Neuro (10-14 q)

Question 1

The skull is a rigid closed box/vault with limited space that includes what (3) things

Answer 1

Brain, Cerebral Spinal Fluid (CSF), and Blood.

Question 2

Monroe-Kellie Hypothesis

Answer 2

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

Question 3

What do you want to avoid with the Monroe-Kellie Hypothesis?

Answer 3

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

Question 4

Normal ICP

Answer 4

0-15 mmHg (0=death)

Increased ICP is defined as >20 mmHg for five minutes or longer

Notify HCP if >15

Question 5

S/S of Increased Intracranial Pressure (ICP)

Answer 5

*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

Question 6

Cerebral Blood Flow

Answer 6

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

Question 7

Cerebral Perfusion Pressure

Answer 7

Pressure required to perfuse the brain.

Calculate difference between the MAP and ICP

CPP=MAP-ICP

CPP determines CBF, ischemia can occur if inadequate.

Question 8

Normal CPP

Answer 8

60-100 mmHg

Question 9

Frontal Lobe

Answer 9

Personality, behavior, emotion, intellectual functions

Question 10

Broca’s Area

Answer 10

motor speech

Question 11

Temporal Lobe

Answer 11

Hearing, taste, smell

Question 12

Parietal Lobe

Answer 12

Sensation

Question 13

Wernicke’s Area

Answer 13

Speech comprehension

Question 14

Occipital lobe

Answer 14

Visual Reception

Question 15

Cerebellum

Answer 15

Motor coordination, equillibrium, balance

Question 16

What do we utilize in the ICU q1 for neuro assesment?

Answer 16

Glasgow Coma Scale
Total 3-15.

Question 17

Unequal Pupils

Answer 17

Late Sign! Contact HCP! Rapid Response!

Question 18

Spontaneous (Abnormal Motor Response)

Answer 18

Occurs without regard to external stimuli and may not occur by request

Question 19

Localization (Abnormal Motor Response)

Answer 19

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

Question 20

Withdrawal (Abnormal Motor Response)

Answer 20

Extremity receving the painful stimuli flexes normally in an attempt to avoid the noxious stimuli

Question 21

Decortication (Abnormal Motor Response)

Answer 21

Abnormal flexion response that may occur spontaneously or in response to noxious stimulus

Pt. is unable to localize sensation

Question 22

Decerbration

Answer 22

Abnormal extension response that may occur spontaneously or in response to noxious stimuli

Question 23

Flaccid

Answer 23

No response to painful stimuli.

Question 24

Oculocephalic Reflex

Answer 24

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.

Question 25

Oculovestibal (Cold Caloric/Iced Caloric Test)

Answer 25

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

Question 26

Decompensation

Answer 26

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.