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RENR FOCUS > Neurological System > Flashcards

Neurological System Flashcards

Cranial Nerves, GCS, TBI, Increased ICP, Meningitis

1
Q

How is CN I assessed?

A

Let them smell some peppermint.

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2
Q

What CN assesses visual acuity, visual fields, pupillary reflexes?

A

II

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3
Q

Jane asked Carla to follow her finger in the form of a letter H. What CNs are she assessing?

A

CN III, IV, VI extraocular eye movement

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4
Q

Which nerve is responsible for sensory corneal reflex?

A

CN V

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5
Q

What muscles are CN V responsible for?

A

Muscles of mastication (Temporalis & Masseter)

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6
Q

Which nerve is responsible for motor corneal reflex?

A

CN VII

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7
Q

Whilst CN VII is tested. Carla is able to show her teeth, raise her eyebrows and puff out her cheeks. What muscles were tested.

A

Oribicularis oris - show her teeth

Frontalis - eyebrows

Buccinator - puff of cheeks

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8
Q

Jim’s hearing was tested using the Rhine method. What would indicate hearing loss and why?

A

Hearing the fork more in the affected ear because air conduction dampens the sound.

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9
Q

When nurse Kula elicited a gag reflex and palate elevation in her patient. Which nerve is she testing.

A

IX & X

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10
Q

During the Weber test, Suzy states that she can hear both air conduction and bone conduction at the same level. What hearing loss does she have?

A

Sensorineural hearing loss

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11
Q

List all the cranial nerves in order

A

Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Acoustic/Vestibulocochlear
Glossopharyngeal
Vagus
Accessory
Hypoglossal.

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12
Q

Eye response (4)

A

4 - Spontaneous eye movement
3 - Eye movement with sound
2 - Eye movement with pain
1 - No eye movement

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13
Q

Verbal response (5)

A

5 - Oriented x 3
4 - Confused
3 - Inappropriate words
2 - Incomprehensible word
1 - No response

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14
Q

Motor response (6)

A

6 - Obeys commands
5 - Localizes to pain
4 - Withdraws from pain
3 - Decorticate flexion
2 - Decerebrate extension
1- No response

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15
Q

Oculomotor controls which muscles

A

Superior rectus
Inferior rectus
Medial Rectus
Inferior Oblique

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16
Q

Carla has a loss of somatosensation from anterior 2/3 of tongue. Which CN is affected?

A

V

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17
Q

There is a loss of taste in the posterior 1/3 of the tongue.

A

IX

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18
Q

There is loss of taste in the anterior 2/3 of the tongue.

A

VII

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19
Q

What is Decorticate posturing characterized by?

A

Internal rotation of shoulder

Flexion of forearm and wrist clenched with fist

Plantar flexion

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20
Q

What is Decerebrate posturing is characterized by:

A

Adduction of arm

Internal rotation of shoulder

Pronation of forearm and extension of elbow

Flexion of wrist and fingers

Leg extension and plantar extension of flexion

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21
Q

Issues with cervical spinal tract or cerebral hemisphere can cause

A

Decorticate

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22
Q

Issues with midbrain or pons

A

Decerebrate

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23
Q

Three characteristics

Primary Brain Injury

A

Occurs at the time of trauma
Not preventable
Largerly irreversible

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24
Q

Three characterisitics

Secondary brain injury

A

Follows the initial insult
Is preventable
Primary focus of head injury management

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25
Q

Coup & contrecoup

A

Coup occurs under the site of injury
Contrecoup occurs at the opposite side.

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26
Q

Clinical manifestation of Basilar skull fracture

A

Raccoon eyes
Double ring sign
CSF rhinorrhoea
Increased ICP

27
Q

ABC

Medical management of TBI

A

Airway - Stablize airway with cervical spine control, intubate if necessary and sedate

Breathing - maintain SpO2 @ 95%, controlled hypervention of PCO 35 mmHg to decrease cerebral blood flow

Circulation - maintain a MAP of 50 - 150 mmHg, restrict fluids in stable pt to avoid edema, avoid pain

28
Q

Nursing Management of TBI

A

1) Assess neurological system - GCS, pupil constriction, focal decifits

2) Blood sugar monitoring

3) AMPLE history - Allergies, Medications, Past medication history, Last meal & Event

4) Rapid Head-to-Toe

5) Avoid NG tube insertion if epistaxis present.

6) Nurse in 30 degree angle

7) Administer Mannitol

8) Clean wounds

9) Abort seizures with Benzodiazepines

29
Q

Upon assessment, pt has a GCS 14/15, mild headache and short period of amnesia. What grade is this TBI?

A

Mild

Manage with advise & f/u

30
Q

Jules came into AED with a GCS 9/15, moderate/severe headache, prolonged amnesia and persistant vomiting. What grade is this TBI?

A

Moderate

Needs CT once stable, probably admit

31
Q

Timothy had a GCS of 8 or less, focal deficits and an open injury. Grade his TBI.

A

Severe

Needs CT & ICU admission.

