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

respiratory center
What area of the brain is responsible for equilibrium?: cerebellum
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?: axons
Where does the Circle of Willis originate?: carotid artery

vertebral 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

blood

cerebrospinal fluid
List the brain's 3 types of compensation used to maintain a stable ICP:: Autoregulation

Metabolic regulation

CSF regulation
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: vasoconstriction
What causes increased intracranial pressure?: Anything that causes an increase in production of CSF

OR

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?: Pons

Medulla
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?: Cheyne-Stokes
What pupillary response is an EARLY sign of increased ICP?: Unequal pupils

Sluggish response
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
*Decorticate/decerebrate posturing
*Loss of gag reflex
*Bradycardia
*Cushings Triad
What is Cushing's triad?: *Severe HTN
*Wide pulse pressure
*Bradycardia
List interventions for IICP:: *Administer diuretics
*Administer sedation as ordered
*Establish euvolemia
*Avoid valsalva (inc. suctioning)
*Establish eucapnia
*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?: 13-15
What is the GCS in a moderate head injury?: 9-12
What is the GCS in a severe head injury?: 3-8
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?: *Headache
*Nausea/vomiting
*Diplopia
*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?: *O2
*glucose
*glycogen
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

OR

*CSF 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?: less
True or false: clot formation is slower with subdural hematomas: true
What is an intracerebral hemorrhage?: Accumulation of blood within the brain tissue
Which type of brain herniation causes compression of the medulla?: cerebellar
What are the long-term effects of head injuries?: *Motor deficits
*Perceptual deficits
*Speech/language deficits
*Cognitive deficits
*Difficulty with bowel/bladder function
*Traumatic epilepsy
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?: *IICP
*Systemic hypotension
*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
*Shampoo hair
Into what position should a craniotomy patient be placed immediately after surgery?: side-lying
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?: Stroke
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?: *Thrombotic
*Embolic
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?: *TIA
*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?: *HTN
*Aneurysm
*AV malformation
Cocaine use causes what two side effects which increase the risk of stroke?: *Hypercoagulability
*HTN
What is dysarthria?: nerve dysfunction
What are the classic symptoms of CVA?: *Contralateral weakness
*Hemianopsia
*Aphasia (expressive/receptive/global)
*Dysarthria
*Facial weakness/paralysis
*Dysphagia
*Transient loss of bowel/bladder control
*Seizures
*Diminished or loss of consciousness
Which cranial nerve affects the ability to chew?: 5th
Which cranial nerve affects swallowing and the gag reflex?: 9th
Which cranial nerve affects tongue movement?: 12th
Damage to which cranial nerve causes facial paresis or paralysis?: 7th
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?: *Ulcer
*Uremia
*Hepatic failure
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?: *Atherosclerosis
What are the symptoms of an aneurysm rupture?: *Sudden explosive headache
*photophobia
*neck rigidity (due to blood in CSF)
*nausea/vomiting
*loss of consciousness
*brain ischemia
*increased ICP
*seizures
*respiratory distress
*shock
What is meningitis?: inflammation of teh meninges of the brain & spinal cord
What can cause meningitis?: *Bacteria
*Viruses
*Chemical inflammation
*Fungi
*Parasites
Which type of meningitis is usually not life-threatening?: Viral
How is meningitis transmitted?: droplet
What type of isolation is indicated for meningitis patients?: droplet isolation
List some predisposing conditions for meningitis:: *Otitis media
*Acute sinusitis
*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
*Experiences aura
*A "deja vu" phenomenon
*Unilateral movement of extremity
*Changes in heart rate
*Skin flushing
*Psychic symptoms
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
*Brief LOC
*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
*Postictal confusion
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
*MEDICAL EMERGENCY
What can cause death or brain damage in status epilepticus?: *hypoxia
*cardiac dysrhythmia
*lactic acidosis
What are teh usual causes for status epilepticus?: *Sudden withdrawal from anticonvulsants
*Infection
*Head trauma
*Cerebral edema
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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