Cerebral Metabolism
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Osmotic Pressure (Image)
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Outline
Overview
The brain has very high perfusion and energy (glucose) requirements.
Nursing Points
General
- Perfusion requirements
- The brain uses:
- 20% of total cardiac output (CO)
- 20% of total delivered oxygen (DO2)
- VERY sensitive to changes in CO or DO2
- Monitor Mean Arterial Pressure (MAP), Cerebral Perfusion Pressure (CPP), PaO2 and SpO2
- The brain uses:
- Energy requirements
- Massive energy needs
- Uses large amount of glucose
- Doesn’t require insulin to uptake glucose
- VERY sensitive to changes in blood glucose levels
- Hypoglycemia
- 50-70 mg/dL = neuro changes (AMS, ↓ LOC)
- <20 mg/dL = coma
- Hyperglycemia
- Hyperosmolar
- Osmotic shift of fluid into vessels
- Cellular dehydration in brain cells
- Hypoglycemia
- If patient presents AMS or ↓ LOC, check a blood glucose level
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ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Cerebral Metabolism
Transcript
When we talk about cerebral metabolism, we’re referring to the perfusion and energy requirements of the brain. So let’s look at this closer.
The brain is a very greedy organ. I like to think of it like a toddler. It wants all of your time and attention. In this case, the brain actually uses about 20% of our cardiac output. It also uses about 20% of the oxygen delivered to the body, we write that DO2. It’s only like 2% of our total body weight, but it uses 20% of our cardiac output and oxygen delivery! Talk about greedy. So what you’ll see, just like a toddler, is that as soon as you even remotely shift that time and attention away, it’s very sensitive to that and you’ll start to see neuro changes.
The same high need applies when it comes to energy. The brain has a super high requirement for glucose for energy. What makes it different from the rest of the body is that the brain cells don’t require insulin in order to uptake glucose for energy. BUT, what we do see is that changes in blood glucose will quickly cause neurological problems for your patient. Even a slightly low blood sugar of 50-70 mg per deciliter can cause neuro changes like confusion or lethargy. I’ve experienced this before, I actually got really dizzy and almost passed out. If the patient’s sugar manages to get below 20 mg per deciliter, we will actually see them more in a comatose or unresponsive state. A LOT of our rapid responses in the hospital are patients whose blood sugars are super low and they aren’t responding. So if your patient is having a significant neuro change, make sure you check their blood sugar!
Now, high blood sugar can also cause some problems neurologically. That’s because it puts the blood in what’s called a hyperosmolar state. What that means is that there’s way more solute in the blood than there is in the tissues and cells. We know the body likes to be in homeostasis, right? So to balance that out, water and fluid from the tissues and cells will begin pouring into the bloodstream. This pulls it out of the cells and causes cellular dehydration. When the brain cells get dehydrated, the patient can get very confused, restless, and even agitated. So again, with any mental status change, make sure you’re also checking a blood sugar because it can have a big effect.
So remember that the brain is like a greedy toddler – it wants 20% of our cardiac output and oxygen delivery and has a super high energy requirement. If it doesn’t get what it wants, it’s very sensitive and will throw a temper tantrum. You can see anything from confusion, to restlessness, to a full-out coma. Make sure you consider these things when assessing a patient with a neuro change.
You guys are gonna be awesome nurses and take such good care of your patients! Go out and be your best selves today! And, as always, happy nursing!
