Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Med II > Ch 61- Neurologic Dysfunction > Flashcards

Ch 61- Neurologic Dysfunction Flashcards

1
Q

define coma

A

unconsciousness, unarousable unresponsiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

akinetic mutism

A

unresponsiveness to the environment, makes no movement or sound but sometimes opens eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

persistent vegetative state

A

devoid of cognitive function but has sleep–wake cycles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

locked-in syndrome

A

inability to move or respond except for eye movements due to a lesion affecting the pons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

locked in syndrome is caused by a lesion affecting what brain structure?

A

pons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the three causes of ALOC?

A

neurologic (head injury or stroke)
toxicologic (drug overdose or alcohol intoxication)
metabolic (hepatic or kidney; DKA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the steps of assessment in a patient with ALOC?

A
  1. LOC including alertness and verbal response
  2. motor response- posturing
  3. respiratory status- if abnormal, may be issue with brainstem aka medulla
  4. eye response- pupil size and response
  5. reflexes- DTR, gag, swallow, corneal, plantar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what should the nurse do for a patient without a corneal reflex

A

place eye coverings/protection on patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the continuum for LOC?

A

awake,alert, oriented; confused; delirious; lethargic; somnolent; stuporous; unconscious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

define confused

A

inability to think as clearly or as quick as you normally would (not at their baseline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

define delirious

A

(do not confuse dementia and delirium) acute confused state that begins with being disoriented; if not recognized and treated quickly  can progress and patients can die

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

lethargic

A

slow to respond, drowsy, little energy,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

somnolent

A

so drowsy, they only want to sleep, difficulty following commands, difficult to arouse,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

stuporous

A

unresponsive except by VIGOROUS stimulation; sternal rub, shake,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

unconscious

A

lack or ability to notice anything in environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what would a patient with decorticate positioning look like?

A

flexion of the upper extremities, internal rotation of the lower extremities, and plantar flexion of the feet.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what would a patient with decerebrate positioning look like

A

involving extension and outward rotation of upper extremities and plantar flexion of the feet.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are some complications that can arise from ALOC?

A

respiratory distress or failure, pneumonia, aspiration, pressure injury, DVT, contractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the primary goal when caring for a patient ALOC

A

maintaining patent airway!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

an increase in what 3 parts of the skull can change the volume of each other

A

brain tissue (parenchyma), blood, CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the Monro-Kellie hypothesis

A

because of limited space in the skull, an increase in any one of components of the skull (brain tissue (parenchyma), blood, cerebral spinal fluid (CSF) will cause a change in the volume of the others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is normal ICP?

A

10-20 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what happens when ICP increases

A

decreased cerebral perfusion which causes ischemia, cell death, and (further) edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is brain herniation and how is it treated?

A

brain tissues shift through dura
no treatment; pt will die!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the term for the brain’s ability to to change the diameter of blood vessels to maintain relatively constant cerebral blood flow

A

autoregulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what happens to the brain vasculature in response to decreased CO2?

A

vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what happens to brain vasculature in response to increased CO2

A

vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are the criteria for BP and ICP levels for autoregulation mechanism to work?

A

SBP must be between 50-150 mmHg
and ICP must be less than 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

where is ICP usually measured

A

lateral ventricles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is a serious complication associated with increased ICP that can result in death?

A

brain herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is the normal Cerebral perfusion pressure (CPP)

A

70-100 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

if a patients BP is 160/70 and their ICP is 15 what is their CPP?

A

85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the MAP of a patient with a BP 160/70?

A

100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

how do you calculate MAP?

A

SBP + (2 x DBP) divided by 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

list the early manifestations of increased ICP?

A
  1. changes in LOC
  2. restlessness, confusion, increased drowsiness, lethargy, increased respiratory effort, purposeless movement
  3. pupillary changes & impaired ocular movements
  4. weakness in one extremity or one side
  5. headache: constant, increasing in intensity, or aggravated by movement or straining
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the first sign of increased ICP?

