Neuro Flashcards by Joanne Hum

Intracranial pressure can be increased by a

a. decrease in venous outflow
b. dilation of the cerebral blood vessels
c. rise in PaCO2
d. change in all of the above

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Initial compensatory vital sign changes with increased ICP include all of the following EXCEPT:

a. decreased pulse rate
b. increased systemic BP
c. decreased temperature
d. slowed respiratory rate with irregularities

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The normal range of intracranial fluid pressure (ICP) is

a. 60-100 mm H2O
b. 110-140 mm H2O
c. 150-180 mm H2O
d. 180-210 mm H2O

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The earliest sign of increasing ICP is

a. a bounding pulse
b. bradycardia
c. HTN
d. lethargy

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As ICP rises, the nurse knows that she may be asked to administer ____________, a commonly used osmotic diuretic

a. glycerin
b. isosbride
c. mannitol
d. urea

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The most common cause of CVA is cerebral

a. arteriosclerosis
b. hemorrhage
c. ischemia
d. thrombosis

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Risk factors associated with CVA include (select all that apply)

a. high-normal Hct
b. HTN
c. preexisting cardiovascular disease
d. vision

A, B, C

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Identify the sequence of events that occur with increasing ICP

Cranial trauma and tissue injury –> breakdown of BBB –> increased ICP –> compression of blood vessels –> decreased cerebral blood flow –> decreased oxygen and brain tissue ischemia –> edema surrounding necrotic tissue –> increased ICP with compression of brainstem and respiratory center –> increased PaCO2, increased H+, decreased pH (acidosis) –> vasodilation –> increased ICP resulting from increased blood volume –> death

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T/F: In the absence of an infection, the client with pyrexia with increased ICP will benefit from antipyretics administration

False

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Decadron is used instead of prednisone for clients with increased ICP because of its

a. more potent anti-inflammatory effect
b. decreased mineralocorticoid effect
c. ability to be stopped without weaning
d. lesser hyperglycemic effect

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When the nurse observes that the patient has extension and external rotation of the arms and wrists and extension, plantar flexion and internal rotation of the feet, she records the patient’s posturing as

a. decerebrate
b. decorticate
c. normal
d. flaccid

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When the patient is diagnosed as having global aphasia, the nurse recognizes that the patient will be unable to

a. comprehend the spoken word
b. form words that are understandable
c. form words that are understandable or comprehend the spoken word
d. speak at all

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Which of the following is a modifiable risk factor for TIA and ischemic stroke?

a. advanced age
b. history of smoking
c. social drinking
d. thyroid disease

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A client receiving tPA should be carefully monitored for

a. bleeding
b. constipation
c. hypostatic pneumonia
d. thrombophlebitis

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The inflammatory attacks associated with MS

a. create a consistent pattern of scarring in all patients
b. occur randomly
c. produce hypermyelinated nerve sheaths
d. shorten transmission times of nerve impulses

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Signs and symptoms of patients with MS vary widely because

a. occasionally, the scars spontaneously heal
b. not all MS patients suffer from demyelinated sheaths
c. plaques are randomly located in the CNS
d. hypermyelinated sheaths affect different areas of the CNS

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MS strikes

a. primarily women ages 20-50
b. primarily men ages 20-40
c. men and women equally
d. men twice as often as women

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Which type of MS is characterized by gradual and progressive disability without stabilization?

a. relapsing-remitting
b. secondary progressive
c. primary progressive
d. progressive-relapsing

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To diagnose MS, a clinician uses MRI to look for plaques that

a. are clustered together in one are of the spinal cord
b. are present only in the grey matter
c. developed in the CNS at approximately the same time
d. exist in 2 distinct areas of the CNS

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An EEG of a patient with MS shows

a. the relative position of plaques along neural pathways
b. a lack of neuron transmission in affected areas
c. slower nerve signals in demyelinated neurons
d. slightly faster nerve signals over plaque areas

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Evoked potential testing for the diagnosis of MS uses

a. visual pathways
b. auditory pathways
c. motor pathways
d. somatosensory pathways

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A patient with relapsing-remitting MS is usually treated with

a. tricyclic antidepressants
b. interferon beta-1a (Avonex)
c. baclofen
d. levodopa

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Which best describes the proportion of patients with MS who are affected by bladder dysfunction?

a. < 10%
b. 10-20%
c. 21-49%
d. at least 50%

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Immobility and opioid use can lead to

a. constipation
b. urinary incontinence
c. diarrhea
d. UTIs

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To treat spasticity, the patient with MS may be prescribed a. interferon beta 1-a (Rebif) b. interferon beta-1b Betaseron) c. baclofen (Lioresal) d. glatiramer (Copaxone)

Which medications are generally best to treat the neuropathic pain of MS? a. opioids b. acetaminophen c. NSAIDs d. antiepileptics or tricyclic antidepressants

To combat the adverse reactions of interferon beta-1a, give acetaminophen as ordered a. 2 hours before the injection b. at the time of the injection c. 1 hour after the injection d. 2 hours after the injection

Which of the following statements about research on MS is correct? a. Researchers have identified the exact antigen involved in MS b. Researchers have identified which immune cells attack myelin sheaths c. Researchers have developed an immunomodulating therapy to prevent attacks on myelin sheaths d. Researchers now know that an infectious trigger is responsible for the development of MS

List the components of the brain and their relative %

Brain tissue 78% Blood 12% CSF 10%

What are the 6 factors that affect ICP?

a. BP b. cardiac function c. intra-abdominal and intra-thoracic pressure d. body position e. temperature f. blood gases

Cerebral blood flow is approximately ______ml/minute

750 ml/min

T/F: the brain is able to store oxygen and glucose for short periods

False - unable to store oxygen or glucose

How much of the body's oxygen and glucose does the brain require?

