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neuro Flashcards

1
Q

changes in LOC can represent

A

ICP

recdued blood flow

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2
Q

myasthenia gravis what is it

A

autoimmune disease

involves a decreased number of atch recports

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3
Q

myasthenia gravis signs

A

weakness of skeletal muscles (ptsosis, diplopia)
bulbar signs (diff speaking and swallowing)
siff breathing
-BLADDER NOT AFFECTED BC SKELTAL MUSCLES ARE THE ONES THAT ARE INVOLVED

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4
Q

myasthenia gravis atch levels

A

muscles are stronge r in the morning and weaker with the days activity as the supply of atch is depled

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5
Q

treatment of myasthenia gravis

A

anticholingeic drugs are adm before meals so that the client can swllow strong

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6
Q

myasthenia gravis education and food

A

semi solid foods (easiily chewed) are preferred over solid to avoid stressing muscles in chewing or swllowing and liquids are not preferred bc of aspiration risks
-annual flu and pnuemonia

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7
Q

NUCHAL rigidity

A

menegitis

inability to flex the neck forward due to rigidity of the neck muscles.

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8
Q

normal pupils are what in diameter

A

3-5mm

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9
Q

oculocephalic reflex (dolls eye)

A

intact brainstem

  • rotate the head and watch the eyes move in opposite direction
  • dont do this test if spinal trauma is suspected
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10
Q

babinski reflex

A

normal finding is absent babinski (toes point townward with stimulus to the sole)
=presence of babinski (toes fan outward and upward) is expected in infants up to 1 age but in adults it indicates brain or spinal cord lesions.

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11
Q

abrnoaml neuorlogical assessment

A

nuchal ridigity

  • pupils less than 3 or greater than 5
  • absent oculucephalic reflex, presence of babinski
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12
Q

multiple sclerosis

A

progressive disease

-affects cns by interupting the nerve impulses

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13
Q

MS symtoms

A

muscle weakness

  • spasicity
  • incoordination
  • loss of balance
  • fatigue
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14
Q

MS treatment

A

walk with feet aprt

  • cane or walker when it gets worse
  • rom excerrcises to help with spasicity
  • balance excercises with rest
  • excecise in cool weather and stay hydrated
  • dehdyration and extremes in temp causes exacerbation
  • wheelchair only when independcne no longer possible
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15
Q

botulism

A

blacks ATCH resulting in muscle paralysi

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16
Q

botulism is found in

A

soil and food

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17
Q

manesifications of botulism

A

descending flaccid paralysis (starting from the face)

  • dysphagia
  • constripation
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18
Q

main source of botulism is

A

improperly canner or stored food

-metal can swollen or bulging end can cause from the gases and should be discarded

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19
Q

in children botulism can occur

A

if they eat honey under one age

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20
Q

giardia

A

contimated water

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21
Q

huntington disease

A

incurable
autosomal dominant
progressive nerve degernation

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22
Q

signs of hunting ton disease

A 
impaired movment
swollowing
specech
cog abilities
chlorea
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23
Q

hallmark sign if huntington disase

A

chorea-involvuntary tic like movement

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24
Q

complications of huntington disease

A

neuromusclar

resp complications

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25
Q

HD vonfirmed by

A

genetic testing

and if client has a parent with HD and want to have children do genetic cousenling

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26
Q

transspehnoidal hypophysectomy

A

surgical removal of the pituatry gland

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27
Q

clients who undergo hypophysectomies are at risk for developing

A

DI

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28
Q

DI signs

A

low ADH

  • decresed sp
  • increased osmoilaity
  • hypernatremia
  • hypovoemia
  • hypotension
  • polydipsia
  • polyuria
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29
Q

alzehmiers clients and food

A

give something when they say they are hungry
small meals throughout the day
-low calorie snakcs
-

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30
Q

bell palsy

A

unilateral facial paralysis

-facial neve (VII)

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31
Q

bell palsy signs

A

inability to close the eye on the affected side

  • alteration in tear production
  • flateening of the nasobial fold
  • inability to smile and frown symerical
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32
Q

trigeminal

A

cranial nerve V

-electric shock like pain in the lips and gums and severe pain along the cheekbones

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33
Q

hemorrhahic stroke

A

blood vessels ruptures in the brain and causes bleeding into the brain tissue

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34
Q

hemmoragic stroke inteventeion

A

seziure due to ICP
=disphagia so remian NPO until swallow function
- neuro assessments
-