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Medical surgical 1 (Cardiac and respiratory)
Concepts Covered:
- Cardiac Disorders
- Emergency Care of the Cardiac Patient
- Cardiovascular
- Shock
- Shock
- Noninfectious Respiratory Disorder
- Respiratory
- Acute & Chronic Renal Disorders
- Hematologic Disorders
- Respiratory Emergencies
- Documentation and Communication
- Preoperative Nursing
- Immunological Disorders
- Intraoperative Nursing
- Vascular Disorders
- Renal Disorders
- Disorders of Pancreas
- Newborn Complications
- Medication Administration
- Central Nervous System Disorders – Brain
- Studying
- Emergency Care of the Trauma Patient
- Infectious Respiratory Disorder
- Endocrine
- Disorders of the Adrenal Gland
- Disorders of the Thyroid & Parathyroid Glands
- Musculoskeletal Trauma
- Oncology Disorders
- Integumentary Disorders
- Integumentary Disorders
- Liver & Gallbladder Disorders
- Circulatory System
- Disorders of Thermoregulation
- Multisystem
- Upper GI Disorders
- Neurological Emergencies
- Communication
- Perioperative Nursing Roles
- Sexually Transmitted Infections
- Peripheral Nervous System Disorders
- Disorders of the Posterior Pituitary Gland
- Lower GI Disorders
- Postoperative Nursing
- Emergency Care of the Respiratory Patient
- Emergency Care of the Neurological Patient
- Respiratory Disorders
- Respiratory System
- Infectious Disease Disorders
Study Plan Lessons
02.06 Heart Murmurs for CCRN Review
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
02.12 Myocardial Infarction- Inferior Wall for CCRN Review
02.13 Myocardial Infarction – Anterior Septal Wall for CCRN Review
02.14 Shock Stages for CCRN Review
02.15 Hypovolemic Shock for CCRN Review
02.16 Cardiogenic Shock for CCRN Review
02.17 Septic Shock for CCRN Review
02.18 Cardiovascular Practice Questions for CCRN Review
10.04 Pulmonary Question Review for CCRN Review
1st Degree AV Heart Block
2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
2nd Degree AV Heart Block Type 2 (Mobitz II)
3rd Degree AV Heart Block (Complete Heart Block)
Acute Kidney Injury Case Study (60 min)
Acute Renal (Kidney) Module Intro
Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)
ACE (angiotensin-converting enzyme) Inhibitors
Absolute Neutrophil Count (ANC) Lab Values
Absolute Reticulocyte Count (ARC) Lab Values
Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
Admissions, Discharges, and Transfers
Airway Suctioning
Anaphylaxis Nursing Interventions for Certified Perioperative Nurse (CNOR)
Anemia for Progressive Care Certified Nurse (PCCN)
Aneurysm (Dissecting, Repair) for Progressive Care Certified Nurse (PCCN)
Aneurysm and Dissection for Certified Emergency Nursing (CEN)
Angiotensin Receptor Blockers
Anion Gap
Anion Gap Acidosis 1 Nursing Mnemonic (KULT)
Aortic Aneurysm – Management Nursing Mnemonic (CRAM)
Aortic Aneurysm – Thoracic signs Nursing Mnemonic (PEE BADS)
Aortic Stenosis Symptoms Nursing Mnemonic (SAD)
Artificial Airways
ASA (Aspirin) Nursing Considerations
Aspiration for Certified Emergency Nursing (CEN)
Asthma (Severe) for Progressive Care Certified Nurse (PCCN)
Asthma for Certified Emergency Nursing (CEN)
Atenolol (Tenormin) Nursing Considerations
Atorvastatin (Lipitor) Nursing Considerations
Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Atrial Fibrillation (A Fib)
Atrial Flutter
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
AVPU Mnemonic (The AVPU Scale)
Bacterial Endocarditis – Symptoms Nursing Mnemonic (Be Joan Of Arc)
Bleeding Complications (Minor) Nursing Mnemonic (BEEP)
Bleeding for Certified Emergency Nursing (CEN)
Bleeding Precautions Nursing Mnemonic (RANDI)
Blood Flow Through The Heart
Blood Salvage Transfusion Anticipation for Certified Perioperative Nurse (CNOR)
Blunt Chest Trauma
Bronchoscopy
Calcium Channel Blockers
Cardiac Course Introduction
