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Med Surg > Neuro > Flashcards

Neuro Flashcards

1
Q

Three layers surrounding brain

A

Meninges
Arachnoid
Pia mater

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2
Q

Anatomical part often implicated in stroke

A

Circle of willis at base of brain

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3
Q

What three things would alter the blood-brain barrier?

A
  • Head trauma
  • Cerebral edema
  • Cerebral hypoxia
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4
Q

How long is the spinal cord?

A

18”

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5
Q

Where does the spinal cord end?

A

L1

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6
Q

Where are epidurals / spinal anesthesias placed?

A

L3

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7
Q

When would you use an MRI / MRA to look at neuro stuff?

A

Non-acute situations (can take 30-90 minutes, looks at circulation)

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8
Q

When would you use a cat scan to look at neuro stuff?

A

For emergencies – dx stroke, type of stroke

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9
Q

When is an EEG used with neuro stuff? (3)

A
  • Diagnose seizures
  • Screen for coma
  • Helps determine brain death
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10
Q

When is a spinal tap indicated?

A

When Cerebral Spinal fluid needs to be assessed for contents or pressure

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11
Q

Pressure reading of CSF (normal

A

1-15 cmH20

70-200 mmHg

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12
Q

3 minor complications of a lumbar puncture

A
  • Headache
  • Voiding problems
  • Backache
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13
Q

3 Major complications of a lumbar puncture

A
  • Herniation of cerebral contents
  • Infection
  • Hematoma
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14
Q

Indication for a blood patch

A

CSF leakage

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15
Q

Structural causes of neurologic dysfuncction (5)

A
  • Head injury
  • Intracranial hemorrhage
  • Encephalitis
  • Brain abcess
  • Stroke
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16
Q

Metabolic causes of neurologic dysfunction (9 - don’t memorize)

A
  • Sepsis
  • Hypovolemia
  • MI
  • Respiratory arrest
  • Hypoglycemia
  • Electrolyte imbalance
  • Drug and / or alcohol abuse
  • DKA
  • Hepatic encephalopathy
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17
Q

Goals for a patient with neurologic dysfunction

A

QUALITY OF LIFE for patient and family

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18
Q

Intracranial pressure is a reflection of 3 relatively fixed volumes:

A
  • The brain
  • CSF
  • Blood
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19
Q

Closed Box Theory (Munro-Kellie Hypothesis)

A

Any increase in ICP within an intact skull results in a compression or decrease in one of the other compartments (Brain, Blood, CSF)

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20
Q

3 possible causes of increased brain volume:

A
  • Tumor
  • Bleed
  • Abcess
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21
Q

3 possible causes of increased blood volume:

A
  • Hypertension
  • Increase in blood flow
  • Decrease in venous return from the head
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22
Q

2 possible causes of increased CSF

A

Hydrocephalis

Obstruction of outflow of CSF

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23
Q

Define Hydrocephalis

A

Increased production of CSF

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24
Q

Blood levels that contribute to increased intracranial pressure (2)

A
  • Hypercapnia: PaCO2 > 45

* Hypoxemia: PaO2 < 50

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25
Q

7 factors contributing to increased increased intracranial pressure (7 - not blood levels)

A
  • Valsalva maneuver:
  • Positioning
  • Isometric muscle contractions:
  • Coughing, sneezing
  • Emotional upset
  • Noxious stimuli (suctioning, starting IVs, any painful procedure)
  • Excessive sensory stimuli
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26
Q

Risk with ICP

A

Brain stem herneating: Can lead to irreversible anoxia, death

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27
Q

Characteristics of a patient with increased ICP (5)

A
  • Lethargy
  • Confusion
  • Obtundation
  • Stuporous
  • Comatose
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28
Q

Six early warnings of increased intracranial pressure - 6 sixs

(which is earliest?)

