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Critical Care Nursing Exam 3 > Neuro > Flashcards

Neuro Flashcards

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1
Q

What does a CT show?

A

shows different layers and tissue density

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2
Q

What is the main job of the nurse in relation to CT scans?

A

Check for allergies to iodine or shellfish

Contrast can worsen these and cause an allergic reaction

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3
Q

When might you use sedation for a CT scan?

A

On a combative patient

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4
Q

What does an MRI show?

A

chemical changes in the cell

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5
Q

What can a patient not have to get an MRI?

A
  • pacer
  • aneurysm clips
  • valves
  • patches
  • piercings
  • intrauterine devices
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6
Q

what is a lumber puncture?

A

removal of CSF for diagnostics and pressure measurement

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7
Q

Where do they insert the needle for an LP?

A

inserted into the 3-5th lumbar vertebrae into the subarachnoid space

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8
Q

When is an LP contraindicated?

A
  • With increased ICP because it is not as effective as an EVD
  • depends on the cause of increased ICP, LP can cause brain herniation
  • positioning is also contraindicated for those with increased ICP
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9
Q

what is the most common illness in need of a LP?

A

looking for infection, most often meningitis

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10
Q

What are some complications of LP?

A
  • Headaches
  • Infection
  • hematoma
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11
Q

Why may a headache result from an LP?

A

frontal or occipital headaches may occur due to a leak of CSF

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12
Q

Why is a blood patch used?

A

If the patient has a headache after an LP, they draw blood from the patient and inject into the epidural space in order to clot/close the area with the leak

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13
Q

What is the brain requirement for oxygen?

A

constant supply of oxygen

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14
Q

What amount of CO does the brain require?

A

15-20% of cardiac output

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15
Q

How much glucose does the brain require?

A

the brain uses 15% of the body glucose, it has a high metabolic demand.

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16
Q

fill in the blank:

_____ ____ is required to meet the brains nutritional requirements

A

blood flow

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17
Q

where is glucose stored?

A

in the brain

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18
Q

what is CPP?

A

cerebral perfusion pressure: the amount of perfusion to the brain

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19
Q

what percent of the body energy demands does the brain require?

A

20%

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20
Q

what is included in a neuromuscular assessment? (5)

A
  • level of consciousness
  • motor response/strength
  • pupillary response
  • reflexes
  • VS
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21
Q

why are LP’s contraindicated with increased ICP?

A

if you remove the cerebrospinal fluid it creates a pressure gradient that may cause downward herniation

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22
Q

what is the first sign of neuromuscular changes in the elderly?

A

Changes in LOC

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23
Q

What do blown pupils look like?

A

large and nonreactive

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24
Q

What do blown pupils indicate?

A

brain death

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25
Q

In eye opening what is the scale for the GCS?

A

4-opens eyes spontaneously
3-opens eyes to speech
2-opens eyes to pain
1-none

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26
Q

in verbal response, what is the scale for GCS?

A 
5-orientated
4-confused
3-inappropriate
2-incomprehensible
1-none
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27
Q

in motor response what is the scale for GCS?

A 
6-obeys commands 
5-localizes to pain
4-withdraws to pain
3-flexion to pain
2-extension to pain
1-none
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28
Q

What is the GCS requiring intubation?

A

less than 8- intubate

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29
Q

what GCS indicates mild disability?

A

GCS of 13-15

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30
Q

what GCS indicates moderate disability? (4)

A
  • GCS of 9-12
  • LOC greater than 30 minutes
  • Physical or cognitive impairments which may or may not resolve
  • benefits from rehab
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31
Q

What GCS indicates severe disability? (4)

A
  • GCS of 3-8
  • unconscious state
  • no meaningful response
  • no voluntary activities
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32
Q

what GCS indicates vegetative state? (4)

A
  • GCS less than 3
  • sleep/ wake cycles
  • arousal with no interaction with environment
  • no localized response to pain
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33
Q

what is used to monitor interaction with environment?

A

continuous EEG

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34
Q

persistent vegetative state

A
  • EEG
  • long term vegetative state lasting longer than a month
  • long term coma
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35
Q

is a vegetative state indicative of brain death?

A

no!!! it is a lack of concsiousness

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36
Q

What indicates brain death?

A

no brain function

no cerebral blood flow

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37
Q

what is a potential cause of brain death?

