exam 5- nuero Flashcards
Frontal lobe- controls
s
s
m c
speech
, smell,
motor control
Parietal lobe- t x2
taste and touch
Temporal lobe controls
h
f r
hearing
facial recognition
Occipital lobe controls what
vision
Cerebellum controls what
- coordination
difference between Consciousness and Unconsciousness
Altered States of Consciousness
Consciousness: responsiveness to sensory stimuli (alertness and cognitive power)
Unconsciousness: inability of the brain to respond to stimuli
confusion
delirium
lethargic
Altered States of Consciousness
Confusion – unable to think clearly or rapidly
Delirium- sudden and more severe change in loc
Lethargic-lacking energy
stupor
coma
Altered States of Consciousness
Stupor – generally unresponsive, may be breifly aroused by painful or repeative stimuli
Coma -unarousable
etiology of Altered Consciousness
all these may cause increased what/ decreased what
trauma,
hypoxia,
infection,
poisoning,
seizures,
endocrine or metabolic disturbances,
electrolyte or acid-base imbalance,
CNS pathology,
congenital structural defect
all may cause increased cranial pressure (ICP) and decreased cerebral perfusion.
manifestations of Altered Consciousness
what decline
what posture
Decline in level of consciousness
Decorticate posturing
Decerebrate posturing
Altered Consciousness pneumonic
AEIOU-
alchohol,
epilepsy,
insulin,
opium,
uremia
Altered consounsess pneumonic
TIPSS-
tumor,
injury,
psyhiactric,
stroke,
sepsis
diagnostics for altered consciousness
c s
m
e
d s
what puncture
Ct scan,
mri,
eeg,
dopler studies,
lumbar puncture,
labs for altered consciousness
g
a
what function
t
serum
glucose,
abg,
liver function,
toxicology
, serum electrolytes, serum osmlalrity
what is priority in altered consciousness
identify
preserve
protect
identify cause
preserve brain function
protect ABC
tx for altered consciousness
put in what
give what
put in Cath
isotonic fluids
tx for altered consciousness
what for hypoglycemia
what for hyperglycemia
what for overdose
what for hyponatramia
what for meningitis
50% dextrose for hypoglycemia
insulin for hyperglycemia
naloxone for overdose
diuretics for hyponatramia
antibiotics for meningitis
signs that there is brain injury
Decoricate
Deceberate
Decoricate- posture is in the core of body
Deceberate posture is at the sude
Respirations x2
Assessment of Deteriorating Brain Function
Cheyne-stokes
Hyperventilation
Arousal / cognition
as impairment to the brain progreses, what is needed to get responses from pt
Assessment of Deteriorating Brain Function
higher intensity stimuli is required to elecite a response from pt
Motor responses–
pt may go from what to what
Assessment of Deteriorating Brain Function
pt may go from being able to repsond( squeeze hand)
to only being able to grimace and less purposeful movmements
Coma states / brain death-
what is persistent vegetative state
what is locked in syndrome
what is brain death
Assessment of Deteriorating Brain Function
Persistent vegetative state- permanent condition of complete unawareness of self/environment
Locked-in syndrome- pt is aware of surroundings, but cannot communicate
Brain death- irreversible damage to brain tissue
Generalized criteria Assessment of brain death-
c w/ no what
what repsiration
what pupils
what eyes
what brain waves
Coma w/ no motor/reflex movements
No spontaneous respirations
Pupils fixed and dilated
Doll’s eyes and no oculovestibular reflex
No brain waves (EEG)
how long do manifestations need to be present for for breath death
how long after coma/apnea
These have been present for at least 30 minutes to 1 hour
6 hours after coma/apnea
Neurologic assessment (brief)
loc->
vs->
pupils->
strength->
sensation->
- LOC- ask about time and place
- VS- take vitals
- Pupils- assess perlla
- Strength- asses againts resistance
- Sensation-assess how well they feel sensations and things
Olfactory 1- how assess
test ability to smell
Optic-2- how assess
assess Snellen eye chart