Cardiac Arrest Nursing Interventions for Certified Perioperative Nurse (CNOR)
Cardiac Labs – What and When to Use Them – Live Tutoring Archive
Cardiac Labs – What and When to Use Them 2 – Live Tutoring Archive
Cardiac Stress Test
Cardiac Surgery (Post-ICU Care) for Progressive Care Certified Nurse (PCCN)
Cardiac Tamponade for Progressive Care Certified Nurse (PCCN)
Cardiac Valves Blood Flow Nursing Mnemonic (Toilet Paper my Ass)
Cardiac/Vascular Catheterization (Diagnostic, Interventional) for Progressive Care Certified Nurse (PCCN)
Cardiogenic Shock and Obstructive Shock for Certified Emergency Nursing (CEN)
Cardiogenic Shock For PCCN for Progressive Care Certified Nurse (PCCN)
Cardiomyopathies (Dilated, Hypertrophic, Restrictive) for Progressive Care Certified Nurse (PCCN)
Cardiovascular Angiography
Cardiovascular Disorders (CVD) Module Intro
Causes of Anaphylaxis Nursing Mnemonic (Many Boys Love Food)
Causes of Dyspnea Nursing Mnemonic (The 6 P’s)
Chest Tube Assessment Nursing Mnemonic (Two AA’s)
Chest Tube Management
02.02 Cardiomyopathy for CCRN Review
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
02.14 Shock Stages for CCRN Review
02.16 Cardiogenic Shock for CCRN Review
02.17 Septic Shock for CCRN Review
03.03 Hypoglycemia for CCRN Review
06.05 Wide Complex Tachycardia for CCRN Review
ACE (angiotensin-converting enzyme) Inhibitors
Acute Inflammatory Disease (Myocarditis, Endocarditis, Pericarditis) for Progressive Care Certified Nurse (PCCN)
Acute Kidney Injury Case Study (60 min)
Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
Adrenal and Thyroid Disorder Emergencies for Certified Emergency Nursing (CEN)
Allergic Reactions and Anaphylaxis for Certified Emergency Nursing (CEN)
Amputation for Certified Emergency Nursing (CEN)
Anemia for Progressive Care Certified Nurse (PCCN)
Aneurysm and Dissection for Certified Emergency Nursing (CEN)
Angiotensin Receptor Blockers
Anti Tumor Antibiotics
Antineoplastics
Aspiration for Certified Emergency Nursing (CEN)
Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Atrial Fibrillation (A Fib)
Atrial Flutter
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
AVPU Mnemonic (The AVPU Scale)
Blood Flow Through The Heart
Blood Salvage Transfusion Anticipation for Certified Perioperative Nurse (CNOR)
Brain Natriuretic Peptide (BNP) Lab Values
Burns for Certified Emergency Nursing (CEN)
Calcium Acetate (PhosLo) Nursing Considerations
Calcium Carbonate (Tums) Nursing Considerations
Calcium Channel Blockers
Cardiac (Heart) Enzymes
Cardiac A&P Module Intro
Cardiac Anatomy
Cardiac Arrest Nursing Interventions for Certified Perioperative Nurse (CNOR)
Cardiac Course Introduction
Cardiac Labs – What and When to Use Them – Live Tutoring Archive
Cardiac Labs – What and When to Use Them 2 – Live Tutoring Archive
Cardiac Stress Test
Cardiac Surgery (Post-ICU Care) for Progressive Care Certified Nurse (PCCN)
Cardiac Tamponade for Progressive Care Certified Nurse (PCCN)
Cardiac Valves Blood Flow Nursing Mnemonic (Toilet Paper my Ass)
Cardiac/Vascular Catheterization (Diagnostic, Interventional) for Progressive Care Certified Nurse (PCCN)
Cardiogenic Shock and Obstructive Shock for Certified Emergency Nursing (CEN)
Cardiogenic Shock For PCCN for Progressive Care Certified Nurse (PCCN)
Cardiomyopathies (Dilated, Hypertrophic, Restrictive) for Progressive Care Certified Nurse (PCCN)
Cerebral Metabolism
Chemotherapy Patients
Cirrhosis for Certified Emergency Nursing (CEN)
Cold Temperature-related Emergencies for Certified Emergency Nursing (CEN)
Compartment Syndrome for Certified Emergency Nursing (CEN)
Congestive Heart Failure Concept Map
Coronary Artery Disease Concept Map
Creatine Phosphokinase (CPK) Lab Values
Cushing’s Syndrome Case Study (60 min)
Day in the Life of a Med-surg Nurse
Disease Specific Medications
Dobutamine (Dobutrex) Nursing Considerations
Dopamine (Inotropin) Nursing Considerations
