Neuro NP 615

Question 1

Neuro H & PE

Answer 1

Migraines: -Tx with compazine or Reglan
If nothing taken, give Imotrex
IF there is stiff neck, fever or changes in mental status, do a CT, Lumbar puncture or both to rule out intracranial pathology or infection.

Question 2

If it is the worst headache ever

Answer 2

do more of a intensive workup

Question 3

If the client is over 50

Answer 3

Consider arteritis
Obtain ESR
There will be jaw cluadification and tenderness over the temporal artery. The ESR will be elevated to more than 50mm per hour

Question 4

Migraine

Answer 4

unilateral pain is eve more characteristic than aura

Question 5

Acute seizure drugs

Answer 5

Give 2-4 mg IV Ativan at 2mg/min

If longer seizure, give Dilantin 10-15 mg/kg IV over 30 minutes See slides below.

Question 6

In status epilepticus

Answer 6

Check blood sugar

Question 7

If the client has tremors, tachycardia and hallucinations, tx with Benzos.

Answer 7

MRI for epilepsy.

Question 8

children who present in status epilepticus

Answer 8

Give Dilantin, 20mg/kg IV at less than 1mg/kg/min up to 1000mg

Question 9

Head injury

Answer 9

Grade 1-no loc but may be briefly confused.
Grade 2-no loc or brief (less than 5 inutes) but confusion lasts longer than 15
Grade 3: los longer than 5 inutes or post amnesia longer than 24 hours

Question 10

head injury

Answer 10

Check head for fx, periorbital ecchymosis (battle &racoon signs) or bony depression. examine the neck and limited rom

Question 11

status epilepticus

Answer 11

0-5 Dx, give O2, establish IV line, obtain blood samples for glucose.
6-9 If hypoglycemic administer glucose
A=thiamine 100 mg followed by 50 ml of 50% glucose IV
Children: give 2 ml/kg 25% glucose
10-20 Give either 0.1g/kg lorazapam at 2mg/min or 0.2mg/kg of diazapem at 5 mg/min by IV
21-60 IF SE persists, give 15-20mg/kg phenytoin IV no faster than 50 mg/min in adults and 1 mg/kg/min for children
>60 If SE does not stop, at the phenytoin, give 20mg/kg of phenobarbital IV at 100 mg/min. If persists, consult anesthesiologist for pentobarbital coma.

Question 12

Head trauma

Answer 12

should include puliarry response, extraocular motion, romberg, gait, finger to nose, memory and concentration.
Do CT

Question 13

More than 5 minutes of unconsciousness

Answer 13

or a 12-14 GCS, seizures or a lesion on the CT scan, should be hospitalized and observed/

Question 14

Headache types

Answer 14

migraine with aura
migraine without aura
tension
cluster

Question 15

Headaches

Answer 15

Look for triggers
Medications
OTCs
N/V
Serious: onset after 50 yrs of age
personality change, worst headache of my life, papilledema, painful temporal arteries. 
CT scan or MRI if indicated