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Nursing School 8 Med Surg 3 > Exam 3 Neuro > Flashcards

Exam 3 Neuro Flashcards

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1
Q

Why would you need an NG tube for epidural hematoma

A

abdominal distention which could lead to IICP

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2
Q

What does ptt mean

A

pain temperature, sensation loss below the level of the lesion. Has to cross over.

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3
Q

When should you do quad cough

A

before a meal or 2 hours after meal. (4x/day)

this is for aspiration pneumonia, SCI

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4
Q

CD 4 Levels for HIV positive & AIDS patient

A

CD4 level below 200

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5
Q

Characteristics of epidural hematoma

A
  • emergency
  • loss of consciousness, lucid period, progresses to coma
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6
Q

Manifestations of neurogenic shock

A

bradycardia, hypotension

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7
Q

What are the 3 components of ICP

A
  1. brain tissue
  2. cerebral blood flow (CBF
  3. CSF
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8
Q

What is IgG

A

tissue fluid and plasma, activates complememnts. Usually autoimmune.

found in blood and extracellular fluid control infection of body tissues. Binds many kinds of pathogens such as viruses, bacteria, and fungi, IgG protects the body from infection

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9
Q

Craniall Nerve VII

A

innervates muscles of expression

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10
Q

Seizure characteristics

A
  • metabolic disorder, alcohol withdrawal
  • electrolyte disturbances, heart disease
  • oxygen, suction (for aspiration)
  • anticonvulsion- bleeding risk, can’t drive
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11
Q

What determines if client is “brain dead”

A

no eye activity, cold caloric test

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12
Q

Normal Level for ICP

A

10-15 mmHG

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13
Q

Who should nurse refer for client diagnosed with a brain tumor

A

social worker

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14
Q

What types of drugs do rehabilitation facilities not take

A

Intravenous

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15
Q

This type of hematoma forms slowly and results from a venous bleed

A

subdural hematoma

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16
Q

Post Op Craniotomy things to watch for

A
  • may be intubated, arterial and central venous lines
  • Vasodilate- CO2 - due to bleeding risk first 24 hrs
  • avoid extreme head rotation
  • risk for IICP.
  • relieve pain
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17
Q

Name your priorities for head injury and dehydrated patient

A
  1. complete neuro assessment
  2. notify the physician
  3. assess specific gravity
  4. start iv fluids and administer desmopressin

This is Diabetes Insipidus

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18
Q

What does rheumatoid arthritis and SLE have in common

A

joint stiffness and pain

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19
Q

First line of defense for increase ICP

A

Hyperventilation, because CO2 causes vasodilation which make it worse

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20
Q

Positioning for infratentorial surgery

A

flat or 30-45 degrees.

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21
Q

The brain stem is made up of 3 components

A

midbrain, pons, medulla

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22
Q

how is HIV tested

A
  • blood test with ELISA
  • if positive another ELISA
  • then Western Blot
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23
Q

How is range of motion performed

A

with another person, maintains mobility and flexibility while pt on bed rest

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24
Q

autonomic dsyreflexia intervention

A

straight cath every 4-8 hours

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25
Q

Nutrition prior to having EEG

A

can eat but no caffeine

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26
Q

Sjogren syndrome

A

dry eyes and dry mucous membranes

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27
Q

overall characteristics of autoimmune

A

fatigue/weakness. Eat well, sleep well.

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28
Q

What organ specificallly is concerning for SLE

A

kidney, proteinuria

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29
Q

Nursing interventions autonomic dysreflexia

A

elevate HOB, 45 degrees, notify physician, determine cause

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30
Q

Pre op pituitary tumor instruction

A

do not blow nose for 2 weeks after surgery, could leak CSF fluid

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31
Q

What is the action of phentoin (dilantin)

A

Decreases synaptic transmission antiarrthythmic, limits seizure by altering ion transport

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32
Q

What is a priority problem for client diagnosed with RA?

A

Alteration in comfort due to chronic pain

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33
Q

Frontal Lobe

A
  • broca’s area for speech.
  • Moral Emotions, reasoning judgment concentration, abstraction
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34
Q

What preprocedure should nurse implement prior to EEG

A

stay awake for 24 hours. Goal is to have a seizure, flashing lights, hyperventilation will induce.

