Neuro Flashcards
What does the GCS measure
measures LOC in a client who has altered LOC or potential of altered LOC
- Eye opening
- Motor response
- verbal response
What is the normal pupil size
2-6mm
What is the normal score for the GCS
13-15
What does PERRLA stand for
Pupil Equal Reactive Round Light Accomodation
Assessment of reflexes name one
Babinski Reflex
Is it normal for a babinski reflex in an infant one year or less
Yes
Is it normal for a babinski reflex in an adult or infant over 1 year
NO
What reflex is normal for an adult or infant over 1
Plantar Reflex
Someone who has a tumor or lesion on spinal cord, MS or Lou Gehrig’s disease what type of reflex do you expect to see
Babinkski (severe problem in the CNS)
In a CT test, what do you need and what should you tell client
A signed consent because of dye
Keep Head still
No Talking
In a MRI do we use a dye or ratiation, magnet
Not usually, doesn’t have to use dye
No radiation
Yes to magnet
Which is better MRI or CT
MRI, Picks up on problems earlier
Someone with a pacemaker can they use a MRI
No
Is fillings ok in teeth ok
YEs it is fine
What type of client can’t tolerate this
Clostraphobic clients
In an MRI can they talk
Yes
What is a cerebral angiography
X ray of cerebral circulation from femoral artery using dye
Do we need a consent for an angiography
Yes
What do we make sure as a nurse pre cerebral angiography
Tell patient to be well hydrated, void
Check peripheral pulses,make sure groin is prepped
Check for BUN and Creatinine because dye will be excreted through kidneys
Hold metformin, monitor output
Check for allergies to iodine/shellfish
Explain that they will have a warmth in face and a metallic taste
What do we make sure as a nurse post-cerebral angiography
Tell client to bed rest 4-6 hours
Watch femoral site for bleeding
Watch for embolus (arm, heart, lung, kidneys
With a cerebral angiography what are we concerned about in terms of embolus
If the embolus goes to brain, we will see a change in LOC, one-sided weakness, paralysis, motor/sensory deficits
What does an Electroencephalopgraphy (EEG)do?
- diagnose seizure disorders
- evaluates types of seizures occuring
- evaluates LOC and dementia
- electric activity in the brain,
- diagnose sleep disorders narcolepsy, cerebral infarct, brain tumors, or abscess
- Screening for COMA
What nursing considerations should occur pre-EEG
- Hold sedatives, because we are measuring electric activity and it would give us a false reading
- No caffeine
- Not NPO (drops BS)
What could the client be asked to be positioned during an EEG
- first lying down quiety
- then hyperventilate to assess brain circulation
- for an unconscious, pain stimuli to see what happends to brain activity
What is the site used for a lumbar puncture
Lumbar Subarachnoid space
What is the purpose of a lumbar puncture
- To obtain and analyze spinal fluid
- To measure pressure using a manometer
- To administer drugs intrathecally (brain, spinal cord)
What position should the client be for a lumbar puncture
Propped to bedside table, head toward chest
Lyying fetal position chin to chest
What position should the client be post-lumbar puncture
Flat for 2-3 hours
Increase fluids to replace lost spinal fluid
Watch for headache- inceases when sitting up and decreases when lying down
How is the headache post lumbar treated
Bed rest
Fluids
Pain meds
Blood patch
What are some complications/ lifethreatening complications from lumbar puncture
- Headache
- Brain Herniation contraindicated with ICP
- Meningitis
If someone has a change in LOC Slurred/slowed speech delay in verbal response increased drowsiness Restless confusion What are these signs
Early signs of Increased ICP
If someone has a change in LOC and is progressing to stupor then coma
They have a change in vital signs; cushings triad and are posturing what are these signs of?
