Unit 14 - Intracranial Regulation Flashcards
Brain/Spinal Cord are part of the _____ nervous system
central
Cranial & Spinal nerves, autonomic/somatic systems are part of the _____ nervous system
peripheral
basic functional unit
neuron
many neurologic disorders are caused be an imbalance in _____
neurotransmitters
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.
CNS cerebrospinal fluid shock absorber nutrients waste
_____: follows derma tones
shingles
Autonomic Nervous System:
- regulate activities of _____ _____/maintain and restore internal _____
internal organ
homeostasis
Sympathetic Nervous System and Parasympathetic nervous system are part of the _____ nervous system
Autonomic
- “fight or flight” responses
- main neurotransmitter is norepinephrine
sympathetic nervous system
- controls mostly visceral function
parasympathetic
autonomic nervous system is regulated by centers in the…
spinal cord
brainstem
hypothalamus
mental status, intellectual function, thought content, emotional status, language ability, impact on lifestyle
consciousness/cognition
muscle size, muscle tone and strength, coordination and balance, Romberg test
motor system
tactile sensation, superficial pain, temperature, vibration and position sense (proprioception)
sensory system
DTRs, biceps, triceps, brachioradialis, patellar achilles, superficial, pathologic, plantar (Babinski)
reflexes
Neurological assessment includes what 5 things?
- consciousness/cognition
- cranial nerves
- motor system
- sensory system
- reflexes
Important to distinguish normal aging changes from abnormal changes
gerontologic considerations
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
- 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
_____ of ______ and ______ is the most important indicator of the patient’s condition
level of responsiveness & consciousness
_____ is a continuum from normal alertness and full cognition (consciousness) to coma
LOC
altered LOC is not the disorder but the result of _____
pathology
unconsciousness, unarousable unresponsiveness
coma
unresponsiveness to the environment, makes no movement or sound but sometimes opens eyes
akinetic mutism
devoid of cognitive function but has sleep-wake cycles
persistent vegetative state
inability to move or respond except for eye movements due to a lesion affection the pons
locked-in syndrome
bilateral _____ should be included in a neurological assessment
symmetry
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.
consciousness 15 8 3 ABCs
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.
90 painful subarachnoid meningitis is not
Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.
Brudzinski’s sign
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.
dark
soft
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
EDECRIN* (Ethacrynic Acid)
_____ _____ are commonly used to reduce ICP
Loop diuretics
_____ such as _____ are used alone or in combination with a hypothermia blanket to treat hyperthermia
Antipyretics
acetaminophen
Gastrointestinal _____ with intravenous _____ H2 _____ are often used because clients with IICP are at increased risk for developing stress gastritis and ulcers
prophylaxis
histamine
antagonists
Antibiotics (are, are not) routinely prescribed as treatment for IICP.
are not
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
Monro–Kellie hypothesis
Compensation to maintain a normal ICP of _____ to _____ mm Hg is normally accomplished by shifting or displacing CSF
10 to 20
Increased ICP _____ cerebral perfusion and causes _____, cell death, and (further) edema
decreases
ischemia
Brain tissues may shift through the dura and result in _____
herniation
refers to the brain’s ability to change the diameter of blood vessels to maintain cerebral blood flow
autoregulation
decreased CO2 results in _____, and increased CO2 results in _____
vasoconstriction
vasodilatation
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
Early
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
Late
Position with head in neutral position and elevation of HOB _____ to _____ degrees to promote venous drainage/Avoid extreme head rotation
0 to 60
Instruct patient to avoid coughing, sneezing, or nose blowing, which may increase the risk of CSF _____
leakage
