Neuro Flashcards
1
Q
Acute head injuries are due to any trauma to the
A
- skull
- scalp
- brain
2
Q
Traumatic brain injuries are more _____
A
serious
3
Q
What are the two most common causes of head injuries?
A
- falls
2. motor vehicle accidents
4
Q
Death occurs at what 3 points following a head injury?
A
- immediately after; usually due to hemorrhage or shock
- 2hrs after; venous bleeds
- 3 weeks after; sustained ICP leading to MODS
5
Q
What type of skull fracture puts the pt at the greatest risk for infection?
A
Open skull fracture
6
Q
In a skull fracture, ____ determines _____.
A
Location determines manifestations
7
Q
What are the two major skull fracture complications?
A
- Infection
2. Bleeding
8
Q
What are the s/s of postconcussion syndrome?
A
- Lingering headache (for weeks)
- Behavioral changes
30 Tired
9
Q
What is postconcussion syndrome?
A
When the clinical manifestations of a concussion last longer than the recovery period.
10
Q
What are contusions and what causes them?
A
Bruising on the brain; caused by traumatic shaking
11
Q
What are contusion patients at high risk for?
A
Rebleeds; monitor LOC changes
12
Q
What should the nurse assess when it is suspected her contusion patient has a rebleed?
A
LOC changes
13
Q
Contusion patients should be monitored for (2)
A
- s/s of rebleeds
2. seizures
14
Q
If a contusion patient is on anticoagulants do you take them off of them due to the risk of rebleeds?
A
NO! keep them on, just monitor closer for bleeding.
15
Q
Risk factors that put head injury patients at an increased Rx for a poor outcome (3)
A
- Age
- Intracranial hematoma
- Sustained ICP
16
Q
What is an epidural hematoma?
A
“epi” before the brain; a bleed between the skull and the lining of the brain
17
Q
An epidural hematoma is a neurological ____
A
emergency
18
Q
Clinical manifestations of an epidural hematoma early and late (5)
A
- Initial period of unconsciousness
- Lucidity
- Decreased LOC
- Headache *Late
- N/V (projectile) *Late
19
Q
How is an epidural hematoma treated?
A
Burr holes; reduce ICP by getting blood out
20
Q
What is a subdural hematoma?
A
a deeper brain bleed
21
Q
What are racoon eyes and what do they insinuate?
A
Bruising around the eyes/black eyes; orbital fractures
22
Q
What are battle signs and what do they insinuate?
A
Bruising behind the ear; occipital trauma/fracture
23
Q
What is rhinorrhea?
A
BAD sign; leaking of CSF from the nose
24
Q
How does the nurse evaluate if a patient is leaking CSF from the nose?
A
Loose gauze under nose assess for halo; glucose crystals from CSF
25
What makes the halo test inconclusive?
the presence of blood
26
Clinical manifestations of TBI/ICP
1. decreased LOC***
2. headache in the am/pm
3. photophobia (sensitivity to light)
4. seizures
5. N/V (projectile) *Late
6. Change in resp./vitals CUSHINGS TRIAD *Late
- widening systolic pulse pressures
- bradycardia (bounding pulse)
- cheynne stokes resp
27
What is cushings triad?
- widening systolic pulse pressures
- bradycardia (bounding pulse)
- cheynne stokes resp
28
How does the nurse assess motor strength in a TBI/ICP pt?
1. squeeze hands
2. pronator drift
3. raising leg off bed or bending knee
29
How does the nurse assess motor response in a TBI/ICP pt?
Spontaneous reaction or reaction to painful stimuli- sternal rub
30
What is decorticate posturing?
Sign of decreased motor function; pts extremities are going towards the core of the body
31
What is deceberate posturing?
Sign of decreased motor function; pts extremities are flexed away from body
32
Can a patient have bot decorticate and deceberate posturing?
yes
33
How is a TBI or increased ICP diagnosed? (5)
1. CT
2. toxicology screen
3. MRI
4. EEG
5. increased or decreased blood glucose
34
What does an EEG assess?
Brain activity; is pt brain dead?
35
How should the nurse manage and prepare a pt. for an EEG?
