1 / 18

Chapter 61

Chapter 61. Level of Concsiouness Headache Intercranial Pressure Seizure. Level of Conscoiuness. Can be any spot on a spectrum from normal to coma Full Conscoiuness would be orineted x’s 4 Person, place, time, and sitution Coma Akinetic Mutism Vegetative State

oliana
Download Presentation

Chapter 61

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 61 Level of Concsiouness Headache Intercranial Pressure Seizure

  2. Level of Conscoiuness • Can be any spot on a spectrum from normal to coma • Full Conscoiuness would be orineted x’s 4 • Person, place, time, and sitution • Coma • AkineticMutism • Vegetative State • Locked-in Syndrome

  3. Level of Consciousness • PATHOPHYS • LOC is not a disease in an of itself but instead a symptom of another condition • Manifestations • Rememeber the GCS • Diagnostics • Full neurological assessment • Labs (cbc,cmp,NH3, LFT, Ca++, urine) • Test (MRI, EEG, CT)

  4. Increased Intracranial Pressure • Normal level is 0-15 • Monro- Kellie Hypothesis • the sum of volumes of brain, CSF, and intracranial blood is constant (Morki, 2001) • If one expands or decreases then the other need to compensate Morki, B. (2001). The Monro-Kellie Hypothesis. Neurology. 56(12).

  5. Pathophysiologyof ^ ICP • Commonly associated with head trauma but also seen with tumors, metabolic acidosis, edema and herniation. • Decreased blood flow • Cell death +/- ischemia causes system pressure rises • This can produce a slow bounding pulse with respiratory irregulatories

  6. Pathophysiology • Cerebral Edema • Abnormal association of water and fluid in the intra and extra areas with an associated an increased volume of Hisse • Autoregulation occur as blood vessels constrict and diliate to keep the blood flow • Cerebral response to increase ICP • CPP= MAP-ICP • Normal CPP= 70-100 mmHg

  7. Cerebral response to ICP • Steady perfusion continues with ICP <40 & SBP 50-150 • CPP<50 = irreversible neuro damage • If CPP=ICP No cerebral circulation

  8. Ceberbral Response Cushing Response Cushing Triad Decreased Heart Rate Increased SBP Decreased Respiration • Widening pulse pressure • Increased SBP • Decreased heart rate • Considered a late sign but still may be treated

  9. Clinical Manifestations • #1 sign of increased intercranail pressure is changes in LOC • Any sudden changes in the neuro status is significant • As ICP increases becomes stuporous, only reactioning to only loud painful stimulus

  10. Posturing

  11. Assessment of ICP • CT, SPECT, cerebral angiography • LP’s are contrindicated if the person is believed to have increased intracrainal pressure

  12. Seizure Disorder Abnormal motor sensory autonomic, or orpysch disorder Due to excessive discharge of neurons Can have 2 classifications partial(simple/complex) general SEE BOX ON PAGE 1881

  13. Epilepsies • Known as a reoccuring seizure • May be primary or secondary • Pathophysiology • Neuron discharge by electrochemical energy to perfer a task • When they are supossed to stop they continue to firing the impluse which lead to a seizure

  14. Eplisies Clinincal Manifestations Assess & Diagnosis Detailed Health History Family History Physical and Neuro Status MRI/EEG- localizes the area better; they may also need to do telemtry EEG In the elderly epilpsey can present as an CVA Status Epilipticus • Depends on what neurons are firing • Could be a small twitch that doesn’t stop or could include decrease level of consciousness

  15. Headache • Most common neuro problem • May be primary but for unknown reasons • 3 types • Migrane • Tension • Cluster • Arteritis

  16. Pathophysiology • S&S of a migrane result from dysfunction of the brain stem pathways that modulate sensory input • Caused usually by vasodilation • May have many different triggers • Tension-usually associated with stress • Cluster-????? • Arteritis-migrane response when complex are deposits in the blood vessels walls

  17. Migranemanifestions Migrane Manifestation Tension Constant steady pressure feeling state @ temple, front of head, or back of neck Arteritis Very general start malise, fatigue, wt loss, fever, may swollen tender • Prodrome • Aura • Headache • Recovery Cluster • Unliateral small and frequent • May 1-8 x’s/day • Last 15 min- 3hr

  18. Assess & Diagnostics • Detailed history • Must be very detailed • Need to determine if the cause is something

More Related