Neuro Flashcards
Review the most important neuro diseases.
What is the most sensitive indicator of neuro status?
Level of consciousness.
Assess for restlessness, irritability, and confusion.
What is the highest score on the Glasgow coma score?
15
At 15, the client is completely alert and oriented
- eyes open spontaneously
- verbalizes pain
- oriented and converses
What is the lowest score on the Glasgow coma scale?
3
At 3, the client is not responsive
- eyes have no response
- no response to pain
- no verbal response
At what Glasgow coma score is the client typically intubated?
(Immediate complication)
“Less than 8, intubate”
8 indicates a coma.
Unconscious clients are completely dependent on caregivers. What are the priority safety concerns?
- assure an airway: may be on a ventilator
- tube feedings: prevent aspiration
- turn every 2 hours: to prevent pressure ulcers
- prevent falls: by keeping side rails up and bed in low position
What is decorticate and decerebrate posturing?
Both postures indicate a deteriorating condition in the brain.
What life-threatening condition are clients at risk for after a head injury, stroke, or brain surgery?
(Immediate complication)
Increased intracranial pressure (ICP)
Increased pressure in the brain due to edema.
What is a late sign of increased intracranial pressure?
- increased systolic blood pressure
- widened pulse pressure: big difference between systolic and diastolic pressure
- bradycardia: due to compensation of a high BP
What position is a client placed in to prevent increased intracranial pressure?
- elevate HOB 30 to 40 degrees
- don’t flex the neck or hips (keep body midline)
What common actions should the client avoid to prevent increased intracranial pressure?
- avoid straining such as coughing, sneezing, and Valsalva’s maneuver
- stool softeners daily
- no toothbrushing; use soft swab
- don’t shiver: keep client warm
Why is there a fluid restriction with increased intracranial pressure?
Due to edema and extra fluids in the brain: fluids are restricted to less than 1200 mL per day to prevent more edema.
Medications:
Increased intracranial pressure
- anticonvulsants: to prevent seizures
- muscle relaxers: to prevent shivering
- antihypertensives: to maintain cerebral perfusion
- steroids: to decrease edema and inflammation
- osmotic diuretic (mannitol): to decrease edema
How is intracranial pressure monitored?
With an ICP machine that measures the pressure in the brain.
How are head injuries prevented?
By wearing a helmet when riding a motorcycle or bicycle.
What is a concussion?
It is when there is a jarring movement of the brain inside the skull.
The client may or may not lose consciousness.
What is an epidural hematoma?
(Immediate complication)
The most serious bleeding head injury. It occurs above the dura and is arterial blood (bleeds fast).
Client can rapidly progress into a coma.
What is a subdural hematoma?
Occurs below the dura and is venous blood (bleeds slowly).
It can resolve on its own or be life-threatening.
What is an intracerebral hemorrhage?
(Immediate complication)
When a blood vessel within the brain has ruptured.
It can occur from a traumatic brain injury (TBI) or cerebral aneurysm.
What is always the concern after a head injury?
Increased intracranial pressure.
What fluid can leak out of the ears or nose after a head injury?
Cerebral Spinal Fluid (CSF)
What are the interventions if cerebral spinal fluid is leaking out of the nose or ears?
- do not suction the nose and don’t allow the client to blow their nose
- if drainage is coming out of the ear, don’t clean it, just put a sterile dressing over the ear.
- tell client not to cough
How is a cerebral spinal fluid leak tested for?
Halo test
What is a craniotomy?
A surgery of the brain to remove blood or a tumor.
What are the priority interventions after a craniotomy?
- make sure the client can breath (may be on a ventilator)
- prevent increased ICP
What is a seizure?
(Immediate complication)
A sudden, uncontrolled electrical disturbance in the brain. It can cause changes in behavior, movements or feelings, and in levels of consciousness.
Epilepsy is a seizure disorder of two or more seizures or a tendency to have recurrent seizures.
Signs and symptoms:
Seizure
- confusion
- aura
- sudden falls
- staring
- uncontrollable jerky movements
- strange sensations and emotions
- loss of consciousness or awareness
Interventions:
During a seizure
- maintain airway and DON’T put anything in the mouth
- place client on floor and protect head and body
- don’t restrain the client
- loosen clothing
- note the type of seizure
- give anticonvulsant IV to stop seizure
Interventions:
After a seizure
- turn client to the side so secretions can drain - possibly suction
- assess respirations and oxygen reading
- document time and duration of seizure
- implement seizure precautions
Notify HCP.
