Exam 2: Neurological Problems Flashcards
1
Q
The Central Nervous System is comprised of what ?
A
- Cerebrum
- Brainstem
- Cerebellum
- Spinal cord
2
Q
The Cerebrum is made up of what ?
A
- Frontal lobe
- Parietal lobe
- Temporal lobe
- Occipital lobe
3
Q
What is the Brain stem comprised of ?
A
- Mid brain
- Pons
- Medulla
4
Q
What is the Cerebellum main functions ?
A
- Movement
- Coordination
5
Q
What is the Medulla responsible for ?
A
- Respiratory
- Vasomotor activity
- Cardiac function
6
Q
The spinal cord is made up of what nerve pathways ?
A
- Ascending nerve pathways
- Descending nerve pathways
7
Q
What do Ascending nerve pathways in the spinal cord do ?
A
Carry sensory information up to the higher parts of the CNS
8
Q
What do the Descending nerve pathways in the spinal cord do ?
A
Carry impulses responsible for movement down to the muscles
9
Q
What does the Blood Brain Barrier do ?
A
Protects our brain from some of the poisonious things that run through our blood.
AKA: it limits the absorption of toxins from getting to the brain
10
Q
When assessing the Nervous system, what objective data do test/look for ?
A
- Mental status
- Cranial nerve function
- Motor function
- Sensory function
- Cerebellar function
- Reflexes
11
Q
When assessing someones Cerebellar function, what are we looking at ?
A
Looking @ balance
Ex: having pt’s
- walk heel to toe
- walk backwards
- Flipping the hands back & forth over the thighs
12
Q
What is the Peripheral Nervous System comprised of ?
A
- Spinal & Cranial nerves
- Autonomic Nervous System
13
Q
What is the Autonomic Nervous System Comprised of ?
A
- Sympathetic nervous system
- Parasympathetic nervous system
14
Q
What are the 3 fluids found within the brain (skull) ?
A
- Brain tissue
- Blood
- Cerebral spinal fluid
15
Q
What are 5 types of Acute Intracranial Problems ?
A
- Increased intracranial pressure (Increased ICP)
- Head trauma
- Brain inflammation
- Brain tumors
- CVA/Stroke
16
Q
What is increased ICP caused from ?
A
There is an increase in pressure in 1 of the 3 fluid areas in the brain (brain tissue, blood, or CSF)
- theres not much room in the brain, so we start to run into problems when this happens
17
Q
Head trauma is also known as what ?
A
Traumatic Brain Injury (TBI)
- can be caused by motor veichle and motorcycle accidents
18
Q
Brain Inflammation can be caused by what ?
A
- Abscess
- Meningitis
- Encephalitis: Bacterial & Viral
19
Q
True or False: Brain tumors can be primary cancers, meaning that they start in the brain OR they can be metastatic tumors meaning the cancer started elsewhere in the body and cancer cells moved to the brain & started to grow there ?
A
True
20
Q
True or False: Treatment for Brain tumors is different depending on the type (primary vs. metastatic) ?
A
True
21
Q
What are the different type of Diagnostic studies for the work up of Neurological problems ?
A
- Cerebral spinal fluid analysis
- Radiology
- X-ray
- CT
- MRI, MRA
- Positron Emission Tomography (PET)
- Electrographic Studies
- Electroencephalography (EEG)
- Electromyography (EMG)
- Electroneurography - Ultrasound
- Carotid artery duplex scan
- Transcranial Doppler
22
Q
What do we know about Cerebral Spinal Fluid Analysis’s ?
- AKA: ?
- What type of technique: ?
- What color should fluid be ?
A
- AKA: Lumbar puncture, spinal tap
- Aseptic technique
- Fluid should be clear
23
Q
Why is X-ray used as a diagnostic for neurological problems ?
A
Looking for any bone abnormalities thats could cause neurological problems
Ex:
- Cant walk
- Shooting pain down leg
- which can all be related to a bony formation or problem in the spine
24
Q
If using a CT as a diagnostic tool, what do we want to check before sending them down (2 things) ?
A
- Check Allergies to
- Iodine
- Shellfish
- Dye itself
- Check kidney function
(dye will eventually have to be excreted by the renal system)
25
True or False: CT scans can be ordered with or without contrast ?
True
26
CT scans can detect what types of things ?
- Hemorrhage
- Tumors
- Cysts
- Edema
- Infarct & atrophy
27
Are MRI's more detailed than a CT ?
yes !
28
What does an MRA scan stand for ?
Magnetic Resonance Angiography
29
What things can an MRI detect ?
- Brain & Spinal cord edema
- Hemorrhage
- Infarction
- Tumors & Bone lesions
30
What should you screen pt's for prior to MRI scans ?
Presence of Metal
31
True or False: During MRI's pt's must lie still ?
True
32
What do PET scans measure ?
Metabolic activity of the brain and spinal cord using radioactive material
33
What does PET stand for ?
Positron Emission Tomography
34
PET scans require how many IV lines ?
2 IV lines
35
PET scans are used with what types of problems/diseases ?
