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CCRN - My Flashcards > Neurological > Flashcards

Neurological Flashcards

1
Q

Cranial Nerves 1-12

A

I - Olfactory (Smell)
II - Optic (Sight)
III - Oculomotor (Pupil function)
IV - Trochlear (Eye Movement)
V - Trigeminal (Chewing, blinking)
VI -Abducens (Eye Movement)
VII - Facial (Expression, taste)
VIII - Vestibulocochlear (Hearing, balance)
IX - Glossopharyngeal (Swallow, gag)
X - Vagus (Pharyngeal/Laryngeal)
XI - Spinal Accessory
XII - Hypoglossal (Tongue movement)

*All cranial nerves arise from the brain stem except for cranial nerves I and II

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2
Q

Circle of Willis

A
  • The circulatory system of arteries which supply blood to the brain

-The basilar artery and middle cerebral arteries are not part of the Circle of Willis

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3
Q

Mental Status

A
  • A change in level of consciousness is ALWAYS the first sign of a neurological problem (Other than during an epidural hematoma; pupil changes may occur first)
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4
Q

Mental Status Changes

A

Memory: Short term usually changes before long term

Personality: Sometimes the first sign of a problem prior to change in LOC

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5
Q

Reticular Activating System (RAS)

A
  • UPPER responsible for awareness
    -If damaged the patient becomes unaware but still sleeps properly
  • LOWER responsible for sleep cycle
    -If damaged the patient goes in to a coma
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6
Q

Eye Changes

A
  • Sympathetic dilates the pupils
    -Parasympathetic constricts the pupils

-Changes occur on the SAME SIDE as the injury
-“Dolls eye” is good (Eyes move opposite side as head turn)
-“Ice Water” eyes move toward side of ice water injection (in to ear)

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7
Q

Vital Sign Changes

A
  • LATE sign of neurological injury

Cushing’s Triad:
1. Slow respiration rate
2. Slow Heart Rate
3. Widening pulse pressure (Increase systolic)

GCS:
Score 8 or lower typically indicates poor outcome

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8
Q

Eyesight Changes

A

-Opposite side of problem

-Neglect to the same side
- Approach from unaffected side to prevent confusion until vision improves… then approach from affected side

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9
Q

Neuro Assessment Summary

A
  • Eyes deviate towards pathology
  • Pupil changes SAME SIDE
  • Visual Changes OPPOSITE SIDE
  • Motor Changes OPPOSITE SIDE
  • Babinski OPPOSITE SIDE
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10
Q

Brain Herniation (Focus on Uncal and Transtentorial (Central) Herniation)

A

UNCAL
-Displacement of the temporal lobe
-NO initial changes to LOC
-Loss of parasympathetic nervous system on affected side
-**Most often caused by epidural hematoma
-Babinski opposite side

CENTRAL (Transtentorial)
-Bilateral swelling of brain with downward displacement
-Pupils start small and then rapidly dilate
-Babinski bilaterally

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11
Q

Encephalopathy

A
  • A diffuse disease that alters bran function or structure

-May result in swelling and ICP
-Avoid conditions that raise ICP more

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12
Q

Stroke

A

-A medical emergency that occurs when blood flow to the brain is blocked or a blood vessel in the brain bursts

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13
Q

Stroke Treatment

A

-Rule out hypoglycemia
-Assess ABC’s
-Only treat BP acutely if SBP > 220

-CT scan within 25 minutes of arrival/onset

-rTPA use indications
- CT Negative
- onset less than 4.5 hours ago
- No contraindications

-rTPA Contraindications
- MI in last 3 months
- Stroke or head trauma last 3 months
- Major surgery last 14 days
- Active bleeding last 21 days

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14
Q

Post rTPA Infusion Care

A

WORST OUTCOME IS INTRACEREBRAL HEMORRHAGE

-Do not give antiplatelets or anticoagulants within 24 hours
-Maintain BG of 80-150
Elevate head to 45 degrees or more
Keep NPO

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15
Q

Subarachnoid Hemorrhage

A

-Middle cerebral artery aneurysm is most common

-LOC doesnt change until a 3+ on Hunt/Hess scale

Signs:
1. Explosive headache
2. Decreased LOC
3. Nuchal rigidity (stiff neck)

-Surgery for Grade I, II, III within 48 hours

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16
Q

Complications of Subarachnoid Hemorrhage

A

-Hydrocephalus due to chorionic villi in the subarachnoid space reabsorbing CSF
-Re-bleed and Vasospasm

17
Q

Vasospasm

A

-Narrowing of vein that restricts blood flow
-Typically occurs 5-7 post bleed (not post-op)

Treatment:
- Transluminal balloon angioplasty
- AVOID hypotension
- Monitor and treat hyponatremia

