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NUR 340 > Exam 2: week 7 > Flashcards

Exam 2: week 7 Flashcards

1
Q

What are the five components of a neuro exam

A
  • level of consciousness
  • motor function
  • pupillary function and eye movement
  • respiratory patterns
  • vital signs
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2
Q

How do we assess level of consciousness

A

Glasgow Coma Scale (GCS)
-earliest and most reliable measure of increased intracranial pressure (ICP)
- increased ICP causes decreased blood flow to the brain depriving it of blood and glucose causing mental status changes
- brain does not store glucose; needs blood flow for energy

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3
Q

What are the categories of the GCS

A

Eye opening
- spontaneous = 4
- to speech = 3
- to pain = 2
- none = 1
Motor function
- obeys commands = 6
- localizes pain = 5
- withdraws to pain = 4
- abnormal flexion = 3
- abnormal extension = 2
- none = 1
Verbal
- oriented = 5
- confused conversation = 4
- inappropriate words = 3
- incomprehensible sounds = 2
- none = 1

LESS THAN 8, INTUBATE

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4
Q

What do you call abnormal flexion

A

decorticate
(hugging)

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5
Q

what do you call abnormal extension

A

decerebrate

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6
Q

what is a dermatome

A

an area of skin innervated by one spinal nerve
- different on everyone
- T4 is always at the nipple line
- T10 is always at the umbilicus

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7
Q

What are the cranial nerves in order

A

I- olfactory (smell)
II- optic (sight)
III- oculomotor (pupils and movement)
IV- trochlear (eyes down and in)
V- trigeminal (corneal reflex)
VI- abducens (eyes towards ears)
VII- facial (face)
VIII- acoustic (hearing; cold calorics)
IX- glossopharyngeal (gag)
X- vagus (gag)
XI- spinal (SCM and trapezius)
XII- hypoglossal (tongue)

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8
Q

What is the cold caloric test

A

Tests oculovestibular reflex
- spray cold water in ear
- normal response is vomit
- negative = absent reflex
- oculomotor and abducens CN (III, VI)

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9
Q

What is “dolls eyes”

A

Tests oculocephalic reflex
- when you move your head, your eyes should move as well
- absent = abnormal

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10
Q

What is anisocoria

A

unequal pupil sizes

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11
Q

What does PERRL stand for

A

pupils equal and reactive to light

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12
Q

What is diplopia

A

Double vision
- indicates problem with CN II, IV, or VI

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13
Q

What is Cushing’s triad

A

Indication of increased ICP
- systolic hypertension (diastolic stays the same causing a widened pulse pressure)
- bradycardia
- respiratory changes (hyperventilation then bradypnea)

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14
Q

What happens to the brain when your temperature increases

A

every tenth of a degree increases the brain’s need for oxygen

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15
Q

What are some signs of a Basilar skull fracture

A

Racoon eyes - bruises around the eyes
Battle’s sign - bruise behind the ear
Halo sign - blood coming from the nose or ears surrounded by cerebrospinal fluid (CSF)

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16
Q

What is ptosis

A

eyelid lag - muscle weakness caused by brain injury
- more commonly in stroke than trauma

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17
Q

What is hemianopsia

A

visual field defect
- usually one sided in stroke
- approach from affected side so they learn to accommodate

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18
Q

What is glaucoma

A

The silent thief of sight
- optic nerve damage caused by increased intraocular pressure (IOP)
- open angle vs closed angle
- cholinergic eye drops to reduce IOP
- surgery to drain aqueous humor

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19
Q

What’s the difference between open angle and closed angle glaucoma

A

open angle = no obstruction, looks normal
closed angle = obstruction, no drainage = increased IOP

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20
Q

What is Meniere’s disease

A

Abnormal inner ear fluid leading to hearing loss, tinnitus, and vertigo

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21
Q

How do we treat Meniere’s disease

A
  • low salt diet
  • medications
  • surgery is vertigo is incapacitating (surgery is elective and will cause pt to go deaf in that ear)
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22
Q

What is an acoustic neuroma

A

slow-growing benign tumors of CN VIII (acoustic nerve)
- diagnosis confirmed with an MRI

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23
Q

What are the treatment options for acoustic neuromas

A

open surgery = optimal unless problems with anesthesia
radiosurgery = gamma knife; does not remove it but stops it from growing
sometimes need to sacrifice hearing in one ear

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24
Q

What is meningitis

A

Inflammation of the lining of the brain and spinal cord (bacterial or viral)

