NEURO Flashcards
What is the most important assessment finding in determining patient’s mental status?
orientation level
Your patient has a severe closed head injury. VS are listed. Which value is it crucial in evaluating him for brain death?
Pt is not normothermic
Your patient has a closed head injury and is ventilated. His ABGs are: pH 7.48, pCO2 35, FiO2 40%, pO2 60. What is the recommended action?
Leave the setting as it is (CO2 in head trauma = 35 goal. Permissive hypocapnea)
Your patient has suffered a spinal cord injury. What sign indicates recovery has begun?
Increase in DTRs
Your patient presents to ED with ischemic stroke-like symptoms. Her BP is 160/90 and she is on Norvasc. Symptom onset was 4 hours ago. Which of the following is a contraindication to fibrinolytic therapy?
Time
Your patient is s/p craniotomy and is about to d/c home. You notice ataxic gait and holding the wall while walking. What is your action?
Consult PT
Patient has a hip fracture, carotid bruit, weakness, and confusion. What do you order?
Carotid US
A patient was diagnosed with cauda equina syndrome and neurosurgery has been consulted. What is the NP responsibility in anticipation of surgery?
discuss the MRI results and how the nerves are affected
Your patient has had a CVA and is now having trouble feeding himself. Who do you consult?
OT
A patient has hyperactive reflexes of the lower extremities. The adult-gerontology acute care nurse practitioner assesses for
ankle clonus by:
sharply dorsiflexing and maintaining the foot in this position, while supporting the knee
Which muscle moves the eye from center, to side, and back?
Rectus
Change in LOC diagnostics
CT wo contrast
MS patho and flare up treatment
Tx for a flare-up: steroids Patho: autoimmune dz, immune system attacking myelin. flare up
Myasthenia gravis patho, s/s, Tx,
Patho: reduction of the number of acetylcholine receptor sites at neuromuscular junction. S/s: ptosis, diplopia, extremity weakness worse w/exercise, respiratory difficulty. Meds/tx: anticholinesterase drugs like prostigmin, plasmapheresis, and immunosuppressives. Vent may be needed in crisis.
Dementia vs delirium
Delirium: sudden transient clouded sensorium, Dementia: gradual, permanent memory/intellectual
What is the number one cause of death in dementia patients?
Pneumonia (think aspiration)
Pt with a 50% R-sided carotid artery occlusion r-sided weakness that went away (TIA)
ASA or Plavix. My version had Plavix.
CVA tPA contraindication:
CVA 2 months ago
Chronic subdural hematoma symptoms
may present with the insidious onset of HA, light-headedness, cognitive impairment, apathy, somnolence, and occasionally Sz.
Chronic subdural hematoma management
surgical evacuation of in pts w/potential for recovery if there is evidence of mod-sev cognitive impairment, if progressive neurologic deterioration, or if clot thickness ≥10 mm or midline shift ≥5 mm
Latest sign that you missed a herniation?
Pupil change and positive babinski (toes fan UP/out)
Left middle cerebral artery infarct symptom
aphasia
CN sensory only:
CN I, II, VIII
CN both motor and sensory?
V Trigeminal, VII Facial, IX Glossopharyngeal, X Vagus
CN nerve: hands on the side of pt face and ask them to chew:
CN V, trigeminal nerve
Status epilepticus-meds not working, low SaO2/desating, family can’t decide:
intubate
Cauda Equina Syndrome
Medical emergency. 18 nerve roots of the cauda equine at base of spine. S/S : Pain, numbness, tingling & LBP radiating into leg(s), S1-S2: weak plantar flexion w/loss of ankle jerks, foot drop. S3-S5: Loss of bowel/bladder. Muscle weakness, sensory loss in the dermatomal distribution of the affected nerve roots. Cause: tumor, spinal stenosis, herniated disc, CA, infxn, inflammation.
What is the pathology of Parkinson’s disease?
imbalance between ACH and dopamine in the corpus striatum
You are examining a pt with PMH of seizures. Pt sustains a seizure lasting around 1 minutes. What is the most appropriate intervention?
Valium 5-10 mg IV
Initial action in a patient with new onset seizures?
CT scan
60 yo M presents to ER and his child reports he passed out in the care while driving, regained consciousness and was drooling and out of it. Pts HR and BP are decreased. You give Nimodipine. What is the rationale for administering Nimodipine to this patient?
Calcium channel blocker, counters vasospasm s/p CVA
What CSF values are characteristic of bacterial meningitis?
↑ opening pressure, ↑ protein, WBC, ↓ glucose
