Neurological

Pregunta	Respuesta
meninges	PAD pia mater - membrane closest to brain arachnoid space - vascular = bleed Dura mater
CSF	transports nutrients protective function around brain and spinal cord pressure measured with LP glucose/protein levels clear fluid - xanthochromia = discolouration
Nursing assessment of neurological signs	determine consciousness - painful stimuli cranial nerve function - pupil assessment motor function - limb strength sensory function - dermatome vital signs - low HR, high BP, irregular breathing
Consciouness	most sensitive indicator to neurological changes largely controlled by RAS a diffuse bundle of nerve fibres within the brain stem and midbrain
Disorders of consciourness	confusion - reduced awareness, delirium - disorientation, fear, irritability, obtunded - reduced alterness, drowiness, stupor, unresponsive, aroused only by vigorous and repeated stimuli vegetative, locked in - total paralysis below 3rd cranial nerve
Stimuli	begin with auditory nail bed pressure no longer than 30 seconds Painful stimuli will increase ICP
Cranial nerves	structure highlights the sensitive relationship between increase in intracranial pressure and changes in cranial nerve function
GCS	reliable measure of neurological state total = E+v+m
Seizure management must be observed for r specific indicators	LOC, limbs involved bi or unilateral, head movement, foaming or discharge from mouth
Pupil assessment PEARL	look for: direct light reflex -responsive to light consensual light reflex - stimulus accomodation - focus size shape reactivity
Ptosis	may indicate myasthenia gravis or increase in ICP
Pupils and nerve function	CNS 111, 1V, V1 - ocular motor function III - motor - shift gaze up and down, inwards and outwards III - parasympathetic - constrict pupil, shape lens IV motor - gaze in and down VI motor - gaze outwards
Oculomotor CN 111 nerve compression	one pupil does not respond to light interuption to the function of parasympathetic component of oculomotor nerve CN 111 - junction of midbrain and tentorial notch
Pressure on CN III	Hematoma, tumour, the same side as the dilated pupil
Pupils at midpoint and nonreactive	midbrain infarction or herniation
Small - nonreactive pupils	haemorrhage
Dilated unreactive pupils	severe anoxia, cerebral pressure, rule out drugs like atropine
Signs of increase in ICP	changes in conscious state pupil size and reaction RR pattern limb strength changes seizures incontinence
Monro - Kellie hypothesis	skull is a rigid vault brain parenchyma is nearly incompressible blood volume is constant venous blood out = arterial blood in
Autoregulation	refers to brains ability to change diameter of it's blood vessels automatically to maintain constant cerebral blood flow in response to metabolic needs
Autoregulatory reserve	difference between current mean CPP and the lower limit of autoregulation autoregulation = constant CBF
Observations suggesting coning (herniation)	changes in conscious state pupil size and reaction motor dysfcuntions RR patterns cushing reflex
Cushing reflex	physiological response to increase in ICP results in triad of: increased SBP, pulse pressure, bradycardia, changes to breathing patterns
LP	insertion of fine bore needle into subarachnoid space at level of 4th and 5th lumbar vertebrae sterile procedure CSF should be clear patient should be positioned on side of knees bent (foetal) to maximisegap between vertebrae
EEG	recoding of electrical activity of brain
ICP monitoring	an ICP greater than 20 is associated with poor CNS function
ICP management	external drainage device, blot to monitor pressues ICP = IP - acting against blood flow into the skull CPP - effective blood supply to the brain MAP - pressure to deliver blood into the brain CPP = MAP - ICP
Burrhole	drill used to access the brain through skull
Craniotomy	procedure to access the brain
Craniectomy	removal of piece of skul
CPP = MPA - ICP	Map is maintained through inotropes the pressure is dynamic
Care of a patient with increased ICP	minimise interventions suction will increased ICP, ventilation (PEEP) will increased maintain sedation ensure good head positioning ensure tracheostomy ties are not intering with venous
Signs of increase ICP	changes in Conscious state changes in pupil size RR motor function changes seizures facial nerve palsy
TCD	transcranial doppler indicates blood flow to the brain
Jugular bulb oximetry	catheter inserted into the jugular vein indicates oxygen that had been used by thebrain indicates uptake of oxygen by the brain
Causes of TBI	Open head injury - traume, gun shots closed head injury - MVA, falls Deceleration injuries (diffuse axonal injury) - axons and neurons damaged contre-coup - brain hits back and front surface causing widespread damage anoxia - depleted of oxygen, irreversible lesion - benign or cancer infections - meningitis

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	Creado por Elizabeth Then hace más de 6 años