Chamberlain College of Nursing NURSING NR 283Patho Final Review.

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Concept Review for Patho Final Exam Vegetative state verses brain death  Vegetative state  Loss of awareness and intellectual function but continued brainstem function  Result of diffuse ... brain damage  Person unresponsive to external stimuli  If consciousness recovered may have significant neuro impairment.  Locked-in syndrome  Individual is aware and capable of thinking but is paralyzed and cannot communicate due to brain damage (may only be able to move their eyes to say yes or no)  Criteria for brain death (declared clinically and legally dead)  Cessation of brain function  Including function of the cortex and the brainstem  Flat or inactive electroencephalogram (EEG)  Absence of brainstem reflexes or responses  Absence of spontaneous respirations when ventilator assistance is withdrawn  Establishment of the certainty of irreversible brain damage by confirmation of cause of the dysfunction  Evaluation twice by different physicians Indicators of increased ICP  Brain is encased in rigid, nonexpendable skull.  Fluids, blood, and CSF are not compressible.  Increase in fluid or additional mass causes increase in pressure in the brain  Ischemia and eventual infarction of brain tissue  Increased ICP is common in many neurological problems.  Brain hemorrhage, trauma, cerebral edema, infection, tumors, abnormal circulation of CSF  Early signs—if cause is not removed  Decreasing level of consciousness or decreased responsiveness (lethargy) 1 st sign often  Severe headache  From stretching of dura and walls of large blood vessels  Vomiting  Often projectile, not associated with food intake  Result of pressure stimulating the emetic center in the medulla  Papilledema (visualize w ophthalmoscope)  Caused by increased ICP and swelling of the optic disc  Vital signs  Development of cerebral ischemia  Vasomotor centers respond in attempt to increase arterial blood supply to brain (causes vasoconstriction) *known as Cushing reflex  Systemic vasoconstriction  Increase of systemic blood pressure—more blood to brain to relieve ischemia  Baroreceptor response  In carotid arteries  Increased blood pressure by slowing heart rate  Chemoreceptor response  Respond to low carbon dioxide levels  Reduction of respiratory rate  Improved cerebral circulation  Relieves ischemia  Short time  Increasing ICP causes ischemia to recur; cycle will repeat  ICP continues to rise, blood pressures rises  Increased pulse pressure is significant in people with ICP. (difference bt systolic and diastolic); caused by slow heart rate and intermittent rapid cycling of the Cushing’s reflex Brain tumors  Space-occupying lesions that cause increased ICP  Benign and malignant tumors can be life-threatening.  Unless accessible and removable  Gliomas form the largest category of primary malignant tumors  Classified according to cell derivation and location of the tumor  Primary malignant tumors rarely metastasize outside the CNS.  Secondary brain tumors  Metastasize from breast or lung tumors  Cause effects similar to those of primary brain tumors  Signs and symptoms  Site of tumor determines focal signs  Seizures often first sign  Headaches (increased ICP), vomiting, lethargy, irritability, personality and behavioral changes, possible unilateral facial paralysis or visual problems  Do not cause systemic signs of malignancy  Will cause death before they cause general effects  Treatment—may cause damage to normal CNS tissue  Surgery if tumor is accessible  Chemotherapy and radiation (many are radioresistant)  Interference with blood supply  Local damage and manifestations depend on cerebral artery involved  Hemorrhage  Increased ICP will cause local ischemia and generalized symptoms.  Global cerebral ischemia  Impaired perfusion of entire brain  Loss of function and generalized cerebral edema  Brain death if not reversed quickly TIA’s: Transient Ischemic Attack  May occur singly or in a series  Result from temporary localized reduction of blood flow in the brain  Partial occlusion of an artery  Atherosclerosis  Small embolus  Vascular spasm  Signs and symptoms  Difficult to diagnose after the attack  Directly related to location of ischemia  Intermittent short episodes of impaired function  e.g., muscle weakness in arm or leg  Visual disturbances  Numbness and paresthesia in face  Transient aphasia or confusion may develop  Repeated attacks may be a warning sign for obstruction related to atherosclerosis [Show More]

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