Chapter 17- Neurologic Emergencies

Question 1

Coma

Answer 1

A state of profound unconsciousness where the patient can’t be awoken

Question 2

What is a tension headache

Answer 2

Caused by muscle contractions in the head and neck and are attributed to stress

Question 3

What is a migraine headache

Answer 3

Thought to be caused by changes in blood vessel size in the base of the brain. Children and adults can experience migraines. Women are three times more likely. Pain includes pounding, throbbing, or pulsating.

Question 4

What is a sinus headache?

Answer 4

A headache caused by pressure that is the result of fluid accumulation in the sinus cavities. Patient me Trece pain when I bend over or when their heads or move forwards.

Question 5

What are headache red flags?

Answer 5

• sudden onset of symptoms
• explosive/thunderclap pain
• altered mental status
• > 50
• depressed immune system
• neurologic deficit’s
• neck stiffness/pain
• fever
• changes in vision
• One sided paralysis or weakness

Question 6

Cerebrovascular accident (CVA) OR stroke

Answer 6

Interruption of blood flow to an area within the brain that results in the loss of brain function

Question 7

Ischemia

Answer 7

A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow

Question 8

Ischemic stroke

Answer 8

When the blood flow through the cerebral arteries is blocked. Accounts for more than 80% of all strokes

Question 9

Thrombosis

Answer 9

When a clot forms at the site of blockage

Question 10

Embolus

Answer 10

Where the blood clot forms in a remote area (such as a diseased heart) and then travels to the site of the blockage

Question 11

What are the two ways that it ischemic stroke can happen?

Answer 11

Thrombosis, or embolus

Question 12

Atherosclerosis

Answer 12

A disorder in which calcium and cholesterol buildup, forming plaque inside the walls of the blood vessels

Question 13

Hemorrhagic stroke

Answer 13

Occurs as a result of bleeding inside the brain. A blood vessel rupture’s in the accumulated blood and forms a blood clot, which compresses the brain tissue next to it. Accounts for 13% of all strokes

Question 14

Aneurism

Answer 14

The swelling or enlargement of the wall of a blood vessel that results from weakening of the vessel wall.

Question 15

Berry aneurysm

Answer 15

Resembles a tiny balloon (or berry) that juts out from the artery. We near here is an ruptures, blood spurts into the subarachnoid space. The strokes are called subarachnoid hemorrhages

Question 16

Transient ischemic attack (TIA)

Answer 16

A disorder of the brain in which the brain cells temporarily stop functioning because of insufficient oxygen, causing stroke like symptoms that resolve completely within 24 hours

Question 17

Signs and symptoms of stroke

Answer 17

• facial drooping
• sudden weakness or numbness in the face, arm, leg, or one side of the body
• decreased or absent movement and sensation on one side of the body
• lack of muscle coordination or loss of balance
• sudden loss of vision in one eye, blurred or double vision
• difficulty swallowing
• decreased level of responsiveness
• speech disorders
• Aphasia; difficulty expressing thoughts or inability to use the right words
• slurred speech (dysarthria)
• sudden and severe headache
• dizziness, confusion, weakness, combativeness, restlessness, tongue deviation, coma

Question 18

Dysarthria

Answer 18

Slurred speech

Question 19

Aphasia

Answer 19

The inability to produce or understand speech. This happens if the left cerebral hemisphere has been affected by a stroke

Question 20

Postictal state

Answer 20

Period following a seizure that lasts between five and 30 minutes, characterized by labored respirations and some degree of altered mental status

Question 21

Seizure

Answer 21

A neurologic episode caused by surge of electrical activity in the brain

Question 22

Epilepsy

Answer 22

A common cause of seizures. A disorder in which abnormal electrical discharges occur in the brain, causing seizure and possible loss of consciousness

Question 23

Generalized (tonic-clonic) seizure

Answer 23

Result from abnormal electrical discharges from large areas of the brain, usually involving both hemispheres.

Question 24

What are the characteristics of generalized seizure?

Answer 24

Characterized by unconsciousness and a general severe twitching of the body’s muscles the last several minutes or longer

Question 25

Partial (focal) seizure

Answer 25

A Seizure affecting a limited part of the brain

Question 26

What are the two classifications of partial seizures?

Answer 26

Simple or complex

Question 27

What is a simple partial seizure?

Answer 27

No change occurs in the patient’s LOC. Patient may report numbness, weakness, or dizziness. The seizure may cause twitching of the muscles in the extremities that spreads slowly from one part of the body to another, but it is not severe twitching. The patient may also experience brief paralysis

Question 28

What is a complex partial seizure?

Answer 28

The patient has an altered mental status and does not interact normally with his or her environment. This type of seizure results from abnormal discharges from the temporal lobe of the brain. Signs may include lipsmacking, I blinking, and isolated conversions or jerking of the body or in one part of the body such as the arm. The patient may experience weird smells and visual hallucinations, uncontrollable fear

Question 29

Aura

Answer 29

A warning sign prior to having a seizure. This can include visual changes like flashing lights or blind spots in the field of vision, or hallucinations.

Question 30

Status epilepticus

Answer 30

Describe seizures they continue every few minutes without the person regaining consciousness or lasts longer than 30 minutes

Question 31

Hypoglycemia

Answer 31

A low blood glucose level

Question 32

Common causes of epileptic seizures

Answer 32

Congenital origin

Question 33

Causes of structural seizures

Answer 33

Tumor, infection, scar tissue from injury, head trauma, stroke

Question 34

Causes of metabolic seizures

Answer 34

Hypoxia, abnormal blood chemical values, hypoglycemia, poisoning, drug overdose, sudden withdrawals from alcohol or medications

Question 35

Causes for febrile seizures

Answer 35

Sudden high fever

Question 36

Febrile seizures

Answer 36

Seizures that result from sudden high fever’s, particularly in children

Question 37

Incontinence

Answer 37

A loss of bowel or bladder control

Question 38

Hemiparesis

Answer 38

Weakness on one side of the body, resembling a stroke

Question 39

Syncope

Answer 39

Fainting

Question 40

Altered mental status

Answer 40

The patient is not thinking clearly or is in capable of being aroused

Question 41

What is a helpful pneumonic to use when reviewing the possible causes of altered mental status?

Answer 41

AEIOU TIPS

Question 42

What does AEIOU TIPS stand for?

Answer 42

Alcohol
Epilepsy, endocrine, electrolytes
Insulin
Opiates and other drugs
Uremia (kidney failure) 

Trauma, temp
Infection
Poisoning, psychogenic causes
Shock, syncope, seizure, stroke, Space occupying lesion, sub arachnoid hemorrhage

Question 43

Delirium

Answer 43

A temporary change in mental status characterized by disorganized thoughts, in attention, memory loss, disorientation, striking changes in personality and affect, hallucinations, delusions, or a DLOC

Question 44

Three items stroke severity scale

Answer 44

Level of consciousness: normal=0, mild dysfunction= 1 severe dysfunction (unconscious)=2

Arm drift: normal=0. Mild =1. Severe=2

Gaze (same)

Question 45

List the key information needed to document for a patient who has had a stroke

Answer 45

• Time of onset of the signs and symptoms
• score on the GCS
• result of the stroke assessment tool
• changes noted on reassessment