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Thursss > Neuro > Flashcards

Neuro Flashcards

1
Q

Glasgow coma scale

Eye=
Motor=
Verbal=

A

4
6
5

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2
Q

Glasgow eyes

SVPNR

A

Spontaneous-4
Verbal-3
Pain-2
No response-1

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3
Q

Glasgow motor

VPWFENR

A 
Verbal-6
Pain-5
Withdraws-4
Flexes abnormally-3
Extends abnormally-2
No response-1
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4
Q

Glasgow verbal

ODWSNR

A 
Oriented
Disoriented
Words are inapprpriate
Sounds are incomprehensible
No response
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5
Q

We like a high number of ____ to ____ in glasgow coma scale.

A

13…15

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6
Q

Babinski reflex is when

It is normal in infants up to_____ year and may be seen up to ______ years.

If toddler is walking already this means they should not have ______.

A

Toes fan out

1 year….2 years

Babinski reflex

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7
Q

Curling of the toes when the bottom of the foot is stroked and is a normal reflex in adult or child >1 year is?

A

Plantar Reflex

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8
Q

DTR scale

0=
1+ =
2+ =
3+ =
4+ =
A 
No response
Hypoactive
Active/normal
Slightly hyperactive
Hyperactive with clonus
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9
Q

Ankle clonus is

A

Abnormal reflex movements of the foot induced by dorsiflexion

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10
Q

Lumbar puncture site

Purposes are:

Obtain cerebrospinal fluid to test for _______ infection and______ cells.

Measures______ ______ and reduce_____ pressure

Administer drug ______

A

Lumbar subarachnoid space

Blood…tumor

Pressure readings…..CSF

Intrathecally ( into the spinal canal )

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11
Q

Positions during lumbar puncture

A 
Propped up over bedside table with head down
Fetal Position( chin to chest and knees flexed)
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12
Q

CSF should be inspected for ______

CSF should be ____ and _____

A

Infection

Clear … colorless

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13
Q

Post lumbar procedure position should be _____ for _____ hours.

A

Prone or lie flat

4-8 hours

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14
Q

What is the most common complication after lumbar puncture?

This pain _______ when client is sitting up or _____ and ________ when the client is laying down

Treatment for this complication?

A

Headache

Increases..standing…decreases

Bed rest,pain meds,increase fluids and BLOOD PATCH

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15
Q

Earliest sign of increased ICP?

Speech may become _____ or ______

______ to respond to commands

______ with no apparent reason and ______

A

Change in LOC

Slurred … Slowed

Slow

Restlessness…. confusion

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16
Q

Late signs of increased ICP

Marked change to LOC progressing to stupor, then _____

Cushings triad requires _______ intervention to prevent further brain ischemia and restore perfusion

Cushings triad are:

A

Coma

Immediate

Systolic HPN with widening pulse pressure
Slow,full and bounding pulse
Irregular respiration

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17
Q

Another late sign for increased ICP are ______ and _______ posturing

This posturing flexes arms inward towards the body and legs extended

This posturing flexes all 4 extremities outward and considered to be the WORST.

A

Decorticate…decerebrate

Decorticate

Decerebrate

18
Q

National Dysphagia Diet consists of_____ stages

A

3

19
Q

Stage I aka _______. Consists of food that are uniform, _______ and _________ texture.
Examples are hot cereals,apple sauce and yogurt.

Stage II aka_______ Includes foods that are______ and ________. Examples are canned fruit(except pineapple),moist ground meat and well-cooked noodles.

Stage III aka_______ Includes ______ foods with exception of hard, sticky and crunchy foods.

A

Dysphagia Puree…..Pureed..Pudding-like

Dysphagia Mechanically Altered…..moist….soft-textured

Dysphagia Advanced…regular

20
Q

A _________ maneuver should be used instead of the _______,________ on a patient with spinal cord injury or trauma to the head or neck.

Why?

The patient should be stabilized and manipulation of the ______ should be ______

A

Jaw-thrust…head tilt chin lift

To avoid further damage to the spine.

Neck….avoided

21
Q

________ is a paralysis or weakness in the muscles involved in lifting the front part of foot.

Use hight top shoes or ______ to provide_______ when at rest.

A

Foot drop

Boots…..support

22
Q

Always _______ a patient with head injury that their ICP is going up if they complain of a ________.

