Term
| Levels of Consciousness in descending function: |
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Definition
•Alert and oriented (“A & O x 3” means Alert and Oriented to “person,” “place” and “time,” or “A&O x 4” adds “situation.”
•Confused and disorganized
•Lethargy (oriented but slowed motor and speech)
•Obtundation (needs continuous stimuli to maintain arousal)
•Stupor (vocalization to pain, has decreased motor movement)
•Coma (does not respond appropriately to stimuli. No verbal response) |
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Term
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Definition
| An irreversible coma or a persistent vegetative state |
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Term
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Definition
| absent cerebral function and unable to maintain physiologic homeostasis |
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Term
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Definition
| means thinking skills that include awareness, language calculation and memory. |
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Term
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Definition
| organic brain degeneration, progressive, untreatable, irreversible decline in mental function |
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Term
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Definition
| false belief brought about without appropriate external stimuli (unrelated to reality) |
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Term
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Definition
| Acute reversible state of agitated confusion. Disoriented to time and place with hallucinations. Usually symptomatic of a disease and is reversible with treatment of the disease. Can be caused by a high fever. |
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Term
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Definition
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Term
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Definition
helps to gauge the impact of a wide variety of conditions affecting the patient’s level of consciousness such as acute brain damage due to
-Trauma
-Vascular injuries
-Infections
-Hypoxia
-Metabolic disorders (renal failure, liver failure,
hypoglycemia, or diabetic ketoacidosis) |
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Term
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Definition
| posturing indicates that there may be damage to the cerebral hemispheres, and possibly midbrain. An ominous sign of severe brain damage but not as bad as decerebrate posturing. (Limbs “Point to the Core” of the body). |
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Term
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Definition
| usually indicative of more severe damage indicating a lesion in the cerebellum or lower in the brainstem. Very poor prognosis. (Hands point away from body = “Brain has gone away”). |
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Term
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Definition
| characterized by limp (floppy) unresponsive muscles that cannot contract. Can be caused by infections (i.e., polio, botulism, Guillan Barre Syndrome) and toxins or damage to the spinal cord or brain. |
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Term
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Definition
brains security system
so effective at protecting against the passage of foreign substances that it often prevents life-saving drugs from being able to repair the injured or diseased brain. |
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Term
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Definition
Vasogenic Edema
Cytotoxic Edema |
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Term
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Definition
| Blood-brain barrier damage causes increased capillary permeability. This occurs with conditions that impair the function of the blood-brain barrier and allow transfer of water and proteins from the vascular space into the interstitial space swollen brain tissue. |
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Term
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Definition
| The blood–brain barrier remains intact but a disruption in cellular metabolism impairs functioning of the sodium/potassium pump. Active transport failure leads to K+ loss and Na+ retention increasing cellular H2O. This leads to ischemia of brain tissue and necrosis of brain cells. |
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Term
| Treatment for Cerebral Edema: |
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Definition
•Positioning of patient – Head of bed elevated 30 degrees (gravity allows for better brain drainage).
•Hypertonic IV fluids - to pull fluid out of the brain.
Examples: hypertonic saline and mannitol (a sugar alcohol that attracts fluid out of the brain).
•Diuretics – medication to increase the production of urine, to help reduce fluid overload.
•Corticosteroids – to suppress the inflammatory response and reduce swelling in the brain.
