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NCLEX > Neuro > Flashcards

Neuro Flashcards

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1
Q

GCS

A

Eye Opening
Motor Response
Verbal Response

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2
Q

Normal pupil size

A

2-6mm

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3
Q

Babinski Reflex is normal when?

A

Child up to 1 year

If they’re walking, it shouldn’t be present

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4
Q

Positive Babinski Reflex

A

Fanning of the toes when you stroke the bottom of the foot. This means there is a severe problem in the CNS. (Tumor or lesion on the brain or spinal cord, multiple sclerosis, lou gehrig’s dz)

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5
Q

Negative Babinski Reflex

A

Good thing, should have a plantar reflex/curling of the toes

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6
Q

Ankle clonus

A

Series of abnormal reflex movements of the foot, induced by sudden dorsiflexion

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7
Q

CT scan

A

With/without contrast dye
Takes pics in layers
Keep head still, no talking

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8
Q

Do you need to sign a consent for a CT w/ dye?

A

Yes

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9
Q

Why are MRIs better than CTs

A

They pick up on the patho earlier

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10
Q

What is used in an MRI

A

A magnet
No radiation
Sometimes dye, not usually

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11
Q

Do teeth fillings matter for MRIs?

A

No, they aren’t metal

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12
Q

Old veterans for MRIs

A

They should get an x-ray first to see if any scrap metal is in their skin

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13
Q

Cerebral angiography

A

Consent is needed bc dye is used
X-ray of cerebral circulation
Goes through the femoral artery, similar to heart cath

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14
Q

Pre-procedure cerebral angiography

A

Well hydrated/void/peripheral pulses/groin prepped
Watch BUN and creatinine, output
Explain they will have a warmth in face and metallic taste
Check for allergies to iodine or shellfish

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15
Q

What med do you hold before a cerebral angiography?

A

Metformin

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16
Q

Why does the client receiving a scan with dye need to be well hydrated?

A

Dye is excreted through the kidneys

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17
Q

Post procedure cerebral angiography

A

Bed rest for 4-6 hours
Watch for bleeding at femoral artery site
Embolus can go to arm, heart, lung, kidney
If it goes to the brain, the client will have a change in LOC, one-sided weakness, and paralysis, motor/sensory deficits.

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18
Q

EEG

A

Records electrical activity of the brain
Helps diagnose a seizure disorder
Evaluates loss of consciousness and dementia
Indicator of brain death
Diagnoses sleep disorders like narcolepsy, cerebral infarct, brain tumors or abscesses

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19
Q

Pre procedure EEG

A

Hold sedatives bc they decrease the electricity of brain
No caffeine-increases electricity
Not NPO be drops BS

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20
Q

During EEG procedure

A

Get a baseline first with client lying quietly
May be asked to hyperventilate for 2-3 minutes to assess brain circulation, assess photo stimulation for seizures, or sedate for sleep study
If you have someone who is completely unconscious, a pain response or noxious stimuli may be introduced to stimulate a brain wave. This can be anything from a strong smell like ammonia to a bright light

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21
Q

Lumbar Puncture site

A

Lumbar subarachnoid space

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22
Q

Purpose of lumbar puncture

A

To obtain spinal fluid to analyze for blood, infection, and tumor cells
To measure pressure readings with a manometer
To administer drugs intrathecally (brain, spinal cord)

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23
Q

How is the client positioned for lumbar puncture?

A

Propped up over the bedside table to arch back for space to form between the vertebrae and needle will go in easily, or side lying fetal position

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24
Q

Care during lumbar puncture

A

Inspect surrounding skin at puncture site for any infection

CSF should be clear and colorless (looks like water)

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25
Q

Post procedure lumbar puncture

A

Lie flat or prone for 2-3 hours

Increase fluids to replace lost spinal fluid

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26
Q

What is the most common complication of a lumbar puncture?

A

HA, increases in when they sit up, decreases when they lie down

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27
Q

How is the HA from lumbar puncture treated?

