Week 2: Neuro Flashcards
intracranial pressure
the pressure exerted bc of the combined total volume of the three components within the skull: brain tissue, blood, and CSF
cerebral blood flow
the amount of blood in mL passing through 100g of brain tissue in 1 min
cerebral perfusion pressure
pressure needed to ensure adequate brain tissue perfusion
compliance
the expandability of the brain
increased ICP
life threatening situation that results from an increase in any or all of the three components within the skull
why is elevated ICP clinically significant
diminishes CPP, increases risks of brain ischemia & infarction, and is associated with a poor prognosis
major complications of uncontrolled, increased ICP
inadequate cerebral perfusion and cerebral herniation
gold standard for monitering ICP
ventriculostomy, in which a catheter is
inserted into the lateral ventricle and coupled to an external transducer.
nursing goals for pt with increased ICP
(1) maintain a
patent airway, (2) have ICP within normal limits, (3) demonstrate normal fluid and
electrolyte balance, and (4) have no complications secondary to immobility and
decreased level of consciousness.
head injury
any trauma to the scalp, skull, or brain. The term head trauma
is used primarily to signify cranio-cerebral trauma, which includes an alteration in
consciousness, no matter how brief.
scalp lacerations
most minor type of head trauma. Because the scalp contains
many blood vessels with poor constrictive abilities, the major complications
associated with scalp laceration are blood loss and infection.
skull fractures
frequently occur with head trauma. There are several ways to describe
skull fractures: (1) linear or depressed; (2) simple, comminuted, or compound; and (3)
closed or open.
concussion
sudden transient mechanical head injury with disruption of neural
activity and a change in the LOC and is considered a mild brain injury.
diffuse axonal injury
widespread axonal damage occurring after a mild,
moderate, or severe TBI.
contusion
bruising of the brain tissue within a focal area. A contusion often
develops in areas of hemorrhage, infarction, necrosis, and edema and frequently
occurs near the site of a skull fracture.
complications from head injury
epidural hematoma, subdural
hematoma, intraparenchymal or intracerebral hematoma, and traumatic subarachnoid
hemorrhage.
epidural hematoma
collection of blood that results from bleeding between the
dura and the inner surface of the skull
subdural hematoma
collection of blood that results from bleeding between the
dura mater and the arachnoid layer of the meningeal covering of the brain.
intraparenchymal hematoma
collection of blood within the
parenchyma that results from bleeding within the brain tissue itself and occurs in
approximately 16% of head injuries.
nursing goals for pt with acute head injury
(1)
maintain adequate cerebral oxygenation and perfusion; (2) remain normothermic; (3)
be free from pain, discomfort, and infection; and (4) attain maximal cognitive, motor,
and sensory function.
tumours of the brain may be
primary, arising from tissues within the brain, or secondary, resulting from a
metastasis from a malignant neoplasm elsewhere in the body.
why do brain tumours rarely metastisize
they are contained by structural (meninges) and
physiological (blood-brain) barriers.
preferred tx of brain tumours
surgery
nursing goals for pt with brain tumour
will (1) maintain
normal ICP, (2) maximize neurological functioning, (3) be free from pain and
discomfort, and (4) be aware of the long-term implications with respect to prognosis
and cognitive and physical functioning.
stereotactic radiosurgery
procedure that involves closed-skull destruction of an
intracranial target using ionizing radiation focused with the assistance of an
intracranial guiding device. A sophisticated computer program is used while the
patient’s head is held still in a stereotactic frame.
nursing goals for pt with cranial surgery
(1) return to normal
consciousness, (2) be free from pain and discomfort, (3) maximize neuromuscular
functioning, and (4) be rehabilitated to maximum ability.
meningitis
an acute inflammation of the meningeal tissues surrounding the brain
and the spinal cord. Bacterial meningitis is considered a medical emergency.
key signs of meningitis
Fever, severe headache, nausea, vomiting, and nuchal rigidity
common causes of viral meningitis
enteroviruses, arboviruses, human immunodeficiency virus (HIV), and herpes simplex virus (HSV).
encephalitis
acute inflammation of the brain, is a serious, and sometimes fatal,
disease.
brain abcess
accumulation of pus within the brain tissue that can result from a
local or a systemic infection. Direct extension from ear, tooth, mastoid, or sinus
infection is the primary cause.
cerebrovascular accident
occurs when
there is ischemia (inadequate blood flow) to a part of the brain or hemorrhage into the
brain that results in death of brain cells. Functions such as movement, sensation, or
emotions that were controlled by the affected area of the brain are lost or impaired.
ischemic stroke
inadequate blood flow to the brain from partial or
complete occlusion of an artery, and account for approximately 87% of all strokes.
transient ischemic attack
a transient episode of neurological dysfunction
caused by focal brain, spinal cord, or retinal ischemia, but without acute infarction of
the brain.
thrombotic stroke
a blood clot forms in a diseased and narrowed
blood vessel in the brain. If the narrowed lumen of the blood vessel becomes
occluded, infarction occurs.
embolic stroke
embolus lodges in and occludes a cerebral artery,
resulting in infarction and edema of the area supplied by the involved vessel.
hemorrhagic stroke
account for approximately 15% of all strokes and result from
bleeding into the brain tissue itself (intracerebral or intraparenchymal hemorrhage) or
into the subarachnoid space or ventricles.
