Patients with Neurologic Dysfunction

Question 1

What is the Cushing’s response?

Answer 1

When cerebral blood flood decreases significantly, vasomotor centre increases arterial blood pressure to try and compensate for increasing ICP. Produces Cushings triad: increase in systolic pressure, widening of pulse pressure, and cardiac slowing

• bradycardia
• hypertension
• bradypnea

Question 2

What are the CMs of increasing ICP?

Answer 2

Early:
Change in level of consciousness, slowing speech, and delay in verbal response (the later two are early signs)
Late:
Stuporous, react only to loud or painful stimuli, comatose with abnormal motor responses including decortication and decerebration or flaccidity

Question 3

What information should be collected during and prior to the onset of a seizure?

Answer 3

• Circumstances before seizure (stimuli, emotional distrubances, sleep, hyperventilation)
• occurance of an aura (visual, olfactory, auditory)
• first thing patient does in seizure (must not if the beginning of seizure was observed), where the movements or stiffness start, gives clues about origin
• type of movement in the part of body involved
• areas of body involved
• size of pupils, eyes open, did head and eyes turn to one size
• presence or absence of automatisms (lip smacking, swallowing)
• incontinence of urine or stool
• duration of each phase of seizure
• duration of unconsciousness if present
• paralysis or weakness in limbs after seizure
• inability to speak after seizure
• movements at end of seizure
• cognitive status after seizure

Question 4

What are the characteristics of different types of seizures

Answer 4

Complex partial: motionless or moves automatically but inappropriately for time and place, excessive emotions, person does not remember episode

Generalized: involved both hemispheres meaning both side of body, intense rigidity in body followed by intense contraction-relaxation cycles, incontinent of urine and stool, confused hard to rouse from coma afterwards

Question 5

What are the major types of stroke and their causes

Answer 5

Ischemic:

• large artery thrombosis
• small penetrating artery thrombosis
• cardiogenic embolic
• cryptogenic (no known cause)
• other

Hemorrhagic:

• intracerebral hemorrhage
• subarachnoid hemorrhage
• cerebral aneurysm
• arteriovenous malformations

Question 6

What are the CMs for ischemic stroke

Answer 6

• numbmess or weakness of the face, arm, or leg, especially one side of body
• confusion or change in mental status
• trouble speaking or understanding speech
• visual disturbances
• difficulty walking, dizziness, loss of balance or coordination
• sudden severe headache