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Nursing: BSN classes > Med Surg 2: Neuro, Spinal/Head Injuries, Thyroid & Adrenal > Flashcards

Med Surg 2: Neuro, Spinal/Head Injuries, Thyroid & Adrenal Flashcards

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1
Q

What diagnostic exam is usually performed first for an acute stroke?

A

CT without contrast: to rule out acute bleed–need to determine if stroke is hemorrhagic or ischemic.

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2
Q

Aphasia that affects speech production; result of an infarction in the ___ lobe of brain

A

Broca’s (expressive or motor); frontal

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3
Q

Aniscoria=

A

Unequal pupils

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4
Q

What is a therapeutic Dilantin level?

A

10-20

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5
Q

What is most often the first sign of increased ICP?

A

Change in LOC.

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6
Q

How do you treat a spinal headache after an LP?

A

Lay flat and giving fluids/drink with straw/caffeine; May have to do Blood Patch if it lasts more than 24 hours–draw blood out of arm and inject blood into hole to seal it off–works almost immediately

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7
Q

Clinical Manifestations of Right side stroke damage:

A 
–Hemiplegia/hemiparesis (weakness/paralysis on one side) --left side. 
–Neglect-left side
–Spacial- perceptual deficits
–Will deny or minimize problems
–Short attention span
*Impulsive: safety risk--aren't cautious
–Impaired judgement

•Generalized findings of stroke no matter what area
–HA
-Increased ICP: often with Hemmorhagic stroke because blood takes up space
–Vomiting
–Seizures
–Mental status changes

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8
Q

What is the nursing management pre-procedure and during an EEG?

A

•Pre-procedure
–Shampoo without conditioner: makes it more slippery
–No caffeine 24-48 hours: alters electrical activity
–Some meds d/cd for 24-48 hours: CNS depressants
–Some are sleep-deprived

•During
–Takes approximately 1 hour
-Patient needs to remain still
–Evoked potential – flashing lights, buzzers, etc
•For brain stem injury and coma assessment

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9
Q

Clinical Manifestations of Left sided Stroke damage:

A 
–Hemiplegia- which side? Right. 
–Aphasia- sometimes global
–Dysarthria: able to express, but words don't come out clearly--garbled, slurred
–Cautious
–Depression/anxiety
–Impaired comprehension
•Language and math
–Memory problems with language

•Generalized findings of stroke no matter what area
–HA
-Increased ICP: often with Hemmorhagic stroke because blood takes up space
–Vomiting
–Seizures
–Mental status changes

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10
Q

What are some things that can lead to seizure other than epilepsy?

A 
–ETOH withdrawal
–Electrolyte imbalances
–Hypoxia
–Fever & dehydration
–Hypoglycemia
–Drug intoxication
–Poisoning
–Tumors
–Traumatic brain injury
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11
Q

Mydriasis=

A

pupil dilation

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12
Q

Manifestations of PD?

A 
•Unilateral Tremors
–pill rolling movements: movement of fingers 
•Rigidity
•Flexed neck, trunk, limbs
•Bradykinesia
–Shuffled gait
–Akinesia – or freezing movements
•Loss of postural reflexes
*Problems with chewing food
•Dysarthria: difficulty articulating clearly
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13
Q

Hypertensive Crisis = higher than ___ or higher than ____

A

180; 110

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14
Q

Tetraplegia occurs from ___ cord injuries.

A

cervical

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15
Q

What two “Signs” are used to assess for meningitis?

A

Kernig’s Sign (patient in supine, with hip flexed at 90 degrees, knee is unable to be extended); Brudzinski’s Sign (patient in supine, when lifting up head, it causes flexion of both legs and thighs)

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16
Q

Hemiparesis=

A

weakness on one side of the body

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17
Q

What are some potential complications of Autonomic Dysreflexia?

A

Seizures, cerebral hemorrhage, MI, death

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18
Q

What is the POE for Meningitis?

A

Nasopharynx

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19
Q

Homonymous Hemianopia =

A

A visual loss in the same half of the visual field of each eye so the pt has only half of normal vision

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20
Q

What is a common osmotic diuretic given for increased ICP?

A

Mannitol

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21
Q

What should the HOB be at with someone with increased ICP?

A

MD will probably set parameters at about 30 degrees.

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22
Q

American Stroke Association recommendations to call 9-1-1 if :

A

•Call 9-1-1 if have 1 or more:
–Sudden numbness or weakness of face, arm, or leg, especially on one side of the body
–Sudden confusion, trouble speaking or understanding
–Sudden trouble seeing in one or both eyes
–Sudden trouble walking, dizziness, loss of balance or coordination
–Sudden severe headache with no known cause

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23
Q

Etiology of Parkinson’s?

