Neuro Flashcards
What does a CT show?
shows different layers and tissue density
What is the main job of the nurse in relation to CT scans?
Check for allergies to iodine or shellfish
Contrast can worsen these and cause an allergic reaction
When might you use sedation for a CT scan?
On a combative patient
What does an MRI show?
chemical changes in the cell
What can a patient not have to get an MRI?
- pacer
- aneurysm clips
- valves
- patches
- piercings
- intrauterine devices
what is a lumber puncture?
removal of CSF for diagnostics and pressure measurement
Where do they insert the needle for an LP?
inserted into the 3-5th lumbar vertebrae into the subarachnoid space
When is an LP contraindicated?
- 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
what is the most common illness in need of a LP?
looking for infection, most often meningitis
What are some complications of LP?
- Headaches
- Infection
- hematoma
Why may a headache result from an LP?
frontal or occipital headaches may occur due to a leak of CSF
Why is a blood patch used?
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
What is the brain requirement for oxygen?
constant supply of oxygen
What amount of CO does the brain require?
15-20% of cardiac output
How much glucose does the brain require?
the brain uses 15% of the body glucose, it has a high metabolic demand.
fill in the blank:
_____ ____ is required to meet the brains nutritional requirements
blood flow
where is glucose stored?
in the brain
what is CPP?
cerebral perfusion pressure: the amount of perfusion to the brain
what percent of the body energy demands does the brain require?
20%
what is included in a neuromuscular assessment? (5)
- level of consciousness
- motor response/strength
- pupillary response
- reflexes
- VS
why are LP’s contraindicated with increased ICP?
if you remove the cerebrospinal fluid it creates a pressure gradient that may cause downward herniation
what is the first sign of neuromuscular changes in the elderly?
Changes in LOC
What do blown pupils look like?
large and nonreactive
What do blown pupils indicate?
brain death
In eye opening what is the scale for the GCS?
4-opens eyes spontaneously
3-opens eyes to speech
2-opens eyes to pain
1-none
in verbal response, what is the scale for GCS?
5-orientated 4-confused 3-inappropriate 2-incomprehensible 1-none
in motor response what is the scale for GCS?
6-obeys commands 5-localizes to pain 4-withdraws to pain 3-flexion to pain 2-extension to pain 1-none
What is the GCS requiring intubation?
less than 8- intubate
what GCS indicates mild disability?
GCS of 13-15
what GCS indicates moderate disability? (4)
- GCS of 9-12
- LOC greater than 30 minutes
- Physical or cognitive impairments which may or may not resolve
- benefits from rehab
What GCS indicates severe disability? (4)
- GCS of 3-8
- unconscious state
- no meaningful response
- no voluntary activities
what GCS indicates vegetative state? (4)
- GCS less than 3
- sleep/ wake cycles
- arousal with no interaction with environment
- no localized response to pain
what is used to monitor interaction with environment?
continuous EEG
persistent vegetative state
- EEG
- long term vegetative state lasting longer than a month
- long term coma
is a vegetative state indicative of brain death?
no!!! it is a lack of concsiousness
What indicates brain death?
no brain function
no cerebral blood flow
what is a potential cause of brain death?
herniation
what do you assess when looking at pupils? (4)
- size
- shape
- reactivity to light
- comparison of one pupil to the other
What pupillary sign may indicate increased intracranial pressure?
sluggish pupils can indicate increased ICP
maybe caused by compression of the third cranial nerve, cerebral edema, and herniation
What are pupillary signs of brain death?
nonreactive and fixed pupils indicate brain death
big and blown with a loss of light reflex
what is anisocoria?
different-sized pupils
what is the doll’s eyes assessment?
moving the head back and forth to see how the eyes react
what is a normal response to the doll’s eyes assessment?
deviation of the eyes to the opposite side of head-turning
indicates brain function
what is an abnormal response to the doll’s eyes assessment?
oculocephalic reflexes are absent, no eye movement in response to head movement; eyes stay straight
what is the corneal reflex test?
using a wisp of cotton and touching the cornea lightly
the normal response to the corneal reflex test?
patient should blink
abnormal response to the corneal reflex test?
no response, no presence of the reflex
