CNS Exam Flashcards
Pathophysiology of Meninginitis
It is an inflammation of the brain and spinal cord that may be caused by either bacterial or viral infections.
Bacterial is a serious infection that is spread by direct contact with discharge from the respiratory track of an infected person.
Viral is more common and rarely serious.
etiology of meningitis
The infection generally begins in another area such as the upper respiratory tract, enters the blood, and invades the CNS
This causes the meninges to become inflamed and intracranial pressure to increase.
Prevention of Meningitis
Hib vaccination and pneumonia vaccination.
s/s of meninginitis
Severe headache Fever, Photophobia, Petechial rash Nuchal rigidity: Positive Kernig Brudzinski’s sign Nausea and vomiting tachycardia alterations in motor function Encephalopathy: Short attention span. Poor memory, and disorientation
What is a positive kerning’s sign
after flexing the knee 90 degrees, trying to extend it all the way will cause hamstring pain.
What is a positive Brudzinski’s sign
When flexing the neck downward, the knees will flex and there will be pain in the neck.
complications of meningitis
Hydrocephalus
Seizures
Respiratory impairment
Neurological deficits
Dx of meningitis
Lumbar puncture
Culture and sensitivity
Bacterial +: fluid is cloudy from the increase in WBC.
Viral: is clear, But the WBC count is elevated.
therapeutic interventions for meningitis
Antibiotics: for bacterial
Antipyretics: for fever
Cooling blanket: for fever
Dark, quiet environment: to decrease risk potential for seizures
Analgesics
Codeine products (once it’s diagnosed)
Antiemetics: to reduce the possibility of further increasing ICP
Isolation: prevention of spread! (remember it’s respiratory)
pathophysiology of encephalitis
Inflammation of brain tissue in a local area
IICP (increased intracranial pressure) may occur and lead to herniation of the brain.
Neurological effects depend on area of brain affected.
etiology of encephalitis
Viruses
Some viruses are carried by ticks or mosquitoes
Some viruses are caused by systemic infections
Herpes simplex is the most common viral cause.
s/s of encephalitis
Headache Fever Nausea and vomiting Nuchal rigidity Confusion Decreased LOC Seizures Photophobia Tremors
complications of encephalitis
Cognitive disabilities Personality changes: These are the hardest on family members. You have to take this into consideration with discharge planning. Ongoing seizures Motor deficits Blindness
Dx of encephalitis
CT
EEG
LP: fluid will be yellow due to possible hemmorhage & elevated WBC
therapeutic interventions for encephalitis
Analgesics
Antipyretics
Anti-virals
Neurological assessment
Symptomatic care
There is no treatment for insect borne encephalitis.
Acyclovit is given for herpes simplex encephalitis.
Meds are given to reduce seizures, headaches and fever.
Pathophysiology of ICP
patient with an intracranial condition is at risk for increased intracranial pressure.
ICP is the pressure exerted within the cranial cavity by it’s components (blood, brain, and cerebrospinal fluid)
Monro-Kellie doctrine: theory stating…
that there are 3 components in the skull: brain, blood, CSF. If one increases and something else doesn’t, the result will be Increased ICP.
S/S of ICP
Restlessness Headache Seizures Irritability Decrease in LOC Pupil changes-due to pressure -papilledema, impaired eye movement increased BP Decrease Pulse Decreased Respirations vomiting changes in speech
s/s of ICP in infants
bulging fontanels
cranial suture separation
increased head circumference
high bitched cry
lowest score of glascow coma scale
3
highest score of glascow coma scale
15
explain migraine
Starts with vasoconstriction followed by vasodilation.
Hereditary is a factor and triggers such as food, noise, lights, alcohol and stress.
These pts may have a prodromal period which there are changes prior to the h/a. Such as: tingling, difficulty speaking, and visual disturbances.
These type of headaches are accompanied with nausea and vomiting and can last from hours to days.
B/P meds may be given prophylactically. (they help eliminate the vascular changes that occur during the headache. Monitor B/P!!
Other meds may be ordered that can be taken at the onset of a migraine. (anti-seizure)
Dietary restrictions may be helpful if precipitating foods or beverages can be identified. Have them take a food inventory diary to determine this.
What is a cluster headache and what is the treatment
These headaches come in clusters periodically.
Stress, anxiety, and emotional distress are proposed causes of cluster headaches
Frequently these headaches will occur at the same time of each day.
Treatment: cool compresses, dark & quiet environment, and NSAID’s may be used.
What is a tension headache and the treatment for it
These headaches consist of persistent contractions of the scalp, facial or cervical muscles can be the cause.
