Exam 4 - Concepts Of Neurologic Dysfunction Flashcards
1
Q
What controls the blood flow to the brain?
A
Baroreceptors in the carotid arteries
2
Q
What is the Monroe Kellie Doctrine?
A
A theory that says there is only so much room in the head. So when new things are added, things spill over
3
Q
What happens if something extra is added to the head?
A
1 - CSF gets pushed down into subarachnoid space
2 - Blood is pushed down to venous sinuses
3 - Brain tissue moves (herniation)
4
Q
What is herniation?
A
Tissue movement
5
Q
What does herniation cause?
A
Decreased LOC
Neurologic changes
Leads to death
6
Q
Normal MAP
A
70-90
7
Q
To prevent brain anoxia, what must MAP be?
A
> 60
8
Q
Normal intracranial pressure
A
0-15
9
Q
What does ICP need to be to lead to herniation?
A
> 20 for 5 minutes or more
10
Q
What does CPP stand for?
A
Cerebral profusion pressure
11
Q
Formula for CPP
A
CPP = MAP - ICP
12
Q
How do we measure ICP when determining CPP?
A
Can estimate it
To know true amount, need to measure by probe in head
13
Q
What type of values are MAP and ICP?
A
Trend values
14
Q
Measurement to determine if we need to act on MAP or ICP
A
> 5 pressure changes in 25 minutes
15
Q
What is auto regulation?
A
Compensatory mechanism (normal body function)
Controls constriction and dilation of blood vessels in the head
16
Q
What happens during autoregulation if a patient has high blood pressure?
A
Carotids alert vessels in head to constrict
Vessels in rest of body would dilate
17
Q
What would happen with autoregulation if a patient had low blood pressure?
A
Carotids would cause vessels in head to dilate
18
Q
What would you, as a nurse, do for a patient with low blood pressure and a high heart rate?
A
Give patient fluids
19
Q
What do vasodilators do in regards to autoregulation?
A
Cause vessels throughout body to dilate
But do not affect autoregulation
20
Q
What does bruit do to baroreceptors in the carotids?
A
Disables the baroreceptors and prevents them from autoregulating
21
Q
What is accommodation?
A
Compensatory mechanism (normal body function)
Downward movement of contents in head. The contents move/change according to need
22
Q
What compensatory mechanism occurs when a patient has hypercapnia?
A
Autoregulation
Carotids send signal for vessels in brain to dilate so brain can get more O2
23
Q
What compensatory mechanism occurs when a patient has hyperoxygenation?
A
None
Autoregulation will not respond
24
Q
What is a jugular obstruction?
A
An obstruction in jugular vein or carotids that cuts of circulation to brain
25
Examples of things that can cause a jugular obstruction
Hyperextending carotids
Coughing
Vomiting
Bearing down
26
How does coughing, vomiting, or bearing down cause a jugular obstruction?
Changes the thoracic pressure
27
What happens to carotids when someone has a jugular obstruction?
Circulation to brain is cut off
| Blocks carotids’ ability to auto regulate
28
Examples of conditions that would make the body need more oxygen
```
Seizure
High temperature
Shivering
Pain
Stimulants
```
29
What happens to the carotids if body needs more oxygen?
Carotids cause dilation to autoregulate
30
What is the only thing that can cause carotids to not be able to auto regulate anymore?
Obstruction (heard as bruit)
31
What is arousal?
State of awareness
32
What is a vegetative state?
Loss of cerebral function (minimal function of brain)
| Crude awakened state
33
What would someone in a vegetative state be able to do?
Awake
May be able to make eye contact
May be able to swallow
Vitals, cardiac and respiratory systems intact
34
What is content of thought?
Encompasses moods (a patient’s mood/emotional intelligence)
35
Example of assessing a patient’s content of thought
Do this while assessing LOC
| Asking them what day it is, etc
36
Tool used to diagnose a patient’s LOC
Glasgow coma scale
37
What is the Glasgow Coma Scale?
15 point scale
| Assesses level of consciousness by considering three areas
38
Three areas of the Glasgow Coma Scale
Eye opening
Motor response
Verbal response
39
Explain the scoring of the Glasgow Coma Scale
Scored on a scale of 0-15
15 = highest, 0 = dead
```
0-3 = coma
3-8 = severe injury
9-15 = injury is not as severe
```
40
What is the main score of a Glasgow Coma Scale we should be concerned with?
3 - 8, which means severe injury
41
Most critical index of nervous system function
Level of consciousness
42
What is a LOC with highest level of functioning?
Alert and oriented to self, others, place, time, and situation
43
What should always be the number one priority?
LOC
| The other symptoms come later
44
What is the first symptom when someone suffers a head injury?
LOC
45
LOC is the only sign for what?
Of perfusion
46
Loss of ability to think rapidly and clearly
| Impaired judgement and decision making
Confusion
47
Beginning loss of consciousness
Disorientation
48
If someone is disoriented, what is the order of orientation that they will lose?
