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Flinders Critical Care Nursing > Neurological Assessment and Dysfunction > Flashcards

Neurological Assessment and Dysfunction Flashcards

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1
Q

Three signs of Cushing’s Triad

A
  1. Increasing blood pressure
  2. Bradycardia
  3. Irregular breathing patterns
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2
Q

Red flags for neurological deterioration include:

A

Increasing headache, decreased conscious state or orientation, confusion or irritability, seizures, slurred speech, neck pain, weakness or numbness, behaviour changes

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3
Q

Biot’s breath is…?

A

Irregular breathing with apnoeic episodes

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4
Q

Cushing’s Triad indicates ….?

A

Late signs of increased ICP and indicate that the brain is about to herniate.

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5
Q

Albumin resus in head injured patients

A

Is contraindicated due to increased mortality and association with increased ICP.

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6
Q

What is the sole energy substrate for the brain?

A

Glucose

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7
Q

3 systems responsible for maintain homeostasis

A

Neurological, endocrine & immune,

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8
Q

CNS consists of:

A

Spinal cord and the brain

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9
Q

CNS is responsible for:

A

Acquire, coordinate and disseminate information about the body and it’s environment.

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10
Q

The peripheral nervous system is composed of:

A

43 pairs of spinal nerves and 12 pairs of cranial nerves that emerge from the base of the brain.

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11
Q

How many neurons in the human brain?

A

100 billion

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12
Q

Two main classes of synapses:

A

Electrical and chemical

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13
Q

Function of electrical synapses

A

Permit direct, passive flow of electrical current from one neuron to another in the form of action potential.

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14
Q

Function of chemical synapses:

A

Enable cell to cell communication via the secretion of neurotransmitters

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15
Q

Function of myelin:

A

Increases conduction velocity

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16
Q

Guillian-Barre syndrome:

A

Demyelination of peripheral nerves, slowing conduction and may result in a conduction block.

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17
Q

Neurotransmitters are:

A

Chemical that act as messengers to relay information between neurons.

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18
Q

4 classes of neurotransmitters:

A
  1. Acetylcholine
  2. Biogenic amines
  3. Excitatory amino acids
  4. Neuropeptides
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19
Q

3 major divisions of the brain:

A
  1. Paired hemispheres of the cerebrum
  2. the brainstem
  3. the cerebellum
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20
Q

7 components of the brainstem:

A
  1. thalamus
  2. hypothalamus
  3. epithalamus
  4. subthalamus
  5. midbrain
  6. medulla oblongata
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21
Q

3 regions of the brain:

A

Forebrain, midbrain, hindbrain

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22
Q

Cerebrum description:

A
  1. Largest and most uppermost portion of the brain.
  2. Two hemispheres.
  3. 2x frontal, parietal, temporal and occipital lobes
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23
Q

Cerebrum functions:

A

Cortex (outer layer) is the site of conscious thought, memory, reasoning and abstract mental functions.

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24
Q

Diencephalon decription;

A

Between the cerebrum and the brainstem.

Contains thalamus and hypothalamus

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25
Q

Thalamus function:

A

Thalamus sorts redirects sensory input

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26
Q

Hypothalamus function:

A

Controls visceral, autonomic, endocrine and emotional function and the pituitary gland.

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27
Q

Midbrain function:

A

Reflex centres concerned with vision and hearing.

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28
Q

Basal ganglia function:

A

Planning and coordinating motor movements and posture,

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29
Q

Basal ganglia description:

A

The mass of grey matter in the midbrain beneath the cerebral hemispheres

30
Q

Pons function:

A

Helps to regulate respiration +?

31
Q

Cerebellum function:

A

Coordinates voluntary muscles, maintains balance and muscle tone, fine movement, position sense and integration of sensory input.

32
Q

One fixed or dilated pupil may be indicative of

A
  1. An expanding or developing intracranial lesion, compressing the oculomotor nerve on the same side as the effect pupil
33
Q

A sluggish pupil may be :

A

An early focal sign of an expanding intracranial lesion and raised ICP.