A

altered LOC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are the late manifestations of increased ICP

A
  1. Vital signs: increased SBP, widened PP, slowing HR, fluctuating pulse from rapid to slow, increased temp
  2. projectile vomit
  3. durther deterioration of LOC: stupor to coma
  4. hemiplegia, decortication, decerebration, or flaccidity
  5. Respiratory pattern alterations include Cheyne-Stokes breathing & arrest
  6. loss of brainstem reflexes- gag, swallow, corneal, pupil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

the nurses sees the patient experiencing cushings triad. is this a late or early sign of increased ICP and what are the components of cushing triad?

A

late sign
cushing triad= HYPERTENSION, BRADYPNEA, BRADYCARDIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what happens to temperature, pulse, and blood pressure during late signs of increased ICP?

A
  • Temp= high/erratic
  • SBP increases and DBP stays the same; causes widened pulse pressure\
  • pulse is slow and bounding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what value is considered a widened pulse pressure?

A

> 100 pulse pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what intervention can be done by the physician to decrease ICP and CO2 levels

A

induce hyperventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what is a risk associated with inducing hyperventilation to reduce ICP

A

alkalosis

43
Q

how do you calculate pulse pressure?
- a narrow pulse pressure is indicative of what type of problem? what about a widened pulse pressure

A

PP= SBP-DBP
- Narrow pulse pressure = < 25% of SBP and indicates cardiac problem
- wide pulse pressure = > 100 and indicative of neuro problem

44
Q

what are the assessment steps of a patient with increased ICP?

A
  • history of event leading up to illness
  • evaluate LOC & mental status
  • cranial nerves
  • cerebellar function
  • reflexes
  • motor & sensory function
  • GCS
  • pupil checks
  • vital signs
  • ICP assessment
45
Q

what is score range for glasgow coma scale?

A

3-15

46
Q

How do you score eye opening response according to glasgow coma scale?

A

spontaneously- 4
to speech- 3
to pain- 2
none- 1

47
Q

how do you score verbal response according to GCS?

A

oriented- 5
confused- 4
inappropriate- 3
incomprehensible- 2
none- 1

48
Q

how do you score motor response according to GCS

A

obeys commands- 6
localizes to pain- 5
withdraws from pain- 4
flexion to pain-3
extension to pain- 2
none-1

49
Q

what areas of the brain can the nurse expect a catheter to be placed for ICP monitoring?

A

ventricle, subarachnoid, intraprenchymal space, subdural space

50
Q

what interventions can be used to decrease ICP?

A
  • monitor ICP & cerebral oxygenation
  • decrease cerebral edema
    -maintain cerebral perfusion- with dobutamine, norepi, levophed
    -control fever
  • reduce CSF and intracranial blood volume
  • maintain oxygenation & metabolic demands
51
Q

How is cerebral edema decreased? what medications, fluid, etc. used?

A
  1. Mannitol- osmotic diuretic to pull fluid from cell
  2. 3% saline- hypertonic saline
  3. fluid restrictions
  4. directly drain CSF via catheter
52
Q

how is temperature controlled in cases of increased ICP

A

cooling blankets, acetaminophen suppository,

53
Q

is it safe to induce hypothermia to patients with neurological problems experiencing increased ICP?

A

controversial- however it can provide brain rest

54
Q

3 major problems assoicated with increased ICP?

A

brain herniation, SIADH, DI

55
Q

what is SIADH

A

syndrome of inappropriate antiduretic hormone
- causes body to hold onto fluid
- patient becomes volume overloaded and sodium is diluted
- treat with fluid restriction

56
Q

what is diabetes insipidus

A
  • decreased secretion of ADH
    patient has excessive urine output, decreased urine osmolality, & serum hyperosmolarity
  • treat with electrolyte replacement, synthetic vasopressin, & fluids
57
Q

what are the goals for patients with increased ICP?

