Management of Patients w Neurologic Dysfunction & Cerebrovascular Disorders Flashcards
Akinetic mutism
a state of unresponsiveness to the environment
coma
a clinical state of unarousable unresponsiveness; no purposeful movements
Decerebration
type of posturing; extending outward
Decortication
major brain injury (if you touch them in anyway, they will pull to the core)
Locked-in syndrome
aware of what is going on; just cannot move or talk
persistent vegetative state
unresponsive but sleep wake cycle exists; no cognitive function
status epilepticus
a form of epilepsy in which the seizure lasts longer than normal; no recovery period between seizures, does not respond to normal treatment
what are possible causes of altered LOC? (3)
disruption in the cells of the NS
neurologic: nerves are damaged due to CVA, high or low blood sugars
Toxicologic: drugs (cocaine, overdose on any sedative, meth, heroin, or fentanyl)
Metabolic: lack of O2 & sugar
what tool to measure LOC?
Glasgow coma scale
what are patients patterns of respiration commonly like if they have a neurological disorder?
deep breathing w loud snoring
nursing interventions for altered LOC patients (11)
- maintaining airway (administer oxygen)
- protecting patient
- managing nutritional needs (NG tube)
- providing mouth care (suction available, monitor for s/sx of infection)
- maintaining skin & joint integrity (turning patient; proper body alignment)
- preserving corneal integrity (if patient not able to blink, admin eye drops & tape eyelids shut if needed)
- maintain body temp (if high temp, means increased ICP causing vasodilation in the brain increasing metabolic demand on the brain)
- preventing urinary retention (bladder scan; straight cath)
- promoting bowel function (manual evacuation, enemas, suppositories)
- meeting family needs
- monitor & manage complications (pressure ulcers, blood clots, aspiration, pneumonia, s/sx of respiratory failure, prevent contractures in joints, s/sx of VTE (swelling, redness, warmth))
what type of lung sounds do patients have if they are aspirating?
rhonchi
which 3 components are in the state of equalibrium?
brain tissue, blood, cerebral spinal fluid (CSF)
Monro-Kellie hypothesis
- Sum of volumes of brain, CSF, & intracranial blood is constant (if one gets off, then the other will be off)
- Limited space for expansion within the skull
- An increase in any one of the components causes a change in the volume of the others
if a patient starts to develop intracranial pressure, what will you first see a change in?
LOC
most common cause of increased ICP
head trauma
list some secondary effects of an increased ICP (6)
- brain tumors
- subarachnoid hemorrhage
- toxic or viral encephalopathies (cause a decrease in O2 to the brain, increase in CO2, changes cerebral blood flow)
- decreased cerebral perfusion
- stimulates edema
- causes herniation
cerebral edema
- definition
- S/Sx (2)
an abnormal accumulation of water or fluid in the intracellular space, extracellular space or both d/t an increase in the volume of brain tissue
S/Sx: decreased level of consciousness, seizures
autoregulation
brain’s ability to change the diameter of its blood vessels to maintain constant cerebral blood flow during alterations in SBP
Cushing’s response (reflex)
- when does it occur?
- what does it increase?
