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NCLEX > Neuro > Flashcards

Neuro Flashcards

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1
Q

what are the three responses of the GCS

A

eye opening
motor response
verbal response

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2
Q

What is normal pupil size

A

2-6mm

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3
Q

What is a Babinski reflex? what age is it normal to see

A

positive when the toes fan when the bottom of the foot is stroked.
should only be seen up to age 1 (don’t want to see it when the patient can walk)
above age 1 toes should curl

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4
Q

what does a positive Babinski reflex mean when seen in someone above the age o 1

A

severe problem in the central nervous system

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5
Q

what are the 5 stages of grading reflex responses

A

0 no response
+1 present, sluggish or diminished
2+ active or expected response (normal)
4+ brisk, hyperactiv, with intermittent or transiet clonus
**clonus –> series of abnormal relfex movements of the foot induced by sudden dorsiflexion

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6
Q

what are 3 tests used to diagnose neuro problems

A

computerized tomography (CT)
Magnetic resonace Imaging (MRI)
Cerebral Angiography

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7
Q

Are CTs done with dye

A

can be done with or without

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8
Q

what type of images does a CT show

A

slices/layers

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9
Q

can you talk in a CT

A

no and head must stay still

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10
Q

what is better in diagnosing CT or MRI

A

MRI - picks up on pathology earlier

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11
Q

is contrast used with an MRI

A

not susually

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12
Q

do tattoos matter when getting an MRI

A

yes, lead is used in the old ink

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13
Q

can you talk and move in a CT or MRI

A

MRI

can’t talk or move in CT

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14
Q

what should you always think when you see the word angiography

A

CONTRAST DYE

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15
Q

what happens in cerebral angiography

A

x-ray of cerebral circulation is taken using contrast dye

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16
Q

what vessel do they go through when doing a cerebral angiography

A

femoral

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17
Q

what needs to be done prior to the use of iodine based contrast dye

A

ensure patient is well hydrated so they can excrete the dye

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18
Q

what 3 things are important to be aware of piror to the use of contrast dye

A

BUN and creatine
Urinary output
hold metformin (donlt want to fuck your kidneys)

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19
Q

What sensation do people receiving contrast dye report

A

warmth in the face and metallic taste

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20
Q

how much bed rest is required for patients following any angiography procedure

A

4-6 hours

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21
Q

what are the 2 risks associated with angiography

A

BLEEDING/HEMORRHAGE
bleeding at femoral artery site
EMBOLUS

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22
Q

what are we worried about regarding emboli and cerebral angiographys

A

stroke like symptoms

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23
Q

what are electroencephalography’s used for (5)

A 
diagnosing seizure disorders 
evaluate loss of consciousness and dementia
screening procedure for coma
indicator of brain death 
used to diangose sleed disorders
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24
Q

should sedatives be given prior to an EEG?

A

no–> decreases electrical activity of the brain

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25
Q

should a patient have caffiene prior to receiving an EEG? should they be NPO

A

no caffeine

no NPO –> drops blood sugar and affectselectricity in brain

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26
Q

What may a patient be asked to do during an EEG

A

hyperventilate –> to assess brain circultion
assess photo stimulation for seizures
sedate for sleep study

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27
Q

what can you do to stimulate the brain for an EEG when a patient is completely unconscious

A

pain or noxisou stimuli

strong smell like ammonia to a bright light

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28
Q

what are the 3 main purposes of a lumbar puncture

A

obtain spinal fluid to analzye for blood, infection and tumor cells
measure pressure readings with a manometer
to adminster drugs intratehcally (brain, spinal cord)

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29
Q

what color should CSF be

A

colorless and clear (looks like water)

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30
Q

how long should a client lay flat for following a lumbar puncture and what position

A

prone for 2-3 horus

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31
Q

what is important regarding fluids and lumbar punctures

A

need to replace lost psinal fluid so increase fluids given

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32
Q

what is the most common complication of a lumbar puncture

A

HA

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33
Q

what are 4 methods to treat post lumbar puncture HA

A

besd rest
fluids
pain med
blood patch

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34
Q

what is a blood patch

A

draw blood from arm and immediately injecti it back to form a seal so no more CSF can escape

