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Critical Care > Neuro > Flashcards

Neuro Flashcards

1
Q

Meninges

A

protects CNS
* Dura
* Arachnoid
Pia

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2
Q

Where is the epideral space

A

between skull bone and dura

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3
Q

Where is the subdural space

A

between dura and arachnoid

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4
Q

Where is the subarachnoid space

A

between the arachoid and pia

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5
Q

Compare the two ruptures in the dura mater

A
  1. Epidural hematoma (Arterial)
  2. Subdural hematoma (Venous)
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6
Q

What are the components of the arachnoid?

A
  • CSF circulates here
  • cerebral vasculature
    if ruptured –> subarachnoid hemmorhage
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7
Q

What is the purpose of arachnoid villi?

A

Absorb CSF for removal

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8
Q

What happens if you block the arachnoid villi?

A

communicating hydrocephalus

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9
Q

What is the pia mater responsible for?

A

production of CSF

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10
Q

Cerebrospinal fluid (CSF)

Characteristics

A
  • clear, colorless
  • flows through subarachnoid
  • shock absorber / brain tissue protector
    * contains glucose
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11
Q

What does the circle of willis do?

A

circulates blood anterior to posterior

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12
Q

What are the three components of intracranial pressure?

A
  1. Blood
  2. CSF
  3. Brain tissue
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13
Q

Monro-Kellie Doctrine

Define

A
  • ability for brain to self regulate
  • increase in one, other one or two should compensate by decreasing
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14
Q

Cerebral Blood Flow

Autoregulation

A

changes the diameter of blood vessels
* vasocontriction = less blood flow
* vasodilation = more blood flow

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15
Q

What activities can cause impaired autoregulation?

A

coughing, suctioning, restlessness

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16
Q

Cerebral perfusion pressure

Define; Values (formula)

A

represents adequacy to delievering oxygen to the brain
60-100mh normal
50-70 adequate with injury**
MAP-ICP = CPP

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17
Q

Pressure autoregulation

A

MAP 50-150
* increase in MAP = constriction
* decrease in MAP = dilation

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18
Q

Metabolic autoregulation

A
  • increase CO2+Lactic = vasodilation
  • decrease CO2 = vasoconstriction
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19
Q

CSF regulation

A

increase ICP –>
CSF will be displaced into spinal canal –>
aarachnoid will increase absorption

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20
Q

Cerebral edema

A

water in cells cause swelling
* cause by brain trauma, CNS infection, tumors, CVA
* impairs circulation leading to hypoxia

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21
Q

Central Herniation

Define

A

Displacement of brain tissue
* leads to ischemia/anoxic injury

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22
Q

Central Herniation

Symptoms

A

Bilateral pupil dilation
Cushings triad
Flaccid paralysis

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23
Q

Cushings triad

A
  1. increased pulse pressure
  2. bradycardia
  3. abnormal respiration
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24
Q

When are intracranial pressure monitoring devices contraindicated?

A

GSC 9-15
(mild to moderate brain injury)

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25
Q

ICP monitoring

Complications

A

infection
obstruction
hemorrhage
misplacement

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26
Q

Three themes of caring for neuro patients

A
  1. Neuro exam (baseline AxO)
  2. ICP with its factors
  3. Interventions/meds
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27
Q

Space occupying lesion

A
  • tumor
  • abscesses
  • bleeds (hemmorrhage)
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28
Q

Subarachnoid Hemmorhage

Cause?

A

caused by ruputured aneurysm

BLOOD IS NOW MIXING WITH CSF IN SUBA

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29
Q

Subarachnoid Hemorrhage

Clinical Manifestations

A

* worst headache of my life*
* decreased LOC
* stiff neck, photophobia
* Positive Kernig’s/Brudzinski’s

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30
Q

Kernig

A

painful knee extension

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31
Q

Brudzinski

A

neck flexion –> knee flexion

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32
Q

Subarachnoid Hemorrhage

Diagnostics

A

CT scan
* If negative –> LBP
* LBP + if bloody CSF
* Angio then needed for location

33
Q

Subarachnoid Hemorrhage

Clinical management Pre-op

A

Prevent rupture
* prevent valsalva (miralax)
* antihypertensives
* antipyretics
* minimal simulation

34
Q

Subarachnoid Hemorrhage

surgical management

A

clipping is gold standard
coiling

35
Q

Subarachnoid Hemorrhage

Post-op

A

Prevent vasospasms
(AEB) change mental, blurred vision
decreases in CBF –>
decrease o2 –>
increase lactic acid

36
Q

Subarachnoid Hemorrhage

Management of vasospasms

A

Nimodipine –> watch for hypotension
Triple H therapy
(hypervolemic, hemodilution, HTN)

37
Q

Levophed triple H parameters

A

BP >20mm over baseline
(under 200)

38
Q

Subarachnoid Hemorrhage

Hydrochepalus

A

blood clot in sub A
obstructs villi reabsorption
communication hydrocephalus
SHUNT!!!!