Oculamtoror3, trochlear4 and abducens6-
follow
assess
follow h
assess perrla
Trigeminal5 how assess
-test ability to feel sensation on face
Facial7- how assess
smile frown raise eyebrows
Acoustic8- how assess
assess hearing
Glossopharangyeal 9 and vagus 10- how assess
assess gag reflex
Spinal nerve11- how assess
shrug shoulders
Hypoglossal 12- how to assess
stick out toungue
glascow coma
EVM
what what number need interventions
Eye opening
Verbal response
Motor response
Want the highest number possible- under 7 may need Interventions
what interventions if low clascow coma scale
what managment
p
airway managemnt
pain
early Signs of increased ICP (Pediatric)
h
what changes
/
d
what vs
headache,
visual changes,
n/v(especially in kids),
dizziness,
changes in vs
late signs of increased ICP in PEDS
c t
what pupils
r
changes x2
Cushing’s Triad
BP (increased systolic)
Breathing - irregular
Bradycardia
Also nonreactive pupils
restlessness,
changes in loc, changes in motor repsonses
manamgent of pediatric LOC
first do what
then check what
figure out what caused it
Check brief neuro, LOC & Glasgow Coma Scale
diagnostics of pediatric altered LOC
L
L p
e
c/m
Labs,
Lumbar puncture,
EEG,
CT/MRI
interventions for pediatric altered loc
check
give
assisted
correct what
maintain what
Check BG,
give O2,
assisted ventilation,
correct imbalances,
maintain cerebral perfusion,
potential meds for pediatric altered loc
d
I
n
t
a
dextrose,
?insulin,
narcan,
thiamine,
?antibiotics)
Cerebral Edema
Increased Intracranial Pressure (IICP)
Increase of brain fluids
Hydrocephalus
Increased Intracranial Pressure (IICP)
Overproduction or abnormal reabsorption of CSF
Brain Herniation
Increased Intracranial Pressure (IICP)
Displacement of brain tissue
what icp is normal
what icp requires interventions
Increased Intracranial Pressure (IICP)
Normal icp is around 5-10. people become symtoatic around 12
12-15 require interventions
manifestations of increased intracranial pressure
what decreases
what posture
what vision
c t
what temp
LOC decreases (headahce / vomiting)
Hemiplegia / posturing
Altered vision / no PERRLA
cushings triad
hyperthermia
increased intracranial pressure
whaat is Cushing’s triad
b
b
b
high bp
bradycardia
irregular breathing
Diagnosis:_
c
m
icp what
Increased Intracranial Pressure (IICP)
ct,
mri
, icp transducer_____
Medications:
what to decrease fluid
what to induce coma
what for hyperthermia
what for seizure
f
anti what
what for gi
Increased Intracranial Pressure (IICP)
osmotic dieurtic (mannitol), maybe loop dierteiic,
potential induction of coma(propofol),
hyperthermia (acetaminophen),
seizures- diazapem,
fluids,
antihypertensives,
ppi(pantoprazole)
Earliest sign of increased ICP is change in what
Increased Intracranial Pressure (IICP)
in LOC & respirations!
Increased Intracranial Pressure (IICP)- medical treatments
s
what monitoring
m v
surgery
icp monitoring
mechanical ventilation
Increased Intracranial Pressure (IICP) Goal:
preserve what
prevent what
Preserve brain function
prevent secondary brain damage
Increased Intracranial Pressure (IICP)-Interventions:
what hob
what movement
no what
Increase HOB
Minimal mvmt / no head rotation
avoid coughing
Increased Intracranial Pressure (IICP)-Interventions:
empty what
avoid what
r
Keep bladder empty
avoid constipation
Rest
Increased Intracranial Pressure (IICP)-Interventions:
monitor what
limit
what for eyes
Monitor fluids (not too much)
limit visitors
Eye patch/drops maybe if one eye is open
seizures
what are they
results in what
Abnormal electrical activity in the brain –>
results in abrupt/temporary altered LOC
seizure interventions
loosen what
turn where
nothing where
what if avaialve
protect what
never do what-
Loosen clothing around neck
Turn pt. on side
Nothing in the mouth
O2, if available
Protect head- to protect from floor
Never move pt, always move objects
seizures medication
a
treat what
anticonvulsants
