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Adults 2 > Module 3 Exam 1- Neuro > Flashcards

Module 3 Exam 1- Neuro Flashcards

1
Q

treatment for acute seizure

A

ativan (lorazepam)

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2
Q

nonacute seizure medications

A

depakote, phenytoin

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3
Q

complications of cerebral injury

A

DVT, pneumonia, hypotension, urinary retention

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4
Q

intracranial surgeries

A

craniotomy, burr holes, cranioplasty, craniectomy

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5
Q

craniotomy

A

opening at the skull; used to remove tumors, relieve elevated ICP, evaluate blood clot, control hemorrhage

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6
Q

burr holes

A

circular openings in the skull; used to provide access to ventricles, shunting procedures, hematoma or abscess, bone flap

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7
Q

cranioplasty

A

surgery to reconstruct bone defects in the skull

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8
Q

craniectomy

A

surgery to remove portion of skull; used to alleviated increased ICP

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9
Q

neuro preop care assessment

A

monitor vitals and LOC; monitor ABGs, ICP; monitor fluid status in labs; monitor for seizures (give meds if needed); monitor for signs and symptoms of infection (give antibx if needed) and complications

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10
Q

diagnostic procedures for neuro

A

CT scan, MRI angiography, transcranial doppler flow studies

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11
Q

levels of traumatic brain injuries

A

concussion = mild; contusion = moderate/severe; diffuse axonal injury (DAI) = severe

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12
Q

concussion

A

mild TBI; sudden trauma induced alteration at the alert state; may or may not experience brief LOC; may or may not experience brain bleed, swelling, or skull FX

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13
Q

contusion

A

moderate to severe TBI; bruising of the brain; experience LOC with stupor and confusion; injury may be at site of impact or opposite side (damages cortex); large contusions may be surgically removed

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14
Q

diffuse axonal injury (DAI)

A

severe TBI; deceleration injury from differential movement of brain and skull; axonal shearing; high mortality rate; posturing

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15
Q

decorticate posturing

A

damage to corticospinal tract (cortex lesion); pathway between brain and spinal cord; rigid extended legs, pointed toes, curled wrists, balled hands against chest

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16
Q

decerebrate posturing

A

severe injury to the brain at level of brainstem; poor prognosis; rigid extended legs, pointed toes, straight tense arms parallel to body, flexed wrists, curled fingers

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17
Q

epidural hematoma

A

between the skull and the dura results from trauma; momentary unconscious, then lucid period, then confusion, then coma; “talking die syndrome”

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18
Q

subdural hematoma

A

venous bleed between dura and brain caused by trauma; dilated pupils and fixed, headache, drowsy, confusion, hemiparesis; intervention is immediate craniotomy and evacuation of clot

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19
Q

intracerebral hematoma

A

bleeding withing brain seen when force exerted to head over small area (ex. bullet, stab); insidious onset progressing to headache and then neurologic deficits

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20
Q

subarachnoid hemorrhage

A

cause by head trauma, ruptured cerebral aneurysm, arteriovenous malformation (AVM)

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21
Q

signs and symptoms of subarachnoid hemorrhage

A

severe headache suddenly that worsens and is worse in back of head; “worst headache of life”; decreased LOC; photophobia; confusion and irritability; N/V; muscle aches, stiffness; seizures; diplopia, blindspots

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22
Q

treatment for subarachnoid hemorrhage

A

remove collection of blood to relieve pressure; repair aneurysm

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23
Q

nursing care of spinal cord injury loss of muscle function

A

maintain ABCs; keep pt immobilized with c-collar, backboard, or halo; assess loss of function

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24
Q

nursing care of spinal cord injury cardiovascular

A

avoid vagal stimulation (careful with suction); monitor vitals; admin atropine to induce sympathetic response and vasopressors if needed; assess need for pacemaker; admin fluid and blood to maintain SBP >90 and MAP > 65; vagal stim can cause brady and then arrest

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25
Q

neurogenic shock

A

acute injury to brain, cervical, or thoracic spine that causes distributive shock d/t loss of autonomic nervous system to control blood vessel; can occur 30 min - 6 weeks following injury

