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N477 > Intracranial Regulation > Flashcards

Intracranial Regulation Flashcards

1
Q

Meninges

A

Membrane covering the brain and spinal cord and protects these structures

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2
Q

Blood brain barrier

A

Allows certain molecules to pass through to the brain and prevents neurotoxic substances from reaching the brain

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3
Q

Parts of the meninges

A
  • Dura mater
  • Arachnoid layer
  • Pia mater
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4
Q

Cerebral spinal fluid (CSF)

A

Surrounds the brain to cushion and support brain and provide nutrients

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5
Q

CSF nutrients (6)

A
  • Potassium
  • Protein
  • Sodium
  • Chloride
  • Bicarbonate
  • Glucose
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6
Q

Autoregulation

A
  • Brain alters its own vasculature to accommodate changes in ICP to ensure consistent CBF
  • Doesn’t work if MAP is <65 or >150
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7
Q

Monro Kelli hypothesis

A

Brain, CSF, blood are contained in a fixed vault (skull) and total volume must remain constant and change in 1 component mandates change in the other components

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8
Q

Blood amount in brain

A

12%

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9
Q

Brain amount

A

80%

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10
Q

CSF amount in brain

A

8%

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11
Q

Intracranial pressure (ICP)

A

brain swelling or cerebral edema

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12
Q

Normal ICP

A

5-15

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13
Q

Elevated ICP

A

Sustained >20

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14
Q

Cerebral Perfusion Pressure (CPP)

A

Amount of pressure needed to maintain blood flow to the brain

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15
Q

CPP calculation

A

MAP - ICP

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16
Q

Goal CPP

A

60-70

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17
Q

What is associated with a CPP <50

A

Ischemia, neuronal death

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18
Q

Causes of increased CSF (3)

A
  • Reduced CSF reabsorption
  • Increased CSF production
  • Obstructed CSF flow
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19
Q

Causes of increased blood (3)

A
  • Hypercapnia
  • Venous outflow obstruction
  • Vasodilation of cerebral blood vessels
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20
Q

Causes of increased brain matter (4)

A
  • Cerebral edema
  • Space occupying lesions
  • Abscesses
  • Hematoma
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21
Q

Perfusion related ICR dysregulation (3)

A
  • CVA
  • Severe hypotension
  • Trauma
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22
Q

Neurotransmission related ICR dysregulation (6)

A
  • Alzheimer’s
  • Drugs/toxins
  • TBI
  • Stroke
  • Infection
  • Genetic abnormalities
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23
Q

Pathological processes related to ICR dysregulation (3)

A
  • Brain tumors
  • Degenerative diseases
  • Inflammatory conditions
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24
Q

Factors influencing ICP (9)

A
  • BP
  • Oxygenation
  • Posture
  • Coughing
  • Hip flexion
  • Temperature
  • Blood gases
  • Intra-abdominal pressure
  • Intra-thoracic pressure
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25
Q

S/S of ICP (13)

A
  • Headache
  • Decrease LOC
  • Nausea
  • Projectile vomiting not preceded by nausea
  • Altered breathing patterns
  • Dilated pupils
  • Pinpoint, non-reactive pupils
  • Fixed, unilateral, dilated pupil (blown pupil)
  • Diplopia
  • Blurred vision
  • Seizures
  • Deteriorating motor function
  • Cushing’s triad
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26
Q

Cushing’s triad

A
  • Systolic HTN with widened pulse pressure
  • Bradycardia
  • Irregular respirations
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27
Q

Brain herniation

A

Shift of brain tissue from normal location into adjacent space

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28
Q

National Institute of Health Stroke Scale (NIHSS) components (12)

A
  • LOC
  • Best gaze
  • Visual field testing
  • Facial palsy
  • Motor function arm
  • Motor function leg
  • Limb ataxis
  • Sensory
  • Best language
  • Dysarthria
  • Extinction and inattention
  • Distal motor function
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29
Q

Decerebrate

A

Abnormal extension

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30
Q

Decorticate

A

Abnormal flexion

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31
Q

Glasgow coma scale: Eye opening response

A
  • 4: spontaneous
  • 3: to voice
  • 2: to painful stimuli
  • 1: no response
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32
Q

