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Med Surg > Neurological > Flashcards

Neurological Flashcards

1
Q

The central nervous system consists of what two components?

A
  1. Brain

2. Spinal Cord

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2
Q

The peripheral nervous system consists of what two components?

A
  1. Cranil nerves (12)

2. Spinal nerves (31)

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3
Q

The autonomic nervous system consist of what two components?

A
  1. Sympathetic “flight or fight” (sweaty palms, increased HR, shaky)
  2. Parasympathetic “rest and digest”
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4
Q

Neurological Assessment (9)

A
  • family hx (hx of MI’s, strokes, & vertigo)
  • level of consciousness/orientation
  • memory & attention (one of the biggest assessment features)
  • sensory function (taste, feel, touch)
  • cerebellar function (Rhomberg test for balance)
  • cerebral function (cerebrum is the largest part of the brain & is responsible for intelligence)
  • cranial nerves
  • motor system
  • sensory system
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5
Q

Expected Findings in Aging Patients (5)

A
  • decreased sensation
  • decreased taste
  • decrease agility & strength
  • shuffled gait
  • decreased cognitive ability
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6
Q

Diagnostic Testing Performed to Determine Neurological Function

A
  • Glasgow Coma Scale
  • Lab Test (blood culture, cerebral angiography, CT scan)
  • MRI
  • EEG
  • Lumbar Puncture
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7
Q

Diagnostic test to measure of how alert & oriented the patient is.

A

Glasgow Coma Scale

  • highest score is 15
  • anything most (ex. sternum rub)
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8
Q

Describe decorticate position. (3)

A
  • inward flexion
  • plantar feet
  • seen post-seizure, had injuries, brain tumors
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9
Q

Describe decerebrate position. (3)

A
  • outward flexion
  • deadly for patient
  • associated w/ brain stem issues (speech, breathing, regulates temperature-hypothalamus)
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10
Q

-test performed to look for specific microorganisms so that exact treatment is known

A

Blood Cultures

*drawback is length of time is takes to get results (7-10 days)

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11
Q

-test performed that looks at the blood flow to the head, brain and neck (to assess if there are any blockages or strokes)

A

Cerebral angiography

*make sure to assess for allergies such as shellfish and iodine

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12
Q

___ ________ are performed on patients that can not have a MRI performed.

A

CT Scans

  • contrast medium causing an increased urine sensation, heart, and possible diarrhea afterwards
  • Major Lab Values: BUN & Creatinine to assess kidney function
  • Increase fluids with this patients!
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13
Q
  • Best test for neurological issues
  • Patient has to remain very still during test
  • contraindicated for patients with impacts and/or pacemakers
A

Magnetic Resonance Imagine (MRI)

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14
Q

Electroencephalography (EEG)

  • purpose
  • use for dx of what
  • meds to avoid
  • prior to test
A
  • purpose: looking at the electrical activity of cerebral hemispheres
  • dx: seizures, most of the time epilepsy
  • meds to avoid: CNS depressants (narcotics), seizure meds, stimulants (ex.caffeine)
  • prior to test: pt needs to be woken up @ 0200 (needs to be sleep deprived) and hair must be washed before test
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15
Q

A lumbar puncture is performed between _____ & _____ in the spine.

A

L4; L5

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16
Q

Indications for a Lumbar Puncture (3)

A
  • meningitis
  • spinal cord lesions (paralyzed patients)
  • pt’s with a lot of back pain
  • used for diagnosis and treatment
  • empty bladder before procedure
  • during procedure- lateral recumbent (side-lying “fetal-like” position) and strict asepsis!!
17
Q

After a lumbar puncture is important for a patient to ______ ________ to avoid spinal leakage and horrible headache.

A

Lay flat

18
Q

-sudden, abnormal, uncontrolled electrical discharge from cerebral neurons

A

Seizure

*epilepsy- medical disorder characterized by chronic recurring abnormal brain electrical activity

19
Q

What are the two different classifications of seizures?

