Neurology System 2

Question 1

A patient with a head injury opens his eyes when his name is called, curses when he is stimulated, and does not respond to verbal command to move but attempts to remove a painful stimulus the nurse records the patients Glasgow coma scale score as what

A. 9
B. 11
C. 13
D. 15

Answer 1

B. 11

E = 3
V = 4
M = 4

Question 2

When assessing a patient with a neurological disorder using the Glasgow coma scale, the nurse is obtaining information relating to what

A. Level of consciousness
B. Presence of cerebral oedema
C. Presence of corneal and pupillary reflexes
D. Integrated functions of the cerebral cortex

Answer 2

A. Level of consciousness

Question 3

When the nurse applies a painful stimuli to an unconscious patient, the patient responds by stiffly extending and abducting the arms and hyper pronating the wrists. The nurse interprets this finding as what?

A. Abnormal flexion/posturing indicating an interruption of voluntary motor tracts
B. Extension posturing indicating an interruption of voluntary motor tracts
C. Abnormal flexion/posturing indicating a disruption of motor fibres in the midbrain and brain stem
D. Extension posturing indicating a disruption of motor fibres in the midbrain and brain stem

Answer 3

D. Extension posturing indicating a disruption of motor fibres in the midbrain and brain stem

Question 4

The nurse suspects possible tentorial herniation and compression of the brain stem when assessment of the oculomotor nerve reveals:

A. Absent corneal reflexes
B. The development of nystagmus
C. Diminishing pupillary response to light
D. Enlargement of the pupil on the contra lateral side

Answer 4

C. Diminishing pupillary response to light

Question 5

What does TBI stand for?

Answer 5

Traumatic brain injury

Question 6

What is the pathophysiology of a TBI (Traumatic Brain Injury)?

Answer 6

After the pt sustains a TBI, cerebral oedema or bleeding increases intracranial volume.

The rigid cranium of the head allows no room for expansion of contents in result, so the ICP starts to increase.

Pressure on the blood vessels within the brain cause reduced blood flow to brain tissues causing cerebral hypoxia and ischemia to occur.

With no intervention, intracranial pressure continues to rise and the brain may herniate causing cerebral blood flow to cease.

Question 7

What does the work herniate mean?

Answer 7

to protrude through an abnormal body opening

Question 8

What is the brief pathophysiology behind autonomic dysreflexia?

Answer 8

An exaggerated reflex response by the autonomic nervous system (SNS) due to an irritating stimulus below the site of spinal injury resulting in hypertension.

Question 9

What causes an irritating stimulus below the site of injury in AD (Autonomic dysreflexia)?

Answer 9

The 3 Big B’s

• Bladder (most common)
• Bowel
• Break down of skin integrity

Question 10

What is the autonomic nervous system?

Answer 10

Your autonomic nervous system is the part of your nervous system that controls involuntary actions. It is composed of two main systems; the Sympathetic nervous system (SNS) and the Parasympathetic nervous system (PNS)

Question 11

How does vasoconstriction affect blood pressure?

Answer 11

It increases blood pressure

Question 12

How does the sympathetic nervous system react to a perceived ‘dangerous’ stimulus?

Answer 12

It causes
- Vasoconstriction of blood vessels
- Sweat gland stimulation
- Bronchodilation (can breathe better)
- Tachycardia
- Dilation of pupils (can see better)

Question 13

How does the parasympathetic nervous system react to the sympathetic nervous system?

Answer 13

It causes
- Vasodilation
- Decrease the HR by stimulating the vagus nerve
- Salivation
- Bronchoconstriction
- Constricts pupils

Question 14

How do the sympathetic and parasympathetic nervous systems work together?

Answer 14

They balance each other in order to keep the body in equilibrium. Such as if one increases blood pressure the other will decrease blood pressure.

Question 15

What is required for effective communication between the sympathetic nervous system and the parasympathetic nervous system?

Answer 15

A healthy and intact spinal cord so messages can be sent across the spine

Question 16

First step of autonomic dysreflexia?

Answer 16

An irritating stimulus such as a full bladder in a patient with a spinal injury at T6.

Question 17

Second step of autonomic dysreflexia?

Answer 17

An exaggerated sympathetic reflex response occurs causing vasoconstriction of blood vessels below the site of the pts spinal injury. Increasing overall blood pressure. The lower body will become pale cool and clammy due to the restricted blood flow in this area.

Question 18

Third step of autonomic dysreflexia?

Answer 18

The baroreceptors will sense the increasing BP causing the parasympathetic nervous system to kick in, and cause vasodilation to try keep the BP down although they cant send signals below the site of injury so vasodilation will only occur above the site of injury causing the upper body to become flushed.

The parasympathetic system will also try to slow the HR (bradycardia) by stimulating the vagus nerve. This will occur.

Question 19

Fourth step of autonomic dysreflexia?

Answer 19

The compensatory mechanisms by the sympathetic and parasympathetic nervous system will not be effective. And vasoconstriction under the site of injury will continue to occur until we can remove the stimulus and treat the patient appropriately.

Question 20

Signs and symptoms of autonomic dysreflexia?

Answer 20

• Throbbing and pounding headache due to inc BP
• Hypertension
• Flushing above the spinal cord injury due to vasodilation
• Pale, cool, and clammy skin below the spinal cord injury due to vasoconstriction
• Bradycardia
• Goosebumps and sweating
• Anxiety
• Dilated pupils

Question 21

What Nursing interventions for a patient with autonomic dysreflexia come under ‘Prevention’?

Answer 21

P - Prevention: Think of the 3 Big B’s (Bladder, Bowel, Breakdown of skin).

