EXAM 1 Flashcards
1
Q
tx of anaphylactic shock
A
Epinephrine, antihistamines, H2-blockers (Zantac), Bronchodilators (albuterol), Steroids
2
Q
be fast
A
balance eyes facial dropping arm /extremity speech time
3
Q
major cause of TIA
A
atherosclerosis
4
Q
clot formation = blocks passage of blood through artery
A
thrombotic ; most common
5
Q
blockage in the brain
A
ischemic
6
Q
bleeding in the brain
A
hemorrhagic
7
Q
major cause of hemorrhagic
A
htn
8
Q
what do you not give a patient with hemorrhagic stroke
A
anticoag and antiplatelet
9
Q
bleeding INSIDE brain caused by RUPTURE OF VESSEL
A
intracerebral hemorrhagic
10
Q
s/s of intracerebral hemorrhagic
A
headache and nausea / vomitting
11
Q
patient reports the worst headache of their life
A
subarachnoid hemorrhagic
12
Q
receptive aphasias- LANGUAGE COMPREHENSION
A
Wernicke’s
13
Q
expressive aphasia- SPEECH CONTROL
Brain stem- breathing
A
broca
14
Q
PERSONALITY MOTOR FUNCTION HIGHER LEVEL SOLVING SKILL
A
frontal lobe
15
Q
elevated bp in ischemic is what
A
this is ok because body is trying to maintain perfusion
16
Q
platelet inhibitors to give
A
Aspirin 325 mg
clopidogrel (Plavix)
17
Q
iicp can be caused by primary or secondary
A
primary: iicp happens at time of injury, trauma from a car accident
secondary: follows a primary injury. Hypoxia, ischemia, hypotension, edema and ultimately IIICP
18
Q
normal icp
A
5-15
19
Q
elevated icp
A
greater than 20
20
Q
how do we check if there is icp
A
pressure transducer
21
Q
1 cranial nerve
A
olfactory
22
Q
2 cranial nerve
A
optic
23
Q
3 cranial nerve
A
oculomotor
24
Q
4 cranial nerve
A
trochlear
25
5 cranial nerve
trigeminal
26
6 cranial nerve
abducens
27
7 cranial nerve
facial
28
8 cranial nerve
acoustics
29
9 cranial nerve
glossopharyngeal
30
10 cranial nerve
vagus
31
11 cranial nerve
accessory
32
12 cranial nerve
hypoglossal
33
cerebral perfusion pressure
60-100
| less than 50 is neuro death and ischemia
34
what to monitor for icp
glasglow coma scale best score 15
seizure safety
sensory/motor impairment
speech changes
35
priorities for icp
airway
| fluids and electrolytes
36
most reliable indicator of patients neuro status
change in loc
37
what is assessed is glascow coma scale
eyes
verbal
motor
38
icp hallmark signs
cushings triad : systolic hypertension with a widening pulse pressure, bradycardia with a full and bounding pulse, and irregular respirations
39
posture that is worse
decerebrate
40
what do you not want to do for a person suspected of icp
no lumbar puncture because it can cause herniation
41
what is the golden standard for monitoring icp
ventriculostomy
42
pao2
greater than or equal to 100
43
paco2
35-45
44
characterized by decreased reflexes, loss of sensation, and flaccid paralysis below the level of the injury.
This syndrome lasts days to months and may mask post injury neurologic function.
spinal shock
45
what do you look at for a spinal cord injury
dermatomes tell you the level of impairment
46
loss of vasomotor tone caused by injury and is characterized by hypotension and bradycardia.
Loss of sympathetic nervous system innervation causes peripheral vasodilation, venous pooling, and a decreased cardiac output.
neurogenic shock
47
neurogenic shock is usually...
t6 or higher injury
48
gold standard in diagnosing stability of the injury, location and degree of injury, and degree of spinal canal compromise.
ct scan
49
assess for soft tissue and neurologic changes and when there is unexplained neurologic deficit or worsening of neurologic status.
MRI
50
rules out any vertebral artery damage
ct angiogram
51
what can a neurogenic bladder lead to
autonomic dysreflexia
52
if no gag reflex....
plan for intubation
53
above t6 injury
decrease in SNS, bradycardia, atropine to increase hr
54
prevention of dvt
enoxaparin
55
used to maintain the mean arterial pressure at a level greater than 90 mm Hg so that perfusion to the spinal cord is improved.