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35
Q

stroke interventions

A 
reduce stimulation
quiet and dim lit env
-limit vistors
-adm stool softners
-reduce exertion
-maintain BED REST
-assist with daily living
-maintain head in midline poistion
-comrpession shocks
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36
Q

what is contraindicated in pts with hemmophagic stroke

A

anticogulants

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37
Q

late onset AD

A

advancing age

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38
Q

risk factors of AD

A

gentic
truma to the brain(wear seat belts, sports helmets, prevent falls)
-lifestyle choices (not eccersiing, drinking, smoking, not particpating in mentally challenging actv)

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39
Q

glasgow scale

A

eye opening, verbal, motor

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40
Q

eye opening grading (max 4)

A

4-spontanoues
3-speech
2-pain
1-none

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41
Q

verbal response (max 5)

A 
5-oriented
4-confused
3-inapp words
2-incomprehensible (sounds no words)
1- none
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42
Q

motor

A 
6-obeys commands 
5-localizes to pain
4-withdraws to pain
3-flexion in resp to pain (decoricate)
2- extension (decerbate
1- none
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43
Q

glascoma scale used to deermine

A

LOC

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44
Q

complication of GBS

A

respiratory failure (priority)
dvt (not as priotiryt)
paralytic ilues

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45
Q

signs of resp failure

A

inability to cough
shallow resp
dyspnea and hypoxia
inabilty to lift the head or eye brows

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46
Q

gold standard for assessing ventilation

A

forced vital capity (FVC)

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47
Q

mannitol SE

A

can cause fluid overload causing LIFE THERANTING PULMOARY EDEMA
-hyponatermia

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48
Q

mannitol complication

A

pulmoary edema so look for crackles

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49
Q

preventing mannitol complication

A

mointor serum osmolarity
I&O
electryoltes
kidney function

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50
Q

mannitol treats

A

acute glucoma

cerbral edema

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51
Q

what is important when giving mannitol

A

normal kidney function

UOP

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52
Q

contrindiation of doing lumbar puncture

A

ICP

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53
Q

poistion for lumbar puncture

A

fetal postion or sitting and leaning over the table

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54
Q

what is enouraged to replace CSF

A

fluids

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55
Q

education for lumbar puncture post op

A

lie flat for 4 hours atleast

prone or supine is recommended to prevent headache

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56
Q

what is expected after lumbar puncture

A

headahce

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57
Q

ischemic stroke

A

loss of brain tissue perfusion due tot bloackage of blood flow

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58
Q

permissive HTN and ischemic stroke

A

the HTN rsolves by itself within 24-48 hours unless (systolic blood pressure >220 mm Hg or diastolic blood pressure >120 mm Hg)

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59
Q

expected finding of ischemic stroke

A

ELEVATED BPPP

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60
Q

cranial nerve

A

18,34,45,49,53,65

61
Q

parkison appearlance

A 
stopped posture
masked facoial expression
ridigity
forward tilt of trunk
reduced arm swinging
fflexed elbows and writist
slightly flexed highs and kees
-trembling of ext
-shuffling short stepped gait
62
Q

parkinson degeneration of

A

dopamine

63
Q

damage to dopamine in PD causes

A

diff to control muscles

  • delay inition of movement (bradykinesia)
  • increase muscle tone (rigitiy)
  • resting tremor
  • shuffling gait
64
Q

poor thiamine intake or abstoption can lead to

A

Wernicke encephalophy

65
Q

wernicke encephalopahy meanifestations

A
  • altered mental status
  • oculomotor dyfunction
  • ataxia
66
Q

elevated blood lvels treatmened

A

no antidote for etoh gotta wait

67
Q

alcholl abusers suffer from

A

poor nutrtion and improper diet such as thiamine

68
Q

seizure phases

A

prodromal- warning signs before aural
aural- might exp cisual or sensory changes before seizure
ictal- seziure
postictal- confusion, reocvering from seizure, headahce,

69
Q

epilepsy

A

chronic seizure actv

70
Q

epilepsy clients require

A

life long anticonvulsanrs

71
Q

seizure triggers

A

etoh excessively

  • sleep dep
  • stress
72
Q

epilpesy education

A
  • wear med idenfitication bracelet
  • use non hormonal bith control if using phentoyin
  • dont stop anticonvusants abriptylu bc it increases risk for seizure
73
Q

coup- countrecoup head injury

A

head strikes an object and the brain receives an injury under the area of impact (coup), after which it rebounds to the opposite side of the skull and sustains injury on that side as well (contrecoup).