Teaching:
Seizure
- take medication for life: may need to monitor medication blood levels
- avoid substances and situations that cause seizures: avoid alcohol, excessive stress, fatigue, strobe lights
What is the difference between a thrombotic CVA (cerebral vascular accident) and embolic CVA?
(Immediate complication)
A thrombotic CVA is caused by a blood clot that develops in the brain.
An embolic CVA is caused by a blood clot or plaque debris that develops somewhere else in the body and then travels to the brain.
Both types are considered ischemic CVAs, where a clot blocks oxygen and blood.
What is a hemorrhagic CVA?
(Immediate complication)
It is caused by bleeding in the brain from hypertension or an aneurysm.
What is the most common test to diagnose a CVA?
A CT scan to see if it’s caused from a blood clot or from bleeding.
There are different interventions based on the type of stroke.
What are the characteristic signs and symptoms of an acute CVA?
FAST
- severe onset headache
- one-sided face drooping
- Arm weakness/ataxia
- Speech difficulties
- Time to call
What medications are given if the client is having a CVA from a blood clot?
Thrombolytics are given to break up the blood clot.
Would thrombolytics be given to a client having a hemorrhagic CVA?
NEVER. The client will bleed more.
Never give thrombolytics to a client having a hemorrhagic stroke or to a client who is actively bleeding. Make sure the CT scan is completed to determine what kind of stroke it is before thrombolytics are given.
What is Neglect syndrome?
When the client is unaware of the existence of the paralyzed side.
Encourage activity on the neglected side.
Define:
Agnosia
The inability to recognize familiar objects or people.
Define:
hemiplegia paralysis
Paralysis on one side.
Define:
Apraxia
The inability to carry out physical movements, even though having the desire and ability to perform them.
Define:
Expressive aphasia
When the client understands what is being said, but can’t communicate verbally.
The client cannot express information.
Define:
Receptive aphasia
When the client cannot understand what is being said or written.
They cannot receive information.
Define:
Hemianopsia
Blindness in half the visual field.
Define:
Dysphagia
Difficulty swallowing.
What is a common referral due to risk of dysphagia in stroke clients?
The speech therapist comes and sees the client to evaluate the gag reflex and swallowing, in order to recommend a diet.
What is the typical recommended diet for a client with dysphagia?
- thickened fluids
- soft foods
How is a client with dysphagia positioned when eating?
- sit client high up in bed
- put head and neck slightly forward and chin tucked
- put food in the back of the mouth on the unaffected side to prevent trapping of food
- no straws
What are the interventions for a client with hemianopsia?
- approach client from the unaffected side
- place objects on the side that they can see on
What do all these neuro diseases all have in common?
- multiple sclerosis
- myasthenia gravis
- Parkinson’s disease
- Guilain-Barre syndrome
All the clients with these neuro diseases have fatigue and muscle weakness (including respiratory muscle weakness).
Assess for difficulty with breathing, swallowing, and prevent falls.
Describe:
Multiple sclerosis
A muscle weakness disease of the CNS due to demyelination of the neurons.
The cause is unknown, but more common between the ages of 20 - 40.
Describe:
Myasthenia Gravis
An autoimmune disease that causes muscle weakness due to a defect in nerve impulse transmission.
There is not enough secretion of acetylcholine and too much secretion of cholinesterase.
What is an early sign of myasthenia gravis?
A droopy eyelid (Ptosis) and double vision.
Describe:
What are the late signs of myasthenia gravis?
- difficulty chewing, swallowing and breathing
- respiratory paralysis and respiratory failure
Medications:
Myasthenia gravis
- pyridostigmine
- neostigmine
end in -mine
What is a myasthenic crisis?
(Immediate complication)
When the client doesn’t get enough of their medication (undermedicated), causing muscle weakness.
It usually occurs about 3 hours after med administration.
What is a cholinergic crisis?
(Immediate complication)
When a client gets too much of their medicine (overmedicated), causing muscle weakness.
It usually occurs about 1 hour after med administration.
