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Critical Care > Neuro Exam 3 > Flashcards

Neuro Exam 3 Flashcards

1
Q

intracranial compliance

A

ability of body to compensate for increased intracranial pressure

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2
Q

increased intracranial pressure

A

occurs when brain tissue, CSF, or blood increase causing the other components to decrease –> further injury r/t compression of tissue

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3
Q

causes of IICP

A

injury
bleeding
hematoma
hydrocephalus
tumor
encephalitis / meningitis

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4
Q

factors that influence ICP

A

body temp
oxygenation status
body position
arterial / venous pressure
vomiting / bearing down –> pressure in intra-abd wall

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5
Q

normal ICP

A

0-15 mmHg

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6
Q

increased ICP range

A

pressure > 20 mmHg for 5 min or more

**sustained IICP = herniation

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7
Q

cerebral perfusion pressure (CPP)

A

pressure that pushed blood to the brain

**when it is too low the brain is not perfused –> brain tissue DEATH

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8
Q

CPP range

A

60-100 mmHg

**MUST be maintained at 70 for those with brain injury

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9
Q

CPP formula

A

CPP = MAP - ICP

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10
Q

early s/s of IICP

A

DECREASED LOC!!!
restless
confused
not responding

**any mental status changes are early sign

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11
Q

late s/s of IICP

A

irregular breathing - Cheyne Stokes hyperventilation –> apnea!!!
Cushing’s Triad
babinski reflex
HA
seizure
posturing
doll’s eye
vomiting

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12
Q

Cushing’s triad

A

increased systolic BP / decreased diastolic BP
bradycardia
irregular RR

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13
Q

decerebrate posturing

A

arms beside body
hands flexed
forearm pronated

**more ominous posture

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14
Q

decorticate posture

A

arms pulled into body , hands flexed

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15
Q

IICP monitoring

A

catheter or sensor

-subarachnoid bolt
-intraparenchymal sensor
-intraventricular catheter

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16
Q

subarachnoid bolt

A

bolt / screw inserted into hole drilled into skull and threaded into place at inner table of skull

-decrease infection risk
-inability to drain CSF, risk of bolt becoming occluded w/ blood, tissue, dura
-increase risk of drifting

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17
Q

intraparenchymal sensor

A

inserted below dura into white matter of frontal lobe

-less drifting overtime
-CSF not able to drain

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18
Q

intraventricular catheter

A

used for monitoring ICP and DRAINING CSF

-MUST be leveled to external auditory meatus of ear
-drainage controlled by raising or lowering collection burette
-high infection risk and bleeding

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19
Q

IICP dx labs

A

ABGs
CBC
coagulation
electrolytes
serum osmolality
urinalysis and osmolality

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20
Q

IICP dx tests

A

CT
MRI
cerebral blood flow with transcranial doppler
EEG

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21
Q

IICP surgical management

A

remove section of cranium and dura to allow space for swelling brain

**hemicraniectomy

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22
Q

IICP medical management

A
  1. oxygenation
  2. diuretics
  3. fluids
  4. BP management
  5. seizure precautions
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23
Q

IICP oxygenation

A

-mechanical ventilation
-MAINTAIN PaO2 > 80 mmHg
-MAINTAIN PaCO2 > 35-45 mmHg

**DO NOT allow hyperventilation

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24
Q

IICP diuretics

A

reduce brain tissue volume

-osmotic = mannitol and hypertonic saline
-loop = lasix

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25
Q

mannitol diuretic

A

need good kidney / heart function
use FILTER NEEDLE
strict i/o management

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26
Q

IICP fluids

A

optimize MAP
-normal saline
-i/o
-serum osmolality < 320

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27
Q

IICP blood pressure

A

MAP 70-90 mmHg
CCP at least 70 mmHg

**AVOID HTN

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28
Q

HTN can cause….

