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Hesi PN > Neurology > Flashcards

Neurology Flashcards

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1
Q

Causes of increased ICP

A

tumor
bleeding
hydorcephalus
edema

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2
Q

early signs of ICP

A

change in LOC (as subtle as a change in attention span or pronounced as a coma
slurred or slow speach
delay in response to verbal suggestion
increase in drowsiness
restlessness with no apparent reason
confusion

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3
Q

late signs of ICP

A

marked changed in LOC progressing to stupor and coma
cushings triad
decerebrate
decorticate

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4
Q

what is causing triad

A

systolic hypertension with widening pulse pressure
slow full and bounding pulse
irregular respirations (cheyne stokes or ataxic)

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5
Q

what is decorticate posturing

A

arms flexed inward and bent in toward the body and legs extended mid brain damage

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6
Q

what is decerebrate posturing

A

all 4 extremities in rigid extension, deep brain damage (worst)
will be rigid, tight and burning more calories

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7
Q

miscellaneous ICP signs

A

headache
change in pupil response
if in profound coma, fixed and dialated
projectile vomiting

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8
Q

complications of increased ICP

A

brain herniation
DI and SIADH

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9
Q

what does brain herniation do

A

obstructs the blood flow to the brain leading to anoxia and then brain death

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10
Q

treatment for Increased ICP

A

reduce cerebral edema
reduce the amount of cerebral spinal fluid or
reduce the blood volume in the brain
maintain oxygenation
maintain adequate cerebral perfusion
keep temperature below 100.4
elevate HOB
keep head midline so the jugular veins can drain
watch the ICP monitor with turning
avoid restraints, bowel/bladder distention, hip flexion , valsalva, and isometrics
no sneezing or nose blowing
limit suctioning and coughing
space nursing interventions

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11
Q

why must you keep temperature below 100.4 with increased ICP

A

increased temperature will increase cerebral metabolism and cerebral edema which increases ICP

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12
Q

what is the first cranial nerve

A

olfactory (smell)

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13
Q

what is the second cranial nerve

A

optic (vision)

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14
Q

what is the 3rd cranial nerve

A

oculomotor (pupil constriction)

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15
Q

what is the 4th cranial nerve

A

trochlear (downward movement of eyes)

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16
Q

what is the 5th cranial nerve

A

trigeminal (jaw movement, sensation of face and neck)

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17
Q

what is the 6th cranial nerve

A

abducens (lateral movement of eyes)

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18
Q

what is the 7th cranial nerve

A

facial (facial movement on anterior 2/3 of tongue)

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19
Q

what is the 8th cranial nerve

A

vestibulocochlear (hearing balance)

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20
Q

what is the 9th cranial nerve

A

glossopharyngeal (swallowing, taste on posterior 3rd of tongue)

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21
Q

what is the 10th cranial nerve

A

vagus (swallowing, speaking)

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22
Q

what is the 11th cranial nerve

A

spinal/accesory (flexion and rotation of head

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23
Q

what is the 12th cranial nerve

A

hypoglossal (tongue movements)

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24
Q

how does oxygenation effect ICP

A

decreased o2 levels and high CO2 levels cause cerebral vasodilation in the brain increasing ICP

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25
Q

why do you want to avoid hypotension and bradycardia with increased ICP

A

it decreases brain profusion

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26
Q

what fluids can you give with ICP

A

isotonic saline and inotropic agents: dobutamine and norepinephrine (emergency short term)

27
Q

signs of a basilar skull fracture

A

Battle’s sign (bruising over the mastoid)
raccoon eyes ( periorbital bruising)
cerebrospinal rhinorrhea

28
Q

how do you check for cerebrospinal rhinorrhea

A

test drainage for CSF
halo test
glucose

29
Q

what is an open skull fracture

A

torn dura

30
Q

what is a closed skull fracture

A

intact dura

31
Q

characteristics of an epidural hematoma

A

rupture to the middle meningeal artery
fast bleed
high pressure

32
Q

symptoms of an epidural hematoma

A

loss of consciousness
recovery period
bleeding into head with compensation
loss of compensation
neuro changes