A

herniation

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38
Q

what do you assess when looking at pupils? (4)

A
  • size
  • shape
  • reactivity to light
  • comparison of one pupil to the other
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39
Q

What pupillary sign may indicate increased intracranial pressure?

A

sluggish pupils can indicate increased ICP

maybe caused by compression of the third cranial nerve, cerebral edema, and herniation

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40
Q

What are pupillary signs of brain death?

A

nonreactive and fixed pupils indicate brain death

big and blown with a loss of light reflex

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41
Q

what is anisocoria?

A

different-sized pupils

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42
Q

what is the doll’s eyes assessment?

A

moving the head back and forth to see how the eyes react

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43
Q

what is a normal response to the doll’s eyes assessment?

A

deviation of the eyes to the opposite side of head-turning

indicates brain function

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44
Q

what is an abnormal response to the doll’s eyes assessment?

A

oculocephalic reflexes are absent, no eye movement in response to head movement; eyes stay straight

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45
Q

what is the corneal reflex test?

A

using a wisp of cotton and touching the cornea lightly

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46
Q

the normal response to the corneal reflex test?

A

patient should blink

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47
Q

abnormal response to the corneal reflex test?

A

no response, no presence of the reflex

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48
Q

what does it indicate when the patient does not blink with the corneal reflex test?

A

brain stem dysfunction or brain death

49
Q

what is the cold caloric test?

A

a small amount of cold water is delivered into the inner ear canal

50
Q

what does the cold caloric test stimulate?

A

the inner ear nerves- vestibulocochlear

51
Q

what does the cold caloric test cause?

A

rapid nystagmus

52
Q

what is a normal response from the cold caloric test?

A

both eyes move away and then towards the cold water

53
Q

what is an abnormal response to the cold caloric test?

A

no response

54
Q

what is a response to the cold caloric seen in patients in a coma without brainstem death?

A

eyes tonically deviate toward cold water

55
Q

what is decerebrate posturing?

A

arms and legs flexed, the patient is very stiff

56
Q

what is decorticate posturing?

A

hands to the chest

57
Q

what is decorticate posturing a sign of?

A

overstimulation

58
Q

what is a decerebrate posturing a sign of?

A

brain stem damage

59
Q

what is the most important indicator of brain function?

A

LOC

60
Q

fill in the blank:

_______ ___ is not a disorder but a resort of pathology.

A

altered LOC

61
Q

symptoms of a coma

A

unconscious
unresponsive
inability to arouse

62
Q

symptoms of persistent vegetative state

A

no cognitive function but has sleep-wake cycles

the patient is not brain dead.

63
Q

what is locked-in syndrome?

A

the patient is unable to move or respond except for eye movements due to a lesion affecting the pons

the patient can feel everything but cannot move

64
Q

what is the formula for CPP?

A

CPP=MAP-ICP

65
Q

what is a herniation of the brain?

A

brain tissues shifting through the dura and sinking into the skull base,
the brain moves into the brainstem and is a very common cause of brain death

66
Q

what is auto regulation?

A

the brains ability to change the diameter of blood vessels to maintain cerebral blood flow

67
Q

what does decreased c02 cause?

A

vasoconstriction

68
Q

what does increased c02 cause?

A

vasodilation

69
Q

what does increased fluid cause in the brain?

A

increased ICP

70
Q

Pts with high ICP become ___________

A

hypercapnic

71
Q

what are some main s/s of Increased ICP? (10)

A
  • HA
  • N/V
  • Decreasing LOC
  • unilateral motor loss
  • change in respiratory pattern
  • change in pulse pressure
  • loss of temp control
  • restlessness
  • seizures
  • posturing
72
Q

what causes a change in pupil size/reaction?

A

3rd cranial nerve compression

73
Q

what is unilateral motor loss?

A

loss of motor function on one side of the body

74
Q

what is the primary concern with seizures?

A

the brain is not getting enough oxygen

75
Q

How does the body compensate for increased ICP in relation to HR?

A

tachycardia to bradycardia

76
Q

what is cushing’s triad?

A
  1. Increased systolic with widened pulse pressure
  2. bradycardia
  3. decreased respiratory rate or change in pattern
77
Q

Late s/s of increased ICP?

A
  • bradycardia
  • apnea
  • cushing’s triad
  • decorticate/decerebrate posturing
  • alteration in pupil size/reactivity
  • seizure
  • papilliedema
78
Q

what is papilliedema?

