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Adult Health 3 > Neurological System > Flashcards

Neurological System Flashcards

1
Q

Clinical manifestations of a basilar skull fracture include _____ ______ deficits, ______ sign and _________ ecchymosis

A

cranial nerve; Battle’s; periorbital

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2
Q

define rhinorrhea

A

CSF leakage from the nose

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3
Q

define otorrhea

A

CSF leakage from the ear

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4
Q

_______ & _______ generally confirms that the fracture has traversed the dura

A

rhinorrhea; otorrhea

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5
Q

The risk of _________ is high with a CSF leak; _______ should be administered as a preventive measure

A

meningitis; antibiotics

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6
Q

What are the two methods of testing for CSF

A
  1. dextrostix/Tes-Tape

2. look for halo or ring sign

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7
Q

What are the major potential complications of skull fractures?

A

intracranial infections, hematoma, meningeal & brain tissue damage

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8
Q

What type of tube would be used with a basilar skull fracture?

A

orogastric tube

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9
Q

_______ is considered a minor diffuse head injury

A

Concussion

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10
Q

what are the three typical signs of a concussion?

A

brief disruption of LOC, amnesia regarding the event, headache

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11
Q

When does postconcussion syndrome usually happen?

A

2 weeks-2 months after injury

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12
Q

What are manifestations of postconcussion syndrome?

A

persistent headache, lethargy, personality/behavioral changes, shortened attention span, decreased short-term memory, intellectual ability changes

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13
Q

What are clinical signs of DAI

A

decreased LOC, increased ICP, decortication or decerebration, global cerebral edema

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14
Q

A _______ is usually associated with a closed head injury

A

contusion

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15
Q

A contusion may contain areas of _______, _______, _______, and _______

A

hemorrhage; infarction; necrosis; edema

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16
Q

A contusion will frequently occur at a ________ site

A

fracture

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17
Q

What occurs with a coup-contrecoup injury?

A

Contusions occur at the site of the direct impact of the brain on the skull and on the opposite side away from the injury - results in multiple contused areas

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18
Q

contusions may continue to _____ or _____

A

bleed; rebleed

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19
Q

Contusions may appear to ______ on subsequent CT scans of the brain

A

“blossom”

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20
Q

_____ can occur as a result of a brain contusion

A

Seizures

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21
Q

What is the best diagnostic tool to evaluate for head trauma?

A

CT san

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22
Q

What is the best diagnostic tool to evaluate for small lesions?

A

MRI

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23
Q

What are the primary management strategies for a patient with concussion and contusion?

A

Observation and management of increased ICP

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24
Q

What are the main goals of nursing for a patient with a head injury?

A

maintain cerebral oxygenation and perfusion; prevent secondary cerebral ischemia

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25
Q

The _____ is useful in assessing the LOC

A

GCS

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26
Q

what are two signs of a deteriorating neurological state?

A

decreasing LOC, decreasing motor strength

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27
Q

What are eye problems associated with a head injury?

A

loss of the corneal reflex, periorbital ecchymosis, periorbital edema, diplopia

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28
Q

Nursing interventions for loss of corneal reflex

A

lubricating eye drops; taping eyes shut

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29
Q

Nursing interventions for periorbital ecchymosis and edema

A

cold & warm compresses

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30
Q

Nursing intervention for diplopia

A

eye patch

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31
Q

If CSF rhinorrhea or otorrhea occurs what do you do?

A

Inform HCP immediately

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32
Q

What do you do when rhinorrhea or otorrhea occurs?

A

raise HOB, loose collection pad under nose or over the ear, no sneezing/blowing nose, no NG tubes, no nasotracheal suctioning

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33
Q

True or False. You place a dressing in the nasal or ear cavities with CSF rhinorrhea or otorrhea

A

False

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34
Q

True or False. Whites have a higher incidence of malignant brain tumors than African Americans

A

True

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35
Q

True or False. White males have the highest incidence of malignant brain tumors

A

True

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36
Q

True or False. Whites have a higher incidence of benign brain tumors than blacks

A

False - Blacks have a higher incidence of benign brain tumors than whites

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37
Q

What kind of brain tumors are the most common?

A

Metastatic

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38
Q

What are the most common primary brain tumors?

A

meningiomas

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39
Q

When are tumor-related headaches the worst?

A

at night, may awaken the patient

40
Q

What are cognitive changes associated with brain tumors?

A

memory problems, mood/personality changes

41
Q

What are the three complications with brain tumor expansion?

A

increased ICP, cerebral edema, obstruction of CSF pathways

42
Q

Which diagnostic tools are the most reliable for brain tumors?

A

MRI & PET

43
Q

The correct diagnosis of a brain tumor can be made by obtaining _______ for _______

A

tissue; histologic study

44
Q

What is the preferred treatment for brain tumors?

A

surgical removal

45
Q

What are the 5 manifestations of a ventricular shunt malfunction?

A

decreased LOC, restlessness, headache, blurred vision, vomiting

46
Q

Three signs of an infection associated with shunt malfunction?

A

high fever, persistent headache, stiff neck

47
Q

Chemotherapy drugs called _______ are used to treat brain tumors

A

nitrosoureas (carmustine, lomustine)

48
Q

________ is an oral chemotherapy agent that can cross the blood-brain barrier

A

Temozolomide

49
Q

Does temozolomide interact with antiseizure medications, corticosteroids or antiemetics?

