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Exam 2 neuro Flashcards

1
Q

what is the goal of neuro problems?

A

prevent further injury

achieve goal by understanding foundations of neuro function so that disfunction is easily identified

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2
Q

what are the neuro problems?

A
  1. traumatic brain injury (TBI): inter-cranial pressure monitoring
  2. cerebrovascular accident (CVA/stroke): tissue plasminogen activator (TPA) and cerebral aneurysm
  3. seizures
  4. spinal cord injuries
  5. Guillain-barre
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3
Q

what is an open TBI?

A

Basilar skull fracture
(Visible on the external skull)

KEY FINDING
Clear or blood-tinged drainage from the eyes, ears, nose that is positive for glucose = Cerebrospinal Fluid (CSF)

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4
Q

what is a closed TBI?

A

Concussion

Clinical findings: brief loss of consciousness, headache, retrograde amnesia (memory loss of events immediately prior to injury)

Contusion
(more emergent)

Described as:

Coup- affecting one area of the brain due to impact

Contrecoup- affecting the area opposite of coup

Together- Coup-Contrecoup
Typically affecting the frontal and occipital lobes

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5
Q

what are the different areas of the brain?

A

frontal lobe
temporal lobe
brainstem
cerebellum
occipital lobe
pariental lobe

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6
Q

motor control (premotor cortex), problem solving (prefrontal area), and speech production (Broca’s area)

A

frontal lobe

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7
Q

auditory processing (hearing), language comprehension (Wernicke’s area), memory/info retrieval

A

temporal lobe

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8
Q

involuntary responses

A

brainstem

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9
Q

balance and coordination

A

cerebellum

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10
Q

sight (visual cortex) and visual reception and visual interpretation

A

occipital lobe

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11
Q

touch perception (somatosensory cortex) and body orientation and sensory discrimination.

A

pariental lobe

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12
Q

what are the 3 types of cerebral hematomas?

A
  1. Epidural hematoma- rapid accumulation of blood in the epidural space.
    -Rapid increase in ICP leading to death
    -Intermittent loss of consciousness and waking.
  2. Subdural hematoma
    -Often resolve but may need intervention depending on the lobe involved
  3. intracerebral hematoma
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13
Q

what is the treatment for cerebral hematomas?

A

The treatment of brain hematomas depends on the severity of the bleed, the location of the bleed, and presentation of the patient condition.

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14
Q

What do you need to monitor for increased ICP?

A

early s/s:
agitation
restlessness/irritability
change in LOC
decreased mental status
sudden vomiting
without nausea

late s/s:
seizures
posturing (decorticate and decerebrate)
Cushing triad

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15
Q

what are the late deadly signs of increased ICP?

A

lungs: irreg. respirations and Cheyne strokes respirations

neck: nuchal rigidity (stiff neck)

brainstem affected:
-eyes: pupils (fixed and dilated, unequal) 8mm (normal = 2-6mm)
-foot: babinski reflex (toes fan out when stimulated = BAD)

seizures and coma

abnormal posturing: decorticate and decerebrate

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16
Q

focus on recognizing the _________ in ICP and _________ interventions.

A

changes
proper

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17
Q

what does ICPS stand for?

A

I- Immobilize C spine. Log roll patient

C- CO2 low: lower CO2 means lower ICP. CO2 dilates vessels and will increase ICP.

P- Positioning: 30-35 degrees (semi-fowlers), no flexing/bending, no coughing, sneezing, etc

S- Suctioning: 10 seconds or less, infrequent, hyperventilate patient

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18
Q

what are the interventions for hematomas?

A

Airway, breathing, circulation – vital signs w/ O2 sat

Stabilize cervical spine(Position client with HOB 30-45 degrees elevation)

Intubate (GCS <8) or if gag reflex impaired or absent
Control external bleeding
Maintain normothermia

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19
Q

what is important to know for prevention of 2nd injury, concussion and contusions, and skull fx in hematomas?

A

Prevent secondary injury:
by treating cerebral edema and increased ICP

Concussion and contusion:
monitor and manage ICP

Skull fractures:
If CSF leak, prophylactic antibiotics
Surgery –elevate depressed bones, remove fragments; craniectomy and cranioplasty

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20
Q

what needs to be managed with hematomas?

