Neurology System Flashcards
What score of the Glasgow coma scale is most likely to indicate airway compromise?
10, 13, 7, 11?
7
True or False?
Accurate and consistent use of the GCS can detect early changes in neuro status
True
Mrs brain has suffered a stoke and has a right hemiplegia. The damage is most likely in what area?
Right motor cortex
Left somatosensory cortex
Right somatosensory cortex
Left motor cortex
Left motor cortex
The area responsible for language comprehension located mainly in the left temporal lobe is what?
Broca’s area
Wernicke’s area
Organ of corti
Bundle of his
Wernickes area
Reflex activities related to the heart rate and blood pressure control are governed mainly by the?
Pons
Mid brain
Medulla oblongata
Cerebellum
Medulla oblongata
These 3 components make up the cranial contents
Brain tissue, parenchyma, and CSF
Blood, CSF and serous fluid
Brain tissue, blood and CSF
CSF, blood and circle of Willis
Brain tissue, blood, and CSF
The brain receives approximately what percentage of oxygen with cardiac output?
20%, 10%, 35%, 50%
20%
Disorientation, restlessness, and confusion in a patient with rising intracranial pressure is related to what?
Altered cerebral blood flow
HTN, bradycardia, severe headache and blurred vision in above T6 spinal cord injury is called what?
Autonomic dysreflexia
Fixed and dilated pupils can be caused by what?
Brain stem hypoxia
An explosive disorderly discharge of cerebral neurons is referred to as what?
A seizure
Acute severe headache, nausea, photophobia and unchallenged rigidity are symptomatic of what?
Meningitis
What are the components of the Neurological assessment?
GCS and PERRLA and Limb Strength
What does the monro kellie hypothesis state?
The sum of volumes of brain cerebrospinal fluid (CSF) and intracerebral blood is constant and that an increase in one should cause a reciprocal decrease in either one or both remaining two
What is a localised/focal brain injury?
A coup - direct impact injury
Can also be a Contrecoup - secondary damage away from injury site
What is a widespread/diffuse brain injury?
A shearing/tearing injury of axons in the brain with high mortality rates and risk for coma
What is cushings triad?
An indicator in nursing assessment to be concerned regarding raised ICP and pressure on the brain stem (i.e imminent death) with the following obs: Increased BP, Decreased HR, and Irregular RR
What causes increased intra-cranial pressure?
An imbalance inside the cranium, typically following a brain injury or other medical condition that increases pressure inside the skull
What is cerebral perfusion pressure?
The pressure required to perfuse oxygen through capillaries in the brain in order for it to preform essential function.
A rise in ICP (intracranial pressure) greater than CPP (cerebral perfusion pressure) results in what?
Reduced blood flow to the brain as vessels are compressed from this pressure. Reduced blood flow will = reduced oxygen and glucose deliver = cerebral ischaemia
What is cerebral ischaemia?
Reduced blood flow in the brain causing reduced oxygen and glucose to brain tissue
How does the body react to cerebral ischaemia?
The sympathetic nervous system activates
Increasing BP and HR to try to increase cerebral perfusion Thus increase oxygen and glucose delivery
Baroreceptors detect the increased BP and activate the parasympathetic nervous system to lower BP by lowering HR.
Without intervention this cycle will continue.
What is the result of the sympathetic and parasympathetic nervous system cycle as a result of untreated cerebral ischaemia?
Continued increasing BP will cause a further increase in ICP (intracranial pressure) therefore an increase in cerebral ischaemia
This increasing pressure in the cranuim will eventually lead to compression of the brainstem - following this death is imminent
What is a symptom of compression on the brainstem due to increased ICP?
Irregular breathing
When you are handing over a shift and the patient is on regular GCS monitoring, what is it essential to do?
Go through a GCS alongside the other nurse - i.e bedside handover. To ensure assessment findings are consistent
Fixed and dilated pupils (big and round) are an indication of what?
Impending death related to raised ICP
Injury to the right side of the brain will cause which sided weakeness?
Left sided
Injury to the left side of the brain will cause which sided weakness?
Right sided
What is the mneumonic we can use to remember the main causes of neurological deterioriation?
AEIOU TIPSS
A Alcohol
E Epilepsy
I Insulin
O Opiates
U Uraemia
T Tumor
I Injury
P Psychiatric
S Stroke
S Sepsis
What are the main causes of neurological deterioration?
Alcohol
Epilipsy
Insulin
Opiates
Uraemia
Tumor
Injury
Psychiatric
Stroke
Sepsis
Priority nursing interventions for a patient having an ischaemic stroke?
Positioning (Head of the bed at 30 degrees)
Supplemental O2
Oral care
Maintenance of BP
Administer analgesia to reduce SNS response
Administer stool softeners to prevent constipation (reduced strain related increases to ICP)
Re-orientate patient to time and place to reduce anxiety
Pressure injury cares
What is the pathophysiology of raised intracranial pressure (ICP)?
A rise in ICP greater than cerebral perfusion pressure ‘CPP’ results in reduced blood flow to the brain as vessels are squashed from the increased pressure. This will cause reduced oxygen and glucose delivery to brain tissues causing cerebral ischaemia
Role of the thalamus?
Directs sensory impulses to the cerebrum
Role of the hypothalamus?
Controls and regulates temperature, appetite, water balance, sleep, and blood vessel constriction and dilation
Also has a role in emotions
Role of the midbrain?
Responsible for eye and auditory reflexes
Role of the pons?
Responsible for certain reflex actions
Role of the medulla oblongata?
For regulating heart an blood vessel function, digestion, respiration, swallowing, coughing, sneezing, and blood pressure - it is the “Centre for respiration”
Afferent spinal nerves do what?
Carry information from the body to the brain
They conduct inwards
Efferent spinal nerves do what?
Carry information from the brain to the body
They conduct outwards
Role of the somatic nervous system?
Carrys motor and sensory information i.e is responsible for all voluntary muscle movements
Role of the sympathetic nervous system?
Fight or flight system. Defends the body when faced with a threat
Role of the parasympathetic nervous system?
Counter to the sympathetic nervous system, it brings the body back to normal countering the effects of the sympathetic nervous system
