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Critical Care. > Neuro Assessment. > Flashcards

Neuro Assessment. Flashcards

1
Q

initial changes

A

will be subtle

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2
Q

brain is the most metabolically active organ

A

consumes 20% oxygen and 25% glucose; if it doesn’t get this, there will be changes

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3
Q

patient history

A

sudden? progressive?

trauma, meds, bleeding; metabolic, recent fall - subdural hematoma

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4
Q

level of consciousness

A

single most important sign of neuro dysfunction

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5
Q

full consciousness

A

aao x3, comprehend, express ideas

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6
Q

confusion

A

disoriented to either time, place, or person

worse at night, brain fatigue, sundowning

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7
Q

lethargy

A

oriented x3, slow and sluggish

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8
Q

obtundation

A

readily a rousable with stimulation, respond verbally, follow command, very drowsy

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9
Q

stupor

A

appropriate response to pain; lie quietly with minimum spontaneous movement; unresponsive except to vigorous/repeated stimuli; incomprehensible sounds or eye opening

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10
Q

coma

A

sleep-like state; do not resound appropriately, no verbal sounds.

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11
Q

light coma

A

unarousable, no spontaneous movement; withdraw purposefully to painful stimuli; may have brain stem reflexes

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12
Q

coma coma

A

unarousable, withdraw non purposefully to painful stimuli; bran stem reflexes may or may not be intact; posturing

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13
Q

deep coma

A

unarousable, no pain response, no brain stem reflex, decerebrate

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14
Q

persistent vegetative state

A

chronic

eyes open, permanent stage of unconsciousness; have sleep cycle but no sense of anything

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15
Q

locked-in syndrome

A

paralysis of voluntary muscles, despite full consciousness - MG

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16
Q

brain death

A

state of irreversible loss of both cortical and brain stem activity

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17
Q

glasgow coma scale

A

eye opening: 4 spontaneous, 3 to verbal command, 2 to pain, 1 none
verbal response: 5 oriented, 4 disoriented, 3 inappropriate word, 2 incomprehensible sound, 1 none
motor response: 6 obeys verbal, 5 localizes pain, 4 withdraws from pain - decorticate, 3 flexion - decerebrate, 2 - extension, 1 none

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18
Q

cranial nerves

A

olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, hypoglossal

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19
Q

olfactory

A

smell

20
Q

optic

A

vision

21
Q

oculomotor

A

eye movement, pupils, lens shape

22
Q

trochlear

A

eye movement

23
Q

trigeminal

A

corneal reflex, sensory - face

24
Q

abducens

A

eye movement

25
Q

facial

A

motor - face, salivation, tears

26
Q

acoustic

A

hearing

27
Q

glossopharyngeal

A

gag/swallow

28
Q

vagus

A

talk, swallow

29
Q

accessory

A

head/shoulder movement

30
Q

hypoglossal

A

tongue, speech, swallow

31
Q

pupils can..

A

help localize the problem

32
Q

normal pupil

A

3.5mm, can range from 1.5-8mm

33
Q

anisocaria

A

pupil asymmetry >1mm; forewarning that it will dilate

34
Q

oval pupil

A

CN 3 compressoin

35
Q

key hole pupil

A

irredectomy, trauma

36
Q

oculocephalic reflex - doll’s eyes

A

normal - eyes turn together to opposite side from turn of head
abnormal - eyes don’t turn in conjugate manner
absent - don’t turn

37
Q

oculovestibular reflex - caloric ice water

A

20-50cc in ear
normal - eyes toward irrigated ear
abnormal - dysconjugate or asymmetric eye movements
absent - no response - no brain stem function

38
Q

motor function assessment

A

muscle size, tone, strength; involuntary movement?
compare side to side
commands - simple and direct, reduce distractions, no visual or tactile stimuli, no reflex activity

39
Q

noxious stimuli

A

acceptable: nail bed pressure, trapezius pinch, pinch arm/leg
unacceptable: sternal rub - skin breakdown, supraorbital pressure - facial trauma, nipple/testicular pinch

40
Q

if one side is different than other..

A

SUDDEN LATERALIZATION IS AN EMERGENCY

41
Q

decorticate

A

flexion of arms, wrist, and fingers with adduction in upper extremities; extension, internal rotation, and plantar flexion in lower extremities

42
Q

decerebrate

A

all four extremities in rigid extension, with hyper-pronation of forearms and plantar extension of feet

43
Q

vital signs are..

A

the last thing to change

body will maintain them in order to perfuse brain

44
Q

cushings reflex (response)

A

increased systolic BP causes widened PP and bradycardia

worry about increased ICP

45
Q

cushings triad

A

hypertension with increased PP, bradycardiea, abn resp pattern - won’t do good on a vent
indicates impending brainstem herniation through the foramen magnum and death

46
Q

increased temp

A

due to infection, sepsis

47
Q

decreased temp

A

r/t therapeutic interventions or really severe brain damage

Critical Care. (9 decks)

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