Can be d/t premenstrual, stress or anxiety.
Pressure, aching, steady and tight are describing words
Symptom management: massage the affected muscles, rest, localized heat, non-narcotic analgesics
Treatment for headaches
Assessment Patient education Keep diary Record triggers, timing, symptoms Medication teaching
Seizures
Abnormal electrical discharge within the brain due to instability of the neuron cell membrane.
Seizures may be a symptom of epilepsy or other neurological disorders such a tumor or brain attack.
What are the classifications of seizures
Partial Seizure
Begin on one side of cerebral cortex
Generalized Seizure
Both hemispheres involved
etiology of seizures
Idiopathic
No cause identified, and they usually begin before age 20
Acquired
Underlying neurological disorder such as a traumatic brain injury and anoxic events (events where the brain is left without oxygen).
partial seizure symptoms
Automatisms may be present and are the classic symptom: They are repetitive, purposeless behaviors
The patient may be in a dreamlike state while picking at his or her clothing, chewing, or smacking his lips.
These behaviors are sometimes inappropriate.
Absence (petit mal) are
classic in children and they stare for several seconds.
two types of generalized seizures
absence (petit mal) tonic clonic (grand mal)
what is a grand mal seizure
Rigidity followed by muscle contraction and relaxation with twitching movements: tonic/clonic
Postictal period follows the seizure which is a recovery period.
After a tonic clonic, the patient may sleep for several minutes to hours.
treatment for seizures
-Anticonvulsant medication
Blood levels must be monitored
May cause drowsiness
-Treatment begins with a dose and it is increased until the therapeutic levels are attained
-Surgical Management: resection of area causing problem. The goal is to reduce the frequency or severity of the seizures
emergency care during seizures
Pad side rails Prevent injury Monitor airway Turn on side to prevent aspiration Suction PRN Observe and document
What is status epileptic
30 minutes of seizure activity without a return to consciousness.
Neuro damage can occur due to the brain not getting it’s metabolic needs.
treatment for status epileptics
Treatment
Ensure airway and oxygenation
Administer IV diazepam
traumatic brain injury can cause
Cerebral edema
Hydrocephalus
Brain herniation
Death
acceleration head injuries
a moving object hitting a stationary head (the frying pan hitting your husband’s head)
deceleration head injury
when the head is in motion and strikes a stationary surface (the husband falling down and hits his head on the floor)
a concussion, and what is it characterized by
A mild brain injury with loss of consciousness for under 5 minutes
Characterized by: headache, dizziness, nausea and vomiting.
what is a contusion
Bruising of the brain tissue, possibly accompanied by hemorrhage.
Respirations, pupil reaction and motor response are affected.
hemotoma
Usually a venous bleed
Classified as acute or chronic based on the time interval between injury and onset of symptoms.
Acute: Occur 24 hours after an injury. As it increases: the patient may exhibit extremity weakness or dilation of the pupil. LOC may further deteriorate as ICP increases
Chronic hematomas are due to the chronic stretches of veins between the brain and the dura. A minor fall can cause the veins to rupture and bleed.
what is an epidural hemotoma
Usually an arterial bleed between the dura mater and the skull. Because it’s arterial, it can become large quickly!
Loss of consciousness occurs and a dilated pupil. Seizures or hemiparesis may occur, especially if there is no interventions.
This is a fatal condition if not treated. The goal is to keep an oral airway and decrease the ICP.
treatment of hemotoma
Surgical removal of hematoma
Control IICP with use of osmotic diuretics (such as Mannitol).
Mechanical hyperventilation: which will lower ICP by causing vasoconstriction.
Therapeutic coma: this reduces the metabolic needs of the brain
Keep in mind that the brain injured patient may be partially or completely dependent for maintenance of respiration, nutrition, elimination, movement, and skin integrity.
complication of brain injuries
Brain Herniation: due to uncontrolled edema
Diabetes insipidus:
due to effects on the pituitary or hypothalamus and the inadequate release of ADH
Acute hydrocephalus:
vital signs fluctuation: due to pressure on the brainstem
Post-traumatic syndrome: Ongoing symptoms
Cognitive and personality changes: This is a biggie!!
potential problems for brain injuries
Ineffective cerebral tissue perfusion r/t increased ICP
Ineffective breathing pattern r/t pressure on the respiratory center
Ineffective airway clearance r/t reduced cough reflex and decreased LOC
Pain r/t tissue damage
Impaired physical mobility r/t decreased LOC
pathophysiology of brain tumors
Neoplastic growths of the brain or meninges
May be primary or secondary (metastatic)
Metastatic tumors arise from the primary cancer of:
Prostate, thyroid, breast, liver and kidney
s/s of brain tumor
Seizures Motor and sensory deficits Headaches Visual disturbances Hormone disturbances
thereaputic intervention for brain tumors
Medical: Involves treating the symptoms Anticonvulsants for seizure control Dexamethasone to lessen the edema Radiation therapy Chemotherapy
postof care for brain surgery
Nursing diagnoses
Risk for ineffective cerebral tissue perfusion r/t edema of the operative site
Risk for infection related to surgical procedure
Body image disturbance related to changes in appearance or function
pathophysiology of herniated disck
Herniation of nucleus pulposis.