39
Q

Tramatic Brain Injury

Primary vs Secondary

A

Primary –> direct force
Secondary –> biochem changes, inadequate perfusion, hypoxia

40
Q

With all head injuries, what should also be assessed?

A

cervical spine

41
Q

An increased GSC is indicative of?

A

Improvement

42
Q

Secondary injury

Cause

A

ischemia
hypercapnia
cerebral edema
sustained hypertension

43
Q

Secondary Injury

Increase brain tissue

A

Ischemic cells swell increasing tissue mass

44
Q

Secondary Injury

Increase CBF

A

Vasodilation occurs to supply oxygen to cells

Hypercapnia from hypoventilation of unconscious patient (CO2 potent cerebral vasodilator)

HTN increases intracranial blood volume

45
Q

Nursing interventions to prevent secondary injury

DO

A
  • minimal stimulation
  • head / neck neutral position
  • maintain o2
46
Q

Nursing interventions to prevent secondary injury

DO NOT

A
  • do not cluster care
  • no tendelenburg
  • no valsalva
47
Q

Compound fracture

A

open

48
Q

Displaced fracture

A

closed

49
Q

Linear fracture

A

depressed-bone fragments

50
Q

Basilar Skull Fracture

Define

A

linear or displaced

51
Q

Basilar Skull Fracture

Assessment/intervention

A
  • assess extraocular movement
  • Assess CSF drainage
  • Avoid nasogastic/trach suctioning
52
Q

Basilar Skull Fracture

Clinical manifestations

A
  • otorrhea (CSF in ear)
    • Rhinorrhea (CSF in nose)
  • Ecchymosis –> battle’s sign(bruising behind ear)
    • Ecchymosis –> raccoon eyes (raccoon)
53
Q

Halo sign

A

CsF leakage, yellow fluid with blood inside

assess glucose
assess beta 2 transferrin

54
Q

Basilar Skull Fracture

Treatment

A

spontaenous healing
loose gauze dressing
cranial/neuro assessment

55
Q

Concussion

Definition

A

alteration in mental status resulting from trauma

high school football

56
Q

Concussion

Clinical manifestations

A
  • Loss of conciousness
  • Retrograde amnesia(before)
  • Anterograde amnesia (after)
  • sluggish
  • concentration issues
57
Q

Concussion

treatment

A

rest the brain
(avoid stimulus)

58
Q

Concussion

Post concussion sundrome

A

6mo-5yr

59
Q

Contusion

A

Brain bruise
coup-contrecoup

complication –> expansion of hematoma, cerebral edema

60
Q

Epidural hematoma

Definition

A

collection of blood between dura/skull resulting from laceration of meningeal artery

low or high impact injuries

61
Q

Epidural hematoma

Clinical manifestations

A
  • temporary skull fracture
  • rapid decrease in conciousness (talk and die)
  • uncal herniation
    * IPSILATERAL PUPIL DILATION
62
Q

Epidural hematoma

Treatment

A

Burr holes

63
Q

Subdural hematoma

Define

A

accumulate venous blood below dura

Elderly/ETOH abusers

64
Q

Subdural hematoma

Clinical manifestations

A
  • headache
  • lethargy
  • confusion
  • seizure
65
Q

Compression of CNIII causes

increased ICP

A

dilated pupils

66
Q

Compression of visual pathways

Increased ICP

A
  • decreased acuity
  • blurring
  • diplopia
67
Q

Increased ICP

interventions to decrease brain tissue volume

A

Mannitol
draws fluid from brain
serum osmo goal <320
Watch for hypovolemia

68
Q

What fluid do you NEVER give neuro patients?

A

hypotonic

69
Q

Increased ICP

decrease cerebra blood flow

A
  • hyperventilation
  • hypothermia
  • Barbiturate coma
70
Q

Increased ICP

decrease CSF

A
  • Furosemide
  • Ventriculostomy (EVD)
71
Q

Level of conciousness

A

awareness/arousal

72
Q

Posturing

Decorticate

A

hands to chest

73
Q

Posturing

Decerebrate

A

hands straight out

74
Q

Increased ICP

Doll’s eye Test

A
  • cervical spine first
    oculocephalic relflex
75
Q

Increased ICP

Cold calorics

A

oculovestibular
confirm tympanic membrane intact

76
Q

Determination of brain death

A
  • CTA, EEG
  • exclude endocrine imbalance
  • exclude drug intoxication
  • core body temp > 32 or 90f for apnea test
  • Absence of motor response
  • Absent reflexes
  • loss of centrally controlled beathing
77
Q

Cranial nerve III

A

corneal reflex

78
Q

Cranial nerve IX/X

A

no cough/gag

Critical Care (9 decks)

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