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Apple RN > Neurology > Flashcards

Neurology Flashcards

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1
Q

ICP increased intracranial pressure

A

Rising pressure in cranium wall cranial vault, caused by trauma hemorrhage, trauma, tumor edema, are inflammation. I see normal level 5 to 15 MM of Hg.

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2
Q

Hypercarbia

A

Increased carbon dioxide in the blood.ICP may be increased by hypercarbia. Which leads to cerebral vasodilation and a edema, endotracheal or oral suctioning, coughing, blowing the nose forcefully.
Extreme neck Or hip flexion/extension, maintaining the head of the bed and the angle less than 30°, increasing intra- abdominal pressure, (restrictive clothing, Valsalva maneuver).

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3
Q

early signs for ICP

A

Include restlessness lead to hypoxia, consciousness late to decreased cardiac output.
Late signs: include increasing system systolic pressure with widened-and plus pressure,
slow heart rate, irregular respiration(Cushing triad)
a change in body temperature may also occur because increased ICP Affects the thalamus
Cheyne strokes respirations. Occular signs can happen. assess neurological status Q1 to 2hrs.Assess bowel(constipation) and bladder (distention)to avoid valsalva maneuver.

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4
Q

head injury

A

Open/penetrating trauma (Skull integrity compromised,skull opened).
Il)closed/ blunt trauma (skull integrity maintained)
inside the skull is fracture but not outside.

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5
Q

fractures

A

Linear-Most common-possible hematoma but Dura intact. Minimal risk.
Comminuted and depressed -overlying skin and Dura can be damaged
high risk for brain damage and infections need surgery within 24hrs –
basilar-involve base of skull -CSF leakage -prevent meningitis.

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6
Q

Basilar skull fracture Signs

A

Battle’s sign: Ekhymosis over mastoid process (back behind the ear ).
hemotympanum-blood visible behind tympanic membrane.
raccoon face – bilateral Peri orbital ecchymosis.
rhinorrhea- CSF leak is through nose to nose.
– otorrhea-CSF leakage through ear.
CSF-test reveals glucose. Mucus- no glucose.halo sign
1hour: “golden window” for treatment of head injuries-emergency treatment provide during this time frame decreased the morbidity and mortality.

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7
Q

Coup-counter head injury

A

 brain injury under the area of impact (coup -frontal)
The rebound injury to the opposite side (contercoup)
Occipital lobe of damages is common-visual problems.
Common in mortar vehicle accident and the shaken baby syndrome
head injuries may associated with hemorrhage.
Epidural hematoma between dura and skull
Usually from tear-in meninges artery,Rapid deterioration in neurological status.

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8
Q

Subdural hematoma

A

Usually involve veins ( might involve small arteries)

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9
Q

Intracerebral

A

Intracerebral: bleeding into brain tissue.most common - frontal or temporal lobes.

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10
Q

Intracerebral bleeding symptoms

A

Monitor for severe headache, rapid decline consciousness, worsening, neurological function,and changes in ICP.

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11
Q

Close head injury

A

Evaluate the patient certain concussion:neurological changes after a blow to the head GCS
confusion bruise on the brain. skull fracture, epidural or subdural bleeding.

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12
Q

Nursing care plan or coup-countercoup head injury.

A

Assist/monitor the client at regularly scheduled intervals:
respiratory status -brain function declines after 3min of oxygen deprivation.
changes in LOC (GCS). Cranial nerve function.
Finding of infection and (nactual rigidity occurs with the meningitis). Bilateral sensory and motor responses.
Inter-cranial pressure I CP: teach patient to report any changes, avoid taking alcohol or anysedative med, don’t drive soon.

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13
Q

Craniotomy

A

craniotomy is the removal of non-viable brain tissue that allows for expansion and/or remove of epidural are subdural hematoma.
it involves during a burr hole or creating bone flap to permit access to the affected area.
This is the life saving procedure, and is associated with many potential complications.