What are the symptoms of a cholinergic crisis (overmedicated) and myasthenic crisis (undermedicated)?
Basically the same:
- muscle weakness
- dyspnea
- dysphagia
- bradycardia
The similar symptoms make it difficult to determine quickly if the client is undermedicated or overmedicated.
What is an edrophonium (Tensilon) test?
Used to determine if the client is in a myasthenic crisis or cholinergic crisis:
- it’s a myasthenic crisis if edrophonium is given and strength improves
- client needs more medicine
- it’s a cholinergic crisis if edrophonium is given and the weakness gets worse.
- client needs less medicine
What is the antidote to a cholinergic crisis?
Atropine sulfate (an anticholinergic)
Describe:
Parkinson’s Disease
A neuromuscular weakness disease caused by the depletion of dopamine.
Dopamine is needed for good muscle control.
What are the characteristic symptoms for Parkinson’s disease?
What are the late signs of Parkinson’s disease?
Due to muscle weakness:
- difficulty swallowing and speaking
- drooling
What are the basic interventions for most neuromuscular disorders that cause muscle weakness?
- prevent falls
- don’t rush client
- provide frequent rest periods
- assess the ability to chew and swallow
- assess breathing
- promote independence
Describe:
Guillain-Barre Syndrome
Immediate complication
Occurs after an infection where the immune system overacts and destroys the myelin sheath (the part that connects nerves).
The client gets ascending paralysis, eventually affecting the respiratory muscles.
What is the priority assessment with Guillain-Barre syndrome?
Assess ability to breathe and respirations due to ascending paralysis.
Is there a cure for Guillain Barre?
No. There is no known cure for Guillain Barre, but client may get immunoglobin therapy to boost the immune system - the client will be on a ventilator.
Most clients recover within 1 year.
Describe:
Meningitis
(Immediate complication)
An infection in the brain and spinal cord.
Risk factors:
Meningitis
- skull fractures
- brain or spinal surgery
- upper respiratory infections
- using nasal sprays
- living in crowded areas
How is meningitis diagnosed?
By lumbar puncture for a cerebral spinal fluid culture.
What populations are most at risk of getting meningitis?
Those who live in crowded areas:
- college dorms
- prisons
- group homes
What are the infection control precautions for meningitis?
Droplet precautions.
Implement airborne and contact precautions.
What are the characteristic signs and symptoms of meningitis?
- fatigue/lethargy/headache
- photophobia
- decreased LOC
- possible rash
What is Kernig’s sign?
A sign of meningitis: when client lays supine, the leg stays flexed at the knee.
What is Brudzinski’s sign?
A sign of meningitis: when the neck is flexed, the hip and knee involuntary flex also.
If a client is found unconscious, what you should you do?
Check airway and pulse. Start CPR if needed.
Interventions:
Meningitis
- assess for increased ICP
- seizure precautions
- droplet precautions with pneumococcal meningitis
- airborne precautions with other types of meningitis
- give antibiotics and analgesics for pain
Define:
Electromyography
A diagnostic test for neuromuscular diseases. A needle is inserted in the muscle and records electrical activity.
Teaching:
Electromyography
No stimulants or sedatives 24 hours before procedure.
Describe:
Trigeminal neuralgia
A sensory disorder of 5th cranial nerve that causes pain.
What foods are avoided with trigeminal neuralgia?
Hot or cold foods.
These foods irritate the 5th cranial nerve.
Describe:
Bell’s palsy
Facial paralysis caused by a lesion on the cranial nerve VII with paralysis of one side of the face.
This condition can get confused with an acute CVA.
What can cause both trigeminal neuralgia and Bell’s palsy?
- trauma
- infection
- hemorrhage
- tumor
Treat the cause.
Describe:
Migraines
Head pain with unknown cause but can be triggered by:
* caffeine
* red wine
* MSG
* weather changes
Are migraines more common in men or women?
Women; mostly due to hormone changes and fluctuations.
What are the characteristic signs and symptoms of migraines?
- severe head pain or headache
- nausea and vomiting
- sensitivity to light
- an “aura”
Medications:
Migraines
NSAIDs, acetaminophen, antimigraine medications, botox
Interventions:
Migraines
- pain medicine
- keep the room dark
- wear sunglasses
- CAM
- avoid triggers