A

increased pressure in the brain causes part of the optic nerve inside the eye to swell

79
Q

what are symptoms of papilliedema?

A

vision changes, HA, Vomiting

80
Q

what causes cushing’s triad?

A

increase in sympathetic outflow to the heart as an attempt to increase arterial blood pressure and widening pulse pressure

81
Q

when is cushing’s triad seen?

A

seen in terminal stages of head injury, this is a late sign

82
Q

how do you monitor for declining neuromuscular function? (7)

A
  • neuro checks
  • LOC
  • GCS
  • pupils
  • speech assessment
  • motor function
  • VS
83
Q

what is an indication for Q15 neuromuscular checks

A

with Increased ICP

84
Q

True or false:

increased ICP is always distributed evenly throughout the brain

A

FALSEEEEEEEEE!!!!

compression and swelling may be unequal.

85
Q

true or false:

EVD’s are inserted on the same side of the brain as the affected area

A

FALSEEE BRO

EVDS are always put on the opposite side of the affected area.

86
Q

what is Pbt02?

A

brain oxygenation

87
Q

what factors represent how much to drive BP?

A
  • ICP
  • CPP
  • Pbt02
88
Q

what is a normal Pbt02 for normal brain tissue?

A

> 20

89
Q

What level of oxygenation in the brain indicates hypoxia

A

pbt02 of 10-20mmHg

90
Q

what level of oxygenation in the brain indicates ischemia?

A

<10mmHg, this is irreversible

91
Q

What is CPP?

A

Cerebral perfusion pressure, amount of perfusion in the brain

92
Q

what is CPP closely linked to ?

A

ICP

93
Q

What is a normal CPP?

A

70-100

94
Q

what does a CPP of less than 50 represent?

A

permanent neuro damage

95
Q

what is a normal Pbt02?

A

20-40mmHg

96
Q

true or false

CPP and CBF are the same thing.

A

FALSE

CPP represents perfusion, while CBF represents blood flow

97
Q

true or false:

In brain death, CBF is not noted.

A

TRUE

CBF is not noted due to the ischemia of the brain

98
Q

with increased ICP we want to ______ the volume of ___.

A

reduce

CSF

99
Q

what are 4 ways to reduce the volume of CSF?

A
  • EVD
  • Ventriculostomy
  • VP shunt
  • diuretics
100
Q

what is a normal ICP

A

5-15

101
Q

what do you want to avoid with increased ICP?

A
  • suctioning, turning, bathing
  • head flexion and extension- off of the midline
  • valsalvas maneuver
102
Q

what is a ventriculostomy?

A

surgical placement of tube in the ventricle of the brain

103
Q

why is a ventriculostomy used?

A

to monitor ICP and relieve pressure through the drainage of CSF.

104
Q

nursing responsibilities in relation to EVD?

A
  • level at the tragus
  • correct pressure set
  • tubing/clamps/stopcocks open
  • monitor drainage
  • do not move patient
  • check dsg and insertion site
105
Q

True or false

nurses are able to do dsg changes on an EVD

A

FALSE

only the doctor can do dsg changes since it is at such high risk for infection

106
Q

what is an LP?

A

lumbar puncture

107
Q

what is a lumbar drain?

A

a line hooked up to an EVD used to relieve high pressure of CSF

108
Q

what is the goal of a lumbar drain?

A

drain and test CSF

109
Q

how can we manipulate CPP?

A

pressors

110
Q

CPP and ICP are _______

A

inverse

111
Q

ways to drive CPP? (3)

A
  • pressors
  • fluids
  • CSF drain
112
Q

ways to minimize ICP?

A
  • sedation
  • osmotic agents
  • ventriculostomy
  • position
  • paralytic agents
113
Q

what are some examples of sedation?

A

opiates
barbs
propofol

114
Q

What is Pbt02?

A

brain tissue oxygen

115
Q

ways to increase brain 02?

A

draining CSF
increasing MAP/ICP
Decreasing temp
Barbituates

116
Q

what are some commonly used vasopressors?

A
  • dopamine
  • low dose levo
  • neosynephrine
  • vasopressin
117
Q

what is the danger of low CO?

A

no perfusion

118
Q

what is the point of early gut functions?

A

the brain needs glucose to funciton

Critical Care Nursing Exam 3 (5 decks)

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