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Terms in this set (125)
Perfusion ICP When disrupted:
infarct - blockage of blood vessel from plaque or
tumor
inter cranial hemorrhage - TBO
severe hypertension
Neurotransmission ICP When disrupted:
seizures
degenerative diseases
Pathology ICP When disrupted:
infection
alzheimer's
huntington's
When does a child's head become age 5
fixed?
no room to expand when swells leading to death of
tissue
Physiologic consequence of the Can become compromised and lead to infection
blood brain barrier
Physiologic process of the meninges Protective layers
Intracranial problems are usually related to a specific
layer
Physiologic consequences of glucose Hypoglycemia episodes, can't function, brain death
,Physiologic processes of auto Blood flow
regulation
Physiologic consequences of Decrease in CO2 causes vasoconstriction
hyperventilation Decrease in blood volume and inter cranial pressure
increase risk of ischemia within first 20 hours of injury,
hyperventilate after this time
Why should we detect and prevent Leads to cerebral edema, increased intracranial
cerebral edema? pressure, decreased perfusion, decreased
oxygenation, cellular death
What is the difference cerebral edema Edema - swelling leads to intracranial pressure
and increased intracranial pressure? Intracranial pressure - finite volume of space
What are early symptoms of IICP in Bulging fontanels
infants? Increased head circumference
Lethargic
Poor feeding/weigh gain
Irritable (shrill cry)
Separation at sutures
What are early symptoms of IICP in Change in LOC
adults? C/O headache
Confusion
Shallow breathing
Nausea without vomiting or vomiting without nausea
Hypertension
What are the components of Cushing's Increase in BP
triad? Decrease in HR
Decrease in respiration
Sign of eminent death
What are important assessment Hypercapnia
findings related to cerebral perfusion Hypoxia
pressure? Hypoventilation leads to increased CO2
, What are the components of the Eye opening
Glasgow Coma scale for adults? Verbal
Motor
What is PERRLA? Pupils equal round reactive to light and
accommodating
CN 1 Olfactory
Olfactory Nerve Assessment Close eyes, smell, name item
CN II Optic
Optic Nerve Assessment Stand arm's length away, cover eye, nurse covered
eye on same side, stare at nurse's uncovered eye,
move other hand in field holding up fingers
Vision chart - cover one eye at a time
CN III Oculomotor
Oculomotor Nerve Assessment Assess for involuntary shaking of eye (nystagmus) -
hold pen light a foot away from the face, move in 6
cardinal fields of gaze
Reaction to light - dim light, shine light on wow from
the side, assess constriction direct and indirect
PERRLA
CN IV Trochlear
Trochlear Nerve Assessment Stare at object far off, follow pen light as it comes
closer to the nose
CN V Trigeminal