A

–Environmental and genetic

  • Long-term exposure to phenothiazines (Thorazine, Compazine)
  • Carbon monoxide/copper miners or mercury poisoning
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24
Q

What is Cushing’s Triad (response)?

A

A late response to increased ICP: bradycardia, systolic hypertension, and widening pulse pressure; Alterations in the respiratory pattern also accompany Cushing’s Triad (ie Cheyne-Stokes respirations)

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25
Q

Risk factors for Stroke:

A

HTN, Cardiovascular Dz, A-Fib (causes blood to pool and form clots), DM, hx of TIA’s, carotid stenosis/valve problems, Cigarette Smoking, Heavy ETOH, Cocaine, Obesity, High-dose Oral Contraceptives combined with HTN/smoking/migraines/and increased age, High Cholesterol, Gender (Men>), Ethnicity (AA’s>).

26
Q

What are the AHA guidelines for Hypertension?

A

Normal = less than 120/80
PreHypertension = 120-139/80-89
Stage One HTN = 140-159/90-99
Stage Two HTN = 160+/100+

27
Q

Agnosia =

A

Inability to identify familiar objects

28
Q

Clinical Manifestations of Bacterial and Viral Meningitis:

A

•Bacterial: more severe than Viral; medical emergency
–Irritable** (then confused stuporous, comatose)
–Photophobia
–Nuchal rigidity: One of Hallmark signs: Stiff Neck
•+ Brudzinski’s & Kernig’s signs
Kernig’s: lift leg and have spasm in hamstring; Brudinski’s=lift head up causes knees to flex
–Fever, tachycardia
–N/V
–Seizures possible
–Petechial/hemorragic rash
–Medical Emergency

•Viral
–Late summer/early fall
–Children and adults <30 yoa
–May have same symptoms as bacterial, but milder illness

29
Q

What are some common s/s of Autonomic Dysreflexia?

A

Pounding headache**, hypertension, flushing above lesion, dilated pupils, diaphoresis, bradycardia, nausea, restlessness, goosebumps, nasal stuffiness, blurred vision

30
Q

Apraxia=

A

condition in which the person cannot carry out a skilled act such as dressing because the “instructions” do not reach the limb from the brain

31
Q

Peak onset of Parkinson’s?

A

70

32
Q

Paraplegia occurs from __ &___ injuries.

A

thoracic and lumbar.

33
Q

When is Bacterial Meningitis most common?

A

Early spring & Late summer/fall

34
Q

Immediate Management of SCI (Spinal Cord Injury):

A

•As always – ABCs #1
–Impaired spontaneous respiration
–Ineffective airway clearance
–Impaired gas exchange
•Stabilize spine! with backboard
•Risk for Hypotension (vasodilation)
–IV fluids: increase volume
–Vasopressors, cardiac monitoring
•Assess disability and environment
•Determine extent of neurologic disability
•Steroids – yes!!! ASAP
•Environmental assessment – prevent hypothermia
•Poikilothermism- will adjust to room temp- lack of SNS innervation
•More of a problem with cervical injuries

35
Q

What are some indications that Spinal Shock is resolving?

A

return of reflexes (hyperreflexia rather than flaccidity) and return of emptying of the bladder

36
Q

The “Jacksonian March” can occur with ___ seizures.

A

Simple Partial Seizures.

37
Q

Lumbar punctures are contraindicated with _____

A

Increased ICP.

38
Q

Considerations for Dilantin?

A

-Interferes with Oral Contraception
-Vitamin D absorption is impaired–may need supplements
–Tonic/clonic & complex partial seizures
–Watch for suicidal thoughts/behaviors
–Rash indicates hypersensitivity – often occurs within 2 weeks – stop drug; can occur from too much med; very noticeable over back/chest
–Enteral feedings: stopped 2 hours before and after giving
–Meticulous oral care: can cause gum hyperplasia (swell/puffy); regular dental visits; floss; use soft toothbrush
–IV administration– Don’t give with D5W
–Therapeutic levels 10-20 mcg/mL

39
Q

“Daydream” Seizure common in kids ages 8-14 =

A

Petit mal

40
Q

Clinical Manifestations of Brain Tumor:

A 
–Deteriorating mental status
–Headaches (worse at night): awaken pt in middle of night
–N/V
–Papilledema: related to increased ICP 
–Seizures
–Increased ICP
•Localized manifestations
–Focal weaknesses
–Sensory/language/coordination/vision disturbances
41
Q

What is Neurogenic Shock?