A

Assume…Headache

23
Q

Projectile_______ can occur. Why?

A

Vomiting. Because the vomiting center in the brain is being stimulated.

24
Q

Complications of increased ICP.

A

Brain herniation
DI
Siadh

25
Q

Brain herniatian obstructs the _____ _______ to the brain leading to anoxia and then brain _______.

A

Blood flow….death

26
Q 
Treatment for increased ICP:
 Goals:
Reducing cerebral \_\_\_\_\_\_\_
Reducing the amount of \_\_\_\_\_\_\_
Reducing \_\_\_\_\_\_ \_\_\_\_\_\_ in the brain
A

Edema
CSF
Blood volume

27
Q

_____ oxygen levels and ____ CO2 levels causes cerebral vasodilation in the brain which increases ______.

Increased ______ = increased _____ = increased_______

A

Decreased….High….ICP

Volume…cardiac output…..brain perfusion

28
Q

If glasgow coma is below 8 think ______

A

Intubate

29
Q 
Maintaining cerebral perfusion
Oxygenation
Hypotension/bradycardia
-dobutamine/norepinephrine
Keep temp below 100.4⁰f 
-hypothalamus
-hypothermia
Elevate and Midline
Watch TURNING
Avoid and Limit
Spaced
A

Because decreased in oxygen and high carbon dioxide causes vasodilation which increases ICP
We dont want hypotension/bradycardia because this decreases cerebral perfusion.
- isotonic solutions or inotropic medications can be given for short term
Increased temp increases cerebral demand and edema which increases ICP
-hypothalamus may not be working properly so cooling blanket is needed
-hypothermia may be used as treatment to decrease metabolic demand in the brain thus decreasing cerebral edema
Elevate the HOB and keep the head in midline position to facilitate drainage
In turning the client, you should monitor for increased ICP, if the ICP has not come down in 15 minutes this means the client is not tolerating that side very well
Avoid restraints,valsalva,nose blowing,bladder distention and Limit suctioning and coughing
Nursing interventions should be spaced

30
Q

ICP monitoring devices:

Ventricular catheter monitor or subarachnoid screw

Greatest risk?

Loose connections
Dressings should be dry

A

Infection

Loose connections should be avoided to decrease bacterial invasion

Bacteria loves wet or moist places

31
Q

Meningitis is

Causes: bacterial or viral

S/S:
Kernig
Brudzinski
Severe 
N/V
Fever
Disorientation 
Seizure
Treatment:
Corticosteroids
Antibiotics
Seizure precautions, give
Droplet preacutions
-immunizations
Contact precautions
-children and infants
A

Inflammation of the meninges which is the covering of the spinal cord

Bacterial or viral whic mainly travels through the resporatory system
S/S:
Kernig is the severe stiffness of the hamstrings. Inability to straighten when hips is flexed 90⁰
Brudzinki is when severe neck stiffness which causes hips and knees to flex when neck is flexed
Severe HEADACHE
nausea and vomiting
Chills and High Fever
Disorientation that can lead to coma

Corticosteroids decreases inflammation of the brain
Antibiotics for bacterial
Seizure precautions must give anticonvulsants
Droplet precautions for bacterial meningitis because it is transferred by the respiratory system
-immunizations is recommended for college students
Contact precautions if viral, usually seen in children and infants and transmitted via feces

32
Q

Traumatic Brain Injury is

Can either be Closed or Open

Basilar skull fracture
-bleeding in

Battles Sign
Raccoons Eyes
Cerebrospinal Rhinorrhea
How to tell if CSF leaking from nose?

Depressed fractures requires

2 types of TBI:
Contusions(whiplash)
Hematoma
-small or massive

Remember: fast bleeding = increased ICP

A

Injury to the brain

Closed TBI there is NO skull fracture and Dura is not Torn
Open TBI there IS skull fracture and Dura is TORN

Basilar is the most serious skull fracture
-bleeding will happen in the EENT (EYES, EARS,NOSE,THROAT)

Battles sign is bruising over the mastoid bone behind the ears
Raccoons eyes is periorbital bruising
Leaking spinal fluid from the nose
Glucose and HALO TEST

Surgery but non depressed dont

Contusions are seen with blunt trauma or acceleration-deceleration injuries like a whiplash
Small hematomas that develops rapidly may be fatal, massive hematomas that develops slowly can allow the patient to adapt

33
Q

Epidural hematoma is

Patho

Treatment:
Burr holes

Ask questions like:
Did they pass out , wake up and pass out again?

