Glossary of Neuro 2006
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- What area of the brain is responsible for temperature control?
- Diencephalon (thalamus & hypothalamus)
- What is the major function of the medulla oblongata?
- cardiac regulation
- What area of the brain is responsible for equilibrium?
- How long can the brain go without oxygen?
- 5 minutes
- Which brain matter is made up of neurons?
- grey matter
- What is the white matter made up of?
- Where does the Circle of Willis originate?
- carotid artery
- Where do the anterior and middle cerebral arteries originate?
- internal carotid artery
- Where do the posterior cerebral arteries originate?
- vertebral arteries
- Where is CSF produced?
- choroid plexus
- What are the three volume components of intra-cranial pressure?
- brain tissue
- List the brain's 3 types of compensation used to maintain a stable ICP:
- What is autoregulation?
- The system that maintains constant cerebral perfusion despite chantes in systemic arterial pressure; blood flow to the brain remains fairly constant
- What is metabolic regulation?
- Changes to o2 & co2 that affect cerebral blood flow
- How does co2 affect the arteries in the brain
- What causes increased intracranial pressure?
- Anything that causes an increase in production of CSF
Anything that causes a decrease in reabsorption of CSF
- What is meant by the term "hydrocephalus?"
- increased intracranial pressure
- What happens if the brain's system for regulating ICP fails?
- Hypoxia and brain cell death
- When does IICP occur?
- When the brain cannot accomodate the increase in volume of one of the components (failure to compensate)
- What areas of the brain are in danger with uncal herniation?
- What is the pupil response when uncal herniation is present?
- fixed and dilated
- True or False: the damage caused by uncal herniation is temporary if treated quickly
- false; the damage is irreversible
- What respiratory pattern is sometimes seen with increased ICP?
- What pupillary response is an EARLY sign of increased ICP?
- Unequal pupils
- What pupillary response is a LATE sign of increased ICP?
- fixed and dilated
- List the late signs and symptoms of increased ICP:
- *Fixed dilated pupils
*Loss of gag reflex
- What is Cushing's triad?
- *Severe HTN
*Wide pulse pressure
- List interventions for IICP:
- *Administer diuretics
*Administer sedation as ordered
*Avoid valsalva (inc. suctioning)
*Elevate head of bed to 45 degrees
*Maintain the patient's head in a midline position
*Maintain normal body temperature
*Decrease environmental stimuli
- What is euvolemia?
- balanced fluid volume
- What is eucapnia?
- balanced o2
- Regarding traumatic brain injuries, the extent of the injury depends on what?
- the amount of force
- Traumatic brain injury is a major cause of death for what age group?
- children younger than age 5
- What event causes the most traumatic brain injuries?
- Motor vehicle accidents
- What is the GCS in a mild head injury?
- What is the GCS in a moderate head injury?
- What is the GCS in a severe head injury?
- 80% of all skull fractures are what type of fracture?
- Linear skull fracture
- What is a common nursing assessment to determine whether fluid leaking from the ear or nose is CSF?
- the "Halo" test: fluid forms a yellow ring when blotted with a tissue
- What severe damage can result from a basilar skull fracture?
- Severe cranial nerve damage
- What are the signs/symptoms of a concussion?
*Possible loss of consciousness (usually brief)
- What is vasogenic edema?
- abnormal permeability of the cerebral vessel wall; plasma filters to ECS causing an increase in brain tissue volume
- What is cytotoxic edema?
- cellular edema; a result of hypoxic insult to the brain cells
- Of what is the brain depleted in cytotoxic edema?
- What can cause vasogenic edema, resulting in further IICP?
- cytotoxic edema
- What is low when cytotoxic edema is present?
- serum Na
- When does interstitial brain edema occur?
- in the presence of acute brain swelling
- Interstitial brain edema is associated with an increase in what?
- *Blood Pressure
- How is Cerebral Perfusion Pressure (CPP) calculated?
- Subtract CSF pressure from the mean arterial pressure
- What are hematomas?