A

increase cerebral blood volume
use antihypertensives –> nicardipine and labetolol

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29
Q

IICP seizure precautions

A

dilantin
fosphenytoin
keppra
valium
ativan

**all prophylaxis

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30
Q

IICP sedatives

A

morphine
versed
fentanyl
propofol

**reduce pain, agitation, restlessness

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31
Q

IICP neuromuscular blockade or barbiturates

A

used for pts unresponsive to other tx

**pts MUST have arterial pressure monitor, mechanical sedation, and intensive nursing management

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32
Q

IICP nursing actions

A

HOB 30-35 degrees!!!
head midline
no flexion of neck / hips
suction only when necessary
neuro exams
vitals
ICP and CPP measurement
temp control
sedatives

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33
Q

IICP suctioning protocol…

A

suction as needed
10-15 seconds –> coughing when increases ICP
HYPERVENTILATE before and after!!!

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34
Q

IICP temperature control

A

cooling blankets , ice packs placed in axilla and groin , centrally placed catheter with cooling water flow

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35
Q

serum sodium / osmolality

A

monitor after mannitol administration
serum sodium ensures pull of water out of brain tissue
-160 mEq / L !!!

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36
Q

IICP EKG

A

monitor rhythm , catecholamines released in body at time of injury increasing risk of cardiac injury

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37
Q

Traumatic brain injury risks

A

alcohol use
drug use
sports
not wearing seat belt
men
very young / very old

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38
Q

TBI classification

A

based off Glasgow Coma Scale (GCS)
-mild = 13-15
-moderate = 9-12
-severe = 8 or less

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39
Q

GCS of 8…

A

INTUBATE

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40
Q

TBI phases

A

primary (Coup) - initial impact
secondary (Contrecoup) injury - rattling around of brain

**want to prevent secondary injury

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41
Q

TBI types

A
  1. skull fracture
  2. concussion
  3. contusion
  4. penetrating
  5. diffuse axonal injury
  6. epidural hematoma
  7. subdural hematoma
  8. subarachnoid hematoma
  9. subarachnoid hemorrhage
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42
Q

linear skull fracture

A

hallmark sign of basilar skull fracture = visualization of fluid from ear / nose (LEAKING OF CSF)

-CSF will separate from blood on gauze
-NO SUCTION, NO blowing nose, NO tubes
-HOB elevated
-neuro check
-pat fluid w/ gauze

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43
Q

late s/s of basilar fracture

A

bruising around eyes (raccoon eyes) or ears (battle’s sign)

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44
Q

depressed skull fracture

A

scalp is lacerated and dura is torn –> meningitis

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45
Q

comminuted skull fracture

A

multiple linear fractures , “eggshell fracture”

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46
Q

concussion

A

structural injury does not appear on imaging damage occurs at cellular level

-CAN go to sleep if someone else is w/ them

47
Q

contusion

A

superficial bleeding on surface of brain
can expand to hematomas or cerebral edema

-frequent neuro assessments to see development of cerebral edema or hematoma

48
Q

diffuse axonal injury (DAI)

A

widespread white matter axonal injury , vasodilation –> increased cerebral blood volume –> IICP

49
Q

epidural hematoma

A

collection b/t inner table of skull and dura
-associated with linear fracture

**typically will have brief LOC followed by lucid period before deterioration

50
Q

epidural hematoma deterioration

A

LOC decrease
contralateral deficits
pupil on side of lesion becomes fixed and dilated

**emergency neurosurgery to get rid of hematoma , ONLY TX

51
Q

subdural hematoma

A

occurs when vein is torn around cerebral cortex
-acute
-subacute
-chronic

52
Q

acute subdural hematoma

A

occurs within 48 hrs of injury , risk of death is high r/t expanding

53
Q

subacute subdural hematoma

A

occurs 48 hrs - 2 weeks post injury , onset is later because hematoma grows slowly

54
Q

chronic subdural hematoma

A

result of low velocity impact, seen in elderly / alcohol abusers / those taking anticoagulants

55
Q

subarachnoid hemorrhage

A

most common, may be r/t cerebral aneurysm
local vasospasm occurs

56
Q

subarachnoid hemorrhage s/s

A

horner’s sign
-miosis = pupillary constriction
-ptosis = eyelid drooping
-anhidrosis = decrease in sweating

57
Q

TBI complications

A

SIADH
Diabetes Insipidus

-IICP
-herniation
-meningitis

58
Q

diabetes insipidus

A

occurs w/ NO ADH

-rapid UO increase (polyuria)
-dehydration
-dry mucous membrane
-thirst
-diluted urine