dopamine / intropin
56
what to monitor with patient who has a SCI
monitor bp; high bp but low heart rate
57
intervention for their bp
sit them up to prevent postural hypotension
58
nursing management for sci
maintain ventilation; 2) Intact skin; 3) Bowel and bladder management program; 4) no episodes of autonomic dysreflexia
59
med given for spinal cord tumors
dexamethasone for edema
60
glascow coma scale
less than 8 intubate
61
loss of csf
rhinorrhea and otorrhea
62
wbc
3-12
63
hemoglobin
12-18
64
bun
10-20
65
creatinine
0.6-1.2
66
fasting glucose
70-100
67
a1c
4-5.6
68
a1c for diabetics
less than 7.0
69
total cholesterol
less than 200
70
ptt
20-35 seconds
71
pt
11.2-13.2 seconds
72
inr therapeutic
2-3.5
73
why is last known normal with a stroke patient important
tpa time frame is up to 4.5 hours
74
testing labs for stroke
CT scan (#1), weight (tpa), glucose a1c, lipids, coagulants, ekg (looking for dysrhythmias), echo, mri, carotid ultra sound, dysphasia screening
75
two anti platelet
aspirin and clopitagril
76
what does NIHSS tell us
```
tells us their disability - higher the # the worse they are.
neuro checks (orientation, LOC, speech, and extremity testing such as pronator drift)
```
77
diabetes, hyperlipidemia, previous stroke or tia, dysrhythmia, smoking, hypertension, sedentary lifestyle, cardiac abnormalities
risk factors for stroke
78
black label warning medication for headaches
imitrex given for cad patients
79
pill rolling (tremors), shuffle gait (bradykinesia), cog wheel (rigidity)
parkinson disease
80
what is issue with dopamine
parkinsons
81
tx for parkinsons
sinamet (levodopa/carvidopa)
82
what are we worried about with sinamet (levodopa/carvidopa)
* Worried about adherence, dosage changes and it is divided throughout the days
* Need consistent amount of moderate protein
* Can be a wearing off of medications
83
increased dopamine; genetic
hunting tons disease
84
what do we want to do with pt for huntingtons
they experience chorea- increased movements so we need to increase their caloric needs
85
progressive muscle weakness that happens in the upper body
myastenia gravis
86
what are we worried about w MG patient
respirations so do a respiratory assessment
87
interventions for patient with ALS
```
Care planning
Cognitively intact
Communication
Passive/ ROM
Skin assessment
Respiratory assessment
```
88
signs and symptoms of multiple sclerosis
bladder or vision disturbances
89
sclerotic plaques on myelin sheath
multiple sclerosis
90
MS paralysis
it can happen during a flare and tx w steriods to decrease the inflammation
91
intervention for MS
try to get ADLs is at once and quickly
92
intervention for epilepsy/seizure
find out what triggers are so they can stay away from them
93
lights, stress, smells, lack of sleep, caffeine, exercise, alcohol
some triggers for a seizure patient
94
tx for status epi
benzos; ending in pam
95
unwitnessed seizure what are we worried about
head and spinal cord injury so we would do assessments to rule this out
96
tx for seizures
gabapentin, keepra, Dilantin, Topamax
97
what is important for seizure meds
taper them down because abrupt stopping can cause seizures
98
trigeminal neuralgia
cranial nerve 5
99
tx for trigeminal neuralgia
antiepileptic drugs
100
bells palsy
cranial nerve 7
101
Cause of it being HSV or herpes, meningitis, tooth infection or any upper infection
bells palsy
102
what does bells palsy mimic
stroke
103
can you recover from bells
yes
104
Autoimmune response to something such as Vaccine, viral illness, bacterium
o Guillain-Barre
105
Guillain-Barre is paralysis
ascending which means it works its way up so we are worried about respiratory muscles
106
can you recover from guillain barre
yes
107
interventions for Guillain-Barre
assessments, respiratory, psychosocial
108
how do you treat viral meningitis
symptomatically
109
how do you treat bacterial meningitis
antibiotics
110
droplet isolation for which meningitis
bacterial
111
Stiff neck, nuchal rigidity, headache, photophobia, change in LOC, nausea and vomiting, papilledema
meningitis
112
what can cause icp
trauma, edema, fluid build up, tumor
113
interventions for patient with icp
having bowel movements, coughing, and turning patient
114
bruising over the mastoid process as a result of a brain bleed
battle sign
115
what to look out for with pt with icp
rhinorrhea, battles sign, halo sign
116
spinal cord injuries
autonomic dysreflexia
117
how do you know if a person with MOD is getting better
LOC improve, I and o is good, BUN, organ labs improve
118
dysphasia
difficulty speaking
119
mannitol
used as a diuretic to reduce cerebral edema
120
what are we checking for MODs
LOC, temp, color
121
management for mod
preventing dic; put them on heparin or lovanox, monitor for bleeding, bruising on skin