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35
Q

what are 2 life threatening complications associated with a lumbar puncture

A

brain herniation

meningitiis

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36
Q

when is a lumbar puncture contraindicated

A

when there is increased ICP b/c it can cause brain herniation

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37
Q

why does meningitis occur with a lumbar puncture

A

bacteria can get into spinal fluid from puncture site

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38
Q

what is the normal range for ICP

A

0-15 mm Hg

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39
Q

what happens to someones speech that is in an early sign of increased ICP

A

speech becomes slow or slurred

delayed response to verbal suggestion

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40
Q

what are 3 late signs of increased ICP

A

change in LOC progressing to stupor then coma

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41
Q

What are the 3 components of cushings triad

A

systolic hypertension with a widening pulse pressure
slow full bounding pulse
irregular respirations –like cheyne stokes or ataxic respirations

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42
Q

what is posturing

A

a response to painful or noxious stimuli

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43
Q

what does posturing indicate

A

the motor response centers of the brain are compromsied

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44
Q

what are the two types of posturing

A

decorticate

decerberate

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45
Q

what happens in decorticate posturing

A

arms flexed inwards and bent twoard the body and the legs are extended

46
Q

what is decerebrate posturing

A

all 4 extremeties in rigid extension

47
Q

what is worse decerebrate or decorticate

A

decerberate

48
Q

what 3 complications of increased ICP

A

brain herniation –> obstructs blood flow to the brain leading to anoxia and brain death
DI
SIADH
(ADH problems secondary to compression of piuatory gland)

49
Q

why is it important to maintain oxygenation with increased ICP

A

decreased O2 levels and high CO2 levels cause cerebral vasodilation which increases ICP

50
Q

how do you maintain adequate cerebral perfusion

A

isotonic saline and inotropic agents such as dobutamine and norephinphrine (LEVO)

51
Q

what temperatuer should someone with increased ICP be kept at

A

less than 38 degrees celsius

52
Q

why does increased temperature exacerbate increased ICP

A

increased temperature increases cerebral metabolism which increases ICP

53
Q

what might be needed to decrease a patient with increased ICPs body temp? why?

A

cooling blanket –> hypothalamus might not be working properly

54
Q

why is hypothermia used as a treatment in patients with ICP

A

decreases cerebral edema by decreasing the meatbolic demands of the brain

55
Q

why should the head of the bed be elevated and the head posisitoned midline

A

aids with SOB and drainage

56
Q

does ICP increase with turning a patient

A

yes –> space nursing interventiuons

57
Q

what should be avoided to in caring for a patient with increased ICP

A 
restraings
bowel/bladder idstention
hip flexion
valsalva
isometrics
no sneezing and nose blowing
58
Q

what should be done with suctioning and coughing in a patient with increased ICP

A

limit it

59
Q

at what level of the glasgow coma scale do you think intubate

A

if the glasgow coma score is below 8 intubate

60
Q

what drug is used to induce coma in increaed ICP patients and why

A

barbituate induced coma to decrease cerebral metabolism

61
Q

what is used to deal with excess fluid in pts with increased ICP

A

osmotic diuretics –> mannitol

62
Q

how does mannitol work

A

pulls fluid from brain cells and filters it out through the kidney

63
Q

can steroids be used in patients with increased ICP

A

yes –> decreases cerebral edema

64
Q

what is a commonly used ICP monitoring device

A

ventricular catheter monitor or subarachnoid screw

65
Q

what is the biggest risk with subarachnoid screws

A

infection

66
Q

what is important to remember regarding connections with ventricular catheter monitors or subarachnoid screws

A

no loose connections

67
Q

what is important with dressings for ventricular catheter monitors or subarachnoid screws

A

keep dressings dry because bacteria can get through

68
Q

what is meningitis

A

inflammation of the spinal cord

69
Q

what are the two causes of meningigitis

A

bacterial or viral

70
Q

what is bacterial meningitis primarily tranmitted from

A

lumbar puncture or upper respiratory system

71
Q

what are the 5 S & S of meningitis

A 
chills and fever 
severe HA
N/V
nuchal ridigidy (stiff neck)
photophobia
72
Q

what are the three pharmacological treatments for meningitis

A

antibiotics if bacterial
steroids
analgesics

73
Q

what precautions are used for bacterial meningitis? viral?

