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NCLEX > Neuro > Flashcards

Neuro Flashcards

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1
Q

When will we use Glascow?

A

Where there is an ALTERED consciousness or potential to (injury)

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2
Q

3 components of Glascow

Best score?

A

Eye opening /4
Motor Response /6
Verbal Response /5

High: 13-15
No response gets a 1

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3
Q

Normal Pupil size

A

2-6 mm

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4
Q

Babinski

Response?
When is it normal?

What does an abnormal response mean?

A

Toes fan

Normal up to 1 year
>1 year should have toes curl

Severe CNS problem

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5
Q

Grading reflexes

A 
0+- absent
1+ - sluggish
2+- active/expected
3+- slightly hyperactive
4+- brisk/hyperactive with clonus (abnormal reflex movement induced by dorsiflexion)
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6
Q

How is a normal reflex documented??????

A

2+/4+

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7
Q

How does CT work?
Consent?
Positioning?

A

Takes picture in layers
Consent if using dye
Keep head STILL and NO talking

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8
Q

Is a CT or MRI better? Why?

A

MRI - it can pick up problems earlier (Bc powerful magnetic field and radio frequency)

CT uses XR + computer

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9
Q

What is used during an MRI?
Is dye used?
Is radiation used?

A

A Magnet
It can be
NO

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10
Q

Things that will mess up an MRI?

What will the patient hear?

What patients can’t tolerate this?

A 
Jewelry
Credit cards
Pacemakers
Old tattoos - lead
Veterans - metal pieces

*Teeth fillings aren’t real metal

A thumping sound

Clastrophobics

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11
Q

Can you talk in a CT or MRI?

A

Can talk in an MRI

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12
Q

Angiography means we are using what?

A

DYE

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13
Q

What is a cerebral angiogram?

How to we get there?

A

XR of the cerebral circulation

Through the femoral artery

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14
Q

Pre-op Cerebral angiogram

What to monitor?

What to hold?

What does the dye cause the patient to feel like?

A

Think like a heart cath

Well hydrated to excrete dye, void, pulse assessment
Allergic to iodine or shellfish?

Monitor kidneys bc dye
BUN & creatinine
I/O

HOLD Metformin

Warm and metallic taste

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15
Q

Post-op Cerebral angiogram

Position?
Watch for what?

A

Bed rest 4-6 hours

BLEEDING and EMBOLUS! Especially since we are in the brain

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16
Q

What is an EEG?

What is it used for?

A

Electroencephalogram

Seizure disorders
Reasons for loss of consciousness and dementia
Coma screening
Brain death
Sleep disorders
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17
Q

What do we hold before an EEG?

Are they NPO?

A

Sedatives - we want that increased electrical activity on the brain

Caffeine

NO!!! This drops blood sugar

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18
Q

How does an EEG begin?

Then what might they assess?

A

Patient lies normally to get a baseline

May then ask patient to hyperventilate to assess brain circulation

Assess photo stimulation for seizures

Sedate for a sleep study

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19
Q

What if you have a patient that is completely unconscious and want stimuli?

A

May use a painful response or noxious stimuli (strong smell, bright light)

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20
Q

Where does a lumbar puncture go in to?

What 3 reasons is this used for?

Position?

A

The lumbar subarachnoid space

  1. Obtain spinal fluid to analyze for blood, infection, tumor cells
  2. Measure pressure readings with a manometer
  3. Administer drugs intrathecally (brain, spinal cord)

Crunches forward or side-lying fetal - may need help to hold them

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21
Q

How should CSF look?

A

CLEAR like water

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22
Q

Post-op Lumbar Puncture

Position?
Fluids?

Common complication?
What makes this worse?

A

Lie flat or prone for 2-3 hours
Increase fluids to replace what was lost**
HEADACHE - worse when sitting up and better when lying down

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23
Q

How to treat lumbar puncture headache

A

Bedrest
Fluids
Pain meds
BLOOD PATCH - draw blood elsewhere and inject it at the lumbar site to form an instant seal and stop CSF from coming out

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24
Q

Life-Threading complications of Lumbar puncture?

A

Brain herniation - brain pushes down on spinal cord obstructing blood flow to the brain and brain death

Meningitis - bacteria can get to the puncture site and spinal fluid!!

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25
Q

Do not do a lumbar puncture with what?

A

INCREASED ICP

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26
Q

What is the normal ICP

A

0-10

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27
Q

Early signs of increased ICP

A 
Change LOC
Slurred/slow speech
Delayed response to people
Increased drowsiness
Restless for no reason
confused

ASSUME THE WORST

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28
Q

Late signs of increased ICP

A 
Change of LOC progressing to stupor and coma
Cushing's Triad
Posturing
Pupils (fixed and dilated)
Projectile vomiting
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29
Q

What is Cushing’s Triad?