34
Q

Approximate blood flow through the brain

A

750 mls/min

35
Q

CPP formula:

A

MAP - ICP = CPP

36
Q

Cerebral perfusion pressure - relationship to cerebral blood flow

A

CBF is a function of the pressure drop across the cerebral circulation

divided by

cerebral resistance

37
Q

CPP serves as a rough index of

A

Cerebral blood flow

38
Q

Normal cerebral perfusion pressure

A

70-100mmHg

39
Q

When ICP and MAP are equal:

A

CPP is zero and CBF ceases

40
Q

Cerebral autoregulation

A

Maintenance of constant CBF rate in face of changing MAP and CPP through alterations in cerebral vascular resistance (dilation and constriction of the vessels) within MAP 50-150mmHg

41
Q

Effect of head injury on cerebral autoregulation

A

Alters vessel reactivity and the relationship between CPP and blood flow.

*CBF becomes passively dependent on changes in blood pressure

42
Q

Effect of CO2 on CBF

A
43
Q

Effect of O2 on CBF

A
44
Q

Effect of pH on CBF

A
45
Q

Effect of temperature on CBF

A
46
Q

Effect of glucose on CBF

A
47
Q

Why is oxygen of critical importance in cerebral metabolism?

A
48
Q

Cerebral oedema

A

Abnormal accumulation of water or fluid, either local or generalised in the:

  • intracellular space
  • extracellular space
  • or both
49
Q

Cerebral oedema can cause:

A

Deterioration in brain function through the compression of tissue and blood vessels

50
Q

Compression of cerebral blood vessels

A

Reduces oxygen delivery to the brain, causing cerebral ischaemia and a decrease in brain function.

51
Q

Cerebral oedema can block the flow of:

A

CSF, causing an increase in ICP

52
Q

3 main types of cerebral oedema

A

Vasogenic, cytotoxic, interstitial

53
Q

Vasogenic oedema:

A
54
Q

Cytotoxic oedema:

A
55
Q

Interstitial oedema:

A
56
Q

Preventing secondary injury of a head injury patient aims to:

A
  1. Control ICP
  2. Maintain cerebral oxygenation
  3. Minimise cerebral oxygen consumption
57
Q

Aim of ICP monitoring:

A

Detect potentially harmful secondary insults early and apply appropriate preventative interventions.

58
Q

Vasospasm post haemorrhage

A

Often occurs 4-14 days post haemorrhage, increasing chances of rebleeding

59
Q

Stroke

A

Descriptive term for the sudden onset of acute neurological deficit persisting for more than 24 hours and caused by interruption of cerebral blood flow

60
Q

Two types of stoke:

A

Ischaemic and haemorrhagic

61
Q

2 Subtypes of haemorrhagic stroke:

A

Subarachnoid and intracerebral

62
Q

Ischaemic stroke

A

Interruption of blood flow due to thrombotic of embolic event

63
Q

Most common cause of cardiac emoboli

A

Atrial fibrillation

64
Q

Ischaemic injury occurs when:

A

Cerebral blood flow is reduce to a level insufficient to maintain neuronal viability

65
Q

Cerebral oedema can cause:

A

Intracranial hypertension

66
Q

Cerebral oedema results from:

A

Loss of metabolic function of the cells, peaking at 4 days.

67
Q

Common cause of death during the first week after stroke:

A

Cerebral oedema

68
Q

Major acute complications of ischaemia stroke

A
  1. Secondary haemorrhage at the site of the stroke lesion

2. Seizures

69
Q

Haemorrhagic conversion

A

Secondary haemorrhage at the site of the stroke lesion

70
Q

Characteristic sign of an ischaemic stroke

A

Sudden onset of focal neurological signs persisting for more than 24 hours

Flinders Critical Care Nursing (3 decks)

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