Neuro Flashcards
What part of the brain has contralateral control
Forebrain
Responsible for motor, sensory, vision, visceral activities etc.
What part of the brain has ipsilateral control
Hindbrain
Responsible for balance and posture
Also responsible for autonomic activities
What part of the brain controls voluntary and involuntary visual motor movements, hearing, production of dopamine
Midbrain
What is a normal intercranial pressure
5-15mmHg, don’t start treating until above 20
How do you calculate cerebral perfusion pressure
mean arterial pressure (MAP) - intercranial pressure (ICP)
CCP=pressure needed to perfuse the brain should be above 60-80mmHg
How do you measure ICP
subarachnoid bolt
How do you remove CSF in a pt with high ICP
Intraventricular drain
What can cause cerebral edema
hyponatremia, TBI, ruptured aneurysm
How do you treat cerebral edema
hypertonic solutions (3% NS), osmotic diuretics (mannitol), corticosteroids
Describe stage 1-4 ICP scale
1: no sx
2: subtle confusion, lethargic, restless
3: small pupil, extreme lethargy, breathing changes, increased BP, decreased HR
4: Cushing’s triad, fixed and dilated pupils
What is cushings triad
low hr, change in respirations, widening pulse pressures
Two nursing interventions for pt’s with brain injuries
Seizure precautions
Low-stimulation environment
difference between tonic and clonic
Tonic-body stiffens
Clonic-body jerks
Describe the pathophysiology of a seizure
One indv neuron becomes excited and starts making nearby neurons go crazy so that they’re taking up way more resources than they should and releases abnormal amount of lactate which tells the body that they need increased blood flow to replace but increases icp and further exacerbates hypoxia
Lab values that may cause seizures
Severe hyper or hyponatremia
Hypoglycemia
Acidosis
precursor to status epilepticus
deep sleep in post-ictal phase
WHAT ARE THE 4 SEIZURE MANIFESTATION PHASES
Prodrome (days/weeks ahead of time)
Possible aura
Ictal phase (physical manifestation of seizure)
Postictal (Confusion)
Name some labs that could indicate the cause of a seizure
CBC increased WBC from infection (fever?)
Glucose hypo
Calcium hyper/hypo can cause neuro
BUN increased if pt w/ kidney disease
Creatinine increased if pt w/ kidney disease
What do you need to do before a Electroencephalogram (eeg) or video electroencephalogram (veeg)
take pt off all seizure meds
What medications PREVENT, DON’T STOP SEIZURES
Anti-seizure medications
Phenytoin (Dilantin)
Carbamazepine
Phenobarbital
Levetiracetam (Keppra)
What medications helps break seizure activity, GIVE WHEN IN SEIZURE
Benzodiazepines
Lorazepam
Diazepam
How do you treat REPEATED SEIZURES, NOT ONE OFF SEIZURE
Deep Brain Stimulation (senses abnormal electrical activity and zaps brain to reset)
How do you treat identified focal seizures
Possible surgical intervention
Diet for patients that experience seizures
Ketogenic diet
Reduces glutamate (which encourages seizure activity) and increases GABA (which suppresses seizure activity)
What are the nursing interventions for a patient having a seizure
OBSERVE (HOW LONG, WHEN DID IT START, PATENT AIRWAY) AND ENSURE SAFETY (POSITIONING, PADDED ENVIRONMENT, GUIDE TO SAFE ENVIRONMENT)
GET IV IN STAT TO ADMIN MEDS, PUT ON SEIZURE PRECAUTIONS
Dark red, bloody CSF indicates a
Hemorrhagic stroke
What can cause a hemorrhagic stroke
Hypertension (sustained 180 systolic)
Tumors (very vascular
Impaired coagulation
Trauma
Stimulant use (meth, cocaine)
What baseline labs should you expect to draw for a patient suspected of stroke
coag studies, electrolytes, renal labs
How do you know a stroke is happening in the hind brain
unbalance and abnormal posture
Also responsible for autonomic activities (weird breathing, irregular heart rate)
Symptoms on same side of brain injury
How do you know a stroke is happening in the Forebrain
Responsible for motor, sensory, vision, visceral activities
Symptoms happening on the opposite side of injury to brain
Fibrinolytics Must be given within the first ____ _______ to be effective
4.5 hours
How do you treat a Subarachnoid hemorrhage
Nimodipine (decrease discharge of neurons)
Ventriculostomy (drains excess cerebrospinal fluid (CSF) from the head. It is also used to measure the pressure in the head)
What is the difference between a focal and diffuse TBI
Focal: affects one area of the brain
Diffuse: affects more than one area of the brain
What intervention can you expect when a patient is diagnosed with an Ischemic Stroke
Hypothermia protocol
What meds might you administer to a patient with seizures
spironolactone for cerebral edema
blood thinners/amiodarone for afib
1.5-3% saline for hyponatremia
phenytoin, levateracital) to prevent seizures
SSRI to improve function (lopram, ertaline)
What types of nursing interventions do you expect to give a stroke patient
Monitor neurological status carefully-GCS
Ensure DVT prophylaxis
Assess for musculoskeletal issues, provide ROM
Facilitate communication (write on whiteboard)
Speech consult to assess swallowing ability
What is the difference between a primary and secondary TBI
Primary TBI: caused by direct force
Focal: affects one area of the brain
Diffuse: affects more than one area of the brain
Secondary TBI: Indirect effects of the primary injury
Systemic responses: edema, hemorrhage, increased ICP, infection
