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Medsurg 2 > Exam 4- Neuro > Flashcards

Exam 4- Neuro Flashcards

1
Q

What should the range be for CPP?

A

60- 80

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2
Q

How to calculate CCP?

A

MAP-ICP = CPP

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3
Q

What is the priority intervention for stroke?

A

Ct scan

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4
Q

What are the 3 signs of cushing’s triad?

A

Bradycardia, widened pulse pressure ( ↑ SBP), abnormal respirations

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5
Q

What is the babinski reflex? Is it good?

A

Stroke the middle of foot, toes flare out
Bad sign in adults

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6
Q

What are interventions to decrease ICP

A

Maintain airway
Elevate HOB, maintain head/neck in neutral position ( log roll), change position slowly, avoid cluster care, minimize stimulation, oxygenate, maintain hydration, avoid coughing/ blowing nose

Avoid vaalsava

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7
Q

What does GCS scoring look at?
Interprete scores

A

Looks at eye, verbal and pain stimuli response

15 is best
3 is worst
Higher the score, better the patient

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8
Q

What should map be for spinal cord injury patients?

A

80-85

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9
Q

What is a TIA?

A

Transient ischemic attack ( mini stroke)

Cerebral artery is temporarily blocked, ↓ blood flow.

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10
Q

What is a thrombotic stroke?

A

Strokes caused by thrombus that develops in arteries that supply blood to brain

(area deprived of blood)

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11
Q

What is an embolic stroke?

A

When fatty plaque or blood clots forms in body, breaks loose and travels to the brain in the bloodstream

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12
Q

What is a hemorrhagic stroke?

A

Happens when a blood vessel breaks and bleeds into brain

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13
Q

Risk factors for stroke

A

HTN, HLD, DM, smoking, and obesity

Not ETOH

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14
Q

What do we assess after stroke?

A

ABC’s
Cognitive, motor, sensory changes
Cranial nerve, cv, psychosocial, and lab assessment
Retrieve imaging (CT, MRI, US)

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15
Q

What does the left side of the brain control?

A

Movement
Critical thinking
Logic & reasoning
Science, math, writing and number skills

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16
Q

What does a left brain stroke cause?

A

R sided weakness, paralysis and sensory impairment

Problems w/speech and understanding (aphasia)

Visual problems, inability to see R visual field of each eye

17
Q

What does the right side of the brain control

A

Movement of left side
Imagination, intuition, insight
Special recognition
Art/ musicia awareness
Holistic thought

18
Q

What does a right sided brain stroke cause?

A

Paralysis of L side
Vision problems
Quick, over curious behavior
Poor decision making
Facial weakness or problems swallowing
Memory loss

19
Q

What is the drug therapy for strokes?

A

Tnrombolytic, anti-coags
Lorazepam (other antiepileptics)
Calcium channel blockers
Stool softeners
Analgesics (pain)
Antianxiety drugs
Neuroprotective drugs (antioxidants)

20
Q

What surgical management do we do for stroke?

A

Carotid artery angioplasty w/stenting
Endarterectomy
Extracranial - intracranial bypass

21
Q

What does BE FAST stand for?

A

F-ace drooping
A-rm weakness
S-peech difficulty
T- ime, call 911 also pertains to TPA admin

22
Q

What is unilateral neglect?

A

Attention disorder arising from cerebral cortex injury
Pt fails to respond to stimuli on affected side (opposite side Otto what side of brain is injured, R brain L neglect)

Affects everyone different

23
Q

What tests do we do for unilateral neglect?

A

Line bisection test
Divide line from the length they perceive

24
Q

What’s a sign of unilateral neglect?

A

Displaying behaviors such as eating only half of their plate, shaving half of their face

They pretend like half their body isn’t there

25
Q

Unilateral neglect interventions

A

Feedback training
Eye patching
Neck muscle vibration
Mirror therapy
Prism adaptations
Visual exploration training

26
Q

What is normal ICP levels?

A

7-15
Icp > 15= abnormal pressures
ICP > 20 = pathological

27
Q

Difference between primary and secondary brain injury

Give examples of secondary brain injury

A

Primary: open/ closed head injury and fractures

Secondary: any processes that occur after initial injury and worsens pt outcomes. Occurs bc delivery of O2/glucose to the brain is interrupted

Intracranial HTN, cerebral edema

28
Q

Describe an epidural hematoma

A

Between skin and scalp

29
Q

Describe a subdural hematoma
What is most commonly from?
How fast does bleeding occur?

A

Venous bleed beneath dura and above arachnoid

Most commonly from tearing of bridging veins or from lacs of brain tissue

Bleeding occurs more slowly, symptoms mirror epidural hematoma

30
Q

Early s/sx of ↑ICP

A

Loc change, irritable, confused, restless
Increasing drowsiness (reticular activating system compromised)
Head ache -increasing in intensity, unrelieved by analgesics

31
Q

Late s/sx of ↑ICP

A

Loc: comatose
Posturing (brainstem compromise)
V/S: Cushings triad = brainstorm compromise

32
Q

Late s/sx of ↑ ICP (respiratory)

A

Abnormal respiration: cheyne stokes (wax/Wayne of depth/rate )
Apneustic (pause w/inspiration)
Cluster ( irregular breathing w/period of apnea)
Ataxic (irregular depth/rate, pauses= brain stem compromise)

33
Q

Late s/sx of ↑ ICP (neuro)

A

Reflexes:
Babinski
No corneal/ gag (brainstem issues = ↑ aspiration & corneal abrasions)

Facial palsy (weakness, cranial near brainstem)
Pupil changes (cranial nerve 3)

34
Q

What are the most common problems of TBI

Main focus of TBI

A

↓ cerebral tissue perfusion
↓ memory sensation and /or mobility

Main focus: maintain cerebral perfusion (cpp) and cognitive rehabilitation

35
Q

What is CPP? What does it represent?
Why would it be impaired?

A

Net pressure gradient that drives O2 delivery to cerebral tissue

Represents cerebral blood flow (CBF)

Impaired with TBI/impaired auto regulation

36
Q

List the steps of ↑ intracranial volume (brain, blood, csf)

A

↓ or absent compliance
↑ ICP and ↓ CPP
↓ cerebral blood flow
↓ pao2, ↑ paco2, ↓ ph
Vasodilation
= ↑ intracranial volume
Repeat!

37
Q

Loss of central autoregulation leads to 2 things, which both lead to more issues, what are they?

A
  1. ↑ blood pressure
    = ↑ cerebral blood volume, ↑ extravasation edema = ↑ ICP
  2. ↓ blood pressure
    = ↓ cerebral blood volume, ↑ hypoxia, hypercarbia and acidosis = ↑ ICP
38
Q

What is the goldstandard for monitoring ICP

A

Ventriculostomy system
Allows monitoring and draining of fluid

Medsurg 2 (7 decks)

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