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Exam 2 - Block 2 > Neuro 1 > Flashcards

Neuro 1 Flashcards

1
Q

Which is the earliest sign of increasing intracranial pressure?

A

Change in level of consciousness

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2
Q

What are the symptoms associated with Cushing’s triad?

A

Bradycardia
Bradypnea
Hypertension (Pulse widening of 40 mmHg)

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3
Q

Extension and external rotation of the arms and wrists and plantar flexion of the feet is what form of posturing?

A

Decerebrate

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4
Q

The cranial vault contains brain tissue, blood, and cerebrospinal fluid; an increase in any of the components causes a change in the volume of the others. This hypothesis is called what?

A

Monro-Kellie

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5
Q

What is the priority concern for a patient with a change of level of consciousness?

A

Maintaining airway clearance

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6
Q

When a PT has an uncontrolled fever along with ICP, what would require immediate intervention?

A

Shivering

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7
Q

When assessing the pupils, what reaction would confirm increasing intracranial pressure?

A

Unequal response

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8
Q

Flexion of the elbows and wrists inwards, plantar flexion of the feet is what form of posturing?

A

Decorticate

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9
Q

What is the normal range of ICP?

A

0-15 mmHG / anything under 20 mmHg

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10
Q

Why is cerebral perfusion pressure needed?

A

To maintain adequate oxygen, blood, and nutrient to the brain

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11
Q

What is the normal range of cerebral perfusion pressure?

A

70-100 mmHg

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12
Q

How is cerebral perfusion pressure calculated?

A

CPP = MAP - ICP

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13
Q

If you need to increase cerebral perfusion pressure what 2 things could be done?

A

Reduce ICP
Support MAP via administering IV fluids or Vasodilators (Dopamine/Dobutamine)

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14
Q

How do you measure ICP?

A

Via Ventriculostomy

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15
Q

What is Ventriculostomy used for?

A

Draining CSF and lowering ICP while maintaining perfusion

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16
Q

What diagnostics are done when ICP is suspected?

A

CT scan and using the Glasgow Coma Scale

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17
Q

What signs and symptoms are monitored for ICP severity?

A

LOC
Glasgow coma scale (8 or lower?)
Pupils (sluggish, unilateral dilation, ptosis etc.)
Decreasing motor function
Posturing (Decorticate or Decerebrate)

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18
Q

What position do we place someone in that has ICP?

A

High fowlers with the head of the bed a 30 degrees

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19
Q

What treatments can be seen in Hospital for a ICP patient?

A

IV mannitol
Steroids (decrease inflammation)
Anticonvulsants (prevent seizures)
Antipyretics (prevent shivering and manage temp.)
Sedatives (relieve anxiety)
Analgesics (pain management)
Stool Softeners

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20
Q

What are our Nursing goals for a patient with ICP?

A

Decreasing of ICP
No infections
Education of: f/u appointments, important s/s to look out for, medication usage

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21
Q

What assessments are done for a patient with an altered level of consciousness?

A

Verbal responses present
Level of alertness
Motor response with or without posturing
Respiratory status
Pupils
Reflexes present

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22
Q

A CPP of less than 50 mmHg means what?

A

Permanent neurological damage

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23
Q

Focal seizures originate where?

A

On one hemisphere of the brain

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24
Q

Generalized seizures originate where?

A

Bilaterally in the brain

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25
Q

“Provoked” seizures are related to what?

A

Acute and possibly reversible conditions due to things like electrolyte imbalances

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26
Q

What is agnosia?

A

The inability to interpret objects and sensation due to brain damage

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27
Q

What are risk factors for Stroke?

A

HTN, Diabetes, Oral contraceptives, CV disease, High cholesterol, Obesity

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28
Q

Strokes are also called?

A

Brain attacks

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29
Q

What are the 2 types of strokes?

A

Ischemic and Hemorrhagic

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30
Q

What occurs with Ischemic strokes?

A

Decreased blood supply and oxygen supply that causes tissue death

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31
Q

What are the types of Ischemic strokes?

A

Large artery
Small penetrating artery thrombosis (Deep in brain)
Cardiogenic embolism (A-fib caused)
Cryptogenic (unknown cause)

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32
Q

What are the manifestations of an Ischemic stroke?

A

Numbness/Weakness/Total paralysis
Change in mental status and confusion
Dizziness/Loss of balance
Sudden severe HA
Perceptual/Vision disturbances

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33
Q

What is Hemiplegia?

A

Paralysis on one side of the body

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34
Q

What is Hemiparesis?

A

Weakness on one side of the body

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35
Q

What is Dysarthria?

