Test 3

Question 1

How is CSF produced?

Answer 1

Through the blood…when it has circulated through the ventricular system of the brain, it is reabsorbed back into the vasculature

Question 2

What is the significance of the Circle of Willis?

Answer 2

It provides different pathways for blood to circulate if there is a blockage in a certain vessel (GOOD). It also is known to commonly accrue aneurysms (BAD).

Question 3

Which category of the GCS is most indicative of the patient’s eventual outcome?

Answer 3

Motor response

Question 4

What are the most commonly used scans for possible brain/spinal cord injuries?

Answer 4

CT, MRI

Question 5

What indicates infection in a lumbar puncture in in CSF?
Low glucose in the CSF indicates what kind of infection?
High protein in the CSF indicates what kind of infection?
Pink CSF is an indication of what?

Answer 5

Elevated WBC
Bacterial
Viral
Subarachnoid bleed

Question 6

Cranial nerves (example: optical nerve) are sympathetic or parasympathetic and central or peripheral? 
Parasympathetic cause the pupils to? 
What does global brain ischemia cause the pupils to do?

Answer 6

Parasympathetic and peripheral
Constrict
Fixed and dilated

Question 7

Explain the oculocephalic reflex and the oculovestibular reflex.

Answer 7

Oculocephalic reflex or “dolls eyes” is standing at the head of the bed, turn head to side to side. If the eyes don’t move there is no brain activity. (Eyes should track back or shift)
Oculovestibular reflex is cold water into the ear and the eyes will move to look at the ear you are shooting water into. (no movement is brain dead)

Question 8

How do you calculate cerebral perfusion pressure? (CPP). And what are the normals

Answer 8

MAP (90-100)-ICP (0-15)= CPP (60-80)

Question 9

What does Cushing’s Triad represent?

Answer 9

• ↑ systolic BP, diastolic normal/↓ (widened pulse pressure)
• ↓ HR (starts tachy, then goes down)
• Slowed/irregular respirations

Question 10

What is the difference between primary and secondary head injuries?

Answer 10

Primary (ie. getting hit in the head with baseball bat)

Secondary (ie. aftermath of wrong treatment of initial head injury)

Question 11

Are epidural bleeds arterial or venous? Subdural?

Answer 11

Arterial, venous

Question 12

What is a classic distinction of epidural hematoma?

Answer 12

“Lucid interval”- they go down, are coherent, then go down again, deadsies

Question 13

How do subdural hematomas present?

Answer 13

Often undetectable on CT then kills you 2-3 days later if not treated

Question 14

What are indications for ICP monitoring?

Answer 14

• GCS <8
• S&S of ↑ ICP
• Post-surgical crani
• Less severe brain injury which requires deep sedation

Question 15

Nursing management for increased ICP:

Answer 15

• HOB 30

- Keep c-spine and head straight

Question 16

What are complications of an aneurysm? (9)

Answer 16

• High morbidity/moratality
• Rebleed
• Vasospasm
• Hydrocephalus
• ↑ ICP
• Seizures
• SIADH/DI
• Neuro deficits
• Cardio/pulm/VTE complications

Question 17

What is the cardinal sign of increased ICP?

Answer 17

Change in LOC

Question 18

A patient displays with a head injury, is hypotensive and tachycardic. What does this indicate?

Answer 18

The pt. likely has an injury elsewhere (ie. internal bleeding, etc.)
Head injuries usually present with hypertension and bradycardia.

Question 19

What are classic signs of a basilar skull fracture?

Answer 19

Leakage of CSF out the nose or ears, raccoon eyes, battle signs.

Question 20

Nursing management for neuro patients:

Answer 20

O2, physical assessment, elevate HOB, check c-spine, ID band for szr precaution, neuro checks, SCD, v/s

Question 21

What is a ventriculostomy and where is it placed?

Answer 21

Used to drain CSF and is placed on non-dominant side of the brain.

Question 22

What is the most common cause of a subarachnoid hemorrhage and where do they commonly occur?

Answer 22

Rupture of a cerebral aneurysm at the Circle of Wilis