- Space occupying lesions
- What is involved in an epidural hematoma?
- Middle meningeal artery
- Where does an epidural hematoma occur?
- around the temporal lobe
- With an epidural hematoma, how soon do signs & symptoms occur?
- Very rapidly
- What is the treatment for an artery that is injured by an epidural hematoma?
- suture the artery
- What is the treatment for a subdural hematoma?
- remove the hematoma
- What causes a subdural hematoma?
- ruptured veins
- When do signs/symptoms occur with a subdural hematoma?
- days to weeks
- Is there more or less bleeding with a subdural hematoma?
- True or false: clot formation is slower with subdural hematomas
- What is an intracerebral hemorrhage?
- Accumulation of blood within the brain tissue
- Which type of brain herniation causes compression of the medulla?
- What are the long-term effects of head injuries?
- *Motor deficits
*Difficulty with bowel/bladder function
- If your client has CSF drainage from the ear, what should the nurse assess?
- nuchal rigidity
- What does nuchal rigidity indicate in head injury patients?
- infection or blood in CSF
- What should the nurse rule out BEFORE assessing for nuchal rigidity
- spinal cord injury
- What should ALWAYS be assessed in head injury patients?
*Hypoxia or hypercapnea
- What are some nursing measures to decrease ICP?
- *Elevate HOB 15-30 degrees
*Avoid flexion of hips, waist & knees
*Logroll patient to transfer
*Avoid rotation/extreme flexion/extension of the head
*Space out nursing activities
*Avoid Valsalva type of activities: cough/vomit/strain
*Suction ONLY as necessary
*Provide O2 before & after suctioning
*O2 via mask or nasal cannula
*Possible ET tube to control pO2 & pCO2
*Prophylactic hyperventilation (only if on ventilator)
- What is significant about prophylactic hyperventilation?
- It has a mild vasoconstricting effect when done properly.
- When is prophylactic hyperventilation contraindicated?
- In the first 20 hours after injury
- When is prophylactic hyperventilation indicated?
- *Acute neurologic deterioration (for brief periods)
*Intracranial HTN that does not respond to standard treatment
- When should ABG's be checked if using prophylactic hyperventilation?
- Twice daily
- What is involved in a craniotomy?
- Removal of hematoma or parts of brain to reduce pressure
- What is normal ICP?
- 10-15 mmHg
- What should you remember when preparing your patient for cranial surgery?
- *NO enemas
- Into what position should a craniotomy patient be placed immediately after surgery?
- What is supratentorial positioning?
- *HOB 30-45 degrees
*large pillow under head & shoulders
- What is infratentorial positioning?
- *HOB flat with small pillow
*log roll with draw sheet
*NO neck flexion
- Regarding positioning, what is important to remember when a patient has had a craniectomy?
- Do not place on affected side
- What is the 3rd cause of death in the US?
- What is significant about an ISCHEMIC stroke?
- caused by a thrombus or emboli (occluding the cerebral artery)
- What are the two types of ischemic stroke?
- What causes a thrombotic stroke?
- atherosclerosis of arteries
- What is an embolic stroke?
- Embolus or emboli break off from other parts of the body and enter cerebral circulation via the carotid artery
- What are the warning signs of ischemic stroke?
*Reversible ischemic neurological deficit (RIND)
- What is a hemorrhagic stroke?
- Vessel breaks down; occurence of bleeding into brain tissue, subarachnoid space, or ventricles
- What are the causes of hemorrhagic stroke?
- Cocaine use causes what two side effects which increase the risk of stroke?
- What is dysarthria?
- nerve dysfunction
- What are the classic symptoms of CVA?
- *Contralateral weakness
*Transient loss of bowel/bladder control
*Diminished or loss of consciousness
- Which cranial nerve affects the ability to chew?
- Which cranial nerve affects swallowing and the gag reflex?
- Which cranial nerve affects tongue movement?
- Damage to which cranial nerve causes facial paresis or paralysis?