32
Q

What must occur for consciousness and alertness to be affected in a TBI patient.

A

Damage to both cerebral hemispheres or the brain stem.

33
Q

Contents of the cranial vault

A

Blood volume
CSF
Brain tissue

34
Q

Normal ICP

A

5 - 15 mmHg

35
Q

What is CPP?

A

Cerebral perfusion pressure is amount of pressure needed to maintain blood flow in the brain

36
Q

Normal CPP

A

60 - 100 mmHg

MAP - ICP

37
Q

Monroe-Kelly Hypothesis

A

How ICP is affected by CSF, brain’s blood and tissue to maintain Cerebral Perfusion Pressure.

Intracranial components are constant. An increase in one should cause a decrease in one or both of the remaining two

38
Q

Intracranial compensation

A

Any increase in intracranial volume decreases CSF or CBV

39
Q

Cerebral autoregulation

A

maintain stable blood flow despite changes in blood pressure

40
Q

Clinical manifestations of ICP

A

LOC changes
Eyes - papilledema, pupillary changes, impaired eye movement
Changes in speech
Headache
Elevated temperature
Vomiting
Seizures
Cushing’s triad

41
Q

Cushing triad

A

Widened pulse pressure (Increased systolic pressure), low pulse and irregular respirations.

42
Q

Medical mangement of ICP

A

1) ICP of at least 20 - 25 mmHg
2) CPP > 60 mmHg by maintaining MAP
3) Avoid factors that aggravate ICP

43
Q

Nursing management of ICP

A

1) Elevate head to 30 - 40 degrees to reduce ICP by enhacning venous outflow

2) Keep head in midline position

3) Monitor ventilation to maintain normal arterial carbon dioxide (normocarbia)

4) Administer antipyretics to prevent fever since pyrexia increaes cerebral metabolism which causes cerebral edema

5) Administer Mannitol to induce diuresis which hinders tubular reabsorption

5) Administer steroids to reduce ICP in tumors by reducting CSF production e.g., Dexamethesone

6) Administer Barbiturates to protect brain from cerebral edema e.g., Phenobarbital

7) Maintain hyperventilation which decreases PaCO2 and constrict arteries by alkalinizing CSF which decreases ICP since CBV is lowered.

44
Q

,What is the time of action and peak time for Mannitol?

A

1 - 5 min

20 - 60 min

45
Q

What two(2) surgical procedure is done for ICP?

A

Ventriculotomy & decompressive craniectomy

46
Q

What is a Basilar skull fracture?

A

a break of a bone in the base of the skull.

47
Q

Racoon eyes

A

Bruising around the eyes

48
Q

Battle’s sign

A

Brusing at the mastoid process of the temporal bone

49
Q

CSF rhinorrhea

A

fluid that surrounds the brain leaks into the nose and sinuses.

50
Q

Double ring sign

A

a characteristic fundus finding in cases with optic nerve head hypoplasia

51
Q

Hemotympanum

A

the accumulation of blood within the middle ear cleft secondary to trauma and impaired drainage through the Eustachian tube,

52
Q

Meningitis

A

Inflammation of the protective barrier covering the brain

53
Q

Meninges

A

System of membranes that envelopes the CNS consisting of the dura mater, arachnoid mater and pira mater

54
Q

Subarachnoid space

A

The space between the arachnoid and pia mater.

55
Q

Who is at risk for meningitis?

i) A patient diagnosed with AIDs
ii) A middle-aged man with a viral upper respiratory infection
iii) A patient using ACE inhibitors
iv) A 4 year old.

A) i & iv
B) ii, iii, iv
C) i, ii, iv
D) All the above

A

C

56
Q

Kernig’s sign

A

Resistance/pain and the inability to extend the patient’s knee beyond 135 degrees

57
Q

Brudzinski sign

A

Involuntary flexing of the hips and knees when head is flexed so chin touches the chest.

58
Q

What are the diagnostic findings of CSF in Bacterial Meningitis?

A

Elevated opening pressure
Elevated PMNs
Elevated proteins
Low glucose

59
Q

What are the diagnostic findings of CSF in Viral Meningitis?

A

Elevated or normal opening pressure
Elevated Lymphocytes
Elevated or normal proteins
Normal glucose

60
Q

What are the diagnostic findings of CSF in Fungal Meningitis?

A

Elevated opening pressure
Elevated lymphoctes
Elevated protein
Low glucose

61
Q

Nursing management of Meningitis

A

1) Follow infection control precautions since oral and nasal secretions are infectious
2) Administer pain medication to combat body aches
3) Assist in getting rest in a quiet, dark room because of photosensitivity
4) Reduce temperature with cooling blanket and antipyretics
5) Ensure patient stays hydrated for fever
6) Monitor neurological system

62
Q

What adverse effect does Gabapentin cause?

A

Vision changes

63
Q

Which is an initial sign of Parkinson’s disease?

A

Tremors

64
Q

Which goal is collaboratively established by the client with Parkinson’s disease, the nurse, and the physical therapist?

A

Build muscle strength

RENR FOCUS (4 decks)

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