Neuro Flashcards
what are the three responses of the GCS
eye opening
motor response
verbal response
What is normal pupil size
2-6mm
What is a Babinski reflex? what age is it normal to see
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
what does a positive Babinski reflex mean when seen in someone above the age o 1
severe problem in the central nervous system
what are the 5 stages of grading reflex responses
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
what are 3 tests used to diagnose neuro problems
computerized tomography (CT)
Magnetic resonace Imaging (MRI)
Cerebral Angiography
Are CTs done with dye
can be done with or without
what type of images does a CT show
slices/layers
can you talk in a CT
no and head must stay still
what is better in diagnosing CT or MRI
MRI - picks up on pathology earlier
is contrast used with an MRI
not susually
do tattoos matter when getting an MRI
yes, lead is used in the old ink
can you talk and move in a CT or MRI
MRI
can’t talk or move in CT
what should you always think when you see the word angiography
CONTRAST DYE
what happens in cerebral angiography
x-ray of cerebral circulation is taken using contrast dye
what vessel do they go through when doing a cerebral angiography
femoral
what needs to be done prior to the use of iodine based contrast dye
ensure patient is well hydrated so they can excrete the dye
what 3 things are important to be aware of piror to the use of contrast dye
BUN and creatine
Urinary output
hold metformin (donlt want to fuck your kidneys)
What sensation do people receiving contrast dye report
warmth in the face and metallic taste
how much bed rest is required for patients following any angiography procedure
4-6 hours
what are the 2 risks associated with angiography
BLEEDING/HEMORRHAGE
bleeding at femoral artery site
EMBOLUS
what are we worried about regarding emboli and cerebral angiographys
stroke like symptoms
what are electroencephalography’s used for (5)
diagnosing seizure disorders evaluate loss of consciousness and dementia screening procedure for coma indicator of brain death used to diangose sleed disorders
should sedatives be given prior to an EEG?
no–> decreases electrical activity of the brain
should a patient have caffiene prior to receiving an EEG? should they be NPO
no caffeine
no NPO –> drops blood sugar and affectselectricity in brain
What may a patient be asked to do during an EEG
hyperventilate –> to assess brain circultion
assess photo stimulation for seizures
sedate for sleep study
what can you do to stimulate the brain for an EEG when a patient is completely unconscious
pain or noxisou stimuli
strong smell like ammonia to a bright light
what are the 3 main purposes of a lumbar puncture
obtain spinal fluid to analzye for blood, infection and tumor cells
measure pressure readings with a manometer
to adminster drugs intratehcally (brain, spinal cord)
what color should CSF be
colorless and clear (looks like water)
how long should a client lay flat for following a lumbar puncture and what position
prone for 2-3 horus
what is important regarding fluids and lumbar punctures
need to replace lost psinal fluid so increase fluids given
what is the most common complication of a lumbar puncture
HA
what are 4 methods to treat post lumbar puncture HA
besd rest
fluids
pain med
blood patch
what is a blood patch
draw blood from arm and immediately injecti it back to form a seal so no more CSF can escape
what are 2 life threatening complications associated with a lumbar puncture
brain herniation
meningitiis
when is a lumbar puncture contraindicated
when there is increased ICP b/c it can cause brain herniation
why does meningitis occur with a lumbar puncture
bacteria can get into spinal fluid from puncture site
what is the normal range for ICP
0-15 mm Hg
what happens to someones speech that is in an early sign of increased ICP
speech becomes slow or slurred
delayed response to verbal suggestion
what are 3 late signs of increased ICP
change in LOC progressing to stupor then coma
What are the 3 components of cushings triad
systolic hypertension with a widening pulse pressure
slow full bounding pulse
irregular respirations –like cheyne stokes or ataxic respirations
what is posturing
a response to painful or noxious stimuli
what does posturing indicate
the motor response centers of the brain are compromsied
what are the two types of posturing
decorticate
decerberate
what happens in decorticate posturing
arms flexed inwards and bent twoard the body and the legs are extended
what is decerebrate posturing
all 4 extremeties in rigid extension
what is worse decerebrate or decorticate
decerberate
what 3 complications of increased ICP
brain herniation –> obstructs blood flow to the brain leading to anoxia and brain death
DI
SIADH
(ADH problems secondary to compression of piuatory gland)
why is it important to maintain oxygenation with increased ICP
decreased O2 levels and high CO2 levels cause cerebral vasodilation which increases ICP
how do you maintain adequate cerebral perfusion
isotonic saline and inotropic agents such as dobutamine and norephinphrine (LEVO)
what temperatuer should someone with increased ICP be kept at
less than 38 degrees celsius
why does increased temperature exacerbate increased ICP
increased temperature increases cerebral metabolism which increases ICP
what might be needed to decrease a patient with increased ICPs body temp? why?