treat potential causes
seizure aura
they can tell they are about to have a seizure
what is ischemic stroke
TIA
Thrombotic
Lacunar infarct
Cardiogenic embolic
what is hemorrhagic stroke
brain bleeding from traumatic experience
what puts pt at risk for Hemorrhagic stroke
what bp
d/ what lipid
s/ a use
what lipids
what heart disease
htn,
diabetes/ Hyperlipedmia,
smoking/ alchohol,
a fib w anticaulation management
how to tell difference between strokes
ct scan
how to treat
ischemic stroke
hemorrhagic stroke
ischemic- tpa w/in 3 hrs and anticaogs after
hemorrhagic- surgery
stroke manifestations
loss of what
inability
loss of what
loss of visual field
inability to identify
loss of consciousness
Traumatic brain injury (TBI)
who’s at risk
what need to get
Most at risk males, ages 15-24 and 75+
Want to get all information// details about whats going on
Traumatic brain injury (TBI)
Contact phenomena-
head is struck by a moving object
Acceleration-deceleration- Traumatic brain injury (TBI)-
coup
contrecoup
coup-contrecoup
Coup-direct- head on steering wheel
Contrecoup- indirect- head going back
Coup-contrecoup- had going back and forth
Rotational injury
Traumatic brain injury (TBI)
-brain rotates within the skull
never put ng until you know what
if suspected tbi->
Traumatic brain injury (TBI)
Never put an ng in until you know where the brain injury is
If suspected tbi- check ears for CSF potentially coming out
If checking for skull fracture, look for
r e
b s
Traumatic brain injury (TBI)
racoon eyes-> (bruises on eyes)
battle sign-> bruising behind ears
Contusion-Traumatic brain injury (TBI)-Manifestations:
LOC how long
a
d/c/d
what vision
LOC > 5 minutes
Amnesia
Drowsiness, confusion, dizziness
Diplopia, blurred vision
Post concussion syndrome
persistent what
d
I
impaired what
Contusion-Traumatic brain injury (TBI)-
Persistent headache
Dizziness
Irritable and insomnia
Impaired memory / concentration / learning problems
decrease what
Contusion-Traumatic brain injury (TBI)
Decrrease environmental stimulation- no reading , no screens, want them just sitting bored, no contact sports- LET BRAIN HEAL
TBI-Epidural Hematoma (blood between skull and brain protection layer)
rapid what
h
v
what pupils
Rapid decline in loc,
headache,
vomiting,
fixed, dilated pupil on same side (ipsilateral)
TBI-Epidural Hematoma (blood between skull and brain protection layer)
how fast does it develop
needs what
Develop rapidly- from traumatic injury
Need immediate interventions!-life threatening-arterial bleed
TBI-Subdural Hematoma (inner layer of skull and brain
unilateral
enlargement of what
Unilateral headache,
enlargement of ipsilateral pupil
Subdural Hematoma (inner layer of skull and brain
how fast does it develop
Can be chronic and develop slowly- venous bleed
TBI-Intracerebral Hematoma-
where is it
is it deadly
directly in brain tissue- anuerysm-
may turn into death qucikly
interventions- what for ABC
what kind of fluids
o-where
TBI-
Epidural Hematoma
Subdural Hematoma
Intracerebral Hematoma
hypertonic fluids
oxygen-et tube
interventions- what meds
o d
anti
s
TBI-Epidural Hematoma
Subdural Hematoma
Intracerebral Hematoma
Osmotic diuretic(mannitol)
anticonvulsants
sedatives
interventions-
keep how
no what
monitor what
TBI-Epidural Hematoma
Subdural Hematoma
Intracerebral Hematoma
keep cooler
no nasal suctioning
monitor icp
Brain Tumor manifestations
c
change in hwat
h
/
what vision
loss of what
confusion,
change in loc,
headache,
n/v,
change in vision,
loss of balance
brain tumor tx
c
s
chemo
surgery(burr hole/cranionomy)
Suggestions to Decrease Incidence ofMigraine Headaches
wake up when
eat when
no what
reduce what
practice what
Wake up at the same time every morning.
Eat your meals and exercise on a regular schedule.
No smoking or caffeine after 3:00 p.m.
Reduce or eliminate red wine, cheese, alcohol, chocolate, and caffeine.
Practice relaxation techniques, such as yoga, meditation, or biofeedback.
