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NURS 428: Evolution > Nervous System Alterations > Flashcards

Nervous System Alterations Flashcards

Exam 3

1
Q

Central Nervous System:

What is it comprised of?

A

The CNS comprises the brain and spinal cord.

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2
Q

Central Nervous System

Skull (cranium): What does it do?

A

Protects brain from traumatic injury

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3
Q

Central Nervous System

Meninges: What is it?

A

Three layers cover brain and spinal cord.

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4
Q

Central Nervous System

Cerebrospinal fluid: What does it do?

A

Fluid shock absorber

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5
Q

Central Nervous System

Cerebral vasculature: What is it made up of?

A

Internal carotids and vertebral arteries

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6
Q

Peripheral Nervous System

What is it comprised of?

A

The PNS consists of 12 pairs of cranial nerves and 31 pairs of spinal nerves.

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7
Q

Peripheral Nervous System

Cranial Nerves: What do they do?

A

Supply motor and sensory fibers to the head, neck, upper back, and viscera to the level of the waist

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8
Q

Peripheral Nervous System

Spinal Nerves: What is it attached to?

A

Attached to spinal cord in pairs

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9
Q

Peripheral Nervous System

Spinal Nerves: Dorsal root?

A

Dorsal root houses nerve cell bodies of sensory neurons.

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10
Q

Peripheral Nervous System

Spinal Nerves: Ventral root

A

Ventral root houses motor axons.

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11
Q

Cells of the Nervous System

Include:

A

Neurons

Neuroglia

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12
Q

Cells of the Nervous System

Include: Neuron

A

Basic functional unit

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13
Q

Cells of the Nervous System

Neuroglia (glia cells)-

A

Neuroglia (glia cells)-constitute the supportive tissue associated with the neurons

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14
Q

Cells of the Nervous System

Four types of neuroglia:

A

Microglia

Astrocytes

Ependymal

Oligodendroglia

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15
Q

Cells of the Nervous System

Four types of neuroglia: Microglia

A

Phagocytic cells

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16
Q

Cells of the Nervous System

Four types of neuroglia: Astrocytes

A

Supportive cells making up the blood-brain barrier

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17
Q

Cells of the Nervous System

Four types of neuroglia: Ependymal

A

Line ventricles,

produce and circulate CSF

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18
Q

Cells of the Nervous System

Four types of neuroglia: Oligodendroglia

A

Found in white matter, produce myelin

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19
Q

Neurological Assessment

Physical Examination includes:

A

Mental status

Glasgow Coma Scale

Mini Mental State Examination

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20
Q

Neurological Assessment

Physical Examination includes: Mental Status

What is included?

A

Level of consciousness and arousal

Orientation to the environment

Thought content

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21
Q

Neurological Assessment

Physical Examination includes: Glasgow Coma Scale - When is this done?

A

if brain injury is suspected

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22
Q

Physical Examination:

Mini Mental State Examination

A

Cognitive assessment, monitors disease progression in dementia and other neurological disease states

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23
Q

Glasgow Coma Scale:

What is the tool for? What do scores range from?

A

The Glasgow Coma Scale is a tool for assessing a patient’s response to stimuli.

Scores range from 3 (deep coma) to 15 (normal)

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24
Q

Testing cranial nerves

CN I: What is it?

A

CN I (olfactory) pertains to smell

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25
Q

Testing cranial nerves

CN II: What is it?

A

CN II (optic) pertains to vision

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26
Q

Testing cranial nerves

CN III, CN IV, and CN VI: What are they?

A

CN III, CN IV, and CN VI are assessed together because they pertain to the innervate extraocular muscles involved in eye movement.

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27
Q

Pupil size/reactivity:

What cranial nerve is assessed?

A

(CNII)

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28
Q

Pupil size/reactivity:

What are the three ways pupils are?

A

Pinpoint pupils

Dilated pupils

Aniscoria

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29
Q

Pupil size/reactivity:

Pinpoint pupils: What would this indicate?

A

Opiates

Medications for glaucoma

Nearly dead

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30
Q

Pupil size/reactivity:

Dilated pupils: What would this indicate?

A

Fear/panic/anxiety

Seizures

Cocaine,

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31
Q

Pupil size/reactivity:

Aniscoria: What is this? What would this indicate?