A

Slurred speech/ trouble swallowing r/t muscle damage

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36
Q

What is Hemianopsia?

A

Blindness over 1/2 of the visual field

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37
Q

What is a Transient Ischemic Attack (TIA)?

A

Temporary neurological deficit that is the warning of an oncoming stroke

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38
Q

What is done to diagnosis a Hemorrhagic stroke?

A

CT scan

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39
Q

What management is done for a Hemorrhagic stroke?

A

Bed rest with sedation
Treatment of: Vasospasm, increased ICP, HTN, Potential seizures and prevention of further bleeding

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40
Q

What medications are used for prevention of secondary TIA’s?

A

Antihypertensives (ACE, ARBs, Beta blockers, Calcium channel blockers)
Statin’s
Anticoagulant therapy (ASA, Clopidogrel)

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41
Q

What is the surgical treatment for prevention of secondary TIA’s and Strokes?

A

Carotid endarterectomy for carotid stenosis (open the vessel to remove plaque)

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42
Q

What medical management is done for Acute Phase of Stroke?

A

Assessment of stroke with NIHSS tool
Thrombolytic therapy
Elevation of HOB
Maintaining airway and ventilation
Continuous hemodynamic monitoring

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43
Q

What is the cause of a Hemorrhagic stroke?

A

Bleeding into the brain tissue, the ventricles or subarachnoid space causing compression of the brain and ischemia

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44
Q

How do Hemorrhagic strokes present?

A

Severe HA
Early/sudden changes to LOC
Projectile vomiting
Similar to Ischemic strokes

45
Q

What nursing management is done for the acute phase of an Ischemic stroke?

A

Frequent monitoring of systems and vitals
Monitoring: LOC, Motor symptoms, Pupil changes, I&O, Oxygen saturation

46
Q

What assessments are done for a patient recovering from an Ischemic stroke?

A

Sensation/Perception
Motor control
Swallowing ability
Nutritional/hydration status
Skin integrity
Activity tolerance
Bowel and bladder function

47
Q

What are the complications for one recovering from an Ischemic stroke?

A

PNA
DVT’s
Inadequate O2 delivery to brain
Decreased cerebral blood flow

48
Q

What nursing interventions are done for one recovering from an Ischemic stroke?

A

Prevention of joint deformities
Prevention of shoulder abduction
Changing positions q2hr
Prevention of shoulder pain
Consults for speech therapy, OT, and PT
Prevention of constipation

49
Q

What are Nursing diagnoses for patients with Hemorrhagic strokes?

A

Risk for ineffective tissue perfusion R/T bleeding and vasospasm
Anxiety R/T illness/medically imposed restrictions

50
Q

What are the complications for a patient with a Hemorrhagic stroke?

A

Vasospasm (#1 cause death in subarachnoid pt’s)
Seizures
Hydrocephalus (R/T impaired circulation)
Rebleeding
Hyponatremia (admin 3% IV and monitor)

51
Q

What are nursing goals for a patient with Hemorrhagic stroke?

A

Improved cerebral tissue perfusion
Relief of anxiety
Absence of complications

52
Q

What nursing interventions are done for one recovering from an Hemorrhagic stroke?

A

Relief of anxiety
Re-orientation
Seizure precaution
Non-stimulating environment
Visitor restriction
HOB at 30 degrees with bedrest

53
Q

What are the Infectious neurological disorders?

A

Meningitis
Brain abscesses

54
Q

What is Meningitis?

A

Inflammation of the meninges covering the brain and spinal cord

55
Q

What are the 2 types of Meningitis?

A

Bacterial and Viral

56
Q

How is bacterial Meningitis transmitted?

A

Secretions and Aerosol contamination

57
Q

How does Meningitis present?

A

HA
Fever
Changes in LOC
Nuchal rigidity
Similar to the Flu

58
Q

Who is eligible for the Meningococcal vaccine?

A

Youth 11-12 y/o

59
Q

What is the medical management of bacterial Meningitis?

A

Dexamethasone (decreases brain swelling)
High doses of broad-spectrum ABX
Appropriate ABX

60
Q

What are the concerns with Meningitis?

A

Dehydration
Shock
Seizurres

61
Q

What is the Nursing management of Meningitis?

A

Pain and fever management
Protection from injury R/T falls and seizures
Frequent assessments of VS and LOC
Monitoring daily weight, electrolytes, urine vol.

62
Q

What is a positive Kernig sign?

A

The inability to fully extend one leg when the other is flexed upwards

63
Q

What is a positive Brudzinski sign?

A

when the patients neck is flexed a instinctive flexion of the knees and hips occurs

64
Q

How do brain abscesses form?