74
Q

coup-contrecoup head injury common in

A

MVA

shaken baby synrdrome

75
Q

expressive aphasia

A

inabilty to express sporken words

-can happen after TIA or stroke

76
Q

autnomic dysreflexia

A

above t6 and unable to feel

77
Q

signs of autnomic dsyreflexia

A
  • HTN
  • SWEATING
  • NEAUSEA
  • BRADYCARDIA
  • HEADCHE
78
Q

stimuli that causes autnomic

A

bladder distention (obstructed urinary cathter)
-fecal impaction
-tight clothing (shoelaces and waistbands)
REMOVE STIMULI TO PREVENT STROKE

79
Q

how to lower bp

A

elevate the bed

80
Q

decrease risk of aspiration pneumonia

A

left side/lateral side because the emesis will drain out of the
mouth
-turning q 2 hours helps prevent stasis BUT DOES NOT PREVENT ASPIRATION
-listening to breath sounds DONT PREVENT ASPIRATION

81
Q

carotid endarectcomy

A

remove plague from the carotid artery to improve cerebral perfusion

82
Q

FAST

A

facial dropping
arm weakness
speech diff
time of onset

83
Q

do not make clients who have uncreases icp

A

TO COUGHHHHHH and deep breatheeee

84
Q

skipped

A

28

85
Q

broca (expressive )aphsia

A

can comprehend sppech but demonstrate sppech diff

  • speech is hsort, limited prases that make sense but require great effort and freeq omission of smaller words such as “and” “is”’ “the”
  • FRONTAL LBE
  • they are aware of their deficits and can become dustrated eaisly
  • nonfluent speech
86
Q

wenicke (receptive) aphsia

A

unwarre of their speech impairment

  • termpral
  • cant comprehend spoekn or wirtten word
  • exhibit long but meaningless psech pattern
  • flient and vloluminous but lacks meaning
  • comprehension is dimished by the client
87
Q

global aphsia

A

inability to read, write, or understand speech. This is the most severe form of aphasia.

88
Q

stroke and permissive HTN

A

HTN is required for the first 24-48 hours to allow perfusion but no more than 220?120
we want the bp to be around 170 mmhg and not below that

89
Q

prior to lumbar

A

empty the bladder
-sitting upright or recumbent postion
(sitting poistion or left side with ke=nees drawn up like fetal position)
-sterile needle inserted into L3/4 or L 4/5
-pain may be felt radiating down the leg and is temporary

90
Q

after lumbar procedure

A

lie flat WITH NO PILLOW for 4 hours to reduce spinal leak and headahce
2) increase fluid intake for at least 24 hours to prevent dehydration

91
Q

bel pasly teaching

A

Eye care: Use glasses during the day; wear a patch (or tape the eyelids) at night to protect the exposed eye. Use artificial tears during the day as needed to prevent excess drying of the cornea (Option 1).
Oral care: Chew on the unaffected side to prevent food trapping; a soft diet is recommended. Maintain good oral hygiene after every meal to prevent problems from accumulated residual food (eg, parotitis, dental caries) (Options 3 and 4).

(Options 2 and 5) Vision, balance, consciousness, and extremity motor function are not impaired with Bell’s palsy. SO THEY CAN DRIVE and dont need cane

92
Q

amyotrophic lateral scleoris ALS signs

A 
muscle weakness
twiching
muscle spasms
diff swallowing
diff speaking
RESP FIALUREEE
93
Q

survival of ALS

A

3-5 years after dignosis NO CURE

94
Q

treatent of ALS

A

symtom management
-resp support (BIPAP OR VENT)
-eeding tube with enteral nutrition
-mobility assistive decides such as walker and wheechair
-consnitpation NOT diarhrea BC OF DECREASE MOBILITY
-communication assitive devices (alphabet boards and computers)
-

95
Q

resting tremor

A

parkinsons

96
Q

alzhmiers disease injury prevention

A

arrange furniture to alow free movmenet
-locks or stairwells and outside doors
-label doors
-provide night light in sleeping area to prevent falls and aid in orientaion and decreased ilusions
-Medical identification/location devices (eg, bracelets, shoe inserts) in case the client wanders outside the designated area (Option 2)
-LOCK ALL MEICATIONS AND DONT DO TEH WEEKLY PILL CONTAINER
Decreased water heater temperature and “hot” and “cold” labels on faucets to prevent burns
Household hazards (eg, gas appliances, rugs, toxic chemicals) removed to prevent injury

97
Q

arteriovenous maformation (AVM)

A

tangle of veins and srteries

98
Q

arteriovenous malformation (AVM) treatment

A

bp control

99
Q

arteriovenous malformation (AVM) complciation

A

inctrecranial bleeding as the veins are weak and dilated so they can eaisly rupture

100
Q

first signs of hemm

A

nueorloic changes
severe sudden headache
NV

101
Q

arteriovenous malformation (AVM) education

A

avoid heavy excercises bc this increases bp

-

102
Q

hemm and ischemic stroke

A

Ischemic stroke occurs when circulation to parts of the brain is interrupted by occlusion of cerebral blood vessels by a thrombosis or embolus. Hemorrhagic stroke occurs when a cerebral blood vessel ruptures and bleeds into the cranial vault. Both types of stroke result in brain tissue death without prompt treatment.