- Which abnormal heart rhythm results in an increased risk for stroke?
- atrial fibrillation
- How often should the GCS and vital signs be checked in stroke patients?
- q 4 hours
- When is the risk for IICP highest in stroke patients?
- first 72 hours following injury
- When are anticoagulants contraindicated?
- What is very important to monitor after a patient has had a carotid endarterectomy?
- swelling of the neck or complaints of dysphagia
- When is embolization indicated?
- arteriovenous malformation
- What are the causes of aneurysm?
- What are the symptoms of an aneurysm rupture?
- *Sudden explosive headache
*neck rigidity (due to blood in CSF)
*loss of consciousness
- What is meningitis?
- inflammation of teh meninges of the brain & spinal cord
- What can cause meningitis?
- Which type of meningitis is usually not life-threatening?
- How is meningitis transmitted?
- What type of isolation is indicated for meningitis patients?
- droplet isolation
- List some predisposing conditions for meningitis:
- *Otitis media
*Fractured base of skull w/CSF leak
*Procedures like LP or surgery
*Anatomic abnormalities like spina bifida
*Foreign objects like ventricular shunts
*Can occur from a focal infection via blood
- What is SIADH?
- Syndrome of Inappropriate Antidiuretic Hormone (too much adh = retain fluid)
- What is Kernig's sign?
- Pain in hamstring when hip & knee are flexed by examiner
- What is Brudzinski's sign?
- examiner elevates head of patient; knees bend involuntarily
- What is opisthotonus?
- severe spasm of back muscles (bends backward)
- What lab findings are consistent in meningitis?
- *CSF changes: appearance, WBC, glucose & protein
*Culture & sensitivity of CSF
*Elevated serum WBC
*Low serum Na
- What is a partial or focal seizure?
- Epileptogenic focus limited to one region of one cerebral cortex; one hemisphere
- What is significant of a simple partial seizure?
- *Patient remains conscious
*A "deja vu" phenomenon
*Unilateral movement of extremity
*Changes in heart rate
- What is significant of a complex partial seizure?
- *black out 1-3 minutes
*automatism (lip smacking/patting/pulling on clothes, etc.)
*Amnesia may follow immediately after
- What is significant of a tonic-clonic seizure?
- *lasts 2-5 minutes
*tonic: rigidity of arm or leg muscles
*immediate loss of consciousness
*Clonic: rhythmic jerking of all extremities
*May bite tongue
*Incontinence of urine or feces
*Postictal fatigue, lethargy, confusion (usually lasts an hour)
- What is significant of a petit mal seizure?
- *More common in children
*Blank staring, like daydreaming
*Return to baseline immediately after
- What is significant of a myoclonic seizure?
- *brief jerking or stiffening of extremities; single or group
*lasts only a few seconds
- What is significant of an atonic seizure?
- *Sudden loss of muscle tone
*Patient may fall
- What is the first-hand treatment for acute seizure?
- Lorazepam or Diazepam rectal gel
- What is the treatment goal for acute seizure?
- to stop clusters and prevent status epilepticus
- What is status epilepticus?
- *Continuous or recurrent generalized seizures, in rapid succession
- What is significant of status epilepticus?
- *Does not regain full consciousness between seizures
*Repeated seizures lasting over 30 minutes, or one seizure lasting over 10 minutes
*More intense then regular seizures
*A potential complication for all types of epilepsy
- What can cause death or brain damage in status epilepticus?
- What are teh usual causes for status epilepticus?
- *Sudden withdrawal from anticonvulsants
- During status epilepticus, what is important to know regarding the administration of ativan or diazepam?
- No more than 50 mg/minute via IV push
- List some nursing care measures during status epilepticus:
- *Maintain ABC's
*O2 via nasal cannula
*Inform physician (intubation may be needed)
*Access vein/start IV NS
*Medications: ativan or diazepam followed by dilantin
*Never leave person alone
- What are typical fluid restrictions for neuro patients?
- 1500-2500 cc/day
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