- Stroke
- Seizure
- Alzheimer's
- Parkinson's
- Tumors
36
Abnormal cells use lots of what ? And show up as what on PET scans ?
- Abnormal cells use lots of Glucose
| - Will appear as Hot spots
37
Lots of metabolic activity & large amounts of glucose will show up as what color on PET scans ?
Red
38
True or False: Infection and Cancer are very metabolic processes and we will see increased uptake/activity ?
True !
39
What type of Diagnostic study uses tiny electrodes and places them on the scalp, trying to pick up on the presence of seizure activity in a certain part of the brain ?
Electroencephalography (EEG)
40
When performing an EEG, what will typically be held, and implemented ?
- Tranquilizers & Seizure meds held
- May sleep deprive the pt (usually not in the hospital setting)
- May utilize lights and loud noises
41
True or False: In pt's with an extensive seizure Hx, when we want to elicit a seizure, they will sleep deprive them, hold meds, etc ? and it could be a matter of waiting 2-3 days ?
True
42
What type of Diagnostic test, utilizes little needles to elicit a muscle response ?
Electromyography (EMG)
43
What are Nerve conduction studies called ?
Electroneurography
44
What are Ultrasounds used for ?
To indicate blood flow and velocity
45
What do Carotid artery duplex scans do ?
Use sound waves to identify blockages in an artery
46
With what type of Ultrasounds are probs placed at the window of the skull (thin, bony areas) to record velocity of blood flow through the blood vessels ?
Transcranial Doppler
47
What type of Ultrasound looks to diagnose embolisms, narrowing of vessels d/t atherosclerosis, and can sometimes pick up on vasospasm of the carotid artery which could interfere with neurological functioning of the brain ?
Transcranial Doppler
48
What Electrographic study, gives us information about a variety of Neuromuscular diseases such as MS, and Myasthenia Gravid ?
Electromyography (EMG)
49
What scale is used to assess Neurological status ?
Glasgow Coma Scale
50
The Glasgow Coma Scale is a standardized assessment for assessing what ?
LOC
51
The Glasgow Coma Scale evaluates a pt's ability to do what ?
- Speak (best verbal response)
- Obey commands (best motor response)
- Open eyes
52
What is the Glasgow Coma Scale score range ?
15 to 3
53
A Glasgow Coma Scale of less than 8 generally indicates what ?
A coma
54
A Glasgow Coma Scale of 3 or less indicates what ?
Pt is pretty much unresponsive to everything
55
What are the 3 volume components inside the skull, and what % of it makes up the volume ?
- Brain tissue (78%) (the fluid in & outside the brain tissue)
- Blood (12%)
- CSF (remaining 10%)
56
What happens if ICP pressure increases ?
Cerebral perfusion is reduced
57
What is Considered a normal ICP ?
5-15mm Hg when the pt is at 30 degrees (HOB 30 degrees)
58
Increased ICP is defined as what ?
Any sustained pressure > 20mm Hg with the pt at 30 degrees
59
What are some normal compensatory adaptations that can take place to keep the ICP between 5-15mm Hg ?
- Alteration of CSF absorption, production & displacement
- Vasoconstriction or dilation
- Distention of the dura or compression of brain tissue
60
What is the dura ?
Covering around the brain & spinal cord
61
If ICP increases, the ability to compensate will be what ?
Limited
* if the volume continues to increase, than we can no longer compensate by the 3 ways anymore.
62
When intracranial pressure rises, and we can no longer compensate by the 3 compensatory mechanisms , we will see what ?
- Compression of blood vessels
- Compression or reduction of perfusion of the brain tissue
- Ischemia/cell death
63
Under normal conditions, what are factors that increase ICP ?
- Arterial pressure
- Venous pressure
- Intra-abdominal & intra-thoracic pressure
- Posture
- Temperature
- Blood gases (CO2 levels)
64
What are causes of increased ICP ?
- Masses
- Hematoma
- Tumors (benign or cancerous)
- Abscesses
- Cerebral Edema
- Hydrocephalies
- Head injury
65
What is Hydrocephalies ?
Build up of fluid in the brain that causes the ventricles of the brain to enlarge
- Can be due to
- Increased production of CSF
- Decreased outflow of CSF
66
What are causes of increased ICP associated with edema ?
- Mass lesions
- Head injuries
- Brain surgery
- Infections
- Vascular injury to blood vessels
- Toxic or Metabolic Encephalopathy
(poisoning of the brain tissue)
67
What are. 2 ways that they monitor ICP ?
- Ventriculostomy (Gold standard)
| - Fiberoptic catheter
68
What is considered the Gold Standard for monitoring ICP ?
Ventriculostomy
69
Simply put what is a Ventriculostomy ?
- Allows us to monitor ICP
&
- Sample CSF and possibly drain some off to lower ICP
70
What type of ICP monitoring involves a tube (transducer) inserted into the lateral ventricle of the brain. And we want the transducer right at the tragus (level of the ear), so that we can accurately measure ICP ?
Ventriculostomy !
71
What type of ICP monitoring involves a catheter being placed in the ventricle with a sensor transducer located within the catheter tip to provide direct measurement of the brain pressure ?