Glasgow coma scale: verbal response

A
  • 5: oriented to person, place, time
  • 4: confused
  • 3: inappropriate words
  • 2: incomprehensible sounds
  • 1: no response
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33
Q

Glasgow coma scale: motor response

A
  • 6: follows commands
  • 5: moves to localized pain
  • 4: flexion withdrawal from pain
  • 3: abnormal flexion
  • 2: abnormal extension
  • 1: no response
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34
Q

ICP catheters are contraindicated in what patients

A
  • Concurrent use of anticoagulants
  • Bleeding disorders
  • Scalp infection
  • Brain abscess
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35
Q

Nonpharmacological ways to lower ICP (6)

A
  • Elevate head of bed >30 degrees
  • Keep head/neck midline
  • Decrease stimulation
  • Hyperventilate
  • Adequate oxygenation
  • NG tube suctioning
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36
Q

Pharmacological ways to lower ICP (7)

A
  • Osmotic diuretic
  • 3% hypertonic saline
  • Sedatives
  • Analgesics
  • Antiepileptics
  • Antipyretics
  • Stool softeners
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37
Q

Osmotic diuretic (Mannitol)

A

Sugar alcohol that draws fluid from the brain into the blood to decrease cerebral edema

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38
Q

Nursing interventions for Mannitol

A

Monitor fluid and electrolytes

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39
Q

3% hypertonic saline

A

Moves water out of cells and into the blood to decrease cerebral edema

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40
Q

Nursing interventions for 3% hypertonic saline

A

Monitor BP and sodium levels

41
Q

Sedatives

A

Decreases metabolic demand

42
Q

Analgesics

A

Decrease oxygen demand by controlling pain

43
Q

Antipyretics

A

Manage hyperthermia

44
Q

Anti-epileptics

A

Prophylactic to prevent seizures

45
Q

Stool softeners

A

Prevent Valsalva maneuver

46
Q

Decompressive craniectomy

A

Part of skull removed to allow brain swelling without causing compression

47
Q

Craniotomy

A

Remove lesions/mass, repair damage, drain blood

48
Q

Ventriculoperitoneal shunt (VP shunt)

A

Catheter passed from cavities of brain into the peritoneum/abdomen to drain excess CSF

49
Q

Traumatic brain injury (TBI)

A

Damage to brain from external mechanical force

50
Q

Mechanisms of TBI: Blunt (direct)

A
  • Car crash
  • Fall
  • Assault
  • Sports related
51
Q

Mechanisms of TBI: sudden/rapid acceleration/deceleration

A

Head moving rapidly and hits stationary object

52
Q

Coup-Countercoup injury

A

Brain hits skull and bounces back hitting opposite side of skull causing secondary injury

53
Q

Mechanisms of TBI: Penetrating

A

Gunshot wound, stabbing

54
Q

Mechanisms of TBI

55
Q

S/S of concussion (3)

A
  • Headache
  • Brief disruption in LOC
  • Retrograde amnesia
56
Q

Epidural hematoma

A

Bleeding into the space between inner skull and dura

57
Q

S/S of epidural hematoma (4)

A
  • Brief unconsciousness
  • Brief lucid interval followed by decreased LOC
  • Headache
  • N/V
58
Q

Subdural hematoma

A

Bleeding between dura and arachnoid

59
Q

Acute subdural hematoma

A

24-48 hours

60
Q

S/S of acute subdural hematoma (3)

A
  • Decreased LOC
  • Headache
  • Ipsilateral pupil dilation
61
Q

Subacute subdural hematoma

A

2 days - 2 weeks

62
Q

S/S of subacute subdural hematoma

A
  • Decline in mental status
63
Q

Chronic subdural hematoma

A

Weeks - months
>20 days

64
Q

S/S of chronic subdural hematoma (7)

A
  • Headache
  • Decreased LOC
  • Motor deficit
  • Aphasia
  • Gait/balance problems
  • Cognitive problems
65
Q

