Neurological Assessment & diagnostics

Question 1

GCS is what?

Answer 1

A scale that measures the degree or LOC

Question 2

GCS is used to assess the LOC in a client who already has altered _____ or has the potential for it

Answer 2

Altered consciousness

Question 3

Three responses of the GCS?

Answer 3

Eye opening (4)
Verbal response (5)
Motor response (6)

Question 4

We like a high number ranging from ____ for the GCS

Answer 4

13-15

Question 5

What is always #1 with neurological assessment

Answer 5

LOC

Question 6

Factors that can alter the GCS?

Answer 6

Drug use
Alcohol intoxication
Shock
Hypoxia

Question 7

Normal pupil size is ?

Answer 7

2-6 mm

Question 8

Hang grips/lifts legs/pushing strength of ___

Answer 8

Feet

Question 9

Babinski reflex is normal in a child up to ___

Answer 9

1 year (depends when child starts walking)

Question 10

Babinski is abnormal in ___

Answer 10

Adult (or basically anyone who walks)

Question 11

The adult or child greater than one year should have a normal reflex or ___ of the toes when the bottom of the foot is stroked

Answer 11

Curling

Question 12

What does it mean if the adult has a present Babinski reflex or fanning of the toes when you stroke the bottom of the foot?

Answer 12

A severe problem in CNS

• tumor or lesion on brain or SC
• MS
• Lou Gehrig disease

Question 13

A normal reflex response would be documented as ?

Answer 13

2+/4+

Question 14

General diagnostic tests: CT

Dye?

Answer 14

With or without —if it has dye then need consent form

Question 15

General diagnostic tests: CT

Take pictures in ___

Answer 15

Slices

Question 16

General diagnostic tests: CT

Head

Answer 16

Keep head still

No talking

Question 17

General diagnostic tests: MRI

What is better: CT or MRI?

Answer 17

MRI

Question 18

General diagnostic tests: MRI

Dye?

Answer 18

Not usually used

Question 19

General diagnostic tests: MRI

Radiation?

Answer 19

No..magnet used

Question 20

General diagnostic tests: MRI

Position?

Answer 20

Will be placed in a tube where client will have to lie flat

Question 21

General diagnostic tests: MRI

What can you not have on

Answer 21

No jewelry
No credit cards
NO PACEMAKERS

Question 22

General diagnostic tests: MRI

Tattoos ?

Answer 22

Old tats may contain medal

Question 23

General diagnostic tests: MRI

Teeth fillings

Answer 23

Don’t matter

Question 24

General diagnostic tests: MRI

What client can’t tolerate this?

Answer 24

Clausterpobic

Question 25

General diagnostic tests: MRI Can talk and hear others when in tube?

Answer 25

Yes

Question 26

Cerebral angiography Consent form? What is it? What artery does it go through

Answer 26

Yes, because dye used X-ray of cerebral circulation Go through the femoral artery

Question 27

Cerebral angiography-Pre procedure Well hydrated/void/peripheral pulses/groin prepped ....Explain

Answer 27

Anytime an iodine based dye used, client will need to be well hydrated to promote excretion of the dye Watch: BUN and Cr, UO, and hold metformin

Question 28

Cerebral angiography-Pre procedure What drug to hold?

Answer 28

Metformin

Question 29

Cerebral angiography-Pre procedure Explain what?

Answer 29

Will feel warmth in face and a metallic taste

Question 30

Cerebral angiography-Pre procedure Allergies?

Answer 30

Cannot have allergies to shellfish or iodine

Question 31

Cerebral angiography-Post procedure Bed rest

Answer 31

4-6 hours

Question 32

Cerebral angiography-Post procedure Monitor for?

Answer 32

Bleeding/hemorrhage!!!

Question 33

Cerebral angiography-Post procedure Possible complication?

Answer 33

Embolus *get baseline data because an embolus could go to arm, heart, lung, kidney, or brain

Question 34

Cerebral angiography-Post procedure Embolus to brain s/s?

Answer 34

Change in LOC One sided weakness Paralysis Monitor/sensory deficits

Question 35

EEG Does what?

Answer 35

Records activity of the brain

Question 36

EEG Used for what?

Answer 36

- Diagnose and evaluate seizures - Evaluates LOC and dementia - Screening procedure for coma - Sleep disorders (narcolepsy, cerebral infarct, brain tumor or abscess)

Question 37

EEG Use this for an indicator of ___

Answer 37

Brain death

Question 38

EEG-Pre-procedure Sedatives? Caffeine? NPO?

Answer 38

Hold sedatives (sedatives decrease electrical activity in brain; alters test) NO caffeine (changes electrical activity of brain) Not NPO!!! (drops blood sugar)

Question 39

EEG Beginning of procedure get what? May be asked to do what?

Answer 39

Baseline first with client lying quietly (resting EEG) May be asked to hyperventilate to assess brain circulation, assess photo stimulation for seizures, or sedate for sleep study *if someone unconscious then pain response or noxious stimuli may be introduced to stimulate brain wave (strong smell/bright light)

Question 40

Puncture site?

Answer 40

Lumbar subarachnoid space

Question 41

Lumbar puncture Purpose? (3)

Answer 41

1. Obtain SF to analyze for blood, infection, and tumor cells 2. Measure pressure readings with manometer 3. To give drugs intrathecally (brain, SC)

Question 42

Lumbar puncture Position

Answer 42

Back arched (side lying fetal or arched over)

Question 43

Lumbar puncture Inspect? Normal CSF?

Answer 43

Insect surrounding skin at puncture site for infection CSF should be clear and colorless (looks like water)

Question 44

Lumbar puncture: Post procedure Position? Fluids? Most common complication?

Answer 44

Lie flat or prone for 2-3 hours so seal can form Increase fluids to replace lost spinal fluid Most common complication: HA

Question 45

Lumbar puncture: Post procedure HA pain increases when the client ___ and decreased when the client ____

Answer 45

Increase when sit up Decrease when lie down

Question 46

Lumbar puncture: Post procedure How to treat HA?

Answer 46

Bed rest Fluid Pain med Blood patch

Question 47

Lumbar puncture: Post procedure Life-threatening complications?

Answer 47

Brain herniation | Meningitis

Question 48

Lumbar puncture: Post procedure Never do LP with someone who has ____

Answer 48

Known increased ICP---this is life threatening to do on this client!!!!

Question 49

Lumbar puncture: Post procedure Meningitis

Answer 49

Bacteria can get in puncture site and into SF and cause meningitis