Questions and Answers
What is the syndrome of inappropriate ADH (SIADH)?
Too much ADH holds on to water.
What are the effects of SIADH?
Dilutional hyponatremia, hypo-osmolar.
What does 'decorticate' indicate?
A problem with the cortex.
What does 'decerebrate' indicate?
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What does 'ipsilateral' mean?
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What is the definition of Cushing's triad?
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What are the signs of meningitis?
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Match the following conditions with their descriptions:
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What causes dilated cardiomyopathy?
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What is normal intracranial pressure (ICP)?
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Bacterial meningitis has normal glucose levels in CSF.
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What is the bilirubin pathway?
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What are the typical symptoms of acute renal failure?
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Study Notes
Syndrome of Inappropriate ADH (SIADH)
- Excessive levels of Antidiuretic Hormone (ADH) lead to water retention.
- Causes dilutional hyponatremia and hypo-osmolarity; potassium levels may increase due to cellular shifts.
Neurological Assessment
- Decorticate: Indicates an issue with the cerebral cortex; characterized by flexed limbs towards the body.
- Decerebrate: Associated with brainstem dysfunction; presents with extended limbs.
Brain Anatomy
- Brainstem includes the midbrain, pons, and medulla.
Herniation Types
- Uncal Herniation: Lateral shift from an epidural bleed results in ipsilateral pupil dilation; mannitol is contraindicated.
- Supratentorial Herniation: Downward brain displacement leads to altered consciousness, bilateral pupil dilation, hyperventilation, and Cushing's reflex.
Cushing’s Triad
- Manifestations include increased systolic blood pressure, decreased heart rate, and decreased respiratory rate.
Increased Intracranial Pressure (ICP) Concerns
- Factors exacerbating high ICP include acidosis, hypotonic solutions, improper head positioning, decreased protein intake, and the use of wrist restraints.
Cerebral Perfusion Pressure (CPP)
- Normal range is maintained at 70-95 mmHg and is calculated as MAP - ICP.
Basilar Skull Fractures
- Symptoms include raccoon eyes, Battle's sign, otorrhea, rhinorrhea, and loss of the sense of smell (cranial nerve I involvement).
Meningitis
- Bacterial vs. Viral: Bacterial meningitis presents with low glucose and purulent CSF; viral shows normal glucose.
- Signs and Symptoms: Headache, nuchal rigidity, and positive Brudzinski's and Kernig's signs.
Myasthenia Gravis
- An autoimmune disorder characterized by decreased acetylcholine at neuromuscular junctions, leading to muscle weakness and fatigue.
- Symptoms include ocular problems, respiratory difficulties, and improvement with rest.
Guillain-Barré Syndrome
- Acute paralysis due to autoimmune attack on the myelin sheath; characterized by ascending paralysis.
Oculocephalic Reflex
- Also called Doll's eyes reflex; involves cranial nerves III, VI, and VIII.
Respiratory Impact of Brain Issues
- Midbrain dysfunction can lead to hyperventilation.
Normal ICP Levels
- Normal intracranial pressure is 5-15 mmHg.
Pancreatitis
- Causes include pancreatic duct obstruction (gallstones, infection) or alcoholism.
- Symptoms include hypocalcemia, hyperglycemia, pleural effusion, and elevated amylase levels.
Cullen's and Grey-Turner's Signs
- Cullen's Sign: Encompasses bruising around the belly due to pancreatitis.
- Grey-Turner's Sign: Bruising around the flank and groin areas, indicative of pancreatitis.
Bowel Obstruction
- Differences between small and large bowel obstruction: small may cause diarrhea and vomiting with less distention, while large causes significant distention.
Albumin Levels
- Low albumin indicates fluid shifts from intracellular to interstitial space.
Hepatic Failure
- Presents with low potassium, high BUN, high protein, and increased ammonia, leading to hepatic encephalopathy.
Jaundice
- Causes include liver failure or gallbladder disease, affecting the bilirubin pathway.
Spleen Rupture Symptoms
- Kehr's Sign: Left shoulder pain indicating potential ruptured spleen.
Acute Renal Failure
- Specific s/sx include retinal hemorrhages and papilledema, particularly with blood pressure at 140.
Cardiomyopathy Treatments
- Dilated Cardiomyopathy: Treated with digoxin.
- Hypertrophic Cardiomyopathy: Managed with beta-blockers or calcium channel blockers, avoiding inotropes and vasodilators.
Normal Pulmonary Artery Pressures (PAS and PAD)
- Normal PAS (systolic): 20-30 mmHg, while normal PAD (diastolic): 6-12 mmHg.
- Elevated PAS often associated with lung conditions.
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Test your knowledge with these flashcards focused on the syndrome of inappropriate ADH (SIADH) and key neurological definitions like decorticate and decerebrate. Great for nursing students and professionals preparing for the CCRN exam. Enhance your understanding of these critical concepts in nursing care.
