Neuro Flashcards
Kernigs Sign is?
And is a postive sign when found in ________ or _________
The Inability to extend a patients legs past 135o with out pain. This is done with a patient supine
Positive sign Of meningittis, or subarachnoid Hemorrhage.
Brudizinski reflex is ?
When you bend a patients head at the neck toward the chest and this causes the same flexation at the hips.
What are the three major catagories of Meningitis
Viral
Fungal
Bacterial
What are the S/S ofViral meningitis
Generally follows another major viral illness, such as measles, mumps, herpes simplex, herpes zoster
Increased Temps, Head Ache, Neucol Ridgitity(Stiff Neck), Nausea, Vomiting
Essentially presents as flu like symptoms
Flu = Virus
What is the Most commonly encountered Meningitis and how is it treated
Viral meningitis, is the most common, it is treated by monitoring for Seziures and treating Symptoms, the general course takes 1-2 weeks
What type of patient is fungal meningitis generally found in.
What are the general s/s
how is it treated
immunosupressive patients.
S/S were dependent on the type of immunosupression
treatment is generally IV antifungals, and symptomatic
what is the worst type of meningitis?
Bacterial Meningitis is the worst type of meningitis
It is a medical emergency
What are the S/S of Bacterial Meningitis
Very Rapid Progression and action
High Fever Nuchal rigidity
What nursing interventions are needed for Bacterial Meningitis
Rapid thourogh assessment
Blood Draw immediately
Prep for L/P
Adminster Broad Spectrum antibiotics
What is the Name of the Vaccine for Meningitis
Menomune
What are two test you can do during assessment that would lead you to suspect meningitis
Brudizinski reflex and Kernigs Sign
Brudinski’s- neck bends feet body draws to core
kernigs- Painful extension of the legs
what are some lab/ Diagnostics for Meningitis
Culture and sensitivity
Cbc with Differential
L/P
CT/ MRI
What are the primary nursing care items for a person with Meningitis
Monitor Neruo with special attention cranial nerves
observe for s/s of ICP
seziure Precations
Monitor for septic shock
Assessment will show Fever, hard to arouse, decreased appetite, decreased mental status
Who are at the greatest risk for Meningitis?
Why?
Antivaxers, Imnunocompromised)
people who live in grouped settings (dorm, prisons, etc)
This is spread by respiratory so close quarters breeds illness
Important Patient care considerations for People with Meningitis
Vital signs at least q2-4 hours
Frequent Neuro Checks
Pain management-balance with ability to arouse
I+0
Decrease environmental stimuli
Bed Rest HOB always 300
Isolation precautions
What are some Prevetions complications for a nurse treating a patient with Meningitis
Intercrainial presssure ICP
Vascualar Dysfunction
F+E imbalances
Seziures
Shock
What is a CVA Stroke
Cerbreal vascular attack, is an interuption of blood flow to the brain similar to a heart attack, that is caused either by a blockage or bleed
What are the types of CVA
- Ischeimic- Occlusive
- Thrombolytic
- embolitic
- Hemorrhagic
What is an Ischemic Stroke
It is a interuption of blood flow to the brain by some form of thrombus or embolus
Thrombus come from larger venus stasis
Embolus tend to come from a cardiac event such as A-fib
Diagnosis of ischemic stroke is done by?
CT MRI
EKG ECG
ABG
CMP CKP
Treatment for an ischemic stroke is
TPA(clot busters)
Must be adminstered within 3 hours of onset of stroke to be successful
TPA dosing is based on
Dosing is based on weight, with max dose being 90mg
What is the Norm for INR
2-3
the higher the number the thiner the blood
What is a TIA
Trans Ischemic attack
Generally Preceeds stroke is a warning sign
It allows for Reversable neruo Deficits or RIND
Damage can be seen by MRI or CT
Multiple TIAs ^ risk for Stroke
Number one cause of Stroke IS?
HTN
Prevention is key so controlled BP is paramont
Blood Thiners and Antiplatets are used to prevent what type of stroke
Ischemic
Can you use TPA for all strokes”
NO
TPA is only for ISCHEMIC Strokes
In hemmoragic you want the blood to clot
Hemoragic Stroke is
A bleed in the brain caused by a rupture of a vessle, Aneurysm, or rupture of an AV fistula malformation
Hemorrhagic stroke risk factors include
Smoking
Coccaine use
obesity
sedintary lifestyle
^stress levels, ^ HTN
^Cholesterol
Previous CVA/TIA
Sudden discontiuance of HTN meds
Treatment for Hemmoragic stroke includes
Clipping, or spiraling artery, montioring for ICP
Regular Neruo assessments
monitor basic Asssesment
HOB 300
Management of Pts with Stroke
Prevention is key:
maintain blood pressure
pharmacology
surgical interventions if needed
prevent complications
Assess FAST
The assessment acryonmm FAST stands for
F- Face Drooping, numbness
A- Arm Weakness, Raising
S- Slurred Speach
T- Time to ED ASAP
Remember TREATMENT FOR ALL STROKES IS IN WHAT PRIORITY
A
B
C
Oxygenate
What are some Degenerative Neurological Conditions
MS
ALS( amytrophic lateral sclerosis)
parkinsons
myasthenia Gravis
Guillain-Barre Syndrome
Huntingtons
What are some commonalities between all Degenerative Neuro Disorders
- Altered Motor activity
- Altered coordination
- Altered Sensory Function
- altered urinary/Bowel functions
- Altered role/Self preception
- altered speech/Swallowing
- impaired Physical Mobility
- risk for Injury
- Nutrition Less than body req.
