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Neurosensory: Altered Cerebral Function and Increased intracranial pressure IICP

Etilogy/Patho Altered Cerebral Function: Consciousness. Dynamic state in that it fluctuatesContinuum from awareness of self and environment to unawarenessConsciousness to deep comaCaused by: lesions/injury to the reticular system or cerebral cortexMetabolic di

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Neurosensory: Altered Cerebral Function and Increased intracranial pressure IICP

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    1. Neurosensory: Altered Cerebral Function and Increased intracranial pressure (IICP) Marnie Quick, RN, MSN, CNRN

    2. Etilogy/Patho Altered Cerebral Function: Consciousness Dynamic state in that it fluctuates Continuum from awareness of self and environment to unawareness Consciousness to deep coma Caused by: lesions/injury to the reticular system or cerebral cortex Metabolic disorders

    3. Altered Cerebral Function: Arousal/cognition (LOC) Patho/assessment Reticular Activating System (RAS) meshwork of gray cell within brainstem/thalamus. Controls wakefulness, arousal and alertness. Cerebral cortex outer layer of gray cell bodies of brain. Controls cognition, thought process.

    4. Reticular Activating System (RAS)

    5. Altered Cerebral Function: Assessment of arousal/cognition (LOC) Observe individuals behavior, call name Verbal response to person/place/time/event If unable- how responds to commands If unable- how responds to central pain stimuli

    6. Assessment of arousal/cognition (Respiratory and pupillary light reflex) Respiratory- changes occur as brainstem is being compressed Pupillary light reflex- Sensory: CN 2 Motor: 3 Note pupil size; darken room; shine light in and note reaction and size Direct/consensual

    7. Assessment Arosual/cognition (EOMS) Eye movement- CN 3,4,6 In COMA- test EOMs Oculocephalic reflex Dolls eyes- Sensory- CN 8; Motor- CN 3,4,6 Good Dolls eyes: eyes move in opposite direction of head movement Bad/negative Dolls eyes: eyes do not move head turned

    9. Assessment arousal/cognition (Motor) Strength, symmetry and ability to move Order from best to worse: Purposeful Generalized response Posturing- flexion or extension Flaccid Planter Reflex- Babinski testing Meningeal signs- Brudzinski, nuchal rigidity

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