18
Q

Brain Tumors

A

-A growth of cells inside or near the brain causing disruption
-The only neurological issue that includes steroid therapy To prevent increased ICP

19
Q

Intracranial Pressure (ICP)

A
  • The first sign of ICP is change in level of consciousness
  • Normal 0-10
  • Moderate 11-20
  • Increased is > 20
  • Monitoring includes transducer placement at the external auditory meatus
  • MEASURE AT “C” wave
20
Q

How to Lower ICP

A

-Decrease volume: Furosemide, mannitol, 3% saline
-Patient Positioning: Sit upright
-Prevent Dilation (acidosis)
-Prevent Constriction (alkalosis)
-Propofol works well
-Use ISOtonic fluids

Keep pH normal ~low~ 7.35

21
Q

Traumatic Brain Injury

A

-A blunt or penetrating insult to the brain from an external force
-CT is diagnostic tool used

22
Q

Epidural Hematoma

Think UNCAL herniation

Younger population

A

-Typically the middle meningeal artery bleeds 2/2 temporal bone trauma
-Symptoms occur RAPIDLY
- Headache, vomiting, contralateral hemiparesis and hemiplegia
- Decreased LOC

Treatment
- Emergent surgery to evacuate the hematoma (burr hole)

23
Q

Subdural Hematoma

Older population

A

-Spontaneously bleeding between the dura and arachnoid matter
-Signs and symptoms occur more slowly and epidural hematoma

Acute: Signs/Symptoms within 24 hours
Subacute: Signs/Symptoms within 2 weeks
Chronic: Sign/Symptoms more than 2 weeks

Treatment
-Monitor for increase ICP
-May need surgical removal

24
Q

Intracerebral Hematoma

A

-Typically caused by a gunshot wound, acceleration-deceleration injury, or laceration of the brain

-Surgery only if neuro status is deteriorating or ICP significantly increased

25
Q

Skull Fractures

A

-A linear fracture does not require surgery
-Elevate depressed skull fractures > 5mm
-Basilar Fracture Next card

26
Q

Basilar Skull Fracture

A

-A linear fracture that occurs in the floor of the cranial vault resulting in a meningeal tear

Signs/Symptoms
- Raccoon eyes
- Periorbitaedema
- Rhinorrhea (no nose blowing)
- Fluid from ear
- Battles Signs (Discoloration behind ear)
-Rare: loss of smell

-Determine if ear/nose drainage is CSF
-Do this by checking for sugar - positive indicates CSF
-Put drainage on 4x4 to watch for “Halo” sign

-DO NOT pack gauze in nose or ear; gently cover areas
-DO NOT block CSF drainage
-DO NOT insert NG tube (use OG)

Surgery ONLY IF CSF is persistent

27
Q

Seizures Overview

A

-Most tonic clonic seizure last less than 3 minutes
-PaCO2 may be high post seizure due to lack of ventilation
-Protect airway and turn to the side

Stop Seizure with
-Ativan or valium (Ativan preferred)

Prevent Seizure with
-Phenytoin, Phenobarbital, Carbamazepine

-Postictal period may follow seizure with transient signs of decreased LOC

28
Q

Status Epilepticus

A

-Seizure activity of 5 minutes or more caused by a single seizure or a series of seizures with no return to consciousness between events
-Death due to cerebral hypermetabolism

29
Q

Meningitis

A

-inflammation of the tissues surrounding the brain and spinal cord

Signs/Symptoms
-Nuchal Rigidity
-Brudzinski’s Sign: Chin to chest causes legs to raise
-Kernig’s Sign: Legs up and out causes pain in leg + neck

-Antibiotics given for bacterial meningitis

30
Q

Brain Death

A

-Complete irreversible cessation of function of the cerebrum, cerebellum, and brain stem
-Apnea Test - 8-12 minutes reconnect ventilator to patient an get an ABG

Provide support to family
Consider organ donation

31
Q

Guillain-Barre Syndrome (GBS)

A

-An autoimmune response to a viral infection.
-Causes demyelination of the lower motor neurons
-ASCENDING paralysis

-IV immunoglobulin (IVIG) over 2-5 days
OR
-Plasma exchange for 5 treatments

32
Q

Myasthenia Gravis

A

-“Grave muscular weakness”
-An autoimmune attack of the neuromuscular junction
-Often has ocular dysfunction

Separated in to 2 Diagnosis:

Myasthenic Crisis: Deficiency of acetylcholine
-Tensilon will IMPROVE outcome

Cholinergic Crisis: Overtreatment/Excess of acetylcholine
-Tensilon will make symptoms WORSE

*Tensilon is given, paient are told to hold their arms out; wait fro signs of weakness or improvement

CCRN - My Flashcards (5 decks)

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