A

Via collection of infectious material from an uncontrolled infection

65
Q

How do you prevent brain accesses?

A

Treating Otitis media and rhinosinusitis

66
Q

How do brain abscesses present?

A

HA that is worse in the AM
Fever
Vomiting
Neurological deficits
S/S ICP

67
Q

What diagnostics are done for a brain abscess?

A

MRI or CT
CT-guided aspiration to identify pathogen

68
Q

What are the nursing managements of brain abscesses?

A

Control ICP
Drain abscess
Administer ABX and corticosteroids

69
Q

What is Encephalitis?

A

An acute, inflammatory process of the brain tissue

70
Q

What causes Encephalitis?

A

Viral infections (Herpes)
Vector-borne infections

71
Q

How does Encephalitis present?

A

HA
Fever
Confusion
Hallucinations

72
Q

How does Vector-borne Encephalitis present?

A

Rash
Flaccid paralysis
Parkinson-like movements

73
Q

What medication is used for HSV Encephalitis infections?

A

Acyclovir

74
Q

What is the nursing management of Encephalitis?

A

Supportive care for symptoms

75
Q

Which subtype of stroke is due to atrial fibrillation?

A

Cardio embolic

76
Q

Which term refers to the inability to perform previously learned purposeful motor acts on a voluntary basis?

A

Apraxia

77
Q

What is akathisia?

A

Restless, a need to move around and agitation

78
Q

What is bradykinesia?

A

Slow movements and speech, seen in Parkinson’s

79
Q

What is dyskinesia?

A

Impaired, uncontrolled involuntary movements

80
Q

What is parasthesia?

A

The sensation of numbness, tingling or pins and needles

81
Q

Where are Gliomas located?

A

In the brain/spinal cord

82
Q

How do Meningioma’s present?

A

Encapsulated (usually benign)

83
Q

What do Acoustic neuromas affect?

A

The 8th CN causing issues with hearing and balance

84
Q

Who do Pituitary adenomas occur in most?

A

Childbearing age women

85
Q

What are Angiomas?

A

Masses of abnormal blood vessels

86
Q

Where do Astrocytoma’s occur?

A

The brain stem

87
Q

What diagnostics are done for Brain Tumors?

A

Neurological exams
CT scans
MRI (best diagnostic)
PET scan
EEG
Study of cerebrospinal fluid
Biopsy

88
Q

What are the types of medical management for Brain tumors?

A

Surgery
Radiation therapy
Chemotherapy
Pharmacologic therapy

89
Q

Medical management for brain tumors depends on what?

A

The type, location, and accessibility of it

90
Q

Intramedullary tumors occur where?

A

Within the spinal cord

91
Q

Extramedullary tumors occur where?

A

Intradural, within or under the spinal dura

92
Q

Extramedullary-Extradural tumors occur where?

A

Outside the dural membrane

93
Q

What treatment is done to relieve compression on Spinal cord tumors?

A

Dexamethasone with radiation

94
Q

What assessments are done for Brain tumors?

A

Baseline neurologic exams (looking for deficits)
Pain checks
Respiration monitoring
Bowel and bladder function check

95
Q

Parkinsons is caused by what?

A

A decrease in Dopamine in the substansia nigra

96
Q

What are the cardinal manifestations of Parkinson’s?

A

Tremor
Rigidity
Bradykinesia

97
Q

What is Bradykinesia?

A

The slowing of voluntary movement

98
Q

What is Akathisia?

A

Restless, urgent needs to move around and agitation

99
Q

ALS is defined as what?

A

The loss of motor neurons in the anterior horn of he spinal cord

100
Q

How does ALS present?

A

Atrophy of muscles
Cramps
Twitching
Lack of coordination

101
Q

How does Muscular Dystrophy present?

A

Muscle weakening and wasting

102
Q

How does Degenerative Disc Disease present?

A

Low back pain

103
Q

What is Radiculopathy?

A

Pain related to the compression of spinal nerves

104
Q

How does post-polio syndrome present?

A

Musculoskeletal weakness & pain
Fatigue

105
Q

What 2 medications are used in Parkinson’s?

A

Levodopa and Benztropine mesylate

106
Q

What assessment is done for Cervical Discectomy?

A

Determining location, onset and pain radiation
Assessing for paresthesias, ROM
Assessing if is bilateral

107
Q

What are complications with Cervical Discectomy?

A

Hematoma
Spinal cord compression
Persistant pain post SX

108
Q

What is a Cervical Discectomy?

A

Surgery to remove a herniated or degenerative disc in the neck

Exam 2 - Block 2 (2 decks)

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