A

No

50
Q

Temozolomide causes _________

A

myelosuppression

51
Q

How can you reduce nausea and vomiting when taking temozolomide?

A

Take on empty stomach

52
Q

Will a patient be taken to the ICU after cranial surgery?

A

Yes

53
Q

What is the primary goal of care after cranial surgery?

A

prevention of increased ICP

54
Q

After a cranial surgery the head of bed should remain at how many degrees?

A

30

55
Q

If a burr hole was made or a posterior fossa approach was used how many degrees should the head of bed be?

A

10-15 or flat

56
Q

When observing a dressing post cranial surgery, when should you notify the surgeon?

A

When there is excessive bleeding or clear drainage

57
Q

Once the dressing is removing post cranial surgery, use ________ for washing the scalp

A

antiseptic soap

58
Q

Who has the greatest risk for a spinal cord injury?

A

young adult men 16-30 years old

59
Q

Primary injuries of a spinal cord injury

A

cord compression by bone displacement, interrupted blood supply to cord, traction from pulling on the cord; gunshot and stab wounds

60
Q

______ can occur following acute SCI

A

spinal shock

61
Q

Characteristics of spinal shock

A

decreased reflexes, loss of sensation, absent thermoregulation, flaccid paralysis below injury level

62
Q

If the _____ cord is involved, paralysis of all four extremities occurs

A

cervical

63
Q

If the _____, ______, or ______ spinal cord is damaged, paraplegia occurs

A

thoracic; lumbar; sacral

64
Q

Respiratory issues with a spinal cord injury above C4

A

total loss of respiratory muscle function

65
Q

Injury or fracture below C4 results in _______ breathing if phrenic nerve is still functioning

A

diaphragmatic

66
Q

Any cord injury above ____ leads to dysfunction of the sympathetic nervous system

A

T6

67
Q

_______ is a common development in acute SCI and spinal shock

A

urinary retention

68
Q

Common GI issues after SCI

A

gastric distention, paralytic ileus, delayed gastric emptying, stress ulcers, dysphagia , intraabdominal bleeding, incontinence, constipation, hemorrhoids

69
Q

Spinal cord disruption is also marked by decreased ability to _____ or _____ below the level of injury

A

sweat; shiver

70
Q

Nasogastric suctioning may lead to _______

A

metabolic alkalosis

71
Q

_______ is a common problem accompanying SCI during the first 3 months

A

VTE

72
Q

_______ is a leading cause of death in patients with SCI

A

pulmonary embolism

73
Q

How is musculoskeletal nociceptive pain described?

A

dull, aching

74
Q

When does musculoskeletal nociceptive pain worsen?

A

with movement

75
Q

How is visceral nociceptive pain described?

A

dull, tender, cramping

76
Q

What causes neuropathic pain in SCIs?

A

damage to the spinal cord or nerve roots

77
Q

How is neuropathic pain described?

A

hot, burning, tingling, pins and needles, cold, shooting

78
Q

What is the preferred diagnostic tool for SCIs?

A

CT scan

79
Q

Initial management includes maintaining oxygen saturation above ___, and SBP greater than ____

A

90%; 90 mmHg

80
Q

Voluntary anal contraction indicates ______

A

incomplete SCI

81
Q

With SCIs the only clue to internal trauma with hemorrhage may be _____ and ______

A

rapidly decreasing BP; increasing pulse

82
Q

How do you move a patient with a SCI

A

logroll

83
Q

What drugs are used to maintain the MAP at greater than 85-90 mmHg to improve perfusion to the spinal cord?

A

phenylephrine, norepinephrine

84
Q

What do you do if a patient with an SCI has crackles or coarse breath sounds?

A

tracheal suctioning

85
Q

Maintain SBP greater than _____ at all times and keep MAP between _____ for the first 7 days following an SCI

A

90 mmHg; 85-90 mmHg

86
Q

What interventions can be used for a SCI patient with orthostatic hypotension?

A

salt tablets, fludrocortisone, midodrine; SCDs; stockings; abdominal binder

87
Q

What type of diet does a SCI get?

A

high-protein, high-calorie, increased fiber

88
Q

What medications can be given for neuropathic pain?

A

Gabapentin, pregabalin

89
Q

What medications can help control spasms?

A

baclofen, dantrolene, tizanidine, botulism toxin injections

90
Q

What is the most common precipitating cause of autonomic hyperreflexia?

A

distended bladder or rectum

91
Q

Autonomic hyperreflexia manifestations?

A

hypertension (up to 300 mmHg), throbbing headache, marked diaphoresis above level of injury, bradycardia, piloerection, flushing of skin above level of injury, blurred vision, spots in the visual field, nasal congestion, anxiety, nausea

92
Q

What do you do when a patient with a SCI complains of a headache?

A

Measure blood pressure

93
Q

Nursing interventions for autonomic hyperreflexia

A

elevate HOB to 45 degrees or sit patient upright, determine the cause, notify HCP, remove constrictive clothing and tight shoes, urinary catheterization, digital rectal exam or anesthetic rectal ointment

94
Q

If autonomic hyperreflexia symptoms persist after the source has been relieved what do you do?

A

administer nitroglycerin, nitroprusside, or hydralazine

95
Q

When should oral stimulant laxatives be used with a SCI?

A

Only if absolutely necessary and not on a regular basis

96
Q

What type of spinal cord injury is the Valsalva maneuver used?

A

Injuries below T12

Adult Health 3 (4 decks)

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