A

Manage intracranial pressure monitoring system and ICP: Manage nausea and vomiting Minimize environmental stimulation

Manage eye problems- prevent corneal damage

Manage hyperthermia (goal 36-37 deg C/96.8-98.6 F): Cooling blanket, etc

Manage CSF leak – rhinorrhea or otorrhea – notify HCP
Teach client not to sneeze or blow nose
No NGT or perform NT suctioning – if basilar skullfracture r/f meningitis

Implement seizure precautions and prophylaxis

Manage headache

Prevent VTE, skin breakdown

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21
Q

A nurses assesses the GCS of a patient who is resting with eyes closed. When the nurse speaks to the patient, they open their eyes. What eye opening score would you give this patient?

A

3
the pt opened eyes to speech

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22
Q

A nurses is assessing the GCS of a patient admitted with a TBI following a motor vehicle accident. When asked where they were, the patient responded his “dorm room” and stated that his dad, who was at the bedside was his roommate. What verbal response score would you give this patient?

A

4
the pt is speaking with intention, but appears confused

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23
Q

A nurses is assessing the GCS of a patient admitted with a TBI following a motor vehicle accident. When assessing the patient for motor response using the Babinski reflex, the nurse notes that the patient’s toes fan out. What does this indicate about the patient and what score would you give?

A

3
When the Babinski reflex is tested, the toes should extend or point down normally. A positive Babinski test indicates brain stem involvement

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24
Q

What is the scoring on the Glasgow coma scale (GCS)?

