Final Exam- Neuro Flashcards
Nervous systems two major parts
- Central nervous system - brain and spinal cord
- Peripheral nervous system - cranial nerves, spinal nerves, autonomic nervous system
In the brain you have…
The cerebrum: divided into frontal, temporal, parietal, and occipital lobe
The brain stem: Midbrain, ponds, medulla
The cerebellum
Brain stem is responsible for
respirations, heart rate, BP, sleep/wakefulness, reflex, balance, consciousness. (Basically everything that allows you to function)
Functions of each of the lobes in the brain
Frontal: concentration, abstract thought, information storage or memory, and motor function. It contains Broca area, which is in the left hemisphere and is critical for motor control of speech
Temporal: auditory receptive areas and plays a role in memory of sound and understanding of language and music.
Parietal: analyzes sensory information, is essential to a person’s awareness of body position in space, size and shape discrimination, and right–left orientation
Occipital: visual interpretation and memory
Structures protections the brain
The meninges
1. Dura mater - thick fibrous protective layer
2. Arachnoid mater - thin (looks like spider web) CSF in this space
3. Pia mater - covers entire brain surface for extra protection
Cerebral Spinal fluid…
Cerebral circulation…
Blood-Brain barrier
The spinal cord…
Cerebral spinal fluid Should always be clear, fluid is very important in maintaining immune and metabolic function in the brain, it protects brain and spinal cord
Cerebral circulation gives constant supply of O2 that the brain needs
Blood brain barrier: acts as a gate keeper keeping harmful substances from entering the brain
The spinal cord is the connection between the brain the the periphery, it is about 18in long and as thick as a finger
How many pairs of spinal nerves are there
31 pairs
Autonomic nervous system
Regulates the activities of internal organs (acts independently of the bodies consciousness)
Sympathetic: wide spread, fight or flight response
Parasympathetic: specific localized response, rest and digest response
Akinetic Mutism:
pt lacks ability to move or speak, unresponsive to the environment around them but may open their eyes
Persistent vegetative state:
devoid of cognitive function
Minimally conscious state
Occasional signs of awareness
Locked-in syndrome:
Inability to move or respond except for eye movements due to a lesion effecting the pons (pt is aware)
Diagnostics: ALC
Glasgow coma scale
CT
MRI
EEG (number one indicator of brain death)
Glasgow coma scale
Mild: 13-15
Moderate: 9-12
Severe: 3-8
“Less than 8 we intubate”
Medical Management: ALC
Airway, circulatory status, ensure adequate perfusion to the brain, IV fluids, meds, nutritional support, reverse the cause
The primary nursing dx is ineffective airway clearance
Decorticate vs Decerebrate
Positioning due to painful stimulus such as needle stick due to injury to the spinal cord. Decerebrate is much worse.
Decorticate is arms to chest
Decerebrate is arms to side
Potential complications of ALC
- Respiratory distress
- Pneumonia
- Aspiration
- Pressure Ulcer
- Venous Thromboembolism
- Contractures (ROM exercises, Q2 turns, and splints help with that)
Normal ICP is…
0-15
Monroe Kellie hypothesis
There are three components; brain, blood, and CSF
If there is an increase in volume in one area, then there needs to be a decrease in volume in a different area to compensate for
This can happen in small ways too ie when you cough or sneeze
Cerebral edema causes there to be…
Decreased CSF production and flow
Cerebral profusion pressure must be between
70-100 or cell death will occur
Causes of increased ICP
TBI
Stroke
Brain tumor
Signs of increased ICP (Cushings triad)
Opposite of shock
1. Bradycardia
2. Hypertension (systolic)
3. Decreased RR
Other signs of increased ICP
• Changes in LOC
• Slowing of speech
• Decreased motor function
• Headache
• Seizures
• Vomiting
• Coma
• Babinski reflex
• Irregular RR
• Pupils fixed and dilated
• Nuchal rigidity
Assessments for increased ICP
Neuro exam
- pupils
- GCS
- Reflexes
- VS
- ICP
Nursing diagnostics/interventions: increased ICP
- Ineffective airway clearance – suction for no more than 15 seconds – we do not want them to cough
- Ineffective breathing pattern
o Hyperventilation causes increased CO2 and increases vasoconstriction - Inadequate cerebral tissue perfusion
o Avoid hip flexion
o Avoid rotation of the neck (may cause blockage of blood flow)
o Have HOB 35-40 degrees
Complications/Priority problems: increased ICP
- Brain Stem Herniation- due to swelling of the brain
- Diabetes Insipidus (if urine output is >200 ml/hr)
o Major fluid and electrolyte replacement
o Give desmopressin (synthetic vasopressin) - Syndrome of inappropriate antidiuretic hormone (SIADH) (decreased urine output)
o Fluid restriction
o Sodium becomes very diluted - Dehydration and Electrolyte imbalance
Assessments and Dx tools: increased ICP
- CT
- MRI
- Neuro assessment
- Invasive ICP monitoring
- Lumbar puncture to check for fluid in the spine
Pharmacological Tx: increased ICP
- Mannitol – diuretic to pull fluid off brain
- Barbiturates (phenobarbital)
- Anti seizure meds (Phenytoin)
- Corticosteroids – helps with inflammation
Medical management: increased ICP
- Monitor ICP and cerebral O2
- Raise HOB
- Low stimulus environment
- Monitor Is and Os
- Decrease cerebral edema
- Maintaining Cerebral perfusion
- Reducing CSF and intracranial blood volume
How to decrease cerebral edema
o by giving mannitol (osmotic diuretic) it dehydrates brain tissue and reduces cerebral edema.
o If it is due to a brain tumor you may see decahedron given a corticosteroid.
o Put on fluid restriction
o Sedatives decrease brain activity which also helps decrease ICP
How to maintain cerebral perfusion
o Increased Cardiac Output from fluid or pressors
o Keep above cerebral perfusion above 70
How to reduce CSF and intracranial blood volume
o Put drains in
o Keep CO2 levels 30-35 to try and cause vasoconstriction
o Barbiturates reduce O2 needed from the brain
o Bring body temp down to decrease the O2 demand on the brain
Intracranial surgeries
- Craniotomy
- Ventriculostomy drain
- Burr holes
