Neurology Flashcards
Causes of increased ICP
tumor
bleeding
hydorcephalus
edema
early signs of ICP
change in LOC (as subtle as a change in attention span or pronounced as a coma
slurred or slow speach
delay in response to verbal suggestion
increase in drowsiness
restlessness with no apparent reason
confusion
late signs of ICP
marked changed in LOC progressing to stupor and coma
cushings triad
decerebrate
decorticate
what is causing triad
systolic hypertension with widening pulse pressure
slow full and bounding pulse
irregular respirations (cheyne stokes or ataxic)
what is decorticate posturing
arms flexed inward and bent in toward the body and legs extended mid brain damage
what is decerebrate posturing
all 4 extremities in rigid extension, deep brain damage (worst)
will be rigid, tight and burning more calories
miscellaneous ICP signs
headache
change in pupil response
if in profound coma, fixed and dialated
projectile vomiting
complications of increased ICP
brain herniation
DI and SIADH
what does brain herniation do
obstructs the blood flow to the brain leading to anoxia and then brain death
treatment for Increased ICP
reduce cerebral edema
reduce the amount of cerebral spinal fluid or
reduce the blood volume in the brain
maintain oxygenation
maintain adequate cerebral perfusion
keep temperature below 100.4
elevate HOB
keep head midline so the jugular veins can drain
watch the ICP monitor with turning
avoid restraints, bowel/bladder distention, hip flexion , valsalva, and isometrics
no sneezing or nose blowing
limit suctioning and coughing
space nursing interventions
why must you keep temperature below 100.4 with increased ICP
increased temperature will increase cerebral metabolism and cerebral edema which increases ICP
what is the first cranial nerve
olfactory (smell)
what is the second cranial nerve
optic (vision)
what is the 3rd cranial nerve
oculomotor (pupil constriction)
what is the 4th cranial nerve
trochlear (downward movement of eyes)
what is the 5th cranial nerve
trigeminal (jaw movement, sensation of face and neck)
what is the 6th cranial nerve
abducens (lateral movement of eyes)
what is the 7th cranial nerve
facial (facial movement on anterior 2/3 of tongue)
what is the 8th cranial nerve
vestibulocochlear (hearing balance)
what is the 9th cranial nerve
glossopharyngeal (swallowing, taste on posterior 3rd of tongue)
what is the 10th cranial nerve
vagus (swallowing, speaking)
what is the 11th cranial nerve
spinal/accesory (flexion and rotation of head
what is the 12th cranial nerve
hypoglossal (tongue movements)
how does oxygenation effect ICP
decreased o2 levels and high CO2 levels cause cerebral vasodilation in the brain increasing ICP
why do you want to avoid hypotension and bradycardia with increased ICP
it decreases brain profusion
what fluids can you give with ICP
isotonic saline and inotropic agents: dobutamine and norepinephrine (emergency short term)
signs of a basilar skull fracture
Battle’s sign (bruising over the mastoid)
raccoon eyes ( periorbital bruising)
cerebrospinal rhinorrhea
how do you check for cerebrospinal rhinorrhea
test drainage for CSF
halo test
glucose
what is an open skull fracture
torn dura
what is a closed skull fracture
intact dura
characteristics of an epidural hematoma
rupture to the middle meningeal artery
fast bleed
high pressure
symptoms of an epidural hematoma
loss of consciousness
recovery period
bleeding into head with compensation
loss of compensation
neuro changes
treatment of epidural hematoma
burr holes
questions to ask for assessing head injury
did you pass out and stay out?
did they pass out and wake up and pass out again
did they just see stars
what is a subdural hematoma
venous bleed between dura and brain
slower and less jpressure
commonly seen in chronic geriatric clients
imitates other conditions
treatment of subdural hematoma
craniotomy
What is hydrocephalus
increased accumulation of cerebral spinal fluid that increases ICP
causes of hydrocephalus
tumor
hemorrhage
infection
congenital
What is meningitis
inflammation of the spinal cord of brain
what causes meningitis
bacterial or biral infection primarily transmitted through respiratory system
which meningitis is worse
bacterial
signs of meningitis
chills and high fever
severe headache
disorientation that can progress to coma
nausea and vomiting
nuchal rigidity
stiff neck
photophobia
seizures
kern and brudinski signs
what is kerning sign
severe stiffness of the hamstrings, inability to straighten leg when hips flexed at 90 degrees
what is brudinski sign
severe neck stiffness causes hips and knees to flex when neck is flexed
treatment for meningitis
steroids
analgesics
antibiotics (bacterial)
what precautions do you use for menengitis
viral (contact)
bacterial (droplet) Medical emergency
how do you prevent menengitis
Hib vaccine
What do you monitor for spinal injuries above T6
autonomic dysreflexia
symptoms of autonomic dysreflexia
sudden severe hypertension
bradycardia
headache
nasal stuffiness
flushing
sweating
blurred vision
anxiety
Trigger of autonomic dyreflexia
stimulus below t6
blister
restrictive clothing
dehydration
fecal inpaction
broken bones
full bladder or UTI
anxiety
pressure areas
treatment of autonomic dyreflexia
antihypertensives-hydralazine
treat cause
what are focal injuries
contusions and hematomas
when are contusions seen
blunt trauma or acceleration-deceleration injureis
What are the two types of stroke
hemorrhagic
ischemic
what are the two types of ischemic strokes
embolic
thrombotic
What happens in a hemorrhagic stroke
vessel ruptures and bleeds in the brain as it accumulates there is increased ICP
what can a hemorrhagic stroke Be caused by
a weakened vessel such as an aneurysm
What causes a ischemic stroke
blood flow to the brain is blocked by a blood clot causing a loss of circulation to the brain causing ischemia and damage
what is a thrombotic ischemic stroke
a blood clot in an artery going to he brain
what is an embolic ischemic stroke
a clot that’s formed elsewhere and travels in the blood stream and clogs a vessel in or leading to the brain (sudden onset)
Signs of a stroke
Balance- dizzy loss of balance
eyes- blurry vision abnormal pupil response emianopia
facial droop- unilateral
arms drift or weakness
speech- aphasia, dysphagia, alter loc/ confusion
treatment of ischemic stroke
permissive hypertension
antithrombotics- tPA,
MUST BE DONE WITHIN AN HOUR
percutaneous thrombectomy- surgical removal of clot done in IR
treatment for hemorrhagic stroke
get bleeding under control
if caused by aneurysm coiling (IR) clipping (OR)
craniotomy
EVD
