Neuro Flashcards
(101 cards)
1
Q
What are common symptoms of a neurological disorder?
A
- Pain
- Seizure (may be first sign of brain lesion)
- Dizziness & Vertigo
- Visual Disturbances
- Muscle Weakness
- Abnormal Sensation
2
Q
What is the most sensitive indicator of neurological function?
A
Level of Consciousness
3
Q
How do you assess for LOC?
A
Alertness and ability to follow commands; Glascow Scale
4
Q
If you notice a patient’s LOC is decreased, what is your next step?
A
Assess cranial nerves
5
Q
What should a nurse assess during neuro physical assessment?
A
- LOC
- Cranial Nerves
- Motor System (muscle strength/tone)
- Balance & Coordination
- Sensory System
- Reflexes
6
Q
What can cause sensory deficits?
A
- Neuropathy
- Spinal injury
- Brain lesions
- Stroke
7
Q
Reflex grading scale
A
0: No response
1: Diminished (hypoactive)
2: Normal
3: Increased
4: Hyperactive
8
Q
Babinski sign (positive vs negative), which is good?
A
Negative Babinski: toes in and down
Postive Babinski: toes fan out and up
Negative babinski sign
9
Q
Hyperactive reflects can elicit what?
A
Clonus
10
Q
What is the affect of age on nervous system?
A
- Decreased strength, balance,
- Decreased sensory & pain perception, temp regulation
- Delirium
11
Q
Nursing Interventions for elders with neurologic disorders
A
- Evaluate fall risk
- Adequate lighting
- Large print materials
- Low pitched, clear voice
- Auditory & visual cue aids
12
Q
What is a CT scan?
A
X ray that provides cross sectional view of brain
13
Q
What can you detect using CT Scan?
A
Tumors Infarction Hemorrhage Displaced ventricles Cortical atrophy
14
Q
Nursing Intervention/Patient Education for CT Scan
A
- Pt must lie quiet and still for procedure
- Sedate for anxiety with constant assessment
- Assess for shellfish allergy and kidney fx if using contrast
- IV insertion and fasting 4 hours before
15
Q
What is a MRI?
A
images using magnetic field
16
Q
What can you detect using MRI?
A
Tumor response to treatment
Stroke
Brain Tumor
Multiple sclerosis
17
Q
Is a MRI useful for emergency situations?
A
No. Takes 1 hr or more to complete
18
Q
Nursing Interventions/Patient Education for MRI
A
- Know about any metal implants (hear valves, IUD, aneurysm clips, etc)
- No metal objects, oxygen tanks, ventilators allowed
- If patient cannot tolerate supine position, MRI is contraindicated
19
Q
What is a PET scan?
A
nuclear imaging that show organ functioning
20
Q
What is a PET scan used for?
A
- Detect change in glucose use
- Alzehiemers disease
- Locate lesions/brain tumors
- Identify oxygen/blood flow with strokes
21
Q
Nursing Intervention/Patient Education for PET scan
A
- Educate about dizziness/lightheadness/headache with procedure
- Relaxation techniques to reduce anxiety
22
Q
Which diagnostic exam is considered gold standard?
A
EEG
23
Q
What is an EEG?
A
Stick electrodes to scalp in order to view electric activity in brain
24
Q
What is EEG used for?
A
to monitor seizure, coma, brain disorders
25
What can cause abnormal EEG patterns?
Tumors
Brain abscess
Blood clots
Infection
26
Pre-Op Nursing Interventions for EEG
1. Shampoo, no conditioner
2. No caffiene within 24-48 h
3. No sedation; may lower seizure threshold
27
Patient Education for EEG
Must be completely still
Takes 45-60m
No electric shock danger
Evoke potential with lights/buzzers
28
What is altered level of consciousness and what causes it?ifest
is when patient is not:
oriented
following commands
respond stimuli
Its caused by head injury/drug overdose/kidney injury
29
Meningitis Clinical Manifestation
```
Headache
Fever
Stiff Neck
Positive Kernig
Positive Brudzinski
Photophobia
Skin rash
```
30
What bacteria causes bacterial meningitis?
Streptococcous pneumoniae
| Neisseia meningitis
31
For meningitis, what is the common route of entry?
Oral & nasal passages
32
Who is at high risk for contracting meningitis?
Ppl living in close areas
| ie. college dorm, military
33
Preventative measures for meningitis
1. Vaccine
| 2. Chemoprophylaxis (rifampin, cipro, ceftriaxone)
34
Nursing Interventions for Meningitis
1. Isolate for 24h
2. Monitor VS
3. Assess neuro status
4. Keep room dark and quiet
5. Seizure precautions
6. Cooling blankets for temp
7. Monitor weight and I&O for SIADH
35
What is the importance of monitoring VS with meningitis?