Time
Place and impaired memory
Recognition of self
49
Limited spontaneous movement or speech
Lethargy
50
Easy arousal with normal speech or touch
Lethargy
51
What is person with lethargy oriented to?
May or may not be oriented to time, place, or person
52
Mild to moderate reduction in arousal with limited response to the environment
Obtundation
53
Person falls asleep unless stimulated verbally or tactilely
Obtundation
54
Answers questions with minimum response
Obtundation
55
Condition of deep sleep or unresponsiveness
Stupor
56
Person may be aroused from deep sleep or open eyes only by vigorous and repeated stimulation
Stupor
57
Pt response when stimulated is often withdrawal or grabbing at stimulus
Stupor
58
No verbal response to external environment or to any stimuli
Coma
59
Pain or suctioning do not yield motor movement
Coma
60
If patient has brain death
Complete death of brain, including brain stem
No recovery
Unable to maintain body’s internal homeostasis
61
If patient has cerebral death
Brain stem does work
Internal homeostasis intact
Irreversible coma
Permanent brain damage
62
What does a patient with cerebral death act like?
Doesn’t respond to stimuli
Can’t follow commands
Can’t swallow = at big risk for aspiration
63
What are the determinants of brain death?
1- Completion of all appropriate and therapeutic procedures
2- Unresponsive coma (no motor or reflex movements)
3- No spontaneous respiration
4- No ocular responses to head turning or caloric stimulation; dilated, fixed pupils
5- Isoelectric (flat) EEG = electrocerebral silence
64
How long do these signs need to persist for to determine brain death?
30 mins to 1 hour
| And for 6 hours after onset of coma and apnea
65
What is an optional test that can be added as a determinant of brain death?
Confirming test indicating absence of cerebral circulation
66
How long is an EEG used for to detect brain waves while determining if pt has brain death?
24 hours
67
If pt has slowing brain waves seen on EEG, what is needed to be done?
Test blood flow
| Can be done through IV contrast test to look for decreased circulation
68
3 main things to determine brain death
1 - EEG - detect brain waves
2 - if slowed brain waves, test blood flow
3 - need to do one additional bedside exam
69
3 exams that can be done as the additional bedside exam when determining brain death
Babinski
Occulocephalic
Occulovestibular response
70
What is a seizure?
Sudden, explosive, disorderly discharge of cerebral neurons
| With sudden transient alteration in brain function
71
What compensatory mechanism occurs when a patient has a seizure?
Autoregulation
72
Types of dysfunction that seizures cause
Motor
Sensory
Autonomic
Psychic
73
What is a convulsion?
Jerky, contract-relax (tonic-clonic) movement associated with seizures
74
What is epilepsy?
Seizure with no underlying correctable cause
75
In general, what causes seizures?
Any disorder that alters neuronal environment
76
Possible etiology of seizure activity
- Cerebral lesions (tumors)
- Biochemical disorders
- Cerebral trauma (injury)
- Epilepsy
77
Examples of biochemical disorders that cause seizure activity?
Schizophrenic
Manic/depressive
Severe hyponatremia
78
Top Risk Factors of seizure activity
Infection; fever
Brain tumor
Vascular disease (AV valve dysfunction)
Drug or alcohol abuse
79
Other Risk Factors of seizures
- Metabolic defects
- Congenital, genetic, perinatal injury
- Postnatal injury
- Myoclonic syndromes
80
What metabolic defect causes seizures?
Not enough bicarbonate produced by the kidneys
| Causes build up of acid
81
What can seizures be precipitated by?
```
Fatigue; lack of sleep
Emotional of physical stress
Febrile illness
Large amounts of water ingestion
Constipation
Drugs
Hyperventilation
Environmental stimulants
```
82
Why does water intoxication precipitate seizures?
ADH malfunction
83
Which drugs can precipitate seizures?
Stimulants
| Withdrawal of antidepressants
84
Environmental stimulants that can precipitate a seizure
Blinking lights
| Loud noises
85
Types of epileptic seizures
Partial (AKA focal or simple)
Complex (AKA psychomotor or temporal lobe)
Secondarily generalized
Generalized
86
What occurs with a partial seizure?
Not full body
| No loss of consciousness, can communicate with eyes
87
What happens with a complex seizure?
Not full body
| Impaired consciousness
88
What happens with a secondarily generalized seizure?
Smaller focal seizure that evolves to generalized
89
What is a generalized seizure?
Full body seizure
90
Types of generalized (full body) seizures
Petit mal
Grand mal
Drop attack (AKA atonic)
91
What is a petit mal seizure?
Small version of a total body seizure
92
Types of petit mal seizures
Absence
Myoclonic
Clonic
Tonic
93
What is an absence petit mal seizure?