A

Systolic HTN
Widened pulse pressure
Slow bounding pulse
Irregular RR (Cheyne Stokes or ataxic)

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30
Q

What is posting a response to?

Can they be different on different sides of the body?

What is their nutrition like?

A

Painful or noxious stimuli

Yes

They are burning calories MORE THAN EVER - will probably need a feeding tube

31
Q

What fluid problems may result from increased ICP?

What about an obstruction?

A

SIADH and DI –> Need to assess for both

Brain herniation! - Blood can’t get to the brain –> brain death

32
Q

Why do patient’s ned increased O2 when they have increased ICP?

What do we monitor closely?

A

Decreased O2 and high CO2 causes an increased in ICP d/t increased vasodilation

*Need an accurate HR and BP so the brain can get O2 and nutrients

33
Q

How will we maintain cerebral perfusion in patients with increased ICP?

What do we want to prevent?

A

Give Isotonic saline and positive inotropes (Dobutamine and NE)

Avoid HTN or bradycardia because they decreases cerebral perfusion

34
Q

What do we want to keep our temperature at when there is increased ICP?
Why?

What if the hypothalamus isn’t working properly?

What will having a low T do?

A

Below 100.4 F
Increased T will increase cerebral metabolism, which increases ICP

They may nee a cooling blanket

Hypothermia is used to decrease cerebral edema by decreasing the brain’s metabolic demands

35
Q

How should we position the patient with increased ICP?

Be careful with what?

A

Elevate HOB
Keep head midline - allows jugular veins to drain

**Be careful with turning (result ^ICP should go back down within 15 minutes)

36
Q

What should we avoid with increased ICP to prevent further increases?

What should we limit?

A 
Restraints
Bowel/bladder distention
Hip flexion
Valsalva
Isometrics
Sneezing/nose blowing

Limit suctioning and coughing

37
Q

How should our nursing care be organized when a patient has increased ICP?

A

Spaced interventions - Because any time we are going to mess with the patient, their ICP will increase

38
Q

What is an indications for intubation with the ICP patient?

A

If the Glasgow score is below 8

~below 8, think intubate~

39
Q

What key things do we want to watch with an ICP patient’s vital signs?

A

Cushing’s Triad

S HTN
Widened Pulse pressure
Irregular respirations
Bradycardia - slow bounding pulse

40
Q

What does a Barbiturate coma do? Example med?

A

Increases cerebral metabolism and used especially when other measures fail

Phenobarbital

41
Q

How does mannitol work?
What kind of med is this?

What about steroids?
Example?

A

It pulls fluid from the brain cells and filters it through the kidneys, resulting in decreased ICP
Osmotic Diuretic

Steroids decrease cerebral edema
Dexamethasone

42
Q

ICP MONITORING DEVICE

Other name?
Greatest risk?
What to be careful with?

A

Ventricular catheter monitor or subarachnoid screw

INFECTION

No loose connections

Keep dressings dry because bacteria travel easier on a moist surface

43
Q

If a neuro patient has a headache, what will we assume?

NCLEX

A

INCREASED ICP

44
Q

What are we going to assume if a neuro patient is vomiting?

NCLEX

A

INCREASED ICP

45
Q

Does vasodilation or vasoconstriction cause increased ICP?

A

VASODILATION

46
Q

QUICK MEMORY TRAINING

Cushing’s Triad vs
Cardiac tamponade

A

Cushings: NARROW PP

Cardiac tamponade: WIDE PP

47
Q

Where is inflammation in meningitis?

What is is caused by?

How is it transmitted?

A

Brain or spinal cord

Viral or bacterial infection
Lumbar Puncture

Bacterial: Transmitted primarily through the respiratory system
Viral: Through feces

48
Q

S/S of meningitis

A

*Severe HA
*Nuchal Rigidity (stiff neck)
*Photophobia
Chills and fever
N/V

49
Q

How do we treat meningitis?

What kind of precautions with viral vs. bacterial?

A

Steroids
Antibiotics of bacterial

Bacterial: Droplet
Viral: Contact

50
Q

Which form of meningitis is worse?

What is recommended?

What kind of meningitis do infants and children get more often?

A

BACTERIAL
Very contagious and is a medical emergency!!
HIGH mortality

Immunizations are recommended especially for college aged students

Viral

51
Q

Is a seizure a disease?

What is epilepsy?

A

Think of it more as a symptom of an underlying issue

Epilepsy is a disorder in which seizures don’t go away when the disease goes away

52
Q

Partial seizure vs Generalized seizure?