Compression of nerve root(s)occurs.
Cause can be from a known injury or unknown event.
s/s of herniated disc
Pain that follows the nerve path. Muscle spasm Numbness or tingling of extremity Weakness of the extremity Muscle Atrophy
what is a myelogram and what does it diagnose
A myelogram is when dye is injected into the fluid by the spinal cord.
This then outlines the spinal cord. for herniated disc Dx
treatment for herniated disc
Bed Rest for 1-2 days Physical therapy: TENS unit, heat/cold, deep massage Traction: for cervial herniations. Muscle relaxants NSAIDs& analgesics Epidural anesthetic injections Steroids &Surgery
pathophysiology of spinal cord injury
Damage to nerve fibers
Therefore there is interference with communication between brain and body
Damage can be caused by bruising, tearing, cutting, edema, or bleeding into the cord.
Common causes are MVA’s, sports injuries, and falls.
Spinal cord injuries are classified by the location or degree of damage to the cord
spinal cord injury that is fatal
C3 or above fatal
s/s of spinal cord injury
Cervical injury
Impaired respiration
Loss of bladder and bowel control
Quadriplegia: loss of function of all extremities
Paresis: Weakness in function of all extremities
C3 or above fatal
Thoracic/lumbar injury
Legs, Bowel and bladder control are affected
characteristics of dementia
Patients have impaired intellectual functioning
They loose the ability to solve problems and maintain emotional control
They may experience personality changes and behavioral problems
Memory loss and dementia are not the same thing!
possible causes of dementia
Huntington’s Parkinson’s Alzheimer’s Multiple “mini-strokes/TIA’s” Chronic alcoholism Neurological infections
Common meds utilized to treat dementia
Aricept Cognex Exelon Reminyl Namenda
parkinsons disease
Destruction of substantia nigra cells in the brain responsible for dopamine production
Therefore: Decreased dopamine production
(Dopamine facilitates the transmission of impulses from one neuron to another)
This results in their classic movements: tremors, muscle rigidity, and slow movements, shuffled gait
s/s of parkinsons disease
onset is usually gradual slowly progressive mask like, blank expression stooped posture pill rolling tremors shuffling gait depression possible mental deterioration muscle rigidity
pathophysiology of Huntington’s disease
Progressive, hereditary, degenerative, incurable neurological disorder.
Huntington disease is a disorder in which nerve cells in certain parts of the brain waste away, or degenerate.
It’s characteristics are of involuntary, irregular, jerky movements.
Characteristics are also noted with their moods and inappropriate behavior
s/s of alzhiemers disease
Stage 1
Increasing forgetfulness
Stage 2 Progressive memory loss Irritibility Depression Aphasia Sleep disruption Hallucinations Seizures
Stage 3 Complete dependency Bowel and bladder control lost Emotional control lost Inability to recognize significant others Death
difficulty swallwing is called
dysphagia
an ___ is a test that uses scalp electrodes to evaluate brain activity
electroencephalogram
a pt might say his leg feels like it is asleep to describe a ___
paresthesia
abnormal flexion posturing when eliciting best motor response is called ___ posturing
decortciate
abnormal extension posturing when eliciting best motor response is called ____ posturing
decerebrate
____ is the term that describes unequal pupils
anisocoria
involuntary eye movement is called ____
nystagmus
permanent muscle contraction s are called ___
contractures
difficulty speaking because of muscle dysfunction is called
dysarthria
puts who have difficulty speaking after a stroke are experiencing
aphasia
which of the following parts of a neuron transmits impulses away from the cell body
axon
which type of neuron transmits impulses fro the central nervous system to the muscle and glands
efferent
which part of the brain controls breathing
- medulla
- cerebellum
- cerebrum
- thalamus
medulla
when a neurologist asks a pt to smile, which cranial nerve is being tested
- optic
- facial
- vagus
- accessory
facial
which of the following responses indicates sympathetic nervous system activation
- tachycardia, dilated pupils
- increased peristalsis, and cramping
- hypoglycemia, headache
- pupil constriction, bronchoconstriciton
tachycardia, dilated pupils
which neurotransmitter mediates the sympathetic response
- acetylcholine
- prostaglandin
- norepinephrine
- serotonin
norepinephrine
contralateral hemiparesis
weak on opposite side
ipsilateral hemiplegia
paralyzed on the same side
quadriplegia
