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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
Q

What are the symptoms of meningitis

A
  • headache
  • nuchal rigidity (neck stiffness)
  • photophobia
  • positive Kernig’s or Brudzinski’s sign
  • rash
  • altered LOC
  • seizures
  • increased ICP
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26
Q

How do we treat meningitis

A
  • antibiotics
  • antivirals (rarely)
  • dexamethasone (decadron) (steroid)
27
Q

What is Kernig’s sign

A
  • lay pt supine and flex the hip and knee
  • extend knee
  • if there’s pain/spasm = positive
  • positive = meningitis
28
Q

What is Brudzinski’s sign

A
  • lay pt supine
  • flex head/neck towards chest
  • if pt bends hips/knees = positive
  • positive = meningitis
29
Q

What is multiple sclerosis

A

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
Q

What is myasthenia gravis

A

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
Q

How do we treat myasthenia gravis

A
  • mestinon (muscle strengthener)
  • IVIG (immunotherapy)
  • plasmapheresis (removes antibodies from blood)
  • thymectomy (removal of thymus to improve swallowing)
32
Q

What is Guillain-Barre syndrome

A

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
Q

What is Parkinson’s disease

A

Slow progressing movement disorder caused by low dopamine levels
- resting tremor
- postural instability
- rigidity
- bradykinesia

34
Q

What is used to treat Parkinson’s

A

Carbidopa (Sinemet)
- can cause dyskinesia after several years of use

35
Q

What is status epilepticus

A

When a pt has more than one seizure before recovering
- medical emergency
- give IV valium or ativan to stop seizures

36
Q

What do you give a person who is in a coma when you don’t know what the cause is

A

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
Q

What is a persistent vegetative state

A

severe brain damage and in a state of “wakefulness without awareness”
- will smile, cry, moan or scream without any stimulus

38
Q

What are the non-modifiable risk factors for stroke

A
  • gender
  • prior stroke
  • genetics
  • age
39
Q

What are the modifiable risk factors for stroke

A
  • cardiovascular disease
  • diabetes
  • high cholesterol
  • alcoholism
  • HTN
  • obesity
  • migraine
  • sedentary lifestyle
  • sleep apnea
  • smoking
40
Q

What are the two types of strokes

A

hemorrhagic
ischemic

41
Q

What is a hemorrhagic stroke

A

Ruptured cerebral artery causes blood to fill the skull increasing ICP
- most common cause is HTN

42
Q

What is an ischemic stroke

A

Blockage in a cerebral artery leads to lack of blood flow and death of brain tissue

43
Q

What are the symptoms of a left sided stroke

A

Left gaze preference
right visual field deficit
right sided paralysis
right sided sensory loss
(most people are left brain dominant)

44
Q

What are the symptoms of a Right sided stroke

A

Right gaze preference
left visual field deficit
left sided paralysis
left sided sensory loss

45
Q

What would you see in a pt who had a stroke in the brainstem

A
  • N/V
  • diplopia/gaze palsy
  • dysphagia
  • vertigo
  • tinnitus
  • hemiparesis or quadriplegia
  • hemisensory loss or in all 4 limbs
  • decreased LOC
  • hiccups
46
Q

What would you see in a pt with a cerebellar stroke

A
  • truncal/gait ataxia
  • limb ataxia
  • neck stiffness
47
Q

What is the timeframe for treatment of a pt with stroke symptoms

A

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
Q

What is included in emergency care of a patient with an ischemic stroke

A
  • 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
Q

Why do we use cardiac monitoring with a stroke

A
  • right side strokes usually caused by arrhythmias
  • A-fib sometimes undetected until it causes a stroke
50
Q

What do we do for a patient with an elevated BP with an ischemic stroke

A

Treat extremely elevated BP
- systolic >220
- diastolic > 120
- MAP > 130
If pt is a candidate for fibrinolytic therapy, BP must be < 185/110

51
Q

How do you choose which antihypertensive to give for someone with an ischemic stroke

A

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
Q

What is cerebral edema

A

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
Q

What is endovascular therapy

A

Placement of a stent in the blocked artery in the brain after an ischemic stroke

54
Q

What is t-PA

A

Tissue plasminogen activator
- protein that converts plasminogen to plasmin
- plasmin breaks down clots

55
Q

What is the procedure for administering t-PA

A
  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
Q

What are the symptoms of a subarachnoid hemorrhage

A
  • excruciating headache
  • nuchal rigidity
  • photophobia
  • diplopia
  • blurred vision
  • stroke symptoms
  • pituitary deficits
57
Q

What is a cerebral arteriovenous malformation (AVM)

A

a jumble of veins and arteries in the brain that can rupture leading to hemorrhagic stroke (usually subarachnoid hemorrhage)

58
Q

How do we treat subarachnoid hemorrhage

A

cerebral vasospasm: triple H therapy
- hypertensive/hypervolemic/hemodilution
- oral nimodipine
- cerebral angioplasty
-

59
Q

What are the different types of (brain) hematomas

A
  • epidural
  • subdural
  • intracerebral
60
Q

What is diffuse axonal injury

A

Injury to the neurons in the brain caused by the twisting of the axons (cannot be repaired)

61
Q

What is the most important intervention when caring for someone with a brain injury

A

blood pressure control

62
Q

What is a normal range for intracranial pressure

A

0-15 mmHg

63
Q

What is cerebral perfusion pressure

A

calculated number: MAP - ICP = CPP
normal CPP = 70 - 100 mmHg

64
Q

What is a brain herniation

A

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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