Molecular cascades and inflammatory events can be involved
What is the difference between a coup and countercoup TBI injury
Coup injury: injury at the site of impact
Contrecoup injury: injury from brain rebounding
What is the difference between a Epidural and Subdural hematoma
Epidural hematoma: arterial bleed, rapid loss of consciousness, regaining of consciousness and then progressive loss of consciousness
Subdural hematoma: venous bleeds (elderly pt on anticoags)
Slower build to altered LOC
What is a Intracerebral hematoma:
bleeding in the brain
Often caused by penetrating trauma or shearing forces
Presents with a slower LOC change as well
What is a Diffuse axonal injury (DAI)
damage to axons caused by shearing forces
Does not immediately increase ICP
Does affect function and can lead to long-term dementia/dysfunction
Is decerebrate or decorticate posturing worse
Decerebrate (brain stem compression) worse than decorticate
What are some manifestations of a serious TBI
Gross ataxia (poor muscle control), Battle’s sign, raccoon eyes, rhinorrhea (Halo sign)
How do you treat increased intracranial pressure
Osmotic diuretics if elevated ICP (mannitol)
Possible hypertonic saline (1.5 % (Peripheral IV)or 3% (Central line))
Barbiturates for reducing ICP and cerebral edema
What are two prophylactic medications you should give your TBI pt
(Keppra, phenytoin)
T/F: Corticosteroids are the first line medication administered when a patient begins to show symptoms of a severe TBI
FALSE
Corticosteroids not recommended for TBI
When would you intubate your TBI patient
if GCS < 8
When would you perform an emergency craniotomy on a patient
evacuate hematomas, give brain room to swell, freeze bone or keep it in the abdomen
What nursing interventions should you expect to provide for a TBI patient
Oxygen
Maintain spinal precautions until cleared
Reduce metabolic rate
Monitor for CSF leaks (halo test)
Low stimulation
What is Chronic traumatic encephalopathy (CTE)
(Can only be dx in a autopsy) compounded TBI that causes anger/aggression
What is Post Concussion syndrome
(lingering manifestations of TBI)
What is Neurogenic Fever
a non-infectious source of fever in a patient with brain injury, especially hypothalamic injury
What is the difference between a primary and secondary spinal cord injury
Primary: Initial trauma and tissue destruction affect the spinal cord
Secondary: physiological response of inflammation, edema and ischemia results in destruction of tissue
Describe paraplegia
Paraplegia = thoracic spine level 🡪 impacts all or part of the trunk, pelvic region, & legs, but NOT the arms
What are the 4 types of vertebral injuries
Flexion
Hyperextension
Compression
Rotational
What are you concerned about with someone with a ACUTE spinal cord injury
Ensure good oxygenation and patent airway
Make sure MAP is 85 or higher and SBP is greater than 90
thermal regulation disruption
Maintain spinal precautions until cleared
Assess for possible ileus-NGT if appropriate
Maintain catheter to ensure client does not develop neurogenic bladder
How do you maintain spinal perfusion if in a state of shock
Vasopressors (epi, dopamine, vasopressor)
How do you treat a spinal cord injury
Immobilization of injury
Surgical repair of vertebral fracture
Therapeutic hypothermia
Hypothermia protocol
What are you concerned about with someone with a spinal cord injury AFTER THE ACUTE PHASE
Ensure clients are wearing braces/ortho devices properly (Nurses should log roll patient until cleared)
Maintain skin integrity
TEDs/SCDs
Manage pain
What are the 3 immobilization devices used for spinal cord injuries
halo 🡪 severe, unstable upper cervical spine injury (neck frx, dislocations)
C collar 🡪 stable c spine injury
TLSO (thoracic-lumbar-sacral orthotic device, aka ‘turtle shell’ for the older hard plastic ones!) 🡪 Spinal precautions 🡪 ‘log roll’
What is Autonomic dysreflexia
(T6 or above): sympathetic stimulation reaches the brain, but parasympathetic compensation cannot travel below the level of injury
Hypertension
Bradycardia
Pounding headache
Blurred vision
Flushed skin/sweating in the face
Caused by ‘noxious stimuli’ below the level of injury. The majority of the time it’s d/t a urological problem: full bladder, clogged Foley, UTI
Tx: sit ‘em upright, find & address noxious stimuli – empty bladder
What is Spinal shock
Occurs in immediate aftermath of damage
Loss of motor, sensory, reflex and autonomic functions below area of damage due to spinal cord ischemia
Flaccid paralysis below the level of injury
Loss of bladder control
Hypotension
Hypothermia
What is Neurogenic shock
hypotension, often with bradycardia
occurs at T6 or higher 🡪 can cause permanent damage IS A MEDICAL EMERGENCY = sympathetic nervous system (your ‘fight or flight’ = incr. HR, BP, RR, vasoconstriction, pupil dilation, slows down GI processes) goes haywire 🡪 parasympathetic cascade jumps in & takes over, does the opposite 🡪 hypotension, bradycardia, hypothermia 🡪 poor perfusion 🡪 blood shunted to vital organs 🡪 more severe hypotension 🡪 exacerbation of cascade 🡪 dead
How do you evaluate the INTERNAL STRUCTURE of the spinal cord, including nerve roots & discs
MRI = first line in the acute setting
Severity of injury 🡪 ‘graded’ via…
American Spinal Injury Scale (ASIA scale)
D is good