59
Q

diabetes insipidus tx

A

replace fluid losses and ADH w/ exogenous form IV , sub-q, intranasally

60
Q

SIADH

A

excessive amount of ADH secreted

-retention of water
-weight gain
-low UO
-concentrated urine
-hyponatremia

61
Q

SIADH tx

A

fluid restriction , 1000-2000 mL / day so UO exceeds intake sodium returns to normal

62
Q

TBI medical management

A

-neuro assessment : GCS
-airway management
-hemodynamic monitor
-ICP
-lab test
-enteral nutrition : AFTER 72 hrs. of not eating
-seizure precaution
-temp control

63
Q

TBI surgical management

A

skull fractures = debridement / clean wound
craniotomy
surgical evacuation of EPIDURAL and SUBDURAL hematomas

**surgery not indication for DAI b/c no specific blood removal

64
Q

Parkinson’s Disease

A

loss of dopamine, Ach neurons proliferate still causing loss of initiation / control of voluntary movement

65
Q

Parkinson’s diagnosis

A

2 or more symptoms with asymmetrical presentation…
-resting tremors
-muscle rigidity
-bradykinesia = slow movement
-akinesia = loss of movement
-postural instability = impaired balance

66
Q

parkinson’s physical assessment

A

mood alteration
slow, shuffle gait
widened gait
postural instability
drooling
“pill rolling” tremor
cogwheel rigidity
masklike face
bowel / bladder function

67
Q

Parkinson’s medications

A

anticholinergic meds
dopamine receptor agonists
Levodopa
entacapone

68
Q

anticholinergic meds are avoided….

A

in OLDER POPULATION and GLAUCOMA

-confusion
-memory impairment
-blurred vision
-dry mouth
-constipation
-urinary retention

69
Q

anticholinergic meds

A

Artane and Benzotropine

70
Q

dopamine receptor agonists avoid….

A

cardiac / renal / psych disorders

-n/v
-drowsiness
-orthostatic hypotension

71
Q

dopamine receptor agonist meds

A

Ropinirole and Pramipexole

72
Q

Levodopa / Carbidopa

A

will take about 3 weeks to work
long term use includes “weaning off”

-nausea
-involuntary movements

73
Q

Entacapone (Comtan)

A

use with Levodopa / Carbidopa

-blocks COMT enzyme that breaks down Levodopa allowing effects to last longer

74
Q

Entacapone avoid….

A

MAO inhibitors
avoid foods high in vitamin B6
high protein meals

75
Q

parkinson’s nursing action

A
  1. meds
  2. safety precaution
  3. nutrition intake
  4. elevate HOB when eating / drinking
  5. suction equipment @ bedside
  6. administer stool softener
  7. self care activities
  8. PT / OT / speech therapy
76
Q

Parkinson’s education

A

MEDICATIONS
safety precautions - take short delicate steps,
psychosocial support - depression is common

77
Q

dementia

A

progressive neurodegenerative disease : impaired cortical fxn
impaired cognitive fxn
umbrella term - Alzheimer’s most common

78
Q

Alzheimer’s disease s/s

A

first symptoms = forgetfulness
difficult w/ language
short term memory loss
agnosia - inability to process sensory info
emotional lability
personality change
loss of cognitive skills
loss of executive functioning

79
Q

Parkinson’s safety

A

shoes with rubber soles
beds low to ground
good nutrition

80
Q

Alzheimer’s medication

A
  1. Donepezil
  2. Excelon
  3. Razadyne

**all increase Ach functioning

81
Q

NMDA antagonist used for Alzheimer’s

A

memantine : decreases symptoms of dementia and cognitive decline

82
Q

Alzheimer’s assessment

A

-weight , I/O
-bowel and bladder fxn
-skin assessment
-ADLs
-environment and safety!!!
-coping

83
Q

Alzheimer’s action

A
  1. encourage feedings
  2. low bed, grab bars
  3. toileting routine
  4. clock / calendar
  5. routine walks
  6. calm speech
  7. diversionary activity
  8. activities during day to rest at night
84
Q

Alzheimer’s teaching

A

-label substances and secure them
-monitor systems that will alert when family member tries to leave
-support groups

85
Q

myasthenia gravis

A

no acetylcholine is binding resulting in skeletal muscle weakness, fatigue, ocular and bulbar symptoms

86
Q

myasthenia gravis s/s

A

Weakness to neck, face, arms
Eyelid Drooping (ptosis)
Appearance masklike, no expression
Keep choking / gagging when eating
No energy
Extraocular muscle involvement
Slurred speech
SOB

**s/s get worse at night!!

87
Q

myasthenia gravis tests

A
  1. serological testing
  2. repetitive nerve stimulation / electromyography
  3. single-fiber electromyography
  4. tensilon test
  5. CT chest scan
88
Q

tensilon test

A

edrophonium given IV push, if NO change additional doses given every min.