all four extremities paralyzed
paraplegia
paralyzed lower extermities
photophobia
sensitive to light
bradykinesia
slow movement
craniotomy
surgical opening in the skull
encephalitis
inflammation of the brain
nuchal rigidity
neck pain and stiffness
prodromal
warning sign
match drug with action
mannitol
osmotic diuretic
match drug with action
tacrine (Cognex)
cholinesterase inhibitor
match drug with action
carbamazepine (Tegretol)
anticonvulsant
match drug with action
dexamethasone (Decadron)
corticosteroid
match drug with action
levodopa/carbidopa (Sinemet)
converts to dopamine in the brain
match the s/s with the correct disorders
unconscious at the accident scene
epidural bleed
match the s/s with the correct disorders
polyuria and polydipsia following head injury
Diabetes insipidus
match the s/s with the correct disorders
hypotension, loss of sympathetic function
spinal shock
match the s/s with the correct disorders
nuchal rigidity
meningitis
match the s/s with the correct disorders
high blood pressure, bradycardia, diaphoresis
autonomic dysreflexia
match the s/s with the correct disorders
brief period of staring
absence seizure
match the s/s with the correct disorders
automatic repetitive movement such as picking or lip smacking
complex partial seizure
match the s/s with the correct disorders
status epilepticus
continusous seizure
match the s/s with the correct disorders
cushing’s triad
increased intracranial pressure
match the s/s with the correct disorders
cerebral vasoconstriction followed by vasodilation
migraine
which of the following settings is the most therapeutic for an agitated pt with a head injury?
- a day room with family visitors and a variety of caregivers
- a semiprivate room with one or two consistent caregivers
- a ward with other patients who have head injuries and volunteers to assist with needs
- a hallway near the nurse’s station with adequate sensory stimulation
a semiprivate room with one or two consistent caregivers
decreasing level of consciousness is a symptom of which of the following physiological phenomena?
- ICP
- sympathetic response
- parasympathetic response
- increased cerebra blood flow
ICP
which of the following blood pressure changes alerts the nurse to increasing ICP, and should be reported immediately?
- gradual increase
- rapid drop followed by gradual increase
- widening pulse pressure
- rapid fluctuations
widening pulse pressure
which of the following nursing interventions will help prevent a further increase in ICP
- encourage fluids
- elevate the HOB
- provide physical therapy
- reposition the pt frequently
elevate the HOB
a pt asks the nurse what side effects to expect from a muscle relaxant medication that has been prescribed. which of the following side effects should the nurse relate?
- hypoglycemia
- hypotension
- drowsiness
- dyspnea
drowsiness
a nurse caring for a pt with a herniated lumbar disk develops a plan of car for impaired mobility r/t nerve compression. which pt outcome indicates that the plan has been successful?
- the pt rates the pain at 3 or 4 on a 0-10 scale
- the pt has full range of motion of the upper extremities
- the pt demonstrates correct self administration of analgesics
- the pt is able to ambulate 25ft without pain
the pt is able to ambulate 25ft without pain
which of the following problems during the immediate postoperative course following lumbar microdiskectomy should be reported to the physician immediately?
- incisional pain
- two inch area of bleeding on dressing
- inability to move affected leg
- muscle spasm of affected leg
inability to move affected leg.
the nurse is caring for a client post-lumbar puncture who reports a throbbing headache when sitting upright for meals. which of the following actions should the nurse take (SELECT ALL)
- use the Glasgow coma scale when checking the client
- assist the client to eat meals while lying flat in bed
- administer an opioid medication
- encourage the client to increase fluid intake
- place the client in a cannonball position
- assist the client to eat meals while lying flat in bed (the prone position may relieve a headache following a lumbar puncture)
- administer an opioid medication (administering an opioid medication for a client’s report of headache pain is an appropriate action)
- encourage the client to increase fluid intake (Maintaining positive fluid balance may relieve a headache following a lumbar puncture)
a nurse is collecting data from a client who is scheduled for a cerebral angiogram with contrast dye. which of the following statements by the client should the nurse report to the provider?