A

Unequal pupils

Can be normal, but can indicate neural dysfunction

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32
Q

Types of Abnormal Pupils include:

A
  1. Small or Pinpoint Pupils
  2. Large pupils
  3. Midposition Fixed Pupils
  4. One Large Pupil (Aniscoria)
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33
Q

Vital Signs:

Respirations: What does shallow indicate?

A

problem with maintaining patent airway/need suctioning

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34
Q

Vital Signs:

Respirations:

Snoring or stridor

A

Obstruction

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35
Q

Vital Signs:

Respirations:

Inability to maintain airway means?

A

Inability to maintain airway = cervical spinal cord lesion, neurodegenerative disease

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36
Q

Vital Signs:

Respirations:

Cheyne Stokes: What does this indicate?

A

Cheyne stokes = increased ICP

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37
Q

Vital Signs:

Respirations:

Hypoventilation: What does this indicate?

A

Hypoventilation = increased CO2, reduced O2- edema

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38
Q

Vital Signs:

Respirations:

Hyperventilation: What does this indicate?

A

Hyperventilation = respiratory alkalosis, decreased CO2-vasoconstriction- decreased cerebral blood flow

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39
Q

Vital Signs:

Temperature: What is it controlled by?

A

Control – hypothalamus

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40
Q

Vital Signs:

Temperature: Loss of control leads to?

A

Loss of control = Hyperthermia

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41
Q

Vital Signs:

Temperature: Hypothermia indicates?

A

Hypothermia = pituitary damage, spinal cord injury (SCI)

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42
Q

Vital Signs:

HR: What indicates increased ICP?

A

Increased ICP = tachycardia, altered ECG such ventricular or atrial dysrhythmias

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43
Q

Vital Signs:

HR: As ICP continues to rise, what happens?

A

As ICP continues to rise, bradycardia results indicating impending herniation

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44
Q

Vital Signs:

Blood pressure: WHat is most common?

A

Hypertension most common… as BP increases, CBF increases, and ICP increases

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45
Q

What is at the root of many neurological problems?

A

Increased intracranial pressure is at the root of many neurological problems.

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46
Q

As such, any patient who has sustained an injury to the central nervous system is at risk for ?

A

for increased intracranial pressure.

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47
Q

Signs of Increased Intracranial Pressure

What should be established?

A

Establish baseline neurologic assessment

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48
Q

Signs of Increased Intracranial Pressure

How does the person behave?

A

Decreased LOC, restlessness, confusion, combativeness

Lethargy, coma

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49
Q

Signs of Increased Intracranial Pressure

How are pupils?

A

Sluggish pupils to fixed and dilated, unequal pupils

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50
Q

Signs of Increased Intracranial Pressure

What are there changes in? What is a late finding?

A

Changes in motor function

Changes in VS are a late finding.

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51
Q

Signs of Increased Intracranial Pressure

What else occurs (triad)

A

Cushing triad:

increased systolic pressure,

bradycardia,

irregular respirations

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52
Q

Increased Intracranial Pressure:
Diagnostic Procedures include:

A

Computed tomography (CT) of the head

Magnetic resonance imaging (MRI)

Cerebral blood flow with transcranial

Doppler

Evoked potentials

EEG

Angiography

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53
Q

Intracranial Dynamics

How is the skull?

A

Skull is a rigid box.

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54
Q

Intracranial Dynamics

Contents include:

A

Blood vessels,

CSF,

brain parenchyma (tissue)

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55
Q

Intracranial Dynamics

According to the _________, the total volume of these three components remains constant because the skull is rigid and non-expandable. If the volume of one component increases, there must be a compensatory decrease in the volume of another to maintain normal intracranial pressure (ICP).

What is this?

A

Monro–Kellie doctrine

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56
Q

Intracranial Dynamics

Normal ICP range?

A

Range 0 to 15 mm Hg

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57
Q

Cerebral blood flow

What is autoregulation?

A

Autoregulation is the ability of an organ to maintain consistent blood flow despite marked changes in arterial circulatory and perfusion pressures.

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58
Q

Cerebral blood flow

What does the normal brain have the ability to do?

A

Normal brain has the ability to maintain CBF.

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59
Q

Cerebral blood flow

What is normal CBF maintained by?

A

Normal CBF maintained by CPP 60 to 100 mm Hg

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60
Q

Cerebral blood flow

To maintain functional autoregulation cerebral vessels, the following must be present: (3 things)

A

Normal Paco2

CPP greater than 60 mm Hg

MAP less than 160 mm Hg

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61
Q

Cerebral blood flow

To maintain functional autoregulation cerebral vessels, the following must be present:

Normal PaCO2: What is this and what does it do?

