Neuro (10-14 q) Flashcards
The skull is a rigid closed box/vault with limited space that includes what (3) things
Brain, Cerebral Spinal Fluid (CSF), and Blood.
Monroe-Kellie Hypothesis
If volume increases in one compartment (or an additional volume is added that should not be there), then one or both of the others must decrease/comply.
Overtime is unable to compensate blood volume causing an increase in intracranial pressure.
Ex. A brain tumor
What do you want to avoid with the Monroe-Kellie Hypothesis?
Herniation, it can lead to death as you cannot function without a brain stem.
The path of least resistance is the ideal route! Ex. craniotomy to allow for swelling of the brain
Normal ICP
0-15 mmHg (0=death)
Increased ICP is defined as >20 mmHg for five minutes or longer
Notify HCP if >15
S/S of Increased Intracranial Pressure (ICP)
*Headache
Nausea
Vomiting (stimulates vomiting center and increases N/V administer antiemetic!)
*Altered LOC
Pupil Changes (LATE SIGN) ex. sluggish, blown, fixed, must contact HCP
** HA and decreased LOC are first s/s of ICP
Cerebral Blood Flow
Bloods ability to perfuse the brain, ESSENTIAL. Hypoxemia for five minutes can permanently destroy neurons.
Inc. MAP – cerebral vessels constrict Ex. HTN
Dec. MAP– cerebral vessels dilate
Remember: Brain regulates fluid and will ensure it gets proper blood flow and perfusion over other organs
Cerebral Perfusion Pressure
Pressure required to perfuse the brain.
Calculate difference between the MAP and ICP
CPP=MAP-ICP
CPP determines CBF, ischemia can occur if inadequate.
Normal CPP
60-100 mmHg
Frontal Lobe
Personality, behavior, emotion, intellectual functions
Broca’s Area
motor speech
Temporal Lobe
Hearing, taste, smell
Parietal Lobe
Sensation
Wernicke’s Area
Speech comprehension
Occipital lobe
Visual Reception
Cerebellum
Motor coordination, equillibrium, balance
What do we utilize in the ICU q1 for neuro assesment?
Glasgow Coma Scale
Total 3-15.
Unequal Pupils
Late Sign! Contact HCP! Rapid Response!
Spontaneous (Abnormal Motor Response)
Occurs without regard to external stimuli and may not occur by request
Localization (Abnormal Motor Response)
Occurs when the extremity opposite the extremity recieving pain crosses modline of the body in an attempt to remove the noxious stimulus from the limb.
Ex. aggressive sternal rub or twisting of the skin
Withdrawal (Abnormal Motor Response)
Extremity receving the painful stimuli flexes normally in an attempt to avoid the noxious stimuli
Decortication (Abnormal Motor Response)
Abnormal flexion response that may occur spontaneously or in response to noxious stimulus
Pt. is unable to localize sensation
Decerbration
Abnormal extension response that may occur spontaneously or in response to noxious stimuli
Flaccid
No response to painful stimuli.
Oculocephalic Reflex
Dolls eyes: the eyes move in the oppsoite direction you turn the head
This reflex is NORMAL. If absent. ABNORMAL, very bad. Brainstem dysfunction.
** Eyes should be compensating to midline.
Oculovestibal (Cold Caloric/Iced Caloric Test)
Push fluid into the ear quickly to get an inner ear response.
Normal: Patient will look towards injected ear
Abnormal: Will look away in the opposite direction
Absent: BAD, usually something wrong in the pons or medulla
Decompensation
Cushings Triad:
Bradycardia
Widening Pulse Pressure (HTN)
Respiratory Changes (shallow, uncoordinated breathing)
If S/S are present call a code patient is about to herniate or actively herniating. Increase in blood pressure, decrease in heart rate.
