Complex: Neurological

Question 1

Neuro: A positive glucose finding from fluid found from the eyes, ears, or nose is an indication of…

Answer 1

Cerebrospinal fluid usually as a result of a traumatic brain injury

Question 2

Neuro: Describe the common manifestations following a concussion

Answer 2

Brief loss of consciousness, headache, retrograde amnesia

Multiple concussions are shown to cause chronic traumatic encephalopathy, leading to changes in behavior and mental health

Question 3

Neuro: Describe the primary and secondary injuries that occur as a contusion

Answer 3

Coup and Contracoup

Coup refers to the primary injury endured on impact and the secondary injury endured on the opposite side of the brain is called a contracoup

Question 4

Neuro: Describe the characteristics of Cushing’s Triad

Answer 4

Cushing’s triad refers to a set of signs that are indicative of increased intracranial pressure (ICP), or increased pressure in the brain. Cushing’s triad consists of bradycardia, irregular respirations, and a widened pulse pressure

Question 5

Neuro: Describe early and late signs of increased intracranial pressure

Answer 5

Early: Restlessness, agitation, change in level of consciousness, mental status change, vomiting without nausea

Late: irregular breathing, seizures, posturing, fixed & dilated pupils, coma, cushing’s triad

Question 6

Neuro: Describe the differences in the manifestations of cerebral hematomas

Answer 6

Epidural Hematoma- Intermittent lucidity and then sudden loss of consciousness

Subdural Hematoma

Acute- gradual decrease in alertness that develops over 48 hr.

Subacute- neurologic deficits that increase up to 2 weeks after the initial head injury.

Chronic- decreases in cognitive perception over several months after the initial head injury.

Intracerebral hematoma- hemorrhagic stroke

Question 7

Neuro: Describe Cheyne Stokes respirations

Answer 7

A respiratory pattern that involves a period of fast, shallow breathing followed by slow, heavier breathing and moments without any breath at all

Cheyne Stokes is a late sign of increased intracranial pressure

Question 8

Neuro: Explain the ICPS acronym for use of a patient with an ICP monitor

Answer 8

ICPS is the acronym used to remember ways to prevent spikes in intracranial pressure

I- immobilize the C-spine

C- keep CO2 low in order to prevent vasodilation

P- keep head of bed 30-45 degrees

S- limit the amount of times you suction, hyperventilate when you do suction, and limit attempt to less than 10 seconds.

Question 9

Neuro: Describe levels of consciousness using the Glascow Coma Scale (GCS)

Answer 9

The higher the score on the GCS, the less severe the impact of an injury.

13-15 = mild

9-12 = moderate

3-8 = severe

A decrease in the GCS score is a priority for reporting to the doctor because it indicates a decrease in level of consciousness

Question 10

Neuro: Describe the use of Mannitol for management of ICP including side effects

Answer 10

Mannitol is an osmotic diuretic that elevates blood plasma osmolality, resulting in enhanced flow of water from tissues, including the brain and cerebrospinal fluid, into interstitial fluid and plasma. However, it can also cause fluid to shift into the interstitial space leading to peripheral edema and if not treated, heart failure

Question 11

Neuro: Describe the rationale for slowly decreasing blood pressure of a hypertensive patient who is recovering from a stroke

Answer 11

Patients who experience a hypertensive stroke should have careful management of their blood pressure so that a pseudo hypotensive state is not induced. This is done by slowly decreasing the systolic pressure over a period of 24-48 hours.

Question 12

Neuro: Describe the goal times for tPA treatment for an embolic stroke

Answer 12

The goal for treating an embolic stroke with tPA are time oriented. Best practice is to start tPA within 4 hours of last known well time and within 60 minutes of arrival at treatment center

Question 13

Neuro: Describe autonomic dysreflexia and the priority actions for treatment

Answer 13

Autonomic dysreflexia is a emergent condition that occurs in people with a spinal cord injury occurring at level T5-T6 who are experiencing a stimulus somewhere below the level of injury. Patients present with a sudden increase in blood pressure, decreased heart rate, anxiety, headache, diaphoresis, and skin flushing above the injury site.

The priority action is to eliminate the source of stimuli and then treat the symptoms caused by the condition.

Common stimuli include a blocked urinary catheter, full bladder, urinary tract infection, fecal impaction, tight clothing, and many other possible stimuli.

Question 14

Neuro: Describe the priority for caring for patients with known seizure disorder

Answer 14

Patient safety is the priority for seizure patients. This includes padded bedrails, bed in lowest position, suction set up, side-lying position

Question 15

Shock: Describe what is unique about neurogenic shock compared to other types of shock

Answer 15

Neurogenic shock occurs in patients with a high level spinal cord injury. Unlike other types of shock, patients in neurogenic shock become bradycardic due to the unopposed SNS and PNS

Question 16

Shock: Describe the 4 stages of shock
(*this can be seen with neurogenic shock and spinal shock)

Answer 16

Initial stage- not enough O2 in blood to perfuse organs;
usually asymptomatic

Compensatory stage- HR increases, RR increases, Renin &
Angiotensin released to try to balance, organs begin to fail

Progressive stage- Progressive poor perfusion leads to
cold, clammy skin

Irreversible- Death is imminent

Question 17

Understanding the pathophysiology of high level spinal cord injuries, describe the assessment priorities related to spinal shock.

Answer 17

Loss of reflexes.
Loss of motor control.
Low blood pressure
Decreased heart rate
Flaccid paralysis.
Urinary retention.
Fecal incontinence.
Spasms/ increased muscle tone