A

13-15 mild
9-12 moderate
3-8 severe
less than 8 = intubate

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25
an osmotic diuretic, elevates blood plasma osmolality, resulting in enhanced flow of water from tissues, including the brain and cerebrospinal fluid, into interstitial fluid and plasma.
Mannitol
26
what is important to know about mannitol?
Used to decrease ICP Must be given IV Systemic edema may occur due to enhanced flow of fluid AWAY from the brain and INTO interstitial space. Watch for signs of heart failure as a result
27
what other meds are used for neuro problems?
Phenytoin- prevents seizures Steroids- decrease swelling Phenobarbital- barbiturate to decrease brain activity
28
what is the #1 risk factor for strokes?
1 risk factor- Hypertension (over 140 systolic)
29
what are the types of strokes?
ischemia hemorrhagic
30
what are the interventions for strokes?
Stroke risk decreases by 50% when blood pressure is controlled. Nursing intervention: Pt EDUCATION to be compliant with BP meds
31
A nurse is caring for a patient who is recovering from a stroke. The nurse notes that the SBP is over 200. What is the best nursing intervention?
Reduce SBP slowly and keep above 170 for first 24-48 hours. This allows the body to normalize rather than having a hypotensive response.
32
What does BE FAST stand for?
B = balance (loss of balance, HA, dizziness) E = eyes (sudden loss of vision in 1 or both eyes) F= face (does the persons face look uneven?) A= arm (weak) S= speech difficulty T = time to call 911
33
What are the S/S of a stroke?
New and sudden loss of balance or dizziness. Sudden, SEVERE headache is most often associated with cerebral aneurysm rupture Sudden loss of vision related to pressure on the occipital lobe Facial drooping or uneven smile New and sudden one-sided weakness, most often manifested as unilateral arm drop Slurred speech or difficulty communicating words appropriately TIME IS BRAIN
34
What is important to know about left brain stroke?
language & logic dysphasia reading or writing probs R hemiparesis (1 sided weak) R side neglect Note: Pt safety: consider which side is stronger Responsible for our verbal abilities
35
what side is affected in a L brain stroke?
Left brain = Right side affect
36
what is important to know about a right brain stroke?
reckless & really creative lack of impulse control behavior changes L hemiparesis (1 sided weak) L side neglect Note: Pt safety: strong side AND behavior and impulse control Can be difficult for families to witness
37
what side is affected in a R brain stroke?
Right brain = Left side affect
38
what is important to know with strokes?
Last known well time determines the start of the stroke Arrival to stroke center/ED = 0 minutes to treatment A CT scan MUST be done to determine treatment approach Ischemic or embolic stroke = blocked vessels tPA is the treatment of choice if started within 60 minutes of arrival to care center
39
how is tPA given and what does it do?
IV injection dissolves blood clots and restores blood flow
40
what is the nursing management for strokes?
Neuro assessment every 1-2 hours, NIH stroke scale Vital signs including ICP, CPP every 1-2 hours and prn Respiratory status I&O, fluid balance, IV fluids, ECG and cardiac enzymes Serum electrolytes especially sodium Bladder and Bowel function Ability to communicate
41
what are the interventions for a stroke?
1. Administer rt-PA as ordered 2. Perform bedside swallow screening 3. Support respiratory function 4. Elevate HOB 30 degrees 5. Place NG tube of feeding tube for nutrition and medication administration - Implement aspiration precautions 6. Bleeding precautions for clients receiving thrombolytics or anticoagulants 7. Positioning, mobility, ROM 8. Manage client with unilateral neglect and visual field cut 9.Obtain PT and OT evaluations early 10. Aphasia Interventions 11. Provide skin care, early mobility, eye care, mouth care Implement 12. Prevent constipation 13. Hemorrhage precautions (preop) if applicable *risk for rebleed 14. monitor for complications
42
what is important to know about managing a client with unilateral neglect and visual field cut?
inattention to weak or paralyzed side Neglect syndrome – decreased safety awareness – injury Encourage to use affected side when performs ADLs Approach from affected side and sit on affected side Anchoring (light house strategy) scan affected side
43
what are the aphasia interventions?
Provide repetitive directions Break tasks down to one step at a time Repeat names of objects frequently used Allow time for patient to comprehend and answer Speak slowly and calmly with simple words/sentences Use picture board, communication board or computer technology Consult speech therapy
44
what are the hemorrhage precautions?
BP control Bedrest Dark quiet room, keep calm Stool softener No restraints Increase HOB 30 degrees
45
what are the teachings for strokes?
1. BP control 2. Stroke diagnosis 3. Activation of EMS 4. Warning signs and symptoms stroke 5. Client specific and family specific risk factors for Stroke 6. Smoking cessation 7. Diet needs (high fiber and adequate fluid intake) 8. Medications for prevention of stroke 9. ”FAST”
46
what are the spinal cord injuries?
cervical injury (C1-C8) thoracic injury (T1-T12) lumbar injury (L1-L5) Acuity of injury depends on location of the spine
47
Cervical injury?
Effects all 4 limbs- Quadriplegia (tetraplegia) Respiratory- Impaired breathing = life threat
48
thoracic injury?
effects lower limbs (paraplegia) legs, bladder, bowels
49
lumbar injury?
effects legs and bladder
50
what do spinal cord injuries complications lead to?
lead to emergency and life-threatening problems
51
what is the pharmacology for spinal cord injuries?
neurogenic shock: IV fluids and vasopressors (increase BP) steroids "-sone": prednisone and dexamethasone muscle relaxers
52
The spinal injury creates a disrupted communication between the sympathetic nervous system and parasympathetic. what is this Life-threatening emergency?
Autonomic Dysreflexia
53
what are the nursing interventions for spinal cord injuries?
1. notify HCP 2. correct the cause: -bladder assessment (palpate bladder, bladder scanner, check the foley for kinks) -bowel assessment -remove "constrictive" clothing -measure BP 3. BP meds (AFTER assessment)
54
what are the seizure precautions?
side rails up side lying position seizure pads against the side rails pillow under head suction available bed in low position curtain for privacy
55
acute inflammatory demyelinating polyneuropathy
Guillain-Barre syndrome most cases are preceded by an infection such as campylobacter jejuni enteritis
56
S/S of Guillain-Barre syndrome?
paresthesia in the hands and feet symmetrical muscle weakness (usually begins in the legs and ascends) severe respiratory muscle weakness (necessitating vent support may develop) absent or depressed deep tendon reflexes Early signs of respiratory failure are inability to cough and inability to lift head and eyebrows
57
what is the treatment for Guillain-Barre syndrome?
modalities of disease modifying therapy for GBS are plasma exchange and IV immune globulin (IVIG).
58
Autonomic dysreflexia?
spinal cord injury at T-6 or higher triggered by sustained stimuli at T-6 or below from: restrictive clothing blister dehydration broken bones fecal impaction anxiety pressure areas full bladder or UTI *almost any stimulus below T6
59
The communication between_______ and PNS is disrupted causing vasodilation above the injury and _______________ below.
SNS Vasoconstriction
60
what are the 2 biggest probs that arise with neurogenic shock?
hypotension and bradycardia. Vasopressors like epi and norepi are used to improve hemodynamics
61
what are the causes of neurogenic shock?
spinal cord injury above T5 spinal anesthesia vasomotor center depression (ex: severe pain, drugs, hypoglycomia)
62
what increases the risk for a stroke?
HTN increases the risk for stroke because of the constant added pressure of the cerebral vessels. This may cause weakness (hemorrhagic) or there may be plaque build up (ischemic)
63
what do we want to see with an increased ICP?
We want “dolls eyes” that move with head movement. Indication of intact brain stem.

COMPLEX (23 decks)

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