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Medsurg exam 3 > Neuro > Flashcards

Neuro Flashcards

1
Q

Acute head injuries are due to any trauma to the

A
  1. skull
  2. scalp
  3. brain
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2
Q

Traumatic brain injuries are more _____

A

serious

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3
Q

What are the two most common causes of head injuries?

A
  1. falls

2. motor vehicle accidents

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4
Q

Death occurs at what 3 points following a head injury?

A
  1. immediately after; usually due to hemorrhage or shock
  2. 2hrs after; venous bleeds
  3. 3 weeks after; sustained ICP leading to MODS
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5
Q

What type of skull fracture puts the pt at the greatest risk for infection?

A

Open skull fracture

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6
Q

In a skull fracture, ____ determines _____.

A

Location determines manifestations

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7
Q

What are the two major skull fracture complications?

A
  1. Infection

2. Bleeding

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8
Q

What are the s/s of postconcussion syndrome?

A
  1. Lingering headache (for weeks)
  2. Behavioral changes
    30 Tired
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9
Q

What is postconcussion syndrome?

A

When the clinical manifestations of a concussion last longer than the recovery period.

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10
Q

What are contusions and what causes them?

A

Bruising on the brain; caused by traumatic shaking

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11
Q

What are contusion patients at high risk for?

A

Rebleeds; monitor LOC changes

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12
Q

What should the nurse assess when it is suspected her contusion patient has a rebleed?

A

LOC changes

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13
Q

Contusion patients should be monitored for (2)

A
  1. s/s of rebleeds

2. seizures

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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.

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15
Q

Risk factors that put head injury patients at an increased Rx for a poor outcome (3)

A
  1. Age
  2. Intracranial hematoma
  3. Sustained ICP
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16
Q

What is an epidural hematoma?

A

“epi” before the brain; a bleed between the skull and the lining of the brain

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17
Q

An epidural hematoma is a neurological ____

A

emergency

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18
Q

Clinical manifestations of an epidural hematoma early and late (5)

A
  1. Initial period of unconsciousness
  2. Lucidity
  3. Decreased LOC
  4. Headache *Late
  5. N/V (projectile) *Late
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19
Q

How is an epidural hematoma treated?

A

Burr holes; reduce ICP by getting blood out

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20
Q

What is a subdural hematoma?

A

a deeper brain bleed

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21
Q

What are racoon eyes and what do they insinuate?

A

Bruising around the eyes/black eyes; orbital fractures

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22
Q

What are battle signs and what do they insinuate?

A

Bruising behind the ear; occipital trauma/fracture

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23
Q

What is rhinorrhea?

A

BAD sign; leaking of CSF from the nose

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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

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25
Q

What makes the halo test inconclusive?

A

the presence of blood

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26
Q

Clinical manifestations of TBI/ICP

A
  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
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27
Q

What is cushings triad?

A
  • widening systolic pulse pressures
  • bradycardia (bounding pulse)
  • cheynne stokes resp
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28
Q

How does the nurse assess motor strength in a TBI/ICP pt?

A
  1. squeeze hands
  2. pronator drift
  3. raising leg off bed or bending knee
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29
Q

How does the nurse assess motor response in a TBI/ICP pt?

A

Spontaneous reaction or reaction to painful stimuli- sternal rub

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30
Q

What is decorticate posturing?

A

Sign of decreased motor function; pts extremities are going towards the core of the body

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31
Q

What is deceberate posturing?

A

Sign of decreased motor function; pts extremities are flexed away from body

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32
Q

Can a patient have bot decorticate and deceberate posturing?

A

yes

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33
Q

How is a TBI or increased ICP diagnosed? (5)

A
  1. CT
  2. toxicology screen
  3. MRI
  4. EEG
  5. increased or decreased blood glucose
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34
Q

What does an EEG assess?

A

Brain activity; is pt brain dead?

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35
Q

How should the nurse manage and prepare a pt. for an EEG?

A

Wash and dry hair, apply electrodes

Avoid stimulants and depressants

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36
Q

How is a concussion/contusion treated?

A

Observe and manage ICP, teach caregiver and pt the s/s of increased ICP, 2 weeks of no stimuli

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37
Q

How are skull fractures treated?