Late signs of Increased ICP
What are cushings triad
- systolic htn with a widening pulse pressure
- Slow full bounding pulse
- Irregular Resps
What is posturing
It’s a response to painful or noxious stimuli and indicates a compromise to motor response in brain
If a patient’s arms are flexed inwards and bent toward the body and the legs are extended what does this indicate
Decorticate posturing
If a patient has all four extremities are rigid extension
Decerebrate posturing
Which client is more serious, decorticate or decerebrate
Decerebrate
Can a client have both decorticate and decerebrate
Yes
What should we be concerned about if a client is rigid and tight
Burning more calories
What are the signs to watch out for with Increased ICP
- Headaches
- changes in pupils and pupil response (fixed and dilated)
- Projectile vomitting (vomitting centers in brain are being stimulated)
What are some complications of Increased ICP
- Brain Herniation
2. DI and SIADH
What is brain herniation
Something in the brain putting pressure, that obstructs the blood flow to the brain and causes anoxia and then brain death
What are the treatments for Increased ICP
- oxygenation
- Maintain cerebral perfusion- isotonic saline and inotropic agents: dobutamine and norepinephrine
- Keep temp below 100.4/ 38
- Elevate HOB
- Keep head in midline so jugular veins can drain
- Watch for ICP monitor turning
- Avoid restraints, valsalva, isometric exercise, sneezing, nose blowing, hip flexion, bladder distention
Should you be suctioning a patient with increased ICP
Limit suctioning
What should you be monitoring for in a client with increased ICP
- monitor GCS
- Monitor vitals for cushings triad
If a client’s GCS is below 8 what should you be thinking
Intubation
Why is phenobarbital given to a patient with increased ICP
cause it causes a decrease in cerebral metabolism treat increased ICP that can’t be treated with other measures
Why is mannitol given with increased ICP
It pulls fluid from brain cells and filters through kidneys
Why is dexamethasone given with increased ICP
decreases cerebral edema
What is a risk for using ICP monitoring device
Infection
How do we prevent infection with ICP monitoring devices
Keep dressings dry
No loose connections
What is meningitis
It’s an inflammation of spinal cord or brain
What causes meningitis
Viral/Bacterial
Bacterial transmitted through resp system
If someone has chills/fever severe headache n/v nuchal rigidity (rigid neck) photophobia (light sensitivity)
Meningitis
What are some treatment options for someone with meningitis
Steroids
Abx - if infection is bacterial
analgesics
What type of precaution should we put the client in if it is a bacterial meningitis
Droplet precautions
What type of precaution should we put the client in if it is a viral meningitis
contact
How is bacterial meningitis transmitted
Respiratory tract
How is viral meningitis transmitted
Feces
What are the 2 types of seizures
Partial
Generalized
If a person has partial seizure what is affected
a specific local area of brain
If a person has a generalized seizure what is affected
involves the entire brain
which seizure is a focal seizure and which is a non-focal
Focal seizure is partial seizure
Nonfocal is generalized
Which seizure can an aura be it’s only manifestation
Partial
In a partial seizure you can have symptoms from simple to complex, what does this mean
- Simple means without loosing conscious, will see numbness, tingling, prickling or pain
- complex is that they have an impaired conscious and may be confused and unable to respond
What is the initial manifestation in a generalized seizure
Loss of Conscious
What is a tonic/clonic seizure
Grand mal
What is a myoclonic seizure
sudden, brief contractures of a muscle or group of muscles
What is an absence seizure
petit mal, brief loss of conscious
What are some complications of seizure
- Status epilepticus
2. Trauma
What is a status epilepticus
it’s when a patient has continous seizures and does not return to conscious between seizures
What are some treatment options for a person with seizures
- Neuro exam including lab and xrays, EEG’s
- Anticonvulsants
- Airway/ safety during seizures
What are phenytoin, phenobarbital
Long acting anticonvulsants
What are lorazepam and diazepam
Rapid acting anticonvulsants
With a skull injury could you damage the brain
may or may not
With a skull injury could you have an open fracture, if so what is torn
Yes Dura is torn
With a skull injury could you have a closed fracture
Yes, Dura is not torn
With a skull injury and with a basal skull fracture where do you see bleeding
Ears
Eyes
Nose
Throat
What is a battle’s sign
It’s bruising over mastoid, bone behind ear
What are peri-orbital bruising
It’s Raccoon eyes
What is cerebrospinal rhinorrhea
It’s having spinal fluid leak from nose
What is it that differentiates CSF from other fluids
Glucose in CSF and halo test
What type of skull fractures require surgery, Depressed or non-depressed
Depressed
What are some brain injuries
Concussion
Hematomas
What happens in a concussion
There is temporary loss of neurological function with complete recovery
Will have a short period where they are unconscious or may just be dizzy or see spots
What should we teach caregivers about s/s to bring the client back to the ED if a concussion occurs
- if they are having a difficult time awakening/speaking
- if the patient is confused
- Severe headache/ vomitting
- Has Pulse changes
- Has unequal pupils
- One sided weakenss
ALl of these indicate increase in ICP
Which one is more fatal of a hematoma:
a) Small hematoma developing rapidly
b) massive hematoma developing slowly
and why
Small hematoma, because a massive one that develops slowly gives the client a chance to adapt
Two types of hematoma to worry about
Epidural
Subdural
What is an epidural hematoma
It’s when you have an injury, rupture to the middle meningeal artery
injury, loss of consc, recovery period, can’t compensate any longer, neuro changes
What is a subdural hematoma
It’s when you have a venous bleed
What are the treatments for a epidural hematoma
Burr Holes and remove clot control ICP
Ask questions to ID the type of injury, eg. how long was the patient out
Which hematoma is an emergency
Epidural
What are the treatment options for subdural hematoma
Chronic imitates other conditions, such as acting drunk
Bleeding and compensating
Neuro changes
Immediate crainotomy and remove clot; control ICP
What is a major complication with an upper spinal cord injury
An upper spinal cord injury (above T6), Autonomic Dysreflexia
Hyperflexia
What are some S/s of autonomic reflexia
Severe HTN and headache Bradycardia Nasal stuffiness Flushing Sweating Blurred vision Anxiety
Does autonomic reflexia occur suddenly or after a while
Suddenly and it is an emergecy
If autonomic reflexia is not treated promptly what can this cause
Hypertensive stroke
What can cause autonomic reflexia
Distended bladder, constipation, painful stimuli
What are some treatment options for autonomic reflexia
Treat BP, have client sit up
Treat cause; put catheter and remove impaction, look for skin pressure or painful stimuli, cold draft or breeze in room
Teach preventions