Different names for each?

A

Partial involves a specific local area of the brain while generalized involves the entire brain

Partial: Focal
Generalized: Non-focal

53
Q

S/S of a partial seizure?

Simple vs. Complex?

A

Aura - thoughts, lights, feelings, perceptions

Simple: No loss of consciousness, but will see various sensations (numbness, tingling, prickling, or pain)

Complex: Impaired consciousness and may be confused and unable to respond

54
Q

S/S Generalized seizure - What is the initial manifestation?

A

Loss of consciousness

55
Q

DIFFERENCES

Tonic - Clonic
Myoclonic
Absence

A

Tonic-Clonic: grand mal

Myoclonic: sudden, brief contraction of a muscle or group of muscles

Absence: Brief loss of consciousness

56
Q

What is Status epileptics?

What is another complication?

A

A continuous seizure without returning of consciousness between seizures

Trauma - Protect the patient because it could lead to death

57
Q

How do we treat seizures?

NCLEX IMPORTANT NOTE

A

THOROUGH Neuro exam including lab, CT and XR (could result from trauma)

Anti-convulsants

AIRWAY AND SAFETY!!
Don’t put anything in their mouth!!!!!

58
Q

Anti-Convulsants —

Types? Examples?
Side effects - prevent them?
Monitor what?
What will cause a seizure?

A

Long or short term therapy

Long-acting: Lorazepam, Diazepam
Short-acting: Phenytoin, Phenobarbital

Toxic SE! Use lowest dose possible!

Monitor for toxicity - labs

Abrupt withdrawal = seizure

59
Q

Skull injury

Open vs. Closed fracture

A

*May not damage the brain

Open: Dura torn
Closed: Dura NOT torn

60
Q

Where do you see bleeding in a basal skull fracture?

Where is this fracture?

A

At the BASE of the skull

Seeing bleeding in the EENT area

61
Q

What are 3 different signs of a basal skull fracture?

A

Battle’s sign: bruising over mastoid (behind ear)

Raccoon eyes: periorbital bruising

CSF rinorrhea: CSF through the nose

62
Q

How to tell CSF vs other drainage?

A

Glucose test

Halo test

63
Q

Which skull fractures require surgery?

A

Depressed skull fractures

64
Q

What is a concussion?

Do they lose consciousness?

When do they need to come to the ER?

A

Temporary loss of neuro function with COMPLETE recovery

They might, or see spots/get dizzy (STAY WITH PATIENT, no driving!)

Signs of increased ICP
Difficulty waking/ speaking
Confusion
Severe HA, vomiting
Pulse changes
Pupil changes
One-sided weakness
65
Q

Differences between small and massive hematoma?

A

Small ones that develop rapidly may be fatal, while a massive one that develops slowly may allow the patient to adapt

66
Q

Major differences between epidural and subdural hematoma?

A

Epidural:
ARTERIAL bleed

Subdural:
VENOUS bleed

67
Q

Epidural Hematoma –

What ruptures?
How fast is the bleed?
How does this occur?

A

Middle meningeal artery
FAST bleed under high pressure

Wil occur due to an injury that causes loss of consciousness, then the patient will recover BUT the continuing bleed will max out the space in the head causing neuro changes (agitation, restless, pupils, seizures)

68
Q

How to treat epidural hematoma?

What key questions need to be asked?

** This is a WHAT

A

Burr holes, remove clot, control ICP

Did they pass out and stay passed out?
Did they pass out, wake up, and pass out again?
Did they just see stars?

EMERGENCY

69
Q

Subdural Hematoma

How fast?

A

Usually a venous bleed (think that venous is slower that artery)

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

70
Q

How to treat subdural hematoma?

What to keep in mind about a slow bleed?

A

RN may just think they are drunk or had a stroke – Hx is KEY! Ask about recent injuries (even if it was a month ago)

Immediate craniotomy, remove clot, control ICP

71
Q

SCI and Autonomic Dysreflexia

Occurs to injury where?
S/S
Onset?

A

Injury above T6 causing abrupt excessive BP

SEVERE HTN and HA, Bradycardia
Nasal stuffiness
Flushing
Sweating
Blurred vision
Anxiety

SUDDEN onset - Neuro emergency! or else a HTN store may occur!

72
Q

What causes autonomic disreflexia?

A

Distended bladder
Constipation
Painful Stimuli

73
Q

How to treat Autonomic Dysreflexia?

Position?

Teaching?

A

Sit them up and put in Semi-Fowlers

Treat the cause - catheter, remove fecal impaction, remove painful stimuli or a cold breeze

PREVENTION teaching! These can occur after the spinal cord injury

NCLEX (23 decks)

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