Wash and dry hair, apply electrodes
| Avoid stimulants and depressants
36
How is a concussion/contusion treated?
Observe and manage ICP, teach caregiver and pt the s/s of increased ICP, 2 weeks of no stimuli
37
How are skull fractures treated?
Conservative treatment; surgery is skull is depressed or bleeding; burr holes/craniotomy
38
What is the nurses priority when treating a skull fracture pt?
Prevent infection
39
What are the major s/s of infection (3)
1. purulent drainage
2. increased WBC
3. fever
40
How are subdural and epidural hematomas treated?
Craniotomy, burr holes
41
Neurological emergency management (think in the field) (5)
1. Stabilize pt (always assume neck/spinal injury)
2. estabilish airway (intubate if GCS is 8 or less)
3. O2 nonrebreather
4. establish IV access
5. IV fluids; NS or LR
42
How should a TBI/ICP pt be positioned?
HOB 30 degrees and above, side lying, do not elevate legs or flex/extend pt
43
Rhinorrhea nursing management (6)
1. keep HOB up
2. no sneezing/blowing nose
3. no NG tubes
4. no suctioning
5. around the clock antiemetics
6. anaglesics
44
What are the three essential components of the skull?
1. brain tissue
2. blood
3. csf
45
What is the monroe-kellie doctrine
essentially claims that if any of the three skull components increase the others decrease to prevent increased ICP
46
What is normal ICP
5-15mmHg
47
What is the ICP buffer zone
15-20mmHg
48
If the ICP is greater than 20mmHg sustained what should the nurse do?
call MD
49
Increased ICP is ____ threatening
Life
50
What 3 components can contribute to increased ICP?
1. brain tissue
2. blood
3. CSF
51
What procedure is contraindicated for patients with increased ICP?
Lumbar puncture; increased risk of hernaition
52
The glasgow coma scale is used to
assess for increased ICP/head injury
53
What does the glasgow coma scale use to create the score?
1. Eye movement (4pts)
2. Speech/verbal response (5pts)
3. Motor response (6pts)
54
What is the best GCS score?
15pts
55
What GCS score indicates the pt. is unresponsive/lowest?
3pts
56
What does an 8 or less GCS mean?
Comatose pt
57
What is a ventriculostomy?
Catheter inserted into ventricle of the brain to assess ICP; can also drain CSF
58
What is the number one complication of a ventriculostomy?
INFECTION; esp. if pt. has had it in for longer than 5 days
59
What technique is used for ventriculostomy and head dressing changes?
Aseptic technique
60
Inaccurate ICP readings can be caused by (4)
1. CSF leaks
2. catheter kinked/obstructed
3. differences in height
4. bubbles in tubing
61
Head injury/TBI/ICP goals (4)
1. maintain patent airway
2. keep ICP WDL
3. maintain normal fluid/electrolyte imbal.
4. prevent complications secondary to immobility (air mattress, bowel care)
62
How should a head injury pt be suctioned?
less than 10 sec no more than 2 passes
63
Should neuro pts have pillows?
no use a neck roll
64
In order to support brain function what do we want the patients PaO2 and PaCO2 to be?
PaO2 greater or equal to 100mmHg
| PaCO2 between 35-45
65
What metabolic state are neuro patients in?
Hypermetabolic and hypercatabolic; need increased nutrition via enteral or parental nutrition
66
What labs need to be monitored to assess for DI or SIADH in head injury pts?
Na+, Mg+
67
Neuro drug therapy (8)
1. Mannitol- steroid that crosses blood brain barrier to reduce cerebral edema
2. Hypertonic saline
3. Corticosteroids (assess blood glucose)
4. prophylactic antiseizure meds
5. anaglesics
6. antiemetics
7. sedatives/barbituates
8. antipyretics
68
What medications should never be abruptly stopped?
antiseizure meds, steroids
69
Bacterial meningitis is caused by
strep pneumo.
70
What is meningitis?
Infection of the meninges of the brain
71
What groups are at greater rx of contracting meningitis?
1. elderly
2. college students
3. skull fracture pts
72
Meningitis patho
1. infection
2. inflammatory response triggers increased CSF prod.
