Neurological Alterations Flashcards
Four Major Regions of The brain
1- cerebrum
2- diencephalon
3- brainstem
4- cerebellum
Functions
1- cerebrum
- interprets sensory input
- controls skeletal muscle
- intellect/emotions
- skills memory
Functions:
2- Diencephalon
- senses and motor
- regulates ANS
- regulates hormones
- mediates emotions
Functions
3- Brainstem
Serves as a conduction pathway
- controls HR, RR, BP, swallowing
- regulates skeletal
- **CANNOT LIVE WITHOUT THIS
Functions
4- Cerebellum
- processes information
- provides info for balance, posture, body mvmt
Cerebral spinal fluid (CSF)
-function
- cushion for the brain
- protects the brain and spinal cord from trauma
- nourishment to brain
- removes waste products from cerebralspinal cellular metabolism
Peripheral Nervous System
*links CNS with the rest of the body
-
PNS
-parts
- nerves
- ganglia
- sensory receptors
PNS subdivisions
sensory or motor
PNS two types of nerves
Spinal nerves or cranial nerves
Autonomic Nervous System
regulates the internal environment of the body
ANS subdivision
1-sympathetic
2- parasympathetic
PARASYMPATHETIC EFFECTS
Rest & digest:
- constrict pupil
- incr. salvation
- decr. HR
- constrict bronchioles
- incr. digestion
- contract bladder and gallbladder
- relax rectum
SYMPATHETIC EFFECTS
Flight or Fight:
- dilate pupil
- decr. saliva
- relax bronchi
- incr. HR
- slows digestion
- glucose release from liver
- secrete epinephrine and norepi
- relax bladder
- contract rectum
what meds stimulate the sympathetic NS
-Levophed-norepi
+++++++++++++++++++++++++++5 major components of Physical exam
- LOC
- Motor function
- Pupil function
- Respiratory function
- Vitals
- ALL 5 MUST BE PERFORMED
Level of Consciousness:
1-alert
responds to external stimuli
doesn’t have to be a GCS of 15
Level of Consciousness:
2- Confused
orientated to person but NOT TO
time and place
-impaired judgement
-decision making and decr. attention span
Level of Consciousness :
3- Delirium
Disorientated to time, place, and person loss of contact with reality auditory and visual hallucinations -disorientated x3 delirium tremors
Level of Consciousness:
4-Lethargic
drowsiness
needs a stronger stimuli to wake up
Level of Consciousness:
5- obtunded
dull indifference to external stimuli
response is minimal
1 word
appear sedated
Level of Consciousness:
6- Stupor
responds to a vigorous and continuous stimuli
Level of Consciousness:
7- Comatose
no response-
Level of Consciousness:
8- Vegetative State
non-purposeful eye movement
GCS:
Eye movement-
4- spontaneous
3- to command
2-to pain
1-no response
GCS:
Best Motor Response
6- obeys verbal orders 5- localizes pain 4-withdraws 3- flexion 2-extension 1-no response
GCS:
Best Verbal response
5-orientated 4-diorientated 3-inappropriate words 2-inappropriate sounds 1-no response
Motor function:
1-spontaneous
2-localization
1-without external stimuli
2-opposite extremity reaches over to relieve pain
Motor function
3-withdrawal
4-flaccid
3-extremity receiving the pain moves away from it
4-no response
Motor function
5-decorticate
6-decerabrate
5-abnormal flexion
6- abnormal extension
Superficial Reflexes
** don’t assess if pt follows commands
- corneal
- blink
- gag
- cough
- plantar
- fanning of toes only normal in babies
What does fixed, dilated pupils mean
pressure on ocular nerve (tumor, bleed, infarction
Respiratory Patterns with neuro probs
- cheyne-stokes
- central neurogenic hyperventilation
- cluster
- ataxic
Cheyne-stokes
change of rate and depth with periods of apnea
Central Neurogenic
very deep, rapid with no apnea
Cluster
irregular gasping, long periods apnea
Ataxic
irregular, random, deep and shallow
irregular apnea
Vital Signs:
CUSHINGS TRIAD
- bradycardia
- Systolic HTN
- Abn, RR
Cerebral Hemodynamics
-normal ICP
0-15
>20 for 10 min = emergency
Cerebral perfusion
-normal CPP
80-100
Formula for CPP
CPP= MAP-ICP
ICP monitoring devices:
ventriculostomy bolt/screw subdural catheter intraparenchymal catheter fiber optic cath
which device is the only one that drains CSF
ventriculostomy
*risk infection
Things that raise ICP
IV colloids (blood) vasopressors Trendelenburg position warming measures shivering and fever coughing agitation pain hypoventilation (incr. CO2 and blood flow)
Interventions to decrease ICP
-diuretics
-hyperventilate
-incr. HOB
-cooling measures
-rest/ sedate
-hypertonic saline : pulls fluids out
-BP control
CSF drainage
Hypertonic saline:
what to do about Na
increases parameters to 150-155
Stroke:
two types
1-ischemic
2- hemorrhagic
Ischemic stroke types
- atherothrobotic
- embolic
- hypoxic
Hemorrhagic stroke types
- subarachnoid
- intracerebral
Hemmorrhagic
1-subarachnoid
-caused by a ruptured cerebral aneurysm (AVM)
Hemorrhagic
2- intracerebral
caused by HTN or trauma
Arteriovenous Malformationd & Aneurysm
-AVM
lack of bridge between arterial pressure and venous pressure
aneurysm
dilation of walls of cerebral artery
Types of aneuryms
1- Berry or SAccular
most common!
at the base of the brain or the circle of willis
Types of aneuryms
2-fusiform or giant
irregular shape and greater than 2.5 cm
- internal carotid artery
- rarely ruptures
- like a lesion in the brain
Treatment for ruptured aneuryms
- surgical clip
- blood pressure control- ICP raises to same as MAP
- ventriculostomy
Intracerebral hemorrhage
bleeding directly into the brain tissue
-leads to edema and increased ICP
what is the most common cause of inctracerebral hemorrhage
HTN
statistics of intracerebral hemorrhage
only 20% will return to baseline functions
S/S stroke
- numbness
- confusion
- trouble speaking
- trouble seeing
- trouble walking
- dizzy
- severe headache
ACT FASTG stroke
Face, Arm, Speech, Time, Glucose check (hypo/hyper)
Time of events after stroke in ER
- general assessment
- Neuro function
- CT
- CT results
- Fibrinolytic therapy
- admission to hospital bed
- 10 min
- 25 min
- 25 min
- 45 min
- 60 min - 3 hr (cant have a brain bleed)
- 3 hours
BP level for those ON FIBRINOLYTICS
less than 185/110
BP level for those NOT ON FIBRINOLYTICS
less than 220/120
BP for those with hemorrhagic stroke
SBP
Herniation: worst kind
Uncal herniation b.c puts pressure on brainstem
S/S herniation
-cingulate
-NO S/S but if not corrected can turn to uncal
S/S herniation
-central
small reactive pupils
- progress to fixed dilated
- resp changes
- affects brainstem later on
S/S herniation
-uncal
- pupis dilated
- decreased LOC
- resp Changed
- decorticate or decerebrate posturing
- flaccid
BRAIN DEATH TEST (3)
OCULOVESTIBULAR reflex- normal is slow, tonic, nystagmus deviating toward the irrigated ear
DOLL’S eyes
APNEA CHALLENGE
2
PaO2 in the 200s
keep stable then disconnect them from vent for 8 min. Draw ABGs
if Co2 >60= BRAIN DEATH!!
who to call if pt declared brain dead?
One Legacy- you don’t ask about donation!
