil size
cheyne stokes respirations
RN interventions for increased ICP
HOB 30+
avoid activities that may increase ICP
eliminate noise
no suctioning
mannitol
be careful of overhydration with IVF
posturing with increased ICP
increased ICP– pressure on medulla oblongota (controls pulse and RR, apart of brainstem)— extension posturing
epidural hematoma
between dura and skull
subdural hematoma
between dura and arachnoid
deeper
concussion
caused by blunt trauma to head
CM: amnesia, confusion, HA, lack of coordination, N/V, dizziness, ringing in ear, sleepiness
complication: hematoma, increased ICP
concerning when sleepiness for more than 24hrs or disorientation for a few hours
meningitis
bacterial or viral
CM: nuchal rigidity, photophobia, HA, vomiting, fever and chills, symptoms of increased ICP
dx: lumbar puncture (CSF will be cloudy, increased protein, decreased glucose, contain RBCs), Brudzinski sign, kerning sign
manage: isolation, abx, antipyretics, restrict hydration, reduce ICP
brudzinski sign
lay supine, lift pt neck
+ if knees flex with neck flexion
kerning sign
lay supine, lift one leg with knee flexed at 90 then slowly straighten leg out
+ if pain or cannot extend
vaccines to prevent meningitits
Hib and pneumococcal
reye syndrome
swelling of liver and brain,
acute form of encephalopathy
dx: liver biopsy
CM: fever, profuse vomiting, neuro impairment, disordered hepatic function
treat: steroids
tonic clonic seizure
generalized
onset without warning
tonic (10-20sec)
clonic (30-50sec/up to 30 min)
postictal (30 min)
absence seizure
generalized
LOC 5-10 sec
blank stare, daydreaming
myoclonic seizure
generalized
contractions
atonic seizure
generalized
“drop attacks”
lost muscle tone causing a fall, period of confusion follows
febrile seizures
partial (local/focal)
sudden spike in temp (38.9-40C) (102-104)
10-15 sec