122
• Need to know when it started, stopped, what it looked like, how long, new onset
seizures
123
phases of seizure
* 1) prodromal (preceding seizure)
* 2) aural (sensory warning before seizure)
* 3) ictal (full seizure)
* 4) postictal (recovery after seizure)
124
what kind of diet can we recommend for seizure patient
ketogenic; high fat low carb
125
drug given for seizures and what do we want to monitor with it
Phenytoin (Dilantin)- liver complications
126
diagnostic lab for seizures
eeg
127
drugs given for symptoms with migraines
aspirin, acetaminophen, analgesic combo, imitrex
128
what to be careful about with imitrex
*(avoid with heart disease/constriction of arteries)
129
prophylactic drugs for migraines
topamax; be careful with abruptly stopping
130
which is worse decorticate or decerebrate
decerebrate more severe (brainstem and midbrain damage)
131
Kernigs sign
lifting knee up
132
Brudinski
lifting head up while supporting
133
modifiable risk factors associated with stroke
HTN, DM, hyperlipidemia, smoking, excessive alcohol, sleep apnea untreated, drug use (risk for hemorrhagic-cocaine), obesity, sedentary lifestyle, heart disease
134
non modifiable risk factors with stroke
age, gender, race (African American-higher risk), family history
o BUT REALLY: A fib, smoking, sedentary lifestyle, DM, excessive alcohol use
135
most common stroke
ischemic Thrombotic
136
which will you see collateral circulation
thrombotic because it is slower onset ; this will show up on a ct scan
137
rapid occurrence and lack of collateral circulation
embolic
138
major cause of hemorrhagic strokes
htn
139
any stroke patient...
is made NPO until they have receive dysphagia screening
140
what can you give for stroke patient and how is it given
aspirin asap unless they fail screening then it can be given rectal
141
total inability to communicate; massive stroke
global aphasia
142
loss of production of language
expressive aphasia
143
loss of comprehension
receptive aphasia
144
impaired ability to communicate; used interchangeably with aphasia
dysphagia
145
ok high bp in
ischemic stroke
146
how is NIHSS score
want it to be 0; higher the number the worse patient is
147
drug approach for restless leg syndrome
Sinemet (also used for PD), Requip, Mirapeto increase dopamine in brain
• Gabapentin: to decrease sensory sensations
148
disseminated demyelination of nerve fibers in brain and spinal cord; relapsing/remission disease
multiple sclerosis
149
• Weakness, paralysis of limbs, speech patterns delayed/interrupted, patchy blindness (early S&S), tinnitus, vertigo, sex dysfunction, bowel/bladder impairments, dysphagia, ataxia, dysarthia (weak speech muscles)
multiple sclerosis
150
“shock” sent down leg when neck flexed
• Lhermitte’s sign in MS
151
tx pt with MS
do adl in morning because they fatigue, may have to straight cath themselves
152
lack of dopamine in the brain
parkinson
153
unusual clumps of proteins; found in brains; contribute to dementia
lewy bodies with parkinson
154
what to take for parkinson and why do some people not take it
sinomet- carvidopa; it takes weeks for effect so some people think it is not working
155
weakness in certain skeletal groups (UPPER body); antibodies attack acetylcholine (ACh) receptors
myasthenia gravis
156
intervention for MG
rr, pulmonary assessment
157
in MG crisis they are high risk for
aspirating
158
drug for mg
Mestinon
159
what slows the process of also / drug
riluzole (Rilutek)
160
limb weakness, dysarthria (facial muscle weakness), dysphagia (difficulty swallowing), muscle wasting, fasciculations (involuntary muscle twitching), drooling, depression, sleep disorder, esophageal reflux
als
161
genetic, autosomal dominant
huntingtons disease
162
excessive dopaminergic(DA), excessive involuntary movements (CHOREA)
hunt
163
interventions for hunt
increase caloric needs due to increase in movement
164
cpp needs to be
60-100
165
eyes GCS
4-1
166
verbal GCS
5-1
167
motor GCS
6-1
168
• Minor head injury: > 13 Moderate: 9-12 Severe: <8
GCS
169
Pt comes in with cerebral edema.... what do we want to look out for
pt complaining of a headache
170
cushings triad tells us about
icp
171
increased SBP, decreased HR and RR
icp
172
decreased BP, increased HR and RR
shock
173
abnormal with basilar skull fracture
temp being high
174
what is the risk of otorrhea and rhinorrhea
risk for meningitis with high csf leak
175
bruising of brain tissue
contusion
176
brain hitting front or back of skull;worried about a c spine injury
Coup-Contrcoup injury with contusion
177
what to ask pt with a contusion
are they on anticoags ? increase risk of hemorrhage
178
sudden transient mechanical injury with disruption of neuronal activity and change in LOC
concussion
