Flashcards in neural regulation Deck (98)
What does the cranium consist of?
*brain tissue (80%)
*blood (10 %)
How does intracranial pressure become elevated?
When one or more of these (brain tissue, blood, CSF) increases significantly without a decrease in either or both of the other two
Disorders that may lead to ICP?
*Traumatic brain injuries from concussions
*Ruptured cerebral aneurysms, stroke, obstructions in the circulation of CSF
*Infectious and inflammatory disorders of the brain (meningitis, encephalitis)
What are the consequences of increased ICP?
impaired cellular activity, temporary or permanent neurologic dysfunction, death
Dilation or constriction of cerebral blood vessels in response to changes in blood pressure, blood oxygen levels, and blood pH maintains constant and consistent tissue perfusion
increased intracranial pressure
What is the ICP range?
5-15 mmHg; ensure normal cerebral perfusion pressure of 70 to 100 mmHg
What does unrelieved pressure lead to?
causes brain tissue to herniate or shift from normal locations intracranially and extracranially
What is the earliest sign of increased ICP?
decreasing level of consciousness
a pulse rate that increases initially but then decreases, systolic BP that rises with a widening pulse pressure, and a respiratory rate that is irregular
rapid breathing with periods of apnea
What are other signs and symptoms that often accompanies the earliest sign of decreasing LOC?
confusion, restlessness, and periodic disorientation
How does the brain compensate for the increase in intracranial pressure?
by autoregulation by limiting blood flow to the head, increasing absorption or decreasing production of CSF, withdrawing fluids from brain tissue and excreting through kidneys
when does brain damage and death occur?
when compensatory methods become ineffective in reducing ICP
What is the number one priority?
check cardiac and respiratory status
drowsiness; difficult to awaken; restlessness;confusion; irritability; glascow coma scale 13> or equal to 13; personality changes; sluggish or unequal pupil response; weakness in arms or legs; slow or slurred speech, dull headache esp upon awakening; vomiting without nausea
early signs of ICP
unresponsive, glascow coma scale less than or equal to 12; decreased response to painful stimuli; decoticate or decerebrate posturing; increased weakness or hemiparesis; dilated pupils; seizures; cushing’s triad (bradycardia, elevated systolic blood pressure with widening pulse pressure, irregular breathing); loss of gag and corneal reflexes; periods of apnea
late signs of ICP
What is the medical management for increased intracranial pressure?
*supplemental oxygen at 95%
*maintain head in midline at 30 degree elevation
*control seizures; administer diazepam
*sedate agitated client; midazolam (Versed)
*indwelling catheter, NG tube, stool softener, histamine antagonist; famotidine (Pepcid)
What is the number one medication given for increased intracranial pressure?
Hypertonic solution that aids with pulling fluid from the cells into the vascular system where the kidneys can as urine( increase); increased urine output
How would we assess whether is working?
increase in urination
What is a complication of increased intracranial pressure?
Brain will shift to the lateral side or herniate downward through the foremen magnum( lower part of the skull where the upper spine connects)
Demyelinating disease; causes permanent degeneration and destruction of myelin sheath; Myelin acts as an insulator, enabling nerve impulses to pass along a nerve fiber.
As disease progresses: pressure ulcers, cachexia, deformities contractures develop
signs and symptoms of multiple sclerosis
*tingling, burning, pins-and-needles
helps with muscle spasticity and rigidity and given IM
Visual disturbances due to lesions on the optic nerve: blurred vision, diplopia (double vision), patchy blindness (scotoma),nystagmus (involuntary movement of eyeball), total blindness
What is the primary symptom of multiple sclerosis?
Difficulty with coordination
What is the secondary symptom of multiple sclerosis?