Unit 14 - Intracranial Regulation

Question 1

Brain/Spinal Cord are part of the _____ nervous system

Answer 1

central

Question 2

Cranial & Spinal nerves, autonomic/somatic systems are part of the _____ nervous system

Answer 2

peripheral

Question 3

basic functional unit

Answer 3

neuron

Question 4

many neurologic disorders are caused be an imbalance in _____

Answer 4

neurotransmitters

Question 5

Meninges:
It also contains an ample supply ofblood vesselsthat deliverbloodto _____ tissue. Another important function of the meninges is that it produces _____. This clear fluid fills the cavities of thecerebral ventriclesand surrounds thebrainandspinal cord. Cerebrospinal fluid protects and nourishes CNS tissue by acting as a _____, by circulating _____, and by getting rid of _____ products.

Answer 5

CNS
cerebrospinal fluid
shock absorber
nutrients
waste

Question 6

_____: follows derma tones

Answer 6

shingles

Question 7

Autonomic Nervous System:

- regulate activities of _____ _____/maintain and restore internal _____

Answer 7

internal organ

homeostasis

Question 8

Sympathetic Nervous System and Parasympathetic nervous system are part of the _____ nervous system

Answer 8

Autonomic

Question 9

• “fight or flight” responses

- main neurotransmitter is norepinephrine

Answer 9

sympathetic nervous system

Question 10

• controls mostly visceral function

Answer 10

parasympathetic

Question 11

autonomic nervous system is regulated by centers in the…

Answer 11

spinal cord
brainstem
hypothalamus

Question 12

mental status, intellectual function, thought content, emotional status, language ability, impact on lifestyle

Answer 12

consciousness/cognition

Question 13

muscle size, muscle tone and strength, coordination and balance, Romberg test

Answer 13

motor system

Question 14

tactile sensation, superficial pain, temperature, vibration and position sense (proprioception)

Answer 14

sensory system

Question 15

DTRs, biceps, triceps, brachioradialis, patellar achilles, superficial, pathologic, plantar (Babinski)

Answer 15

reflexes

Question 16

Neurological assessment includes what 5 things?

Answer 16

• consciousness/cognition
• cranial nerves
• motor system
• sensory system
• reflexes

Question 17

Important to distinguish normal aging changes from abnormal changes

Answer 17

gerontologic considerations

Question 18

Alterations to intracranial regulation

• affected by _____ or _____
• brain function deterioration usually follows a predictable progression, that is, a pattern in which _____ _____ of function are impaired initially

Answer 18

• affected by illness or injury
• brain function deterioration usually follows a predictable progression, that is, a pattern in which higher levels of function are impaired initially

Question 19

_____ of ______ and ______ is the most important indicator of the patient’s condition

Answer 19

level of responsiveness & consciousness

Question 20

_____ is a continuum from normal alertness and full cognition (consciousness) to coma

Answer 20

LOC

Question 21

altered LOC is not the disorder but the result of _____

Answer 21

pathology

Question 22

unconsciousness, unarousable unresponsiveness

Answer 22

coma

Question 23

unresponsiveness to the environment, makes no movement or sound but sometimes opens eyes

Answer 23

akinetic mutism

Question 24

devoid of cognitive function but has sleep-wake cycles

Answer 24

persistent vegetative state

Question 25

inability to move or respond except for eye movements due to a lesion affection the pons

Answer 25

locked-in syndrome

Question 26

bilateral _____ should be included in a neurological assessment

Answer 26

symmetry

Question 27

The GCS (Glasgow Coma Scale) is a standardized system for assessment of _____. A score of _____ indicates full alertness and a score of _____ or less is usually indicative of coma; the lowest possible score is _____. The client's score is low so the nurse should follow the _____ (airway, breathing, and circulation) of care in this case.

Answer 27

``` consciousness 15 8 3 ABCs ```

Question 28

Kernig's sign (after Waldemar Kernig (1840–1917), a Russian neurologist) is positive when the thigh is flexed at the hip and knee at _____ degree angles, and subsequent extension in the knee is _____ (leading to resistance). This may indicate _____ hemorrhage or meningitis manifestations of a sore neck, chills, fever, and photophobia are consistent with meningitis. Assessing for the Brudzinski sign (is, is not) a routine part of the physical assessment.

Answer 28

``` 90 painful subarachnoid meningitis is not ```

Question 29

Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.

Answer 29

Brudzinski's sign

Question 30

Increased Intracranial pressure ( ICP): A _____, quiet room is important to reduce stimuli. Family members should be encouraged to talk to the client in a _____ voice with minimal touching. Visitors should be limited. Care should be provided throughout the day for short periods of time to limit extended stress and stimulation. Elevating the head of the bed is important to reducing intracranial pressure but has no effect on stimulation.

Answer 30

dark | soft

Question 31

is a potent diuretic which, if given in excessive amounts, may lead to profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required, and dose and dose schedule must be adjusted to the individual patient's needs

Answer 31

EDECRIN* (Ethacrynic Acid)

Question 32

_____ _____ are commonly used to reduce ICP

Answer 32

Loop diuretics

Question 33

_____ such as _____ are used alone or in combination with a hypothermia blanket to treat hyperthermia

Answer 33

Antipyretics | acetaminophen

Question 34

Gastrointestinal _____ with intravenous _____ H2 _____ are often used because clients with IICP are at increased risk for developing stress gastritis and ulcers

Answer 34

prophylaxis histamine antagonists

Question 35

Antibiotics (are, are not) routinely prescribed as treatment for IICP.

Answer 35

are not

Question 36

because of limited space in the skull, an increase in any one of components of the skull (brain tissue, blood, CSF) will cause a change in the volume of the others

Answer 36

Monro–Kellie hypothesis

Question 37

Compensation to maintain a normal ICP of _____ to _____ mm Hg is normally accomplished by shifting or displacing CSF

Answer 37

10 to 20

Question 38

Increased ICP _____ cerebral perfusion and causes _____, cell death, and (further) edema

Answer 38

decreases | ischemia

Question 39

Brain tissues may shift through the dura and result in _____

Answer 39

herniation

Question 40

refers to the brain’s ability to change the diameter of blood vessels to maintain cerebral blood flow

Answer 40

autoregulation

Question 41

decreased CO2 results in _____, and increased CO2 results in _____

Answer 41

vasoconstriction | vasodilatation

Question 42

Early or Late manifestations of increased ICP? Changes in LOC Any change in condition Restlessness, confusion, increasing drowsiness, increased respiratory effort, purposeless movements Pupillary changes and impaired ocular movements Weakness in one extremity or one side Headache: constant, increasing in intensity, or aggravated by movement or straining

Answer 42

Early

Question 43

Early or Late manifestations of increased ICP? Respiratory and vasomotor changes VS: Increase in systolic blood pressure, widening of pulse pressure, and slowing of the heart rate; pulse may fluctuate rapidly from tachycardia to bradycardia; temperature increase Cushing triad: bradycardia, hypertension, bradypnea Projectile vomiting Further deterioration of LOC; stupor to coma Hemiplegia, decortication, decerebration, or flaccidity Respiratory pattern alterations including Cheyne–Stokes breathing and arrest Loss of brainstem reflexes: pupil, gag, corneal, and swallowing

Answer 43

Late

Question 44

Position with head in neutral position and elevation of HOB _____ to _____ degrees to promote venous drainage/Avoid extreme head rotation

Answer 44

0 to 60

Question 45

Instruct patient to avoid coughing, sneezing, or nose blowing, which may increase the risk of CSF _____

Answer 45

leakage