Head, Spinal Cord, CVA Flashcards
1
Q
What are the hallmark symptoms of a cluster headache?
A
One-sided pain (usually behind the eye), nasal congestion, rhinorrhea, tearing, and eye redness
2
Q
What medications are used for migraine management?
A
Atenolol
Nortiptyline
Carbamazepine
Sumatriptain
Methysergide
3
Q
what is a TIA and why is it important?
A
A transient ischemic attack is a brief neurological impairment caused by temporary cerebral blood flow interruption. It is a warning sign for a possible stroke.
4
Q
Key difference between epidural and subdural hematoma?
A
Epidural=arterial bleed ABOVE dura (rapid onset)
Subdural=venous bleed BELOW dura (slower onset)
5
Q
Signs of right-hemispheric stroke (left-sided hemiplegia)?
A
Spatial-perceptual deficits, impulsive behavior, short term memory loss, neglect of left body side.
6
Q
What is spinal shock?
A
Loss of sympathetic reflex activity below spinal cord injury; signs include hypotension, bradycardia, & warm skin
7
Q
Normal ICP vs. elevated ICP?
A
Normal = 5-15
Elevated = >20
8
Q
What is autonomic dysreflexia?
A
Life-threatening complication after spinal injury; includes severe hypertension, bradycardia, headache, flushing above level of injury
9
Q
What does the FAST acronym stand for in stroke assessment?
A
Face dropping
Arm weakness
Speech difficulty
Time to call 911
10
Q
What medication is used in ischemic stroke to dissolve clots?
A
Alteplase (tPA/Activase)
11
Q
What are the three types of ischemic strokes?
A
Thrombotic
Embolism
Transient ischemic attacks (TIAs, if temporary)
12
Q
What causes a hemorrhagic stroke?
A
Rupture of a cerebral blood vessel, often due to hypertension or aneurysm
13
Q
List at least four risk factors for stroke
A
Hypertension
A-Fib
Smoking
Diabetes
Obesity
Hyperlipidemia
Age-genetics
TIA/CVA
14
Q
What does hemianopia mean?
A
Loss of half the visual field in one or both eyes
15
Q
What medications are commonly used after a CVA to prevent clot formation?
A
Warfarin
Dabigatran
Rivaroxaban
Clopidogrel
Aspirin
16
Q
What is a craniotomy?
A
Surgical removal of part of the skull to access the brain
17
Q
Define coup and contrecoup injury
A
Brain injury at the site of impact (coup) and the opposite side (contrecoup) due to brain movement within the skull
18
Q
Which hematoma is most likely to deteriorate rapidly and why?
A
Epidural hematoma due to fast arterial bleeding
19
Q
What are the five levels of consciousness from most alert to least?
A
Conscious
Lethargic
Stuporous
Semicomatose
Comatose
20
Q
Name three complications of head trauma surgery
A
Cerebral edema
Infection
Increased ICP
CSF leakage
Seizures
21
Q
What is tetraplegia?
A
Paralysis of all four limbs, typically due to cervical spinal cord injury
22
Q
What does the spinal cord’s dorsal root do?
A
Carries sensory (afferent) information to the brain
23
Q
What is baclofen used for in spinal cord injury
A
Reducing muscle spasticity
24
Q
What are signs of spinal nerve root compression?
A
Pain, weakness, parenthesis, paralysis (depending on nerve affected)
25
What is chemonucleolysis?
Injection of an enzyme to dissolve a herniated intervertebral disc
26
Describe the difference between flaccidity and spasticity
Flaccidity = limp muscles
Spasticity = stiff, contracted muscles
27
What are some long-term management strategies after spinal cord injury?
Functional electrical stimulation, treadmill training, tendon transfer surgery, cell transplantation
28
What is the usual cause of intracerebral hematoma?
Trauma or rupture of cerebral aneurysm causing bleeding within brain tissue
29
When is a carotid endarterectomy indicated?
To remove plaque in carotid artery, preventing stroke or after a TIA
30
What medication class is tizanidine (Zanaflex)?
Alpha-2 adrenergic agonist used to reduce muscle spasticity
31
What is the action of Alteplase (Activase) in stroke treatment?
It is a thrombocytes that dissolves clots in ischemic stroke (must be given within a specific time window)
32
What is Clopidogrel (Plavix) used for in neurological disorders?
Antiplatelet used to prevent stroke or TIA recurrence
33
Whic anticoagulants are used for atrial fibrillation to prevent stroke?
Warfarin, Dabigatran (Pradaxa), Rivaroxaban (Xarelto)
34
What are common side effects of Rivaroxaban (Xarelto)?
Bleeding, bruising, GI upset; no routine monitoring needed unlike warfarin
35
Why is Warfarin (Coumadin) important for CVA prevention?
Reduces clot formation in atrial fibrillation; requires INR monitoring
36
What condition is Sumatriptan (Imitrex) used for?
Acute migraines headache relief; a serotonin receptor agonist
37
What is the purpose of Baclofen (Lioresal) in spinal cord injury?
Muscle relaxant that helps reduce spasticity
38
What is Dantrolene (Dantrium) used for?
Muscle relaxant for spasticity; works directly on skeletal muscle
39
What is Tizanidine (Zanaflex) and what does it treat?
Alpha-2 adrenergic agonist; reduces muscle tone/spasticity
40
What is the role of Corticosteroids in spinal cord injury management
Reduces inflammation and edema around the spinal cord
41
What does Riluzole (Rilurek) do in neurological management?
Neuroprotective drug studied for reducing nerve damage (used off-label in SCI research)
42
Why might Methysergide (Sanskrit) be used for headache management?
It is used prophylactically for migraines and cluster headaches
43
Which medications are used for spinal nerve root compression?
Carisoprodol
Chlorzoxazone
Diazepam
NSAIDS
Corticosteroids
Chemonucleolysis
44
A client with A-fib on warfarin presents with a headache, drowsiness, and vomiting. What is your next nursing action?
Notify the provider; anticipate order for neuroimaging (MRI) to rule out hemorrhagic stroke or hematoma
45
After a severe MVC, your patient has a coup - contrecoup injury and an ICP of 24. How should you interpret this?
This IC is elevated (normal=5-15); monitor for signs of increased ICP & implement measures to reduce pressure
46
You assess a post-spinal cord injury patient who is flushed, diaphoretic above the injury level, and has a BP of 248/120. What is likely occurring?
Autonomic dysreflexia—a medical emergency. Check for triggers (bladder/bowel impairment), elevate HOB, notify provider
47
A post-stroke patient has neglect of the left side, impulsivity, and difficulty with spatial orientation. What side was the stoke on?
Right hemisphere (causing left-sided hemiplega and perceptual deficits)
48
Your patient has right-sided hemiplegia, expressive aphasia, and requires frequent reminders. Where is the lesion likely located?
Left hemisphere (language centers are usually dominant on the left)
49
On day 14 post-spinal cord injury, your patient complains of a pounding headache and blurry vision. What do you suspect?
Autonomic dysreflexia. Treat immediately by removing the noxious stimulus and managing BP
50
What findings would you expect in a patient with a subdural hematoma developing slowly over weeks?
Gradual onset of confusion, headache, LOC changes; especially in older adults
51
After a head injury, a patient is lethargic with altered LOC and CT shows a midline shift. What is a likely diagnosis?
Expanding hematoma (possibly epidural or subdural) increasing ICP
52
A client with a basilar skull fracture has blood-tinged drainage on their pillow with a yellow halo around it. What does this indicate?
A CSF leak
The “Halo sign” suggests cerebrospinal fluid leakage, which requires prompt attention (also glucose strip)
53
A patient is post MVA with raccoon’s eyes and Battle sign. What type of fracture is suspected?
Basilar skull fracture, which presents with peri orbital & mastoid ecchymosis
54
After a spinal cord injury, a patient develops a sense of reflexes and flaccid extremities. What is the condition?
Spinal shock, an acute response to spinal cord trauma
55
A patient with spinal cord injury at T4 complains of a pounding headache and sweating. BP is 240/120. What is this?
Autonomic dysreflexia, a life-threatening emergency caused by noxious stimuli below the level of injury
56
What is the priority nursing intervention during autonomic dysreflexia?
Raise the HOB immediately & place client in a sitting position to reduce BP
57
A patient with a C4 herniation is receiving conservation treatment. What will be used?
A cervical collar to immobilize the spine
58
Which vital sign change is an early sign of increased ICP?
Change in LOC, followed by widened pulse pressure & bradycardia (Cushing’s reflex)
59
A 17-year old is brought to the ED after falling from a roof and is awake but disorientated. What is the priority nursing action?
Cervical & spinal immobilization until cleared by imaging
60
A client with paraplegia asks why daily leg exercises are needed. What’s the best response?
To prevent contractures from disuse syndrome and promote mobility
61
What are cardinal signs of brain death?
Coma, apnea, and absence of brain stem reflexes
62
Why is Mannitol given to a patient with increased ICP?
It’s an osmotic diuretic that reduces cerebral edema by drawing fluid out of brain tissue
63
What does Dexamethasone (Decadron) do post-craniotomy?
Reduces inflammation and cerebral edema
64
Why is Phenytoin (Dilantin) given pre- and post- neurosurgery?
To prevent seizures, a common complication of head trauma
65
Which medication is used to control muscle spasticity after spinal cord injury?
Baclofen (Lioresal)—a muscle relaxant acting on spinal reflexes
66
What is the purpose of antiembolism stockings in a spinal injury client?
To prevent deep vein thrombosis (DVT) due to immobility
67
What is the rate to set an IV pump if 20mL needs to infuse over 15 minutes?
80 mL/hr
(20mL / 15mins x 60 (hr) = 80
68
What class of medication is used acutely for autonomic dysreflexia?
Antihypertensives (though not explicitly named in the file, this is the class used to control severe BP elevation)
69
A client with a halo brace reports they apply powder under the liner. What should you do?
Educate them not to use powder, as it increases the risk for pressure injuries
70
Why is oxygen important in spinal cord injury management?
To maintain high PaO2; hypoxia can worsen neurological damage
71
Which of the following signs indicates Cushing’s reflex in TBI?
Bradycardia, widened pulse pressure, and elevated systolic BP
72
Types of headaches:
Tension: pressure or constriction on both sides of the head
Migraine: may involve aura (flashing lights); prodromal period includes mood changes, fatigue, nausea, vertigo, sensitive to light, irritability
Cluster: one sided (usually behind the eye); nasal congestion, rhinorrhea, tearing, redness
73
Treatment of Headaches
Methysergide (Sanskrit)
Atenolol (Tenormin)
Nortriptyline (Pamelor)
Carbamazepine (Tegretol)
Sumatriptan (Imitrex)
Duloxetine, Valproic acid
74
TIA (Transient Ischemic Attack)
Sudden, brief neurological deficit due to temporary cerebral blood flow interruption
-Warning sign for stroke: lightheadedness, confusion, speech disturbances, diplopia, vision changes, numbness, weakness, paralysis
Diagnostics: Carotid bruit on auscultation, ultrasound, CT, MRI, carotid arteriogram
Treatment: Warfarin, Heparin, Aspirin, Clopidogrel, Alteplase, Rivaroxaban—Carotid endarterectomy, percutaneous transluminal angioplasty
75
CVA / Stroke (Cerebrovascular Accident)
Types: Ischemic (Thrombus, embolus) & Hemorrhagic
Risk Factors: age, sex, race, genetics, hypertension, A-fib, hyperlipidemia, diabetes, smoking, obesity, previous TIA/CVA, thrombogenic substances, valvular disease
Signs: FAST: facial droop, arm weakness, speech difficulty, time to call 911; severe headache, impaired gait, hemiplegia, aphasia, hemianopia
Left VS Right sided:
Right stroke—left hemiplegia: spatial-perceptual defects, impulsivity, distractibility, neglect of left side, poor judgement, short-term memory loss
Left stroke—right hemiplegia: aphasia, intellectual impairment, cautiousness, poor new learning, abstract thinking problems
Diagnostics: CT/MRI, EEG, SPECT, Doppler, lumbar puncture, cerebral angiography
Treatment: Alteplase (tPA), Dabigatran, Rivaroxaban, Clopidogrel—hypothermia, carotid endarterectomy
Nursing care priorities: monitory for dysphagia, prevent skin breakdown, promote self-care, manage incontinence
76
Head injuries
Types: Concussion: jarring of the brain; Contusion: bruising of brain tissue; Coup - Contrecoup: injury at point of impact & opposite site
Hematomas:
Epidural: arterial bleeding above dura (rapid decline);
subdural: venous bleeding below dura (slower accumulation (acute, subacute, chronic);
Intracerebral: bleeding into brain (may be from trauma or aneurysm)
Assessment tools: MRI, CT, ICP monitoring, LOC levels: conscious -> lethargic -> stuporous -> semicomatose -> comatose
ICP consideration: Normal ICP: 5-15; Elevated: < 20
surgical options: trephining, craniotomy, craniectomy (take out) , cranioplasty (repair)
complications: cerebral edema, infection, neurogenic shock, electrolyte imbalance, seizures, hemorrhage
77
Spinal cord anatomy & injury
Spinal cord function:
sensory: dorsal root
Motor: ventral root
Sympathetic vs parasympathetic nervous system
Injury terms:
Paresis, paralysis, spasticity, flaccidity, hemiplegia, paraplegia, tetraplegia
Injury causes:
MVA (39%), falls (31.8%), violence (13.5 %), sports (8%)
78
Spinal cord anatomy & injury
Continued…
Pathophysiology: Trauma -> vertebral fracture -> spinal cord compression; edema, hematoma formation, partial/complete cord severance
Immediate complications: respiratory arrest, spinal shock
Spinal shock: loss of sympathetic reflexes below injury, hypotension, bradycardia, warm skin, can last from days to months
Long-term complications: autonomic dysreflexia, pressure ulcers, spasticity, contractures, infections, sexual dysfunction
Autonomic dysreflexia signs: pounding headache, blurred vision, flushed face, sweating, cold/dry legs, high BP, bradycardia
Spinal Root compression: due to trauma, herniated disk, tumors
Symptoms: pain, weakness, paralysis, parenthesis
Treatment: muscle relaxants, NSAIDS, corticosteroids, cheminucleoysis
79
Spinal cord injury treatment
Corticosteroids, Riluzole, Cethrin
Baclofen, Dantrolene, Tizanidine, Clonazepam
Diazepam, NSAIDS, Carisoprodol, Chlorzoxazone, Phenylbutazone
Diagnostics: X-ray, CT, MRI, Myelogram
Rehab: Electrical stimulation, treadmill training, tendon transfer, cell transplant
80
What’s the nursing priority for a client immediately post-intracranial surgery?
Monitor temperature
Hyperthermia increases cerebral metabolism and may worsen brain injury
81
What nursing intervention helps prevent deep vein thrombosis (DVT) in a client with spinal cord injury?
Apply thigh-high elastic stockings and encourage passive range of motion to promote venous return
82
What nursing interventions support a diagnosis of ineffective airway clearance in head injury?
Monitor respiratory rate, apply suctioning as indicated, and elevate HOB to facilitate drainage
83
How can a nurse support a patient experiencing interrupted family processes after trauma?
Encourage family to join support groups and involve them in care planning
84
What’s a good nursing intervention for disturbed sleep pattern post-head trauma?
Offer back rubs, cluster care to promote rest, and minimize nighttime interruptions
85
What should be monitored at least every 15-30 minutes in a post-craniotomy client?
Neurological assessments: LOC, pupil response, motor function, vital signs
86
What should the nurse assess daily in a client wearing a halo device?
Pin sites for drainage, redness, or pain, and vest liner for dampness or skin breakdown
87
What education should you provide about CSF leakage with a skull fracture?
Let CSF drain freely onto gauze; do not plug or block the orifice
88
What’s a top nursing priority for a client in autonomic dysreflexia?
Sit the client up to lower BP, check for bladder or bowel obstruction, notify provider
89
What should you include in a care plan for a client with altered mobility?
Perform passive ROM, prevent foot drop, reposition every 2 hours, and provide pressure relief.
90
What’s the nursing diagnosis for spinal cord injury client with bladder dysfunction?
Risk for urinary retention or impaired urinary elimination
91
What should a care plan include for a client post-spinal cord injury to prevent pressure ulcers?
Turn every 2 hours, inspect skin daily, keep skin dry, and use pressure-relieving surfaces
92
What are the first steps when caring for a client with a possible cervical spinal injury?
Maintain cervical spinal immobilization and perform a full neuro assessment before clearance
93
How should you prevent complications in a client recovering from spinal surgery?
Monitor neurovascular status, dressing site, encourage coughing & deep breathing, monitor I & O, vitals
94
A client with spinal cord injury is at risk for orthostatic hypotension. What should you do?
Assist slowly to upright position, use compression stockings, monitor BP closely.
