Exam 3 Saunders Neuro Flashcards
Syndrome characterized by paroxysmal hypertension, bradycardia, excessive sweating, facial flushing, nasal congestion, pilomotor responses, and HA. Occurs with spinal lesions above T6 after the period of spinal shock is complete. Triggers include visceral stimulation from a distended bladder or impacted rectum. This is a neurological emergency and must be treated immediately to prevent a hypertensive stroke.
autonomic dysreflexia aka autonomic hyerreflexia
dorsiflexion of the big toe with extension; elicited by firmly stroking the lateral aspect of the sole of the foot
is a pathological or abnormal reflex in anyone older than 2 years and represents the presence of CNS disease
babinski reflex
involuntary flexion of the hip and knee when the neck is passively flexed; indicates meningeal irritation
Brudzinski’s sign
stiff extension of one or both arms, and possibly the legs; indicates a brainstem lesion
decerebrate (extensive) posturing
memory trick: (cerebrate-cerebellum–>brainstem)
flexure of one or both arms on the chest and possibly stiff extension of the legs; indicates damaged cortex
decorticate (flexor) posturing
memory trick: (corticate-cortex damage)
loss of the ability of a supine client to straighten the leg completely when it is fully flexed at the knee and hip-indicates meningeal irritation
Kernig’s sign
occurs most commonly in clients with injuries above T6 and usually is experienced soon after the injury. Massive vasodilation occurs, leading to pooling of the blood in the blood vessels, tissue hypoperfusion, and impaired cerebellar metabolism
neurogenic shock
stiff neck, flexion of the neck onto the chest causes intense pain
nuchal rigidity
a complete but temporary loss of motor, sensory, reflex, and autonomic fxn that occurs immediately after injury as the cord’s response to the injury. Usually last less than 48 hours but can continue for several weeks
spinal shock
an inability to recognize a physical impairment on one side of the body. It occurs most commonly in clients who have had a right cerebral stroke.
unilateral neglect or neglect syndrome
Where is the respiratory center and breathing regulation?
Pons
CSF normal pressure and normal volume
50-175 mm H20 is normal pressure
125-150 mL is normal volume
Why is metformin withheld before a CT scan with contrast?
risk of metformin induced lactic acidosis
Why is MRI contraindicated for pregnant women?
increase in amniotic temperature that occurs during the procedure may be harmful to the fetus
When is lumbar puncture contraindicated?
Lumbar puncture is contraindicated in clients with increased ICP bc lumbar puncture will cause a rapid decrease in ICP and may lead to brain herniation
Why do we assess pupils?
unilateral pupil dilation suggests compression of the third cranial nerve
midposition fixed pupils indicates midbrain injury
pinpoint pupils indicate pontine damage
rhythmic, with periods of apnea
can indicate a metabolic dysfunction or dysfunction in the cerebral hemisphere or basal ganglia
cheyne-stokes
regular rapid and deep sustained respirations
indicates a dysfunction in the low midbrain and middle pons
neurogenic hyperventilation
irregular respirations, with pauses at the end of inspiration and expiration
idicates a dysfunction in the middle or caudal pons
apneustic
totally irregular in rhythm and depth
indicates a dysfunction of the medulla
ataxic
cluster of breaths with irregularly spaced pauses
indicates a dysfunction in the medulla and pons
cluster breathing
bilateral dilated, fixed pupils
ominous sign
increased pulse and BP
dilated pupils
decreased peristalsis
increased perspiration
SNS
decreased pulse and BP constricted pupils increased salivation increased peristalsis dilated blood vessels bladder contraction
PNS
Early indication of increased ICP?
altered consciousness (then comes the HA, abnormal respirations, rise in BP with widening pulse pressure, slowing of pulse, elevated temp, vomiting, pupil changes)
Late signs of ICP
increased systolic BP, widened pulse pressure, and slowed heart rate, weakness to hemiplegia, a positive babinski reflex, docorticate or decerebrate posturing, seizures
What do you do if some one has ICP?
maintain mechanical ventilation with PaCo2 at 30-35 mm Hg, which will result in vasocontriction of the cerebral blood vessels, decreased blood flow, and therefore, decreased ICP.
What do high CO2 levels in blood do?
increases ICP
Why give anticonvulsants in increased ICP
seizures increase metabolic requirements and cerebral blood flow and volume,thus increasing ICP. Anticonvulsants may be given prophylactically to prevent seizures
why give antipyretics and muscle relaxants to clients with increased ICP?
temperature reduction decreases metabolism, cerebral blood flow, and thus intracranial pressure. Muscle relaxants prevent shivering
Why give BP meds to someone with increased ICP?
blood pressure medication may be required to maintain cerebral perfusion at a normal level. Notify HCP if systolic bp is 150.