No visible symptoms, person stares ahead
94
What is a myoclonic petit mal seizure?
Mixture of tonic and clonic in one seizure
95
What does clonic petit mal seizure mean?
Relaxation
96
What does tonic petit mal seizure mean?
Stiffness
97
What is a grand mal seizure?
Big seizure
| Patient has both tonic and clonic movement
98
What is a drop attack?
Seizure where person stiffens and falls over
99
What is an aura?
Partial seizure (partial state of awareness) preceding onset of generalized seizure
100
Description of an aura
Can be gustatory, visual, or auditory
| Can experience dizziness, numbness, or a “funny feeling”
101
What is prodroma?
A very early sign/symptom that a person will have a seizure. Occurs hours or days before a seizure
102
What does a person feel like while experiencing prodroma?
Malaise
Headache
Sense of depression
103
Definition of tonic
State of muscle contraction with excessive tone (prolonged)
104
Definition of clonic
State of alternating contraction with relaxation of muscles (usually rapid)
105
What is a postictal phase?
Time period immediately following the cessation of seizure activity
106
How long does the postictal phase last?
Minutes to hours, to a day or longer
107
What does a person in the postictal phase feel like? And why?
Exhausted
Because seizure had high O2 demand and used a lot of glucose
May have migraine or incontinence
108
*Nursing considerations for a client with seizure activity
1. No hands in mouth
2. No tongue blades
3. Bed in lowest position
4. Bed side rails up
5. Wrap padding around side rails
6. Put mattress on floor for patient to lay on
109
*How to document a seizure
1. When it started
2. When it ended
3. How long it lasted
4. Describe postictal phase
5. Any injuries?
110
Definition of dementia
Long-term progressive failure of many cerebral functions
| *NOT caused by impaired LOC
111
Clinical manifestations of dementia
Decreased:
- Orientation
- Recent memory (1st to go)
- Remote memory (happens much later)
- Language affected
- Executive networks (entire thought process eventually affected)
112
Can dementia kill a person?
No, they eventually wither away
113
Leading cause of sever cognitive dysfunction in older adults
Alzheimer disease
114
What does Alzheimer disease cause?
Atrophy of brain and loss of neurons
115
How is Alzheimer disease diagnosed?
By exclusion, based on clinical findings
(Must exclude other issues before diagnosing. This is time consuming and expensive, so often doctors just guess that a pt has Alzheimer’s)
Usually don’t know for sure until death and an autopsy is done
116
How long does Stage 1 of Alzheimer Disease last?
2-4 years
117
Clinical manifestations of Stage 1 of Alzheimer disease
Memory loss
Subtle personality changes
Disorientation to time and place
118
What is stage 2 of Alzheimer disease called?
Confusion stage
119
How long does Stage 2 of Alzheimer disease last?
Several years
120
Clinical manifestations of Stage 2 of Alzheimer disease
```
Impaired cognition
Restlessness
Agitation
Wandering
Sundowner’s syndrome
Repetitive behavior
```
121
What is sundowner’s syndrome?
Up all night and sleep all day
| Wander around during night
122
What is Stage 3 of Alzheimer disease called?
Terminal stage
123
How long does Stage 3 of Alzheimer disease last?
1-2 years
124
Clinical manifestations of Stage 3 of Alzheimer disease
Emancipation
Inability to communicate
Bowel and bladder incontinence
Seizures
125
Definition of hydrocephalus
Excess fluid in cranial vault
| In subarachnoid space or both
126
Cause of hydrocephalus
Increased fluid production
| Or defective reabsorption of fluid
127
Types of hydrocephalus
Noncommunicating - obstruction in draining pathway
| Communicating - defective absorption
128
Clinical manifestations of hydrocephalus
```
Unsteady, broad-based gait
History of falls
Apathy
Inattentiveness
Indifference to self, family, and environment
```
In infant - large head
129
If an adult has hydrocephalus, skull can’t move, so what occurs in head?
Accommodation
130
How can chronic hydrocephalus be treated for an adult?
EVD (electro ventricular device)
| Pulls CSF out and drops it back into circulation
131
Definition of paresis
Weakness and partial paralysis
| With incomplete loss of muscle power
132
Definition of paralysis
Loss of motor function
133
Weakness on one side of the body (spelling)
Hemiparesis
134
Paralysis on one side of the body (spelling)
Hemiplegia
135
Paralysis of both upper and lower extremities (spelling)
Diplegia
136
Paralysis of lower extremities (spelling)
Paraplegia
137
Paralysis of all four extremities (spelling)
Quadriplegia
138
Definition of Parkinson disease
Degenerative disorder of basal ganglia function
139
What is Parkinson disease characterized by?
Progressive destruction of nigrostriatal pathway
| Subsequent reduction striata concentrations of *dopamine
140
Cardinal manifestations of Parkinson disease
Tremor
Rigidity
Bradykinesia (slowness of movement)
