Exam 4: Chapters 36 and 6

Question 1

What 3 elements must be balanced to maintain ICP?

Answer 1

brain tissue, csf, and blood

Question 2

What is a normal ICP?

Answer 2

7-15mmHg

Question 3

What can cause an increase to ICP?

Answer 3

trauma, edema, increased csf, hemorrhage, tumor, inflammation, ischemia, blockage of venus return, vasodilation

Question 4

What are early signs of increased ICP?

Answer 4

vomiting, severe headache, decreased LOC (confusion and drowsy)

Question 5

What are the late sx of increased ICP?

Answer 5

Cushing triad (systolic HTN, bradycardia, bradypnea), worsening LOC, posturing (decorticate or decerebrate), altered pupil size and response to light

Question 6

What is the Glasgow Coma Scale?

Answer 6

measures a pts consciousness by eye opening response, verbal response, and motor response

Question 7

What is brainstem herniation?

Answer 7

when to much downward pressure is put on the brain due to increased ICP that leads to death

Question 8

What are caused of TBI?

Answer 8

coup-contrecoup, penetrating injury, blunt injury, and blast injury

Question 9

Causes of Diffuse Axonal Injury

Answer 9

coup-contrecoup

Question 10

Risk factors for Diffuse Axonal Injury

Answer 10

motor vehicle accident, fall, sports, violence/abuse

Question 11

Pathophysiology of Diffuse Axonal Injury

Answer 11

shearing/ tearing of an axon that leads to bleeding, swelling, brain cell damage, and impairment of signal transmission. there is decreased blood flow to the brain

Question 12

Sx of Diffuse Axonal Injury

Answer 12

loss of consciousness and pt may never regain consciousness. if pt does then significant neurological impairment is possible

Question 13

Cause of a concussion

Answer 13

blunt trauma and coup-contrecoup

Question 14

Risk factors of a concussion

Answer 14

motor vehicle accident, contact sports, violence/abuse

Question 15

Pathophysiology of a concussion

Answer 15

mild TBI that causes a temporary neuronal cellular swelling that resolves over time

Question 16

Sx of a concussion

Answer 16

headache, brief loss of consciousness, nausea, flat affect, lack of coordination, brief amnesia, “seeing stars”

Question 17

Causes of a cerebral contusion

Answer 17

coup-contrecoup, blunt trauma, penetrating injury

Question 18

Risk factors of cerebral contusion

Answer 18

anticoagulants, contact sports, fall

Question 19

Pathophysiology of cerebral contusion

Answer 19

vascular and tissue damage; cerebral edema is present 48-72 hours after injury

Question 20

Sx of a cerebral contusion

Answer 20

severe headache, dizziness, vomiting, increased size of pupil (ipsilateral), sudden weakness in arm or leg (contralateral), restless, agitated, irritable, memory loss

Question 21

Causes of intracranial bleed

Answer 21

coup-contrecoup, blunt trauma, penetrating injury

Question 22

Causes of an epidural hematoma

Answer 22

skull fracture lacerating the cerebral and meningeal artery

Question 23

Sx of a EDH

Answer 23

headache, midline shift, hemiplegia contralateral to injury, sx of increased ICP, seizures, rapid worsening status, and late sx include crushing’s triad

Question 24

Causes of a subdural hematoma

Answer 24

tearing of veins in subdural space, csf may leak into subdural space; characterized by slow bleeding that can take days to accumulate

Question 25

Sx of a SDH

Answer 25

may or may not cause a midline shift

Question 26

Causes of a subarachnoid hemorrhage

Answer 26

tearing of the cerebral and meningeal vessels or rupture of a cerebral artery that fills the subarachnoid space

Question 27

Sx of a SAH

Answer 27

worst headache of pts life, diplopia, nuchal rigidity, stroke sx, often unconscious

Question 28

Causes of a skull fracture

Answer 28

blunt trauma

Question 29

Sx of a skull fracture

Answer 29

battle sign, racoon eyes, csf otorrhea, csf rhinorrhea

Question 30

What is a primary spinal cord injury?

Answer 30

injury caused by trauma

Question 31

What is a secondary spinal cord injury

Answer 31

injury caused by ischemia that is worsened by damage from primary injury

Question 32

What deficits are caused by descending injury

Answer 32

motor

Question 32

What deficits are caused by ascending injury?

Answer 32

sensory

Question 32

What is caused by a complete transection

Answer 32

motor and sensory deficits that is a permanent injury

Question 33

What is an incomplete injury (transection)?

Answer 33

injury where some function may return

Question 34

What are the mechanisms of injury in SCI?

Answer 34

hyperflexion, hyperextension, rotation, vertical compression, penetrating injury

Question 35

What is spinal shock?

Answer 35

shock that is not about perfusion; long term function is unknown until after spinal shock resolves

Question 36

Sx of spinal shock

Answer 36

loss of bowel and bladder control, loss of (motor movement, sensation, vasoconstriction, shivering) at and below level of injury, if cervical it may impact breathing

Question 37

What is neurogenic shock?

Answer 37

shock that is influenced by perfusion, only if injury is at T6 or above and affects the SNS

Question 38

Sx of neurogenic shock

Answer 38

decreased cardiac output, hypotension, inadequate perfusion, bradycardia, vasodilation

Question 39

What are the systemic complications of SCI?

Answer 39

cardiovascular (orthostatic HTN), autonomic dysreflexia, cervical and thoracic injuries weaken breathing and increase the risk of respiratory infection, weaken the immune system, neuropathic pain

Question 40

What is the gate control theory?

Answer 40

when pain is occurring at two or more sites the pt will only report one

Question 41

What is the neuromatrix theory

Answer 41

emphasizes that the brain has an influence in pain experiences

Question 42

What is an open gate?

Answer 42

interneuron allows transmission of pain stimulus from the periphery to ascend the spinal cord to the brain

Question 43

What is a closed gate?

Answer 43

interneuron does not allow transmission of neural stimulus from pain fibers in the periphery

Question 44

How can pain occur?

Answer 44

noxious stimulation of nociceptors or no obvious stimulation to nociceptors

Question 45

What are the different types of pain?

Answer 45

acute, chronic, neuropathic

Question 46

What are the different sources of pain?

Answer 46

cutaneous, deep somatic, visceral pain

Question 47

Which neurotransmitters enhance pain?

Answer 47

prostaglandins, interleukins, tumor nectroic factor, leukotrienes, bradykinins

Question 48

Which neurotransmitters amplify pain?

Answer 48

substance p and glutamate

Question 49

Which neurotransmitters inhibit pain?

Answer 49

endorphins, enkephalins, acetylcholine, dopamine, gamma-aminobutyric acid, norepinephrine, serotonin