question

Monro-Kellie Hypothesis

answer

-States that the cranial vault is rigid and fixed. -Any increase in one compartment requires a decrease in the other, otherwise there will be an increase in ICP

question

3 compartments of Cranial Vault

answer

Blood, Brain Tissue, and CSF

question

Arousal

answer

An individual's ability to respond to environmental stimuli, such as opening the eyes to speech or turning the head toward a noise. "Wakefulness" or "Alertness"

question

Awareness (Content)

answer

A higher level of functioning then arousal A patient's orientation to person, place, and time The ability of a patient to respond to questions appropriately "Responsiveness"

question

Cerebral Perfusion Pressure should be?

answer

Greater than 70mmHg

question

AEIOU

answer

Mnemonic for Impaired Consciousness: Alcohol, Epilepsy, Insulin, Opiates, Uremia

question

TIPSS

answer

Mnemonic for Impaired Consciousness: Tumor, Injury, Psychological, Stroke, Sepsis

question

Decorticate Posturing

answer

-Abnormal Flexion of extremities -Indicates cerebral hemispheric dysfunction

question

Decerebrate Posturing

answer

-Abnormal Extension of extremities -Indicates brainstem dysfunction -More ominous sign

question

2 Components of Consciousness

answer

Arousal and Awareness (or Content)

question

What aspect of mentation does the Glasgow Coma Scale assess?

answer

Arousal

question

Doll's Eye Movements

answer

Eyes will remain fixed in the midposition as the head is turned

question

Cheyne-Stokes Breathing

answer

Rhythmic waxing and waning in the depth of respirations followed by a period of apnea Indicates a bilateral lesion in the cerebral hemispheres, cerebellum, midbrain or upper pons

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Central Neurogenic Hyperventilation

answer

Regular, rapid respirations (> 24) that increase in depth Indicates a lesion in the low midbrain or upper pons

question

Apneustic Breathing

answer

Prolonged inspiration, with a pause at the point where the respiration is at its peak, lasting for 2 or 3 seconds. Indicates a lesion in the mid or lower pons

question

Cluster Breathing

answer

Clusters of irregular breathing with periods of apnea that occur at irregular intervals Indicates a lesion in the lower pons or upper medulla

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Ataxic Breathing

answer

Completely irregular, with deep and shallow random breaths and pauses. Indicates a lesion in the medulla

question

Aphasia

answer

Total loss of ability to understand or express speech AKA Global Aphasia

question

Receptive Aphasia

answer

Inability to understand written or spoken words

question

Expressive Aphasia

answer

Inability to write or use languatge appropriately

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Dysphasia

answer

Difficulty with comprehending, speaking, or writing

question

Dysarthria

answer

An impairment of the muscles that control speech, characterized by slurred, muffled, or indistinct speech.

question

Agnosia

answer

Cortical impairment that results in the inability to recognize or interpret familiar sensory information although there is no impairment of sensory input or dementia.

question

Delerium

answer

Acute-onset confusional cognitive disorder characterized by attention deficits, FLUCTUATING mental status, and either disordered thinking or altered LOC.

question

Broca's Aphasia

answer

An expressive aphasia characterized by nonfluent, telegraphic speech with outbursts of profanity, uninhibited speech, and word finding difficulty, which reflects impaired memory for language.

question

Wernicke's Aphasia

answer

-A receptive aphasia characterized by fluent, well-articulated speech with intact tone but inappropriate speech content that is unintelligible because of poor word choices. -The patient may make up new words.

question

The diagnostic procedure of choice for a Non Traumatic Acute Brain Injury

answer

MRI

question

Apraxia

answer

The inability to carry out a purposeful movement although movement, coordination, and sensation are intact.

question

What is PET scanning useful for evaluating?

answer

Cerebral Blood Flow

question

Evoked Potentials

answer

A sensory response to a stimulus

question

What does brain tissue oxygen monitoring (pbt02) measure?

