NR 325 Final Exam
Intracranial regulation - ANS-Cognitive function
Mobility
Gas exchange
Perfusion
Gerontologic considerations: Nervous system - ANS-Anticipate changes in
-Memory
-Vision
-Hearing
-Taste
-Smell
-Muscle strength
-Reaction time
-Position sense
Increased intracranial pressure - ANS--ICP = Pressure in the brain confined within the skull
-When the brain becomes injured it swells due to inflamed brain tissue, blood, and CSF
-The skull cannot expand and increased pressure is placed on delicate brain tissue
,Glasgow coma scale - ANS-a neurologic scale used to assess level of consciousness
-Score from 3-15
-coma = 3-8
Glasgow coma scale categories - ANS-Eyes opening
Verbal Response
Motor response
Eyes opening scale - ANS-1: none
2: to pain
3: to voice
4: spontaneously
Motor response scale - ANS-1. none
2. abnormal extension
3. abnormal flexion
4. withdraws from pain
5. localises to pain
6. obeys command
Manifestations of increased ICP - ANS-Headache
Seizures
Cushing's Triad
Vomiting (not preceded by nausea, may be projectile)
Changes in speech
Changes in LOC
Flattening affext
Decreased orientation and attention
Coma
Papilledema
Pupillary changes
Impaired eye movement
Posturing changes
Decreased motor function
Manifestations of increased ICP in infants - ANS-Bulging fontanels
Cranial suture separation
Increased head circumference
Warning signs after a head injury (1st 24 hrs) - ANS-Changes in LOC:
-Increased drowsiness
-Confusion
-Difficult to arouse
Seziures
Bleeding or water drainage from nose/ears
Pupils slow to react or unequal
Visual problems
Loss of sensation to any extremity
Slurred speech
Projectile vomiting
Causes of seizures - ANS-Severe birth injury
Congenital defects
Inborne errors of metabolism
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