A

Paco2 is a potent vasodilator and will increase ICP.

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62
Q

Cerebral perfusion pressure (CPP)

How is it calculated?

A

Calculated: MAP – ICP = CPP

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63
Q

Cerebral perfusion pressure (CPP)

A CPP greater than 100mmHg indicates what?

A

CPP greater than 100 mm Hg indicates hyperperfusion and increased ICP.

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64
Q

Cerebral perfusion pressure (CPP)

CPP less than 60 mm Hg does what?

A

CPP less than 60 mm Hg decreases blood supply and hypoxia.

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65
Q

Cerebral perfusion pressure (CPP)

When MAP = ICP, what does this indicate?

A

MAP = ICP would indicate no cerebral blood flow.

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66
Q

Cerebral perfusion pressure (CPP)

CPP of ______ is maintained in critically ill patients.

A

CPP of 70 mm Hg is maintained in critically ill patients.

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67
Q

Increased Intracranial PressureMedical Management

What is needed?

A

Adequate Oxygenation

Carbon Dioxide Management

Blood Pressure

Metabolic Demands

Diuretics

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68
Q

Increased Intracranial PressureMedical Management

Adequate Oxygenation:
What is the goal?

A

Goal: PaO2 > 80 mm Hg

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69
Q

Increased Intracranial PressureMedical Management

Adequate Oxygenation:
What must be done for this?

A

Airway vigilance

Mechanical ventilation

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70
Q

Increased Intracranial PressureMedical Management

Adequate Oxygenation:

Mechanical ventilation: What is used and how?

A

Positive end-expiratory pressure (PEEP) – use with caution

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71
Q

Increased Intracranial PressureMedical Management

Carbon Dioxide Management:

A

PaCO2 35-45 mm Hg

Avoid hyperventilation

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72
Q

Increased Intracranial PressureMedical Management (Cont.)

Blood Pressure: What is the Goal?

A

Goal: MAP 70-90 mm Hg

CPP: at least 70 mm Hg

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73
Q

Increased Intracranial PressureMedical Management (Cont.)

Blood Pressure: What should be avoided?

A

Avoid hypertension

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74
Q

Increased Intracranial PressureMedical Management (Cont.)

Blood Pressure: What should be given to stop hypertension?

A

Nicardipine

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75
Q

Increased Intracranial PressureMedical Management (Cont.)

Metabolic Demands- What is done?

A

Temperature control

Pharmacological therapy

Seizure prophylaxis

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76
Q

Increased Intracranial PressureMedical Management (Cont.)

Metabolic Demands- Temperature control

What is done?

A

Induced hypothermia

Hypothermia continues to be explored as a means of reducing the brain’s metabolic demands during peak times of cerebral edema and brain injury.

77
Q

Increased Intracranial PressureMedical Management (Cont.)

Metabolic Demands- Pharmacological therapy

What meds are used?

A

Benzodiazepines

Propofol

Analgesia

78
Q

Increased Intracranial PressureMedical Management (Cont.)

Metabolic Demands-Diuretics?

What diuretics are used? What do they do?

A

Osmotic diuretics

Reduce brain tissue volume

79
Q

Increased Intracranial PressureMedical Management (Cont.)

Metabolic Demands-Diuretics?
What kind of osmotic diuretics reduce brain tissue volume?

A

Mannitol

Hypertonic saline (3% or 5% NaCl

80
Q

Cerebral vascular disease: Acute Stroke

What is key to identify correct treatment and vascular distribution?

A

Differential early diagnosis is key to identify correct treatment and vascular distribution

81
Q

Cerebral vascular disease: Acute Stroke

What occurs?

A

Neurologic deficit with sudden onset, resulting in permanent damage to brain tissue due to a disruption in blood flow

82
Q

Cerebral vascular disease: Acute Stroke

Neurologic deficit with sudden onset, resulting in permanent damage to brain tissue due to a disruption in blood flow

What are the two main types?

A

Ischemic (75-85%)

Hemorrhage (15-25%)

83
Q

Cerebral vascular disease: Acute Stroke

Neurologic deficit with sudden onset, resulting in permanent damage to brain tissue due to a disruption in blood flow

Ischemic (75-85%): What is this due to?