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14
Q

craniotomy Complications

A

severe neurological impairment, infection, persistent Seizures,neurological deficiencies and/ or death

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15
Q

What is the nursing action for craniotomy

A

Postoperative treatment:it will depend upon the neurological status of the client after surgery. Five supra tentorial surgery, elevate 30° with body portioning to prevent increase ICP.
Intra tentorial craniotomy: keep client flat on either side for 24 to 48 hours to prevent pressure on neck incision site.
hyperventilate:the mechanically ventilated client for 24 to 48 hours as prescribed to maintain PaCO2 around 35 MM Hg
Monitor wound dressing and Mark drainage every 1 to 2 hours, documenting output every 8hours

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16
Q

Seizures 

A

Abnormal, sudden, excessive discharge of electric activity within the brain.
A generalized seizures is also called Tonic- clonic Seizures (grand malseizures).
triggers: hormonal changes, fatigue, stress, genetic inherited, toxins.
A generalized Seizure begins for only a few seconds with a tonic episode( stiffening of muscles) and losses of consciousness
A1to2minclonic episode (Rhythmic jerking of the extremities) follows the tonic episode. Incontinence can also accompany a seizure.
During postictal phage,a period of Confusion and sleepiness follows the scissors.

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17
Q

Complex partial seizures

A

Complex partial seizures have associated automatisms(behaviors that the client is unaware of,such as least lipsmacking are picking at clothes).
The seizures can caused the loss of consciousness for several minutes
amnesia may occur immediately prior to and after the seizures

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18
Q

Tonic Seizures

A

During a seizure,only the tonic phase is experienced.
The seizures usually lasts 30 seconds to several min
A loss of consciousness occur.


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19
Q

clonic seizures

A

Only the clonic phase is experienced.
The seizures lasts several minutes.
During this type seizures,the muscle contract and relax

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20
Q

Absence of seizure seizure

A

Include unconscious,involuntary behavior associated with eye fluttering, smacking of the lips, and then picking at clothes, called automatism.
The seizures consists of a loss of consciousness lasting if you seconds (genetics).
It is associated with blank staring and (starting at someone) and children common in children.

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21
Q

Mayoclonic seizures

A

Consistent brief jerking at it stiffening of the extremities, which may be symmetrical or asymmetrical.It lasts for second.

22
Q

simply partial seizures

A

Consciousness is maintained throughout simple partial seizures.
Seizures activity may consist of unusual sensation, a sense of déjà vu , autonomic abnormalities, such as changes in heart rate and abnormal flashing, unilateral abnormal extremity movements, pain or offensive to smell.

23
Q

Nursing care for seizures 

A

During seizures: protect the clients privacy and the client from injury (move furniture away, hold head in lap if on the floor.
Position Clint, to provide patent airway. Be prepared to suction oral secretions.
Turn the client to the side to decrease the risk of aspiration
Loosen restrictive clothing. Do not attempt to restrain the client.
Do not attempt to open jaw or insert airway during seizure activity (may damage teeth, lips, and tongue). Do not use padded tongue blade
document onset and duration of seizure and client findings/observations prior to during,and following the seizure.



24
Q

Post seizures

A

The postical phase of the seizure episode.
maintain the Client in a side-lying position to prevent aspiration and to facilitate of oral secretions.Check vital signs. Access for injuries.
Perform neurological checks. Allow the client to rest if necessary
Reorient and calm the client (maybe it’s agitated or confused).
Institute seizure precautions and including placing the bed in the lowest position and padding the side rails to prevent future injury.

25
Q

Status epilepticus

A

Prolonged seizure activity occurring over-a 30 minutes timeframe(coming and going)
Complications: due to decreased oxygen levels, inability of the brain to Return to normal functioning, and continue to assault on neuronal tissue.

26
Q

Causes of status epilepticus

A

Withdrawal from drugs-or alcohol, sudden withdrawal from antiepileptic medication, head injury, cerebral edema, infection and fever.