Reyes syndrome -what is it
Acute encephalopathy caused by a toxic, injury, inflammatory or anoxic insult
reyes syndrome
develops after what
associated w what
a mild viral illness (varicella/influenza)
Association with use of ASA for a mild flu like illness
reyes syndrome manifestations
change in what
high what level
what glucose
what organ function
Change in loc,
high ammonia levels,
high glucose,
high lft,
Hydrocephalus - imbalance of what
Imbalance between the production and absorption of cerebrospinal fluid
Hydrocephalus-Manifestations
increased what x2
: increased head circumference
increased icp,
Hydrocephalus-Diagnosis
p e
c
m
- physical exam,
ct,
mri,
Hydrocephalus Tx
- vp and va shunt,
vp shunt -
watch for what
may need what
Watch for infections,
may need to be replaced as growth happens,
Myelodysplasia (Spina Bifida)
what is it
Neuro Tube defects:
Defect in one or more vertebrae through which spinal cord contents can protrude
Myelodysplasia (Spina Bifida)
manifestation
put infant where
Neuro Tube defects:
Sac like protrusion
place infant prone to avoid tension on sac
Myelodysplasia (Spina Bifida) Dx:
when
c/ m
Neuro Tube defects:
prenatally,
CT/MRI
Neuro Tube defects: Myelodysplasia (Spina Bifida)
what cause
take what
Unknown cause
take prenatal vitamins
Long term complications-
potential for what pain
limited
problems w what
what to lower extremities
Neuro Tube defects: Myelodysplasia (Spina Bifida)
potential for joint pain,
limited mobility,
problems w bowel and bladder,
paralysis to lower extremities,
cerebral palsy- abnormality where
Abnormality of the immature brain that occurs in the prenatal, perinatal or postnatal period
cerebral palsy- characterized by what
abnormal what
lack of what
abnormal muscle tone
lack of coordination with spasticity- like cannot control bowel/bladder
cerebral palsy
may be because of what
can lead to what
May be because of hypoxic events pre birth
Can lead to seuizures
cerebral palsy
support who
talk to who
do what exercises
Support partents,
pt/ot,
range of motion
Cervical vertebra
what functions
autonomic functions, breathing and diahpragm
thoracic vertabra
regulates what
moves what extremities
Temperature regulation,
trunk extremities
lumbar vertabrae
controls what
Controls lower extremites and bowel/bladder
dermatomes
parts where spinal nerve Is innervated
Spinal Cord Injury
injury identified by where
do what to spine
determine what
identified by vertebral level
immobilize spine
determine the level of the injury
cervical cord injury
Interventions-
needs what
Spinal Cord Injury
rapid intervention
needs intubation
spinal cord injury manifestations
what shocks x2
spinal shock
neurogenic shock
Spinal Cord Injury surgery
s
d L
s f
insertion of what
stabilization,
decompression laminectomy
, spinal fusion,
insertion of metal rods
spinal cord injury
never do what
what if you need to
never move pt
log roll if you need to
spinal cord injury complications
impaired m
impaired g e
ineffective
c
a
impaired mobility,
impaired gas excahgne,
ineffective breathing,
contractures,
atrophy
Spinal Cord Injury- spinal shock
what is it
Temporary loss of function below level of injury
Spinal Cord Injury- spinal shock
where is it
f
p
loss of what x2
intentional what
manifestations
below level of injury,
flacid, paralysis, loss of reflexes, loss of sensation
intestinal paralysis
Neurogenic shock manifestations
what bp
what hr
what pulses
what temp
what urine output
hypotension
bradycardia
bounding pulses
hypothermic
oliguria
meds for neruogenic shock
c
p
f
p
a
corticosteroids,
pressors,
fluids,
ppi,
analegesics
Cervical Spinal Cord Injury - complications
needs what
diaphragm / phrenic nerve-
intubation and mechanical ventilation.
Thoracic Spinal Cord Injury - complications
need what administered
– abd. Muscles-
Oxygen is administered to the patient with a thoracic-level injury
Autonomic Dysreflexia
above where
is it deadly
Spinal Cord Injury - complications
Above T6 / not able to control autonomic nervous system
Can be fatal!