20% of oxygen | 25% of glucose

How long does the inflammatory process take place before clinical manifestations of IICP are present?

24-48 hours

How does CO2 affect ICP?

CO2 causes vasodilation --> increased ICP due to increased blood flow

With each 1 degree increase of body temperature, oxygen demand in the brain increases by how much?

6-10%

How is Cerebral perfusion pressure (CPP) calculated? What is normal CPP?

CPP = MAP - ICP | Normal CPP is 70-100 mm Hg

How is MAP calculated? What is MAP a measure of?

MAP = [SBP + 2(DBP)]/3 | MAP is a function of CO and resistance

What are the 3 components of Cushing's triad? It is an EARLY/LATE indicator of increased ICP.

Increased SBP (with widening pulse pressure) Bradycardia Irregular and decreased respirations = late indicator

2 Types of head injuries/fractures?

Open and closed

Describe the difference between acceleration and deceleration

Acceleration: head fixed and object mobile e.g. bat to head Deceleration: head in motion stopped by fixed barrier e.g. fall on head

What are the 3 types of skull fractures?

1. Linear 2. Depressed 3. Basilar

What tool is used to determine the degree of head injury?

GCS: mild, moderate or severe

Give the GCS scores and clinical hallmarks of mild vs moderate vs severe head injury

Mild (13-15): brief period of loss of consciousness Moderate (9-12): typically confused, ~focal neurological deficits, follow simple commands Severe (8 or less): unable to follow commands, comatose

Contrast diabetes insipidus with SIADH

DI: low ADH --> diuresis/water loss of > 9L/day - treated with fluid/electrolyte balance and ADH replacement or vasopressin or desmopressin acetate (DDAVP) SIADH: too much ADH --> water retention and oliguria --> IICP and edema d/t increased blood volume - self limiting - may be treated with possible water restriction

``` Describe the manifestations that may occur with damage to the following cranial nerves: I (olfactory) II (optic) VIII (vestibulocochlear) III (oculomotor) VII (facial) ```

I: loss of smell II: vision changes III: pupil fixed/constricted/dilated and loss of some eye movement VII: facial paresis/paralysis VIII: loss of hearing or vertigo or nystagmus

What are some manifestations of head injury/fracture?

``` CSF drainage Cranial nerve damage Blood behind tympanic membrane Periorbital ecchymoses (raccoon eyes) Bruising over the mastoid (Battle's sign) ```

What are the 3 major goals of care of patients with severe head injury?

1. Prompt recognition and treatment of hypoxia and acid-base disorders that impact cerebral edema 2. control increasing ICP resulting from factors such as cerebral edema or expanding hematoma 3. stabilization of other conditions

What are the 6 complications of ICP

``` "HI SID O: ABCDE" Hydrocephalus (acute) Infection SIADH IICP Diabetes Insipidus Other: AV Aneurysms Behaviour Changes Dysrhythmias Edema (pulmonary) ```

What are the 3 mechanisms in which the brain responds to fluctuations in CSF?

1. autoregulation 2. metabolic regulation 3. CSF regulation

Compare autoregulation, metabolic regulation, and CSF regulation

AUTOREGULATION - maintains constant cerebral perfusion despite changes in systemic arterial pressure ie. when pressure increases, cerebral arterioles constrict/ opposite when pressure decreases METABOLIC - changes in O2 and CO2 affect vasodilation (high CO2)/constriction (low CO2) CSF - brain regulates CSF production/absorption: increased reabsorption --> decreased ICP

What is the most sensitive indicator of ICP?

changes in LOC

``` What are some clinical indicators of increased ICP in terms of: respiratory pattern ocular changes motor function/strength temperature pain GI symptoms ```

Respiratory: decreased --> increased CO2 --> vasodilation --> increased ICP Ocular: unequal pupils, sluggish pupil response, fixed or dilated Motor function: decorticate and decerebrate posturing - may have loss of gag reflex, corneal reflex, and bradycardia Hyperthermia Headache - not pain from brain tissues, but of other intracranial structures e.g. veins and arteries Vomiting - NOT preceded with nausea

T/F: lumbar puncture is usually performed as a diagnostic study for ICP

False: change of pressure with lumbar puncture can result in herniation

What medications are administered in collaborative management of IICP?

Oxygen: to maintain PaO2 at 100 mmHg or higher/ PaCO2 at 30-35 mmHg (to induce vasoconstriction) Mannitol - does not cross an intact BBB*** - hyperosmotic draws fluid from ISF and cells - if BBB is damaged, enters brain and causes increased swelling*** Steroids eg. dexamethasone - reduce leakiness of BBB and stabilize cell membranes Antibiotics - especially if CSF leak or direct portal of entry to blood system Antipyretics - Tylenol, cooling blanket or muscle relaxants to reduce shivering Anticonvulsants - prophylaxis Barbiturates and paralyzing agents: to decreased cerebral metabolism to decrease ICP H2 agonists - reduce risk of ulcers from stress and steroids

What nursing interventions must be included when caring for patients with IICP?

BP maintenance - SBP 100-160 mmHg Hydration - via IV to 75% of body requirements; monitor electrolytes Nutrition: NPO until peristalsis resumes (~5 days) then enteral feeds if peristalsis or TPN if aspiration risk Position HOB 30 degrees for aspiration risk and align head to avoid flexion of jugular vein Monitor neurovitals Monitor ICP

What is the optimal rate of cerebral blood flow?

750-1000 ml/min, or 20% of cardiac output

According to Lewis, what is normal ICP?

0-15 mmHg

What are the classifications of stroke?

Ischemic: thrombotic + embolic Hemorrhagic: subarachnoid + intracerebral