**improvement within 5 min = positive test

89
Q

myasthenic crisis

A
  1. NOT ENOUGH anticholinesterase meds
  2. stress
  3. respiratory infection!!!
  4. surgery
90
Q

myasthenic crisis tx

A

IV immunoglobulin or plasmapheresis

91
Q

cholinergic crisis

A

TOO MUCH anticholinesterase medication

92
Q

cholinergic crisis s/s

A

bradycardia
muscle twitch
sweating
pallor
excessive secretions
small pupils

93
Q

edrophonium antidote….

A

atropine –> anticholinergic

94
Q

myasthenia gravis priority meds

A

Mestinon
Neostigmine
Immunoglobulin
Plasmapheresis
Immunotherapy

95
Q

myasthenia gravis actions

A

meds
elevate HOB
speech consult
dietary education
MEDICATION
rest periods
medical alert bracelet
GET ALL VACCINES

96
Q

pyridostigmine education

A

keep this medication on hand AT ALL TIMES…. need to take every 4 hrs

97
Q

Guillain barre syndrome

A

occurs after infection progressing into rapid progressing flaccid paralysis

**resp / GI infections are most common

98
Q

GBS patho

A

pts immune system begins to destroy the myelin around nerves eventually leading to paralysis

99
Q

GBS s/s

A

-SYMMETRICAL ascending motor weakness / paralysis
-after first few days of weakness, neuro assessment diminished
**starts in the toes and up it goes

100
Q

GBS dx

A

progressive weakness of 2 or more limbs
electromyography : slowed nerve conduction
Lumbar puncture

101
Q

GBS tx

A

supportive care,
-IV immunoglobulin
-plasmapheresis

102
Q

GBS actions

A
  1. respiratory assessment
  2. CN assessment
  3. Motor / sensory assessment
  4. pain assessment
  5. turn / ROM exercise
  6. VTE prevention
  7. method of communication
103
Q

GBS CSF

A

will have protein but ABSENT WBCs

104
Q

multiple sclerosis

A

neurological disorder where nerves of CNS degenerate

105
Q

multiple sclerosis s/s

A

depends on location of affected nerve fibers :
-numbness / weakness of one or more limbs
-partial / complete vision loss , often with pain during eye movement
-double or blurred vision
-tingling or pain
-electric shock sensations w/ head movement
-tremor , lack of coordination , unsteady gait
-fatigue
-dizziness
-bowel / bladder dysfunction

106
Q

MS tests

A

NO specific test, must have 2 separate symptomatic events or MRI changes in at least 2 separate locations

**rule out literally everything else

107
Q

MS meds

A

-immunodulators
-immunosuppressants
-muscle relaxants
-corticosteroids
-anticonvulsants
-laxatives

108
Q

complete spinal cord injury

A

total loss of motor function below level of injury

109
Q

incomplete spinal cord injury

A

incomplete structural damage w/ some function below injury

110
Q

spinal cord injury treatment

A

maintain airway
adequate breathing and oxygenation
prevent shock
spinal immobilization
restore / maintain BP

111
Q

thoracic injuries s/s

A

autonomic dysreflexia
visceral distention from noxious stimuli - distended bladder, impacted rectum

112
Q

gardner wells tongs

A

used for cervical traction, pressure control pins are inserted into skull, tongs are attached to wts

113
Q

halo traction

A

maintain cervical mobilization, ring around pts head attached to special vest

**think regina george

114
Q

spinal cord injury interventions

A
  1. respiratory assessment
  2. vitals
  3. pain management
  4. i/o
  5. spinal immobilization
  6. bowel sounds
  7. reposition
  8. ROM and VTE prophylaxis

Critical Care (15 decks)

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