Autonomic Dysreflexia
pounding
what hr
f
/
what vision
what skin
what bp
Spinal Cord Injury - complications
Pounding headache,
bradycardia,
flushing
, n/v,
blurred vision,
diahpretic skin
severe hypertension
Autonomic Dysreflexia
causes
f b
f I
i
Spinal Cord Injury - complications
full bladder
feral impaction
infection
Autonomic Dysreflexia
treat what
what schedule
Spinal Cord Injury - complications
treat cause and symptoms
are on Cath schedule
Spinal Cord Injury - complications
I
u/c
skin
immobility
urinary/ constipation
asses skin
Herniated Intervertebral Disk
when what happens
When the nucleus pulposus protrudes through weakened or torn annulus fibrosus of an intervertebral disk
Lumbar disk Manifestations:
s
Herniated Intervertebral Disk
sciatica- burning pain, numbness, tingling down one leg
Cervical disk manifestations-
pain where
p where
Herniated Intervertebral Disk
pain in shoulder, neck and arm
parethesia along dermatome
Herniated Intervertebral Disk-Diagnosis
: differentiate cause of back pain, X-ray, CT, EMG, myelogram
Herniated Intervertebral Disk Treatment-: medications to relieve pain and reduce swelling and muscle spasms-
d
I
s
diazepam,
ibuprofen
/steroids,
Herniated Intervertebral Disk
Conservative treatment
start w like physical therapy, losing weight and all that, then surgery
do this first
Herniated Intervertebral Disk
Surgical-
L
s f
laminectomy,
spinal fusion,
Herniated Intervertebral Disk
Surgical- nurses role
n assessments
d assessment
what check
c
normal
- neuro assessments,
dermatomes assessment,
voiding checks,
c&db
, normal post op like vitals
CNS Infection includes what
CNS
brain
spinal cord
meninges
neural tissue
blood vessel
Common causes: of CNS infections
b
v
f
p
r
bacteria,
viruses,
fungi,
protozoans
rickettsiae
Meningitis- Infection that involves what
pia mater, arachnoid, subarachnoid space, cerebral spinal fluid
Meningitis Manifestations
h
n s
pain where
f
p
r
what symptoms
: headache,
neck stiffness,
, pain in neck,
fever,
petechia,
restless,
flu like symptoms
Meningitis- 2 types
Acute purulent meningitis (bacterial)
Acute lymphocytic meningitis (viral)
meningitis tests
k/b
l p
kernigs and brudzinskis
lumbar puncture
Acute purulent meningitis (bacterial) tx w
a
d
c
what control
antibiotics,
dexamethasone,
corticosteroids,
pain control
Acute lymphocytic meningitis (viral) tx w
anti
s
p m
antivirals
steroids
pain meds
Encephalitis
infection of where
caused by what
Infection of the parenchyma of the brain or spinal cord
Usually caused by viral organism following a viral infection
Encephalitis
pathophysiology
Invasion of the brain tissue, reproduces inflammatory response (no exudate noted) degeneration of the neurons of the cortex (destruction of white matter) necrotizing hemorrhage, edema, & hollow cavities within the cerebral hemispheres
Encephalitis -> edema leads to what
compression of what
increased what
possible what
compression of blood vessels
and ↑ICP
possible death
Encephalitis Manifestations
f
h
s
n r
changes in
: fever,
headaches,
seuizire,
nuchal rigidity,
change in loc
Encephalitis dx
m
c
need to figure out if what
mri,
ct,
need to figure out if bacterial or viral
Encephalitis-Are put on
v
p
s
p m
anti
ventilator,
profolol,
and then steroids,
pain meds,
anti biotic/viral`
MYASTHENIA GRAVIS
W
E
A
K
N
E
S
S
W: Weakness of face
E: Eyelid drooping
A: Appearance mask-like
K: Keeps choking
N: No energy
E: EOM weakness
S: Slurred speech
S: SOB
MYASTHENIA GRAVIS
what is it
affects what
Autoimmune disorder
that affects the neurotransmitter acetylcholine
what does acetylcholine do
stimulates muscles
MYASTHENIA GRAVIS
symptoms
w
f
weakness
fatigue
MYASTHENIA GRAVIS
risk for what dt what
for aspiration dt impaired swallowing
MYASTHENIA GRAVIS meds
what anticholinesterase
what immunosupreseants
take when
anticholinesterase- (pyridostigmine and neostigmine),
immunosuppressants- (prednisone
take 30 mins before eating
MYASTHENIA GRAVIS
monitor for what
what s/s (HR, difficulty what x2)
Monitor for Myasthenic Crisis
(Tachycardia, difficulty swallowing/breathing)
surgical tx for myasthenia gravis
Thymectomy
GUILLIAN-BARRE SYNDROME (GBS)
what is it
acute what
Acute autoimmune disease,
acute inflammatory demyelinating disorder of the PNS
GUILLIAN-BARRE SYNDROME (GBS)
Causes what
from where
motor paralysis (usually ascending) from toes to head
GUILLIAN-BARRE SYNDROME (GBS)
Cause is unknown but precipitating factors
a I
s
v i
: acute infections,
surgery,
viral immunizations
GUILLIAN-BARRE SYNDROME (GBS) Manifestations
p
p
what tingling
if diapghtam is affected-worry about what
: pain,
paralysis,
face/jaw tingling
if diaphragm is affected breathing!