A
  1. Partial seizures- begin in one part of the brain; simple partial->consciousness remain intact, complex partial->impairment of consciousness
  2. Generalized seizures- involve the whole brain
20
Q

Causes of Seizures (6)

A
  • fever (children)
  • head injuries
  • hypertenson
  • brain tumors
  • drug & alcohol withdrawal
  • allergies
21
Q

Documentation of Seizure (5)

A
  • length of time
  • injuries
  • type/movements
  • what happened before the seizure
  • if patient was incontinent during seizure
22
Q

Safety Measures During a Seizure (5)

A
  • bed rails up (may be padded if on seizure precaution)
  • bed in low position
  • patient in chair->move to floor
  • nothing in the mouth
  • loosen restrictive clothing (if possible)
23
Q

Interventions After a Seizure

A
  • side-lying position (prevent aspiration & open airway)
  • vital signs
  • assess for injuries
  • may have to reorient patient (pt usually very lethargic)
  • documentation
24
Q

Common side effect of seizure medications.

A

Gum overgrowth

-oral hygiene important

25
Q

Surgical Interventions for Seizure Patients (2)

A
  1. Vagal Nerve Stimulator (“pace maker” to slow brain activity)
  2. Surgical removal of brain tissue causing seizure (exact affect lobe is known, pt is awake, EEG monitoring)
26
Q

-prolonged seizure activity occurring over a 30 minute time frame

A

Status Epilepticus

**#1 cause is abruptly stopping seizure medications

27
Q

Complications Associated with Status Epilepticus (2)

A
  • decreased oxygen levels->brain damage

- glucose uptake->metabolic needs not being met

28
Q

Priorities of Status Epilepticus (3)

A
  • airway!!!
  • admin meds (monitor IV patenct; usually given Ativan & Valium)
  • after med given, following protocol for “after a seizure” (e.g side-lying, vital signs…)
29
Q

Meningitis

-definition

A

inflammation of the membrane and the fluid space surrounding the brain and spinal cord

30
Q

Assessment Findings of Meningitis (6)

A
  • fever
  • headache (hallmark)
  • neck stiffness
  • positive Kernig’s sign
  • positive Brudzinski’s sign
  • photophobia (sensitive to light)
31
Q

_____________ meningitis is contagious, however all patient are put on isolation precautions.

A

Bacterial

32
Q

Guillain-Barre

  • definition
  • recovery time
  • major issue
A
  • demyelination of peripheral nerves (the immune system overreacts to the infection and destroys the myelin sheath)
  • ascending paralysis that can take 6-12 months to recover from
  • major issue: respiratory care (ventilator may be necessary)
  • associated with: acute illness, surgery, HIV
33
Q

Myasthenia Gravis

A
  • progressive autoimmune disease
  • severe skeletal muscle weakness
  • insufficient secretion of acetylcholine->muscle fibers are unresponsive to acetylcholine
34
Q

Nursing Assessment of Patient with Myasthenia Gravis (3)

A
  • muscle weakness (heart, respirations, incontinence, drooping eyelids)
  • diplopia (double vision)
  • difficulty chewing & swallowing

*Tensilon test is performed to diagnosis this disease

35
Q

Multiple Sclerosis

  • definition
  • hallmark
  • 3 different types
A
  • chronic demyelinating disease affecting myelin sheath of neurons in CNS
  • hallmark: extreme fatigue
  • relapsing-remitting, secondary progressive, primary-progressive
36
Q

Relapsing-remitting (MS)

-description

A
  • most common (85%)

- episodes of acute worsening with recovery

37
Q 
Secondary Progressive (MS)
-description
A
  • affects about 50%
  • develop in 10 years
  • period of doing well then get worse

*meds need to be introduced

38
Q

Primary-Progressive (MS)

-description

A
  • rare (approx. 10%)
  • slow, worsening
  • no relapse
  • patient gradually deteriorates

Med Surg (5 decks)

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