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Critical Care > Neuro > Flashcards

Neuro Flashcards

1
Q

What is the most important aspect of the neuro exam?

A

Level of consciousness

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2
Q

What is assessed during a mental status exam?

A

1) Awareness of surroundings and alertness.
2) Orientation to person, place and time.
3) Short and long term memory.

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3
Q

What is often the first sign of a neuro problem?

A

Change in LOC

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4
Q

When is the Glasgow Coma Scale used?

A

To determine LOC in clients with altered mental status or the potential to develop altered consciousness (think trauma).

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5
Q

What is the highest (best) score on the Glasgow Coma Scale?

A

15

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6
Q

If Glasgow score is less than 8…..

A

Your patient you must intubate!

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7
Q

What are the symptoms of Cushing’s triad?

A

1) HYPER-tension with widening pulse pressure (high systolic)
2) BRADY-cardia
3) BRADY-pnea
* think HYPER BRADY BRADY

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8
Q

Is Cushing’s triad an early or late sign of increased ICP?

A

Late. It’s an emergency!

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9
Q

Is the Babinski reflex normal in adults?

A

No

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10
Q

What does the presence of the Babinski reflex indicate?

A

A CNS problem affecting an upper motor neuron.

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11
Q

What might cause a Babinski reflex?

A

Tumors, brain lesions, spinal cord lesions, meningitis, MS, Lou Gehrig’s disease.

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12
Q

How do you grade reflex response?

A 
0 = no response (absent)
1+ = present but slugish
2+ = Active or expected (normal)
3+ = More brisk than expected, but not necessarily pathological
4+ = brisk, hyperactive with intermittent or transient clonus (abnormal reflex movements of foot induced by sudden dorsiflexion)
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13
Q

How are reflex responses documented?

A

Number of assessment over highest number of scale.

Ex: 2+/4+

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14
Q

What is the normal foot reflex in an adult called?

A

Plantar reflex

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15
Q

Why are lumbar punctures performed?

A

To obtain CSF for testing, measure readings with an a manometer, reduce CSF pressure, administer drugs intrathecally (into spinal canal).

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16
Q

How are patients positioned for lumbar puncture?

A

Side lying in fetal position or over bedside table. Back must have a lot of arch and patient must be very still.

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17
Q

What is the preferred position for 4-6 hours post lumbar puncture?

A

Prone

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18
Q

What should be increased after a lumbar puncture?

A

Fluids, to replace lost CSF

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19
Q

What is the most common complication of lumbar puncture?

A

Headache that worsens with sitting/standing and decreases with lying down.

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20
Q

How is headache post lumbar puncture treated?

A

Bed rest, fluids, pain meds and blood patch.

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21
Q

What is the most serious complication of a lumbar puncture?

A

Brain herniation. This occurs when a puncture is made in a patient with increased ICP. The puncture creates a pressure gradient, drawing the high pressure in the brain downwards, which herniates the brain and brain stem. This is FATAL in 99% of cases.

22
Q

When is lumbar puncture absolutely contraindicated?

A

In patients with increased ICP.

23
Q

What must be assessed prior to lumbar puncture?

A

ICP, check for lesions around puncture site before procedure to reduce risk of bacterial meningitis. Alert physician to any possibility of increased ICP or lesions near site.

24
Q

What is the earliest sign of increasing ICP?

A

LOC changes, slowed or slurred speech, changes in attention span, delay in verbal response, increase in drowsiness, restlessness, confusion

25
Q

What are late signs of increasing ICP?

A

Marked changes in LOC progressing to stupor or coma, Cushing’s triad, slow, full and bounding pulse, irregular respirations, decerebrate/decorticate posturing

26
Q

What is the worst form of posturing?

A

Decerebrate (all 4 extremities in rigid extension)

27
Q

Anytime a patient with a head injury complains of headache, assume what?

A

Increasing ICP

28
Q

What are complications of increased ICP?

A

Brain herniation, DI and SIADH

29
Q

Problems with ___ are always secondary to other problems?

A

ADH. Think head injuries.

30
Q

What is the treatment for increased ICP?

A

1) Maintain cerebral perfusion (oxygenation)
2) Reduce cerebral edema by: reducing amount of CSF or reducing blood volume in the brain.
3) Keep temperature below 100.4 (38 C) (may use cooling blanket if hypothalamus not working)
4) Elevate the HOB
5) Keep head midline so jugular veins can drain. Neutral position.

31
Q

What should be assessed during treatment for increased ICP?

A

1) Monitor vitals for Cushing’s triad and increased temperature
2) Watch ICP monitor with turning. ICP pressure increases with intervention but should decrease within 15 minutes.
3) Monitor Glasgow coma scale
4) Monitor fluids to prevent fluid volume excess.

32
Q

What should be avoided during treatment for increased ICP?

A

7) Avoid restraints, bowel/bladder distention, hip flexion, valsalva, isometrics, sneezing/nose blowing
8) Limit suctioning
9) Space interventions

33
Q

What can be used to treat hypotension in the client with increased ICP?

A

Isotonic solutions and inotropic agents like dobutamine and norepinephrine (short term).

34
Q

What can be used to decrease cerebral edema by decreasing metabolic demands of the brain?

A

Hypothermia

35
Q

____ induced coma is used to decrease cerebral metabolism.

A

Barbituate (phenobarbital, thiopental, propofol)

36
Q

What is the osmotic diuretic most commonly prescribed to reduce cerebral edema?

A

Mannitol

37
Q

What else can be used as an osmotic diuretic?

A

Hypertonic saline.

38
Q

If a tumor is the cause of increased ICP, what medication may be used to decrease cerebral edema?

A

Steroids

39
Q

What are the two most common forms of ICP monitoring devices?

A

Ventricular catheter and subarachnoid screws.

40
Q

With ICP monitoring devices, what is the greatest risk?

A

Infection. No loose connections! Keep dressings dry!

41
Q

What is the most serious type of skull fracture?

A

Basilar fracture

42
Q

Where do you see bleeding with a basilar skull fracture?

A

EENT (eyes, ears, nose, throat)

43
Q

What is Battle’s sign?

A

Bruising over the mastoid (bone behind ear).

44
Q

What is an epidural hematoma?

A

A rupture or laceration of the middle meningeal artery. Signs include initial loss of consciousness, recovery period, then neuro changes leading to coma. Emergency!

45
Q

What is the treatment for epidural hematoma?

A

Burr holes to remove clot.

46
Q

What is a subdural hematoma?

A

Collection of blood (usually a venous bleed) between the dura and the brain. Chronic (slow) bleeds are tricky as they mimic other disorders.

47
Q

What kind of injury can put a patient at risk for autonomic dysreflexia?

A

A spinal injury ABOVE T6.

48
Q

What is the FIRST treatment for autonomic dysreflexia?

A

Sit patient up to lower blood pressure. THEN treat the cause (bladder, bowel, skin irritant, etc)

49
Q

What are S/S of autonomic dysreflexia?

A

Severe hypertension, severe headache, bradycardia, nasal stuffiness, flushing, sweating (esp on forehead), blurred vision, nausea, and anxiety.

50
Q

Why are patients with increased ICP placed on fluid restriction?

A

Less volume, less pressure!

Critical Care (10 decks)

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