- i think i may be pregnant
- i take coumadin
- i take antihypertensive medication
- i am allergic to shrimp
- i am allergic to latex
- I think I may be pregnant ( the contrast dye may place the fetus at risk)
- I take coumadin ( potential for bleeding following the angiogram)
- I am allergic to shrimp (potential allergic reaction)
a nurse is reinforcing teaching to a client who is to undergo an EEG the next day. which of the following information should the nurse include in the teaching?
- do not wash your hair the morning of the procedure
- try to stay awake most of the night prior to the procedure
- the procedure will take approximately 15 minutes
- you will need to lie flat for 4 hours after the procedure
-try to stay awake most of the night prior to the procedure
(to provide cranial stress and increase the possibility of abnormal electrical activity)
also, do not drink caffeinated coffee the morning of the procedure
a nurse is checking for the presence of Brudzinski’s sign in a client who has suspected meningitis. which of the following action should the nurse take when performing this technique (SELECT ALL)
- place the client in supine position
- flex the client’s hip and knee
- place hands behind the client’s head
- bend the client’s head toward chest
- straighten the client’s flexed leg at the knee
- place the client in supine position
- place hands behind the client’s head
- bend the client’s head toward chest
a nurse is collecting data from a client who reports severe headache and a stiff neck. the nurses data collection reveals positive kernig’s and Brudzinski’s sign. which of the following actions should the nurse perform first?
- administer antibiotics
- initiate droplet precautions
- limit visitors
- decrease bright lights
-initiate droplet precautions
prevent the spread of the disease to others
a nurse is assisting an RN who is admitting a client who has bacterial meningitis. which of the following findings should the nurse expect?
- bradycardia
- restlessness
- hypoactive deep tendon reflexes
- fever
- n/v
- bradycardia
- restlessness
- fever
- n/v
a nurse is contributing to the plan of care for a client who has bacterial meningitis. which of the following action should the nurse include in the plan of care? (SELECT ALL)
- perform neuro checks q6h
- encourage the client to cough frequently
- administer antipyretic medication
- limit visitors
- keep the head of the bed flat
- administer antipyretic medication
- limit visitors
a nurse is caring for a client who has a seizure disorder. the client reports he thinks he is about to have a seizure. which of the following action should the nurse implement? (SELECT ALL)
- provide privacy
- move furniture away from the client
- loosen the client’s clothing
- protect the client’s head with padding
- restrain the client
- provide privacy (minimize embarrassment)
- move furniture away from the client (prevent injury)
- loosen the client’s clothing (minimize restriction of movement)
- protect the client’s head with padding
a nurse is caring for a client who just experienced a generalized seizure. which of the following actions should the nurse perform first?
- place the client in a side-lying position
- request a prescription for seizure precautions
- reorient the client to the environment
- provide a quiet environment
-place the client in a side-lying position
greatest risk to the client is aspiration during the postictal phase. sideways so secretions can drain from the mouth
a nurse is reviewing trigger factors that can cause seizures with a client who has a new diagnosis of generalized seizures. which of the following factors should the nurse include?
- high fat intake
- excessive fatigue
- acute alcohol intake
- decreased physical activity
- exposure to bright light
- high fat intake
- excessive fatigue
- exposure to bright light
a nurse is collecting data from a client who has Parkinson’s disease. which of the following are expected findings (SELECT ALL)
- decreased vision
- pill rolling tremor of the fingers
- shuffling gait
- bilateral ankle edema
- lack of facial expressions
- pill rolling tremor of the fingers
- shuffling gait
- lack of facial expressions
(all due to overstimulation of the basal ganglia by acetylcholine)
a nurse is assisting with a plan of care for the nutritional needs to a client who has stage 4 parkinson’s disease. which of the following actions should the nurse include in the plan of care?
- provide 3 large balanced meals daily
- record diet and fluid intake daily
- document weight every other week
- add thickener to liquids
- offer nutritional supplements between meals
- record diet and fluid intake daily
- add thickener to liquids
- offer nutritional supplements between meals
after drinking a large amount of fluid, the client reports a severe headache and is found to sweating profusely. the client’s blood pressure is 220/110 and HR of 54/min. which of the following actions should the nurse take first?
- call the provider
- sit the client upright in bed
- check the client’s bladder for distention
- administer an antihypertensive
sit the client upright in bed
this will naturally lower the blood pressure secondary to postural hypotension.
which of the following are other stimuli that could cause the client to experience autonomic dysrflexia? (SELECT ALL)
- kidney stone
- fecal impaction
- metabolic acidosis
- pulmonary embolism
- pressure ulcer
kidney stone
fecal impaction
pressure ulcer
(distention of the bladder is the most common cause. can include fractures too)