•Surgical decompression – removing part of the skull allows the brain to swell without being compressed. |
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Term
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Definition
Decreased LOC
Pupil changes: PERRLA (“Pupils Equal, Round, Reactive to light, and Accommodation”)
Vision abnormalities (brain swelling is putting pressure on the optic and oculomotor nerves)
Headache
Vomiting (pressure on the vagal nerve center of the brain that controls vomiting)
Nuchal rigidity – stiff neck |
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Term
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Definition
•Impaired reflexes (corneal, gag, and swallowing)
•Papilledema (optic disc swelling)
•Abnormal posturing - Decorticate/decerebrate |
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Term
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Definition
Hypertension (Widening Pulse Pressure - the difference between the Systolic and Diastolic B/P increases)
Bradycardia (reflexive slowing of the heart to compensate for increased B/P)
Hypoventilation (Respiration slows down) Hypercapnia
(↑ CO2) which causes vasodilation leading to worse cerebral edema and increased ICP. |
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Term
| Traumatic Brain Injury (TBI) |
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Definition
| a traumatic insult to the brain capable of producing physical, intellectual, emotional, social and vocational changes |
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Term
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Definition
Focal Injuries: Contusions, Hematoma’s
Diffuse Injuries: Concussions; Diffuse Axonal Injury; Traumatic Subarachnoid Hemorrhage |
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Term
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Definition
Causes damage to parts of the brain that were not initially injured
Damage caused by the inflammation process
Swelling->ICP -> brain herniation ->tissue necrosis |
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Term
| S/S of Head Injury and TBI |
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Definition
| Loss of consciousness, headache, vomiting, drowsy, confusion, seizure, drowsiness, restlessness, agitation, LOC changes, contralateral hemiplegia, ICP, signs of herniation. |
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Term
| H.I. can result from a ground level fall, especially in the elderly always assume |
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Definition
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Term
| Nursing care for HI and TBI |
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Definition
| Frequent assessment of LOC (using GCS). Keep patient’s head elevated 30° to prevent increased intracranial pressure. (NOTE: an order that reads: “HOB ⬆ 30°” means “Keep the head of bed up 30 degrees”). Protect airway (suction equipment at the patient’s bedside) due to vomiting. |
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Term
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Definition
| No gross pathology. Possible transient loss of consciousness. CT scan is normal. Post-concussion syndrome s/s are headaches and memory lapses. |
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Term
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Definition
| Bruising of the brain surface underneath a fracture or at the under-surface of the frontal and temporal lobes, due to shearing forces. Diagnosed on CT scan. |
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Term
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Definition
| Tearing of the brain substance. Diagnosed by CT scan. |
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Term
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Definition
| This is localized in the glial cells, myelin sheaths, and intercellular spaces. It causes increased intracranial pressure, which may impair brain circulation, or result in brain herniation. It may be missed in early CT scans. Later CT scans or MRI show edema more reliably. |
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Term
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Definition
| Displacement of brain tissue towards the other side of the brain which increases pressure on the non-injured side. The further the brain tissue has herniated “passed midline” the worse the prognosis. |
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Term
| Acceleration–deceleration head injury |
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Definition
Coup-contrecoup” hitting both front and back of head.
Results in brain contusions and hematomas (more than one injury from the same blow). |
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Term
| Cerebrovascular infarction: |
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Definition
| Focal brain necrosis due to complete and prolonged ischemia that affects all tissue elements (neurons, glia, and vessels). In every infarct, there is a central core of total ischemia and necrosis, which is irreversible. |
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Term
| Brain Trauma Indicator (BTI) |
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Definition
measures two brain-specific proteins, ubiquitin C-terminal hydrolase (UCH-L1) and glial fibrillary acidic protein (GFAP), that are rapidly released by the brain into the blood within 12 hours of serious brain injury.
Test results can be available within three to four hours. Low blood levels of these proteins indicate that, if the person has damage, it is likely too small to be seen on a CT scan. If these protein levels are high, healthcare practitioners could rule out mild concussion and order a CT scan to look for bleeding and damage that would require intervention. |
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Term
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Definition
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Term
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Definition
| a blood clot that forms between the skull and the top lining of the brain (dura). This blood clot can cause fast changes in the pressure inside the brain. Usually an ARTERIAL bleed so can expand very quickly. Early sign is ipsilateral pupil dilation (dilation of pupil on the same side as the brain hematoma). |
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Term
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Definition
| a blood clot that forms between the dura and the brain tissue. If this bleeding occurs quickly it is called an acute subdural hematoma. If it occurs slowly over several weeks, it is called a chronic subdural hematoma. The clot may cause ICP and may need to be removed surgically. May be either arterial or venous bleed but is usually venous so the rate of blood flow is slower and the hematoma (hemorrhage) develops slower. |
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Term
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Definition
| A blood clot deep in the middle of the brain that is hard to remove. Pressure from this clot may cause damage to the brain. Surgery may be needed to relieve the pressure. Can be either arterial or venous. |
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Term
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Definition
A progressive decline in first MENTAL then PHYSICAL abilities.