27
Q

Nursing action status epilepticus

A

maintain an airway, provide oxygen, establish IV access,perform ECG monitoring,monitor pulse oximetry and ABG results.give medications phenytoin.

28
Q

phenytoin

A

Side effects:Gingival hyperplasia:need good oral hygiene.
folic acid deficiency-need supplementation.
Therapeutic range of 10 to 20 MCG/ML need regular blood test.
early signs of toxicity:nystagmus(involuntary movement),under unsteady gait(they can’t work properly,not stability and balance problem)
Late sign:lethargy,confusion,coma.

29
Q

Arteriovenous malformation (AVM)

A

Weak and dilated connections in artery and vein in brain.
AVM Can cause the neurological deficit. Treatment blood pressure control
AVM - risk for intracranial bleed- report any neurological changes immediately.
Sudden severe headache, nausea, and vomiting.

30
Q

Stroke

A

Sudden, focal neurological deficit.
risk factors: cerebral aneurysm, hypertension, DM AVM, obesity, atherosclerosis, hyperlipidemia, hypercoagulability, arterial fibrillation, use of oral contraceptives, smoking, cocaine use.

31
Q

thrombolytic ischemic

A 
Blood clots, 
most common atherhotic plague, 
Hypertension,DM, 
TIA( transient ischemic attack), 
symptoms over several hours to days.
32
Q

embolic ischemic

A

emboli,
thrombolytic enzyme (RTPA) is helpful.stroke is with in 3to 4hrs.
Rheumatic heart disease (endocarditis,ct scan)younger
Warning signs that are less common
sudden, and rapid occurrence of severe clinical manifestation. Neurological deficits are in loss of consciousness instantly occur.

33
Q

hemorrhagic

A

Bleeding,
poor prognosis,
occur secondary to a raptured artery or aneurysms, hypertension.
Sudden onset of symptoms,( bad prognosis mostly common),
50% of the deaths occurred within the first 48 hours.

34
Q

Left-sided stroke

A

 the left cerebral hemisphere is responsible for language, mathematics skills, and analytical thinking.

35
Q

Symptoms consistent with a left hemisphere stroke include the following

A

aphasia:inability to speak and understand language respectively.
Agnocia: unable to recognize familiar objects(pens , pencil),
Alexia:reading difficulty,
AGraphia :writing difficulty,
right extremity hemiplegia (paralysis)
Or hemiPharisees (weakness).
Slow caution behavior ,depression, anger and quick to become frustrated,
visual changes hemianopsia (loss of visual field in one or both eyes-right)
Dysphasia-impaired ability to communicate-speech problem.
Apraxia-loss of the ability to perform a learned moment hey (eg: whistling,clapping, dressing due to neurological impairment).

36
Q

hydrocephalus for babies syndrome

A

result in head enlargement (prior to fontanels closing) increased ICP.
Types:Communicating: result of impaired absorption within subarachnoid space.
Non communicating-obstruction of cerebrospinal fluid (CSF)within ventricular system.

37
Q

Cerebral palsy for Peadiatric

A

Disorder characterized by impaired movement and Posture;abnormality in extraparametal or Piramidal motor system

38
Q

Cerebral policy assessment

A

Abnormal posturing,such as opisthotonos(boat like neck)(exggerated arching of back)
Stiff and rigid arms and legs, feeding difficulties, delayed grass motor activity.
Alterations of muscle tone, persistence of primitive infantile reflexes.

39
Q

Interventions for cerebral policy

A

Assess developmental level, encourage early intervention programs..
Prepare for the use of mobilizing device, (crane crutches),provide safe environmental
Provide safe, developmentally appropriate toys, position of upright after meals,
administer muscle relaxant as prescribed.

40
Q

Spina bifida

A

central nervous system (CNS)defect occurs as a result of neural tube failure to close during embryonic development. When the fetal in the pregnancy.
Types:-1)Spina bifida occult
2)spina bifida cystica-
3)meningocele, myelomeningocele.