A

bacterial - droplet (very contagious high mortality rate)

viral - contact - transmitted via feces

74
Q

what patients is viral meningitis typically seen in

A

infants and childrens

75
Q

what should be thought about seizures

A

they are a symptom of an underlying disorder rather than a disease

76
Q

what are the two classes of seizures

A

partial

gneralized

77
Q

what is a partial seizure also called? what is it

A

focal seizure

seizure limited to a specific local area of the brain

78
Q

what may be the only manifestation of a focal or partial seizure

A

aura

79
Q

what is an aura

A

perceptual disturbane that occurs before such as a strange smell or confusion

80
Q

what are simple symptoms seen with partial or focal seizures

A

no loss of consciousness

numbness, tingling, prickling or pain

81
Q

what are complex symptoms in a partial seizure

A

impaired consciousness and may be too fonfused and unable to respond

82
Q

what does a generalized seizure involve? what is another name for them

A

entire brain

also called non-focal seizures

83
Q

what is the inital manifestation of a generalized seizure

A

loss oc consciousness

84
Q

what are the 3 international classifications of seizure disorders

A

Tonic clonic
myoclonic
absence

85
Q

what is a tonic/clonic seizure

A

formerly known as grand mal

86
Q

what is a myoclonic seizure

A

sudden, brief contractions of the muscle

87
Q

what is an absence seizure

A

formerly called peitit mal and characterized by a brief loss of consciousness

88
Q

what are the 2 major complications of seizures

A

status epilecpticus - a continouus seizure without retrungint o consciousness between seizures
trauma - protect the client

89
Q

what drugs are used to treat seizures

A

anticonvulsants

90
Q

what are the two types of anticonvulsants

A

rapid acting ushc as loarzepam (ativan) or diazepam (valium)

long acting pheytoin (dilantin) or phenobarbital

91
Q

what are 3 important things to remember with anticonvulsants

A

1) toxic effects - must monitor lab values

2) abrupt withdrawal can cause a seizure

92
Q

what is damaged in an open skull fracture

A

dura

93
Q

is the dura torn in a closed fracture

A

no

94
Q

with basal skull fractures where is bleeding observed

A

ears, eyes, nose and throat (EENT)

95
Q

what is battle sign

A

brusing over mastoid bone behind ear

96
Q

what is cerebrospinal rhinorrhea

A

spinal fluid leaking from nose

97
Q

how do we tell CSF from other drainage

A

positive for glucose and the halo test - ring forms halo around blood spot

98
Q

what is a concussion

A

temporary loss of neurologic function with complete recovery

- brief period of unconsciousness or may just get dizzy/see spots

99
Q

what are the two types of hematomas

A

epidural

subdural

100
Q

what happens in an epidural hematoma

A

rupture of middle meningeal artery (bleed faster)

101
Q

how does a epidural hematoma present

A

loss of consciousness —> recovery period –> cant compensate any longer –> neuro changes –> restlessness posturing

102
Q

what is the treatment for epidural hematoma

A

burr holes and remove the clot

contorl ICP

103
Q

what are the three questions to ask to determine what type of hematoma

A

did they pass out and stay out?
did they pass out and wake up and pass out again?
did they see starts

104
Q

are subdural hematomas always slow bleeds

A

no

105
Q

what is done with acute subdrural hematomas

A

immediate craniomotmy and relieve clot; control ICP

106
Q

what are you worried about with spinal cord injury above T6

A

autonomic dysrelfexia or hyperreflexia

107
Q

what is autonomic dysreflexia characterized by

A 
severe HTN
HA
brady
nasal stuffiness
flushing
sweating
blurred vision 
anxiety
108
Q

what can cause autonomic dysreflexia

A

distneded bladder
constipation
painful stimuli

109
Q

how should a client be posisited with autonomic dysreflexia

A

sat up to decrease BP

110
Q

how should autonomic dysreflexia be treated

A

put in cateher
remove impaction
look for skin pressure or painful stimuli
or a cold draft in the room

NCLEX (10 decks)

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