A

Conservative treatment; surgery is skull is depressed or bleeding; burr holes/craniotomy

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38
Q

What is the nurses priority when treating a skull fracture pt?

A

Prevent infection

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39
Q

What are the major s/s of infection (3)

A
  1. purulent drainage
  2. increased WBC
  3. fever
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40
Q

How are subdural and epidural hematomas treated?

A

Craniotomy, burr holes

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41
Q

Neurological emergency management (think in the field) (5)

A
  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
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42
Q

How should a TBI/ICP pt be positioned?

A

HOB 30 degrees and above, side lying, do not elevate legs or flex/extend pt

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43
Q

Rhinorrhea nursing management (6)

A
  1. keep HOB up
  2. no sneezing/blowing nose
  3. no NG tubes
  4. no suctioning
  5. around the clock antiemetics
  6. anaglesics
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44
Q

What are the three essential components of the skull?

A
  1. brain tissue
  2. blood
  3. csf
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45
Q

What is the monroe-kellie doctrine

A

essentially claims that if any of the three skull components increase the others decrease to prevent increased ICP

46
Q

What is normal ICP

A

5-15mmHg

47
Q

What is the ICP buffer zone

A

15-20mmHg

48
Q

If the ICP is greater than 20mmHg sustained what should the nurse do?

A

call MD

49
Q

Increased ICP is ____ threatening

A

Life

50
Q

What 3 components can contribute to increased ICP?

A
  1. brain tissue
  2. blood
  3. CSF
51
Q

What procedure is contraindicated for patients with increased ICP?

A

Lumbar puncture; increased risk of hernaition

52
Q

The glasgow coma scale is used to

A

assess for increased ICP/head injury

53
Q

What does the glasgow coma scale use to create the score?

A
  1. Eye movement (4pts)
  2. Speech/verbal response (5pts)
  3. Motor response (6pts)
54
Q

What is the best GCS score?

A

15pts

55
Q

What GCS score indicates the pt. is unresponsive/lowest?

A

3pts

56
Q

What does an 8 or less GCS mean?

A

Comatose pt

57
Q

What is a ventriculostomy?

A

Catheter inserted into ventricle of the brain to assess ICP; can also drain CSF

58
Q

What is the number one complication of a ventriculostomy?

A

INFECTION; esp. if pt. has had it in for longer than 5 days

59
Q

What technique is used for ventriculostomy and head dressing changes?

A

Aseptic technique

60
Q

Inaccurate ICP readings can be caused by (4)

A
  1. CSF leaks
  2. catheter kinked/obstructed
  3. differences in height
  4. bubbles in tubing
61
Q

Head injury/TBI/ICP goals (4)

A
  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
Q

How should a head injury pt be suctioned?

A

less than 10 sec no more than 2 passes

63
Q

Should neuro pts have pillows?

A

no use a neck roll

64
Q

In order to support brain function what do we want the patients PaO2 and PaCO2 to be?

A

PaO2 greater or equal to 100mmHg

PaCO2 between 35-45

65
Q

What metabolic state are neuro patients in?

A

Hypermetabolic and hypercatabolic; need increased nutrition via enteral or parental nutrition

66
Q

What labs need to be monitored to assess for DI or SIADH in head injury pts?

A

Na+, Mg+

67
Q

Neuro drug therapy (8)

A
  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
Q

What medications should never be abruptly stopped?

A

antiseizure meds, steroids

69
Q

Bacterial meningitis is caused by

A

strep pneumo.

70
Q

What is meningitis?

A

Infection of the meninges of the brain

71
Q

What groups are at greater rx of contracting meningitis?

A
  1. elderly
  2. college students
  3. skull fracture pts
72
Q

Meningitis patho

A
  1. infection
  2. inflammatory response triggers increased CSF prod.
  3. purulent secretions
  4. Increased cerebral edema and ICP
73
Q

Meningitis s/s (5)

A
  1. severe headache
  2. fever
  3. nuchal rigidity
  4. decreased LOC *Late
  5. coma *Late
74
Q

Meningitis Dx

A
  1. Blood culture- neutrophils
  2. Lumbar puncture (if dx verified)
  3. CT
75
Q

Major lumbar puncture adverse effect

A

headache; drawing too much fluid out

76
Q

How should a pt be positioned for a lumbar puncture

A

side lying in a ball or leaned over a table

77
Q

Meningitis drug treatment (3)

A
  1. steroids
  2. broad-spectrum antibiotics
  3. specific antibiotics
78
Q

Spinal cord injuries are due to

A

Trauma; severing or displacing the spinal cord

79
Q

Spinal cord injuries are usually ongoing _____ damage that occurs _____ the initial injury.