41
Q

Assessment of spina bifida

A

depends on spinal cord involvement; visible spinal defect; flaccid paralysis of legs; altered ladder,bowel function;hip,joint deformities.

42
Q

Immunology Sjogren syndrome

A

Chronic auto immune disorder.
Moisture -producing endocrine glands of the body are attacked by white blood cells.
The most common affected glands are the slavery and lachrymal glands, leading to dry eyes (xeropthalmia),and dry mouth (xerostomia).

43
Q

Symptoms sjogren syndrome

A

dryness in these areas can lead to corneal ulceration, dental care,and oral thrush.
dry skin and rashes,
throat and bronchi -chronic dry cough,
supportive care-Alleviate symptoms
over-the-counter or prescription drops are used to relieve itching, burning, dryness and gritty sensation in the eyes eyes.

44
Q

Precautions of sjogren syndrome

A

Where goggles,
dry mouth: sugarless gum and candy or artificial saliva.
Lukewarm water and mild soap when showering can prevent dry skin
use humidifier, avoid decongestant.

45
Q

Systemic lupus erythematosus

A

Chronic multisystem inflammatory auto immune disease.
No cure-treatment is supporting. More common in women
Remission and relapses (flares). Anti-nuclear, antibody and ESR will be elevated
mostly common affects skin, muscles, lining of the lungs, heart, nervous tissue, and kidneys. Arthritis occurs in more than 90% of patients with SLE. Painful/ swollen joints,morning stiffness.

46
Q

Lupus nephritis

A

Serious complication of SLE: look for abnormal KFT.
Multi system involvement of SLE
Health promotion and a SLE. Infection is a major cause of death for patients with a SLE. pneumonia being the most common infection.
Vaccination is essential, Avoid contact with sick people. Following a healthy lifestyle (example 7to 8 hours of sleep,no smoking video)
Balanced exercise with alternating periods of rest. (No extreme fatigue)
Rash: sunlight-avoid exposure between 10 AM to 4 PM, apply sunscreen. wash with mild soap and water(no harsh soap)
treatment : corticosteroids: immunosuppression.
Anti malarial drugs:( hydroxychloroquine and chloroquine)and the anti-leprosy drugs (Dapsone) might also be used to treat fatigue and moderate skin and joint problems.

47
Q

fibromyalgia

A

fibromyalgia results from of abnormal central nervous system pain transmission and processing.
signs: chronic musculoskeletal pain, multiple tender points, Fatigue,sleep/Cognitive disturbances. Treatment: the Duloxetine(Cymbalta)and amitriptyline (anti-depressant) help with general neuropathy pain-relief, sleep issues and fatigue
Tender points in fibromyalgia.

48
Q

Anaphylactic shock

A

Acute-onset, and manifestation usually develop quickly (20 to 30 minutes)
common cause: drugs (example antibiotics), foods (examples of shellfish, peanuts).
Diagnostic agents (example contrast), biologic agents (eg,blood and vaccines).
Poison: venom (example, bees, snakes).
cardiovascular: vasodilation- hypotension tissue Edema, tachycardia.
Respirator: upper airway edema -Stridor and hoarseness, bronchospasm, and wheezing
cutaneous:urticarial rash, pruritus, Flushing.
Gastrointestinal: nausea vomiting and abdominal pain.

49
Q

Management of anaphylactic shock

A

Airway and oxygen. Remove insect a stinger if present
I/M Epinephrine: Repeat every 5 to 15 minutes if needed
Place in recumbent position and elevate legs, maintain BPwith IV fluids and meds.
Bronchodilator (Albutrol), antihistamine (diphenhydramine)
corticosteroids (methylprednisone)
anticipate tracheostomy with severe laryngeal edema.

50
Q

EpiPen

A

 the epipen designed to be administered through clothing.
Do not waste the precious time to save the client.
Use a swing and firm push against the mid outer thigh until the injector clicks.
Hold the position for 10 seconds to allow the entire contents to be injected.
the site should be massaged for an additional 10 seconds.

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