A

–Usually with cervical and high thoracic injury– T6 or above
–Loss of vasomotor tone
•Characterized by hypotension and bradycardia
–Loss of SNS
•Peripheral vasodilation
•Venous pooling and decreased C.O.

42
Q

What can people not have with Tegretol?

A

No grapefruit juice

43
Q

An immediate response that occurs with a spinal cord transection where the person experiences a complete loss of skeletal muscle function, bowel and bladder tone, sexual function, and autonomic reflexes. Loss of venous return and hypotension can also occur; Most likely in C-spine injuries; can last days to months

A

Spinal Shock

44
Q

What do you do if you suspect that patient has Autonomic Dysreflexia?

A

1) FIRST: Elevate HOB to at least 45 degrees immediately
2) Check BP
3) Check for source of irritation and remove if it can be done quickly (distended bladder or bowel, clogged catheter, blanket too tight, etc
4) Give Hypertensives if protocol says so and BP stays up
5) Monitor closely

45
Q

Automatisms can occur with ___ seizures.

A

Complex Partial

46
Q

Spinal cord injury above ___ is when we worry about respiratory muscle involvement.

A

C4

47
Q

What are the lowest and highest possible scores on the GCS?

A

lowest=3; highest=14 or 15 (depending on institution); 3=in a coma.

48
Q

What is the “classic” chain of events that occur with an Epidural Hematoma?

A

1) pt is unconscious immediately after head trauma.
2) pt awakens and is quite lucid.
3) Loss of consciousness occurs and pupil dilation response rapidly deteriorate, with onset of eye movement paralysis on the same side as the hematoma.
4) The client lapses into a coma.

49
Q

Who gets to receive Thrombolytic therapy? (tPA–Tissue Plasminogen Activator)

A

–Diagnosed ischemic stroke with neurologic deficit
–Within 3-4.5 hours since the start of symptoms (revised)
–No head trauma or MI within last 3 months
–No GI/GU bleed within 3 weeks
–No major surgery with 2 weeks
–No acute bleeding
–BP <185 systolic & <110 diastolic
etc…

50
Q

How long can the secondary injury last for someone with a SCI (spinal cord injury)?

A

weeks to months! The primary injury is the initial insult, the secondary is what happens after it.

51
Q

Papilledema=

A

swelling of the optic disk.

52
Q

Life-threatening syndrome that can occur with SCI’s above T6 after spinal shock has resolved=

A

Autonomic Dysreflexia

53
Q

Condition in which there’s paralysis of the sympathetic nerves to the eye, causing sinking of the eyeball, ptosis of the upper eyelid (drooping), slight elevation of the lower lid, constriction of the pupil, and lack of tearing in the eye =

A

Horner Syndrome (can be caused by stroke)

54
Q

Why does Autonomic Dysreflexia occur?

A

Because of an exaggerated sympathetic response (vasoconstriction) to noxious stimulus below the level of the spinal cord lesion (noxious stimuli include bladder and bowel distention commonly, among other things); Vasodilation occurs above the lesion.

55
Q

What would the labs look like with someone with bacterial meningitis?

A

CSF cloudy, positive gram stain, elevated CSF pressures, elevated CSF protein level, decreased CSF glucose level, elevated WBC count

56
Q

____ hematomas most often occur in the elderly and alcoholics.

A

Chronic subdural hematomas

57
Q

If bacterial meningitis is suspected, what should you do?

A

Place the client in respiratory isolation and ensure that all personnel who had contact with the patient receive prophylaxis.

58
Q

What are the 3 things assessed with the Glasgow Coma Scale (GCS)?

A

Verbal, motor, and eye opening responses

59
Q

Aphasia that affects speech comprehension; result of infarction in ____ lobe of brain.

A

Wernicke’s (sensory or receptive) aphasia; temporal

60
Q

Clinical Manifestations of Increased ICP:

A

Changes in Neuro assessment (other than those evaluated with GCS)

- HA
- Nau	sea
- Diplopia 
- Papilledema: swelling of optic disk; need opthalmascope to see this  
- Pupil Changes--Aniscoria (unequal pupils) ,Mydriasis (dilation of pupil)
Late findings of increased ICP (herniation is imminent)
	*Cushing’s triad
		§Increased SBP/Decreased DBP
		§Widening pulse pressure
		§Bradycardia
		§Respiratory pattern changes
			-Cheyne-Stokes breathing pattern
			-Periods of apnea
	*Temperature changes
		§Hypothalamus  involvement

Nursing: BSN classes (14 decks)

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