A

progressive, after

80
Q

Apoptosis in spinal cord injuries leads to

A

Apoptosis: programmed cell death weeks after initial injury

leads to scar tissue formation, irreversible nerve damage, and permanent neuro damage

81
Q

Spinal cord injury pts have the most improvement in the 1st ____ months

A

3 to 6

82
Q

Within the 1st 24 hours of a SCI it is vital that the nurse gets swelling down as the edema can cause

A

permanent damage

83
Q

Spinal shock affects ____ function

A

motor

84
Q

spinal shock is characterized by what manifestations (4)

A
  1. decreased reflexes
  2. loss of sensation
  3. flaccidity below site on injury
  4. absent thermoregulation
  5. low BP low HR
85
Q

spinal shock lasts

A

days to weeks

86
Q

Neurogenic shock is a more ____ type of shock

A

serious

87
Q

Neurogenic shock is characterized by

A
  1. hypotension
  2. bradycardia
  3. loss of sympathetic nervous system function
    - venous pooling
    - peripheral vasodilation
    - decreased cardiac output
88
Q

Neurogenic shock is often prevalent in a spinal injury ___ and above

A

T6 and above

89
Q

neurogenic shock patients are ___ unstable

A

hemodynamically

90
Q 
spinal segment purposes:
cervical
thoracic
lumbar
sacral
A

Cervical: head, neck, arms, diaphragm
Thoracic: hands, chest, abdomen
Lumbar: legs
Sacal: sex, bowel, bladder

91
Q

C4 injury results in

A

tetraplegia; paralysis below the neck (resp. problems)

92
Q

C6 injury results in

A

paralysis below the shoulders (resp. problems)

93
Q

T6 injury results in

A

paraplegia; paralysis below the chest (bowel problems)

94
Q

L1 injury results in

A

paraplegia; paralysis below the waist

95
Q

patients with T6 injuries and above have lost the ability to ____ and ____

A

pee and poop; will have to self cath and digitally remove for the rest of their lives

96
Q

Immobile SCI pts will be on heparin or lovenox to

A

prevent VTE

97
Q

Vasopressors are given to SCI pts. to

A

prevent shock; keep systolic BP greater than 85-90mmHg

98
Q

If a diabetic pts blood glucose is greater than ____, insulin must be administered in conjunction with the steroid

A

greater than 150

99
Q

What is autonomic dysreflexia?

A

Severe HTN in SCI pts when they fail to frequently evacuate their bowels

100
Q

Autonomic dysreflexia is commonly seen in pts with ___ or higher injuries

A

T6 or higher

101
Q

Autonomic dysreflexia pt teaching

A

teach pt and caregiver to regularly evacuate bowels; intermittent cath every 2hrs, digital bowel disimpaction

102
Q

Autonomic dysreflexia clinical manifestations (4)

A
  1. increased HTN
  2. throbbing headache
  3. goosebumps
  4. diaphoresis
103
Q

SCI cardiac instability goal

A

avoid cardiogenic shock; assess vitals, fluids, admin vasopressors to keep systolic BP >85-90mmHg

104
Q

Spinal cord injury pts are at risk for this bowel problem

A

paralytic ileus

105
Q

how is a paralytic ileus dx

A

listen to bowel; absent bowel sounds

106
Q

when should fluids be initiated for SCI pts

A

within the first 72hrs following injury

107
Q

SCI pts have which system probs (4)

A

cardiovascular
fluid and nutrition
neurogenic bladder
temp. reg probs

108
Q

neurogenic bladder pts are at an increased risk for ___

A

UTIs due to self cath

109
Q

mannitol is contraindicated for ___ pts

A

renal

110
Q

c1 to c3 injury can cause

A

SUPER BAD; death if not intubated

111
Q

SCI pts need increased nitrogen to promote

A

healing

Medsurg exam 3 (3 decks)

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