Neuro System Flashcards

Question

Triptans

Answer 1

Binds at receptors in the blood vessels of the brain – vasoconstriction Also inhibit the release of a compound that causes inflammation, so it decreases inflammation around blood vessels Can be given orally, intranasally, or SubQ zolmitriptan (Zomig) sumatriptan succinate (Imitrex) Side effects Coronary vasospasm (not given to patients with CAD) Chest heaviness- transient

Answer 2

``` Skull is closed vault Balance between Brain tissue Blood Cerebrospinal fluid When there is increase in one the others must decrease- compensation or compliance Hemorrhage Tumor Obstruction in CSF outflow Increased CO2= vasodilation ```

Answer 3

Caused by traction on cerebral blood vessels from swelling tissue, and pressure on pain-sensitive dura Depends on location of pressure – tumor, hemorrhage Is usually subtle, so need to observe patients closely

Answer 4

``` Change in LOC- restlessness, irritability, confusion- know examples of confusion Decrease in Glasgow Coma Scale score Best Eye opening (1-4) Best Verbal Response (1-5) Best Motor Response (1-6) Changes in speech Pupil change Motor or sensory changes Change in HR, or rhythm Headache, N&V, blurred vision Review breathing patterns ```

Answer 5

Cheyne stokes- shallow-deep-shallow-apnea Central neurogenic hyperventilation- deep & fast Apneustic- prolonged inspiration, hold, exhale, apnea Ataxic- completely irregular

Answer 6

Symptoms Skull x-ray to see shifts CT/MRI to see fluid, tumor, abscess Lumbar Puncture generally not done – risk of herniation of brain stem Pressure lowered in spinal cord and brain tries to find ways of decreasing pressure – is usually fatal

Answer 7

``` Maintain cerebral oxygenation Intubation, ventilation Keep O2 at 90-100% Steroids to reduce edema Decrease intracranial pressure Hyperventilation – remove more CO2 Osmotic diuretic Keep HOB elevated, neck in neutral position to facilitate venous drainage ```

Answer 8

Maintain Cerebral perfusion IV fluid to prevent hypotension & secondary brain injury Vasoactive meds to  or  B/P ICP monitoring – in ventricles Control body temp, prevent chilling Prevent seizures Sedation Mannitol- hyperosmotic agent- increases plasma osmolality to cause fluid to be pulled into vascular supply – and be excreted Created osmotic gradient and pulls fluid out of cells creating diuresis

Answer 9

High dose barbiturates-  metabolic needs of brain Provides pain control and sedation Requires mechanical ventilation Neuromuscular Blocking Agents Skeletal muscle relaxation Pain medication and sedatives are needed too

Answer 10

Decorticate – abnormal flexion due to brain damage at the cortical level Decerebrate – abnormal extension, usually a more serious injury and worse prognosis Bilateral flaccidity – no muscular response to stimulation – very poor prognosis These postures may be unilateral or bilateral and are usually seen in response to pain or stimulation

Answer 11

Glasgow Coma scale- 3-15 ( 9 = coma) Change in LOC- early change Pupil response- unresponsive, unequal On same side as brain lesion (hematoma, tumor, etc) Brain lesion will cause pupil change on ipsilateral side Motor/sensory deficits are usualy contralateral side Vital signs- late changes Dropping B/P can be very dangerous Treating with IV fluids can further  ICP Cranial nerve assessment Blink reflex- stroke lashes Gag reflex

Answer 12

Altered cerebral tissue perfusion Supine with HOB , neck in alignment Avoid severe hip flexion -  intra-abd pressure Maintain airway, limit suctioning Fluid balance- strict I&O Control body temp- shivering  ICP Monitor serum glucose levels – metabolic demand Avoid blowing nose, coughing, holding breath

Answer 13

Monitor intracranial pressure Monitor site for signs of infection or leaking Test CSF leak by testing for glucose Clear nasal drainage means dural tear, so don’t suction nose- meningitis Fluids sometimes replaced based on output  temp increased metabolic needs and ICP, avoid shivering

Answer 14

Insult to brain that is capable of producing physical, intellectual, emotional, social, and vocational changes 30% are fatal Often seen with facial, abdominal of musculoskeletal injuries

Answer 15

Skull fracture common blunt force Bullet/knife wound Skull fragments can cause laceration of brain tissue, nerves, blood vessels Hematoma common

Answer 16

Causes tearing of tissue and blood vessels at brain area of impact

Answer 17

Injury at point of impact as well as at opposite side of brain

Answer 18

``` Complex function controlled by Reticular Activating System with feedback loops 2 criteria Wakefulness Awareness Self Environment Time ```

Answer 19

alteration in thought, attention, comprehension

Answer 20

drug or medical condition induced, often reversibly. Less able to focus, change in cognition

Answer 21

Chronic Confusion

Answer 22

One criteria of confusion, unable to identify self, environment, time

Answer 23

Almost any bacteria can cause this Meningococci Pneumoncocci Haemophilus influenzae (h-flu) Inflammation of the meninges – usually arachnoid and sub-arachnoid space Skull fracture provided easy entry for bacteria

Answer 24

``` Nuchal rigidity – classic symptom Brudzinski’s sign Kernig’s sign Photophobia Fever, chills, tachycardia, headache Nausea & vomiting Petechia or hemorrhagic rash Irritability in early stages to acute illness, confusion or coma MEDICAL EMERGENCY ```

Answer 25

lay flat with hip and knee flexed at 90 degrees. The extend the lower leg. If meningeal irritation there is hamstring spasm, pain and resistance to further extension

Answer 26

lay flat, lift the head rapidly from the bed. If meningeal irritation this produces forward flexion of the hips, and flexion of the knees and ankles.

Answer 27

Lumbar Puncture Be sure there is no increased ICP- brain herniation Elevated pressure Elevated proteins Decreased glucose – bacteria feeding on it Elevated white count – immune response Anticonvulsants IV antibiotics help some Blood brain barrier is interrupted by inflammation and antibiotics can help

Answer 28

Same issues as with  ICP Watch for CSF leak from nose or ears, especially with skull fracture Tests positive for glucose Separates out into bloody and yellow concentric rings on dressings

Answer 29

``` Between Dura and skull (above dura) From injury to blood vessels Usually with skull fracture Bleeding is continuous and arterial Immediately unconscious (arterial bleed) Awakens and is alert (CSF compensation) Loss of consciousness with rapid decline to coma (Compensation fails) ```

Answer 30

Between Dura and Arachnoid Caused by tearing of bridging veins Acute, subacute, chronic Symptoms within 24-48 hrs of injury, due to venous bleeding If conscious- severe headache All symptoms of  ICP Chronic in alcoholics- brain atrophy, very subtle changes

Answer 31

Support of all organs Ventilatory support Management of fluid balance Nutrition/ GI function Initial management same for all head injuries Sometimes evacuation of clot or blood through burr hole

Answer 32

Cessation and irreversibility of all brain functions including the brainstem Criteria vary a bit from state to state No evidence of cerebral or brainstem function for at least 6-24 hours No depressant drugs or alcohol poisoning can be present

Answer 33

``` Unresponsive coma, no motor or reflex movement No spontaneous respiration Pupils fixed and dilated (unresponsive) Absent ocular response to head turning Absent Dolls eye response (in coma only) No nystagmus with caloric test Flat EEG No cerebral circulation on angiogram Persistence of these symptoms for 1 hour, and for 6 hours after onset of coma ```

Answer 34

Dolls eye- movement of eyes in opposite direction of head rotation- THIS IS NORMAL means brainstem is still functioning. If eyes move in the same direction as the head is – means brainstem in dead.