answer

Brain regional oxygen partial pressure

question

Nystagmus

answer

A condition in which the eyes make repetitive, uncontrolled movements

question

Formula for Cerebral Perfusion Pressure (CPP)

answer

MAP - ICP = CPP Systolic BP + 2(Diastolic BP) / 3 = MAP

question

Cushings Triad

answer

-Bradycardia, Irregular Respirations, and Widening Pulse Pressure (Increase in systolic blood pressure with a Decrease in diastolic blood pressure), -Classic syndrome that indicates Increased ICP

question

Seizures and delirium may occur with sudden discontinuation of which class of drugs?

answer

Benzodiazepines

question

Which disorders of mentation are common in the critically ill population?

answer

Delirium and Altered level of consciousness

question

Dementia

answer

A slow, insidious onset of memory impairment that follows a log-term, progressive course over a period of months to years.

question

3 Facts about Delirium

answer

-Preventable -Occurs in 20-50% of ICU Patients -Associated with higher in-hospital mortality

question

Septic Encephalopathy

answer

A particular type of delirium that can be an early sign of sepsis (systemic infection).

question

Coma

answer

A persistent state of unresponsiveness from which the patient cannot be aroused

question

Persistent Vegetative State (PVS)

answer

When the patient maintains arousal but has lost awareness components of consciousness.

question

Brain death

answer

The irreversible cessation of all brain activity, including brainstem function.

question

Tonic Phase of a Seziure

answer

-Characterized by a sudden loss of consciousness and sharp tonic muscle contractions where muscles become rigid, arms and legs extend, and the jaw is clenched. -The patient often develops apnea during this phase

question

Clonic Phase of a Seziure

answer

Characterized by alternating contraction and relaxation of the muscles in all of the extremities along with hyperventilation. -The eyes often roll back and there is increased lacrimation (tears)

question

Postictal Period

answer

-Occurs immediately following a seizure, characterized by transient impairment of mentation and sensorium. -The person slowly becomes more aware of the surroundings, but does not remember the seizure.

question

Reversal Agent (Antidote) for benzodiazepine overdose

answer

Romazicon (Flumazenil)

question

Status Epilepticus

answer

-Refers to seizures that are continuous for more than 5 minutes or seizures that recur without a recovery of consciousness -Medical Emergency

question

Stroke

answer

An acute neurologic deficit that occurs when impaired blood flow to a localized area of the brain results in injury to brain tissue.

question

Ischemic Stroke

answer

Caused by an interruption of cerebral blood flow by a thrombus or embolus

question

Hemorrhagic Stroke

answer

Bleeding in the brain that accumulates and compresses the surrounding brain tissue

question

Transient Ischemic Attack (TIA)

answer

-Brief episodes of focal neurologic deficits that usually resolve in a few minutes or hours and do not cause permanent brain injury. -AKA "Mini Stroke" -Increases the risk of having a real stroke

question

What are the 2 major classifications of Stroke?

answer

Hemorrhagic and Ischemic

question

What is the most important modifiable risk factor for Stroke?

answer

Hypertension

question

Modifiable risk factors for Stroke

answer

-Hypertension, hypotension, and dehydration in the elderly, coronary heart disease, dyslipidemia (high cholesterol) Physical INactivity, Heavy use of alcohol, and smoking. -Elimination of some or all of these risk factors reduces the risk of stroke.

question

Nonmodifiable risk factors for Stroke

answer

Advancing age, male gender, African- American race, and family history of stroke.

question

What is the most common manifestation of Stroke?

answer

Numbness and weakness of the face and arm

question

During administration of TPA, how frequently should neurological assessments be made?

answer

Every 15 minutes

question

Homonymous Hemianopsia

answer

Refers to the loss of the same visual fields in both eyes, essentially causing right or left visual field blindness.

question

Asteragnosia

answer

The inability to identify an object by active touch of the hands without other sensory input such as visual or sensory information.

question

Triple H therapy

answer

-Induced Hypertension, Hypervolemia, and Hemodilution -Used to prevent and control cerebral vasospasm

question

3 primary mechanisms of injury associated with traumatic brain injury (TBI)

answer

1. Acceleration/Deceleration 2. Rotational 3. Penetrating

question

Acceleration injury

answer

Occurs when the brain suddenly and rapidly moves along a linear path in one direction

question

Deceleration injury

answer

Occurs when the brain stops moving within the cranial vault

question

Rotational injury

answer

Occurs when the head rotates on its axis, resulting in shearing force injury to the brain and axons.

