Neural/Hormonal Lab

Question 1

Benzodiazepines

Answer 1

• Ativan
• Valium
• Versed

Question 2

Opiates

Answer 2

• Propofol/diprivan
• Demoral
• Morphine
• Fentanyl

Question 3

Discharge Criteria for Conscious Sedation

Answer 3

•  VS
•  Airway patent
•  LOC
•  Tolerate fluids
•  Discharge instructions
•  Responsible driver

Question 4

•  Depressed LOC
•  Arouse to stimulation
•  Protective reflexes intact

Answer 4

conscious/moderate sedation

Question 5

Indications for focosed neuro assessment:

Answer 5

• • head injury
  • stroke
  • cranial surgery
  • drug/alcohol overdose
  • metabolic disorders (renal, electrolyte)

Question 6

is the most important assessment for neuro pts; changes are earliest indicator of neuro compromise

Answer 6

Level of Conscious (LOC)

Question 7

Eye opening in response to voice or painful stimulus

Answer 7

 Spontaneous (4) = opens eyes without any stimulus
 To sound (3) = only opens eyes in response to voice stimulus
 To pain (2) = only opens eyes in response to painful stimulus
 Never (1) = never opens eyes in response to any stimulus

Question 8

Motor Response:
Posturing status of patient:

Answer 8

 Obeys commands (6)
 Localizes pain (5) =
 Normal flexion (4) = withdrawal from painful stimulus
 Abnormal flexion (3) = decorticate posturing; abnormal flexion of arms/wrists in response to stimuli.
 Extension (2) = decerebrate posturing; abnormal arm extension in response to stimuli.
 No response (1) = no movement in response to painful stimulus.

Question 9

Quality of verbalization


Answer 9

Oriented (5) = oriented to time, person, place
 Confused conversation (4) = is confused regarding time, person, and/or place
 Inappropriate words (3) = using words which make no sense in the context of the conversation.
 Incomprehensible sounds (2) = No words or conversation, just sounds such as groaning.
 None (1) = no words or sounds, even in response to stimuli.

Question 10

• Invasive procedure that allows for detection of cerebral edema (↑ ICP) which could lead to compromised cerebral perfusion/injury.

Answer 10

ICP

Question 11

When is an ICP indicated?

Answer 11

• Indicated for unconscious pts w/ GCS rating of <9

Question 12

Pt presents a value of 20-25 on ICP

Answer 12

requires treatment

Question 13

Primary complication of ICP

Answer 13

Infection

Question 14

• Types (location) of ICP monitoring

Answer 14

1, intraventricular

2. subarachnoid
3. epidural
4. subdural
5. intraparenchymal

Question 15

• ICP reduced via:

Answer 15

a) Osmotic diuresis (Mannitol)
b) Upright positioning (elevate HOB @ least 30 degrees)
c) CSF drainage
d) Proper head/neck alignment in neutral position.
e) Hyperventilation (↓ CO2)
f) IV sedation (↓ metabolic demand)

Question 16

Calculated CPP

Answer 16

MAP - ICP

Question 17

indicator of perfusion to the brain

Answer 17

CPP

Question 18

Normal CPP; Critical level CPP

Answer 18

• N = 70-80 mmHg; critical level = < 60 mmHg (inadequate blood supply)

Question 19

test for unconscious pts; pts head moved quickly side to side from the midline position.

Answer 19

doll’s eyes reflex

Question 20

eyes deviate in opposite direction from side to which head is turned.

Answer 20

Intact doll’s eyes pupil assessment

Question 21

eyes move in the direction that the head is turned, remain midline, or move in the opposite direction from one another.

Answer 21

Not intact doll’s eyes

Question 22

brain tissue compression, atropine effect, eye injury.

Answer 22

dilated pupil

Question 23

lower brain injury or narcotic use/overdose

Answer 23

pinpoint pupil

Question 24

late sign of nerve (oculomotor) compression due to edema or mass.

Answer 24

change in pupil size (esp.unilateral change
non-reactive pupil - or brain ischemia if bilateral

Question 25

• A sluggish response to light

Answer 25

cerebral edema

Question 26

postural; best chance reversible, hands turn towards core

Answer 26

decoriticate

Question 27

postural; hands/feet flip away from body

Answer 27

Decerebrate

Question 28

Normal ICP

Answer 28

0-15 (7)

Question 29

how to calculate MAP

Answer 29

((diastolic x2) + systolic) /3

Question 30

Medications which are primarily administered to reduce anxiety

Answer 30

benzo

Question 31

medications which are primarily administered to reduce pain

Answer 31

opiates

Question 32

medications which are primarily administered as a sedative

Answer 32

versed (midazdam), diprivan (profolol)