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neuro Flashcards

1
Q

what are the most common neurological problems?

(5)

A
  • TBI
  • CVA (stroke)
  • seizures
  • spinal cord injuries
  • Guillain-Barre
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2
Q

what causes an open TBI?

A

basilar skull fracture

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3
Q

what are the causes for a closed TBI?

(2)

A
  • concussion
  • contusion
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4
Q

what are the manifestations of a closed TBI caused by concussion?

A
  • loss of consciousness
  • HA
  • retrograde amnesia
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5
Q

what are the types of injuries of a closed TBI caused by contusion?

brain matter bumps against skull

A
  • coup
  • contrecoup
  • coup-contrecoup
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6
Q

definition

coup

A

affecting one area of the brain due to impact

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7
Q

definition

contra-coup

A

affecting the area opposite of coup

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8
Q

definition

coup-contrecoup

A

effects to the frontal & occipital lobes

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9
Q

control

frontal lobe

A
  • motor control
  • problem solving
  • speech
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10
Q

control

temporal lobe

A
  • auditory processing
  • language comprehension
  • memory retrieval
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11
Q

control

parietal lobe

A
  • touch perception
  • body orientation
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12
Q

control

occipital lobe

A
  • sight
  • visual reception
  • visual interpretation
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13
Q

control

cerebellum

A
  • balance
  • coordination
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14
Q

control

brainstem

A

involuntary responses

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15
Q

which cause of closed TBI is more emergent?

A

contusion

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16
Q

what are the types of cerebral hematoma?

(3)

A
  • epidural hematoma
  • subdural hematoma
  • intracerebral hematoma
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17
Q

definition

epidural hematoma

A
  • rapid accumulation of blood in epidural space
  • rapid increase of ICP
  • intermittent loss of consciousness & waking
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18
Q

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?

A

early signs of increased ICP

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19
Q

signs of impending emergency for a patient with late manifestations of ICP

PNBCDC

A
  • fixed, dilated, & unequal pupils
  • Nuchal rigidity
  • positive Babinsky reflex
  • Cheyne-Stokes respirations
  • decorticate/ decerebrate
  • Cushing’s triad
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20
Q

what is Cushing’s triad?

A
  • high SBP, low DBP (wide pulse pressure)
  • slow RR
  • low HR
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21
Q

what are called the key findings of an open TBI?

A

clear drainage from the eyes, nose, & ears

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22
Q

how is the clear drainage from an open TBI tested?

A

glucose strips

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23
Q

what is a series of concussions called?

A

chronic traumatic encephalopathy

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24
Q

what are the types of hematoma?

A
  • subdural
  • epidural
  • intracerebral
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25
Q

which of the hematomas is the most serious?

A

epidural hematoma

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26
Q

how does a surgeon treat intracerebral hematoma?

A

coil embolization

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27
Q

how is ICP monitored?

A

with an intraparenchymal fiberoptic catheter inserted through a burr hole in the cranium

28
Q

what does the nursing intervention “ICPS” mean?

A
  • immobilize (log roll)
  • CO2 (needs to be lowered)
  • positioning (30 degrees HOB)
  • suctioning (< 10 seconds)
29
Q

what measure does the nurse need to take first before suctioning a patient with ICP?

A

hyperventilate the patient

30
Q

what is the goal when caring for a patient with ICP?

A
  • asepsis
  • frequent GCS assessment
  • prevent corneal damage
  • seizure precautions
31
Q

what are components of the GCS?

A
  • eye opening
  • verbal response
  • motor response
32
Q

how can a nurse prevent corneal damage due to involuntary eye opening?

A

use clear tape on the eyes of the patient

33
Q

what are the types of stroke?

A
  • ischemic
  • hemorrhagic
34
Q

what is the MOA of mannitol?

A

elevates blood plasma osmolality–enhances flow of water away from tissues & CSF into the interstitial space

35
Q

what are the side effects of mannitol?