question

Penetrating injury

answer

Occurs when a foreign object (e.g., bullet, knife) invades the brain.

question

Primary Injury

answer

Occurs from direct mechanical injury caused by the force of the impact from the trauma event.

question

Secondary Injury

answer

-Occurs in response to the primary injury, arising from local tissue and systemic responses to the primary injury -Involves ischemia, neuronal death, inflammation and cerebral swelling

question

4 types of skull fractures

answer

Basilar, Open, Linear, and Depressed Think "BOLD"

question

Linear Fracture

answer

A simple fracture involving the entire bony thickness without bone movement.

question

Depressed fracture

answer

-A fracture in which a high energy force depresses the skull inward. -Usually causes bone fragmentation with fragments potentially tearing through the dura and into brain tissue.

question

Open Skull Fracture

answer

A fracture in which the scalp has been lacerated, creating a communication between the skull and the outside environment.

question

Basilar fractures

answer

A fracture that develops at the base of the skull.

question

Accumulation of CSF can result in what condition?

answer

Hydrocephalus

question

Focal Injuries

answer

Occur in a well defined area of the brain and may be the result of hematomas.

question

Diffuse Injuries

answer

Occur in several areas of the brain and may occur with concussion and diffuse axonal injury.

question

Concussion

answer

A Mild Traumatic Brain Injury (MTBI)

question

The presence of dizziness, headache, and confusion for long periods of time after concussion is known as:

answer

Postconcussive Syndrome

question

Diffuse Axonal Injury (DAI)

answer

Occurs when shearing forces disrupt the structure of neurons and their nearby blood vessels.

question

What should be done if the patient's GCS is 8 or less?

answer

Intubation

question

Controlling which factors will optimize cerebral perfusion pressure (CPP)?

answer

Venous Return Blood Pressure Temperature

question

Mannitol reduces ICP through which action?

answer

Increases reabsorption of water by the renal tubules

question

The single most important indicator of progression of brain injury is:

answer

Change in mental status exam

question

Unstable Spinal Injury

answer

When the vertebral structures are unable to support the injured area.

question

Paraplegia

answer

-The result of injury to the thoracolumbar region (T2 to L1) -Causes loss of motor and sensory function of the lower extremities -Upper extremity function remains intact-

question

Tetraplegia

answer

-The result of injury to the cervical or thoracic regions (C1 to T1) -Muscle function depends on the specific segments involved -AKA Quadriplegia

question

Which region of the spine is most vulnerable to injury?

answer

Cervical

question

Spinal Shock

answer

-Occurs 30 to 60 minutes after the injury -Manifests as the absence of all reflex activity, flaccidity, and loss of sensation below the level of the injury. -Usually subsides within 24 hours but may last 7 to 20 days

question

Which Spinal Cord Injury (SCI) requires long term mechanical ventilation?

answer

C1-C2

question

The main cause of complications or death after Spinal Cord Injury (SCI) is related to which condition?

answer

Respiratory Complications

question

Brown-Sequard Syndrome

answer

-Characterized by paralysis and proprioception on the same side as the injury and loss of pain and temperature sensation on the opposite side -Caused by damage to one half of the spinal cord

question

Shock

answer

Circulatory failure that creates an imbalance between tissue oxygen supply (delivery) and oxygen demand (consumption).

question

4 stages of Shock

answer

Initial, Compensatory, Progressive, and Refractory.

question

When shock develops, the body attempts to meet the crisis through which mechanisms?

answer

Releasing cortisol, norepinephrine, and epinephrine

question

3 parameters used to evaluate the patient's acid base balance during shock?

answer

Arterial pH, Serum Lactate, and Base Excess/Base Deficit

question

What is a major adverse effect of intravenous vasopressor therapy?

answer

Tissue Ischemia and Necrosis

question

Hypovolemic Shock

answer

Develops when inadequate circulating volume results in inadequate Cardiac Output caused by an absolute or relative fluid volume deficit

question

Clinical manifestations of hypovolemic shock develop when the patient has lost what percent of fluid volume?