BP can assess for shock which could lead to cardiac/respiratory failure
High temp increases heart workload and ICP pressure
36
What diagnostics should be completed first to determine presence of meningitis?
Blood culture and CT Scan
37
When would lumbar puncture be contraindicated in meningitis?
If there is increased ICP
38
Why would you need to complete a CT scan first when diagnosing meningitis?
A CT scan will determine if there is an increase in ICP
39
What are nursing interventions for Lumbar Puncture?
1. Obtain consent
2. Put in prone position to stop CSF loss & spinal headache
3. Measure pressure & collect fluid for
4. Sedate
5. Give local anesthetic
6. Increase fluid intake
7. Have client pee before procedure
40
How would you treat a headache caused by lumbar puncture? Why?
Have patient lie down
Sitting up forces fluid to drain. Drainage is what is cause=ing the headache
41
What precautions would you provide if a patient may have meningitis?
Treat like bacterial meningitis until culture
42
What is the difference between seizure and epilipsy?
Seizures are sudden interruptions in normal functions
Epilepsy is are recurrent seizures due to chronic condition
43
List some things that may cause seizures
```
Alcohol withdrawl
electrolyte imbalances
fever/dehydration
Brain injury
Tumors
```
44
Key Characteristics of a focal seizure
impaired LOC
automatisms (involuntary fce movements)
can progress into generalized seizure
45
Characteristics of Clonic Tonic Seizure
stiff muscles
rigidity
arm/leg jerking
46
Characteristics of Post-Ictal Stage
Occurs after clonic tonic symptoms
Hard to wake patient
47
Nursing Interventions for Post Ictal Stage
1. Ensure patient is on side
2. Ensure airway is clear to prevent aspiration
3. Allow to rest for 20m - 1h
48
Characteristics of Petit Mal (Absence Seizure)
1. Lose focus, staring spell, unresponsive
| 2. seen in kids
49
Characteristics of Generalized Seizure
1. Tonic Phase
2. Clonic Phase
3. Duration (should be less than 5 minutes)
50
What should nurse think if seizure lasts longer than 5 minutes?
Patient could be entering status epileptics (developing hypoxia)
51
Nursing Interventions for Seizure Patients
1. MAINTAIN ABCs
2. Eliminate things that cause seizure
3. Remove harmful surroundings, nothing in mouth, on floor and on side
4. IV access
5. Remain with client until seizure is over
6. Document events leading up to/during/after seizure
52
What is status epilepticus?
back to back generalized seizure
53
What can cause status epilipetecius?
1. Interrupt seizure meds
2. Fever
3. Infection
54
Goals for Status Eplipeticus
1. Stop as quickly as possible
2. Ensure adequate oxygenation (may need to intubate)
3. Give IV diazepam to stop immediately
4. Give barbiturates later to keep seizure free
55
What medications are given during a seizure?
1. IV Benzos
| 2. Barbituates
56
If a seizure is caused by hypoglycemia, what is given?
IV Dextrose
57
What medications are given to stop spread of seizure?
1. Phenytoin
2. Carbamazepine
3. Clonazepam
4. Gabapentin
5. Valproate
6. Primidone
58
What are nursing considerations for phenytoin?
1. Dont give with tube feedings (stop 2 hours before)
2. Dont give IV with D5W
3. Need oral care to lower risk of gingival hypertrophy
4. Watch for suicidal thought
59
What are considered primary headaches?
Migraines
Tension Type
Cluster
60
Whats the difference between primary and secondary headaches?
Primary: no organic cause
Secondary: associated with another cause (tumor, trauma, hypertension)
61
How would you treat a cluster headache?
Give high flow oxygen administration
62
What are some characteristics of a cluster headache?
1. Continuous throughout day (1-8)
2. Localized over 1 eye
3. Eye watering
4. Nasal congestion
5. Intense allergies
6. Lasts 15m - 3h
63
What is the most common type of headache?
Tension
64
What are the phases of a migraine?
1. Premonitory Phase
2. Aura Phase
3. Headache Phase
4. Postdrome Phase
65
What are characteristics premonitory phase?
1. Occurs hours-days before actual migrant
| 2. Symptoms: irritable, cold, food craving, increased urination, diarrhea/constipation, depression
66
What are characteristics aura phase?
1. visual disturbances
2. Hemianopic (see out of one eye)
3. May occur simultaneously with migraine
67
What are characteristics headache phase?
1. Photophobia (light sensitive)
2. Phonophobia
3. N/V
68
What are the characteristics. of postdrome phase?