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26
Q

manifestations of neurogenic shock

A

hypotension, bradycardia, poikilothermia, anhidrosis

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27
Q

treatment for neurogenic shock

A

spinal stabilization, vasopressors, atropine, pacemaker

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28
Q

patho of neurogenic shock

A

loss of SNS tone, massive vasodilation and venous pooling, hypotension, low perfusion, cell death

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29
Q

GI/GU affected from spinal cord injury

A

neurogenic bladder and bowel due to disrupted innervation; no signal to go leads to either incontinence or retention or paralytic ileus; spastic bladder;

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30
Q

nursing care for spinal cord injury GI/GU

A

intermittent foley cath q4 hr; digital rectal exam or stimulation- enema, stool softener, fiber, water; medications like H2 blocker (famotidine), PPI (omeprazole), metoclopramide (reglan)

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31
Q

nursing care spinal cord injury metabolic/nutrition

A

nutritional support d/t high cal demand, anorexia from depression, and atrophy; parlytic ileus; monitor fluids, electrolytes, ABGs (sodium and potassium) \; feed via NG, G, or TPN within 24-48 hrs; ETT, Trach, NG tube- risk for metabolic acidosis

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32
Q

autonomic dysreflexia

A

SNS below level or injury responds to stimulus of sensory receptor and hyperstimulates SNS, vasoconstricts, and causes HTN; no opposition from PNS from spinal cord; PNS stimulated throgh baroreceptors in carotid arch and causes bradycardia and no vasodilation

33
Q

manifestations of autonomic dysreflexia

A

HTN with throbbing headache, blurry vision, diaphoresis above SCI, bradycardia, piloerection (aka goosebumps), flushing above SCI

34
Q

treatment of autonomic dysreflexia

A

remove stimulus by intermittent cath, removing fecal impaction, removing pain trigger; lower BP with nifedipine which is calcium channel blocker

35
Q

poikilotherma

A

inability to sweat/shiver or control temperature; occurs below SCI

36
Q

nurse treatment for poikilothermia

A

control external temperature; vital signs frequently

37
Q

nociceptive pain

A

musculoskeletal and visceral pain controlled via tylenol, ibuprofen, opioids

38
Q

neuropathic pain

A

nerve pain controlled with gabapentin, pregabalin

39
Q

complications of skin and reflexes from SCI

A

immobility- at risk for DVT, PE, decubiti; hyperactive reflexes

40
Q

treating skin and reflex complications from SCI

A

LMWH/Warfarin, repositioning, logrolling for DVT and PE; repositioning q2 and logrolling for decubiti; baclofen, ROM, PT/OT for hyperactive reflexes

41
Q

complications of SCI

A

pain, spinal sock, neurogenic shock, skin, reflexes, thermoregulation, metabolic/nutrition, cardiac, muscular, respiratory

42
Q

spinal shock

A

occurs 24hrs-6 weeks after injury; complete but temporary loss of motor function, sensation, autonomic activity; brain unable to transmit signals to muscles and organ

43
Q

manifestations of spinal shock

A

flaccid paralysis, clonus (first sign), no DTR, low visceral/somatic sensations, anhidrosis, parlytic ileus

44
Q

treatment of spinal shock

A

spinal stabilization, maintain ABCs, Pt and OT

45
Q

anhidrosis

A

absence of sweating

46
Q

respiratory complications with SCI

A

total loss of respiratory function if C4 or higher-phrenic nerve injured; Lower C or T spin affects intercostal muscles and abdomen leading to hypoventilation, long term causes secretions, pneumonia, atelectasis;

47
Q

nursing care of respiratory SCI

A

obtain breath sounds and monitor for hemothorax, monitor breathing patterns, care of ETT and tracheostomy, encourage cough deep breathing and incentive spirometer

48
Q

cushing triad

A

signs of a brain injury consisting of hypertension (widened pulse pressure), bradycardia, and irregular respirations

49
Q

somatic

A

voluntary muscle and skeletal

50
Q

autonomic

A

involuntary-automatic; consist of the unconscious; sympathetic and parasympathetic