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35
Q

Technical position to put patient in for spinal cord injury suspected

A

leaning forward with head over the knees. Neck should be immobilized prior to x-rays

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36
Q

What is the most common brain tumor

A

infratentorial, located posterior (cerebellum or brainstem)

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37
Q

Preventitive nursing measures for brain injury

A

oxygenation, bladder and urine output, dressing, pad and side rails

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38
Q

What is areflexic (flaccid bladder)

A

lost ability to contract and easily stretching. Allow large amounts of urine to accumulate. Bladder can overflow and leak (SIADH). SCI sacral spinal cord. Cred method

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39
Q

If you are a first responder for a head injury, what would you implement first

A

stabilize client’s cervical spine. Always assume head injury has a spinal injury

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40
Q

Diet for SLE

A

limit sodium and protein intake (should be well balanced)

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41
Q

Prevention of head injury

A

helmets, seatbelts car seats,

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42
Q

If a client has slow breathing what does that cause

A

acidotic, build up of CO2, pressure

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43
Q

Pre op Craniotomy

A
  • Hair will be clipped or shaved
  • awaken with a dressing and a drain on head
  • headache and facial swelling for 2-3 days after surgery
  • baseline neuro assessment
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44
Q

Intervention for minimizing risk for seizure activity undergoin diagnostic studies after having several episodes of sezure

A

Cabamazepine Tegretol 200 mg, twice a day

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45
Q

teaching when taking immunosuppressive

A

class C drug, should not get pregnant.

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46
Q

Nursing Dx for Spinal Cord Injury

A
  • Ineffective breathing pattern r/t respiratory muscle fatique
  • Impaired skin integrity r/t immobility
  • impair urinary elimination
  • constipation r/t neurogenic bowel
  • risk for autonomic dyreflexia
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47
Q

What is an example of natural immunity

A

breastfeeding

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48
Q

In a client with RA what assessment requires immediate intervention

A

signs of depression

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49
Q

Lumbar puncture, aseptic or sterile

A

aseptic

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50
Q

Prevent injury during lumbar puncture

A

do not move during insertion, lie on side curling forward so that kneees are flexed toward the chest.. DOES NOT USE DYES TO INJECT IN THE BODY.

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51
Q

Nursing Dx for Head Injury

A
  • Risk for ineffective cerebral tissue perfusion r/t interrupted CBF (hematoma)
  • Hyperthermia r/t metbaolism, infection hypothalamic injury
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52
Q

Discharge teaching with dilantin/phenytoin

A

brush teeth after every meal to avoid gingival hyperplasia

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53
Q

Prevention Tx with RA

A

exercise, increase muscle strenth, improves joint stability, preserve joint motion/flexibility, boosting aerobic condition.

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54
Q

What is hyperreflexic bladder

A

overactive, holds less than urine than before SCI. Frequent small urinations. Upper Motor Neuron.

Recommendation: Valsalva Maneuver

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55
Q

Discharge teaching for craniotomy

A
  • may need to take anticonvulsants for up to 12 months after surgery
  • adverse drug reactions should be reported (drowsiness, confusion)
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56
Q

Who can help finding employment after spinal cord injury?

A

Rehabilitation commission

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57
Q

Manifestation of basilar skull fracture

A
  • Battle’s sign (bruising mastoid)
  • Bulging of tympanic membranes
  • CSF
  • tinnitus or hearing difficulty
  • rhinorrhea
  • facial paralysis
  • deviation of gaze
  • vertigo
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58
Q

Cranial Nerve II

A

Optic Nerve, sensory repsoniible for vision. Use the snellen chart to assess for visual acuity. Or visual field in four places.

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59
Q

CREST syndrome and SLE

A
  • Calcium deposits
  • Raynauds phenomenon
  • Esophageal dysmotility
  • Sclerodactyly (fingers stiffen)
  • Telangiectasis (spider like hemangiomas
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60
Q

Halo Sign and Closed Head injury

A

CSF leakage. Monitor and inform the physician, not an emergency though.

61
Q

Nursing Care for autonomic dysreflexia

A

sitting position, catheter to re-establish patency, check rectum for fecal mass, admiin IV antiHTN (slowly)

62
Q

headache treatment

A

transduction, NSAIDS, heat, or cold

modulation: yoga, herbs acupuncture

63
Q

Rehabilitation for spinal cord injury, medical nursing implementation

A

DVT risk, physical immobility, SQ anticoagulants (Lovenox)

64
Q

What drug do you give for Autonomic dysreflexia

A

hydralazine/apresoline IV–vasodilate, alpha blocker

65
Q

Early Signs of ICP

A

pupils fixed, Inc BP, Ataxia (can’t move), Uneven gate, 8 GCS, Rapid/deep breathing

66
Q

What is important characteristic to know about TBI

A

it is a process not an event. Risk for urinary retention or constipation.

67
Q

where does sensory lie in brain

A

dorsal root (white matter)

68
Q
A
69
Q

What is the term called for RA sign?