Epidural hematoma is a

A

Rupture or laceration of the middle meningeal artery which is a fast bleeder under high pressure

Injury ➡️ loss of consciousness ➡️ recovery period ➡️ bleeding into their head ➡️ cant compensate anymore➡️ neuro changes

Burr holes to remove clot, stop bleeding and control ICP

Medical emergency

34
Q

Subdural hematoma

Usually a Venous bleed which is
-May be acute, subacute, or chronic

Treatment
Acute or chronic is

A

Collection of blood between the dura and the brain

Which is much slower than arterial

Immediate craniotomy to remove clot and control ICP

35
Q

Concussion is

Bring patient to ED if these signs appear:

☆☆Difficulty awakening/speaking, confusion, severe headache,one sided weakness

A

Temporary loss of neurologic function with complete recovery

These are signs that ICP is going up

36
Q

Spinal cord injury:

Autonomic dysreflexia is

  • T6
  • exaggerated

☆☆Causes: (DCS)
Distended bladder
Constipation
Sttimulation to skin like:

S/S:
Sweating
Severe 
Bradycardia
Blurred vision
Nausea and anxiety
☆☆treatment
First is to sit
-if bed bound
Treat the cause like
-distended bladder
-impaction
-skin stimuli
A

Life threatening emergency that can occur with an upper spinal cord injury above the T6. Aka hyper-reflexia
Exaggerated response to stimuli that are harmless to someone without spinal injury

Pressure, pain or temperature

Sweating especially on the forehead
Hypertension
Decreased pulse

Sit the client up to lower BP
-if bedbound put them in semi-fowlers
Treat the cause like 
Distended bladder insert catheter
Remove impaction with local anesthetic
Remove the skin stimuli causing pain, pressure or cold temp
37
Q

CT scan

With or without
Takes pictures
Check for allergy to
Velcostrap on 
Claustrophobic
A

Computerized tomography of the brain

Dye
In slices
Shellfish or iodine
Forehead to immobilize client and keep head still
May become claustrophobic so make sure to tell client they can talk and hear others

38
Q

MRI

Picks up on
Enclosed and no jewelry
Tattoos
Veterans could have
Claustrophobic
Thumping sound
A

Magnetic resonance Imaging

Pathology earlier than CT scan
Client will be enclosed in a tube and remove jewelry
Find out if client has tattoos that contains lead
Veterans could have shrapnels
Client may become claustrophobic so talk to them
Teach client that a thumping sound may be heard to relieve their anxiety

39
Q

PET

Nuclear image test

Useful in diagnosing
During procedure must inhale or injected with
- may have dizziness,lighthead,headache
After procedure no contact with

A

Positron emission tomography

Test to view parts of the brain or any part of the body as its working

Alzheimer’s disease, brain tumors, CVA(stroke), parkinsons, aspects associated with mental illness
Radioactive Gas or radioactive substance and may experience dizziness or lightheadedness or headache upon inhalation of gas
NO contact with infants, children or pregnant women for 24 hours because they are radioactive

40
Q

Cerebralangiography

Femoral or brachial artery
Check for allergy to
Protect kidneys
-hold metformin
-hydration
-BUN/Crea
Facial flushing and metallic taste
Peripheral pulse is 
4-6 hours on
Complications:
Bleeding and Embolus
A

Series of timed x-rays of the cerebral corculation using dye

Injected through the femoral or brachial artery like a heart cath
Iodine and shellfish
Dye is excreted through the kidneys so we must make sure kidneys are functioning properly. We need to HOLD metformin for 24 hours prior to administering and 48 hours more before resuming
Hydration is maintained pre and post procedure
BUN/CREA is monitored pre and post procedure
Upon injection of dye, facial flushing and metallic taste will happen
Peripheral pulses are Monitored pre and post
Bed rest for 4-6 hours same as heart cath clients
Bleeding and embolus can happen so monitor these closely

41
Q

Electroencephalography records

Diagnostic for
Screens for
Indicator for
Hold caffeine
Blood sugar
A

Records electrical brain activity

Seizure disorders
Coma
Brain death
Hold stimulants like coffee it increases electrical brain activity
Not npo because we dont want blood sugar to drop because it could affect brain electricity

Thursss (17 decks)

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