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Health Promotion > Neuro > Flashcards

Neuro Flashcards

1
Q

Kernigs Sign is?

And is a postive sign when found in ________ or _________

A

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.

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2
Q

Brudizinski reflex is ?

A

When you bend a patients head at the neck toward the chest and this causes the same flexation at the hips.

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3
Q

What are the three major catagories of Meningitis

A

Viral

Fungal

Bacterial

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4
Q

What are the S/S ofViral meningitis

A

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

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5
Q

What is the Most commonly encountered Meningitis and how is it treated

A

Viral meningitis, is the most common, it is treated by monitoring for Seziures and treating Symptoms, the general course takes 1-2 weeks

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6
Q

What type of patient is fungal meningitis generally found in.

What are the general s/s

how is it treated

A

immunosupressive patients.

S/S were dependent on the type of immunosupression

treatment is generally IV antifungals, and symptomatic

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7
Q

what is the worst type of meningitis?

A

Bacterial Meningitis is the worst type of meningitis

It is a medical emergency

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8
Q

What are the S/S of Bacterial Meningitis

A

Very Rapid Progression and action

High Fever Nuchal rigidity

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9
Q

What nursing interventions are needed for Bacterial Meningitis

A

Rapid thourogh assessment

Blood Draw immediately

Prep for L/P

Adminster Broad Spectrum antibiotics

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10
Q

What is the Name of the Vaccine for Meningitis

A

Menomune

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11
Q

What are two test you can do during assessment that would lead you to suspect meningitis

A

Brudizinski reflex and Kernigs Sign

Brudinski’s- neck bends feet body draws to core

kernigs- Painful extension of the legs

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12
Q

what are some lab/ Diagnostics for Meningitis

A

Culture and sensitivity

Cbc with Differential

L/P

CT/ MRI

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13
Q

What are the primary nursing care items for a person with Meningitis

A

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

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14
Q

Who are at the greatest risk for Meningitis?

Why?

A

Antivaxers, Imnunocompromised)

people who live in grouped settings (dorm, prisons, etc)

This is spread by respiratory so close quarters breeds illness

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15
Q

Important Patient care considerations for People with Meningitis

A

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

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16
Q

What are some Prevetions complications for a nurse treating a patient with Meningitis

A

Intercrainial presssure ICP

Vascualar Dysfunction

F+E imbalances

Seziures

Shock

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17
Q

What is a CVA Stroke

A

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

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18
Q

What are the types of CVA

A
  • Ischeimic- Occlusive
  1. Thrombolytic
  2. embolitic
  • Hemorrhagic
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19
Q

What is an Ischemic Stroke

A

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

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20
Q

Diagnosis of ischemic stroke is done by?

A

CT MRI

EKG ECG

ABG

CMP CKP

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21
Q

Treatment for an ischemic stroke is

A

TPA(clot busters)

Must be adminstered within 3 hours of onset of stroke to be successful

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22
Q

TPA dosing is based on

A

Dosing is based on weight, with max dose being 90mg

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23
Q

What is the Norm for INR

A

2-3

the higher the number the thiner the blood

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24
Q

What is a TIA

A

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

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25
Q

Number one cause of Stroke IS?

A

HTN

Prevention is key so controlled BP is paramont

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26
Q

Blood Thiners and Antiplatets are used to prevent what type of stroke

A

Ischemic

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27
Q

Can you use TPA for all strokes”

A

NO

TPA is only for ISCHEMIC Strokes

In hemmoragic you want the blood to clot

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28
Q

Hemoragic Stroke is

A

A bleed in the brain caused by a rupture of a vessle, Aneurysm, or rupture of an AV fistula malformation

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29
Q

Hemorrhagic stroke risk factors include

A

Smoking
Coccaine use

obesity

sedintary lifestyle

^stress levels, ^ HTN

^Cholesterol

Previous CVA/TIA

Sudden discontiuance of HTN meds

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30
Q

Treatment for Hemmoragic stroke includes

A

Clipping, or spiraling artery, montioring for ICP

Regular Neruo assessments

monitor basic Asssesment

HOB 300

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31
Q

Management of Pts with Stroke

A

Prevention is key:

maintain blood pressure

pharmacology

surgical interventions if needed

prevent complications

Assess FAST

32
Q

The assessment acryonmm FAST stands for

A

F- Face Drooping, numbness

A- Arm Weakness, Raising

S- Slurred Speach

T- Time to ED ASAP

33
Q

Remember TREATMENT FOR ALL STROKES IS IN WHAT PRIORITY

A

A
B
C

Oxygenate

34
Q

What are some Degenerative Neurological Conditions

A

MS

ALS( amytrophic lateral sclerosis)

parkinsons

myasthenia Gravis

Guillain-Barre Syndrome

Huntingtons

35
Q

What are some commonalities between all Degenerative Neuro Disorders

A
  • 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
36
Q

MS is characterized by periods of remission and exacerbation but what is it

A

it is an inflamatory response that is autoimmune where the body attacks its own mylean sheaths on the nerve cells

