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NURS 2514 > week 9 patho intracranial regulation > Flashcards

week 9 patho intracranial regulation Flashcards

1
Q

what are some things that affect intracranial regulation

A

impaired blood flow
damage to brain tissue
compromised neurotransmission (loss of neurons in the brain)
impaired glucose regulation

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2
Q

what happens when intracranial regulation is affected

A

cerebral edema and increased ICP

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3
Q

how is cerebral edema and ICP related

A

one will most likely cause the other (ex. if you have high ICP it will probably cause cerebral edema)

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4
Q

what are the three parts of the brain compartment

A
  • brain tissue (78%)
  • blood (12%)
  • cerebrospinal fluid (10%)
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5
Q

what is the Monro-kellie doctrine

A

describes how the body maintains normal pressure in the skull
ex. increased pressure in one area will most likely decrease pressure in another or ICP will increase

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6
Q

which 2 things does the brain depend on for normal functioning

A
  • consistent supply of blood (for oxygen, nutrients, and glucose)
  • healthy heart and lungs to pump oxygenated blood to the brain
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7
Q

why does the brain need a consistent supply of blood

A

because the brain cant store oxygen and glucose, so it needs a constant flow of it

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8
Q

what is cerebral perfusion pressure

A

pressure needed to ensure adequate brain tissue perfusion

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9
Q

what who pressures make up CPP (cerebral perfusion pressure)

A

MAP (mean arterial pressure) minus ICP

MAP: forces blood into the brain
ICP: compresses blood flow in the arteries and pushes blood flow out

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10
Q

what is auto regulation

A

brain regulates its own blood flow by vasodilation and vasoconstriction

high CO2: vasodilation
high O2: vasoconstriction
pH: based on acidiy and alkalinity of brain

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11
Q

what are the two compensatory mechanisms of the brain

A

CSF volume: brain will produce more CSF or move it around
Autoregulation

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12
Q

what is normal ICP

A

5-15 mmHg

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13
Q

what things could cause failure of auto regulation

A

severe hypotension/shock, now the only thing that determines cerebral perfusion is BP alone

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14
Q

what will happen to a hypotensive patient if auto regulation fails

A

they will have severe cerebral ischemia

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15
Q

what would happen to a hypertensive patient if auto regulation is lost

A

stroke or rupture/ v high ICP

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16
Q

what can increase ICP for the brain tissue, blood and CSF

A

brain tissue: tumour, abscess, cerebral edema
blood: intracranial hemorrhage, intracranial hematoma
CSF: hydrocephalus

17
Q

what is hydrocephalus

A

Hydrocephalus is a neurological disorder caused by an abnormal buildup of cerebrospinal fluid in the ventricles (cavities) deep within the brain

18
Q

what are the three types of cerebral edema

A

vasogenic: permeability of capillary endothelium is shitty and it leaks all over
cytotoxic: cells become hypoxic = swelling from Na/K pump failing
interstitial: obstruction causes cerebrospinal fluid to leak and move around

19
Q

what causes vasogenic cerebral edema

A

permeability of endothelium sucks d/t injury, proteins leak into intravascular space

20
Q

what are some causes of vasogenic cerebral edema

A

brain tumours, head trauma, abscesses, tocins

21
Q

how does cytotoxic cerebral edema happen

A

injury to brain tissue causes hypoxia to the cells, cells stop working and Na/K pump fails
this causes sodium retention and water moves into the cells, causing swelling and loss of cellular function

22
Q

how does interstitial cerebral edema happen

A

hydrocephalus causes obstruction, prevents cerebral spinal fluid from leaving ventricles. this leads to increase in intraventricular pressure which pushes CSF into extracellular space.

23
Q

what are the four types of brain hemmorhage

A

epidural hemmorhage (above dura mater)
subdural hemmorhage (below dura meter)
subarachnoid hemmorhage (below arachnoid)
incracerebral hemorrhage (in the brain)

24
Q

how does high ICP lead to brain herniation

A

cerebral edema, compression of brain vessels, tissue, and ventricles, decreased blood flow, tissue hypoxia, death of brain cells, acidosis, impaired auto regulation, brain stem compression, brain herniation

25
Q

what is brain herniation

A

basically brain tissue shifts from one space to another to make room for extra things.

26
Q

how does high ICP cause ocular issues

A

swelling compresses oculomotor nerve (cranial nerve 3)

27
Q

how does high ICP affect LOC

A

pressure pushes on the brain stem (always check LOC in neuro patients)

28
Q

whats cushings triad

A

late signs of intracranial pressure affecting systemic vital signs

  • increased blood pressure
  • decreased heart rate
  • irregular respiratory rate (cheyne stokes)
29
Q

what are the three signs of cushings triad

A

hypertension
bradycardia
bradypnea

30
Q

whats the difference between decorticate posturing and decerebrate posturing

A

decorticate: arms flexed and pulled inward (means damage to both corticospinal tracts)
decerebrate: arms extended with wrists pronated and fingers flexed (VERY BAD, means damage to brain steM)

31
Q

how does high ICP cause vomitign

A

direct pressure on vomiting centre (medulla)
usually projectile vomiting with no nausea

32
Q

what is bacterial meningitis

A

inflammation of the meninges. bacteria enters the brain and crosses BBB, cytotoxic agents come in and make BBB more leaky which causes cerebral edema and increase in ICP

33
Q

which people does bacterial meningitis usually occur in

A

infants, older adults, high risk populations

34
Q

why is bacterial meningitis more prevalent in the winter and spring

A

because they’re secondary to vital and respiratory disease

35
Q

what are the two most common types of meningitis

A

pneumococcus meningitis and meningococcal meningitis

36
Q

what is a positive kerning sign

A

you bend the knee up and down and it causes pain (sign of bacterial meningitis)

37
Q

what is nuchal rigidity

A

stiff neck (also associated with bacterial meningitis)

NURS 2514 (31 decks)

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