Dysrhythmias for Certified Emergency Nursing (CEN)
Dysrhythmias Labs
Echocardiogram (Cardiac Echo)
Endocarditis Case Study (45 min)
Endocarditis for Certified Emergency Nursing (CEN)
Envenomation Emergencies for Certified Emergency Nursing (CEN)
Epinephrine (EpiPen) Nursing Considerations
General Anesthesia
GERD (Gastroesophageal Reflux Disease)
Heart (Cardiac) and Great Vessels Assessment
Heart (Cardiac) Failure Module Intro
Heart (Cardiac) Failure Therapeutic Management
Heart (Cardiac) Sound Locations and Auscultation
Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)
Heart Failure Case Study (45 min)
Heart Failure for Certified Emergency Nursing (CEN)
Heat Temperature-related Emergencies for Certified Emergency Nursing (CEN)
Hemorrhagic Fevers for Certified Emergency Nursing (CEN)
Hiatal Hernia
Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)
Hypertensive Crisis Case Study (45 min)
Hyperthyroidism Case Study (75 min)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hypoparathyroidism
Hypovolemic and Distributive Shock for Certified Emergency Nursing (CEN)
Influenza for Certified Emergency Nursing (CEN)
Intake and Output (I&O)
Interdisciplinary Team Participation for Certified Perioperative Nurse (CNOR)
Intraoperative Positioning
Lactate Dehydrogenase (LDH) Lab Values
Lung Cancer
Malignant Hyperthermia
MI Surgical Intervention
Minimally-Invasive Cardiac Surgery (Non-Sternal Approach) for Progressive Care Certified Nurse (PCCN)
Myocardial Infarction (MI) Case Study (45 min)
Neurogenic Shock for Certified Emergency Nursing (CEN)
Noncardiac Pulmonary Edema for Certified Emergency Nursing (CEN)
Norepinephrine (Levophed) Nursing Considerations
Nursing Care and Pathophysiology for Anaphylaxis
Nursing Care and Pathophysiology for Cardiogenic Shock
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Gonorrhea (STI)
Nursing Care and Pathophysiology for Heart Failure (CHF)
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
Nursing Care and Pathophysiology for Myasthenia Gravis
Nursing Care and Pathophysiology for Pneumothorax & Hemothorax
Nursing Care and Pathophysiology for Pulmonary Edema
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care and Pathophysiology for Valve Disorders
Nursing Care and Pathophysiology of Acute Kidney (Renal) Injury (AKI)
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology of Hypertension (HTN)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Myocarditis
Nursing Care Plan (NCP) for Activity Intolerance
Nursing Care Plan (NCP) for Acute Kidney Injury
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Anaphylaxis
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Nursing Care Plan (NCP) for Blunt Chest Trauma
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Chronic Kidney Disease
Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis
Nursing Care Plan (NCP) for Endocarditis
Nursing Care Plan (NCP) for Gastroesophageal Reflux Disease (GERD)
Nursing Care Plan (NCP) for Glomerulonephritis
Nursing Care Plan (NCP) for Hashimoto’s Thyroiditis
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Hypoparathyroidism
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Lyme Disease
Nursing Care Plan (NCP) for Myasthenia Gravis (MG)
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Nursing Care Plan (NCP) for Pancreatitis
Nursing Care Plan (NCP) for Pericarditis
Nursing Care Plan (NCP) for Pneumonia
Nursing Care Plan (NCP) for Pulmonary Embolism
Nursing Care Plan (NCP) for Sepsis
Nursing Care Plan (NCP) for Stroke (CVA)
Nursing Care Plan (NCP) for Syncope (Fainting)
Nursing Care Plan (NCP) for Thrombophlebitis / Deep Vein Thrombosis (DVT)
Nursing Care Plan for Coronary Artery Disease (CAD)
Nursing Care Plan for Distributive Shock
Nursing Care Plan for Myocarditis
Nursing Care Plan for Pulmonary Edema
Nursing Case Study for Acute Kidney Injury