Why give corticosteriods to pt with increased ICP?
corticosteriods stabilize the cell membrane and reduce leakiness of the BBB and also reduce cerebral edema
Why give IV fluids to a pt with increased ICP?
a hyperosmotic agent increases intravascular pressure by drawing fluid from the interstitial spaces and from teh brain cells. Monitor renal fxn and expect diuresis
How often do you measure drainage from the hemovac or jackson-pratt drain?
q8hours and record the amount and color-notify HCP if >30-50mL per shift
what is fluid restriction post-craniotomy?
1500mL/day
How often do you perform ROM exercises post craniotomy?
q8h
Loss of motor fxn and vibration, position and deep touch sensation on same side as the cord damage and loss of pain, temp and light touch on the opposite side
Brown-Sequard syndrome
central cord syndrome
loss of motor fxn is more pronounced in the upper extremities
anterior cord syndrome
motor fxn, pain, and temp sensation are lost below the level of the injury. the sensations of position, vibration, and touch remain intact.
posterior cord syndrome
motor fxn remains intact, but vibration, crude touch, and position sensation are lost
conus medullaris syndrome
follows damage to the lumbar nerve roots and conus medullaris in the spinal cord. Bowel and bladder areflexia and flaccid LE. if damage is limited to the upper sacral segments of the spinal cord, bulbospongiosus penile (erection) and micturition reflexes remain intact
cauda equina syndrome
injury to the lumbosacral nerve roots below the conus medullaris. Areflexia of the bowel, bladder, and LE
usually fatal
injury C2-C3
Where is the major innervation to the diaphragm by the phrenic nerve?
C4
S2 and S3 center on micturition
therefore below this level the bladder will contract but not empty (neurogenic bladder)
Injury above ______ allow males to have an erection, but they are unable to ejaculate bc of Sympathetic nerve damage
S2
CNV
diff chewing
CN VII
Facial paralysis
CN IX and X
dysphagia
CN XI
absent gag reflex
CN XII
impaired tongue mvmt
the inability to recognize familiar objects or persons
agnosia
characterized by loss of ability to execute or carry out skilled movements or gestures, despite having the desire and physical ability to perform them
apraxia
What breathing pattern is common in a stroke
cheyne stokes
expressive aphasia
damage to Broca’s area of the frontal brain. The client understands what is being said, but is unable to communicate verbally
receptive aphasia
injury involves Wernicke’s area in the temporoparietal area. Client is unable to understand the spoken and often the written work.
global or mixed aphasia
language dysfunction occurs in expression and reception
Stroke interventions
airway
VS
usually a bp of 150/100 is maintained to ensure cerebral perfusion
client is more at risk for ICP first 72 hours post stroke
position client on his side with HOB 15-30 degrees
How long can the client be positioned on the affected side following a stroke (with regard to the turning schedule)?
2 hours on unaffected side, then 20 minutes on affected side. position client prone for 30 mins 3 times/day
a chronic, progressive, noncontagious , degenerative disease of the CNS characterized by demyelination of the neurons
Multiple Sclerosis
caused by insufficient secretion of acetylcholine, excessive secretion of cholinesterase, and unresponsiveness of the muscle fibers to acetylcholine
myasthenia gravis
weakness and fatigue, diff chewing and swallowing, dysphagia, ptosis, diplopia, weak, hoarse voice, diff breathing, diminished breath sounds, respiratory paralysis and failure
myasthenia gravis
bradykinesia, abnormal slowness of mvmt, and sluggishness of physical and mental responses, akinesia, monotonous speech, handwriting that becomes progressively smaller, tremors in hands and fingers at rest (pill rolling), tremors increasing when fatigued and decreasing with purposeful activity or sleep, rigidity with jerky mvmts, restlessness and pacing, blank facial expression; masklike faces, drooling, diff swallowing and speaking, loss of coordination and balance, shuffling steps, stooped position, and propulsives gait
Parkinson’s Disease
flaccid facial muscles, inability to raise the eyebrows, frown, smile, close the eyelids, or puff out the cheeks
upward mvmt of the eye when attempting to close the eyelid
loss of taste
bells palsy
what is the major concern in Guillain-Barre syndrome?