answer

25%

question

Cardiogenic shock

answer

Most commonly results from failure of the left ventricle to pump sufficient oxygenated blood into the coronary arteries and systemic circulation -Impaired cardiac contractility and cardiac output

question

Autonomic dysreflexia (AD)

answer

A potentially life-threatening complication that involves an EXAGGERATED SYMPATHETIC NERVOUS SYSTEM RESPONSE and occurs in patients with a spinal cord injury at or above the T6 level. -Symptoms include Headache, Hypertension, Sweating above the level of spinal injury, Goosebumps, Bradycardia

question

Distributive Shock

answer

Involves impaired oxygenation related to altered blood flow distribution

question

Septic shock

answer

-Sepsis is the body's response to an infection, usually of bacterial origin, and septic shock is the severe form of sepsis. -Form of distributive shock.

question

Clinical manifestations of Neurogenic Shock

answer

Hypotension, bradycardia, and hypothermia with an absence of sweating below the injury level.

question

Anaphylactic shock

answer

Results from a severe type I hypersensitivity IgE/mast cell response whereby vasodilatory mediators are released from mast cells

question

Clinical manifestations of Anaphylactic shock

answer

Hypotension, upper airway obstruction, urticaria (hives), and pruritus (itching)

question

Obstructive shock

answer

Mechanical barriers to blood flow that block O2 delivery

question

3 common causes of Obstructive Shock

answer

Pulmonary Embolism (PE), Tension Pneumothorax, and Cardiac Tamponade.

question

Clinical Manifestations of Tension Pneumothorax

answer

Decreased cardiac output, Chest pain, and Air hunger with Respiratory distress, Tracheal Deviation

question

Becks Triad

answer

-Elevated Right Arterial Pressure, Hypotension, Muffled Heart Sounds -Indicates a possible Cardiac Tamponade

question

Neurogenic shock

answer

-Occurs in patients with an injury above T6. -Causes Vasodilation below the level of the injury. Blood pools in the lower extremities. -Symptoms include hypotension, bradycardia, decreased Cardiac output, and Hypothermia with the loss of the ability to sweat below the level of injury

question

Circle of Willis

answer

A connecting junction that provides collateral blood flow to each side of the brain

question

ICP is usually less than what amount?

answer

15mmHg

question

Autograft

answer

-Transplantation of tissue from one part of a person's body to another part of the body. -Ideal situation for tissue compatibility and graft survival.

question

Heterograft

answer

Transplantation of tissue between 2 different species. AKA "Xenograft" -Usually used for temporary transplantation -Tissue rejection usually occurs rapidly

question

Allograft

answer

Transplantation of tissue between members of the same species. AKA "homograft"

question

Isograft

answer

Transplantation of tissue between identical twins. AKA "Syngraft"

question

Which aspects are included in the definition of brain death?

answer

-Irreversible -Loss of brainstem function -Glasgow Coma Scale of 3

question

How are organs preserved for transport?

answer

-Preservation solution -Cold Packing

question

The chart must contain which required documentation for organ recovery?

answer

-Signed or Recorded consent form -Time of death declaration -Date of death declaration

question

Somatic Symptom Disorders

answer

Characterized by physical symptoms suggesting medical disease, but without demonstrable organic pathology or known pathophysiological mechanism to account for them.

question

Dissociative Disorders

answer

Defined by a disturbance of or alteration in the usually integrated functions of consciousness, memory, and identity.

question

Dissociation

answer

The splitting of of clusters of mental contents from conscious awareness, a mechanism central to hysterical conversion and dissociative disorder.

question

Hysteria

answer

A polysymptomatic disorder that usually begins in adolescence (rarely after the 20's), chiefly affects women, and is characterized by recurrent multiple somatic complaints that are unexplained by organic pathology. It is thought to be associated with repressed anxiety.

question

Munchausen Syndrome

answer

A pattern of behavior in which individuals fabricate or embellish their histories and signs and symptoms of illness.

question

Factitious Disorder

answer

Involves conscious, intentional feigning (faking) of physical or psychological symptoms.

