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z Here you go, Alexis! > neuro > Flashcards

neuro Flashcards

1
Q

glasgow coma scale

A

eye opening
motor response
verbal response

ideal: 13 - 15

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2
Q

normal pupil size

A

2 - 6 mm

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3
Q

babinski reflex

A

normal up to age 1 / walking = no babinski

should have plantar reflex (toe curl) when foot stroked

toe splay = severe problem in central nervous sytem

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4
Q

CT scan

A

can be with dye

pics in slices, no talking

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5
Q

MRI

A

picks up on pathology earlier than CT

magnet, thumping sound, tube, can talk

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6
Q

cerebral angiography

A

x ray of cerebral circulation, through femoral artery

consent needed

neuro assessment before (baseline)

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7
Q

iodine based dye nursing considerations

A

monitor: BUN/creat, uop
hold metformin
hydrate to excrete
iodine/shellfish allergies!

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8
Q

EEG

A

records electrical activity of brain

  • diagnose seizure disorders, sleep disorders, cerebral infarct, brain tumor, abscess
  • eval: seizure types, LOC, dementia
  • coma screening, indicates brain death

hold sedatives before! (decrease activity)

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9
Q

lumbar puncture

A

site: lumbar subarachnoid space
obtain spinal fluid to analyze for blood, infection, tumor cells;
pressure readings with manometer;
administer drugs intrathecally (brain, spinal cord)

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10
Q

post-lumbar puncture

A

lie flat OR prone (preferable, seal forms) - 2 to 3 hours

  • increase fluids (replace)
  • common: headache with pain increasing if sitting up
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11
Q

lumbar puncture positioning

A

1) propped over bedside table, head down

2) side lying fetal - arch back max

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12
Q

contraindication for lumbar puncture

A

ICP - brain herniation can result

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13
Q

early s/s ICP

A

earliest: change in LOC
- drowsy, randomly restless, confusion
speech: slurred, slowed
response: delayed

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14
Q

late s/s ICP

A

marked change in LOC (stupor to coma progression)
cushing’s triad
posturing

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15
Q

cushing’s triad

A

1) systolic htn (widening pulse pressure)
2) slow, full, bounding pulse
3) irregular respirations

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16
Q

posturing

A

response to painful/noxious stumuli, indicates motor response centers of brain are compromised; rigid, tight, burning calories

  • decorticate
  • decerebrate
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17
Q

decorticate posturing

A

arms flexed inward, bent in toward body and legs extended

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18
Q

decerebrate posturing

A

all four extremities in rigid extension

WORST

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19
Q

CSF circulates in which space

A

subarachnoid

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20
Q

lumbar puncture goes into

A

subarachnoid space

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21
Q

ICP tx

A
  • O2
  • adequate cerebral perfusion
  • T under 100.4/38 (metabolic demand)
  • elevate HOB
  • head midline (jugulars drain)
  • limit suction/cough
  • space interventions
  • barbiturate induced coma (phenobarb)
  • osmotic diuretics (mannitol)
  • steroids (dexamethasone) decrease cerebral edema
22
Q

GCS: 8

A

intubate!

23
Q

meningitis

A

inflammation of spinal cord or brain
(meninges lining of brain/spinal cord)

causes viral (fecal trans) or bacterial (resp trans)

24
Q

bacterial meningitis: nursing considerations

A

very contagious, medical emergency; high mortality

droplet precautions (respiratory transmission)

25
Q

viral meningitis: nursing considerations

A

transmitted by feces, common infants kids

contact precautions

26
Q

seizures

A

symptom of underlying disorder rather than disease

- not considered epilepsy if resolves with disease ending

27
Q

partial seizure

A

aka focal; limited to specific local area of brain

  • aura may be only manifestation
  • s/s: simple to complex
28
Q

partial seizure simple s/s

A

without loss of consciousness, numbness, tingling, prickling, pain

29
Q

partial seizure complex s/s

A

impaired consciousness, confused, unable to respond

30
Q

generalized seizure

A

aka non-focal; involves entire brain

- loss of consciousness initial manifestation

31
Q

tonic clonic seizures

A

formerly grand mal

- entire brain, convulsive

32
Q

myoclonic seizures

A

sudden, brief contractures of muscle or group of muscles

33
Q

absence seizures

A

formerly petit mall

  • brief loss of consciousness
  • behavior change very little, maybe short memory loss
34
Q

status epilepticus

A

continuous seizure without returning to consciousness between seizures

35
Q

rapid acting anticonvulsants

A

lorazepam, diazepam

36
Q

long acting anticonvulsants

A

phenytoin, phenobarbital

37
Q

anticonvulsants nursing considerations

A

monitor for toxicity
use smallest dose necessary
abrupt withdrawal can cause seizure

38
Q

how do you tell CSF from other drainage

A 
glucose +
halo test (blood spot with ring around)
39
Q

neurological hematoma nota bene

A

small that develops rapidly may be fatal, massive that develops slowly may allow client to adapt

40
Q

epidural hematoma

A

rupture of the middle meningeal ARTERY - fast bleed under high pressure

injury -> LOC -> recovery -> can’t compensate (ICP max) -> neuro changes

agitation, restlessness, pupil changes, seizures, posturing

EMERGENCY

41
Q

subdural hematoma

A

usually VENOUS

acute (fast), subacute (med), chronic (slow; s/s drunk, stroke-like)

42
Q

myasthenia gravis

A

acquired autoimmune disease of neuromuscular junction

  • fatigue, weakness primarily in muscles innervated by the cranial nerves (eye, swallow), also skeletal and respiratory muscles, gu
  • progressive loss of muscle strength
  • cause unclear, thymus and hyperthyroid associations
43
Q

myasthenic crisis

A

sudden exacerbation, sometimes post-infection

  • oropharngeal weakness: upper airway obstruction, loss of gag, dysphagia + aspiration
  • respiratory failure (muscle weakness)
  • VS increase, dec uop, incontinence, hypoxia

HOLD cholinesterase inhibitors temporarily

44
Q

cholinergic crisis

A

too much cholinesterase inhibitor (anticholinergic): SLUDGE BAM
hard to distinguish from myasthenia gravis
rare

45
Q

differentiate myasthenic vs cholinergic crisis

A

tensilon test (increases ACh by inhibiting breakdown)

myasthenic: temp improvement
cholinergic: gets worse

46
Q

parkinson’s

A

progressive, neurodegenerative

t remor
r igidity (cogwheel, plastic, lead pipe)
a kinesia
p ill rolling

give dopamine (agonist)

47
Q

guillain barre

A

acute autoimmune disorder assoc w pns demyelination; hypothesis - response to virus

  • varying degrees of motor weakness, paralysis, sensory abnormalities
  • ascending (most common), pure motor, descending
  • give immunoglobulin, plasmapheresis
48
Q

multiple sclerosis

A

chronic autoimmune disease affecting myelin sheath, conduction pathway of cns,

remission and exacerbation (ex more freq as severity, duration progresses)

FATIGUE!

49
Q

amyotrophic lateral sclerosis

A

aka lou gehrig’s; adult-onset upper/lower motor neuron disease
- progressive weakness, muscle wasting, spasticity - eventually leads to paralysis

50
Q

myelogram

A

insertion of contrast medium into subarachnoid space of spine via lumbar puncture

pre: fluids, allergies; anti-psych/dep/coag can be held for several days; valium ok to give
post: supine with head elevated, several hours

z Here you go, Alexis! (23 decks)

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