Dementia symptoms gradually worsen over several years. |
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Term
| Alzheimer’s disease early stages |
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Definition
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Term
| Alzheimer’s disease late stages |
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Definition
| individuals lose the ability to carry on a conversation and respond to their environment. |
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Term
| what is the 6th leading cause of death in the US |
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Definition
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Term
| Alzheimer's live an average of |
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Definition
| 8 – 10 years after their symptoms become noticeable to others, but survival can range from four to 20 years, depending on age and other health conditions. |
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Term
| STAGES of Alzheimer’s disease: |
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Definition
First: Short-term memory loss
~Second: Confusional stage (Disorientation, lack of insight, impaired hygiene and language use, “sundowner” syndrome)
~Third: Incontinence; long-term memory loss (inability to recognize family and friends) |
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Term
| Alzheimer’s RISK FACTORS include: |
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Definition
Age, Heredity (genetic predisposition), and Family HX.
Hispanics and African-Americans are at greater risk because there is a connection between HEART health and BRAIN health.
According to a growing body of evidence, risk factors for vascular disease — including diabetes, high blood pressure and high cholesterol — may also be risk factors for Alzheimer’s and stroke-related dementia. |
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Term
| Pathophysiology of Alzheimer’s |
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Definition
| neuronal proteins develop into neurofibrillary tangles causing areas of degenerated tissue called senile plaques. These plaques impair transmission of neural impulses. |
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Term
| Familial Alzheimer Disease |
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Definition
| FAD” or Early-onset Alzheimer’s - 30% of cases, occurs before 50 yrs. |
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Term
| Nonhereditary (late-onset) Alzheimer |
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Definition
| 70% of cases; occurrence after age of 50. |
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Term
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Definition
Cognitive: mental decline, difficulty thinking and understanding, mental confusion, disorientation, delusion, inability to create new memories, inability to recognize common things, inability to do simple math, difficulty concentrating, making things up, confusion in the evening hours, or forgetfulness.
Behavioral: agitation, lack of restraint, meaningless repetition of own words, irritability, personality changes, aggression, difficulty with self-care, or wandering and getting lost.
Mood: loneliness, anger, apathy, mood swings, or general discontent.
Psychological: paranoia, hallucination, or depression
Also common: restlessness, behavioral s/s, loss of appetite, inability to combine muscle movements, or jumbled speech. |
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Term
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Definition
| : Supportive care to maintain function. Medication is sometimes helpful to slow the rate of mental loss but will not cure or prevent ongoing decline in either mental or physical symptoms |
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Term
| signs of Alzheimer's vs typical age related changes |
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Definition
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Term
| Cerebrovascular Accidents |
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Definition
| ischemic, embolic, hemorrhagic |
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Term
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Definition
Thrombi cause arterial occlusion (narrows blood vessel) = MOST COMMON
S/S Acute onset (hrs to days), occasional HA, no LOC, + Hx* TIA’s
Rx-Decrease edema and ICP |
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Term
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Definition
Patho- Emboli break off from thrombi in the aorta or carotids
S/S- Acute onset, often moderate HA, occasional brief LOC, no Hx TIA’s
RX- Acute onset, severe HA,
+ stiff neck, + LOC, + blood in Cerebral Spinal Fluid |
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Term
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Definition
Patho- decreased edema and ICP
S/S -anticoagulants-eliminate cause
RX Stop bleed, decrease ICP & vasospasm (NO ANTICOAGS) |
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Term
Risk factors for Stroke – Brain Attack:
Non modifiable |
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Definition
Genetics. Having a family history of stroke
Age. Being 55 or over
Gender. Slightly more than half of all strokes occur in men, but more than 60% of stroke deaths occur in women, possibly because women tend to be older when they have strokes
Race. Black and Hispanic
Medical history. Having had a prior stroke, TIA (see Transient Ischemic Attack on next page), or heart attack |
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Term
Risk factors for Stroke – Brain Attack:
modifiable |
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Definition