Nursing Case Study for Cardiogenic Shock
Nursing Case Study for Hepatitis
Nursing Case Study for Rheumatic Heart Disease
Nursing Case Study for Type 1 Diabetes
Nutrition (Diet) in Disease
Obstructive Sleep Apnea for Progressive Care Certified Nurse (PCCN)
Pacemakers
Peptic Ulcer Disease Case Study (60 min)
Performing Cardiac (Heart) Monitoring
Pericardial Tamponade for Certified Emergency Nursing (CEN)
Phenobarbital (Luminal) Nursing Considerations
Pleural Effusion for Certified Emergency Nursing (CEN)
Post-Anesthesia Recovery
Premature Ventricular Contraction (PVC)
Product Evaluation and Selection for Certified Perioperative Nurse (CNOR)
Protein in Urine Lab Values
Pulmonary Embolus for Certified Emergency Nursing (CEN)
Renal Failure for Certified Emergency Nursing (CEN)
Renal Failure- Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD) for Progressive Care Certified Nurse (PCCN)
Respiratory Trauma for Certified Emergency Nursing (CEN)
Seizure Disorders for Certified Emergency Nursing (CEN)
Sepsis Labs
Septic Shock (Sepsis) Case Study (45 min)
Shock States (Anaphylactic, Hypovolemic) For PCCN for Progressive Care Certified Nurse (PCCN)
Sinus Bradycardia
Sinus Tachycardia
Specialty Diets (Nutrition)
Stroke Case Study (45 min)
Stroke for Certified Emergency Nursing (CEN)
Stroke for Progressive Care Certified Nurse (PCCN)
Stroke Therapeutic Management (CVA)
Supraventricular Tachycardia (SVT)
Sympatholytics (Alpha & Beta Blockers)
Thrombolytics
Thyroxine (T4) Lab Values
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Transient Ischemic Attack (TIA) for Certified Emergency Nursing (CEN)
Triiodothyronine (T3) Lab Values
Troponin I (cTNL) Lab Values
Valvular Heart Disease for Progressive Care Certified Nurse (PCCN)
Vasopressin
Ventilator Settings
Ventricular Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Ventricular Fibrillation (V Fib)
Wound Bleeding (Uncontrolled External Hemorrhage) for Certified Emergency Nursing (CEN)
02.02 Cardiomyopathy for CCRN Review
Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
AIDS Case Study (45 min)
Airway Suctioning
Anemia for Progressive Care Certified Nurse (PCCN)
Anesthetic Agents
Anesthetic Agents
ARDS Case Study (60 min)
ARDS causes Nursing Mnemonic (GUT PASS)
Artificial Airways
Aspiration for Certified Emergency Nursing (CEN)
Assessment for Myasthenic Crisis Nursing Mnemonic (BRISH)
Asthma for Certified Emergency Nursing (CEN)
AVPU Mnemonic (The AVPU Scale)
Carbon Dioxide (Co2) Lab Values
Chest Tube Management
Chest Tube Management Case Study (60 min)
Chronic Obstructive Pulmonary Disease (COPD) Case Study (60 min)
Chronic Obstructive Pulmonary Disease (COPD) for Certified Emergency Nursing (CEN)
Coronavirus (COVID-19) Nursing Care and General Information
Day in the Life of a Med-surg Nurse
General Anesthesia
Heart Failure Case Study (45 min)
Heart Failure for Certified Emergency Nursing (CEN)
Infectious Diseases: Influenza for Progressive Care Certified Nurse (PCCN)
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care and Pathophysiology of Pneumonia
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Case Study for Pneumonia
Respiratory A&P Module Intro
Respiratory Alkalosis
Respiratory Course Introduction
Respiratory Depression (Medication-Induced, Decreased-LOC-Induced) for Progressive Care Certified Nurse (PCCN)
Respiratory Distress Syndrome for Certified Emergency Nursing (CEN)
Respiratory Failure (Acute, Chronic, Failure to Wean) for Progressive Care Certified Nurse (PCCN)
Respiratory Infections (Pneumonia) for Progressive Care Certified Nurse (PCCN)
Respiratory Infections Module Intro
Respiratory Procedures Module Intro
Respiratory Trauma for Certified Emergency Nursing (CEN)
Respiratory Trauma Module Intro
Thoracentesis
Trach Suctioning
Tuberculosis for Certified Emergency Nursing (CEN)
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)