INTRACRANIAL REGULATION Flashcards
NORMAL INTRACRANIAL REGULATION FINDINGS
LOC-is alert to person,place,time and situation and oriented x4.
PUPILLARY RESPONSE- brisk and equal(respond at same time) PERRLA.
OCULOMOTOR RESPONSES- eyes move as the head turns, caloric test produces nystagmus.
MOTOR RESPONSES- purposeful movements, responds to commands
BREATHING- eupnea(regular pattern with normal rate and depth)
PERRLA
Pupils Equal Round Reactive to Light and Accommodation
Normal ICP
1-15 mm pressure in brain, at 20 mm and above ICP needs to be monitored.
Caloric Test
When cold or warm water is injected into ears nystagmus is the normal response.
INTRACRANIAL REGULATION DEFINITION
Processes that affect intracranial compensation and adaptive neurological function- how the brain does what it’s supposed to do
Alterations in intracranial regulation - perfusion
Low blood ➡️ low 02➡️ low glucose(Brain needs blood oxygen and sugar)
Carotid artery blockage, aneurism,stroke,TIA,hypoxemia, hypoglycemia,heart attack - can all impair brain perfusion
Alterations in intracranial regulation-Neuroatransmission
Liver Toxins➡️ammonia causes hepatic encephalopathy
MS,PARKINSONS,ALS,SEIZURES
Alterations in intracranial regulation- pathology/injury
Lyme disease Trauma Tumor Infection Encephalitis Meningitis Dementia
ALTERATIONS IN INTRACRANIAL REGULATION - FIRST CHANGES SEEN:
IN CEREBRAL HEMISPHERES: Altered LOC, behavior changes
IN MIDBRAIN/BRAINSTEM: Patterns of respirations(cheyne strokes), widening pulse pressure, pupillary, oculomotor, and motor responses
OUTCOMES OF ALTERED LEVEL OF CONSCIOUSNESS:
- Full recovery with no long term residual effects
- Recovery with residual damage (change of personality,paralysis,tremor, dysphagia
- Severe consequences (persistent vegetative state, locked in syndrome , brain death
COMPLETE VEGETATIVE STATE
- complete unawareness of self and environment
- loss of all cognitive function
- continued function of brainstem and cerebellum
- usually result of severe brain trauma or global ischemia
LOCKED IN SYNDROME
- patient is alert and fully aware of environment
- intact cognitive abilities
- unable to communicate through speech or movement
- upper cranial nerves may remain intact which can allow client to communicate through blinking and eye movements
- caused by infarct or hemorrhage in the pons, myasthenia gravis,ALS(amyotrophic lateral sclerosis)
What brain is made up of
Brain Tissue- 80%
Blood-10%
CSF-10%
BRAIN DEATH
Cessation and irreversibility of all brain functions including brain stem, no evidence of cerebral or brainstem function for an extended period.
BRAIN DEATH CRITERIA
- unresponsive coma
- absent motor and reflex motions
- no spontaneous respirations(apneic)
- pupils fixed and dilated
- absent ocular responses to head turning and caloric testing
- flat EEG(total loss of brain activity)
- body temp must also be in normal range to be considered brain dead
DIAGNOSTIC TESTS
- MRI
- CT SCAN OF HEAD WITH OR WITHOUT CONTRAST
- RADIOGRAPHIC STUDIES (X-ray)
- EEG (brain waves)
- CEREBRAL ANGIOGRAPHY (blood flow)
- MYELOGRAM (muscle activity)
- SPINAL TAPS (infection)
NEUROLOGICAL ASSESSMENT- SIMPLE
-assessed by observation when you walk in the room
Terms to use : Alert, confused, lethargic,unresponsive, comatose
- you are checking for changes
ASSESSING ORIENTATION
Normal is alert and oriented x4
1- To Person: “can you tell me your name?”
2- To Place: “can you tell me where you are?”
3-To Time: “do you know the date, day of week, next holiday?”
4-To Situation: “do you know why you are here?”
ASSESSING PUPILS
Cranial nerve 3
- opening in the iris through which light passes before reaching the lens and being focus on the retina.
- sympathetic stimulation of CN 3 causes dilation.
- parasympathetic stimulation causes construction.
- adjust size based on light and proximity of object being focused on
PUPILS SHOULD ALWAYS do the __________________
Same thing at the same time
NEUROLOGICAL ASSESSMENT- COMPLETE
5 PARTS
- mental status exam
- cranial nerve assessment
- reflex testing
- motor system assessment
- sensory system assessment
NEUROLOGICAL ASSESSMENT - MENTAL STATUS EXAM
ASSESS THE FOLLOWING:
- general appearance
- LOC using Glasgow Coma Scale
- orientation(person,place,time,situation)
- behavior,affect and speech
- cognitive function(talking to them, “how do you do this?” , “how do you do that?”
COGNITIVE EXAMS
- MMSE (mini mental state examination)
- mini cog
CN I
1, OLFACTORY
- controls sense of smell
- located in nose
