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CCRN > Neuro > Flashcards

Neuro Flashcards

1
Q

If you lower part of your reticular activating system (RAS) is damaged, what happens?

A

Coma

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2
Q

If the upper part of reticular activating system (RAS) is damaged what happens?

A

You lose awareness but still wake up and go to sleep

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3
Q

Sensory deficits are generally on the _____ side as motor deficits, which are _________ to the side of injury.

A
  1. same side

2. contralateral

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4
Q

Which cranial nerve is responsible for pupillary response? Which side does the changes occur during an injury?

A

Cranial nerve III

sympathetic effects DILATE
parasympathetic effects CONSTRICTS

Changes occur on the ipsilateral (same) side of the injury

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5
Q

Oculocephalic reflex assessment, also known as doll’s eye, assesses which cranial nerves? What is considered normal during this assessment?

A

Cranial nerve III, VI, VIII

Normal eyes reflexively turn opposite of the side the head is turned (ie- head turns right, eye go left)

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6
Q

What is the oculovestibular reflex, also known as cold calorics?

A

It is a test where the patient’s eyes are held open while ice water is slowly injected into the ear canal and the eye response is observed.

A positive response is good
A positive response means that the patient’s eyes move towards the side of ice water injection

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7
Q

What is Cushing’s triad and what does it mean?

A

Cushing triads is: increase systolic pressure, widening pulse pressure, decrease heart rate (bradycardia), decrease RR

it is a sign of herniation of the brain

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8
Q

What is homonymous hemianopsia? It indicates damage to what cranial nerve?

A

a loss of vision in half the field of each eye (hemi= half, anopia=of each field)

cranial nerve II (Optic nerve)
occurs on the opposite side of the problem (ie-stroke, tumor)

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9
Q

What is uncal herniation?

A

displacement of the temporal lobe against the brain stem and the third canal nerve (oculomotor)

lateral shift with NO initial change in LOC

Compresses the parasympathetic innervation to the affected side, dilated pupil on the same side seen before change in LOC

Most often caused by an epidural hematoma

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10
Q

What is central herniation?

A

swelling on both sides, downward displacement of hemispheres. Usually due to diffuse edema and is slower to develop.

slight change in LOC but then could lead to coma

first pupils are small and then parasympathetic innnervation is blocked on both sides causing both pupils to dilate

Babinski reflex to both sides

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11
Q

During the treatment of an ischemic stroke, which parameters need to be met prior to treating a blood pressure?

A

SBP >220 mmHg
DBP >120 mmHg

a sudden decrease in blood pressure will decrease perfusion to an area of the brain that has already lost perfusion; this may increase the size of the ischemic area

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12
Q

What are the inclusion criteria for the use of TPA?

A

onset of symptoms was less than 4.5 hrs ago
CT scan is negative
no contraindications

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13
Q

What is the exclusion criteria for TPA?

A

Evidence of hemorrhage, stroke, head trauma
major surgery in the past 14 days, active bleeding in the past 21 days
MI in the past 3 months
Sz at the onset of stroke
Platelets <100,000
serum glucose <50
INR >1.7 if the patient is taking warfarin or if the patient has a noncompressible arterial puncture
spontaneous clearing of symptoms or only minor (NIHSS 1)
persistent blood pressure elevation

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14
Q

What are pontine infarct stroke characteristics?

A

Think P!

aPneustic breathing pattern
Pinpoint Pupils
Parasympathetic innervation

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15
Q

What is the classic triad of symptoms for a ruptured aneurysm?

A
  1. sudden explosive HA
  2. Decreased LOC
  3. Nuchal rigidity, positive kernig’s sign (pain to the neck and leg when moving the patient’s leg up and out)

may have a prominent U wave on ECG

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16
Q

Complications of a SAH are rebleed and vasospasm. If a vasospasm occurs what happens and how do you treat / prevent it?

A

Vasospasm results in brain ischemia
treatment : transluminal balloon angioplasty for select cases
prevention:
providing calcium channel blockers (Nimotop) for an aneurysmal SAH,
maintain CPP at 60-70 mmHg with fluids, pressors and inotropes
monitoring for and treating hyponatremia

17
Q

True or false

It is contraindicated for a patient with a brain tumor to be treated with steroid therapy.

