Neuro Flashcards
Glasgow Coma Uses and Definition
Assess the level of consciousness who is altered or potential to alter. It is used to measure the degree of consciousness
Three responses of glasgowcoma
Eye
motor
verbal
13-15 best range
Size of pupils for peerla
2-6MM
Babinski Reflex
Normal for 1 year and below if they walk it is not normal and not normal in adults.
Adults who have babinski or fanning means
central nervous system affecting upper motor neuron. Or a tumor / lesion pressing on spinal cord, meningitis, MS
General Dx tests
Lumbar Puncture
Purpose to get CSF and analyze for blood and even tumor cells, measure with manometer and reduce CSF. Administer it intrathecally (into spinal canal). Client should be bent over table with head down arching the back why? or fetal position chin to chest. inspect for infection and csf should be clear and colorless.
Post Procedure of Lumbar Puncture
Lie flat or prone 4-8 hrs, increase fluids. Watch for headache as itll increase when client sits up and or stands and feels relief lying down. This is treated with bed rest, fluids, pain meds and blood patch.
Complications of Lumbar Puncture
Headache - when walking/standing and relieved when lying down. Txt : Bed rest, increase fluids, pain meds, and blood patch
Brain herniation meaning increased ICP and is contraindicated
Infection via could cause meningitis
S/S of ICP increase
Change in loc, either coma or decrease attention span, speech becomes slurred or slow, delay in verbal and increase drowsiness, restlessness, and confusion
Late signs of ICP
Stupor -> coma
v/s changes cushing triads -> require immediate intervention to prevent further ischemia and restore perfusion.
Slow, full bounding pulse, irregular resp, cheyenne stokes or ataxic resp.
Decerebrate / decort - response to painful or noxious indicate motor response and mid -stem compromise
What is cushing triad?
Sys hypertension with widened pulse pressure
Decor/ Decere
Decor inwards and bent
Decerebrate - WORST all 4 extremities more calories burned.
Misc symptoms of Late ICP
Headaches with headinjury assume increased ICP
Change in pupils and pupil response coma - fixed and dilated. Projectile vomitting
Complication of ICP
Brain Herniation, obstructs blood flow causing brain death
DI or SIADH
Goals of Treatment for Icp
Goal should be to reduce cerebral edema, csf fluid amount and reduce blood v. in brain.
Treatment For ICP
When I enter the room, I’ll do a quick survey of the room. OXYGEN is important to allow brain perfusion. IV, should be hooked up such as isotonic (dobutamine) and iontropic (nor) to allow adequate cerebral perfusion. Upon looking at the patient ill observe, HOB up jug midline. No movement such as straining valvasa, no nose blowing. As ICP needs to monitored with repositioning. I take my vitals temp should be lower than 38 and their hypothalamus might not be working so ill give a cooling blanket to decrease the metabolic needs of the brain. Ill get my other vitals making sure pt doesnt show cushing’s triad. Lastly I’ll do my glasgowcoma scale 8 and below i’ll intubate.
I’ll come back for meds, and may induce a barbituate coma to decrease the metabolism, and osmotic diuretic such as mannitol to putll fluid from brain to decrease ICP, hypertonic solution to pull fluid from brain. And steroiods dexathemsaone, when ICP increase is due to a tumor. I’ll restrict fluids.
What I should do is any activity i need to space out and limit suctioning.
What are your ICP monitoring devices?
Ventricular cath or subarachnoid screw but dont have any loose connections, dry dressings
Meningitis
Inflammation in the covering of spine and brain caused by a bacterial or viral infection via transmission resp system
S/s of meningitis
Chills , fever severe headache disorientation -> coma n/v nucchal ridgidity photophobia seizures kernig - stiff legs, hips flexed and brudzinski - neck stiff hips and kneed flex when neck if flexed.
Txt of meningitis
Corticosteriods, abx, analgesics, anticonvulsants, droplet precautions of bacterial menin - high mortality, meningitis immunizations. Viral menin require contact seen in children and infants
TBI
Injury to the brain
Close TBI brain injured but skull not broken
Open TBI skull is broken, fractured, dura is torn via penetrating injury
S/S of TBI Open / close
Basilar fractures are very serious you’ll see bleeding EENT, Battle sign over the mastoid, Raccoon eyes, Cerebrospinal rhinnorrhea leadking from nose, CSF leaks with glucose
Another type of TBI: Focal Injury
Contusions with blunt trauma, aka whiplash, brain is bruised and damage mild-severe
Hematoma, can lead to clients adapting to it.
Epidural Hematoma Patho
Rupture or laceration of the middle of meningeal artery.
Injury - Loss of consciousness - recovery period - bleeding in head - cant compensate - neuro change
