Neurological System Flashcards by Kaitlin Zemanek

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

cranial nerve; Battle’s; periorbital

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define rhinorrhea

CSF leakage from the nose

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define otorrhea

CSF leakage from the ear

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

rhinorrhea; otorrhea

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

meningitis; antibiotics

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What are the two methods of testing for CSF

dextrostix/Tes-Tape

2. look for halo or ring sign

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What are the major potential complications of skull fractures?

intracranial infections, hematoma, meningeal & brain tissue damage

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

orogastric tube

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_______ is considered a minor diffuse head injury

Concussion

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what are the three typical signs of a concussion?

brief disruption of LOC, amnesia regarding the event, headache

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When does postconcussion syndrome usually happen?

2 weeks-2 months after injury

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What are manifestations of postconcussion syndrome?

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

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What are clinical signs of DAI

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

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A _______ is usually associated with a closed head injury

contusion

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

hemorrhage; infarction; necrosis; edema

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A contusion will frequently occur at a ________ site

fracture

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What occurs with a coup-contrecoup injury?

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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contusions may continue to _____ or _____

bleed; rebleed

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

“blossom”

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_____ can occur as a result of a brain contusion

Seizures

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

CT san

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

MRI

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

Observation and management of increased ICP

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

maintain cerebral oxygenation and perfusion; prevent secondary cerebral ischemia

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The _____ is useful in assessing the LOC

GCS

what are two signs of a deteriorating neurological state?

decreasing LOC, decreasing motor strength

What are eye problems associated with a head injury?

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

Nursing interventions for loss of corneal reflex

lubricating eye drops; taping eyes shut

Nursing interventions for periorbital ecchymosis and edema

cold & warm compresses

Nursing intervention for diplopia

eye patch

If CSF rhinorrhea or otorrhea occurs what do you do?

Inform HCP immediately

What do you do when rhinorrhea or otorrhea occurs?

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

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

False

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

True

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

True

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

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

What kind of brain tumors are the most common?

Metastatic

What are the most common primary brain tumors?

meningiomas

When are tumor-related headaches the worst?

at night, may awaken the patient

What are cognitive changes associated with brain tumors?

memory problems, mood/personality changes

What are the three complications with brain tumor expansion?

increased ICP, cerebral edema, obstruction of CSF pathways

Which diagnostic tools are the most reliable for brain tumors?

MRI & PET

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

tissue; histologic study

What is the preferred treatment for brain tumors?

surgical removal

What are the 5 manifestations of a ventricular shunt malfunction?

decreased LOC, restlessness, headache, blurred vision, vomiting

Three signs of an infection associated with shunt malfunction?

high fever, persistent headache, stiff neck

Chemotherapy drugs called _______ are used to treat brain tumors

nitrosoureas (carmustine, lomustine)

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

Temozolomide

Does temozolomide interact with antiseizure medications, corticosteroids or antiemetics?

Temozolomide causes _________

myelosuppression

How can you reduce nausea and vomiting when taking temozolomide?

Take on empty stomach

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

Yes

What is the primary goal of care after cranial surgery?

prevention of increased ICP

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

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

10-15 or flat

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

When there is excessive bleeding or clear drainage

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

antiseptic soap

Who has the greatest risk for a spinal cord injury?

young adult men 16-30 years old

Primary injuries of a spinal cord injury

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

______ can occur following acute SCI

spinal shock

Characteristics of spinal shock

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

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

cervical

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

thoracic; lumbar; sacral

Respiratory issues with a spinal cord injury above C4

total loss of respiratory muscle function

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

diaphragmatic

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

_______ is a common development in acute SCI and spinal shock

urinary retention

Common GI issues after SCI

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

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

sweat; shiver

Nasogastric suctioning may lead to _______

metabolic alkalosis

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

VTE

_______ is a leading cause of death in patients with SCI

pulmonary embolism

How is musculoskeletal nociceptive pain described?

dull, aching

When does musculoskeletal nociceptive pain worsen?

with movement

How is visceral nociceptive pain described?

dull, tender, cramping

What causes neuropathic pain in SCIs?

damage to the spinal cord or nerve roots

How is neuropathic pain described?

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

What is the preferred diagnostic tool for SCIs?

CT scan

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

90%; 90 mmHg

Voluntary anal contraction indicates ______

incomplete SCI

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

rapidly decreasing BP; increasing pulse

How do you move a patient with a SCI

logroll

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

phenylephrine, norepinephrine

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

tracheal suctioning

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

90 mmHg; 85-90 mmHg

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

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

What type of diet does a SCI get?

high-protein, high-calorie, increased fiber

What medications can be given for neuropathic pain?

Gabapentin, pregabalin

What medications can help control spasms?

baclofen, dantrolene, tizanidine, botulism toxin injections

What is the most common precipitating cause of autonomic hyperreflexia?

distended bladder or rectum

Autonomic hyperreflexia manifestations?

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

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

Measure blood pressure

Nursing interventions for autonomic hyperreflexia

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

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

administer nitroglycerin, nitroprusside, or hydralazine

When should oral stimulant laxatives be used with a SCI?

Only if absolutely necessary and not on a regular basis

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

Injuries below T12