A
  • edema
  • HF

HF needs to be PREVENTED

36
Q

how is mannitol administered?

A

IV

37
Q

what is the primary risk factor of stroke?

A

HTN (over 140 systolic mmHg)

38
Q

BEFAST

stroke symptoms & interventions

A

B(alance)
E (sudden vision loss)
F(acial asymmetry)
A(rm weakness)
S(peech difficulty)
T(ime to call 911)

39
Q

s/s of stroke that affects the left brain

A
  • expressive aphasia
  • reading/ writing problems
  • right hemiparesis
  • right side neglect
40
Q

s/s of stroke that affects the right brain

A
  • lack of impulse control
  • behavioral changes
  • left hemiparesis
  • left side neglect
41
Q

what kind of diagnostic test is used to determine the type of stroke a pt suffered?

A

CT scan

42
Q

the patient comes in to the ED with signs of stroke, why does the nurse ask when was the patient’s last “normal time”?

A

to determine their eligibility for tPA treatment

43
Q

what is the treatment for an ischemic stroke?

A

tPA

44
Q

through which route is tPA administered if the patient started having an ischemic stroke less than 3 hours ago?

A

IV

45
Q

what are the most important to monitor for a stroke patient?

A
  • neuro assessment q1-2h
  • NIH stroke scale
  • VS (including ICP & CPP) q1-2h
  • respiratory status
46
Q

what other factors does the nurse need to manage for a stroke patient?

A
  • I&O
  • ECG
  • cardiac enzymes
  • sodium levels
  • bladder & bowel function
  • ability to communicate
47
Q

The patient was given tPA through an arterial line. How long have they been suffering from the ischemic stroke?

A

3-5 hours

48
Q

a patient with their last known “normal time” 5 hours ago cannot be given tPA

A

true

49
Q

what are the bedside interventions for a stroke patient?

(6)

A
  • swallow screening
  • HOB 30 degrees
  • mobility
  • ROM exercises
  • bleeding precautions
  • monitor unilateral neglect (strengthen affected side)
50
Q

what are the manifestations of cervical injury?

A
  • impaired breathing
  • quadriplegia
51
Q

what are the manifestations of thoracic injury?

A

paraplegia (including GU)

52
Q

what are the manifestations of lumbar injury?

A

legs & bladder paralysis

53
Q

what are the causes of neurogenic shock?

A
  • spinal cord injury (to above T5)
  • spinal anesthesia
  • vasomotor center depression
54
Q

s/s of neurogenic shock

A
  • low SVR
  • excessive PNS activity
  • bradycardia
  • hypotension
  • low cardiac output
55
Q

what are the treatments for neurogenic shock?

A
  • IV fluids
  • vasopressors (Epi/ Norepi)
  • steroids
  • muscle relaxers (for muscle spasms)

increase BP

56
Q

neurogenic shock is specific to injuries above T5

A

true

57
Q

the nurse assesses a patient and determines the GCS score to be 8, what is the priority action?

A

intubation stat

58
Q

definition

Guillain-Barré

A

an idiopathic inflammatory demyelinating polyneuropathy that leads to ascending paralysis & paresthesia

59
Q

what is the treatment for Guillain-Barré?

A
  • plasmaphoresis
  • immunoglobulin therapy
60
Q

what is autonomic dysreflexia?

A

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)

61
Q

what is the body’s response to autonomic dysreflexia in the area above the injury?

A

vasodilation of vessels to counteract vasoconstriction ocurring below the level of injury (T5 or T6)

62
Q

what is the first symptom of autonomic dysreflexia?

A

throbbing HA

63
Q

what is the patient presentation of autonomic dysreflexia?

A
  • flushed face
  • diaphoretic
  • bradycardia
64
Q

what causes spinal shock?

A

the spinal cord is compressed and causes an increase of swelling

65
Q

what are the manifestations of spinal shock?

A
  • weakness
  • loss of sensation

COMPLEX (11 decks)

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