A

ulnar drift

70
Q

Why do we taper steroid medication

A

because adrenal stops producing cortisol, allows adrenal to gradually start producing again.

71
Q

Leading cause of seizures in the elderly

A

CVA

72
Q

Nursing Dx for ICP

A
  • Ineffective Cerbral Tissue Perfusion
  • Impaired Physical Mobility
73
Q

Head ache issue arise from

A

vessel issues, constricted or dilated

74
Q

What is an important goal for a client diagnosed with a brain tumor and has self care deficit

A

client can perform adl’s with assistance

75
Q

If someone has a low GCS score, why should be clean their eyes

A

corneal irritation

76
Q

When is lumbar puncture contraindicated

A

IICP can lead to brain herniation

77
Q

pathophysiology of autoimmune

A

auto-antibodies, directed against cellular DNA

78
Q

Teaching for a brain tumor patient that has diminished gag reflex

A

direct food and fluid toward the unaffected side

79
Q

In a spinal cord injury what causes headch and high blood pressure,

A

bladder distention

80
Q

Vital Signs for increasing ICP

A

high temp, high bp, low pulse, low respirations

81
Q

What is SLE

A

autoimmune disease may have genetic or hormonal component. Exaggerated production of antibodies.

82
Q
A
83
Q

Cushings triad

A

systolic hypertension, widening pulse pressure, bradycardia, bounding pulse, irregular respirations)

84
Q

Discharge instruction for epileptic client

A
  • Record seizure activity, avoid over the counter medications, check serum levels regularly
85
Q

Risks for intracranial hematoma aspiration (epidural, subdural, intracerebral)

A

infection, seizures, immobility, cerebral edema, permanent neurologic deficitys, coma, death

86
Q

Procedures for Rheumatoid Arthritis

A

arthrocentesis, tissue biopsy, blood studies (ESR, CPT)

87
Q

Spinal Cord Injury Proper technique for CPR

A

jaw thrust maneuver

88
Q

risk for intracerebral hemorrhage

A

needs craniotomy, control icp, blood clot

89
Q

population with head injury

A

15-24 years

90
Q

What is a conceptual pupil response

A

crossed reflex in which light directed at one eye causes contraction of both eyes

91
Q

Anticonvulsant medication for posttraumatic seizure

A

Dilantin (phentoin)

92
Q

Why is a craniotomy peformed

A
  • To expose brain for tx
    • ventricular shuntin, tumor/ absecc,excision, hematoma aspiration, anurysm clipping
93
Q

Diagnostic test for SLE

A

CBC and antinuclear antibody tests

anemia, leukopeia, thrombocytopenia

94
Q

What should you monitor when administering phytoin

A

vital signs and cardiac status

95
Q

Dopamine (Intropin)

A

Indication: Improve BP, CO, and Urine Output (neurogenic shock)

Action renal vasodilation

Class- adrenergic, vasopressor

Nursing: irritation at IV site, beta blocker may counteract effects, hemodynamic values,

96
Q

What could be a discrete symptom of ICP

A

unusual sleepiness

97
Q

Nursing intervention to prevent valsalva maneuver

A

instruct pt to exhale when turning or moving in bed

98
Q

In a person with RA what do movable nodules in SQ tissue represent

A

rapidly progressive destruction of affected tissue

99
Q

Nurse intervention for patient experiencing vertigo

A

(Menier’s disease) pt in bed with pillow on either side of head.

100
Q

If nurse sees someone having a seizure what action should nurse implement first

A

note the first thing the client does during the seizure

101
Q

What can sun exposure trigger for patient with SLE

A

itchy discoid rash

102
Q

What is the primary goal for SLE

A

maintenatce of organ function. Can cause MI, pericarditis, pneumonia, and pleural effusion.

103
Q

What are the 3 most common complications in pts with neuro disorders?

A
  • respiratory infection, UTI, infected pressure ulcers
104
Q

What should you observe after concusiion

A

changes in level of consciousness, difficulty awakening, lethargy, dizziness, confusion, irritability

105
Q

Why do you need to take NSAIDS on a full stomach

A

can cause ulcers

106
Q

Manifestations of spinal shock

A

flaccid paralysis, loss of reflex activity below the level of injury, bradycardia, hypotension, paralytic ileus

107
Q

Hematoma treatment

A

think blood, bleeding edema, mannitol, respiratory acidosis or alkalosis.

108
Q

Complication for a craniotomy

A

diabetes insipidous (monitor i/os), increased ICP, hemorrhage, infection, respiratory compromise

109
Q

What is the most serious type of hematoma

A

epidural hematoma

110
Q

Occiptal Lobe

A

visual area

111
Q

Can client who is unconcious eat?