A
  • Maintenance of patent airway
  • Normalization of respirations
  • Adequate cerebral tissue perfusion
  • Respirations
  • Fluid balance
  • Absence of infection
  • Absence of complications
58
Q

what should be avoided in pts with increased ICP?

A
  • vasalva maneuver & no enemas
  • loud atmospheres & increased stimuli
  • minimize stress
59
Q

what should the nurse monitor in patients with increased ICP?

A
  • respiratory status & lung sounds
  • position head in neutral position w/ HOB raised 0-60 degrees to promote venous drainage
  • no hip flexion, valsalva menuver, abdominal distension, or other stimuli that could increase ICP
  • maintain calm quiet, atmosphere that is stress free
  • monitor fluid status; I&O
  • use strict aseptic technique when assessing ICP monitoring systems
60
Q

what is a craniotomy

A

opening of the skull

61
Q

what are the purposes of a craniotomy

A

remove tumor, relieve elevated ICP, evacuate a blood clot, control hemorrhage

62
Q

craniectomy

A

excision of portion of skull

63
Q

cranioplasty

A

repair of cranial defect using a plastic or metal plate

64
Q

Burr Holes

A

circular openings for exploration or diagnosis to provide access to ventricles or for shunting procedures, aspirate a hematoma or abscess, or make a bone flap

65
Q

what is a tentorium

A

imaginary line that is a dural fold separating the upper portion of cerebrum and cerebellum
- divided into supra & infratentorium

66
Q

what are the three cranial surgical approaches

A

Supratentorial, infratentorial, transphenoidal

67
Q

what is the medical management preoperative care for cranial surgery

A
  • Preoperative diagnostic procedures may include CT scan, MRI, angiography, or transcranial Doppler flow studies
  • Medications are usually given to reduce risk of seizures
  • Corticosteroids, fluid restriction, hyperosmotic agent (mannitol), and diuretics may be used to reduce cerebral edema
  • Antibiotics may be given to reduce potential infection
  • Diazepam may be used to alleviate anxiety and for seziure prohylaxis
68
Q

what is nursing management preoperative care for cranial surgery

A
  • Obtain baseline neurologic assessment
    -Assess patient and family understanding of and preparation for surgery
  • Provide information, reassurance, and support
69
Q

whata re the 4 aims of postoperative care from cranial surgery?

A
  • Detecting and reducing cerebral edema
  • Relieving pain
    -Preventing _seizures
  • Monitoring ICP and neurologic status
    *pt may be intubated and have arterial and venous lines
70
Q

What should you assess in patients undergoing cranial surgery

A
  • respiratory function/ABGS
  • VS and LOC: signs of icnreasing ICP
  • assess dressing and siogns of bleeding or CSF leakage
  • potential seziures; document if occurs
  • signs and symptoms of complications
  • fluid status and labs
71
Q

complications of cranial surgery

A
  • Increased ICP
  • Bleeding and hypovolemic shock
  • Fluid and electrolyte disturbances
    -Infection
  • CSF leak
  • Seizures
72
Q

goals for pts undergoing cranial surgery

A
  • Improved tissue perfusion
  • Adequate thermoregulation
  • Normal ventilation and gas exchange
  • Ability to cope with sensory deprivation
  • Adaptation to changes in body image
  • Absence of complications
73
Q

1 intervention for pt under going cranial surgery

A

maintain cerebral perfusion
- Monitor respiratory status; even slight hypoxia or hypercapnia can affect cerebral perfusion
- Assess VS and neurologic status every 15 minutes to every hour
- Strategies to reduce cerebral edema; cerebral edema peaks 24 to 36 hours after surgery
- Strategies to control factors that increase ICP
- Avoid extreme head rotation
- HOB may be flat or elevated 30 degrees according to needs related to the surgery and surgeon preference

74
Q

when does cerebral edema peak after cranial surgery

A

24-48 hours after surgery

75
Q

how to regulate pt temp after cranial surgery?