cooling blanket –> hypothalamus might not be working properly
why is hypothermia used as a treatment in patients with ICP
decreases cerebral edema by decreasing the meatbolic demands of the brain
why should the head of the bed be elevated and the head posisitoned midline
aids with SOB and drainage
does ICP increase with turning a patient
yes –> space nursing interventiuons
what should be avoided to in caring for a patient with increased ICP
restraings bowel/bladder idstention hip flexion valsalva isometrics no sneezing and nose blowing
what should be done with suctioning and coughing in a patient with increased ICP
limit it
at what level of the glasgow coma scale do you think intubate
if the glasgow coma score is below 8 intubate
what drug is used to induce coma in increaed ICP patients and why
barbituate induced coma to decrease cerebral metabolism
what is used to deal with excess fluid in pts with increased ICP
osmotic diuretics –> mannitol
how does mannitol work
pulls fluid from brain cells and filters it out through the kidney
can steroids be used in patients with increased ICP
yes –> decreases cerebral edema
what is a commonly used ICP monitoring device
ventricular catheter monitor or subarachnoid screw
what is the biggest risk with subarachnoid screws
infection
what is important to remember regarding connections with ventricular catheter monitors or subarachnoid screws
no loose connections
what is important with dressings for ventricular catheter monitors or subarachnoid screws
keep dressings dry because bacteria can get through
what is meningitis
inflammation of the spinal cord
what are the two causes of meningigitis
bacterial or viral
what is bacterial meningitis primarily tranmitted from
lumbar puncture or upper respiratory system
what are the 5 S & S of meningitis
chills and fever severe HA N/V nuchal ridigidy (stiff neck) photophobia
what are the three pharmacological treatments for meningitis
antibiotics if bacterial
steroids
analgesics
what precautions are used for bacterial meningitis? viral?
bacterial - droplet (very contagious high mortality rate)
viral - contact - transmitted via feces
what patients is viral meningitis typically seen in
infants and childrens
what should be thought about seizures
they are a symptom of an underlying disorder rather than a disease
what are the two classes of seizures
partial
gneralized
what is a partial seizure also called? what is it
focal seizure
seizure limited to a specific local area of the brain
what may be the only manifestation of a focal or partial seizure
aura
what is an aura
perceptual disturbane that occurs before such as a strange smell or confusion
what are simple symptoms seen with partial or focal seizures
no loss of consciousness
numbness, tingling, prickling or pain
what are complex symptoms in a partial seizure
impaired consciousness and may be too fonfused and unable to respond
what does a generalized seizure involve? what is another name for them
entire brain
also called non-focal seizures
what is the inital manifestation of a generalized seizure
loss oc consciousness
what are the 3 international classifications of seizure disorders
Tonic clonic
myoclonic
absence
what is a tonic/clonic seizure
formerly known as grand mal
what is a myoclonic seizure
sudden, brief contractions of the muscle
what is an absence seizure
formerly called peitit mal and characterized by a brief loss of consciousness
what are the 2 major complications of seizures
status epilecpticus - a continouus seizure without retrungint o consciousness between seizures
trauma - protect the client
what drugs are used to treat seizures
anticonvulsants
what are the two types of anticonvulsants
rapid acting ushc as loarzepam (ativan) or diazepam (valium)
long acting pheytoin (dilantin) or phenobarbital
what are 3 important things to remember with anticonvulsants
1) toxic effects - must monitor lab values
2) abrupt withdrawal can cause a seizure
what is damaged in an open skull fracture
dura
is the dura torn in a closed fracture
no
with basal skull fractures where is bleeding observed
ears, eyes, nose and throat (EENT)
what is battle sign
brusing over mastoid bone behind ear
what is cerebrospinal rhinorrhea
spinal fluid leaking from nose
how do we tell CSF from other drainage
positive for glucose and the halo test - ring forms halo around blood spot
what is a concussion
temporary loss of neurologic function with complete recovery
- brief period of unconsciousness or may just get dizzy/see spots
what are the two types of hematomas
epidural
subdural
what happens in an epidural hematoma
rupture of middle meningeal artery (bleed faster)
how does a epidural hematoma present
loss of consciousness —> recovery period –> cant compensate any longer –> neuro changes –> restlessness posturing
what is the treatment for epidural hematoma
burr holes and remove the clot
contorl ICP
what are the three questions to ask to determine what type of hematoma
did they pass out and stay out?
did they pass out and wake up and pass out again?
did they see starts
are subdural hematomas always slow bleeds
no
what is done with acute subdrural hematomas
immediate craniomotmy and relieve clot; control ICP
what are you worried about with spinal cord injury above T6
autonomic dysrelfexia or hyperreflexia
what is autonomic dysreflexia characterized by
severe HTN HA brady nasal stuffiness flushing sweating blurred vision anxiety
what can cause autonomic dysreflexia
distneded bladder
constipation
painful stimuli
how should a client be posisited with autonomic dysreflexia
sat up to decrease BP
how should autonomic dysreflexia be treated
put in cateher
remove impaction
look for skin pressure or painful stimuli
or a cold draft in the room