37
Q

MS is more common in women then men and more prevailant in northern climates, when does the onset generally begin

A

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

38
Q

there are two focus types of ms they are

A

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

39
Q

MS Trigger Factors Include

A
  • Virus or infectious agent
  • living in a cold climate
  • physical injury
  • emotional stress
  • pregnancy
  • fatigue
  • overexertion
  • temperature extremes
  • hot bath/shower
40
Q

MS is diagnosed how

A

History, and symptoms, there is no test to confirm

41
Q

What are the primary Symptoms of MS

A

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)
42
Q

More Primary symptoms of MS include

A

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

43
Q

MS Secondary Symptoms - Problems related to primary symptoms

A
  • Repeated utis
  • loss of muscle tona and disuse weakness
  • poor posture and torso control
  • decreased body density
  • shallow ineffcient breathing
    • pressure ulcers from immobility
      *
44
Q

MS drug of Choice is ?

What are some other common drugs used

A

Avonex(inteferon beta 1) given subq once a week

also used are prednisone, baclofen(spacitiy) Keppra

45
Q

Parkinsons is a disease that affects?

A

The neuro transmission of impulses causeing

tremors, ridgitity slow movement(Bradykinesia) poor posture, depression/psych, dementia, autonomic symptoms, sleep distrubances

46
Q

Cause of Parkisons is unknown but it affects what

A

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

47
Q

MOST SEEN Symptoms IN PARKINSONS

A

Temors

Rigidity

Poor Posture

Bradykinesia(Slow Movement)

48
Q

What is the most used and gold standard treatment for Parkinsons meds

A

Levodopa and Carbidopa- may take up to 6 months to reach theraputic effect

49
Q

what are some adverse affects of Levodopa-Carbidopa

A

Involuntary movements

ataxia(loss of full control of body movements)

Increased Tremors

anorexia

50
Q

Symmetrel is

A

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

51
Q

Major Complications from parkinsons include

A

Aspiration Pnemonia from aphasia

Altered cognition/ Dementia

52
Q

Other than medication what is another theraputic option for parkinsons treatment

A

Deep brain stimulation-

This is like a pacemaker to the heart but is place in the brain to help regulate

53
Q

Not every case of parkinsons is believed to be from brain issues, what are some other thoughts of what may contribute to parkinsons

A

Medications(esp Psych)

Heavy metal poisoning,

pestasides

mid-brain injuries

and High levels of CO poisoning

54
Q

True or False

Parkinsons is a slowly progressing neurological dissorder that eventually leads to disablity

A

TRUE

55
Q

Assessment and Care of parkinsons patients

A

Focus on degree of disabiltiy

TEACHING AND SAFETY ARE KEY

56
Q

Goals of treatment for Parkinsons Include

A

Improved functional ability,

maintaining indepence with adls

achieveing adequate bowel elimination

maintiaining appropiate nutritional status, copiing skills, and communicatoin

57
Q

Ways to focus on improving mobility for a parkinsons patient are

A

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

58
Q

What is ALS

Amyotrophic Lateral Sclerosis

A

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

59
Q

How is ALS Diagnosed

A

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
    *
60
Q

ALS is a traditional assessment, with focus on speech and airway function, Primarily AIRWAY. What are some interventions.

A
  • 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
61
Q

Meds used treatment of ALS include Rilusole, Quinine, Levsin, Baclofen, Dantrolene, Diazepam, what is each used for

A

Rilusole- Used to prolong Survival time of the Trachea

Levsin-Dry Secretion

Quinine - Muscle Cramps

BACLOFEN, dantrolene Diazepam- Antispasmodics

62
Q

When is Rilusole given

A

Generally toward the end of the disease process, and is used and good for 12 weeks

63
Q

What is Diplopia

A

Double Vision

64
Q

Myasthenia Gravis is

A

A progressive autoimmune disease, that leads to severe muscle weakness that affects women 15-35 or men over 40

65
Q

Myastheia Gravis presents as

A

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

66
Q

Diagnosed with

A
  • 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
67
Q

Theraputic Treatments of Myasthenia Gravis include

A

Plasmapheresis- which removes antibodies that are believed to be the cause of the condition

68
Q

Medications given for M Gravis

A
  • 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
69
Q

What are two potential complications with medication of MGravis

A
  1. Myasthenic crisis- Under medication
  2. cholinergic crisis- over medication
70
Q

What are the S/s Of Myasthenic crisis(undermedication)

A
  • 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
71
Q

12 Cranial nerves

Ooo, ooo, ooo, to touch and feel a girls vagina ah heaven

A

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)

72
Q

Cholinergic Crisis Presentations Include

A
  • 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.
73
Q

What is GBS, Guilian Barre Syndrome

A

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

74
Q

Guillian Barre Syndome Presents

A

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

75
Q

Interventions For GBS

A

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

76
Q
A

Health Promotion (14 decks)

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