A
  • Cover patient appropriately
  • Treat high temperature elevations aggressively; apply ice bags, use hypothermia blanket, administer prescribed acetaminophen
76
Q

how to imporve gas exchange in post-op pt from cranial surgery?

A
  • Turn and reposition every 2 hours
  • Encourage deep breathing and incentive spirometry
    -Suction or encourage coughing cautiously as needed (suctioning and coughing increases ICP)
  • Humidification of oxygen may help loosen secretions
77
Q

which medication CANNOT be taken after cranial surgery? why?

A

ibuprofen & other NSAIDS
- they have an antiplatelet effect

78
Q

why is sensory deprivation important after cranial surgery

A

Periorbital edema may impair vision, announce presence to avoid startling the patient; cool compresses over eyes and elevation of HOB may be used to reduce edema if not contraindicated

79
Q

how can self image be enhanced after cranial surgery

A

Encourage verbalization
Encourage social interaction and social support
Attention to grooming
Cover head with turban and, later, a wig

80
Q

what other interventions can be done post-op in regards to fluid regulation and infection control?

A
  • I & O, weight, blood glucose, serum and urine electrolyte levels, and osmolality and urine specific gravity
  • Assess incision for signs of hematoma or infection
  • Assess for potential CSF leak
  • Instruct patient to avoid coughing, sneezing, or nose blowing, which may increase the risk of CSF leakage
  • Use strict aseptic technique
  • Patient education for self-care
81
Q

what is delirium

A
  • confused state, begins with disorientation and can progress to changes in LOC, irreversible brain damage, and sometimes death
  • 80% of patients in ICUs are affected. The presence of delirium triples in-hospital mortality rates.
82
Q

chornic, long term changes in confusion and LOC is likely to be?

A

dementia

83
Q

what are the risk factors for delirium?

A

include age, existing dementia, prior coma, recent emergency surgery/trauma, taking benzos, having blood transfusions.

84
Q

how can delirium be prevented?

A
  • Provide therapeutic activities for cognitive impairment
  • Reorient patient as needed
  • Ensure early mobilization
  • Control pain
  • Minimize the use of psychoactive drugs
  • Prevent sleep deprivation
    -Enhance communication methods (particularly eyeglasses and hearing aids)
  • Maintain O2 level and fluid/electrolyte balance
    -Prevent surgical complications
85
Q

what is dementia

A
  • Cognitive, functional, and behavioral changes eventually destroy the ability to function
  • Symptoms are usually subtle in onset and often progress slowly until they are obvious and devastating.
  • Dementia in older adults is typically caused by some degree of neurodegeneration
  • The most common type of dementia is Alzheimer’s disease.
  • Other dementias include degenerative, vascular, neoplastic, demyelinating, infectious, inflammatory, toxic, metabolic, and psychiatric disorders.
86
Q

true or false: alzheimers can only be diagnosed via autopsy

A

TRUE

87
Q

what is pseudobulbar effect?

A
  • Involves inappropriate or exaggerated emotional expression, usually episodes of laughing or crying associated with brain injury
  • “Pseudobulbar” refers to damage that occurs in the corticobulbar tracts in the brain. The emotional outbursts can cause embarrassment, anxiety, and depression, and often impair quality of life.
  • Condition can coexist with mood disorders, such as depression, although crying in these patients should not be considered indicative of depression.

-Effective management with dextromethorphan hydrobromide and quinidine sulfate in patients with ALS, MS, stroke, TBI, and dementia.

88
Q

what are seizures

A

Abnormal episodes of motor, sensory, autonomic, or psychic activity (or a combination of these) resulting from a sudden, abnormal, uncontrolled electrical discharge from cerebral neurons

89
Q

Whata re the 4 classifications of seizures

A
  • Focal: originates in one hemisphere (partial seizures)
  • Generalized: occur and engage bilaterally
    -Unknown: epilepsy spasms
  • “Provoked” related to acute, reversible condition
90
Q

patients is said to have epilepsy when?