subarachnoid hemorrhage
intracranial bleeding into
the cerebro-spinal fluid–filled space between the arachnoid and pia mater membranes
on the surface of the brain.
motor deficits of strokes
impairment of (1) mobility, (2) respiratory function, (3) swallowing and speech, (4) gag reflex, and (5) self-care abilities.
health management of strokes
on (1) BP control, (2) blood glucose control, (3) diet and
exercise, (4) smoking cessation, (5) limiting alcohol consumption, and (6) routine
health assessments.
nursing goals of stroke pts
(1) maintain a stable or improved level of consciousness
(2) attain maximum physical functioning
(3) attain maximum self-care abilities and skills
(4) maintain stable body functions (e.g., bladder control)
(5) maximize communication abilities
(6) maintain adequate nutrition
(7) avoid complications of stroke
(8) maintain effective personal and family coping
migraine headache
a recurring headache characterized by throbbing
pain, a triggering event or factor, strong family history, and manifestations
associated with neurological and autonomic nervous system dysfunction. Some
migraines are preceded by auras and/or prodromes.
tension type headache
characterized by its bilateral location and pressing/tightening quality. Tension-
type headaches are usually of mild or moderate intensity and can last from
minutes to days.
cluster headaches
are a rare form of headache with a sharp stabbing pain.
Cluster headaches involve repeated headaches that can occur for weeks to months
at a time, followed by periods of remission.
auras
neurological symptoms such as visual field defects, tingling or burning
sensations, paresthesias, motor dysfunction (e.g., weakness, paralysis), dizziness,
confusion, and even loss of consciousness that usually precede the onset of migraine
pain
prodrome
(signs or symptoms that may precede a MH), includes psychic
disturbances, gastro-intestinal upset, and changes in fluid balance.
seizure
transient, uncontrolled electrical discharge of neurons in the brain that
interrupts normal function. Seizures are often symptoms of an underlying illness.
epilepsy
condition in which a person has spontaneously recurring seizures (at
least two, more than 24 hours apart) caused by a chronic underlying pathology.
generalized seizures
characterized by bilateral synchronous epileptic discharges
in the brain from the onset of the seizure. Because the entire brain is affected at the
onset of the seizures, there is no warning or aura.
tonic clonic seizure
characterized by loss of consciousness and falling to the
ground if the patient is upright, followed by stiffening of the body (tonic phase)
for 10 to 20 seconds and subsequent jerking of the extremities (clonic phase) for
another 30 to 40 seconds.
typical absence seizure
usually occurs only in children and rarely continues
beyond adolescence. The typical clinical manifestation is a brief staring spell that
lasts only a few seconds, so it often occurs unnoticed.
atypical absence seizure
characterized by a staring spell accompanied
by other signs and symptoms, includes brief warnings, peculiar behaviour during
the seizure, or confusion after the seizure.
focal seizures
caused by electrical activity
that is focal to a particular area of the brain, resulting in unilateral manifestations.
status epilepticus
state of continuous seizure activity in which seizures recur in
rapid succession without return to consciousness between seizures. It is the most
serious complication of epilepsy and is a neurological emergency.
multiple sclerosis
a chronic, progressive, degenerative autoimmune disorder
of the CNS characterized by disseminated demyelination of nerve fibres of the brain,
spinal cord, and optic nerves.
MS characterization
by chronic inflammation, demyelination, and gliosis (scarring) in
the CNS.
parkinsons disease
progressive, neurodegenerative disease of the basal
ganglia characterized by slowness in the initiation and execution of movement
(bradykinesia), increased muscle tone (rigidity), tremor at rest, and impaired postural
reflexes. It is the most common form of parkinsonism (a syndrome characterized by
similar symptoms).
myasthenia gravis
autoimmune disease of the neuro-muscular junction
characterized by the fluctuating weakness of certain skeletal muscle groups.
MG cause
autoimmune process in which antibodies attack acetylcholine (ACh) receptors, resulting in a decreased number of ACh receptor sites at the neuro-
muscular junction.
myasthenic crisis
acute exacerbation of muscle weakness triggered by
infection, surgery, emotional distress, drug overdose, or inadequate drugs in a person
with MG. The major complications of MG result from muscle weakness in areas that
affect swallowing and breathing, resulting in aspiration, respiratory insufficiency, and
respiratory infection.
restless leg syndrome
characterized by unpleasant sensory (paresthesias) and motor abnormalities of one or
both legs. There are two distinct types of RLS: primary (idiopathic) and secondary.
amyotrophic lateral sclerosis
a rare
progressive neurological disorder characterized by loss of motor neurons and by
weakness and atrophy of the muscles of the hands, the forearms, and the legs,
spreading to involve most of the body and the face. ALS usually leads to death within
2 to 6 years after diagnosis.
huntingtons disease
genetically transmitted, autosomal dominant disorder
that affects both men and women of all races, and is characterized by chronic,
devastating loss of all neurological function, resulting in dementia.
HD s&s
abnormal and excessive involuntary
movements (chorea) and psychiatric abnormalities. The chorea involves writhing,
twisting movements of the face, limbs, and body. The movements get worse as the
disease progresses.