A

Bed rest, fluids, pain med, blood patch

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28
Q

Life threatening complications of lumbar puncture

A

Brain herniation: with known increased ICP, lumbar puncture is contraindicated (tell doc immediately if you suspect increased ICP)
Meningitis- bacteria can get into the puncture site and into spinal fluid

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29
Q

Early signs of increased ICP

A

Change in LOC
Slurred or slowed speech
Restless with no apparent reason

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30
Q

Late signs of increased ICP

A

Marked change in LOC progression to stupor, then coma
Cushing’s Triad-requires immediate intervention to prevent brain ischemia
Posturing-response to painful or noxious stimuli

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31
Q

Cushing’s Triad

A

Systolic HTN with widening pulse pressure
Slow, full, bounding pulse
Irregular respirations-look for change in pattern (cheyne stokes or ataxic respirations)

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32
Q

Posturing indicates what?

A

That the motor response centers of the brain are compromised. The client will be rigid and tight and burning

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33
Q

Decorticate posturing

A

Arms flexed inward and bent in toward the body and the legs are extended. Think towards “core”

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34
Q

Decerebrate posturing

A

All 4 extremities in rigid extension. Think away from body

35
Q

Is decorticate or decerebrate worse?

A

Decerebrate

36
Q

What does the posturing client need?

A

Calories, doc will start feedings ASAP

37
Q

Miscellaneous signs of increased ICP

A

HA
Changes in pupils and pupil response (fixed, dilated)
Projectile vomiting

38
Q

Complication of increased ICP

A

Brain herniation-obstructs blood flow to the brain leading to anoxia and then brain death
DI and SIADH-assess for both

39
Q

Tx of increased ICP

A

Maintain oxygenation
Maintain adequate cerebral perfusion-don’t want hypotension or bradycardia bc that decreases brain perfusion
Keep temp below 100.4-increased temp increases cerebral metabolism which increases ICP, hypothalamus may not be working and a cooling blanket may be used, hypothermia is used as tx to decrease cerebral edema by decreasing the metabolic demands of the brain
Elevate HOB
Keep head in midline so jugular veins can drain
Watch ICP monitor with turning-it should come back down within 15 min, if not then try another position
Avoid restrains/bowel/bladder distention, hip flexions, valsalva, isometrics. No sneezing/blowing
Limit suctioning and coughing
Spaced nursing interventions
Barbiturate induced come to decrease cerebral metabolism: phenobarbital
Osmotic diuretics like mannitol to pull fluid from brain cells and filter it out through kidneys
Steroids like dexamethasone to decrease cerebral edema

40
Q

Decreased O2 levels and increased CO2 causes what?

A

Cerebral vasodilation which increases ICP

41
Q

How can you prevent hypotension?

A

Isotonic saline and inotropic agents like dobutamine and norepi to cause vasoconstriction

42
Q

GCS less than 8, think what?

A

Intubate

43
Q

ICP monitoring devices

A

Ventricular cath monitor or subarachnoid screw
Greatest risk is infection
No loose connections
Keep dressings dry (Bacterial travel faster through something wet)

44
Q

Meningitis

A

Inflammation of spinal cord or brain

45
Q

Causes of meningitis

A

Either viral or bacterial. Bacterial is transmitted through the respiratory system

46
Q

S/S of meningitis

A 
Chills and fever
Severe HA
N/V
Nuchal rigidity (stiff neck)
Photophobia
47
Q

Treatment of meningitis

A

Corticosteroids
ABX if bacterial
Analgesics

48
Q

What precautions for bacterial meningitis?

A

Droplet. It is very contagious, medical emergency. Has high mortality and vaccine is recommended for college aged students

49
Q

Viral meningitis precautions

A

Transmitted through feces so contact. Commonly seen in infants and children

50
Q

Partial seizure

A

Limited to a specific local area of brain

Aura may be only sign

51
Q

What is also called a focal seizure?