- Occurs when coronary blood flow decreases significantly
- Increases systolic BP, widening pulse pressure (130/60, 190/40), & cardiac slowing
cushing’s triad
bradycardia, hypertension, bradypnea
clinical manifestations of cushing’s response (5)
- Changes in LOC
- Abnormal respiratory & vasomotor responses
- Restlessness
- Confusion
- Increased drowsiness
clinical manifestations of IICP (3)
- Stuporous, reacting only to loud or painful stimuli
- Decortication
- Decerebration
complications of cushing’s response (3)
- Brain stem herniation: vitals all over the place
- S/Sx of diabetes insipidus
- Placidity: no muscle tone whatsoever
these first two conditions both deal w the posterior pituitary (trauma to the brain)
medical / nursing management goals for ICP (3)
- Decreasing cerebral edema
- Lowering volume CSF
- Decreasing cerebral blood volume
how to achieve goals for managing ICP (6)
- Osmotic diuretics: mannitol
- Restricting fluids
- Draining CSF (VP shunt: drains excess CPF into the peritoneal cavity)
- Controlling fever (Cooling blanket & tylenol)
- Maintaining BP & oxygenation
- Reducing cellular metabolic demands
nursing interventions for ICP (6)
- Maintaining patent airway
- Adequate breathing pattern
- Optimize cerebral tissue perfusion (HOB 30 degrees)
- Maintaining negative fluid balance (Putting out more than taking in)
- Preventing infection (Washing hands)
- Monitor & manage potential complications
craniotomy
opens skull
craniectomy
removing the skull
cranioplasty
replacing skull
seizures
- definition
episodes of abnormal motor, sensory, autonomic or psychic activity
Excessive electrical excitation of the neurons in one section of the brain
list & describe the 3 seizure types
- Generalized: occurs in both hemispheres of the brain
- Focal: only on one hemisphere of the brain; potential to travel to the other; both motor & non-motor symptoms
- Provoked seizure: anxiety, fever, tumor, alcohol or alcohol withdrawal, electrolyte imbalances (Ca, Mg, Na levels being high or low) can be causes
VS. Unprovoked seizure: do not know how it is caused
Unknown - do not fit in either of above types
all ___ are seizures, but not all seizures are ___
convulsions!
4 main S/Sx of seizures
- LOC
- excessive movement
- loss of muscle tone or movement
- disturbance of behavior, mood, sensation, & perception
list 10 potential causes of seizures
- Cerebrovascular disease: due to lack of blood flow to area of the brain
- Hypoxemia: lack of oxygen in the blood
- Febrile (childhood)
- Head injury: causes swelling in the brain
- HTN
- CNS infections: can cause swelling, drainage, & fever
- Metabolic & toxic conditions: not enough sugar or oxygen in brain; high ammonia levels can be toxic to the brain
- Brain tumor
- Drug & ETOH withdrawal: patients have higher risks of seizures
- Allergies: anaphylactic reaction
what to do after a patient’s seizure (6)
- Find out triggers
- The behavior during seizure
- How long seizure lasted (what time did it start & stop)
- Any injury during the seizure?
- Are they in the post ictal state: when seizure is done; patient very lethargic, longer the seizure is, the longer the post ictal state is (Often times will be difficult to arouse & will have loud snoring)
- Lactic acid levels may be drawn! (will be very high) - tourniquet not used
big differences between generalized & focal seizures
Generalized: intense rigidity of entire body, tonic-clonic contractions, tongue often chewed, incontinent of urine & feces (after 1-2 minutes: movement subsides, relaxes & lies in deep coma breathing nosily, postictal state)
Focal: no natural classifications, may be impairment of consciousness or awareness, dyscognitive features, localization, & progression of ictal events
list diagnostic tests used to diagnose seizires including lab studies
- **EEG (major diagnostic tool)
- CT / MRi (R/O lesions)
- PET / SPECT (measure cerebral blood flow)
- complete seizure profile & history (includes baseline neurologic exam)
- description of seizure activity
lab studies: ABGs, CBC, electrolytes
epilepsy
- definition
- classified by what 3 specific patterns?
- primary vs. secondary
A group of syndromes characterized by unprovoked, recurring seizures
classified by: age of onset, family history, seizure type
primary: idiopathic (do not know cause)
secondary: (epilepsy is a symptom)
risk factors for epilepsy (11)
- Genetic
- Birth trauma
- Asphyxia neonatorum
- Head injuries
- Hormonal: menstruation in females
- Infections: herpes, cephalitis, meningitis
- Toxicities
- Fever
- Circulatory problems
- Metabolic disorders
- Drug / alcohol intoxication