51
Q

sympathetic

A

fight or flight

52
Q

parasympathetic

A

rest and digest

53
Q

hypothalamus controls

A

HR, BP, sleep

54
Q

brain stem

A

consist of midbrain, pons, medulla- controls respiration, heart, GI, CN 8-12

55
Q

cerebellum

A

controls motor and sensory integration, coordination, fine movement, balance

56
Q

mean arterial pressure

A

depends on BP and chemicals like CO2; normal is 70-100; below 60 mmHg- peripheral organs not perfused; below 50mmHg- brain not perfused; need to maintain normal MAP with increased ICP

57
Q

autoregulation of the brain

A

ability of the brain to maintain relatively constant blood flow despite changes in perfusion pressure; maintained by cerebral blood flow and cerebral arterioles

58
Q

neurological assessment

A

consists of subjective and objective data; physical exam looking at mental status, motor system/cerebellar function, sensory system, DTR, cranial nerves

59
Q

motor system/cerebellar function consists of

A

gait, muscle coordination, muscle strength (5 point scale), atrophy, tremors

60
Q

sensory system consists of

A

pain, temperature, proprioception

61
Q

altered LOC on GCS

A

minor injury- 13-15, moderate injury- 9-12, severe injury- 3-8; intubate at 8; 3 is brain death

62
Q

altered LOC is considered…

A

any measure of arousal that is not normal

63
Q

normal intracranial pressure

A

0-15mmHg (15 is high end of normal)

64
Q

if ICP is sustained over 20mmHG

A

brain injury issues will arise

65
Q

cerebral perfusion pressure (CPP)

A

the pressure needed for adequate blood flow to the brain; CPP = MAP - ICP

66
Q

CPP ranges

A

70-100mmHg is normal; <60mmHg is sign of ischemia; <50mmHg is sign of death

67
Q

how to manipulate cardiac output for brain perfusion

A

fluid volume and inotropic agents like dobutamine and levophed

68
Q

venticulostomy

A

how we measure ICP; catheter placed into ventricle; decrease ICP by releasing CSF; continuously measures ICPc

69
Q

complications of ventriculostomy

A

infection, meningitis, occlusion, ventricular collapse

70
Q

caring for ventriculostomy

A

1 inch above (too high = less drainage; too low = increased drainage); maintain asepsis, monitor for bleeding and CSF leakage; monitor vitals; monitor WBC; monitor drain site and assess for drainage; monitor for over drainage (headache), HOB at 30 degrees

71
Q

causes of increased ICP

A

mass, lesions, cerebral edema, increased CSF production, decreased CSF absorption, obstructive hydrocephalus, obstruction of venous flow

72
Q

early signs of increased ICP

A

decreasing LOC, headache and increased sensitivity (worse in AM), restlessness, contralateral muscle or sensation loss, pupillary change (fixed, dilated, unequal, diplopia, ptosis), changes in speech

73
Q

late signs of increased ICP

A

further decrease in LOC, fever without clear source, projectile vomiting, changes in vitals such as increased SBP and decreased DBP (widened pulse pressure), bradycardia, bradypnea, bilateral pupil dilation, loss of corneal and gag and swallow, posturing

74
Q

complications of increased intracranial pressure

A

brain stem herniation, diabetes insipidus (DI - dry inside), syndrome of inapropriate antidiuretic hormone, cushings triad

75
Q

treatment of diabetes insipidus from increased ICP

A

fluids, electrolytes, vasopressin, monitor I/O

76
Q

treatment of inappropriate antidiuretic hormone

A

electrolytes, restrict fluid, monitor I/O

77
Q

patho for diabetes insipidus

A

lack of anti-diuretic hormone (vasopressin) causes body to not hold onto water and results on lots of urine creating a dry inside

78
Q

nursing interventions for increased ICP

A

patent airway, monitor RR and O2, adequate cerebral tissue perfusion, normalize respirations, fluid balance, absence of infection, absence of complications, seizure precautions, treat pain

79
Q

management of increased ICP

A

decrease cerebral edema, lower volume of CSF, decrease blood volume but maintain cerebral perfusion; admin osmotic diuretics to dehydrate brain and reduce cerebral edema like mannitol

Adults 2 (7 decks)

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