Neurological 2- Exam 2 Flashcards
Definition: Failure to recognize familiar objects perceived by the senses.
Agnosia
What is the functional abnormality of the CNS that occurs when the blood supply to the brain is disrupted?
Cerebrovascular Disorder
What is the most important modifiable risk factor in CVA prevention?
Hypertension
What are some risk factors of cerebrovascular disorders?
-Age
-Gender
-Ethnicity
-HTN
-CV disease
-^ chol & ^ Hct
-Obesity
-Diabetes
-Smoking/alcohol/drug use
-Oral contraceptives
What is a stroke known as? (in hospital)
“brain attack”
What are the 2 types of strokes?
Ischemic & Hemorrhagic
What type of stroke is most common?
Ischemic
What types of ischemic strokes are there?
-Large artery thrombosis
-Small penetrating artery thrombosis
-Cardiogenic embolism
-Cryptogenic
-Other
What do symptoms of a stroke depend on?
Location & size of affected area
What are some C.M. of a stroke?
-Numbness or weakness of face, arm, or leg, especially on one side
-Confusion or change in mental status
-Trouble speaking & understanding speech
-Difficulty in walking, dizziness, loss of balance
-Sudden, severe HA
Definition: Paralysis on 1 side of body.
Hemiplegia
Definition: weakness on 1 side of body.
Hemiparesis
Definition: difficulty speaking caused by brain damage, results in inability to control the muscles used in speech.
Dysarthria
Definition: difficulty swallowing.
Dysphagia
Definition: can understand but not talk or express themselves.
Expressive aphasia
Definition: can talk but can’t understand.
Receptive aphasia
Definition: blindness over 1/2 of the visual field.
Hemianopsia
Definition: loss of ability to identify objects or people.
Agnosia
What is a temporary neurologic deficit resulting from a temporary impairment of blood flow?
TIA
What is a TIA a warning of?
Impending stroke
What are preventative tx of TIA & stroke?
-Carotid endarterectomy for carotid stenosis
-Anticoagulant therapy for A-Fib
-Antiplatelet therapy
-“Statins”
-Antihypertensive meds
What type of stroke is thrombolytic therapy used for?
Ischemic
Why should the HOB be elevated in the acute phase of a stroke?
Decreased ICP & ^ venous drainage
What diagnostic should be performed if a stroke is suspected?
Head CT
What are C.M. of a hemorrhagic stroke?
-Severe HA
-Early & sudden changes in LOC
-Projectile vomiting w/out nausea
-Bleeding
How is the type of stroke differentiated?
CT
What is the most important NURSING intervention if a patient is experiencing a hemorrhagic stroke?
ABC’s
How should the HOB be positioned in a post stroke pt?
High Fowler’s ~ 90 degrees to prevent aspiration
How is impaired physical mobility after a stroke improved?
PT
Why are analgesics usually prescribed after a stroke?
Shoulder pain
Who can help with self-care deficits after a stroke?
OT
Who assesses for gag reflex after a stroke?
Speech therapist
Should a Foley catheter be inserted in a patient with urinary incontinence following a stroke?
No, bowel & bladder retraining should take place
What is nuchal rigidity a C.M. of?
Hemorrhagic stroke OR meningitis
What are potential problems in a hemorrhagic stroke?
-Vasospasm
-Seizures
-Hydrocephalus
-Rebleeding
-Hyponatremia
What is the #1 reason for morbidity or mortality for subarachnoid hemorrhagic stroke?
Vasospasm
When will a patient begin rehabilitation after a stroke?
Same day
Definition: inflammation of the meninges, which cover & protect the brain and spinal cord.
Meningitis
What are the 2 types of meningitis?
Bacterial & viral
What are some C.M. of meningitis?
-HA
-fever
-changes in LOC
-behavioral changes
-nuchal rigidity (stiff neck)
-photophobia
What is the positive Kerning sign?
Pt. is lying w/ thigh flexed, other leg cannot be completely extended w/out severe back pain
What is the positive Brudzinski sign?
Nuchal rigidity causes the knees to flex when the neck is raised
How can meningitis be prevented?
Meningococcal vaccine to youth 11-12 y/o, booster at 16.
What is the tx for bacterial meningitis?
-Early administration of IV broad spectrum abx
-Dexamethasone
-Tx for dehydration, shock, & seizures
What type of precaution is bacterial meningitis?
Droplet
What is a brain abscess?
Collection of infectious material w/in brain tissue
What is the tx for a brain abscess?
CT-guided aspiration or drain content of abscess & treat for pathogen to decrease ICP
What can cause encephalitis?
Viral infections (HSV, west nile), fungal infections
What are C.M. of encephalitis?
-HA
-fever
-confusion
-hallucinations
-rash
-flaccid paralysis
-Parkinson-like movements
What is the tx regimen for encephalitis?
Acyclovir for HSV infection, amphotericin, & other antifungal agents for fungal infection
What is the normal ICP?
<20 mmHg
What is the anti-seizure medication given to a pt. with meningitis?
Lorazepam
What is the antidote to a benzodiazepine?
Flumazenil
Why is the GCS used?
Detects early deterioration of a patient LOC
A GCS of 15 is good or bad?
Good
A GCS of 8 is good or bad?
Bad
What is retrieved during a lumbar puncture?
CSF
Name some interventions for seizure precautions.
-Side rails up
-Side lying position
-Seizure pads against the side rails
-Pillow under head
-Suction available
-Bed in low position
-Curtain for privacy
What are some common anti epileptic medications?
-Carbamazepine
-Lamotrigine
-Gabapentin
-Levetiracetam
-Phenytoin
-Valproic Acid
Phenytoin is used for what condition?
Seizures
What are some infections that can lead to bacterial meningitis?
-Upper respiratory infections
-Otitis media
-Strep throat
-Influenza B
What type of meningitis is usually more mild? Bacterial or viral
Viral
What are some risks associated with bacterial meningitis?
-Increased ICP
-Cerebral Edema
-Septic Shock
-Coma
-Death
Can tPA be used for an ischemic stroke?
Yes
Can tPA be used for a hemorrhagic stroke?
No
What is the IV medication used to decrease ICP?
Mannitol