GUILLIAN-BARRE SYNDROME (GBS) Medications
I g
m
anti
v
: Immune globulin,
morphine,
anticoagulants,
vasopressors
TRIGEMINAL NEURALGIA- what is it-severe what
Severe, repetitive attacks of stabbing pain when the trigeminal nerve is stimulated-
TRIGEMINAL NEURALGIA- manifestaitons
what type of pain
where
severe stabbing, burning, ringing pain, wherever the nerve is at
TRIGEMINAL NEURALGIA
usually from what
could be from what
Usually from a vascular compression or demyelination of the nerve.
Could be from trauma, dental/jaw infections, flulike illnesses, tumor, MS
TRIGEMINAL NEURALGIA
Medications
p m
anti
: pain meds-
anticonvsulants- carbamaepizne, gapbapentin,
TRIGEMINAL NEURALGIA-if meds don’t control pain..
Possible surgery
FACIAL PARALYSIS (BELL’S PALSY)
what does it look like
Acute paralysis that affects one side of the face.
Similar to stroke symptoms but is not a CVA
FACIAL PARALYSIS (BELL’S PALSY) medications
p
anti
a
what care x3
Prednisone,
antivirals,
analgesics
, eye care (artificial tears), face and mouth care,
FACIAL PARALYSIS (BELL’S PALSY)
why PT
what diet
Pt to help regain strength- can take over an year
Soft diet to help chewing
FACIAL PARALYSIS (BELL’S PALSY)
why Can happen in younger people
looks like initially-then what
-in stressful times and acquire a viral infection
tingling, blurred vision, then wake up w full bells
Corneal Abrasion- what is it
tx w ( ep and a)
EYE TRAUMA
-disruption of superficial epithelium of cornea- eye patch and antibiotic
EYE TRAUMA Burns-
from what
how tx
from heat, radiation or explosion-
flush eye
Penetrating trauma-
what is it
do not do what
may need what
EYE TRAUMA
something that penetrates eye-
do not put pressue,
may need surgery
Blunt Trauma-
lid ecchymosis-
Subconctival hemorrhage-
Hyphema-
EYE TRAUMA
Lid ecchymosis- black eye
Subconctival hemorrhage- rupture of blood vessel in eye
Hyphema- bleeding in anterior chamber of eye
blunt trauma eye trauma
what position
e s
semi fowelrs. Eye sheild
eye trauma Orbital blowout fracture
eye may fall out
ACOUSTIC NEUROMA-VESTIBULAR SCHWANNOMA
tumor where
does what
Benign tumor of CN VIII
Compresses the auditory nerve and affects the vestibular and cochlear branches
ACOUSTIC NEUROMA-VESTIBULAR SCHWANNOMA
Manifestations
t
unilateral
n
v
: tinnitus,
unilateral hearing loss,
nystagmus,
vertigo
ACOUSTIC NEUROMA-VESTIBULAR SCHWANNOMA
How do we diagnose?
c
m
CT scan or MRI
ACOUSTIC NEUROMA-VESTIBULAR SCHWANNOMA
how tx
Remove tumor in or