33
Q

treatment of epidural hematoma

A

burr holes

34
Q

questions to ask for assessing head injury

A

did you pass out and stay out?
did they pass out and wake up and pass out again
did they just see stars

35
Q

what is a subdural hematoma

A

venous bleed between dura and brain
slower and less jpressure
commonly seen in chronic geriatric clients
imitates other conditions

36
Q

treatment of subdural hematoma

A

craniotomy

37
Q

What is hydrocephalus

A

increased accumulation of cerebral spinal fluid that increases ICP

38
Q

causes of hydrocephalus

A

tumor
hemorrhage
infection
congenital

39
Q

What is meningitis

A

inflammation of the spinal cord of brain

40
Q

what causes meningitis

A

bacterial or biral infection primarily transmitted through respiratory system

41
Q

which meningitis is worse

A

bacterial

42
Q

signs of meningitis

A

chills and high fever
severe headache
disorientation that can progress to coma
nausea and vomiting
nuchal rigidity
stiff neck
photophobia
seizures
kern and brudinski signs

43
Q

what is kerning sign

A

severe stiffness of the hamstrings, inability to straighten leg when hips flexed at 90 degrees

44
Q

what is brudinski sign

A

severe neck stiffness causes hips and knees to flex when neck is flexed

45
Q

treatment for meningitis

A

steroids
analgesics
antibiotics (bacterial)

46
Q

what precautions do you use for menengitis

A

viral (contact)
bacterial (droplet) Medical emergency

47
Q

how do you prevent menengitis

A

Hib vaccine

48
Q

What do you monitor for spinal injuries above T6

A

autonomic dysreflexia

49
Q

symptoms of autonomic dysreflexia

A

sudden severe hypertension
bradycardia
headache
nasal stuffiness
flushing
sweating
blurred vision
anxiety

50
Q

Trigger of autonomic dyreflexia

A

stimulus below t6

blister
restrictive clothing
dehydration
fecal inpaction
broken bones
full bladder or UTI
anxiety
pressure areas

51
Q

treatment of autonomic dyreflexia

A

antihypertensives-hydralazine
treat cause

52
Q

what are focal injuries

A

contusions and hematomas

53
Q

when are contusions seen

A

blunt trauma or acceleration-deceleration injureis

54
Q

What are the two types of stroke

A

hemorrhagic
ischemic

55
Q

what are the two types of ischemic strokes

A

embolic
thrombotic

56
Q

What happens in a hemorrhagic stroke

A

vessel ruptures and bleeds in the brain as it accumulates there is increased ICP

57
Q

what can a hemorrhagic stroke Be caused by

A

a weakened vessel such as an aneurysm

58
Q

What causes a ischemic stroke

A

blood flow to the brain is blocked by a blood clot causing a loss of circulation to the brain causing ischemia and damage

59
Q

what is a thrombotic ischemic stroke

A

a blood clot in an artery going to he brain

60
Q

what is an embolic ischemic stroke

A

a clot that’s formed elsewhere and travels in the blood stream and clogs a vessel in or leading to the brain (sudden onset)

61
Q

Signs of a stroke

A

Balance- dizzy loss of balance
eyes- blurry vision abnormal pupil response emianopia
facial droop- unilateral
arms drift or weakness
speech- aphasia, dysphagia, alter loc/ confusion

62
Q

treatment of ischemic stroke

A

permissive hypertension
antithrombotics- tPA,
MUST BE DONE WITHIN AN HOUR
percutaneous thrombectomy- surgical removal of clot done in IR

63
Q

treatment for hemorrhagic stroke

A

get bleeding under control
if caused by aneurysm coiling (IR) clipping (OR)
craniotomy
EVD

Hesi PN (24 decks)

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