A

1) Change in LOC or behavior **Earliest sign! Extremely sensitive to decrease in oxygenation
2) Pupils react sluggishly
3) Motor function
4) Constant headache – not a reliable sign
5) VS
6) Visual disturbances

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29
Q

What vital signs would be off in a patient experiencing early intracranial pressure?

A
  • Tachycardia

- Hypertensive swings

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30
Q

5 sxs of a late picture of ICP

A

1) LOC becomes stuporous or comatose
2) Loss of rain stem reflexes (corneal, pupillary)
3) Characteristic motor response
4) Vital signs off
5) Projectile vomiting

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31
Q

When is death inevitable with ICP?

A

When pupils are fixed and dilated

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32
Q

Three characteristic motor responses of ICP

A
  • Decorticate
  • Decerebrate
  • Total flaccidity
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33
Q

What does a decorticate position look like?

A

Arms up “toward the core”

Feet are flexed and pointed

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34
Q

What does a decerebrate position look like

A

Arms at side, hands flexed and pronated

Feet are flexed and pointed

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35
Q

What does a decorticate position indicate?

A

Hemisphere damage

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36
Q

What does a decerebrate position indicate?

A

Mid brain damage

37
Q

What does total flaccidity indicate?

A

Lower brain damage (worst prognosis)

38
Q

What vital signs would be off with a late-picture ICP patient?

A

Cheyne stokes respirations (intermittent apnea and irregular)

39
Q

What tool is used to monitor ICP

A

Intraventricular catheter in lateral ventricle

40
Q

Nursing interventions with ICP

A

1) Monitor ICP
2) Decrease cerebral edema
3) Maintain cerebral perfusion
4) Reduce CSF and blood volume
5) Control fever
6) Reduce metabolic demands
7) Maintain a patent airway
8) Improve cerebral tissue perfusion
9) Monitor fluid balance
10) Prevent infection
11) Monitor for complications

41
Q

To maintain cerebral perfusion, what would you do if pressure is low? (2)

A
  • Administer fluid

- Positive inotropic agents

42
Q

To maintain cerebral perfusion, what would you do if pressure is high?

A
  • Decrease fluids

- Administer vasodilators

43
Q

What would you do to control fever in an increased ICP patient?

A
  • Acetaminophen

- Cooling blanket - no shivering

44
Q

What drug would decrease shivering

A

Thorazine

45
Q

What paralyzing agent would decrease metabolic demands with ICP?

A

Norcuron

46
Q

When would you give a patient Norcuron

A

Only if they are in the ICU and on a ventilator - it paralyzes their breathing!

47
Q

PEEP with ICP? and - why?

A

DO NOT USE PEEP because it increases thoracic pressure and can decrease venous return from the head!

48
Q

Patient position to improve cerebral tissue perfusion

A
  • Keep head midline (no tilting forward)

- Elevate the head of the bed 30 degrees

49
Q

What could Cheyne-Stokes respirations indicate?

A

Brain lesion

50
Q

What could hyperventilation indicate?

A

Brain or metabolic injury

51
Q

Head injury: Patient is PERRLA. What could this indicate?

A

Injury is toxic or metabolic

52
Q

Head injury: Pupils are unequal. What could this indicate?

A

Pupils are localizing.

53
Q

Head injury: Pupils are dilating. What could this indicate?

A

ICP or brain injury

54
Q

If blink reflex is unilateral, what type of brain injury is this?

A

Local

55
Q

Stiff neck could indicate

A

Subarachnoid heme meningitis

56
Q

3 measurements of the glascow coma scale

A
  • Eye opening
  • Motor response
  • Verbal response
57
Q

Most common type of complication with head injuries

A

RESPIRATORY

58
Q

Three respiratory complications with head injury

A
  • Pneumonia
  • Aspiration
  • Respiratory infection
59
Q

Transient cerebral ischemia timing

A

Within 24 hours (new research = 3-6 hourse)

60
Q

How often does TIA lead to stroke?

