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Complex 2 > Neurological Unit- Assessment > Flashcards

Neurological Unit- Assessment Flashcards

1
Q

History taking

A

1.Hx
2. General Appearance
3. Hx of present illness (PQRST)
4. Past medical Hx
Family Hx
5. Medical Hx
6. Degree of stimuli
7. Social Hx

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2
Q

Degree of Stimuli

A
  1. Verbal Stimulation: Say something they open eyes
  2. Tactile Stimulation: Touch them they open eyes
  3. Painful Stimuli (Nocous stimuli): Sternum rub and trapezius squeeze
  4. Peripheral Stimuli: Pressure on nail beds
    AS Decrease in list more stimuli is needed to elicit a response
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3
Q

Vital Signs: Cushing Triad

A
  1. Increased Systolic BP
  2. Widened pulse pressure
  3. Bradycardia
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4
Q

Vital Signs: Blood Pressure
Hypotension
Hypertension
Pulse Pressure

A

Hypotension: CANNOT b/c cranium is non expandable
Hypertension: Systolic bp increased
Pulse Pressure: NORM: 30-40

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5
Q

Temperature:

WHAT increases it?

A 
Infection
Subarachnoid Hemorrhage
Seziures
Restlessness
Injury to Hypothalmus
Neurological Fever: Swelling around the hypothalmus
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6
Q

Temperature:

WHAT decreases it?

A

Shock
Metabolic coma
Terminal Stages of neurologic disease

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7
Q

Level Of Conciousness

A

A state of awareness regarding self,enviroment, and response

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8
Q

LOC:

Arousal function of

A

Function of RAS

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9
Q

LOC:

Awareness Function of

A

Requires both intact RAS and crebral hemispheres

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10
Q

LOC:

Coma

A

The absence of awareness
Structural lesion
Metabolic or psychiatric disorder

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11
Q

Glasgow Coma Scale:

Definition

A

A method to standardize observation of responsiveness in neurologic patients
Best or highest response is recorded
Parameters
Min: 3
MAX: 15
Coma:8 or less
Clinical significance: change in 2 points

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12
Q

Glasgow Coma Scale: SCALE

A 
EYE opening:  
4: Spontaneously
3: To verbal command
2: To Pain
1: NONE
0: Untestable (if pt is on nuromusclar blockades or swollen eye)
BEST VERBAL response:
5: Orientated and converses
4: Disorientated and converses
3: Inappropriate words: Calling things wrong name 
2: Incomprehensible sounds: Slurred mumbling
1: NONE
0: Untestable: if have trach, intubated
BEST MOTOR response:
6: Obeys
5: Localizes pain: pushes stimuli away
4: Withdrawls from pain
3: Abnormal flexion
2: Abnormal extension
1: NONE
0: Untestabe: On neuromuscluar blockade, spinal cord injury
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13
Q

Speech Disorders:

Dysphoniac

A

Difficulty producing sounds

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14
Q

Speech Disorders:

Dysarthria

A

Difficulty ariculating

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15
Q

Speech Disorders:

Dysprosody

A

Lack of inflection while talking

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16
Q

Speech Disorders:

Dysphasia

A

Difficulty understanding or expressing language

17
Q 
Speech Disorders:
Aphasia
1. Receptive
2. Expressive
3. Global
A 
1. Wernik : Difficult understanding
Sensory
2. Broca: difficult cant get words out
Motor
3. Both
18
Q

Involuntary Movements

A

Abnormal flexion: Indicative of cerebral lesion
Abnormal Extension: Indicative of midbrain or brainstem lesion
Opisthotonos: Arching , indicative of brainstem injury

19
Q

Abnormal Reflexes

A

Babinski - Fanning of toes
Grasp: Hold on but dont let go
Sucking: Start to do mouth care and pt starts sucking

20
Q

Signs of Basilar Skull Fractures

A

Battle sign
Rhinorrhea
Otorrhea
Raccoon Eyes

21
Q

Meningeal Irritation:

Nuchal rigidity

A

Nuchal rigidity: Inability to flex neck

22
Q

Meningeal Irritation:

Kernig’s sign

A

Pain when go to raise leg up as pt is lying down

23
Q

Meningeal Irritation:

Brudzinski sign

A

Bring neck forward pt pulls legs up

24
Q

Clinical Indication of BRAIN DEATH

A 
LOC
Pupils (Fixed)
Motor
Reflexes - may have root reflexes
Ventilation: Apneic 
Confirming Definitive Diagnosis studies:
Cerebral angiography- look at blood flow (complication -bleeding)
Transcranial Doppler- Look for blood flow (non invasive)
Cerebral Blood flow study
25
Q

Oculocephalic Reflex - DOLL EYES

A

See if intact cranial lobes or lesion near brain stem
Only do if pt is unconscious - suspect brain death
Normal: is looking away from the turn (turn head force eyes open)
Anormal- Looking toward turn or stationary eyes
(C- SPINE MUST BE INTACT)

26
Q

Oculovestibular Reflex - Cold Caloric Test

A

Unconcious, suspect brain death
MUST HAVE INTACT TYMPANIC MEMBRANE
Putting ice cold water near - EXTREMELY painful
-Normal-Look toward the ear where water is inserted
ABNORMAL- eyes drift to other ear or none

27
Q

TEST: CT

A

CT- FIRST TEST with change in LOC

Complex 2 (4 decks)

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