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Med Surg III Final > Intracranial > Flashcards

Intracranial Flashcards

1
Q

Frontal lobe

A

Broca’s area for production of speech

▪Morals, emotions, reasoning and judgment, concentration, and abstraction

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2
Q

Parietal lobe

A

Interpretation of taste, pain, touch, temperature, and pressure
▪Spatial perception

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3
Q

Temporal Lobe

A

Auditory center

▪Wernicke’s area for comprehension of speech

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4
Q

Occipital

A

Vision

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5
Q

Limbic system

A

Emotional and visceral patterns for survival

▪Learning and memory

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6
Q

Which 2 sets of arteries supply the brain?

A

Right and left internal carotid, and vertebral

Connect to make the loop of Willis

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7
Q

Is a lumbar puncture contraindicated if pt has ICP?

A

Yes, LP will cause a rapid decrease in pressure, leading to brain herniation.

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8
Q

What is the most sensitive indicator of neurological status?

A

LOC

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9
Q

What does an increased temprature due to the metabolic rate of the brain?

What does it indicate?

A

Increases it

Dysfunction in the hypothalamus or brain stem.

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10
Q

What is cranial nerve 3?

A

Oculomotor

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11
Q

What does unilateral pupil dilation represent?

A

Compression of CN 3

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12
Q

What is decorticating posturing? (Flexor)

What does it indicate?

A

Pt can flex 1 or both arms on the chest and may extend their legs stiffly.

Nonfunctioning cortex

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13
Q

What is decerebrate posturing?

What does it indicate?

A

Pt stiffly extends 1 or both arms and possibly legs.

Brain stem lesion.

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14
Q

What are the three portions of the GCS?

A 
Eye opening (4)
Verbal response (5)
Motor response (6)
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15
Q

What is the lowest GCS someone can have? And what does it indicate?

A

3

Deep coma or death

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16
Q

At what number in the GCS is coma present?

A

Lower than 8

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17
Q

What are some late signs of ICP?

A

Increased systolic BP, Brady, posturing, seizure

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18
Q

What types of meds do we give pts with ICP?

A 
Antiseizure
Antipyretic, muscle relaxants
BP meds
IVF carefully
Hyperosmotic agent-watch renal function
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19
Q

What is the halo sign?

A

Bloody spot with a yellowish, pink ring around it.

Shows a CSF leak

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20
Q

What is a craniotomy?

A

Incision through the cranium to remove blood, or a tumor.

Lots of PC’s

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21
Q

What are the indications of spinal shock?

A

A complete but temporary loss of motor, sensory, and autonomic function.

This is the cords response to the injury.
Usually 48 hours

Hypo/brady, ileus**

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22
Q

What are the indications of neurogenic shock?

A

Loss of vasomotor tone
Hypotension and brady**
Associated with a injury at T6 or higher

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23
Q

What is autonomic dysreflexia?

What is it commonly caused by?

Emergency?

Treatment?

A

Occurs after spinal shock has resolved.

Commonly caused by distention of the bladder or rectum

Yes, have to prevent HTN stroke!

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24
Q

What is the normal range for CPP?

A

60-100 mm Hg

25
Q

What is the most sensitive measure of mental status?

A

LOC

26
Q

What is the patho for ICP?

A

Increased ICP leads to decreased RR, which leads to increased CO2, which leads to vasodilation of brain(to decrease ICP), which increases ICP because of increased blood flow

27
Q

How does the brain auto regulate?

A

Vasoconstriction

Reabsorption of CSF

28
Q

What amount of O2 and glucose does the brain take up?

A

O2- 20% of CO

Glucose-25% of CO

29
Q

CBF decreases after MAP is less than what?

A

50

30
Q

What is the normal CPP?

A

60-100 mmHG

31
Q

At what number is the CPP associated with ischemia and neuronal death?

A

Less than 50

32
Q

How do you calculate CPP?

A

MAP - ICP

33
Q

A CPP less than 30 means what?

A

Death, not sustainable with life.

34
Q

What is the bodies normal range for MAP?

A

50-150

35
Q

What are the three parts of cushings triad?

A 
Increased systolic pressure, with a widening pulse pressure
Decreased HR (sympathetic system blocked so para takes over.
RR changes, usually down.
36
Q

What do you do if cushings triad begins?

A

Call MD, probably give manitol or 3% NS. Must give slow

37
Q

If the left pupil is dilated than which side of the brain is the injury on?

A

Left.

38
Q

In stages 1 and 2, can the brain auto regulate?

A

Yes. Increase in volume does not increase ICP.

Stage 2 increases the risk of increased ICP

39
Q

What stage will the nurse start to see cushings triad?

A

Stage 3.
Loss of auto regulation
Increased BP

40
Q

At what stage will ICP reach lethal levels?

Will this lead to herniation?

A

Stage 4

Yes

41
Q

What is a tentorial herniation?

A

When the lesion forces the brain downward.

Watch RR and HR

42
Q

What is a uncal herniation?

A

When the lesion forces the brain towards the other hemisphere and downward.

43
Q

What is a cingulate herniation?

A

Lesion forcing the brain towards the other hemisphere.

44
Q

An increase in CO2 leads to what?

Decrease in CO2?

A

Dilated cerebral vessels and an increase in CBF.

The opposite.

45
Q

Is oxygen a potent vasodilator or constrictor?

A

Vasodilator

46
Q

What do low levels of O2 in the brain lead to?

A

Cerebral dilation, which increases CBF.

47
Q

Why wont we give too much pain meds to a pt in the acute phase of injury?

A

Because it decreases LOC and RR. Which will increase CO2.

48
Q

What are some clinical manifestations of ICP?

A 
Change in LOC and temp regulation.
V/S (cushings triad)
Pupil change
Blurry vision, HA, vomiting,
Papilledema(optic disk swelling
49
Q

Which posturing is a worse sign, decerebrate or decorticate?

A

Decerebrate.

50
Q

What is the gold standard for measuring ICP?

A

Ventricolostomy.

Measures ICP and CSF removal

51
Q

In a pt with ICP, do they need more or less glucose?

A

More

52
Q

What is included in a head injury?

A

Any trauma to the skull, cap, brain.

Any alteration in consciousness, no matter how brief is also considered a head injury.

53
Q

What are the types of skull fractures?

A

Linear or depressed.
Simple, comminuted, or compound
Closed or open

54
Q

What is battles sign?

A

Bruising at the mastoid process.

Takes at least a day to present after basilar skull fx.

55
Q

What is a conjugate gaze?

A

Inability to move both eyes in the same direction.

56
Q

Concussion

A

Brief change in LOC, anemia, HA, disruption of neural activity.

57
Q

What is post concussion syndrome?

A

Persistent HA, lethargic, personality changes, short attention span and decreased short term memory.

58
Q

What are the classic signs of an epidural hematoma?

A

Unconsciousness
N/V, HA
Brief period of lucidness then decreased LOC.
Focal findings (plégia, weakness to extremity)

59
Q

What is the best diagnostic test to determine craniocerebral trauma?

A

CT

Med Surg III Final (13 decks)

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