3. purulent secretions
4. Increased cerebral edema and ICP
73
Meningitis s/s (5)
1. severe headache
2. fever
3. nuchal rigidity
4. decreased LOC *Late
5. coma *Late
74
Meningitis Dx
1. Blood culture- neutrophils
2. Lumbar puncture (if dx verified)
3. CT
75
Major lumbar puncture adverse effect
headache; drawing too much fluid out
76
How should a pt be positioned for a lumbar puncture
side lying in a ball or leaned over a table
77
Meningitis drug treatment (3)
1. steroids
2. broad-spectrum antibiotics
3. specific antibiotics
78
Spinal cord injuries are due to
Trauma; severing or displacing the spinal cord
79
Spinal cord injuries are usually ongoing _____ damage that occurs _____ the initial injury.
progressive, after
80
Apoptosis in spinal cord injuries leads to
Apoptosis: programmed cell death weeks after initial injury
| leads to scar tissue formation, irreversible nerve damage, and permanent neuro damage
81
Spinal cord injury pts have the most improvement in the 1st ____ months
3 to 6
82
Within the 1st 24 hours of a SCI it is vital that the nurse gets swelling down as the edema can cause
permanent damage
83
Spinal shock affects ____ function
motor
84
spinal shock is characterized by what manifestations (4)
1. decreased reflexes
2. loss of sensation
3. flaccidity below site on injury
4. absent thermoregulation
5. low BP low HR
85
spinal shock lasts
days to weeks
86
Neurogenic shock is a more ____ type of shock
serious
87
Neurogenic shock is characterized by
1. hypotension
2. bradycardia
3. loss of sympathetic nervous system function
- venous pooling
- peripheral vasodilation
- decreased cardiac output
88
Neurogenic shock is often prevalent in a spinal injury ___ and above
T6 and above
89
neurogenic shock patients are ___ unstable
hemodynamically
90
```
spinal segment purposes:
cervical
thoracic
lumbar
sacral
```
Cervical: head, neck, arms, diaphragm
Thoracic: hands, chest, abdomen
Lumbar: legs
Sacal: sex, bowel, bladder
91
C4 injury results in
tetraplegia; paralysis below the neck (resp. problems)
92
C6 injury results in
paralysis below the shoulders (resp. problems)
93
T6 injury results in
paraplegia; paralysis below the chest (bowel problems)
94
L1 injury results in
paraplegia; paralysis below the waist
95
patients with T6 injuries and above have lost the ability to ____ and ____
pee and poop; will have to self cath and digitally remove for the rest of their lives
96
Immobile SCI pts will be on heparin or lovenox to
prevent VTE
97
Vasopressors are given to SCI pts. to
prevent shock; keep systolic BP greater than 85-90mmHg
98
If a diabetic pts blood glucose is greater than ____, insulin must be administered in conjunction with the steroid
greater than 150
99
What is autonomic dysreflexia?
Severe HTN in SCI pts when they fail to frequently evacuate their bowels
100
Autonomic dysreflexia is commonly seen in pts with ___ or higher injuries
T6 or higher
101
Autonomic dysreflexia pt teaching
teach pt and caregiver to regularly evacuate bowels; intermittent cath every 2hrs, digital bowel disimpaction
102
Autonomic dysreflexia clinical manifestations (4)
1. increased HTN
2. throbbing headache
3. goosebumps
4. diaphoresis
103
SCI cardiac instability goal
avoid cardiogenic shock; assess vitals, fluids, admin vasopressors to keep systolic BP >85-90mmHg
104
Spinal cord injury pts are at risk for this bowel problem
paralytic ileus
105
how is a paralytic ileus dx
listen to bowel; absent bowel sounds
106
when should fluids be initiated for SCI pts
within the first 72hrs following injury
107
SCI pts have which system probs (4)
cardiovascular
fluid and nutrition
neurogenic bladder
temp. reg probs
108
neurogenic bladder pts are at an increased risk for ___
UTIs due to self cath
109
mannitol is contraindicated for ___ pts
renal
110
c1 to c3 injury can cause
SUPER BAD; death if not intubated
111
SCI pts need increased nitrogen to promote
healing