A

False.

Brain tumor is the one neurological problem that includes steroid therapy (ie decadron). Steroids can prevent elevated ICP.

18
Q

What is a normal ICP?

A

0-10mmHg

19
Q

How do you calculate the cerebral perfusion pressure? what is a normal CPP?

A

MAP-ICP=CPP

80-100mmHg

20
Q

When leveling a bolt/ICP monitor the transducer should be at the level of what?

A

external auditory meatus, which is at the level of the foramen of Monro

21
Q

What type of herniation results from an epidural hematoma?

A

uncal herniation

22
Q

Which of the following symptoms are TRUE for an epidural hematoma?
A. Pupillary change occurs before decreased LOC
B. contralateral pupil dilation
C. Ipsilateral hemiparesis/hemiplegia
D. Occurs more slowly, and is more prevalent in elderly

A

A. ipsilateral pupil dilation occurs before decreased LOC

along with contralateral hemiparesis/hemiplegia
develops rapidly in the younger population

23
Q

What are immediate indications for elevation of a open depressed skull fracture?

A

Greater than 5mm below the inner table of the adjacent bone, gross contamination, dural tear with pneumocephalus, and underlying hematoma

24
Q

A basilar skull fracture results in what kind of tear? what are the sign/symptoms?

A
  1. Meningeal
  2. raccoon eyes (periorbital edema and ecchymosis); battle’s sign (discoloration at the back of the ear),rhinorrhea due to the meningeal tear, otorrhea, damage to cranial nerve I resulting in loss of smell
25
Q

What happens if the phenytoin (Dilantin) level is therapeutic and the patient has a seizure?

A

Give benzos (ativan)

26
Q

A patient presenting with early status epilepticus will have:

  1. Cerebral blood flow- increase or decrease
  2. HR and BP - increase or decrease
  3. glucose increase or decrease
  4. potassium increase or decrease
  5. PaCO2 and PaO2
A
  1. increase
  2. increase - tachycardia and HTN
  3. increase (Stress response)
  4. increase (destruction of skeletal muscle cells)
  5. increase, decrease
27
Q

What is the difference between bacterial and viral meningitis?

A

Bacterial: glucose is down, opening lumbar puncture pressure >180cm H2O

Viral: Clear CSF, opening LP pressure is normal

But both bacterial and viral meningitis have one or more signs of meningeal irritation

28
Q

What are positive signs of meningeal irritation?

A

Kernig’s sign (pain to neck and leg when moving the leg up and out)
Brudzinski’s sign (move the patient’s chin to their chest and the legs come up)
nuchal rigidity (flex their head to chest and pain and stiffness occur)

29
Q

What indicates a positive (supports brain death) apnea test in regards to their ABG?

A

PaCO2 is greater than or equal to 60mmHg or PaCO2 is greater than or equal to 20 mmhg over baseline

30
Q

What is Guillain Barre Syndrome?

A

It is an autoimmune response to a viral infection (parainfluenza, measles, mumps, chicken pox), a recent vaccination, a recent surgical procedure

31
Q

What type of paralysis occurs in GBS? What should you monitor for?

A

ascending paralysis

monitor for impending respiratory failure and urine retention

32
Q

What is myasthenia gravis?

A

it is an autoimmune attack of the neuromuscular junction resulting in “grave muscular weakness”

70% of patients with MG have ocular dysfunction (ptosis, diplopia, difficulty keeping an eye closed)

33
Q

How can you differentiate between myasthenic crisis and cholinergic crisis?

A

Tensilon test

MG Crisis: tensilon 2mg IV – clinical improvement
Cholinergic crisis: tensilon 2mg IV – increased muscle weakness–SLUDGE (Salivation, lacrimation, urination, defecation, gastrointestinal distress, emesis)

34
Q

How do you treat MG?

A 
pyridostigmine (Mestinon)
corticosteroids, 
removal thymus gland
plasmapheresis
IV immune globulin

CCRN (8 decks)

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