Neuro

Question 1

Glasgow Coma Uses and Definition

Answer 1

Assess the level of consciousness who is altered or potential to alter. It is used to measure the degree of consciousness

Question 2

Three responses of glasgowcoma

Answer 2

Eye
motor
verbal
13-15 best range

Question 3

Size of pupils for peerla

Answer 3

2-6MM

Question 4

Babinski Reflex

Answer 4

Normal for 1 year and below if they walk it is not normal and not normal in adults.

Question 5

Adults who have babinski or fanning means

Answer 5

central nervous system affecting upper motor neuron. Or a tumor / lesion pressing on spinal cord, meningitis, MS

Question 6

General Dx tests

Answer 6

Lumbar Puncture
Purpose to get CSF and analyze for blood and even tumor cells, measure with manometer and reduce CSF. Administer it intrathecally (into spinal canal). Client should be bent over table with head down arching the back why? or fetal position chin to chest. inspect for infection and csf should be clear and colorless.

Question 7

Post Procedure of Lumbar Puncture

Answer 7

Lie flat or prone 4-8 hrs, increase fluids. Watch for headache as itll increase when client sits up and or stands and feels relief lying down. This is treated with bed rest, fluids, pain meds and blood patch.

Question 8

Complications of Lumbar Puncture

Answer 8

Headache - when walking/standing and relieved when lying down. Txt : Bed rest, increase fluids, pain meds, and blood patch

Brain herniation meaning increased ICP and is contraindicated

Infection via could cause meningitis

Question 9

S/S of ICP increase

Answer 9

Change in loc, either coma or decrease attention span, speech becomes slurred or slow, delay in verbal and increase drowsiness, restlessness, and confusion

Question 10

Late signs of ICP

Answer 10

Stupor -> coma
v/s changes cushing triads -> require immediate intervention to prevent further ischemia and restore perfusion.
Slow, full bounding pulse, irregular resp, cheyenne stokes or ataxic resp.

Decerebrate / decort - response to painful or noxious indicate motor response and mid -stem compromise

Question 11

What is cushing triad?

Answer 11

Sys hypertension with widened pulse pressure

Question 12

Decor/ Decere

Answer 12

Decor inwards and bent

Decerebrate - WORST all 4 extremities more calories burned.

Question 13

Misc symptoms of Late ICP

Answer 13

Headaches with headinjury assume increased ICP

Change in pupils and pupil response coma - fixed and dilated. Projectile vomitting

Question 14

Complication of ICP

Answer 14

Brain Herniation, obstructs blood flow causing brain death

DI or SIADH

Question 15

Goals of Treatment for Icp

Answer 15

Goal should be to reduce cerebral edema, csf fluid amount and reduce blood v. in brain.

Question 16

Treatment For ICP

Answer 16

When I enter the room, I’ll do a quick survey of the room. OXYGEN is important to allow brain perfusion. IV, should be hooked up such as isotonic (dobutamine) and iontropic (nor) to allow adequate cerebral perfusion. Upon looking at the patient ill observe, HOB up jug midline. No movement such as straining valvasa, no nose blowing. As ICP needs to monitored with repositioning. I take my vitals temp should be lower than 38 and their hypothalamus might not be working so ill give a cooling blanket to decrease the metabolic needs of the brain. Ill get my other vitals making sure pt doesnt show cushing’s triad. Lastly I’ll do my glasgowcoma scale 8 and below i’ll intubate.

I’ll come back for meds, and may induce a barbituate coma to decrease the metabolism, and osmotic diuretic such as mannitol to putll fluid from brain to decrease ICP, hypertonic solution to pull fluid from brain. And steroiods dexathemsaone, when ICP increase is due to a tumor. I’ll restrict fluids.

What I should do is any activity i need to space out and limit suctioning.

Question 17

What are your ICP monitoring devices?

Answer 17

Ventricular cath or subarachnoid screw but dont have any loose connections, dry dressings

Question 18

Meningitis

Answer 18

Inflammation in the covering of spine and brain caused by a bacterial or viral infection via transmission resp system

Question 19

S/s of meningitis

Answer 19

Chills , fever
severe headache
disorientation -> coma
n/v
nucchal ridgidity
photophobia
seizures
kernig - stiff legs, hips flexed and brudzinski - neck stiff hips and kneed flex when neck if flexed.

Question 20

Txt of meningitis

Answer 20

Corticosteriods, abx, analgesics, anticonvulsants, droplet precautions of bacterial menin - high mortality, meningitis immunizations. Viral menin require contact seen in children and infants

Question 21

TBI

Answer 21

Injury to the brain
Close TBI brain injured but skull not broken
Open TBI skull is broken, fractured, dura is torn via penetrating injury

Question 22

S/S of TBI Open / close

Answer 22

Basilar fractures are very serious you’ll see bleeding EENT, Battle sign over the mastoid, Raccoon eyes, Cerebrospinal rhinnorrhea leadking from nose, CSF leaks with glucose

Question 23

Another type of TBI: Focal Injury

Answer 23

Contusions with blunt trauma, aka whiplash, brain is bruised and damage mild-severe

Hematoma, can lead to clients adapting to it.

Question 24

Epidural Hematoma Patho

Answer 24

Rupture or laceration of the middle of meningeal artery.

Injury - Loss of consciousness - recovery period - bleeding in head - cant compensate - neuro change

Question 25

Txt of Epidural Hematoma

Answer 25

Burr holes to remove the clot to stop bleeding and control the ICP

Ask questions, pass out and stay out and pass out again see stars?

Question 26

Subdural Hematoma Patho

Answer 26

Collection of blood between dura and brain usually via venous blood can be acute, subacute or chronic.

Question 27

Txt for subdural hematoma

Answer 27

Chronic imitates other conditions, bleeding and compensating, neuro changes leads to maxed out. Acute or chronic = craniotomy to remove clot to control ICP

Question 28

Diffuse Brain Injuries - Concussion

s/s and recommendations

Answer 28

Temporary loss of neuro fx w/ complete recovery, short period of unconsciousness, dizzy, and see spots

Teach caregiver to bring to ed if:
Difficult to arrouse, speaking, confusion, headache, pulse changes unequal pupils

Question 29

Spinal Cord injury autonmic dysreflexia, Patho, Cause, s/s

Answer 29

Life threatening with upper spinal cord injury above t6, exaggerated response to stimuli versus norm person

s/s
Severe hypertension, headache, brady, nasal stuffiness, sweating and nausea. Could lead to stroke

Causes: bladder distention, constipation or impaction

Question 30

Txt of Autonomic dysreflexia

Answer 30

Client up to lower bp, swemi fowlers, treat the cause : catheter, remove impaction, look for skin pressure, antihypertenssive to help lower BP, teach prevention measures.