Neuro Emergency p2 Flashcards
Cerebral Edema
1. Definition
2. Clinical signs (3)
3. Therapy for perfusion (3)
- Poor brain perfusion
- Signs
- Abnormal mentation
- Abnormal pupils
- Abnormal pupillary reflexes - Therapy
- IV fluids
- O2
- Reverse cerebral edema
Seizures are ___ disturbances in the ___ function.
Clinical signs (4)
- Transitory
- Brain
Signs
- Loss or change in consciousness
- Change in muscle tone or movement
- Behavior changes
- Change of autonomic function
What are the 3 components of a seizure?
- Aura
- Preictal period - Ictus
- Seizure activity - Postictal period
- This can last from minutes to days
Status Epilepticus
1. Etiology
2. Side effects (3)
- Seizures lasting continuously >15min
- Side effects
- Cerebral edema
- Coma
- Death
T/F: Status epilepticus is a medical emergency
YES!!
Cerebral Edema Therapy (4)
- Elevate head
- Stop seizures
- Medication
- Treat cause - Corticosteroids IV
- Mannitol IV over 20min
Status Epilepticus “Must Haves” (7)
Must Have:
1. IVC(s)
2. Functional airway
- Intubate is necessary
3. Continuous supervision
4. Blood glucose checks
5. Temp checks
6. Excellent nursing care!
What are 3 of out of the 6 things needed for Excellent Nursing Care? (3/6)
- Lubricate eyes with ointment QID
- Roll patient QID
- Monitor urinary bladder size q. 4-6hrs; express if needed.
- Monitor urine output
- Consider indwelling urinary catheter - TPR minimum q. 6hrs
- Fluids & medication on schedule!!
- Clean & dry at all times
ICU Flow Sheets
1. What are they designed for? (2)
2. What can be used to indicate services needed?
- Designed for:
- Concise & thorough recording of patient parameters & treatments.
- Designed for 24hr monitoring/care. - Highlighters are best! Circling works fine
T/F: ICU flow sheets only come in one style
False. Many styles are available
Neurological Monitoring:
Cerebral Disease (5)
Monitor:
1. Vision
2. Consciousness
3. Mentation
4. Seizures
- Generalized
- Partial
5. Aura
- “Preictal period”
Aura (Preictal period) clinical signs (4)
FTI: These are signs that are imminent of a seizure!
- Fluttering whiskers
- Hyperaesthesia
- Anxious behaviors
- Partial motor seizures prior to generalized
Spinal Diseases:
Intervertebral Disc Disease
1. Etiology
2. Clinical signs (3)
- Herniation of one or more intervertebral discs impinges the spinal cord.
- Signs
- Back pain (often severe)
- Paresis or paralysis of limbs caudal to lesion
- Altered pain sensation caudal to the lesion.
Intervertebral Disc Disease
1. Diagnosis (5)
2. Treatment (4)
- Dx
- Clinical signs
- Neurologic signs
- Plain radiographs
- Myelogram
- CT or MRI - Tx
- Pain relief
- Corticosteroids
- DMSO
- Emergency surgery
When is surgery indicated for Intervertebral Disc Disease? Pick one
Declining Neurologic Exam
1. Loss of conscious proprioception (CP)
2. Loss of superficial pain
3. Loss of voluntary mobility
4. Crossed extensor pain
5. Loss of deep pain (v bad!)
- Loss of voluntary mobility - SURGERY!
- Anything beyond this, patient can go to Sx but prognosis is low.
Conscious proprioception (CP)
1. This reflex is partially responsible for what? Good indicator for what?
2. How is this test preformed?
- Responsible for many of the other postural reflex responses & is good indicator of spinal cord dysfunction.
- Turning over each paw, one at a time, so Pt is standing on dorsum of the foot.
Pt should return paw to plantar surface. Results are evaluated based on time & if they reposition their paw.
Superficial Pain test (3)
- Tested by pinching the webbing between the toes.
- Withdrawal of the limb is only a spinal reflex.
- Perception of the discomfort by the brain proves the spinal cord is functioning all the way craniad.
Vestibulospinal Tract
How is this spinal pathway tested? (3)
- Determining the animal’s ability to stand & walk.
- Pressure can be applied over the back or shoulders of the animal to examine motor strength.
- By lifting one leg, difference in strength between each leg can be determined.
Crossed-Extensor
1. How is this test preformed?
2. What do the results indicate?
- Test
- Animal is in lateral recumbency
- Gently flex the toe of the down leg. This creates a progressive painful stimulus in that leg.
- The upper leg is observed for extension during this.
- Repeat on both sides. - The side which extends has the damage.
- Presence of a crossed extensor reflex after injury indicates severe upper motor (..?)
- Where does the urinary bladder receive nerves on the spinal cord?
- If injury is cranial to that location, what results? (3)
- Caudal to it? (3)
- From the spinal cord at L5-7
- Upper motor bladder results
- Inability to urinate
- Difficult to express - Lower motor bladder results
- Inability to urinate normally, urine may leak out.
- Easily expressed
T/F: During a spinal injury in L5-7 (affecting the urinary bladder), the function of the bladder should be closely monitored.
True!
Nursing Spinal Cord Patient
1. How often should they be monitored?
2. What should be evaluated? (4)
3. How can sores be prevented? (3)
- At least q.2-6hrs. Immediately report decline!
- Eval:
- Ability to walk
- Ability to urinate
- Pain perception in rear legs
- Neurologic status!! - Prevention of sores:
- Roll patient q.4hrs
- Deeply bedded
- Clean & dry at all times!!
Nursing Spinal Cord Patient
1. How to maintain small bladder (2)
2. How often should pain level be assessed?
3. How often should physical therapy be done? What should be done?
- Small bladder
- Indwelling urinary catheter
- Monitor & express bladder q.4-6hrs (prevent infection & bladder muscle damage). - q. 4-6hrs
- q. 6-8hrs
- Passive range of motion
- Assisted walking (towels, slings, frames)
