Exam 3 Saunders Neuro Flashcards by megan kaiser

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

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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

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involuntary flexion of the hip and knee when the neck is passively flexed; indicates meningeal irritation

Brudzinski’s sign

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stiff extension of one or both arms, and possibly the legs; indicates a brainstem lesion

decerebrate (extensive) posturing

memory trick: (cerebrate-cerebellum–>brainstem)

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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)

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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

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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

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stiff neck, flexion of the neck onto the chest causes intense pain

nuchal rigidity

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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

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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

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Where is the respiratory center and breathing regulation?

Pons

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CSF normal pressure and normal volume

50-175 mm H20 is normal pressure

125-150 mL is normal volume

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Why is metformin withheld before a CT scan with contrast?

risk of metformin induced lactic acidosis

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Why is MRI contraindicated for pregnant women?

increase in amniotic temperature that occurs during the procedure may be harmful to the fetus

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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

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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

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rhythmic, with periods of apnea

can indicate a metabolic dysfunction or dysfunction in the cerebral hemisphere or basal ganglia

cheyne-stokes

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regular rapid and deep sustained respirations

indicates a dysfunction in the low midbrain and middle pons

neurogenic hyperventilation

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irregular respirations, with pauses at the end of inspiration and expiration
idicates a dysfunction in the middle or caudal pons

apneustic

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totally irregular in rhythm and depth

indicates a dysfunction of the medulla

ataxic

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cluster of breaths with irregularly spaced pauses

indicates a dysfunction in the medulla and pons

cluster breathing

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bilateral dilated, fixed pupils

ominous sign

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increased pulse and BP
dilated pupils
decreased peristalsis
increased perspiration

SNS

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decreased pulse and BP
constricted pupils
increased salivation
increased peristalsis
dilated blood vessels
bladder contraction

PNS

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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?

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

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