CNS assessment Flashcards

Question

Mannitol 7 things

Answer 1

Mannitol- IV no PO Plasma extension and osmotic measure Is and OS need cath for accuracy in unconscious can cause metabolic acidosis, hypok BBW bronchospasms CI in renal or increased osmolality can cause edema/heart fail because of fluid overload

Answer 2

``` Mannitol Hypertonic saline Corticosteroids H2 receptor antag to prevent bleeds and ulcers Antiseizure meds Antipyretics Sedatives, analgesics, barbituates stool softeners ```

Answer 3

Fever, agitation, shivering, pain, seizures

Answer 4

Secretions may cause tongue to slip to back of throat

Answer 5

general appearance and behavior, cognition-AandO, memory, judgement, problem solve, mood and affect

Answer 6

Strength, tone, coordination, symmetry, balance

Answer 7

Touch, pain, temp, vibration, position, cortical-graphesthesia and stereognosis

Answer 8

Babinski-toes up or down you brush up on foot and across brudinski-pull head up and knees go up kernigs0 cant straighten leg when hip is flexed to 90 clonus dolls eye

Answer 9

HTN | Alcohol, apnea, metabolic syndrome, BCP

Answer 10

A fib, valve, congenital defects, History of TIA

Answer 11

Clot stops blood flow to brain Thrombotic-Injury and formation of blood clot causes narrowing of blood vessle most common from HTN and DM and athero Embolic- Embolism travels from some place else and occludes art=Infaraction and edema usually from A FIB

Answer 12

Bleeding and swelling from bleeding usually from aneurysm HTN and age

Answer 13

Bleeding into brain from rupture of a vessle Suddent onset, Poor prog, htn most common cause, usually during activity,

Answer 14

Intracranial bleeding into cerebrospinal fluid | rupture of aneurysm, trauma, drugs, fall,

Answer 15

Vasospasms, in cirle of willis, silet killer, loss of conscousness or not survivors often have significant complications

Answer 16

Paralysis of L side, L side neglect, spatial perception neglect, Minimize problems, Impulsive, impaired judgment, Impaired time concepts,

Answer 17

Paralysis of R side, R side neglect, impaired speech and language, slow cautious movements, aware of def, depression, impaired comprehension, aphagias,

Answer 18

Apraxia, akensia, hypo/hyper reflexia, mobility, swallowing, gag, self-care, elemination issuesm, flaccidicy and spasticity

Answer 19

Exaggerated emotional response depression frustration

Answer 20

ABC, neuro checks, TX of edema, Prevent further injury,

Answer 21

Tpa-breakdown clot, 3-4 hours after onset, cant for hem!

Answer 22

Carotis endarterectomy stent for occluded caroted art

Answer 23

Face-Smile one side droops? Arms raise arms on side droops? Speech-Simple sentence Time-any symptoms call 911

Answer 24

Tinnitus, vertigo, HA, Dark blurred vison, Diploplia, ptosis, dysartheria, dysphagia, ataxia, uni/bilat weakness or numbness

Answer 25

c4-Tetra and paralysis of respiratory, C6-tetra with pa in hands and arms, T6 para below chest, L1-Para below waist

Answer 26

A-complete no S or M B-incomplete-S nut no motor C incomplete-M preserved- MM greater than 3 more than 1/2 D-Incomplete0 M presereved mm greater than 3 in 1/2 E-Normal

Answer 27

Anterior cord syndrome-Damage to anterior spinal cord from compression r/t flextion-motor paralysis, loss of pain and temp sensation below (B)LOI Brown-Damage to 1/2 of spinal cord commonly cervical-Contralateral (opposite side) - loss of pain/temp sensation BLOI Ipsilateral (same side) – loss of voluntary motor function conus-Damage to lowest part of spinal cord-motor weakness and altered sensation, burning sensation in UEs (LEs not as affected) cauda-Damage to cauda equina-nerve bundle rootmotor function in LEs mb preserved, flaccid, or weak – more mid-moderate backpain Decrease/loss of sensation in peri area  impotence, areflexic B/B

Answer 28

- Occurs shortly after injury (30-60 mins) - Loss of DTRs, sphincter reflexes - Loss of sensation, thermoregulation - Flaccid paralysis BLOI - Lasts days-weeks - Often masks postinjury neuro function

Answer 29

Occurs in injury ABOVE T6. SNS not working right to control vasomotor tone in the blood vessels  vasodilation  decreased resistance  HpTN  venous blood pooling  less filling of the ventricles  bradycardia and hypothermia (warm extremities, cold inside)  decreased CO + tissure perfusion  death SX: HpTN Bradycardia Hypothermia d/t blood pooling (warm outside, cold inside) Decreased preload/filling

Answer 30

Maintain patent airway/adequate ventilation (prehospital) Prevent further damage via immobilization (prehospital) Maintain perfusion via fluid replacement, control bleeding (monitor other trauma) Keep pt warm (can’t regulate temp) Indwelling catheter to prevent bladder distension Only real tx = surgery (decompress, help reduce secondary injury, fuse bones) – 24 hours!

Answer 31