question

Illness Anxiety Disorder

answer

An unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease.

question

Conversion Disorder

answer

A loss of or change in the body function that cannot be explained by any known medical disorder or pathophysiological mechanism.

question

Primary Gain

answer

When a person may avoid stressful obligations, may postpone unwelcome challenges, and is excused from troublesome duties.

question

Secondary Gain

answer

Relieves conflict within the family as concern is shifted to the ill person and away from the real issues.

question

Amnesia

answer

Pathologic loss of memory; a phenomenon in which an area of experience becomes inaccessible to conscious recall.

question

Dissociative Fugue

answer

A sudden, unexpected travel away from customary place of daily activities, or by bewildered wandering, with the inability to recall some or all of one's past. -Individual may not be able to recall personal identity and sometimes assumes a new identity

question

Dissociative Identity Disorder (DID)

answer

The existence of two or more personalities in a single individual. Formerly known as multiple personality disorder.

question

Depersonalization

answer

A disturbance in the perception of oneself A feeling of unreality or detachment from one's body

question

Derealization

answer

An alteration in the perception of the external environment An experience of unreality or detachment with respect to one's surroundings

question

Integration

answer

A blending of all the personalities into one

question

Dissociative Response

answer

A defense mechanism to protect the ego in the face of overwhelming anxiety

question

Personality

answer

The totality of emotional and behavioral characteristics that are particular to a specific person and that remain somewhat stable and predictable over time.

question

Paranoid Personality Disorder

answer

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.

question

Schizoid Personality Disorder

answer

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings.

question

Schizotypal Personality Disorder

answer

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior.

question

Histrionic Personality Disorder

answer

A pervasive pattern of excessive emotionality and attention seeking.

question

Narcissistic Personality Disorder

answer

A pervasive pattern of grandiosity, need for admiration, and lack of empathy.

question

Avoidant Personality Disorder

answer

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

question

Dependent Personality Disorder

answer

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation.

question

Obsessive-Compulsive Personality Disorder

answer

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.

question

Borderline Personality Disorder

answer

A pervasive pattern of instability of interpersonal relationships, self image, and affects, and marked impulsivity.

question

Splitting

answer

An inability to integrate and accept both positive and negative feelings about someone or something. A primitive ego defense mechanism that is common in people with borderline personality disorder.

question

Oppositional Defiant Disorder (ODD)

answer

A persistent pattern of angry mood and defiant behavior that occurs more frequently than is usually observed in individuals of comparable age and developmental level. Interferes with social, educational, occupational, or other important areas of functioning.

question

Temperament

answer

Personality characteristics that define and individuals mood and behavioral tendencies. The sum of physical, emotional, and intellectual components that affect or determine a person's actions and reactions

question

Conduct Disorder

answer

A repetitive and persistent pattern of behavior in which the basic rights of others or major age appropriate societal norms or rules are violated. Behaviors include aggression, destruction of property, deceitfulness, theft, and serious violations of rules

question

Sexuality

answer

The constitution and life of an individual relatie to characterstices regarding intimacy. Reflects the totality of the person and does not relate exclusively to the sex organs or sexual behavior.

question

Exhibitoinistic Disorder

answer

Recurrent and intense sexual arousal from the exposure of one's genitals to an unsuspecting individual.

question

Fetishistic Disorder

answer

Recurrent and intense sexual arousal from the use of either non living objects or specific non genital body parts.

question

Frotteuristic Disorder

answer

Recurrent and intense sexual arousal involving touching or rubbing against a nonconsenting person.

question

Pedophilic Disorder

answer

Sexual Arousal from prepubescent or early pubescent children equal to or greater than that derived from physically mature persons.

question

Sexual Masochism Disorder

answer

Recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer.

question

Sexual Sadism Disorder

answer

Recurrent and intense sexual arousal from the physical or psychological suffering of of another individual.

question

Transvestic Disorder

answer

Recurrent and intense sexual arousal from dressing in the clothes of the opposite gender.

question

Voyeuristic Disorder

answer

Recurrent and intense sexual arousal involving the act of observing an unsuspecting individual, in the process of disrobing, or engaging in sexual activity.

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