High blood pressure- most important controllable risk factor
Smoking
Atherosclerosis narrowing /stiffening of the arteries from plaque
Diabetes
Atrial fibrillation (causes clots to form in the heart)
High cholesterol levels
Overweight-especially abdominal fat**
Lack of exercise
Overconsumption of alcohol
Use of cocaine or amphetamines
Vasculitis (inflamed blood vessels)
Birth control pills |
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Term
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Definition
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Term
| that people with excess belly fat (waist measurements greater than 35 inches for women and 40 inches for men |
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Definition
| four times more likely to have a stroke. |
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Term
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Definition
| can be caused by a CVA. It is the loss of comprehension or production of language that impairs the patient’s ability to communicate. |
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Term
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Definition
| Patient understands what is being said to them but cannot speak (or “express” themselves) coherently. |
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Term
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Definition
| Patient can speak coherently but does not understand (is not “receiving”) what is being said to them. |
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Term
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Definition
| Time” is vital in saving brain tissue. Thrombolytic medication (“clot-buster” drugs) must generally be given within 3 hours of onset of symptoms. Thrombolytic medicine can be given for ISCHEMIC STROKE (Thrombolytic or Embolic strokes) but can NOT be given in a HEMORRHAGIC stroke because it will cause more bleeding in the brain. |
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Term
| Transient Ischemic Attack (TIA's) – aka, “Mini-stroke” |
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Definition
Considered “angina of the brain.
Brief episodes of neurologic dysfunction. Can have all the S/S of a stroke but reverses before infarction
occurs. TIA’s are temporary and resolve without treatment. NO PERMANENT DAMAGE. |
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Term
| TIA’s are a warning sign for a brain attack (stroke) since they frequently |
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Definition
precede Thrombotic brain attack
1 in 3 people who have a transient ischemic attack will eventually have a stroke, |
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Term
| Spinal Cord Injury (SCI) Pathophysiology |
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Definition
| Trauma, tumors, concussion, contusion, compression, tearing, or ischemic injury to the spinal cord with or without vertebral (bone) damage. Commonly associated w/ injury at C1-C2, C4-C7, and T12-L2. |
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Term
| Spinal Cord Injury (SCI) S/S |
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Definition
Depends on type of spinal injury and location on the spinal column
Cervical Spine Injury = quadriplegia (paralysis that results in the partial or total loss of use of all limbs and torso).
Thoracic Spine Injury (T1 – T7) = paraplegia (impairment in motor or sensory function of the lower extremities).
C1 – C3 injury: Requires mechanical ventilation of the patient |
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Term
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Definition
| all reflexes including somatic (voluntary) and autonomic involuntary) are TEMPORARILY lost below level of injury. Average 1-3 weeks but may be up to 3 months. Resolves as edema/injury resolves. Could have HYPERreflexia (spacisity) for another year after sensation returns. |
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Term
| Compressed vs. Transected cord: |
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Definition
Compressed Spinal cord remains intact but could be contused (“bruised”) and swollen, thereby preventing conduction of nerve signals below the point of injury.
Transected Spinal cord is completely severed. |
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Term
| Incomplete Spinal Injury: |
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Definition
| Some FUNCTION (either motor, sensory or both) is preserved. Only a portion of the spinal cord may be injured (i.e., Central Cord Syndrome and Anterior Cord Syndrome) |
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Term
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Definition
| Contraction of the anus when lightly touched (called the “anal wink”). If this reflex is present in a person paralyzed after a spinal cord injury, the injury may be incomplete, and the chance of recovery is better than if the reflex were absent. |
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Term
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Definition
| All FUNCTION (motor, sensory, reflex, and autonomic function) is lost below the damaged spinal cord. |
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Term
| Complete Spinal Injury causes |
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Definition
| Spinal cord severed (transected); disruption of nerve fibers although they may remain intact; or interruption of blood supply to a segment or spinal cord resulting in complete destruction of neural tissue. |
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Term
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Definition
A condition common in patients with spinal cord injury at T6 and above (T6 – C1).