difficulty breathing-monitor respiratory status closely
eventually, the respiratory muscles become affected, leading to respiratory compromise, pneumonia, and death
Amyotrophic Lateral Sclerosis (ALS)
presence of cold sores, lesions, or ulcerations of the oral cavity, history of insect bits and swimming in fresh water, exposure to infectious disease, travel to areas where the disease is prevalent, n/v, fever, nuchal rigidity, changes in LOC, signs of increased ICP, motor dysfunction and focal neurological deficits
Encephalitis
assess for Kernigs and Brudzinski’s signs
Encephalitis
CSF is analysized to determine the diagnosis and type. CSF is cloudy, with increased protein, increased WBC and decreased glucose
Meningitis (transmitted by direct contact, including droplet)
mild lethargy, photophobia, deterioration in the LOC, nuchal rigidity, Kernig’s sign, Brudzinski’s sign, red, macular rash or abdominal and chest pain
meningitis
red, macular rash with meningococcal meningitis
abdominal and chest pain with viral meningitis
What do you do with a patient with pneumococcal meningitis?
maintain respiratory isolation
how do you assess cerebral response to pain?
sternal rub, placing upward pressure on the orbital rim, or squeezing the clavicle or sternocleidomastoid muscle
abdominal cramps, n/v/d, pupillary miosis, hypotension and dizziness, increased bronchial secretions, increased tearing and salivation, increased perspiration, bronchospasm, wheezing, and bradycardia
cholinergic crisis-give atropine sulfate
Sinemet, Levodopa, Mirapex, Cogentin
Anti Parkinsons meds
which anti parkinson med is dangerous if taken with an MAOI?
levodopa
signs of blood dyscrasia
sore throat, bruising, nose bleeds (anticonvulsants)
Who cant get Romazicon?
increased ICP or status epilepticus bc Romazicon will reverse benzodiazepines
elevate HOB, avoid Trendelenburg position, and prevent flexion of the neck and hips
nursing management of IICP
what is normal ICP?
5-15 mm Hg
Autoregulation to maintain constant blood flow to the brain becomes ineffective when the MAP is below ___
50mm HG which causes the brain to become ischemic
Autoregulation becomes ineffective when MAP is above _____ because the vessels are maximally _____.
150 mm Hg, constricted
What is CPP?
the pressure needed to ensure blood flow to the brain. Normal is 60-100mm Hg.
What level of CPP is incompatible with life?
a CPP less than 30 mm Hg is incompatible with life.
Cushings Triad
increased SBP, widening pulse pressure, bradycardia with a full, boudning pulse, and irregular RR
cingulate herniation
displacement of brain tissue to the opposite hemisphere beneath the falx cerebri
What is the priority intervention during intraventricular catheterization?
aeseptic technique to prevent infection
during ICP monitoring, the patient may be at risk for development of increased ICP when the height of the P2 wave is ______ than the p1 wave.
higher
Where should hte transducer of the ICP monitor be?
level with the tragus of the ear
What consideration is necessary when measuring ICP using a CSF drainage device?
device must be closed at least 6 mins prior to reading in order to get an accurate reading
what is a complication of removal of CSF during ICP monitoring?
ventricular collapse
What measures brain oxygenation and temperature?
Licox brain tissue oxygenation catheter
What is the normal range for the pressure of oxygen in brain tissue? (PbtO2)
20-40 mmHG
What do barbs do to manage IICP?
Barbituates decrease cerebral metabolism
What happens to the brain if malnourished?
cerebral edema
What three criteria does the Glascow Coma Scale measure?
Eye openning, vest verbal response, best motor response
Testing the pupillary response to light is testing function of which cranial nerve?
CNIII
Testing the corneal reflex is testing the function of which cranial nerves?
CN V and CNVII
Testing for oculocephalic (doll’s eyes) reflex is testing for fxn of which CN?
All CN’s involved w eye mvmt
If a patient is unconscious at the time of a head injury with a brief period of consciousness followed by a decreased in LOC what do you suspect?
arterial epidural hematoma which is the most acute neurological emergency
If a patient is exhibiting nonspecific, nonlocalizing progression of alteration in LOC occurring over weeks or months, what do you suspect?
chronic subdural hemotoma
If a patient is exhibiting a rapid deterioration of neurologic function within 24-48 hours following a head injury, what do you suspect?
acute subdural hematoma
When a patient is admitted to the ED following a head injury, the nurse’s first priority in management of the patient once the airway is confirmed is
maintaining cervical spine precautions; always assume a patient with a head injury has a cervical spine injury until cleared
symptoms of visual disturbances and seizures may indicate a tumor where?
occipital lobe
what is the most common malignant brain tumor?
a glioblastoma multiforme
what are the highest risk factors for thrombotic stroke?
hypertension and diabetes
dysarthria
Dysarthria is a condition in which you have difficulty controlling or coordinating the muscles you use when you speak, or weakness of those muscles.
What would hyperventilation of a stroke patient do?
Hyperventilation of a stroke patient would vasodilate and thus increase risk for hemorrhage