A

Thrombosis

Embolism

84
Q

Cerebral vascular disease: Acute Stroke

Neurologic deficit with sudden onset, resulting in permanent damage to brain tissue due to a disruption in blood flow

Hemorrhage (15-25%): What is this due to?

A

Intracerebral

Subarachnoid

85
Q

Definition and Classifications of Strokes

Stroke: What occurs?

A

Acute neurologic deficit that occurs when impaired blood flow to a localized area of brain results in injury to brain tissue

86
Q

Definition and Classifications of Strokes

What is the fifth leading cause of death in the US? What is the leading cause of long term disability?

A

Stroke

Fifth-leading cause of death in United States

Leading cause of serious long-term disability

87
Q

Definition and Classifications of Strokes

Major Classifications of Stroke include:

A

Ischemic strokes

Hemorrhagic strokes

88
Q

Definition and Classifications of Strokes

Major Classifications of Stroke include:

Ischemic strokes: What is it?

A

When blood supply to a part of the brain is suddenly interrupted

89
Q

Definition and Classifications of Strokes

Major Classifications of Stroke include:

Ischemic strokes: When blood supply to a part of the brain is suddenly interrupted

Interrupted by what?

A

Interruption of cerebral blood flow by thrombus or embolus

90
Q

Definition and Classifications of Strokes

Major Classifications of Stroke include:

What is the most common type of stroke?

A

Ischemic strokes

91
Q

Definition and Classifications of Strokes

Major Classifications of Stroke include:

Hemorrhagic strokes: What occurs?

A

When there is bleeding into brain tissue or the cranial vault

92
Q

Definition and Classifications of Strokes

Major Classifications of Stroke include:

Hemorrhagic strokes: What does it result from? What percent of strokes is hemorrhagic strokes?

A

Brain trauma, aneurysms, arteriovenous malformations, or hypertension

10% of all strokes

93
Q

Assessment and Diagnosis of Stroke:

Acronym: slide 30

A

BE FAST

Balance
Eyes
Face
Arm
Speech
Time

94
Q

Acute Stroke – Hemorrhagic

What are the three types?

A

Intracerebral hemorrhage

Ruptured cerebral aneurysm

Arteriovenous malformation

95
Q

Acute Stroke – Hemorrhagic

Intracerebral hemorrhage: What occurs? What is it caused by?

A

Bleeding into the brain

Uncontrolled hypertension

96
Q

Acute Stroke – Hemorrhagic

Intracerebral hemorrhage: What is mortality?

A

mortality 44-75 % (highest if brainstem hemorrhage)

97
Q

Acute Stroke – Hemorrhagic

Ruptured cerebral aneurysm: What occurs?

A

Dilated cerebral artery that ruptures

98
Q

Acute Stroke – Hemorrhagic

Ruptured cerebral aneurysm: Where does the bleeding occur?

A

Bleeding into subarachnoid space (SAH)

99
Q

Acute Stroke – Hemorrhagic

Arteriovenous malformation: What occurs?

A

Congenital abnormality forming an abnormal communication between arterial and venous systems in the brain

100
Q

Nursing care and National Institutes of Health Stroke Scale (NIHSS):

What does NIHSS determine?

A

Severity of stroke, and if candidate for t-PA

101
Q

Nursing care and National Institutes of Health Stroke Scale (NIHSS):

If appropriate, what should be administered?

A

If appropriate: Prepare to administer t-PA

102
Q

Nursing care and National Institutes of Health Stroke Scale (NIHSS):

What kind of problems should be identified?

A

Hyperglycemia

Neuro assessment/impulsiveness, risk for falls

Communication

ASPIRATION RISK- Dysphagia screen

ECG changes-dysrhythmias

Thrombosis- PE, MI, DVT

U/O- inability to void, incontinence

Skin, contractures

Psychosocial-grief, depression, family coping

103
Q

SEIZURES:

What is it?

A

Episode of abnormal and excessive discharge of neurons

104
Q

SEIZURES:

Epilepsy: What is it?

A

Epilepsy-condition spontaneous and recurrent seizures

105
Q

SEIZURES:

Status epilepticus: What is it?

A

Status epilepticus is continued or repetitive activity.

Status epilepticus is defined as a condition of either continued seizure activity or repetitive seizures without interictal recovery, over a period exceeding 30 minutes.

106
Q

Status epilepticus can be associated with

A

Status epilepticus can be associated with tonic–clonic, complex–partial, or absence seizures.