1. Pain gradually goes away
2. Tired, weak, mood change, muscle contraction in neck, localized tenderness and aches
3. May sleep for extended periods
69
Characteristics of tension headaches
steady feeling of pressure in forehead/temple/back of neck
described as a weight on top of head
70
Nursing interventions for headache
1. Preventive therapy/abortion measures**
2. Quiet, cool, dark room
3. Anti emetics
4. Monitor for neuro changes
5. Assess for cardiac issues
71
What is encephalitis?
Inflammation of brain tissue typically spread by ticks and mosquitoes
72
What type of diagnostics should occur for encephalitis?
Neuro imaging
CSF evaluation
Antibody testing
73
Clinical manifestations of encephalitis
Flulike symptoms
decline in mental status
Motor dysfunction
Ulceration/sores in oral cavity
74
What medications are prescribed for encephalitis?
Interferon (for arthropod)
Acyclovir (for HSV)
Antifungal agents (for fungal)
75
Considerations for giving acyclovir for encephalitis
1. Continue for up to 3 weeks to prevent relapse
2. Slow IV administration over hour.
3. History of renal function, lowers dose
76
Hemorrhagic stroke vs Ischemic stroke
Hemorrhagic: Ruptured blood vessel
Ischemic: Vessel obstruction
77
What causes Intracerebral Hemorrhage?
Mostly hypertension, but could also be caused by tumors, certain meds (anticoags/illegal drugs)
78
What causes subarachnoid hemorrhage?
Aneurysms, trauma, hypertension
79
What is the most common cause of hemorrhagic strokes?
Uncontrolled hypertension
80
What is the difference between thrombotic and embolic strokes?
Thrombotic: occlusion stays at one site
Embolic: occlusion starts at heart and travels to artery which cause stroke
81
What causes cerebral embolism?
A-fib
Endocarditis
Valve replacement
82
Modifiable risk factors of stroke
```
Hypertension**
Smoking
Diabetes
Carotid Artery Disease
Valve issue
Atrial fib
History of TIA
Hyperlipidemia
Obese
Alcohol
Cocaine
```
83
Non modifiable risks of stroke
Race (black, hispanic, asian at high risk)
Age
Gender (men more than women; women die more)
84
What is a TIA?
Warning sign for stroke
85
What are the warning signs of TIA/Brain Attack?
1. Sudden numbness/ weakness of face/arm/leg on one side of body
2. Sudden confusion or trouble speaking/understandin
3. Sudden trouble in eyes
4. Sudden coordination issue
5. Sudden headache with no known cause
86
TIA vs Stroke
TIA is warning sign for stroke & last for 24h
87
Manifestation of Stroke on Right Side of Brain
- Affects left side of body
- Self Care Neglect
- Impulsive/Impaired Judgement
- Life Deficits
- Short Attention Span
- Spacial perception deficit
88
Manifestation of Stroke on Left Side of Brain
- Affects left side of body
- Issue with speech
- "Left is language"
- impaired comprehension
- Dysarthria: clearness of speech
- Aphasia: cant find words
89
Wernicke's Aphasia
Occurs in left temporal lobe
"Word Salad"
Words clear but dont make sense
90
Broca's Aphasia
Occurs in frontal lobe
| Can understand but can create words
91
Global Aphasia
Wernickes & Brocas
| SEVERE
92
Apraxia
cant complete ADLs by command
93
What is hemianopia?
One sided vision
94
Nursing Consideration/Patient Education for Hemianopia
Approach on side they can see
| Advise patient to turn head to scan the room
95
Immediate Management for Ischemic Stroke patients
1. ABCs
2. BP Management
3. Thrombolytic therapy (ischemic stroke ONLY)
4. Must help within 4.5h of start of symptoms
96
Why is thrombolytic therapy contraindicated for hemorrhagic stroke patients?
TPA is a clot buster. You dont want more bleeding within brain
97
Post Care for Stroke Patients
1. Monitor IV for hemorrhaging
2. Assess urine for blood
3. Frequent neuro checks
98
Management for Hemorrhagic Stroke
1. Increase Cerebral Oxygenation
| 2. Decrease ICP
99
What are ways to decrease ICP?
1. Prevent agitation
2. Osmotic diuretifcs
3. Suction only when needed; excessive suctioning increases ICP
4. Turn patient often, and keep HOB elevated to 30
100
What are ways to incresase cerebral oxygenation?
1. Maintain Airway (Ventiliate/Intubate if needed)
2. Keep pO2 at 85-100
3. Prevent vasospasm
101
How would a nurse maintain cerebral perfusion?
1. Frequent neuro checks
2. Keep HOB at 30 to promote blood outflow to prevent ICP
3. Give IV fluids to prevent hypotension
4. Administer vasoactive meds
5. Control body temperature (avoid shivering)
6. Prevent seizures