A

if have more than one provoked seizure

91
Q

what are the specific causes of seizures?

A
  • Cerebrovascular Disease
  • Hypoxemia
  • Fever (Childhood)
  • Head Injury
  • Hypertension
  • Nervous System Infections
  • Metabolic and Toxic conditions
  • Brain Tumor
  • Drug And Alcohol Withdrawal
  • Allergies
92
Q

what is the plan of care for pt experiencing a seizure?

A

Observation and documentation of patient signs and symptoms before, during, and after seizure

93
Q

What needs to be nearby in case of seizure?
what seizure precautions should be in place?

A

oxygen tubing, oxygen, and suction
- 2-3 side rails up and padded
- bed in lowest position
- patient in side lying position (immediate postseize)
- patient needs to be wearing loose clothing

94
Q

what is status epilecticus

A
  • Defined as a seizure lasting 5 minutes or longer or serial seizures occurring without full recovery of consciousness between attacks.
  • Considered a medical emergency.
  • Status epilepticus produces cumulative effects.
  • Vigorous muscular contractions impose a heavy metabolic demand and can interfere with respirations.

-May produce venous congestion and hypoxia of the brain.

-Repeated episodes of cerebral anoxia and edema may lead to irreversible and fatal brain damage

95
Q

Nursing interventions for status epilepticus

A
  • draw labs: venous draw; serum electrolytes, serum glucose, phenytoin levels
    - pts taking dilantin need phenytoin levels drawn
    - if phenytoin levels low- can give more dilantin
    • ensure working IV
    • EEG
    • VS
    • neuro checks
    • possible glucose if glucose levels are LOW
    • if initial treatment ineffective; general anesthesia w/ short acting barbiturate to stop seizure activity
      • pt will need to be intubated and sent to ICU (code blue will be called if this step is necessary)

Postictal period- time immediately after seizure and there is an INCREASED RISK OF CEREBRAL EDEMA

  • Ictal period- during the seizure
96
Q

what is the ictal period of a seizure

A

during the seizure

97
Q

what does post ictal mean

A

after the seziure

98
Q

what is a headache

A
  • Also known as cephalalgia
  • One of the most common physical complaints

Secondary headache is a symptom with an organic cause such as a brain tumor or aneurysm
Headache may cause significant discomfort for the person and can interfere with activities and lifestyle

99
Q

what is primary vs secondary headache

A
  • Primary headache has no known organic cause and includes migraine, tension headache, and cluster headache
    -Secondary headache is a symptom with an organic cause such as a brain tumor or aneurysm
100
Q

how should the nurse assess a headache

A

A detailed description of the headache is obtained
Include medication history and use

The types of headaches manifest differently in different persons and symptoms in one individual may also change over time

Although most headaches do not indicate serious disease, persistent headaches require investigation

Persons undergoing a headache evaluation require a detailed history and physical assessment with neurologic exam to rule out various physical and psychological causes

Diagnostic testing may be used to evaluate underlying cause if there are abnormalities on the neurologic exam

101
Q

how can the nurse manage headache pain?

A

Provide individualized care and treatment

Prophylactic medications may be used for recurrent migraines

Migraines and cluster headaches require abortive medications instituted as soon as possible with onset

Provide medications as prescribed

Provide comfort measures

Quiet, dark room

massage

Local heat for tension

102
Q

what is a common med used to treat headaches

A

Imitrex

103
Q

what should the nurse educate the patient on regarding headaches

A

Help patient identify triggers and develop a preventive strategies and lifestyle changes for headache prevention

Medication instruction and treatment regimen

stress reduction techniques

Nonpharmacologic therapies such as massage, cold compress, relaxation therapy,

Follow-up care

Encouragement of healthy lifestyle and health promotion activities

Med II (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions