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Adults Exam 3 > Management of Patients w Neurologic Dysfunction & Cerebrovascular Disorders > Flashcards

Management of Patients w Neurologic Dysfunction & Cerebrovascular Disorders Flashcards

1
Q

Akinetic mutism

A

a state of unresponsiveness to the environment

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2
Q

coma

A

a clinical state of unarousable unresponsiveness; no purposeful movements

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3
Q

Decerebration

A

type of posturing; extending outward

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4
Q

Decortication

A

major brain injury (if you touch them in anyway, they will pull to the core)

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5
Q

Locked-in syndrome

A

aware of what is going on; just cannot move or talk

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6
Q

persistent vegetative state

A

unresponsive but sleep wake cycle exists; no cognitive function

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7
Q

status epilepticus

A

a form of epilepsy in which the seizure lasts longer than normal; no recovery period between seizures, does not respond to normal treatment

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8
Q

what are possible causes of altered LOC? (3)

A

disruption in the cells of the NS
neurologic: nerves are damaged due to CVA, high or low blood sugars
Toxicologic: drugs (cocaine, overdose on any sedative, meth, heroin, or fentanyl)
Metabolic: lack of O2 & sugar

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9
Q

what tool to measure LOC?

A

Glasgow coma scale

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10
Q

what are patients patterns of respiration commonly like if they have a neurological disorder?

A

deep breathing w loud snoring

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11
Q

nursing interventions for altered LOC patients (11)

A
  1. maintaining airway (administer oxygen)
  2. protecting patient
  3. managing nutritional needs (NG tube)
  4. providing mouth care (suction available, monitor for s/sx of infection)
  5. maintaining skin & joint integrity (turning patient; proper body alignment)
  6. preserving corneal integrity (if patient not able to blink, admin eye drops & tape eyelids shut if needed)
  7. maintain body temp (if high temp, means increased ICP causing vasodilation in the brain increasing metabolic demand on the brain)
  8. preventing urinary retention (bladder scan; straight cath)
  9. promoting bowel function (manual evacuation, enemas, suppositories)
  10. meeting family needs
  11. monitor & manage complications (pressure ulcers, blood clots, aspiration, pneumonia, s/sx of respiratory failure, prevent contractures in joints, s/sx of VTE (swelling, redness, warmth))
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12
Q

what type of lung sounds do patients have if they are aspirating?

A

rhonchi

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13
Q

which 3 components are in the state of equalibrium?

A

brain tissue, blood, cerebral spinal fluid (CSF)

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14
Q

Monro-Kellie hypothesis

A
  • Sum of volumes of brain, CSF, & intracranial blood is constant (if one gets off, then the other will be off)
  • Limited space for expansion within the skull
  • An increase in any one of the components causes a change in the volume of the others
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15
Q

if a patient starts to develop intracranial pressure, what will you first see a change in?

A

LOC

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16
Q

most common cause of increased ICP

A

head trauma

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17
Q

list some secondary effects of an increased ICP (6)

A
  1. brain tumors
  2. subarachnoid hemorrhage
  3. toxic or viral encephalopathies (cause a decrease in O2 to the brain, increase in CO2, changes cerebral blood flow)
  4. decreased cerebral perfusion
  5. stimulates edema
  6. causes herniation
18
Q

cerebral edema
- definition
- S/Sx (2)

A

an abnormal accumulation of water or fluid in the intracellular space, extracellular space or both d/t an increase in the volume of brain tissue
S/Sx: decreased level of consciousness, seizures

19
Q

autoregulation

A

brain’s ability to change the diameter of its blood vessels to maintain constant cerebral blood flow during alterations in SBP

20
Q

Cushing’s response (reflex)
- when does it occur?
- what does it increase?

A
  • Occurs when coronary blood flow decreases significantly
  • Increases systolic BP, widening pulse pressure (130/60, 190/40), & cardiac slowing
21
Q

cushing’s triad

A

bradycardia, hypertension, bradypnea

22
Q

clinical manifestations of cushing’s response (5)

A
  1. Changes in LOC
  2. Abnormal respiratory & vasomotor responses
  3. Restlessness
  4. Confusion
  5. Increased drowsiness
23
Q

clinical manifestations of IICP (3)

A
  1. Stuporous, reacting only to loud or painful stimuli
  2. Decortication
  3. Decerebration
24
Q

complications of cushing’s response (3)

A
  1. Brain stem herniation: vitals all over the place
  2. S/Sx of diabetes insipidus
  3. Placidity: no muscle tone whatsoever
    these first two conditions both deal w the posterior pituitary (trauma to the brain)
25
Q

medical / nursing management goals for ICP (3)

A
  1. Decreasing cerebral edema
  2. Lowering volume CSF
  3. Decreasing cerebral blood volume
26
Q

how to achieve goals for managing ICP (6)

A
  1. Osmotic diuretics: mannitol
  2. Restricting fluids
  3. Draining CSF (VP shunt: drains excess CPF into the peritoneal cavity)
  4. Controlling fever (Cooling blanket & tylenol)
  5. Maintaining BP & oxygenation
  6. Reducing cellular metabolic demands
27
Q

nursing interventions for ICP (6)

A
  1. Maintaining patent airway
  2. Adequate breathing pattern
  3. Optimize cerebral tissue perfusion (HOB 30 degrees)
  4. Maintaining negative fluid balance (Putting out more than taking in)
  5. Preventing infection (Washing hands)
  6. Monitor & manage potential complications
28
Q

craniotomy

A

opens skull

29
Q

craniectomy

A

removing the skull

30
Q

cranioplasty

A

replacing skull

31
Q

seizures
- definition

A

episodes of abnormal motor, sensory, autonomic or psychic activity
Excessive electrical excitation of the neurons in one section of the brain

32
Q

list & describe the 3 seizure types

A
  1. Generalized: occurs in both hemispheres of the brain
  2. Focal: only on one hemisphere of the brain; potential to travel to the other; both motor & non-motor symptoms
  3. Provoked seizure: anxiety, fever, tumor, alcohol or alcohol withdrawal, electrolyte imbalances (Ca, Mg, Na levels being high or low) can be causes
    VS. Unprovoked seizure: do not know how it is caused
    Unknown - do not fit in either of above types
33
Q

all ___ are seizures, but not all seizures are ___

A

convulsions!

34
Q

4 main S/Sx of seizures

A
  1. LOC
  2. excessive movement
  3. loss of muscle tone or movement
  4. disturbance of behavior, mood, sensation, & perception
35
Q

list 10 potential causes of seizures

A
  1. Cerebrovascular disease: due to lack of blood flow to area of the brain
  2. Hypoxemia: lack of oxygen in the blood
  3. Febrile (childhood)
  4. Head injury: causes swelling in the brain
  5. HTN
  6. CNS infections: can cause swelling, drainage, & fever
  7. Metabolic & toxic conditions: not enough sugar or oxygen in brain; high ammonia levels can be toxic to the brain
  8. Brain tumor
  9. Drug & ETOH withdrawal: patients have higher risks of seizures
  10. Allergies: anaphylactic reaction
36
Q

what to do after a patient’s seizure (6)

A
  1. Find out triggers
  2. The behavior during seizure
  3. How long seizure lasted (what time did it start & stop)
  4. Any injury during the seizure?
  5. Are they in the post ictal state: when seizure is done; patient very lethargic, longer the seizure is, the longer the post ictal state is (Often times will be difficult to arouse & will have loud snoring)
  6. Lactic acid levels may be drawn! (will be very high) - tourniquet not used
37
Q

big differences between generalized & focal seizures

A

Generalized: intense rigidity of entire body, tonic-clonic contractions, tongue often chewed, incontinent of urine & feces (after 1-2 minutes: movement subsides, relaxes & lies in deep coma breathing nosily, postictal state)

Focal: no natural classifications, may be impairment of consciousness or awareness, dyscognitive features, localization, & progression of ictal events

38
Q

list diagnostic tests used to diagnose seizires including lab studies

A
  1. **EEG (major diagnostic tool)
  2. CT / MRi (R/O lesions)
  3. PET / SPECT (measure cerebral blood flow)
  4. complete seizure profile & history (includes baseline neurologic exam)
  • description of seizure activity
    lab studies: ABGs, CBC, electrolytes
39
Q

epilepsy
- definition
- classified by what 3 specific patterns?
- primary vs. secondary

A

A group of syndromes characterized by unprovoked, recurring seizures
classified by: age of onset, family history, seizure type
primary: idiopathic (do not know cause)
secondary: (epilepsy is a symptom)

40
Q

risk factors for epilepsy (11)

A
  1. Genetic
  2. Birth trauma
  3. Asphyxia neonatorum
  4. Head injuries
  5. Hormonal: menstruation in females
  6. Infections: herpes, cephalitis, meningitis
  7. Toxicities
  8. Fever
  9. Circulatory problems
  10. Metabolic disorders
  11. Drug / alcohol intoxication

Adults Exam 3 (2 decks)

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