- Risk for aspiration
MS is characterized by periods of remission and exacerbation but what is it
it is an inflamatory response that is autoimmune where the body attacks its own mylean sheaths on the nerve cells
MS is more common in women then men and more prevailant in northern climates, when does the onset generally begin
typically occurs between 20-40 y/o, believed to be related to childberaring and new stressors, and there is thought to be a link to family there is no cure
there are two focus types of ms they are
Relapse/Remit vs Chronic
R/R is treatable and less debilitating, Chronic is progressive and leads to a rapid decrease in function and need for total care
MS Trigger Factors Include
- Virus or infectious agent
- living in a cold climate
- physical injury
- emotional stress
- pregnancy
- fatigue
- overexertion
- temperature extremes
- hot bath/shower
MS is diagnosed how
History, and symptoms, there is no test to confirm
What are the primary Symptoms of MS
Fatigue weakness numbness
Difficulty with coordination, loss of balance
visual disturbances
- blurring
- dilopia(double vison)
- patchy or total blindness
- change in peripheral vision
- nystagmus(repetative uncontroled movements)
More Primary symptoms of MS include
Speech defecits (stutter)
Dysarthria
Dysphagia
spastic weakness, ataxia, tremors, dysmeteria
Emontial labilit, depression, euphoria
bladder and bowl dysfunction-loss of sensation
Tinitus, vertigo, decrease hearing
Cognative changes
MS Secondary Symptoms - Problems related to primary symptoms
- Repeated utis
- loss of muscle tona and disuse weakness
- poor posture and torso control
- decreased body density
- shallow ineffcient breathing
- pressure ulcers from immobility
*
- pressure ulcers from immobility
MS drug of Choice is ?
What are some other common drugs used
Avonex(inteferon beta 1) given subq once a week
also used are prednisone, baclofen(spacitiy) Keppra
Parkinsons is a disease that affects?
The neuro transmission of impulses causeing
tremors, ridgitity slow movement(Bradykinesia) poor posture, depression/psych, dementia, autonomic symptoms, sleep distrubances
Cause of Parkisons is unknown but it affects what
Affects Gross motor Function,
Degeneration of the nerves that control voluntary movment
Occurs in the brain
affects response to dopamines
causes death of cells that create dopamine
MOST SEEN Symptoms IN PARKINSONS
Temors
Rigidity
Poor Posture
Bradykinesia(Slow Movement)
What is the most used and gold standard treatment for Parkinsons meds
Levodopa and Carbidopa- may take up to 6 months to reach theraputic effect
what are some adverse affects of Levodopa-Carbidopa
Involuntary movements
ataxia(loss of full control of body movements)
Increased Tremors
anorexia
Symmetrel is
An antiviral antiparkonsionian med that is thought to increase dopamine release.
it is used to treat Bradykinesia, tremor, and ridgity, but is commonly avoided due to adverse effects:
Dizziness, insomnia, confusion, orthostatic hypo-tension, which can all lead to increased risk for falls
Major Complications from parkinsons include
Aspiration Pnemonia from aphasia
Altered cognition/ Dementia
Other than medication what is another theraputic option for parkinsons treatment
Deep brain stimulation-
This is like a pacemaker to the heart but is place in the brain to help regulate
Not every case of parkinsons is believed to be from brain issues, what are some other thoughts of what may contribute to parkinsons
Medications(esp Psych)
Heavy metal poisoning,
pestasides
mid-brain injuries
and High levels of CO poisoning
True or False
Parkinsons is a slowly progressing neurological dissorder that eventually leads to disablity
TRUE
Assessment and Care of parkinsons patients
Focus on degree of disabiltiy
TEACHING AND SAFETY ARE KEY
Goals of treatment for Parkinsons Include
Improved functional ability,
maintaining indepence with adls
achieveing adequate bowel elimination
maintiaining appropiate nutritional status, copiing skills, and communicatoin
Ways to focus on improving mobility for a parkinsons patient are
Daily excersise program,
ROM
Postural excersises
PT EVAL and TX
Techniques to ensure saftey and balance while walking
Frequent rest, proper footwear
Use of assistive devices PRN
What is ALS
Amyotrophic Lateral Sclerosis
Loss of motor neurons in the anterior horn of the spinal cord and the motor nuclei of the brainstem:
Leads to progressive weakness of extremities and trunk then, Muscle Atrophy, and weakness of the bulbar muscles which impairs swallowing and speech. Respiratory function is also imparied Due to Difficulty clearing secretions leading to drowning in own fluids
How is ALS Diagnosed
There is no diagnostice test but some test are used to attempt to rule it out.