Subarachnoid hematoma

A

Bleeding between arachnoid mater and Pia mater

66
Q

S/S of subarachnoid hematoma (8)

A
  • Mental status changes
  • Headache
  • N/V
  • ICP
  • Nuchal rigidity
  • Seizures
  • Photophobia
  • Restlessness
67
Q

Diffuse Axonal Injury (DAI)

A

Widespread axonal damage from twisting/sudden forceful stopping that stretches/tears axon bundles

68
Q

S/S of DAI (5)

A
  • Decreased LOC
  • Increased ICP
  • Decortication
  • Decerebration
  • Global cerebral edema
69
Q

Battle sign

A
  • Bruising behind the ear over the mastoid process
  • Skull fracture
70
Q

Raccoon Eyes

A
  • Basal skull fracture
  • Bruising around the eyes
71
Q

Halo sign

A

Clear drainage that separates from bloody drainage

72
Q

CSF rhinorrhea

A

Clear, white liquid from nose, metallic taste in the back of the throat

73
Q

CSF otorrhea

A

Clear liquid discharge from the ear

74
Q

Oculocephalic reflex (Doll’s eye reflex)

A

Head is turned but eyes stay facing forward

75
Q

Oculovestibular (cold caloric reflex)

A

Warm/cold water is placed in ear and eye response is observed

76
Q

Cold caloric reflex

A

Eyes deviate to same side ear and nystagmus beats away to opposite ear

77
Q

Warm caloric relfex

A

Eyes deviate to opposite ear and nystagmus beats toward same ear

78
Q

COWS

A

Cold
Opposite
Warm
Same

79
Q

Complete SCI

A

Spinal cord is injured where all innervation below level of injury is eliminated

80
Q

Incomplete SCI

A

Injury allows some function/movement below level of injury

81
Q

Mechanism of SCI: Hyperflexion

A

Sudden forced acceleration of head forward causing extreme flexion (car accidents, diving)

82
Q

Mechanism of SCI: Hyperextension

A

Often from MVA when hit from behind, fall when chin is struck

83
Q

Mechanism of SCI: Axial Loading/ Vertical Compression

A

Diving accidents, falls on butt

84
Q

Mechanism of SCI: Excessive rotation

A

Turning head beyond normal range

85
Q

Mechanism of SCI: Penetrating

A

Knife, bullet causing direct/indirect spinal cord damage

86
Q

Cervical injury

A

Injury above C4

87
Q

Cervical injury paralysis

A

Paralysis of all extremities including respiratory system

88
Q

C5-C8 injury paralysis

A

Allows some movement of shoulders

89
Q

Thoracic injury

A

Loss of sensation/movement of chest, trunk, bladder, bowel, legs

90
Q

Lumbar/sacral injury

A

Loss of sensation/movement in legs, neurogenic bladder, erection/ejaculation problems

91
Q

Tetraplegia

A

C1 - T1 injury and paralysis of all extremities

92
Q

Paraplegia

A

Below T2 and paralysis of legs

93
Q

Neurogenic shock

A

Due to loss of SNS input

94
Q

S/S of neurogenic shock (4)

A
  • Bradycardia
  • Hypotension
  • Peripheral vasodilation leading to hypothermia
  • Dysrhythmias
95
Q

Treatment for neurogenic shock

A
  • IV fluids
  • Vasopressors
96
Q

Autonomic dysreflexia/hyperreflexia

A

Uncontrolled HTN due to pain, irritation, strong stimulus below level of injury

97
Q

S/S of autonomic dysreflexia (7)

A
  • HTN
  • Blurred vision
  • Throbbing headache
  • Marked diaphoresis
  • Bradycardia
  • Nasal congestion
  • Nausea
98
Q

Treatment for autonomic dysreflexia

A
  • Figure out what’s causing irritation
  • Notify MD
  • Loosen clothes/devices
99
Q

Causes of autonomic dysreflexia (6)

A
  • Fecal impaction
  • Distended bladder
  • UTI
  • Decubiti
  • DVT/PE
  • Constrictive clothing

N477 (13 decks)

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