neuro Flashcards
what are the most common neurological problems?
(5)
- TBI
- CVA (stroke)
- seizures
- spinal cord injuries
- Guillain-Barre
what causes an open TBI?
basilar skull fracture
what are the causes for a closed TBI?
(2)
- concussion
- contusion
what are the manifestations of a closed TBI caused by concussion?
- loss of consciousness
- HA
- retrograde amnesia
what are the types of injuries of a closed TBI caused by contusion?
brain matter bumps against skull
- coup
- contrecoup
- coup-contrecoup
definition
coup
affecting one area of the brain due to impact
definition
contra-coup
affecting the area opposite of coup
definition
coup-contrecoup
effects to the frontal & occipital lobes
control
frontal lobe
- motor control
- problem solving
- speech
control
temporal lobe
- auditory processing
- language comprehension
- memory retrieval
control
parietal lobe
- touch perception
- body orientation
control
occipital lobe
- sight
- visual reception
- visual interpretation
control
cerebellum
- balance
- coordination
control
brainstem
involuntary responses
which cause of closed TBI is more emergent?
contusion
what are the types of cerebral hematoma?
(3)
- epidural hematoma
- subdural hematoma
- intracerebral hematoma
definition
epidural hematoma
- rapid accumulation of blood in epidural space
- rapid increase of ICP
- intermittent loss of consciousness & waking
a patient who suffered a TBI is in the ICU presents the following s/s
- agitation
- restlessness
- change in LOC
- decreased mental status
- sudden emesis (no nausea)
what is the pt currently experiencing?
early signs of increased ICP
signs of impending emergency for a patient with late manifestations of ICP
PNBCDC
- fixed, dilated, & unequal pupils
- Nuchal rigidity
- positive Babinsky reflex
- Cheyne-Stokes respirations
- decorticate/ decerebrate
- Cushing’s triad
what is Cushing’s triad?
- high SBP, low DBP (wide pulse pressure)
- slow RR
- low HR
what are called the key findings of an open TBI?
clear drainage from the eyes, nose, & ears
how is the clear drainage from an open TBI tested?
glucose strips
what is a series of concussions called?
chronic traumatic encephalopathy
what are the types of hematoma?
- subdural
- epidural
- intracerebral
which of the hematomas is the most serious?
epidural hematoma
how does a surgeon treat intracerebral hematoma?
coil embolization
how is ICP monitored?
with an intraparenchymal fiberoptic catheter inserted through a burr hole in the cranium
what does the nursing intervention “ICPS” mean?
- immobilize (log roll)
- CO2 (needs to be lowered)
- positioning (30 degrees HOB)
- suctioning (< 10 seconds)
what measure does the nurse need to take first before suctioning a patient with ICP?
hyperventilate the patient
what is the goal when caring for a patient with ICP?
- asepsis
- frequent GCS assessment
- prevent corneal damage
- seizure precautions
what are components of the GCS?
- eye opening
- verbal response
- motor response
how can a nurse prevent corneal damage due to involuntary eye opening?
use clear tape on the eyes of the patient
what are the types of stroke?
- ischemic
- hemorrhagic
what is the MOA of mannitol?
elevates blood plasma osmolality–enhances flow of water away from tissues & CSF into the interstitial space
what are the side effects of mannitol?
- edema
- HF
HF needs to be PREVENTED
how is mannitol administered?
IV
what is the primary risk factor of stroke?
HTN (over 140 systolic mmHg)
BEFAST
stroke symptoms & interventions
B(alance)
E (sudden vision loss)
F(acial asymmetry)
A(rm weakness)
S(peech difficulty)
T(ime to call 911)
s/s of stroke that affects the left brain
- expressive aphasia
- reading/ writing problems
- right hemiparesis
- right side neglect
s/s of stroke that affects the right brain
- lack of impulse control
- behavioral changes
- left hemiparesis
- left side neglect
what kind of diagnostic test is used to determine the type of stroke a pt suffered?
CT scan
the patient comes in to the ED with signs of stroke, why does the nurse ask when was the patient’s last “normal time”?
to determine their eligibility for tPA treatment
what is the treatment for an ischemic stroke?
tPA
through which route is tPA administered if the patient started having an ischemic stroke less than 3 hours ago?
IV
what are the most important to monitor for a stroke patient?
- neuro assessment q1-2h
- NIH stroke scale
- VS (including ICP & CPP) q1-2h
- respiratory status
what other factors does the nurse need to manage for a stroke patient?
- I&O
- ECG
- cardiac enzymes
- sodium levels
- bladder & bowel function
- ability to communicate
The patient was given tPA through an arterial line. How long have they been suffering from the ischemic stroke?
3-5 hours
a patient with their last known “normal time” 5 hours ago cannot be given tPA
true
what are the bedside interventions for a stroke patient?
(6)
- swallow screening
- HOB 30 degrees
- mobility
- ROM exercises
- bleeding precautions
- monitor unilateral neglect (strengthen affected side)
what are the manifestations of cervical injury?
- impaired breathing
- quadriplegia
what are the manifestations of thoracic injury?
paraplegia (including GU)
what are the manifestations of lumbar injury?
legs & bladder paralysis
what are the causes of neurogenic shock?
- spinal cord injury (to above T5)
- spinal anesthesia
- vasomotor center depression
s/s of neurogenic shock
- low SVR
- excessive PNS activity
- bradycardia
- hypotension
- low cardiac output
what are the treatments for neurogenic shock?
- IV fluids
- vasopressors (Epi/ Norepi)
- steroids
- muscle relaxers (for muscle spasms)
increase BP
neurogenic shock is specific to injuries above T5
true
the nurse assesses a patient and determines the GCS score to be 8, what is the priority action?
intubation stat
definition
Guillain-Barré
an idiopathic inflammatory demyelinating polyneuropathy that leads to ascending paralysis & paresthesia
what is the treatment for Guillain-Barré?
- plasmaphoresis
- immunoglobulin therapy
what is autonomic dysreflexia?
a SCI complication that only occurs with injuries T5 and above resulting in vasoconstriction below the injury & HTN (SNS response) in response to simple stimuli (such as tight clothing or full bladder)
what is the body’s response to autonomic dysreflexia in the area above the injury?
vasodilation of vessels to counteract vasoconstriction ocurring below the level of injury (T5 or T6)
what is the first symptom of autonomic dysreflexia?
throbbing HA
what is the patient presentation of autonomic dysreflexia?
- flushed face
- diaphoretic
- bradycardia
what causes spinal shock?
the spinal cord is compressed and causes an increase of swelling
what are the manifestations of spinal shock?
- weakness
- loss of sensation