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25
What are the symptoms of meningitis
- headache - nuchal rigidity (neck stiffness) - photophobia - positive Kernig's or Brudzinski's sign - rash - altered LOC - seizures - increased ICP
26
How do we treat meningitis
- antibiotics - antivirals (rarely) - dexamethasone (decadron) (steroid)
27
What is Kernig's sign
- lay pt supine and flex the hip and knee - extend knee - if there's pain/spasm = positive - positive = meningitis
28
What is Brudzinski's sign
- lay pt supine - flex head/neck towards chest - if pt bends hips/knees = positive - positive = meningitis
29
What is multiple sclerosis
when the myelin sheath of CNS neurons are damaged, inflamed, and scarred - autoimmune attack of myelin - progressive and debilitating - no cure - symptoms exacerbated by stress and warm weather
30
What is myasthenia gravis
Autoimmune disorder that attacks and damages the neuromuscular junction - weakness/fatigue worse later in the day - ocular symptoms (ptosis, diplopia) - bulbar symptoms (weakness of face and throat)
31
How do we treat myasthenia gravis
- mestinon (muscle strengthener) - IVIG (immunotherapy) - plasmapheresis (removes antibodies from blood) - thymectomy (removal of thymus to improve swallowing)
32
What is Guillain-Barre syndrome
Autoimmune syndrome involving the rapid demyelination of peripheral (and some cranial) nerves - usually after a viral infection - ascending weakness, hyporeflexia Treatment includes plasmapheresis and IVIG
33
What is Parkinson's disease
Slow progressing movement disorder caused by low dopamine levels - resting tremor - postural instability - rigidity - bradykinesia
34
What is used to treat Parkinson's
Carbidopa (Sinemet) - can cause dyskinesia after several years of use
35
What is status epilepticus
When a pt has more than one seizure before recovering - medical emergency - give IV valium or ativan to stop seizures
36
What do you give a person who is in a coma when you don't know what the cause is
Thiamine (low thiamine can cause coma) Glucose (hypoglycemia can cause coma) Narcan (opioid overdose can cause coma) giving these won't hurt anyone so might as well try it
37
What is a persistent vegetative state
severe brain damage and in a state of "wakefulness without awareness" - will smile, cry, moan or scream without any stimulus
38
What are the non-modifiable risk factors for stroke
- gender - prior stroke - genetics - age
39
What are the modifiable risk factors for stroke
- cardiovascular disease - diabetes - high cholesterol - alcoholism - HTN - obesity - migraine - sedentary lifestyle - sleep apnea - smoking
40
What are the two types of strokes
hemorrhagic ischemic
41
What is a hemorrhagic stroke
Ruptured cerebral artery causes blood to fill the skull increasing ICP - most common cause is HTN
42
What is an ischemic stroke
Blockage in a cerebral artery leads to lack of blood flow and death of brain tissue
43
What are the symptoms of a left sided stroke
Left gaze preference right visual field deficit right sided paralysis right sided sensory loss (most people are left brain dominant)
44
What are the symptoms of a Right sided stroke
Right gaze preference left visual field deficit left sided paralysis left sided sensory loss
45
What would you see in a pt who had a stroke in the brainstem
- N/V - diplopia/gaze palsy - dysphagia - vertigo - tinnitus - hemiparesis or quadriplegia - hemisensory loss or in all 4 limbs - decreased LOC - hiccups
46
What would you see in a pt with a cerebellar stroke
- truncal/gait ataxia - limb ataxia - neck stiffness
47
What is the timeframe for treatment of a pt with stroke symptoms
door-to-doctor = 10 min dr. exam = 15 min door-to-CT = 25 min door-to-CT read = 45 min door-to-thrombolytic therapy = 60 min neurosurgical procedure = 2 hours admitted and monitored = 3 hours
48
What is included in emergency care of a patient with an ischemic stroke
- frequent neuro assessments - vitals (all) - IV (avoid D5W) - antipyretics (fever is bad, treat even 99 degree fever) - control hyper and hypoglycemia (>140 and <60) - Make NPO (swallow screen to avoid aspiration) - manage elevated BP - cardiac monitoring
49
Why do we use cardiac monitoring with a stroke
- right side strokes usually caused by arrhythmias - A-fib sometimes undetected until it causes a stroke
50
What do we do for a patient with an elevated BP with an ischemic stroke
Treat extremely elevated BP - systolic >220 - diastolic > 120 - MAP > 130 If pt is a candidate for fibrinolytic therapy, BP must be < 185/110
51
How do you choose which antihypertensive to give for someone with an ischemic stroke
labetalol - used when you want to lower BP in a patient with baseline tachycardia Nicardipine - preferred if patient has bradycardia, CHF, or a history of COPD or bronchospasm
52
What is cerebral edema
Swelling of the brain due to large, multilobar infarcts - peaks 3-5 days post ischemic stroke - only a problem in the first 24 hours if large cerebellar infarcts or young patients - this causes increased ICP (monitor GCS)
53
What is endovascular therapy
Placement of a stent in the blocked artery in the brain after an ischemic stroke
54
What is t-PA
Tissue plasminogen activator - protein that converts plasminogen to plasmin - plasmin breaks down clots
55
What is the procedure for administering t-PA
1. Insert lines before administering (Foleys, IV, art lines, NG tubes) 2. draw waste dose from bottle; have another nurse verify 3. bolus 10% of dose over 1 minute 4. administer remaining 90% of dose continuously over 60 minutes 5. evaluate closely for throat and mouth edema 6. no antithrombotic or antiplatelet drugs for 24 hours after administration
56
What are the symptoms of a subarachnoid hemorrhage
- excruciating headache - nuchal rigidity - photophobia - diplopia - blurred vision - stroke symptoms - pituitary deficits
57
What is a cerebral arteriovenous malformation (AVM)
a jumble of veins and arteries in the brain that can rupture leading to hemorrhagic stroke (usually subarachnoid hemorrhage)
58
How do we treat subarachnoid hemorrhage
cerebral vasospasm: triple H therapy - hypertensive/hypervolemic/hemodilution - oral nimodipine - cerebral angioplasty -
59
What are the different types of (brain) hematomas
- epidural - subdural - intracerebral
60
What is diffuse axonal injury
Injury to the neurons in the brain caused by the twisting of the axons (cannot be repaired)
61
What is the most important intervention when caring for someone with a brain injury
blood pressure control
62
What is a normal range for intracranial pressure
0-15 mmHg
63
What is cerebral perfusion pressure
calculated number: MAP - ICP = CPP normal CPP = 70 - 100 mmHg
64
What is a brain herniation
Increased ICP pushes the brain out of position - pushes to center of brain - pushes against bone - pushes against rigid folds of dura mater compression of oculomotor nerve is an early sign leads to brain death

NUR 340 (10 decks)

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