Causes Dangerously high blood pressure - (can be high enough to cause a stroke
or seizures), skin pallor, and goose flesh associated with piloerector response. Autonomic dysreflexia is often triggered by a “noxious” stimulus below the spinal cord injury such as a full bladder. Other triggers can be: UTIs; overfull bowel; GI problems; pressure sores; sexual activity; tight clothing; temperature extremes or quick temperature changes; skin problems or even ingrown nails. |
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Term
| Symptoms of Autonomic Dysreflexia: |
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Definition
HTN (due to vasoconstriction);
A slow heart rate (bradycardia)-to compensate for HTN.
ABOVE the injury – Parasympathetic Nervous System dominates – causing vasodilation!
A flushed face and/or red blotches on the skin above the level of spinal injury (due to vasodilation). Nasal congestion (sinus vasodilation). Pounding headache (vasodilation in brain and HTN).
Sweating above the level of spinal injury (activation of glands by parasympathetic NS).
BELOW the injury – Sympathetic Nervous System dominates – causing vasoconstriction!
Pale, cold, clammy skin below the level of injury (due to vasoconstriction).
Goose bumps below the level of spinal injury. |
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Term
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Definition
• Throbbing headache
• Nuchal rigidity (stiff neck)
• Fever
• Photophobia
• Projectile vomiting
• Altered LOC
• Increased ICP
• Red purpuric or blotchy rashes that do not blanch when applying pressure
• Kernig’s sign and/or Brudzinski's sign may be present (see diagram below under Meningism). |
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Term
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Definition
| usually from direct exposure or systemic bacteremia – most serious form of meningitis- can cause long term and or permanent brain damage/death. High mortality rate. |
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Term
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Definition
| usually from upper respiratory infection – most common cause of meningitis and usually the least severe. Often resolves in 2 weeks without treatment. |
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Term
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Definition
| usually found in immunosuppressed individuals. |
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Term
| Meningitis Pathophysiology: |
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Definition
| Infection of the meninges/spinal fluid/ventricles (droplet precautions – one of the “M’s” in “MR PIMP”). Cerebral Spinal Fluid (CSF) and ventricles become inflamed leading to obstruction of CSF flow, edema of infected tissues, and potential ischemia due to increased ICP. |
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Term
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Definition
| related to pathogen (antibiotic or antifungal meds); vaccination is available against some pathogens. |
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Term
| Incidence: for meningitis |
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Definition
| Viral is most common; bacterial is most severe. Spread by social contact such as handshakes or sneezes. Occurs to all ages, genders, races, etc. High density living conditions (colleges, prisons, camps, military, etc.) allows for contagion to spread easier so these populations are higher risk. |
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Term
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Definition
| group of s/s that are commonly present (but not always) when the meninges are irritated, as in infection [meningitis], subarachnoid hemorrhages, or other diseases. |
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Term
| signs of meningeal irritation |
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Definition
Photophobia is the intolerance of bright light
Nuchal rigidity is the inability to flex the neck forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent.
Opisthotonus is a type of spasm of the whole body that leads to legs and head being bent back and body bowed backwards. Can occur in some types of meningitis, tetanus, strychnine poisoning.
Kernig's sign is positive when the thigh is bent at the hip and knee at 90-degree angles, and subsequent extension in the knee is painful (leading to resistance). This may indicate subarachnoid hemorrhage or meningitis.
Brudzinski's neck sign is the appearance of involuntary lifting of the legs when lifting a patient's head while the patient is lying supine. |
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