A

20% (within a few years)

61
Q

Most common risk factors for CVD (6)

A
  • Cardiovascular Disease
  • HTN
  • DM
  • Smoking
  • Family history of CVA
  • Sedentary lifestyle
62
Q

o Temporary episode of neurological dysfunction manifested by a sudden loss of motor, sensory or visual function

A

TRANSIENT ISCHEMIC ATTACK (TIA)

63
Q

What do you use to assess a TIA (3)?

A
  • Auscultate carotid arteries
  • Carotid Doppler study
  • Carotid angiogram
64
Q

Stroke risk: Racial disparities

A

2x more likely in blacks

65
Q

Acronym to recognize a stroke

A

Face
Arms
Speech
Time

66
Q

Two general causes of CVA

A
  • Ischemia

- Hemorrhagic

67
Q

Risk factors for Ischemic CVA (3)

A
  • AFib (#1)
  • Ateriosclerosis
  • Heart valve disease
68
Q

Risk factors for hemorrhagic CVA (4)

A
  • Uncontrolled HTN
  • Arteriovenous malformation
  • Intracranial aneurisms
  • Anticoags
69
Q

What % of CVAs are hemorrhagic?

A

10-20%

70
Q

Define Hemianopsia

A

Partial loss of visual field

71
Q

CVA: 3 visual field manifestations

A

Hemianopsia
Loss of peripheral vision
Diplopia

72
Q

CVA: 5 motor manifestations

A 
Hemiparesis
Hemiplegia
Ataxia
Dysarthia
Dyspagia
73
Q

CVA: 2 sensory manifestations

A

Paresthesias

Problems with proprioception

74
Q

CVA: 3 forms of aphagia

A

Expressive: Can’t express language
Receptive: Can’t understand language
Global: Both receptive and expressive

75
Q

CVA: 4 cognitive manifestations

A

Memory loss
Decreased attention span
Can’t concentrate
Poor reasoning, altered judgment

76
Q

CVA: 5 emotional manifestations

A
  • Loss of self-control
  • Emotional lability
  • Decreased tolerance to stress
  • Depression, withdrawal, feeling of isolation
  • Fear, hostility, anger
77
Q

3 characteristics unique to left hemisphere CVA

A

Aphasia (right handed people)
Altered intellectual ability
Slow, cautious behavior

78
Q

3 characteristics unique to right hemisphere CVA

A

Spacial, perceptual deficits, very distractible
Impulsive behavior and poor judgment
Lack of awareness of deficits

79
Q

Two characteristics common of either hemisphere CVAs

A
  • Same-sided paralysis or paresthesias

- Deficit in same-sided visual field

80
Q

Medical management for ischemic stroke (2)

A
  • Thrombolitic therapy

- Anticoagulants

81
Q

Medical management for hemorrhagic stroke

A
  • Manage ICP

- Surgery

82
Q

3 common CVA complications

A
  • Cerebral hypoxia
  • Decreased cerebral blood flow
  • Extension of the area of injury
83
Q

What would cause extension of the area of injury (CVA)

A

hyper or hypo tension

84
Q

Craniotomy: Indications (4)

A
  • Remove clot
  • Relieve intracranial edema
  • Remove tumor
  • Control hemorrhage
85
Q

Craniotomy: C&DB Patient teaching

A

o Deep breathing good

o Coughing not good

86
Q

Craniotomy: Anticonvulsant meds (2)

How long administered?

A

o Often continued for 6 months to a year (discontinue if no seizures at that point)
o Dilantin, phenobarbitol

87
Q

Drugs to reduce cerebral edema - craniotomy (2)

A

steroids

diuretics

88
Q

Craniotomy: Complications to assess for and avoid (6)

A 
o	Increased ICP
o	Bleeding at operative site
o	Fluid and electrolyte embalances
o	Infection
o	Seizures
89
Q

Decreased mental status: Craniotomy

A

o Common: Decreased mental status 2nd day 2/2 swelling.

Med Surg (13 decks)

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