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Critical Care Final > Neurological Alterations > Flashcards

Neurological Alterations Flashcards

1
Q

Four Major Regions of The brain

A

1- cerebrum
2- diencephalon
3- brainstem
4- cerebellum

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2
Q

Functions

1- cerebrum

A
  • interprets sensory input
  • controls skeletal muscle
  • intellect/emotions
  • skills memory
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3
Q

Functions:

2- Diencephalon

A
  • senses and motor
  • regulates ANS
  • regulates hormones
  • mediates emotions
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4
Q

Functions

3- Brainstem

A

Serves as a conduction pathway

  • controls HR, RR, BP, swallowing
  • regulates skeletal
  • **CANNOT LIVE WITHOUT THIS
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5
Q

Functions

4- Cerebellum

A
  • processes information

- provides info for balance, posture, body mvmt

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6
Q

Cerebral spinal fluid (CSF)

-function

A
  • cushion for the brain
  • protects the brain and spinal cord from trauma
  • nourishment to brain
  • removes waste products from cerebralspinal cellular metabolism
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7
Q

Peripheral Nervous System

A

*links CNS with the rest of the body

-

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8
Q

PNS

-parts

A
  • nerves
  • ganglia
  • sensory receptors
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9
Q

PNS subdivisions

A

sensory or motor

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10
Q

PNS two types of nerves

A

Spinal nerves or cranial nerves

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11
Q

Autonomic Nervous System

A

regulates the internal environment of the body

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12
Q

ANS subdivision

A

1-sympathetic

2- parasympathetic

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13
Q

PARASYMPATHETIC EFFECTS

A

Rest & digest:

  • constrict pupil
  • incr. salvation
  • decr. HR
  • constrict bronchioles
  • incr. digestion
  • contract bladder and gallbladder
  • relax rectum
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14
Q

SYMPATHETIC EFFECTS

A

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
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15
Q

what meds stimulate the sympathetic NS

A

-Levophed-norepi

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16
Q

+++++++++++++++++++++++++++5 major components of Physical exam

A
  • LOC
  • Motor function
  • Pupil function
  • Respiratory function
  • Vitals
    • ALL 5 MUST BE PERFORMED
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17
Q

Level of Consciousness:

1-alert

A

responds to external stimuli

doesn’t have to be a GCS of 15

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18
Q

Level of Consciousness:

2- Confused

A

orientated to person but NOT TO
time and place
-impaired judgement
-decision making and decr. attention span

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19
Q

Level of Consciousness :

3- Delirium

A 
Disorientated to time, place, and person
loss of contact with reality
auditory and visual hallucinations
-disorientated x3
delirium tremors
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20
Q

Level of Consciousness:

4-Lethargic

A

drowsiness

needs a stronger stimuli to wake up

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21
Q

Level of Consciousness:

5- obtunded

A

dull indifference to external stimuli
response is minimal
1 word
appear sedated

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22
Q

Level of Consciousness:

6- Stupor

A

responds to a vigorous and continuous stimuli

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23
Q

Level of Consciousness:

7- Comatose

A

no response-

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24
Q

Level of Consciousness:

8- Vegetative State

A

non-purposeful eye movement

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25
Q

GCS:

Eye movement-

A

4- spontaneous
3- to command
2-to pain
1-no response

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26
Q

GCS:

Best Motor Response

A 
6- obeys verbal orders
5- localizes pain
4-withdraws
3- flexion
2-extension
1-no response
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27
Q

GCS:

Best Verbal response

A 
5-orientated
4-diorientated
3-inappropriate words
2-inappropriate sounds
1-no response
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28
Q

Motor function:
1-spontaneous
2-localization

A

1-without external stimuli

2-opposite extremity reaches over to relieve pain

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29
Q

Motor function
3-withdrawal
4-flaccid

A

3-extremity receiving the pain moves away from it

4-no response

30
Q

Motor function
5-decorticate
6-decerabrate

A

5-abnormal flexion

6- abnormal extension

31
Q

Superficial Reflexes

** don’t assess if pt follows commands

A
  • corneal
  • blink
  • gag
  • cough
  • plantar
  • fanning of toes only normal in babies
32
Q

What does fixed, dilated pupils mean

A

pressure on ocular nerve (tumor, bleed, infarction

33
Q

Respiratory Patterns with neuro probs

A
  • cheyne-stokes
  • central neurogenic hyperventilation
  • cluster
  • ataxic
34
Q

Cheyne-stokes

A

change of rate and depth with periods of apnea

35
Q

Central Neurogenic

A

very deep, rapid with no apnea

36
Q

Cluster

A

irregular gasping, long periods apnea

37
Q

Ataxic

A

irregular, random, deep and shallow

irregular apnea

38
Q

Vital Signs:

CUSHINGS TRIAD

A
  • bradycardia
  • Systolic HTN
  • Abn, RR
39
Q

Cerebral Hemodynamics

-normal ICP

A

0-15

>20 for 10 min = emergency

40
Q

Cerebral perfusion

-normal CPP

A

80-100

41
Q

Formula for CPP

A

CPP= MAP-ICP

42
Q

ICP monitoring devices:

A 
ventriculostomy
bolt/screw
subdural catheter
intraparenchymal catheter
fiber optic cath
43
Q

which device is the only one that drains CSF

A

ventriculostomy

*risk infection

44
Q

Things that raise ICP

A 
IV colloids (blood)
vasopressors
Trendelenburg position
warming measures
shivering and fever
coughing
agitation
pain
hypoventilation (incr. CO2 and blood flow)
45
Q

Interventions to decrease ICP

A

-diuretics
-hyperventilate
-incr. HOB
-cooling measures
-rest/ sedate
-hypertonic saline : pulls fluids out
-BP control
CSF drainage

46
Q

Hypertonic saline:

what to do about Na

A

increases parameters to 150-155

47
Q

Stroke:

two types

A

1-ischemic

2- hemorrhagic

48
Q

Ischemic stroke types

A
  • atherothrobotic
  • embolic
  • hypoxic
49
Q

Hemorrhagic stroke types

A
  • subarachnoid

- intracerebral

50
Q

Hemmorrhagic

1-subarachnoid

A

-caused by a ruptured cerebral aneurysm (AVM)

51
Q

Hemorrhagic

2- intracerebral

A

caused by HTN or trauma

52
Q

Arteriovenous Malformationd & Aneurysm

-AVM

A

lack of bridge between arterial pressure and venous pressure

53
Q

aneurysm

A

dilation of walls of cerebral artery

54
Q

Types of aneuryms

1- Berry or SAccular

A

most common!

at the base of the brain or the circle of willis

55
Q

Types of aneuryms

2-fusiform or giant

A

irregular shape and greater than 2.5 cm

  • internal carotid artery
  • rarely ruptures
  • like a lesion in the brain
56
Q

Treatment for ruptured aneuryms

A
  • surgical clip
  • blood pressure control- ICP raises to same as MAP
  • ventriculostomy
57
Q

Intracerebral hemorrhage

A

bleeding directly into the brain tissue

-leads to edema and increased ICP

58
Q

what is the most common cause of inctracerebral hemorrhage

A

HTN

59
Q

statistics of intracerebral hemorrhage

A

only 20% will return to baseline functions

60
Q

S/S stroke

A
  • numbness
  • confusion
  • trouble speaking
  • trouble seeing
  • trouble walking
  • dizzy
  • severe headache
61
Q

ACT FASTG stroke

A

Face, Arm, Speech, Time, Glucose check (hypo/hyper)

62
Q

Time of events after stroke in ER

  • general assessment
  • Neuro function
  • CT
  • CT results
  • Fibrinolytic therapy
  • admission to hospital bed
A
  • 10 min
  • 25 min
  • 25 min
  • 45 min
  • 60 min - 3 hr (cant have a brain bleed)
  • 3 hours
63
Q

BP level for those ON FIBRINOLYTICS

A

less than 185/110

64
Q

BP level for those NOT ON FIBRINOLYTICS

A

less than 220/120

65
Q

BP for those with hemorrhagic stroke

A

SBP

66
Q

Herniation: worst kind

A

Uncal herniation b.c puts pressure on brainstem

67
Q

S/S herniation

-cingulate

A

-NO S/S but if not corrected can turn to uncal

68
Q

S/S herniation

-central

A

small reactive pupils

  • progress to fixed dilated
  • resp changes
  • affects brainstem later on
69
Q

S/S herniation

-uncal

A
  • pupis dilated
  • decreased LOC
  • resp Changed
  • decorticate or decerebrate posturing
  • flaccid
70
Q

BRAIN DEATH TEST (3)

A

OCULOVESTIBULAR reflex- normal is slow, tonic, nystagmus deviating toward the irrigated ear
DOLL’S eyes
APNEA CHALLENGE

71
Q

2

A

PaO2 in the 200s
keep stable then disconnect them from vent for 8 min. Draw ABGs
if Co2 >60= BRAIN DEATH!!

72
Q

who to call if pt declared brain dead?

A

One Legacy- you don’t ask about donation!

Critical Care Final (5 decks)

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