Neuro Flashcards
What is ICP?
Increased cranial pressure is when vessels in the brain are compressed and causes compression on the brain stem which decreases hr and rr
What is the first sign of increased ICP?
Mental staus change
What type of vomiting occurs with increased ICP?
Vomiting without nausea
Late signs of ^ ICP
Cushing Triad:
-low hr and rr
- wide pulse pressure- systolic up, diastolic down
- HTN
Deadly signs of ^ ICP
- pupils fixed, dilated, and unequal
*8mm normal 2-6 - doll eyes- brain stem is intact when eyes can move on their own
*severe brainstem damage when they remain fixed and dilated - babinski reflex present- brain stem herniation
- decorticate- arms flex inwards
- decerebrate- arms flex out, worse
What test is done for brain injuries?
Ct scan
Normal ICP
5-15
Lumbar punctures (spinal taps)
Should she avoided with increased ICP
Interventions for Increased ICP
- immobilize head
- Log roll to turn pt
- HOB Semi Fowlers 30-45*
What should you not allow for increased ICP patients
-No flexing or bending extremities
- No coughing, sneezing, blowing nose
- No valsalva maneuver
- No straining during bowel movement (give stool softener)
Glasgow coma scale
3-15
less than 8 intubate
Meds for increased ICP
- steroids to decrease swelling
- phenytoin- to prevent seizures
- mannitol- decreases pressure
What causes seizures?
increased brain swelling
- stress
- sleep deprivation
- strobe lights
- low sugar
-low sodium
prodromal phase
warning phase before seizure
aura phase
visual, auditory, or swelling sensation clues before a big seizure
ex: burnt toast
ictal phase
active phase of seizure
(ignition phase)
postictal phase
after seizure when pt’s are confused and disoriented
Interventions for seizures
- Assist to the ground, turn to side
- prepare suction
- never insert anything in mouth
- don’t restrain
Best drug for seizures
Benzodiazepines
- lorezapam
- diazepam
Electroencephalogram
EEG assess electrical activity for seizures
no caffeine 12-24 hrs before
no seizure meds before
want them to be sleep deprived to increase activity
pt can eat
Open TBI
basilar skull fracture with csf leaking from eyes, ears, nose
- test clear fluid for glucose to determine if csf
Closed TBI
skull not fractured
Coup Contrecoup
Closed TBI
- front to back of brain ex: whiplash
- Frontal lobe injury= expressive aphasia and memory problems
- Occipital lobe= vison problems
Meningitis
inflammation in the brain caused by bacteria or virus
s/s of meningitis
Headache and photophobia
hard stiff neck - nuchal rigidity
high temp
Peds: hight pitched cry, bulging fontanelle
Adults: altered loc first sign
Meningitis tests
CT scan
lumbar puncture: viral- very clear
bacterial- cloudy
Meningitis requires what type of precautions
Droplet
Diagnostics for meningitis
Kernig sign: straightening leg is painful
Brudzinski sign: neck flex causes hip and knees to flex
Parkinsons
Low dopamine and high acetylcholine
- permanent and no cure
s/s of Parkinsons
- shuffling gait with decreased arm swing
-pill rolling - tremors at rest
Meds for parkinsons
levodopa and carbidopa
avoid protein blocks absorption
Multiple Sclerosis
autoimmune disease that attacks myelin sheath of muscles
MS s/s
muscle spams
muscle stiffness
Pts with MS need to
Mellow out and stay cool
- Avoid sun, hot tubs, hot baths, sauna, extreme heat
- smoking
- surgery
-stress
-sepsis
Pharm for MS
- IV IG
- Cylcosporin- immunosupressant
Myasthenia Gravis
autoimmune disorder
think * dry asthenia gravity
- present with dry body and muscle weakness, droopy eyelids
- avoid sun, stress, smoking, sickness
Meds for Myasthenia Gravis
pyridostigmine give before meals
increases secretions to help swallow
ALS
- all organs in the body shut down, mind still intact
entire body becomes paralyzed
safety concern= dysphagia
increased resp secretions kill pt as diaphragm becomes paralyzed= can’t breathe
Guillian Barre Syndrome
rapidly ascending paralysis from ground up
- killed from resp failure- diaphragm becomes paralyzed
worsening signs of Gillian barre syndrome
inability to cough
can’t lift eyebrows or head
Cervical injury
causes quadriplegia
impaired breathing= deadly
Thoracic injury
paraplegia- paralysis of the legs
Pelvic organs
Lumbar injury
legs and leaky bladder
Autonomic Dysreflexia
Spine cord injury t6 or higher
causes:
- Bladder issue: example would be a distended or urinary tract infection
Bowel issue: like hard stool that collects in the rectum leading to impaction
Break down of skin: due to any type of binding devices or clothing, pressure injury, burns, infection, cuts etc.
s/s: HTN, low hr, sweating, dilated pupils, flushing of face, cool and clammy below injury
Prevent: bladder distention or infection, prevent bowel impaction, asses for skin issues
Treat: position high fowlers with legs lower to lower bp
look for what is causing problem BBS
administer nitro