Some diagnostic proceedures Include:
- CK- will be increased Muscle damage
- EMG(electromyography) muscle Fasciculations-muscle twitching
- Muscle Biopsy- testing atrophy
- Serial muscle Testing- loss of stregnth
- Pulmonary Function Testing- VIP to do at DX to establish a baseline for monitoring of progression
*
ALS is a traditional assessment, with focus on speech and airway function, Primarily AIRWAY. What are some interventions.
- Excercise and mobility are used
- Managment of Swallowing
- Maitain Respiratory function
- includes L/S assessments
- prn suctioning
- Cough and DB
- Meds for Issues Rilusole, Quinine, Baclofen, Dantrolene, Diazepam
- Pt Family Teaching
Meds used treatment of ALS include Rilusole, Quinine, Levsin, Baclofen, Dantrolene, Diazepam, what is each used for
Rilusole- Used to prolong Survival time of the Trachea
Levsin-Dry Secretion
Quinine - Muscle Cramps
BACLOFEN, dantrolene Diazepam- Antispasmodics
When is Rilusole given
Generally toward the end of the disease process, and is used and good for 12 weeks
What is Diplopia
Double Vision
Myasthenia Gravis is
A progressive autoimmune disease, that leads to severe muscle weakness that affects women 15-35 or men over 40
Myastheia Gravis presents as
Extreme muscle weakness, Fatigue
diplopia and ptosis are early signs
Sleepy mask like expression
dysphonia
problems with chewing and swallowing leading to aspiration
progressive weakness of Diaphram leading to Resp. Distress
Diagnosed with
- Pt Hist & Phys
- Tensiloon Testing-
- 10 cc’s IV, 2cc’s pushed to monitor for reaction then remaining 8cc’s Tensilon test reverse the effects of MG within 30 secs
- ENSURE ATROPINE IS AT THE BEDSIDE, in case of adverse effects
Theraputic Treatments of Myasthenia Gravis include
Plasmapheresis- which removes antibodies that are believed to be the cause of the condition
Medications given for M Gravis
- Anticholinesterase meds-
- pyridostigmine(Mestinon)- give with food due to gi upset, and must be taken sametime each day to ensure theraputic levels
- ambenonium (mytelase)
- Both may cause Cholinergic Crisis
- Chorticosteroids and Immunosupressents to tx inflamation
What are two potential complications with medication of MGravis
- Myasthenic crisis- Under medication
- cholinergic crisis- over medication
What are the S/s Of Myasthenic crisis(undermedication)
- Resp Muscle weakness > need Mechanical Ventilation
- Myasthenic Symptoms > Weakness incotinece fatigue, hypertension,
- temporary relief of symptoms with tensilon
- PT’s Cant breath from stopping medications
12 Cranial nerves
Ooo, ooo, ooo, to touch and feel a girls vagina ah heaven
Most typically, humans are considered to have twelve pairs of cranial nerves (I–XII). They are:
olfactory nerve (I),
optic nerve (II),
oculomotor nerve (III),
trochlear nerve (IV),
trigeminal nerve (V),
abducens nerve (VI),
facial nerve (VII),
vestibulocochlear nerve (VIII),
glossopharyngeal nerve (IX)
vagus nerve (X),
accessory nerve (XI),
and hypoglossal nerve (XII)
Cholinergic Crisis Presentations Include
- Muscle twitching that results in muscle weakness and causes need for mechanical ventilation
- Leads to hypersecretions, hypermotility
- Hypotension
- Tensolin has no positive effect on symptoms
- Symptoms will improve with Anti cholinergic meds due to med overdose.
What is GBS, Guilian Barre Syndrome
It is an acute inflammatroy disease usually preceeded by a viral infection(URI or GI) 1-4 weeks
Degeneration of the mylein sheath of the peripheral nerves, which is diagnosis by H&Pyshical and CSF
Guillian Barre Syndome Presents
Ascending paralysis that starts at the feet ascending up the body until It decides to stops which can take up to 3 weeks to progress, and may take up to 6 months to a year to go away
Interventions For GBS
Monitor Cerebral vascular status
Monitor Respitory treat accordingly, Vent, HOB ^, Chest PT Trach
Nutritional interventions PRN, NG, TPN, Bowel sounds,
Ensure communication, Lip reading, pic cards, eye blinks
Pyschological support, prevention of deformities as ROM, Skin care prevention of Breakdown, Consider Steroids if needed
Plasmaphoresis- attempt to remove antibobies believed to be a possible cause
