238 Neuro Flashcards
What is a myelography?
Test to see the subaranchnoid space, spinal cord, and vertebrae after injection of dye by LP
What is a contraindication to LP?
Increased ICP
What is specific of “neurogenic” or “central” DI?
It is caused by a lesion in the brain; it is the most common type
What is specific about “primary” DI?
It’s also called “psychogenic”, because it is caused by excessive water intake. Could be caused by a structural lesion in the thirst center or psych issues
What is “nephrogenic” DI?
It is when there is enough ADH in circulation, but decreased kidney response
What is one of the most common causes of Nephrogenic DI?
Lithium
How is central DI treated?
Desmopressin acetate is drug of choice; some form of vasopressin is used to replace missing ADH
How is Nephrogenic DI treated?
Low sodium diet and thiazide diuretics
What would be the clinical presentation of a patient with SIADH?
Hypobatremia; muscle cramping, weakness, dyspnea on exertion. As it get more severe: vomiting, abdominal cramps, muscle twitching and seizures
What is the treatment for SIADH?
Fluid restriction, duiretics (Lasix) and hypertonic saline.
What is Declomycin given for?
Treatment of SIADH; blocks the effects of ADH on the renal tubules (allowing a more dilute urine)
What is Samsca and Vaprisol given for?
They are vasopressin receptor antagonists (lessen the effect of AHD on the kidneys)
What disease results from a decrease in Acetylcholine-secreting neurons?
Alzheimer’s
What disease results from a reduction in acetylcholine receptors?
Myasthenia Gravis
What disease is due to destruction of dopamine-secreting neurons?
Parkinson’s
What does dopamine control?
Emotions, moods and regulation of motor control
What does Serotonin control?
Moods, emotions and sleep
What is normal ICP?
5-15
What is the brain’s use of glucose and oxygen?
20% of oxygen and 25% of glucose
What is normal CPP (cerebral perfusion pressure)?
60-100
What CPP indicates cerebral ischemia?
<50
What GCS score indicates a coma?
<8
What CSF lab value indicates infection?
> 5
The myelin sheath of CNS nerve fibers are composed of what?
Oligodendrocytes
The extrapyramidal carries impulses concerned with what?
Voluntary movement
What is the earliest sign of increased ICP?
Altered LOC
What is Cushing’s Triad?
Increasing systolic BP (with widening pulse pressure), bradycardia and irregular breathing
What is normal ICP?
5-15
What is normal CPP?
60-100
What CPP indicates ischemia?
<50
How is CPP calculated?
CPP= MAP - ICP
How can MAP be calculated?
MAP = SBP + 2(DBP) divided by 3
What is Trigeminal Neuralgia?
Recurrent episodes of sharp, stabbing pain that last seconds to 2-3 minutes
What is the etiology of TN?
It is not fully understood
What are risk factors for TN?
MS, HTN, herpesvirus, tooth/jaw infection and brainstem infarct
What drugs are “1st line therapy” for TN?
Tegretol and Trileptal
What is the “cardinal sign” of Bell’s Palsy?
An eye that will not blink
What is meant by the “primary” spinal cord injury?
The initial injury to the spinal cory
What is meant by the “secondary” spinal cord injury?
Ongoing progressive injury that occurs after the initial injury
What is “spinal shock”?
Decreased reflexes, loss of sensation and flaccid paralysis below the level of spinal injury
What is “neurogenic shock” (as contrasted with spinal shock)?
Loss of vasomotor tone – characterized by hypotension and bradycardia
How are spinal cord injuries classified?
By:
- Mechanism of injury
- Level of injury
- Degree of injury
What is tetrapelgia?
Injury is T1 or above; all 4 extremities involved
What is Paraplegia?
Injury is below T1; lower extremities affected
Cervical injury above C4 means that what is required?
Mechanical ventilation
Cervical injury below C4 results in what type of breathing?
Diaphragmatic with hypoventilation because of use of intercostals
What difficulties will a patient with an injury below C4 have?
Ineffective or absent cough; artificial airway possibly leading to atelectasis and/or pneumonia (bronchial and oral hygiene is very important)
Spinal cord injury above which level reduces the sympathetic nervous system and causes bradycardia?
T6
What is the drug of choice to increase HR in a pt with injury above T6?
Atropine
Pt may have paralytic ileus and gastric distention after a cord injury at what level?
Above T5
Excessive HCL in the stomach puts a pt at risk for what?
Stress ulcers
What meds would a pt be given to reduce risk of stress ulcers?
H2 receptor blockers (Zantac, Pepcid) and Proton Pump Inhibitors (Protonix, Prevacid and Prilosec)
Neurogenic bowel occurs when spinal shock or injury is at what level?
T12 or below
What is Pikilothermism?
Adjustment of body temperature to room temperature
Tetanus causes what type of muscle response?
Spacicity
What is trismus?
“lockjaw”; spasms and stiffness of jaw
How often do adults need the Tetanus/diptheria toxoid booster?
Every 10 years
If you have an injury, you will be reimmunized if you haven’t had a booster in how many years?
5
NG suctioning may lead to what state?
Metabolic Alkalosis
Decreased tissue perfusion may lead to what state?
Acidosis
Autonomic dysreflexia only occurs with injuries above?
T6
What triggers autonomic dysreflexia?
Irritation, or discomfort; most common cause is distended bladder or bowel
What are manifestations of Autonomic Dysreflexia?
Hypertension, Blurred vision, throbbing headache, marked diaphoresis, flushing of skin above injury, nasal congestion, anxiety, nausea and hair standing on end
What are nursing interventions for autonomic dysreflexia?
Elevate HOB, notify MD, assess cause, loosen tight clothing, monitor VS q15, assess for bladder distention and cath if distended