103
Q

tpa

A

ishcmic stroke unless contrindicatied (active bleeding, uncontrolled HTN, anueysm)
-must adm within .5 hours from onset of he symtoms

104
Q

conussion signs

A
  • A brief disruption in level of consciousness
    • Amnesia regarding the event (retrograde amnesia)
    • Headache
105
Q

concussion education

A

fam membes should observe them

  • dont particpate in atelctic or strenous actv for 1-2 days
  • rest and light diet
106
Q

serious brain injury that are not expected with simple concussion

A

worsening of headache and vomiting (ICP)

  • sleepiness or confusion (ICP)
  • visual changes
  • weakness ot nombess of part of the body
107
Q

what should be avoided following head injury

A

opiod meds because the SE of opoiods might be misitnerpreted as symtoms of worsening of head injury

  • avoid etoh and other cns depressants
  • avoid driving, using heay machinerym contact sports, taking hot baths for 1-2 days
  • use nsaids or non narcotics instead
108
Q

quadriplegia

A

lower limbs are paralyzed and partial paralyis or complete paalysis of the upper ext

109
Q

piority of quadripligia

A

airway and o2 so assess breath sounds

-vital capicity and tidal volume and abg

110
Q

risk factors for stroke

A 
DM
high chloesterol
HTN
smoking
obesity
older age
geentic
111
Q

signle most modifiable risk factors in stroke

A

HTNNNN

112
Q

stroke can be reduced 50% by

A

app treatment for HTNNN

113
Q

epidural hematoma bleeding

A

arterial

114
Q

epidural hematoma charactersitc

A

lose consciounsess at time of impact and then regains the consicouness quick and feels well for some time (lucid interval)
it is then followed by a quick decline in mental function and can progress into coma and death

115
Q

emergnecy dgnosis and treatment needed for epiural hematoma to prevent

A

brain stem hernimation

116
Q

cushing traiad signs

A

loc is the earliest sign

late: bradycardia, increases sbp with widening pulse pressure
- slowed irrgular resp (cheyne stokes)

117
Q

cushing triad

A

later sign and does not appear until ICP is icnreased for some time

118
Q

cushing traid indicates

A

brain stem compression

119
Q

Homonymous hemianopsia

A

loss of one half of the field of vision on the same side in both eyes.

120
Q

parietal

A

sensory input

sensation

121
Q

frontal

A

order processing
personality
-beh changes if damaged

122
Q

temportal

A

visual and audiroty and past expericnes

-if injured clients cannot understand verbal or written language

123
Q

occiptal

A

vision

124
Q

spinal immbolization procedure

A

N - Neurological examination. Focal deficits include numbness and decreased strength.
S - Significant traumatic mechanism of injury
A - Alertness. The client may be disoriented or have an altered level of consciousness (Option 2).
I - Intoxication. The client could have impaired decision-making ability or lack awareness of pain (Option 1).
D - Distracting injury. Another significant injury could distract the client from spinal pain.
S - Spinal examination. Point tenderness over the spine or neck pain on movement (if there is no midline tenderness) may be present (Option 5).

125
Q

aphasia

A

aka dysphasia

126
Q

receptive aphasia

A

impaired comprehension of speech and writing. A client with receptive aphasia may speak full sentences, but the words do not make sense. The nurse should speak clearly, ask simple “yes” or “no” questions, and use gestures and pictures to increase understanding.

127
Q

expressuve aphsia

A

impaired speech and writing. A client with expressive aphasia may be able to speak short phrases but will have difficulty with word choice (Option 1). The nurse should listen without interrupting and give the client time to form words. A client may have one type of aphasia or a combination of both, and the severity will vary with the individual.

128
Q

apraxia

A

loss of the ability to perform a learned movement (eg, whistling, clapping, dressing) due to neurological impairment.

129
Q

Dysarthria is

A

s weakness of the muscles used for speech. Pronunciation and articulation are affected. Comprehension and the meaning of words are intact, but speech is difficult to understand (eg, mumble, lisp).