A

No, NPO

112
Q

If a patients body is rigid and making guttural sounds. Legs are contracting and relaxing, which action do you take first?

A

Ease the client to the floor

113
Q

Skin Care and SLE

A

dry skin by patting, risk for abrasians and breakdown. Use mild soap

114
Q

Treatment for ICP

A
  • Ventilation
  • IV flud therapy
  • Mannitol (osmotic diuretic)
  • sedation and anesthesia
  • Stool softener
115
Q

Discharge instruction for pt with hypophysectomy

A
  • sleep with HOB elevated
  • keep humidiefier in the room
  • use caution when perfomring oral care
  • notify HCP if developing a cold or fever
116
Q

Characteristics of cognitive improvement

A

able to stay on task, judment, memory, reasoning

117
Q

Priority Nursing Actions for Autonomic Dysreflexia

A
  1. raise hob
  2. loosen tight clothing
  3. check bladder distention or noxious stimulus
  4. administer antihypertensive medication
118
Q

Where does autonomic dysreflexia get stimulated

A

below level fo SCI

119
Q

Where is suprtentorial tumor located

A

anterior 2/3rds of the brain, mainly cerebrum (thought, action)

120
Q

Raynaud’s phenomenon

A

causes some areas of your body — such as your fingers and toes — to feel numb and cold in response to cold temperatures or stress. In Raynaud’s disease, smaller arteries that supply blood to your skin narrow, limiting blood circulation to affected areas (vasospasm)

autoimmune disorders

121
Q

Cushing’s Triad

A

decreasing pulse, alteres respirations, increased BP. Late sign of ICP

122
Q

Normal Size of pupil

A

2-5 mm

123
Q

Neurogenic shock treatment

A

dopamine, vasopressing, epinephrine, atropine

124
Q

Positioning for Suprtentorial surgery

A

elevated 30 degrees to promote venous outflow through jugular veins

125
Q

Parietal lobe

A
  • taste, pain, temperature, pressure
  • spatial perception
126
Q

Cranial Nerves III, IV, VI

A

eye movement.

127
Q

Late signs of ICP

A

fixed dilated pupils, decreased HR, Widening Pulse Pressure, Decerebrate, Decorticate, Less than 8 GCS, slow breathing

128
Q

Which 4 nerves are affected to incrase in ICP

A

optic II, oculomotor III, trochlear IV, abducens V

129
Q

Temporal Lobe

A
  • auditory center
  • Wernicke’s area for sensory and speech
130
Q

Who would you referr a RA patient to

A

occupational therapist to utilize hands

131
Q
A

emotional and visceral patterns for survival. Learning and memory.

132
Q

What antigen should be matched for organ transplantation

A

human leukocyte antigen

Risks are rejection and infection.

133
Q

When does autonomic dysreflexia occur?

A

spinal cord lesions above t6 after spinal shock has subsided. reaction to overstimulation

134
Q

Where does motor senses lie in brain

A

ventral root

135
Q

Cranial Nerve V

A

sensation to the face and innervation to the muscle of mastication

136
Q

What should you assume regarding unconcious patient and hearing

A

assume they can hear

137
Q

A client has HIV, what is urgent to tell a HCP

A

dehydration, tented skin

138
Q

CSF contains what 2 things

A

proteina and glucose

139
Q

Risk with aspirin

A

otoxicity, tinnusitis

140
Q

Reactions with autonomic dysreflexia

A

vasoconstriction increasing BP, throbbing headache, diaphoresis (above level of injury), bradycardia, goose bymps, spots in the visual field, anziety, anausea

141
Q

What do absense seizure look like

A

brief episodes of consciousness. Blank stare for a few seconds

142
Q

Epidural Hematoma Nursing Interventions

A
  • HOB no more than 30 degrees
  • sedative for agitation
  • NO narcotics
  • Stool softeners
143
Q

HIV diet

A

high calorie, high protein, low residue

144
Q

S/Sx of Autonomic Dysreflexia

A

nasal stuffiness, dilated pupils or blurred vision, sweating, goose pumps (piloerection)

145
Q

S/Sx of autonomic dysreflexia

A

pounding headache, sweating, nasal congestion, piloerection, hypertension

146
Q

Post Op Craniotomy

A
  • gradually increase level of activity
  • monitor neuro status
  • watch for pupil changes, weakness, headach and change in LOC (signs of IICP)
  • residual neuro deficits, family support
147
Q

First action if you see csf drainage for ear or nose

A

check for glucose

148
Q

Post op Lumbar Puncture

A

lie flat 4-8 hours

Nursing School 8 Med Surg 3 (1 decks)

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