``` Prevent DVTs (measure calf) Prevent skin breakdown (immobile and lack of sensation) Maintain adequate nutrition/fluid needs (this is usually increased – need lots nutrients to heal) Treat pain (neuropathic) ```

Answer 32

PT/OT to manage/prevent contractures SP for swallow assess Bladder/bowel training – self cath, retraining, prevent retention/infx Recognize and manage autonomic hyperreflexia Psychological support Pt teaching – rehab goals, expectations of improvement

Answer 33

``` Grief and depression – loss of control, mb function, SI R/T immobility: Pneumonia UTIs Pressure ulcers Sepsis DVTs Mechanical ventilation probs, infx ```

Answer 34

Injury @ T6 or higher. Exaggerated response from the SNS which is running unopposed by the PNS Some irritating stimulus below T6 - usually bladder distension, bowel impaction, restrictive clothing, skin breakdown … SNS overreacts but can’t do much bc signals aren’t getting to the brain correctly. Signals ARE getting to SNS/PNS but they’re not working together, so … SNS turns on  vasoconstriction  severe HTN, HA, bradycardia, diaphoresis (ALOI), piloerection (BLOI)  baroreceptors can get signal to the brain and are like OMG HELP!  decreases HR in response to HTN but can’t dilate peripheral vessel BLOI

Answer 35

Sit pt upright or elevate HOB 45 Identify the cause and help – insert cath or look for kink, resolve impaction, remove clothing Notify HCP Monitor and manage BP (vasodilators) if sx continue If left untx’d  M.I., stroke, status epilepticus

Answer 36

Chronic, progressive neurodegenerative D/O characterized by a gradual onset of sx r/t depletion of dopamine (affects movement, memory, focus)  - slow movements - bradykinesia - increased muscle tone – rigidity - tremor @ rest, gait changes Exact cause unknown – mb r/t environment, family hx, exposure to toxins, drugs, mb post-neuro problem (hydrocephalus, stroke, NG d/o’s, hypo-PTH, tumor, trauma - abnormal clumps of Lewy Bodies Men > women

Answer 37

``` Tremors (1st sign) -pill rolling Rigidity Akinesia (brady) Postural instability (shuffling gait) Depression, anxiety, apathy, fatigue, pain, urinary retention, constipation, ED, ST memory loss, cogwheel rigidity, lewy body clumps, retropulsion, fenestration, arms flexed, hypokineticdysartharia, loss of smell. ```

Answer 38

Deep brain stimulation and ablation exercise , transplantation of fetal neural tissue anticohlenergics

Answer 39

Halucinations, Immobility issues, orthostatic hypotn, dementia

Answer 40

Death is usually from respiratory dysfunction

Answer 41

``` Loss of motor neurons mod-intense endurance exercises for trunk and limbs facilitate communications decrease aspiration risk Detect respiratory dysfunction decrease pain Risk for fall divert ```

Answer 42

Progressive, degenerative brain d/o – genetic Onset usually 30-50 yo Deficiency in ACH + GABA  excess DP

Answer 43

- excessive and involuntary movements (chorea0 - chewing, swallowing, gait severely impacted - severe depression, high r/f suicide

Answer 44

ccurs when brain moves inside skull d/t high energy or high impact injury mechanisms. Coup/primary = direct impact of brain on skull Contrecoup/secondary = second area of damage on opposite side from injury (more severe)

Answer 45

- damage to structures that protect the brain @ base of skull  leakage of CSF - only break in very severe trauma - NO NGT if this is happening

Answer 46

SX = rhinorrhea (CSF leak from nose), otorrhea (CSF leaks from ear), Battle’s Sign (ecchymosis @ cheek bones), Raccoon Eyes (ecchymosis around eyes) High r/f meningitis Clinical Manis: - Altered LOC - HA - N/V - Seizure activity - IICP - Hyperthermia if hypothalamus damaged