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NUR 170 EXAM 3 > INTRACRANIAL REGULATION > Flashcards

INTRACRANIAL REGULATION Flashcards

1
Q

NORMAL INTRACRANIAL REGULATION FINDINGS

A

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)

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2
Q

PERRLA

A

Pupils Equal Round Reactive to Light and Accommodation

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3
Q

Normal ICP

A

1-15 mm pressure in brain, at 20 mm and above ICP needs to be monitored.

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4
Q

Caloric Test

A

When cold or warm water is injected into ears nystagmus is the normal response.

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5
Q

INTRACRANIAL REGULATION DEFINITION

A

Processes that affect intracranial compensation and adaptive neurological function- how the brain does what it’s supposed to do

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6
Q

Alterations in intracranial regulation - perfusion

A

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

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7
Q

Alterations in intracranial regulation-Neuroatransmission

A

Liver Toxins➡️ammonia causes hepatic encephalopathy

MS,PARKINSONS,ALS,SEIZURES

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8
Q

Alterations in intracranial regulation- pathology/injury

A 
Lyme disease 
Trauma
Tumor
Infection
Encephalitis 
Meningitis 
Dementia
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9
Q

ALTERATIONS IN INTRACRANIAL REGULATION - FIRST CHANGES SEEN:

A

IN CEREBRAL HEMISPHERES: Altered LOC, behavior changes

IN MIDBRAIN/BRAINSTEM: Patterns of respirations(cheyne strokes), widening pulse pressure, pupillary, oculomotor, and motor responses

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10
Q

OUTCOMES OF ALTERED LEVEL OF CONSCIOUSNESS:

A
  • 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
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11
Q

COMPLETE VEGETATIVE STATE

A
  • 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
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12
Q

LOCKED IN SYNDROME

A
  • 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)
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13
Q

What brain is made up of

A

Brain Tissue- 80%
Blood-10%
CSF-10%

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14
Q

BRAIN DEATH

A

Cessation and irreversibility of all brain functions including brain stem, no evidence of cerebral or brainstem function for an extended period.

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15
Q

BRAIN DEATH CRITERIA

A
  • 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
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16
Q

DIAGNOSTIC TESTS

A
  • 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)
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17
Q

NEUROLOGICAL ASSESSMENT- SIMPLE

A

-assessed by observation when you walk in the room

Terms to use : Alert, confused, lethargic,unresponsive, comatose

  • you are checking for changes
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18
Q

ASSESSING ORIENTATION

A

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?”

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19
Q

ASSESSING PUPILS

A

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
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20
Q

PUPILS SHOULD ALWAYS do the __________________

A

Same thing at the same time

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21
Q

NEUROLOGICAL ASSESSMENT- COMPLETE

A

5 PARTS

  • mental status exam
  • cranial nerve assessment
  • reflex testing
  • motor system assessment
  • sensory system assessment
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22
Q

NEUROLOGICAL ASSESSMENT - MENTAL STATUS EXAM

A

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?”
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23
Q

COGNITIVE EXAMS

A
  • MMSE (mini mental state examination)

- mini cog

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24
Q

CN I

A

1, OLFACTORY

  • controls sense of smell
  • located in nose
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25
Q

CN II

A

2, OPTIC NERVE

  • Controls central and peripheral vision
  • located in and behind eyes
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26
Q

CN III

A

3, OCULOMOTOR

  • controls pupillary constriction
  • positioned in and behind eyes

-Easy to check CN nerves III,IV and VI together

27
Q

CN IV

A

4, TROCHLEAR

-acts as a pulley to move the eyes down toward tip of nose

28
Q

CN V

A

5, TRIGEMINAL NERVE

  • facial sensations
  • located all over face
  • if patient has problem it will usually involve forehead ,cheek or jaw.
29
Q

CN VI

A

6, ABDUCENS

-controls eye movements to the sides

30
Q

CN VII

A

7, FACIAL

  • controls facial movements and expressions
  • ability to taste
31
Q

CN VIII

A

8, ACOUSTIC

  • controls hearing
  • located in ears
32
Q

CN IX

CN X

A

9, GLOSSOPHARYNGEAL

-ability to swallow,cough and gag
-located in tongue and throat
— taste

10, VAGUS

  • ability to swallow cough and gag
  • located in tongue and throat
  • assessed with CN IX
33
Q

CN XI

A

11, SPINAL ACCESSORY

  • controls neck and shoulder movement
34
Q

CN XII

A

12, HYPOGLOSSAL

  • ability to move tongue
  • located in tongue
35
Q

What protects the CNS?

A
  • skull
  • meninges
  • CSF
  • vertebrae
36
Q

4 lobes of brain

A

Frontal,parietal,temporal, occipital

37
Q

Responsible for balance

A

Cerebellum

38
Q

Largest part of brain, divided into hemispheres and lobes:

39
Q

The relay center for brain-directs signals to correct region of brain

40
Q

Controls body temperature

A

Hypothalamus

41
Q

Chambers filled with CSF

A

Ventricles

42
Q

Area that controls all basic life functions

A

Brain stem

43
Q

Connects the hemispheres

A

Corpus collosum

44
Q

Part of endocrine system

A

Pituitary gland

45
Q

Vomiting center in brain

46
Q

In between forebrain and hindbrain

47
Q

Involved in signal transmission and REM SLEEP

48
Q

UNILATERAL NEGLECT

A

Inattention to one side of body

49
Q

APHASIA

A

Defective or absent language function

50
Q

Dysarthria

A

Difficulty speaking

51
Q

Nystagmus

A

Involuntary eye movement

52
Q

Ptosis

A

Dropping eyelid

53
Q

Hemiparesis

A

Weakness on one side

54
Q

Paralysis

A

Loss of muscle movement

55
Q

DYSPHAGIA

A

Difficulty swallowing

56
Q

FASICULATIONS

A

Irregular twitches

57
Q

TREMORS

A

Rhythmic movements

58
Q

HEMIPLEGIA

A

Loss of movement on one side

59
Q

ATAXIA

A

Unbalanced, clumsy gait

60
Q

FLACCIDITY

A

Decrease muscle tone

61
Q

SPASTICITY

A

increased muscle tone

62
Q

REFLEXES

A
  • rapid,involuntary,predictable motor responses to a stimulus
  • occurs over reflex arc
  • primitive reflexes present at birth: startle,sucking,stepping & babinski
  • continued evident of these reflexes indicates cerebral damage
63
Q

REFLEX TESTING

A

Deep Tendon Reflex Testing- biceps,triceps,patellar,Achilles (striking tendon to elicit the contraction of the muscle)

0= no response
+2= normal
+4=hyperactive with clonus

NUR 170 EXAM 3 (4 decks)

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