A

Partial

52
Q

Simple partial seizure

A

Without loss of consciousness, will see numbness, tingling, prickling, or pain

53
Q

Complex partial seizure

A

Means they have impaired consciousness and may be confused and unable to respond

54
Q

Generalized seizure

A

Involves entire brain

Loss of consciousness is the initial manifestation

55
Q

What is also called a non-focal seizure?

A

Generalized

56
Q

Tonic clonic seizure is formally known as what?

A

Grand mal

57
Q

Myoclonic seizure

A

Sudden, brief contractions of a muscle or group of muscles

58
Q

Absence seizure

A

Formally called petit mal and characterized by a brief loss of consciousness

59
Q

Status epilepticus

A

Continuous seizure without returning to consciousness between seizures

60
Q

Tx for seizure

A 
Anticonvulsants: long or short term
Rapid acting: lorazepam and diazepam
Long acting: phenytoin or phenobarbital
*Toxic SE, use smallest dose
*Abrupt withdrawal can cause seizures
61
Q

Can you bag a seizing pt if they’re turning blue?

A

Yes, don’t stick anything in their mouth

62
Q

Open skull fx

A

Torn dura

63
Q

Closed skull fx

A

Durn not torn

64
Q

With basal skull fx, you see bleeding where?

A

Eyes, ears, nose, throat

65
Q

Battle’s sign

A

Seen with skull injury

Bruising over mastoid

66
Q

Raccoon eyes

A

Seen with skull injury

Peri-orbital bruising

67
Q

Cerebrospinal rhinorrhea with skull injury

A

Leaking spinal fluid from nose-don’t blow or absorb, let it flow out freely

68
Q

How do you tell CSF from other drainage?

A

Positive for glucose and the halo test

69
Q

Non-depressed skull fx

A

Usually don’t require sx, depressed fx do

70
Q

Concussion

A

Temporary loss of neurologic function with complete recovery

Will have short (maybe seconds) period of unconsciousness or may just get dizzy or see spots

71
Q

When will a concussion pt have to come back to hospital?

A

Difficulty awakening/speaking, confusion, severe HA, vomiting, pulse changes, unequal pupils, one-sided weakness (all signs of increased ICP)

72
Q

Small hematoma that develops rapidly

A

May be fatal

73
Q

Large hematoma that develops slowly

A

May allow client to adapt

74
Q

Epidural hematoma

A

Rupture of the middle meningeal artery (faster bleeding under high pressure)
Injury then loss of consciousness then recovery period then they can’t compensate any longer and have neuro changes
EMERGENCY!

75
Q

Tx of epidural hematoma

A

Burr Hoes and remove clot, control ICP

76
Q

What questions do you ask to identify the type of injury and tx needed with epidural hematoma?

A

Did they pass out and stay out?
Did they pass out and walk up and pass out again?
Did they just see stars?

77
Q

Subdural hematoma

A

Usually a venous bleed

Can be an acute (fast) bleed, subacute (medium) or chronic (slow)

78
Q

Tx of subdural hematoma

A

Chronic: imitates other conditions, bleeding and compensation, neuro changes are maxed out
Acute or chronic: immediate craniotomy and remove clot, control ICP

79
Q

Autonomic dysreflexia

A

With an upper spinal cord injury (above T6), major complication to look for is autonomic dysreflexia or hyperreflexia.

80
Q

S/S of autonomic dysreflexia

A

Severe HTN and HA, bradycardia, nasal stuffiness, flushing, sweating, lured vison, anxiety
Sudden onset, near emergency is not treated promptly.

81
Q

What can occur with autonomic dysreflexia if not treated promptly?

A

HTN stroke

82
Q

Causes of autonomic dysreflexia

A

Distended bladder, constipation, painful stimuli

83
Q

Tx of autonomic dysreflexia

A

First: sit the client up to lower BP
Put in catheter, removed impaction with topical anesthetic, look for skin pressure, painful stimuli, or cold draft breeze in the room

NCLEX (14 decks)

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