neuro Flashcards
define glasgow coma scale
a scale that measures the degree or level on consciousness.
used to assess the level of consciousness or has the potential of altered consciousness.
three responses of the glasgow coma scale
- eye opening
- motor response
- verbal response
we like to have a number ranging from ___ for the glasgow coma scale.
13-15. 15 is the best score
never will be 0. at least 3
what is included in a neuro assessment?
glasgow coma scale
pupillary changes (normal pupil size 2-6) PERRLA
hand grips/lift legs/ pushing strenght of feet
reflex assessment (babinski reflex)
___ is always the #1 with neuro assessment.
LOC
babinski reflex
normal in a child up to 1 yr.
abnormal in an adult!
the adult or child greater then one year should have a planter reflex or curling or the toes when the bottom of the foot is stroked.
what does it mean if the adult has a present babinski reflex or faning on the toes when you stroke the bottom on the foot?
a severe problem in the central nervous system. (tumor or lesion on the brain or spinal cord, MS, lou gehrig’s disease)
a normal reflex response would be documented as ___.
2+/4+
will you need the client to sign a consent form prior to the test when using dye? (CT scan)
YES
CT takes pictures in slices(layers), head still, no talking.
MRI:
is dye used?
mri is better than ct. mri picks up on a problem earlier.
NO DYE. no radiation. a magnet is used.
cerebral angiography:
will a consent form be needed? why?
xray of cerebral circulation through the femoral artery.
yes signed consent because they are using dye
when cerebral angiography , what should you tell the patients?
they will have a warmth in the face and a metallic taste.
post procedure for cerebral angiography?
bed rest 4-6 hrs.
watch for bleeding at the femoral artery
embolus (embolus will go to brain bc of this… changes in loc, one sided weakness, paralysis, motor/sensory deficits)
***baseline neuro assessment before they go for procedure.
EEG helps to diagnose…
seizure disorders and evaluate the types of seizures occuring.
evaluates loss of consciousness and dementia
screening procedure for coma
indicator of brain death
used to diagnose sleep disorders
whats the one test we dont want client to be NPO
EEG
pre procedure of eeg
hold sedatives (decrease electricity in brain), no caffeine, not NPO (drops blood sugar)
how should a client be positioned with lumbar puncture?
back arched up!!
leaning on table or side lying fetal position
post procedure for lumbar puncture?
lie flat or prone for 2-3 hours
increase fluid to replace lost spinal fluid
HA most common complication
life threatening complication of lumbar punction?
brain herniation (with known increased ICP, a lumbar puncture is contraindicated)
meningitis
normal lab value for icp
0-15mmHG
early sign of increased icp
earliest sign? change in loc speech slurred and slow delayed in response to verbal increasing drowsiness restless with no apparent reason cofusion
late signs of increased icp
marked changes in loc progressing to stupor, then coma!!
vital signs changes (cushing traid)
posturing
cushing’s traid
- systolic hypertenson with a widening pulse pressure
- slow, full, and bounding pulse
- irregular respirations
decorticate posturing
arms flexed inward and bent in towards the body and the legs are extended
decerebrate posturing
all 4 extremities in rigid extension; WORST
complications of increased ICP
brain herniation :this herniation obstructs the blood flow to the brain leading to anoxia and then brain death
DI and SIADH: can either so you must assess for both
with increased icp, you should keep the temperature below ___.
they should be getting ___ saline and ____agents
100.4
isotonic and inotropic (to prevent hypotension)
if the glasgow come scale is below 8, think ___
intubate
meningitis
inflammation of the spinal cord or brain
can be either viral or bacterial. bacterial is transmitted throught the respiratory system
s/s of meningitis
- chills and fever
- severe HA
- N/V
- nuchal rigidity (stiff neck)
- photophobia
tx meningitis
steriod
antibiotics if bacterial
analgescis
drop precautions for BACTERIAL meningitis
bacterial meningitis is very contagious, medical emergency. it has a high mortality and _____ is recommended for college-aged students.
viral meningitis is transmitted by feces and requires ___ precautions . most commonly seen in infants and children.
immunizations
DROPLET PRECATIONS
contact precautions!
partial seizure
is limited to a specific local area of the brain
an aura may be the only manifestation
called focal seizure
symptoms can range from simple to complex
aura
things before seizure, bright light etc.
simple symptoms
means without loss of consciousness; will see numbness, tingling, prickling or pain
complex symptoms
means that they have impaired consciousness and may be confused and unable to respond
generalized seizures
involves the entire brain
called non-focal seizure
loss of consciousness is the initial manifestations
____ formerly known as grand mal
___sudden, brief contractions of a muscle or group of muscles
____ formerly called petit mal and characterized by a brief loss of consciousness.
tonic -clonic
myoclonic
absence
a continuous seizure without returning to consciousness between seizures
status epilepticus
anticonvulsants: can be long or short term therapy.
rapid acting are_____.
long acting are _____.
lorazepam and diazepam
phenytoin and phenobarbital
battle’s sign
bruising over mastoid
with basal skull fracture, where do you see bleeding
EENT
how do we tell CSF from other drainage?
positive for glucose and the halo test (bloody spot on pillow then it will form a halo)
non-depressed skull fractures usually ______; depressed fracture ___ surgery.
do not require surgery
do require
what should you be watching for with a client with a concussion?
concussion is a temporary loss of neurologic function with complete recovery!
watch for increased ICP!
epidural hematoma
is this an emergency?
rupture of the middle meningeal artery. fast bleeder under high pressure
injury—loss of consciousness–recovery period—cant compensate any longer—neuro changes
tx-burr holes and remove the clot; control the icp
YES THIS IS AN EMERGENCY
subdural hematoma
usually a venous bleed.
can be acute (fast), subacute (medium), chronic (slow)
tx- chronic imitates other conditions. bleeding and compensating. neuro changes= maxed out (cant compensate anymore!!)
acute or chronic- immediate craniotomy and remove clot and control ICP
autonomic dysreflexia
with upper spinal cord injury (above t6)!
sudden onset. medical emergency. hypertensive stroke could occur.
distended bladder, constipation, and painful stimuli can cause this