Fiberoptic catheter
72
What are complication (3) of having an ICP monitor in place ?
- Infection
- Inadequate cerebral perfusion
- Herniation
(if theres too much pressure placed on one of the ventricles of the brain)
73
A __________________ is a short term way to manage pressure while the brain heals and swelling goes down, and then we can give that CSF back ! ?
Ventriculostomy
74
What are manifestations of IICP (Increased Intracranial Pressure) ?
- Changes in LOC
- Changes in vital signs (Cushings' Triad)
- Ocular signs (overall change in pupil size & reactivity)
- Decreased motor function
- Headache
- Vomiting without nausea
75
In regards to manifestations of IICP, What are changes to LOC due to ?
D/t decreased oxygen flow to the cerebral cortex & RAS (Reticular Activating Syndrome)
76
Chushings' Triad is defined by what changes in vital signs ?
- Systolic hypertension with widening pulse pressure
- theres a bigger difference between systolic and diastolic #s. Example: 140/30 (instead of 120/80)
- Bradycardia with a full, bounding pulse
- Decrease irregular respirations
(aka: irregular respiratory pattern)
77
IICP stands for what ?
Increased Intracranial Pressure
78
In regards to manifestations of IICP, what happens with Ocular signs ?
- We can see a change in pupillary response
Example:
- pupils may be fixed
- fixed on one side
- sluggish to respond while the other responds normally
* Overall there is a change in pupil size and reactivity*
79
_____________________ is significant when we look at signs of ICP ?
Cushings' Triad
80
What does Contralateral mean ?
Ex: injury to the R side of the brain, causes a reduction in motor function on the left side of the brain
OR Vice Versa
81
What does Ipsilateral mean ?
Occuring on the same side of the body
82
When talking about Manifestations of ICP, Decreased motor function could result in ?
- could be one sided
- Hemiparesis (one sided weakness)
- Hemiplegia (one sided paralysis)
83
What is Hemiparesis ?
One sided weakness
84
What is Hemiplegia ?
One sided paralysis
85
True or False: Brain tissue itself is insensitive to pain ?
True
86
When talking about the manifestations of IICP, headaches are usually caused by what ?
Arteries, veins, and Nerves can cause quite a headache
87
When talking about the manifestations of IICP, vomiting without nausea is due to what ?
Due to the increased ICP
88
True or False: Vomiting in response to IICP, can be projectile and unexpected ?
True
89
What does the collaborative care for IICP involve ?
- Identify cause !
- Increase HOB to 30 degrees w/head in neutral position
- Intubation & ventilation (if pt. not breathing well)
- ICP & cerebral oxygen monitoring
- Maintenance of PaO2 greater or equal to 100mmHg
- Maintenance of fluid balance- Osmolality in bloodstream
- Maintenance of SBP 100 to 160mmHg
- Maintenance of CPP > 60mmHg
- Reduction of cerebral metabolism
- want to reduce any agitation of the pt
- Don't want pt's shivering
- Don't want pt's in pain
- Maintain temperature between 96.8 and 98.6
- Reduce stimuli !
- Low lights, quiet, calm :)
(CPP = Cerebral Perfusion Pressure)
90
What does CPP stand for ?
Cerebral perfusion pressure
91
What type of Drug therapy is used to manage IICP ?
- Osmotic diuretics (med= Mannitol)
- Hypertonic solution
- Anti-seizure drugs (med=Phenytoin (Dilantin))
- Corticosteroids (**Dexamethasone)
- PPI (Ex: protonics)
92
How do Osmotic diuretics like Mannitol work to decrease ICP ?
Moves fluid from tissues into blood vessels to decrease ICP
93
True or False: Hypertonic solutions cause also cause a shift in fluid ?
True
94
What is the Corticosteroid drug of choice for treating IICP ?
**Dexamethasone !
95
What is Dexamethasone the corticosteroid drug of choice when treating IICP ?
Because of its anti-inflammatory effects that it has on the brain and spinal cord.
Used for things such as:
- Brain tumors
- Spinal cord tumors
- Bacterial meningitis
96
Why are PPIs given when trying to reduce IICP ?
Given prophylactically to prevent GI ulcers and bleeding, if the pt. is receiving Corticosteroids
97
What type of surgery is used to reduce IICP ?
Decompressive Craniectomy
98
In short terms, what is a decompressive Craniectomy ?
Part of the skull is removed to relieve the IICP
99
What type of surgery is it when Dr.'s open the cranium and remove a bone flap (part of the bone), open the dura covering to relieve the IICP ?
Decompresive Craniectomy
100
True or False: With a Decompressive Craniectomy, a drain may be placed into the ventricle of the brain or a shunt may be placed, which basically takes the fluid from the brain and we tunnel the shunt down under and in through the Sub Q and then it dumps/empties into the periotenium (Abdomen) ?
True !
101
True or False: The shunt in the brain (if there is one placed) responds to the IICP on its own and then opens up and lets the fluid drain down if need be ?
True
102
True or False: With a Decompressive Craniectomy, initially a part of the skull will be removed to relieve IICP, but later on when things start to heal, it will be put back and wired shut back into place ?
True
