Neuro Flashcards
Glasgow coma scale
Eye=
Motor=
Verbal=
4
6
5
Glasgow eyes
SVPNR
Spontaneous-4
Verbal-3
Pain-2
No response-1
Glasgow motor
VPWFENR
Verbal-6 Pain-5 Withdraws-4 Flexes abnormally-3 Extends abnormally-2 No response-1
Glasgow verbal
ODWSNR
Oriented Disoriented Words are inapprpriate Sounds are incomprehensible No response
We like a high number of ____ to ____ in glasgow coma scale.
13…15
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 ______.
Toes fan out
1 year….2 years
Babinski reflex
Curling of the toes when the bottom of the foot is stroked and is a normal reflex in adult or child >1 year is?
Plantar Reflex
DTR scale
0= 1+ = 2+ = 3+ = 4+ =
No response Hypoactive Active/normal Slightly hyperactive Hyperactive with clonus
Ankle clonus is
Abnormal reflex movements of the foot induced by dorsiflexion
Lumbar puncture site
Purposes are:
Obtain cerebrospinal fluid to test for _______ infection and______ cells.
Measures______ ______ and reduce_____ pressure
Administer drug ______
Lumbar subarachnoid space
Blood…tumor
Pressure readings…..CSF
Intrathecally ( into the spinal canal )
Positions during lumbar puncture
Propped up over bedside table with head down Fetal Position( chin to chest and knees flexed)
CSF should be inspected for ______
CSF should be ____ and _____
Infection
Clear … colorless
Post lumbar procedure position should be _____ for _____ hours.
Prone or lie flat
4-8 hours
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?
Headache
Increases..standing…decreases
Bed rest,pain meds,increase fluids and BLOOD PATCH
Earliest sign of increased ICP?
Speech may become _____ or ______
______ to respond to commands
______ with no apparent reason and ______
Change in LOC
Slurred … Slowed
Slow
Restlessness…. confusion
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:
Coma
Immediate
Systolic HPN with widening pulse pressure
Slow,full and bounding pulse
Irregular respiration
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.
Decorticate…decerebrate
Decorticate
Decerebrate
National Dysphagia Diet consists of_____ stages
3
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.
Dysphagia Puree…..Pureed..Pudding-like
Dysphagia Mechanically Altered…..moist….soft-textured
Dysphagia Advanced…regular
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 ______
Jaw-thrust…head tilt chin lift
To avoid further damage to the spine.
Neck….avoided
________ 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.
Foot drop
Boots…..support
Always _______ a patient with head injury that their ICP is going up if they complain of a ________.
Assume…Headache
Projectile_______ can occur. Why?
Vomiting. Because the vomiting center in the brain is being stimulated.
Complications of increased ICP.
Brain herniation
DI
Siadh
Brain herniatian obstructs the _____ _______ to the brain leading to anoxia and then brain _______.
Blood flow….death
Treatment for increased ICP: Goals: Reducing cerebral \_\_\_\_\_\_\_ Reducing the amount of \_\_\_\_\_\_\_ Reducing \_\_\_\_\_\_ \_\_\_\_\_\_ in the brain
Edema
CSF
Blood volume
_____ oxygen levels and ____ CO2 levels causes cerebral vasodilation in the brain which increases ______.
Increased ______ = increased _____ = increased_______
Decreased….High….ICP
Volume…cardiac output…..brain perfusion
If glasgow coma is below 8 think ______
Intubate
Maintaining cerebral perfusion Oxygenation Hypotension/bradycardia -dobutamine/norepinephrine Keep temp below 100.4⁰f -hypothalamus -hypothermia Elevate and Midline Watch TURNING Avoid and Limit Spaced
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
ICP monitoring devices:
Ventricular catheter monitor or subarachnoid screw
Greatest risk?
Loose connections
Dressings should be dry
Infection
Loose connections should be avoided to decrease bacterial invasion
Bacteria loves wet or moist places
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
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
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
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
Epidural hematoma is
Patho
Treatment:
Burr holes
Ask questions like:
Did they pass out , wake up and pass out again?
Epidural hematoma is 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
Subdural hematoma
Usually a Venous bleed which is
-May be acute, subacute, or chronic
Treatment
Acute or chronic is
Collection of blood between the dura and the brain
Which is much slower than arterial
Immediate craniotomy to remove clot and control ICP
Concussion is
Bring patient to ED if these signs appear:
☆☆Difficulty awakening/speaking, confusion, severe headache,one sided weakness
Temporary loss of neurologic function with complete recovery
These are signs that ICP is going up
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
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
CT scan
With or without Takes pictures Check for allergy to Velcostrap on Claustrophobic
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
MRI
Picks up on Enclosed and no jewelry Tattoos Veterans could have Claustrophobic Thumping sound
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
PET
Nuclear image test
Useful in diagnosing
During procedure must inhale or injected with
- may have dizziness,lighthead,headache
After procedure no contact with
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
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
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
Electroencephalography records
Diagnostic for Screens for Indicator for Hold caffeine Blood sugar
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