107
Q

Seizure Risk Factors:

A

Cerebrovascular disease

Hypoxemia

Fever (childhood)

Head injury

Hypertension

CNS infections

Brain tumor

Drug and alcohol withdrawal

108
Q

Plan of Care for a Patient Experiencing a Seizure

Observation and documentation of what?

A

Observation and documentation of patient signs and symptoms before, during, and after seizure

109
Q

Plan of Care for a Patient Experiencing a Seizure

What are nursing actions?

A

Nursing actions during seizure for patient safety and protection

110
Q

Plan of Care for a Patient Experiencing a Seizure

What is done after seizure?

A

After seizure care to prevent complications

111
Q

What are the types of seizures?

A

SIMPLE PARTIAL SEIZURE (SPS)

Complex Partial Seizures (CPS)

Generalized Tonic-Clonic Seizure

Absence Seizures

112
Q

SIMPLE PARTIAL SEIZURE (SPS):

What is it?

A

Focal seizure without alteration in awareness

113
Q

SIMPLE PARTIAL SEIZURE (SPS):

What is an example?

A

An “aura” is a simple partial seizure

114
Q

SIMPLE PARTIAL SEIZURE (SPS):

What is it not associated with?

A

No associated EEG changes in the majority of cases

115
Q

What is the most common seizure type?

A

Complex Partial Seizures (CPS)

116
Q

Complex Partial Seizures (CPS)

What is it? What does it result in?

A

Focal seizure (often temporal) with bilateral spread resulting in an alteration in awareness.

May have SPS as aura

117
Q

Complex Partial Seizures (CPS)

What may they have as an aura?

A

May have SPS as aura

118
Q

Complex Partial Seizures (CPS)

What are signs and symptoms?

A

Staring often with automatisms, may be partially reactive, last 1-2 minutes

119
Q

Complex Partial Seizures (CPS)

How are patients postictally?

A

Postictally often confused and tired

120
Q

Complex Partial Seizures (CPS)

What would EEG show?

A

EEG with bilateral temporal ictal discharge

121
Q

Generalized Tonic-Clonic Seizure:

What is this called?

A

“Grand mal”

Generalized Tonic-Clonic Seizure

122
Q

Generalized Tonic-Clonic Seizure:

What occurs?

A

Loss of consciousness with generalized tonic then clonic activity

Cyanosis, foaming, tongue-biting, urinary incontinence, last 1-2 minutes

123
Q

Generalized Tonic-Clonic Seizure:

What occurs postictally?

A

Postictally, often deep sleep then lethargy and confusion

124
Q

Generalized Tonic-Clonic Seizure:

What should be done as first aid?

A

FIRST AID: maintain airway, protect head, don’t restrain

125
Q

Generalized Tonic-Clonic Seizure:

What would EEG show?

A

EEG shows generalized polyspike activity

126
Q

Absence Seizures:

What is this called?

A

“Petit mal”

127
Q

Absence Seizures:

What does NOT occur in this?

A

No aura or postictal state

128
Q

Absence Seizures:

What are symptoms? How long does this seizure last?

A

Unresponsive staring, often with blinking

Last 10-20 seconds

129
Q

Absence Seizures:

What appears on EEF? What are seizures precipitated by?

A

Generalized 3 Hz spike-wave on EEG; seizures precipitated by hyperventilation

130
Q

Absence Seizures:

How long in life do these last?

A

Usually outgrown by late childhood

131
Q

Nursing MANAGEMENT OF SEIZURES

What should be maintained?

A

Maintain airway and ventilation

132
Q

Nursing MANAGEMENT OF SEIZURES

What should be assessed? For what?

A

Neurological assessment

For Characteristics of seizure activity

133
Q

Nursing MANAGEMENT OF SEIZURES

What kind of precautions should be taken?

A

Safety precautions

134
Q

Seizure Medical Management:

What medications?

A

Benzodiazepines

Anticonvulsants

Barbituates

135
Q

Seizure Medical Management:

Benzodiazepines: What do they do?

A

Block excessive activity of the gamma-aminobutyric acid-A (GABA-A) receptors in the brain and other areas in the central nervous system.

136
Q

Seizure Medical Management:

Benzodiazepines: What are examples?

A

Xanax, Klonopin, diazepam, Ativan, midazolam

137
Q

Seizure Medical Management:

Anticonvulsants: What do they do?

A

slow down impulses in the brain that cause seizures

138
Q

Seizure Medical Management:

Anticonvulsants: What is an example?

