Nervous System Flashcards
damage to wernicke’s area results in…
word salad
damage to wernicke’s results in…
wouldn’t be able to understand what someone is saying to you
levels of the meninges (outer to inner)
dura mater
arachnoid mater
pia mater
what should MAP be over to ensure good cerebral perfusion
MAP > 60 (for adults)
normal ICP
5-15
symptoms of increased ICP
headache
vomiting
mental status
posturing
eyes (pupillary changes, nystagmus)
speech
vital signs
cushing’s triad
increased systolic, decreased diastolic
decreased heart rate
altered respirations
what does cushing’s triad show
increased ICP, could lead to herniation
what does decorticate posturing indicate
lesion above midbrain
what does decebrate posturing indicate
can indicate brain herniation
*more serious!
what is paresis
weakness in muscles
“incomplete paralysis”
ataxia
poor muscle coordination
dyspraxica
partial inability to perform purposeful or skilled motor acts
apraxia
inability to perform purposeful or skilled motor acts
what medication is rapid acting and will stop a seizure
lorazepam
which benzo is short acting with rapid onset and 1-2 duration
midazolam
which benzos are intermediate acting
alprazolam (6-12 hours)
clonazepam (18-50)
lorazepam (2-6 hours)
long acting benzo
diazepam
onset is rapid, duration 20-50 hours
therapeutic levels for phenytoin?
10-20 mcg/ml
max daily dose of acetaminophen?
4g per day
for longer term use - 3g per day
antidote for acetaminophen
acetylcysteine
why is aspirin used in caution with peds patients
can cause reye’s syndrome if they have viral illness
what is a open skull fracture
torn dura
when is a closed skull fracture
dura is intact
what is a basilar skull fracture
skull fracture at base of skull, where brain connects to spinal cord
what are three signs of a basilar skull fracture
battle’s sign - bruising over mastoid process
raccoon eyes
CSF rhinorrhea - test with halo test
should you insert an ng tube in a patient with a basilar skull fracture
no
will CSF be positive or negative for glucose
positive
are epidural hematomas arterial or venous bleeds
arterial which means they will be rapid
b/w dura mater and skull
are subdural hematomas arterial or venous bleeds
venous which means they will be slower
b/w arachnoid and dura mater
if injuries occur above T6, what should we monitor for
autonomic dysreflexia
s/s of autonomic dysreflexia
sudden and severe hypertension
bradycardia
headache
nasal stuffiness
flushing
sweating
blurred vision
anxiety
triggers for autonomic dysreflexia
restrictive clothing
dehydration
anxiety
broken bone
pressure ulcer
uti
blister
bladder
fecal impaction
tx for autonomic dysreflexia
antihypertensive med
find cause and treat
if a patient says they have the worst headache of their life, what might they have
hemorrhagic stroke
what is a hemorrhagic stroke
vessel ruptures and bleeds into the brain
blood accumulates and increases pressure on the brain
what is an ischemic stroke
blood flow to the brain is blocked by a blood clot
difference between thrombotic and embolic stroke
thrombotic - blood clot in an artery going to the brain
embolic - clot that is formed elsewhere and travels in the bloodstream and clogs a blood vessel in or leading to the brain, sudden onset
symptoms of stroke BEFAST
balance - dizziness, headache, loss of balance
eyes - blurry vision
face - face drooping
arms - arm or leg weakness
speech difficulty
time to call 911
door to TPA
60 minutes
4 signs of meningitis
nuchal rigidity
photophobia
kernig’s sign
brudzinski’s sign
kernig’s sign
with patient place supine and hip flexed at 90 degrees, knee cannot be completely extended due to pain
brudzinski’s sign
patient placed supine, passive flexion of neck causes involuntary flexion of knee and toes
s/s of MS (two danishes)
tingling & numbnes
weakness
optic neuritis
dysdiadochokinesia - cannot perform rapid alternative movements
ataxia
nystagmus
intentional tremor
scanning speech
hypotonia
epilepsy, seizures
spasticity (muscle, bladder)
what has descending vs ascending paralysis
ascending = guillain barre
descending = botulism toxin
tensilon test
give patient tensilon (basically Ach that body is blocking)
if muscle strength is improved –> patient has myasthenia gravis
key assessment finding: eye lids perk up (usually ptosis)
s/s of parkinsons’s TRAP
tremor
rigidity
akinesia (absence of movement)/ataxia (poor muscle control)
postural instability