130
Q

cerebellum major functiosn

A

coordination of voluntary mmovmenets

maintence of balance and posture

131
Q

how maintence of balance is tested

A

first watch their normal gait and then gait on heel to toe, on toes, and on heels

132
Q

coordination testing

A

Finger tapping – ability to touch each finger of one hand to the hand’s thumb (Option 4).
Rapid alternating movements – rapid supination and pronation
Finger-to-nose testing – clients touch the clinician’s finger and then their own nose as the clinician’s finger varies in location
Heel-to-shin testing – client runs each heel down each shin while in a supine position

133
Q

neuro assessment

A

Glasgow Coma Scale (GCS)—best eye, verbal, and motor responses. Best verbal response assesses orientation to person, place, and time (time is the most sensitive).
Pupils—equal, round, response to light, and accommodate (PERRLA)
Motor—strength and movement in all four extremities
Vital signs—especially any signs of Cushing’s triad of bradycardia, bradypnea/abnormal breathing pattern and widening pulse pressure (the difference between systolic and diastolic blood pressure readings). The nurse is assessing for signs of increased intracranial pressure (ICP).

134
Q

absence seziures

A

Daydreaming episodes or brief (<10 seconds) staring spells
Absence of warning and postictal phases
Absence of other forms of epileptic activity (no myoclonus or tonic-clonic activity)
Unresponsiveness during the seizure
No memory of the seizure

135
Q

menegitis signs

A 
fever
headache
n/v
nuchal rigifity
icp
phtophobia
alterned MS
136
Q

For bacterial meningitis with sepsis

A

fluid resuscitation is the priority to increase BP

137
Q

, interventions and prescriptions for a client with sepsis and meningitis may include:

A

Administer vasopressors.
Obtain relevant labs and blood cultures prior to administering antibiotics.
Administer empiric antibiotics, preferably within 30 minutes of admission (Option 1). This client will continue to decline without antibiotic therapy.
Prior to a lumbar puncture (LP), obtain a head CT scan as increased ICP or mass lesions may contraindicate a LP due to the risk of brain herniation (Option 4).
Assist with a LP for cerebrospinal fluid (CSF) examination and cultures (Option 3). CSF is usually purulent and turbid in clients with bacterial meningitis. CSF cultures will allow for targeted antibiotic therapy.

138
Q

essential part of discharging client with head injury is

A

ensuring that a respobile adult will check their LOC

139
Q

return back to ER if you have the following after head injury

A

Change in level of consciousness (eg, increased drowsiness, difficulty arousing, confusion)
Worsening headache or stiff neck, especially if unrelieved by over-the-counter analgesics
Visual changes (eg, blurring)
Motor problems (eg, difficulty walking, slurred speech) (Option 3)
Sensory disturbances
Seizures
Nausea/vomiting or bradycardia (indicates IIC

140
Q

neuro examination should be done by a

A

clinician not fam or anyone else

141
Q

Interventions to help decrease aspiration

A

swllowing 2 times before thaking another bite of the food

  • thicekning liquids
  • avoiding OTC cold meds bc they have antichloingeic properties which causes drowniess and derreased salvia and dry mouth and salivia helps with swllowing
  • sit upright for 30-40 mins after meals
  • brushing teeth and mouth wash before and after meals
  • chin tuck
  • smoking cessation
  • smoking cessaition
142
Q

status epulepticus

A

serious, life therening ermgency which a client has been seizuing fofr 5 mins or longer

143
Q

2 common signs of STATUS epil

A

grunity

dazed appearance

144
Q

clients with what are at higher risk for seizures

A

hydropcephalus and ventriculoperitoneal shunt

145
Q

number one proioty in SE

A

stopping the seizure act as long as theres airway and breathing so give IV benzo such as diapezma or lorazepam but rectal can be given too

146
Q

aspiration prevention methods include

A

thicken liquids
ensure lcient is fully awake before eating so be careful the timing of meds
-elevate head of bed 90 degree and for 30 mins after meals and never place bed lower than 30
-ecnourage ti swllow by flexing the neck (chin to chest)
- monitored for coughing, gagging, and pocketing food.

147
Q

When transferring a client from bed to chair the following are recommended for client safety:

A

Clients should wear nonskid shoes (first step)
Make sure the bed and chair (wheelchair) brakes are locked
Use a transfer belt. A transfer belt worn around the client’s waist allows the nurse to assist the client while maintaining proper body mechanics and safety.
Transfer the client toward the stronger (not the weaker) side. If the client is weak on the left side, ask the client to pivot on the right side.

148
Q

never bend where

A

at waist bc you are using your back to lift

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