139
Q

Seizure Medical Management:

Barbituates: What do they do?

A

increasing the activity of the inhibitory neurotransmitter GABA.

140
Q

Seizure Medical Management:

Barbituates: What is an example?

A

Phenobarbital

141
Q

Guillain Barre Syndrome (GBS):

What is this?

A

Immune mediated demyelinating neuropathy

142
Q

Guillain Barre Syndrome (GBS):

Symptoms?

A

Ascending weakness of limbs to paralysis-including respiratory muscles

143
Q

Guillain Barre Syndrome (GBS):

What are ANS Symptoms?

A

ANS- postural hypotension, arrhythmias, facial flushing, sweating , urinary retention

144
Q

Guillain Barre Syndrome (GBS):

Symptoms: What kind of pain occurs?

A

Pain in shoulder, back posterior thighs

145
Q

Guillain Barre Syndrome (GBS):

How long is the acute phase:

A

Acute phase 1-4 weeks

146
Q

Guillain Barre Syndrome (GBS):

How long is the acute phase:Acute phase 1-4 weeks: What occurs after?

A

then patient stabilizes and rehabilitation can begin; however, recovery may be lengthy, from 3 months to 2 years.

147
Q

Nursing management of GBS

What kind of support may be necessary?

A

Ventilatory support as required

148
Q

Nursing management of GBS

What should be monitored?

A

Monitor blood pressure and heart rate; detect and treat arrhythmias early

Monitor for constipation

Monitor for urinary retention

149
Q

Nursing management of GBS

Monitor blood pressure and heart rate; What should be detected and treated early?

A

detect and treat arrhythmias early

150
Q

Nursing management of GBS

Monitor for urinary retention: How?

A

intermittent urinary catheterization

151
Q

Nursing management of GBS

What should be treated? What should they have assistance in?

A

Treat pain

Assist with ADLs

152
Q

Autonomic dysreflexia:

What is it?

A

Autonomic dysreflexia is a syndrome in which there is a sudden onset of excessively highblood pressure

153
Q

Autonomic dysreflexia:

Who is it most common in?

A

More common in people withSCI- spinal cord injury that involve thethoracic nerves or above (T7 or above).

154
Q

Autonomic dysreflexia:

What are symptoms? (Not having to do with skin)

A

A pounding headache.

Nasal stuffiness.

Nausea.

Bradycardia

155
Q

Autonomic dysreflexia:

What are symptoms? (having to do with skin)

A

A flushed face and/or red blotches on the skin above the level of spinal injury.

Sweating above the level of spinal injury.

Goose bumps below the level of spinal injury.

Cold, clammy skin below the level of spinal injury.

156
Q

Autonomic Dysreflexia: Cause, Prevention / treatment

What are causes (What are triggering conditions)

A

Overfilled bladder

Overfull bowel or constipation

Pressure injuries, ingrown nails

Tight clothing or devices

157
Q

Autonomic Dysreflexia: Cause, Prevention / treatment

What are causes (What are triggering conditions): Overfilled bladder

What is prevention and treatment of this?

A

Prevent UTI, assess bladder, monitor I &O,

may be incontinent or neurogenic bladder… bladderscan q4-6h for residual volume,

regular toileting if able

158
Q

Autonomic Dysreflexia: Cause, Prevention / treatment

What are causes (What are triggering conditions): Overfull bowel or constipation

What is prevention and treatment of this?

A

Fiber and fluids.

Assess bowel sounds,

elimination

Potential for ileus, GI ulcers

159
Q

Autonomic Dysreflexia: Cause, Prevention / treatment

What are causes (What are triggering conditions): Pressure injuries, ingrown nails

What is prevention and treatment of this?

A

Check skin, podiatry consult if necessary

160
Q

Autonomic Dysreflexia: Cause, Prevention / treatment

What are causes (What are triggering conditions): Tight clothing or devices

What is prevention and treatment of this?

A

Ensure comfort

Avoid wrinkles in sheets,

Monitor equipment to ensure not pulling

161
Q

Spinal Cord Injury Nursing Management include:

A

Airway management

Cardiovascular stability

DVT prophylaxis

Skin care

Elimination

162
Q

Spinal Cord Injury Nursing Management include:

Airway management: What are you assessing?

A

Assessment of respiratory function

163
Q

Spinal Cord Injury Nursing Management include:

Airway management: What are you optimizing? How?

