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NURS 470 > Neurology > Flashcards

Neurology Flashcards

1
Q

How would an obtundated patient present themselves?

A

lethargic, somnolent, responsive to verbal or tactile stimulation, but quickly drifts back to sleep

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2
Q

What kind of patient would present generally unresponsive; may be briefly aroused by vigorous, repeated, or painful stimuli; may withdraw (shrink away from) or localize (grab at) the source of stimuli?

A

a patient presenting with stupor

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3
Q

What scale is used to assess changes in arousal?

A

glascow coma scale

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4
Q

What are the three categories assessed in the Glascow Coma Scale?

A

Eye opening, verbal response, and best motor response

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5
Q

What are three examples of central stimulation? What does this address?

A

Trapezius pinch, sternal rub, supraorbital pressure
This will assess if the brain stem is still intact/functioning

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6
Q

What does peripheral stimulation assess?

A

spinal cord function

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7
Q

If a patient is presenting with decorticate posturing, what may this indicate?

A

cerebral hemispheric dysfunction

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8
Q

If a patient is presenting with decerebrate posturing, what may this indicate?

A

brainstem dysfunction

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9
Q

Is decorticate or decerebrate posturing more concerning? Why?

A

decerebrate, as this means there is brainstem dysfunction

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10
Q

What is the inability to understand written or spoken words?

A

wernicke’s (receptive) aphasia

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11
Q

What is the inability to express language through speech or writing?

A

broca’s (expressive) aphasia

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12
Q

What can pupillary reaction provide information on?

A

the location of the lesions or mass effect from cerebral edema

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13
Q

If both pupils are nonreactive, where is damage indicated?

A

the midbrain

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14
Q

If pupils are dilated on a patient, what is important to assess before getting too concerned?

A

medications.. atropine and epinephrine can cause pupil dilation

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15
Q

If a patient has pinpoint pupils, what can this be an indicator of?

A

pons lesion or opiate drug overdose

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16
Q

What are the two oculomotor responses that determine brainstem integrity?

A

oculovestibular (caloric) and oculocephalic (doll’s eyes) reflexes

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17
Q

What kind of drugs can depress oculocephalic/oculovestibular reflexes?

A

ototoxic drugs, neuromuscular blockers, and ethyl alcohol

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18
Q

What kind of respirations are seen in a bilateral lesion in the cerebral hemispheres, cerebellum, midbrain, or, in rare circumstances, upper pons, and it may be caused by cerebral infarction or metabolic disease?

A

Cheyne-stokes

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19
Q

What type of respirations indicate a lesion in the low midbrain or upper pons and may be caused by infarction or ischemia of the midbrain or pons, anoxia, or tumors of the midbrain?

A

central neurogenic hyperventilation

20
Q

What may an increased pulse be indicative of?

A

poor cerebral oxygenation

21
Q

In the late stages of ICP, there will be a ____ in heart rate?

A

decrease

22
Q

What is the reason that widening pulse pressure may occur?

A

ICP exceeds MAP

23
Q

What do cranial nerve reflexes indicate?

A

brainstem functioning

24
Q

What are the 4 protective reflexes?

A

(1) corneal reflex (blink), (2) gag reflex, (3) swallow reflex, and (4) cough reflex

25
Q

What is the gold standard for measuring ICP?

A

intraventricular monitoring

26
Q

What are the major disadvantages of having an intraventricular drain?

A

it is very invasive and carries a high risk for hemorrhage and infection

27
Q

Why is a subarachnoid pressure monitoring device not ideal for someone with an increased ICP?

A

they are unable to drain CSF

28
Q

What is the anatomic landmark for the lateral ventricle?

A

foramen of Monroe (tragus)

29
Q

Why is the waveform of a subarachnoid bolt/screw easily dampened?

A

fragments of bone or brain tissue may obstruct the bolt

30
Q

What is the p1 waveform on an ICP monitor?

A

pulse pressure

31
Q

What does the p2 waveform represent on an ICP monitor?

A

compliance of brain tissue

32
Q

What is the p3 waveform on an ICP monitor?

A

dicrotic wave

33
Q

When do A waves typically occur? What do they look like?

A

When there is an increase in ICP. They are sharp increases that plateau

34
Q

What kind of neurological changes typically accompany A waves?

A

decreased level of consciousness, pupillary changes, and posturing

35
Q

What are the two types of cerebral oxygenation monitoring?

A

jugular bulb oximetry and brain tissue oxygen monitoring

36
Q

What does a transcranial doppler measure?

A

cerebral blood velocity

37
Q

Three primary types of TBIs

A

Accelerational/decelerational, Rotational, Penetrating

38
Q

What are the 5 trademark signs of a basilar skull fracture?

A

Battle sign, raccoon eyes, otorrhea, rhinorrhea, positive halo sign.

39
Q

What are three circumstances that may cause an increase in cerebral blood volume?

A

hypoxemia and/or hypercapnia, cerebral venous outflow obstruction, or loss of cerebral autoregulation

40
Q

Why does hypoxemia/hypercapnia result in an increased CBV?

A

it causes vasodilation

41
Q

What term describes the process whereby cerebral vessels have the capacity to dilate or constrict in response to changes in perfusion pressures?

A

Autoregulation

42
Q

A brief loss of consciousness followed by a period of being alert and oriented and then a loss of consciousness again is a typical presentation for which condition?

A

epidural hematoma

43
Q

What is the term used to describe an accumulation of blood between the dura and the arachnoid layers of the meninges?

A

Subdural hematoma

44
Q

What should the MAP be maintained at for management of an intraparenchymal hematoma?

A

70mmHg or less

45
Q

Presence of dizziness, headache, and confusion for long periods of time after concussion is _______.

A

postconcussive syndrome

46
Q

What are the components of the beside neurological assessment?

A

LOC, motor function, pupillary response, respiratory function, and VS

47
Q

What interventions are used to manage cerebral metabolism?

A

sedation, anticonvulsants, antipyretic therapies

NURS 470 (33 decks)

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