Neurological Disorders Flashcards
Monroe-Keller
3 components
-> 80% brain
-> 10% blood volume
-> 10% CSF
* if one volume increase, then one or both of the others must decrease/comply
within limits ( increased ICP)
Herniation can/will occur when the limit is exceeded
Management: craniotomy, burr holes
ICP- 1-15 mmHg
* increased ICP =? 15 mmhg for 5 minutes or longer
Increased ICP
headache, N/V, altered LOC,
pupil changes (late)
* Sluggish, fixed, small, non-reactive
ICU Q1 hours
GCS, LOC, Vitals, reflexes, sensory
Cerebral Blood Flow (CBF)
neurons are destroyed if hypoxic events lasts > 5 mins
Autoregulations ensures CBF -> brain, despites MAP
> Increase MAP=> cerebral vessels constrict ( to decrease perfusion, prevent stroke)
Decrease MAP => cerebral vessels dilate (to improve circulation to the brain)
Cerebral Perfusion Pressure (CPP)
Pressure required to perfused the brain
* invasive line needed to determine
CPP= MAP-ICP
* Norm= 60-100 mmHg
* Increase CPP > 100 -> STROKE
* Decrease CPP < 60 -> anoxic brain injury
Glasgow Coma Scale
Eye Opening (4), Verbal(5) , Motor (6) Responses
Posturing
Localizations- Extremity crosses midline to remove noxious stimuli from another extremity
Withdrawal- Extremity recieving painful stimuli flexes to avoid noxious stimuli
Flaccid- no response to painful stimuli
Decorticate - curled to core, pointed toes, arms bent
Decerebrate - Straight, tense arms paralol. Pointed toes
from least to worst
Brain Death Protocol
Coma, unresponsive to noxious stimuli - dx by neurologist (twice)
Absence of brainstem activity
* fixed/dilated pupils
* no ocular movement
* no corneal reflexes/blinking
* no facial/TMJ movement
* gag absence
* no autonomic respirations
Oculocephalic Relex
Doll Eyes
eyes move opposite of head= good
same direction= brain death
Oculvestibular Reflex
Cold caloric
Any eye movement = good
Absent= bad, brain death ?
Cushing Triad’s
bradycardia + widened pulse pressure + resp changes
CODE ! -> go o OR
to relieve pressure
* herniation eminent
* brainstem compromised
Traumatic Brain Injury
mild: GCS 13-15
moderate: GCS 9-12
Severe: GCS < 8
Injury Types: missle injuries, cerebral, epidural, subdural hematoma, diffuse axonal injuries ( life long problem), coup-contrecoup injures (whiplash)
Basilar Skull Fracture: Hard to see on Xray, sits behind sinuses
* Battle sign + racoon eyes - nothing in nose/ears!!
* Care: dexa-strips test rhinorrhea or otorrhea - sugar/CSF
Invasive ICP Monitoring Devices
Contraindications: coagulopathy, systemic infections, CNS infection
* #1 concern= infection
Ventriculostomy- removes CSF + monitors ICP
* connected to drainage bag via gravity
* NEVER connected to fluids
* level @ pt’s tragus
* CSF color = clear/yellow
* know Dr. orders….. draining etc
* monitor s/s infections!
Nursing Management
ICP stressors: activity, noxious stimuli, pain, straws, vomiting , positioning, noise
Interventions: cluster care, sedate, decrease stimuli, mannitol, 3%. NS, minimize suctioning
Goal: maximize CPP
* * Diuretics, keep peep < 20 cm H2O, allow rest, normothermic temp
* BP control ( MAP 60-100)
* Seizure control, prophylactic anticovulsants
* Surgical management
Surgical Management:
* craniotomy (ventric not enough)
* NC: no bone- palpate for boggyness Qshift
* boggy= good
* monitor s/s
* helmet when OOB!
Complications
Diabetes Inspidus
Low ADH
decrease specific gravity, urine not concentrated
excessive urination >4L/24HR
increase serum sodium
Treat: fluids, vasopressin
SIADH
Too much ADH
holding onto fluid
decrease serum sodium
* seizure, increase ICP
little UO, very concentrated
* increase specific gravity
Cerebral Vascular Accident
Stroke
ishemic or hemorrhagic
“worst HA of my life”-> abrupt onset
* LOC decrease, N/V, stiff neck
Dx: CT, LP, cerebral angiography, asymmetrical weakness
**Med Emergency! **airway, ventric, BP managment, surgery
Ischemic does not show on CT -> give Tpa ! ( w/in 1.5 hrs onset)
Hemorrhagic = seen on CT-> anti-HTN IV, surgery ( NO Tpa)
Tpa contraindications- ICH, head trauma, uncontrolled HTN, seizures, recetn MI, active internal bleeding