A

Optimize pulmonary function

Positioning

164
Q

Spinal Cord Injury Nursing Management include:

Cardiovascular stability: Why?

A

Maintain spinal cord perfusion

165
Q

Spinal Cord Injury Nursing Management include:

Spinal cord stabilization: How?

A

Halo vest

Surgical intervention (plates, rods, bone grafts)

166
Q

Spinal Cord Injury Nursing Management include:

What kind of meds are used?

A

Glucocorticoids – high dose

Vasopressors/fluids

Proton pump inhibitors (Prilosec, protonix)

IV fluids

167
Q

CNS Infections:

What is an example?

A

Bacterial meningitis

168
Q

CNS Infections:

Bacterial meningitis: What is it considered?

A

Neurological emergency

169
Q

CNS Infections:

Bacterial meningitis: What is it an infection of?

A

Infection of the pia and arachnoid layers of the brain and spinal cord,

and the Cerebrospinal Fluid (CSF)

170
Q

CNS Infections:

Bacterial meningitis: How is it transmitted?

A

Blood

CSF contamination during surgical procedures

Skull

171
Q

Acute Meningitis

*Meningoencephalitis: What does this refer to as?

A

*Meningoencephalitis refers to inflammation to meninges and brain parenchyma

172
Q

Acute Meningitis

What is it?

A

An acute inflammatory process of leptomeninges and CSF

173
Q

Acute Meningitis

Leptomeninges: What is this?

A

(Leptomeninges: The two innermost layers of tissues that cover the brain and spinal cord. The two layers are called the arachnoid mater and pia mater.)

174
Q

Acute Meningitis:

What is the infection process?

A

Bloodstream infection and multiplies in CSF, resulting in inflammation of sub arachnoid space and pia mater

175
Q

Acute Meningitis:

What are the types?

A

Septic (bacterial)

Aseptic (viral infection, lymphoma, leukemia, or brain abscess)

176
Q

Acute Meningitis:

Septic (bacterial): Like what bacteria?

A

(Streptococcus pneumoniae, Neisseria meningitidis)

177
Q

Acute Meningitis:

Aseptic : Like what?

A

Aseptic

(viral infection,

lymphoma,

leukemia,

or brain abscess)

178
Q

Acute Meningitis:

What are manifestations?

A

headache, fever

changes in LOC: disorientation, poor memory

behavioral changes,

nuchal rigidity (stiff neck),

positive Kernig’s sign,

positive Brudzinski’s sign

photophobia

179
Q

Meningitis:

Diagnosis/Management:

What is needed for prevention?

A

Prevention meningococcal conjugated vaccine – entry to high school, college

Also: vaccination against Haemophilus influenzae and S. pneumoniae for all children and all at-risk adults

180
Q

Meningitis:

Diagnosis/Management:

What is diagnosis?

A

CT scan

MRI

Lumbar puncture:

181
Q

Meningitis:

Diagnosis/Management:

What is diagnosis? Lumbar puncture:

A

CSF for bacterial culture and Gram staining

182
Q

Meningitis:

Diagnosis/Management:

What is management?

A

Initiation of appropriate antibiotic therapy

183
Q

Meningitis:

Diagnosis/Management:

What is medical management: What should be administered early? What else is given?

A

Early administration of high doses IV antibiotics for bacterial meningitis

Dexamethasone

Treatment dehydration, shock, and seizures

184
Q

Meningitis:

Diagnosis/Management:

What is medical management: What should be treated?

A

Treatment dehydration, shock, and seizures

185
Q

Nursing care of patient with Meningitis:

What should be instituted? How long?

A

Instituting infection control precautions until 24 hours after initiation of antibiotic therapy (oral and nasal discharge is considered infectious)

186
Q

Nursing care of patient with Meningitis:

What should there be assistance in?

A

Assisting with pain management due to overall body aches and neck pain

Assisting with getting rest in a quiet, darkened room

187
Q

Nursing care of patient with Meningitis:

What should there be implemented?

A

Implementing interventions to treat the elevated temperature, such as antipyretic agents and cooling blankets

188
Q

Nursing care of patient with Meningitis:

What should be encouraged to the patient?

A

Encouraging the patient to stay hydrated either orally or peripherally

189
Q

Nursing care of patient with Meningitis:

What should be ensured?

A

Ensuring close neurologic monitoring

NURS 428: Evolution (17 decks)

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