• Assess UOP (FBC, Bladder diary, Routine Bladder scan), and check foley catheter is draining.
• Abdominally assess using auscultation for bowel sounds, and use palpation for assessing bowel impaction, and use the bristol stool chart to assess last BM.
• Reposition every 2 hours to prevent pressure injury, preform regular skin checks to assess for infection or injury, remove any binding devices or clothing below the site of injury to prevent break down of skin.

Question 22

What is the acronym used to remember the nursing interventions for a patient with autonomic dysreflexia?

Answer 22

PDA “Prevention, detection, action”

Question 23

What Nursing interventions for a patient with autonomic dysreflexia come under ‘Detection’

Answer 23

D - Detection

Assess blood pressure and monitor for elevation of a systolic 20-40mmhg more than baseline

Assess for signs and symptoms of AD

Question 24

Which patients are at the highest risk for autonomic dysreflexia?

Answer 24

Patients with a spinal injury at T6 or higher

Question 25

What Nursing interventions for a patient with autonomic dysreflexia come under ‘Action’

Question 26

What is the Aetiology of Stroke? Including non-modifiable risk factors.

Answer 26

Age over 55 (Older age)
Being a women
Being NZ Maori or south asian or african/carribean
Genetics

Question 27

What is the Aetiology of Stroke? Including modifiable risk factors.

Answer 27

High cholesterol
Diabetes
Obesity
Inactivity
Smoking and ETOH
Hypertension!

Question 28

What is an ischaemic stroke?

Answer 28

An ischemic stroke occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. This can occur due to a cerebral embolism or thrombosis.

Question 29

What is a haemorrhagic stroke?

Answer 29

A stroke caused by a burst blood vessel in the brain causing blood to leak into brain tissue and surrounding structures causing a rise in intracranial pressure and damage to brain tissue

Question 30

What is a cerebral embolism?

Answer 30

A blood clot or debris formed elsewhere in the body that travels to the brain and occludes a brain vessel interrupting blood flow causing tissue ischaemia

Question 31

What is cerebral thrombosis?

Answer 31

A narrowing of the cerebral arteries by plaque build up causing a clot to form on the plaque and occlude the vessel restricting blood flow to an area of the brain. Tissue ischaemia will occur if not thrombolysed

Question 32

What is a transient ischaemia attack? TIA

Answer 32

A temporary loss of neurological function caused by ischaemia (less than 24 hours) resulting from inadequate blood flow to the brain from partial or complete occlusion of an artery.

Question 33

What is the pathophysiology of an ischaemic stroke?

Answer 33

The disrupted blood blood to an area in the brain causes anaerobic respiration. This anaerobic respiration in the will occur to try form ATP causing the increased production of lactic acid.

This increases intracellular calcium and glutamane causing vasoconstriction of the surrounding blood vessels of the ‘dying’ tissue.

This causes the cell membrane and proteins in this tissue to break down leading to cell injury and death.

Question 34

What is the pathophysiology of a haemorrhagic stroke?

Answer 34

An explosive eruption of blood from a vessel into surrounding tissues and structures occurs causing haematoma.

The exposure of the brain to blood causes an increase in ICP and secondary ischaemia will result from reduced blood flow.

There will be a mismatch between blood flow and metabolic demand and a breakdown of the sodium/potassium pump maintaining cellular function. Anaerobic respiration in the cells will occur to try form ATP causing the increased production of lactic acid.

The cell membrane and proteins will break down leading to cell injury and death.

Question 35

What is haematoma?

Answer 35

Hematoma is generally defined as a collection of blood outside of blood vessels. Most commonly, hematomas are caused by an injury to the wall of a blood vessel

Question 36

What is a cerebral aneurysm?

Answer 36

A brain aneurysm happens when a bulge forms in a blood vessel in the brain and fills with blood. It is mostly asymptomatic until rupture and has a sudden onset.

Question 37

What is the first symptom of a cerebral aneurysm?

Answer 37

A severe ‘thunderclap’ headache

Question 38

Brainstem strokes may lead to what?

Answer 38

Coma, breathing problems, spontaneous changes in blood pressure and HR, and nausea and vomiting

Question 39

Cerebellar strokes may lead to what?

Answer 39

Ataxia (impaired balance), dysarthia (slow/slurred speech), incoordination, and nystagmus (involuntary eye movements)

Question 40

Clinical manifestations of a stroke?

Answer 40

Changes in
Motor function
Communication
Intellectual function
Spatial perception
Affect

Question 41

What are the contralateral symptoms of a right brain injury?

Answer 41

Paralysed left side
Special perceptual deficits
Quick, impulsive behavioural style
Memory deficits

Question 42

What are the contralateral symptoms of a left brain injury?

Answer 42

Paralysed right side
Speech and language deficits
Slow, cautious behavioural style
Memory deficits

Question 43

Quick way to remember stroke manifestations?

Answer 43

FAST
F = Face drooping
A = Arm weakness
S = Speech difficulty
T = Take action (call 111)

Question 44

Main treatments for an ischaemic stroke/TIA?

Answer 44

Thrombolytic agents (t-PA) (clot busters that need to be administered within 3 hours of symptoms)

Carotid endarterectomy (removal of plaque from extra cranial cerebral arteries)

Question 45

Main treatments for an hemorrhagic stroke?

Answer 45

Surgical evacuation of haematoma via craniectomy

Relief of raised ICP using surgical removal or placement of external ventricular drains

Clipping or endovascular coiling of cerebral aneurysm to prevent re-bleeding

Question 46

Nursing interventions for a stroke in the acute phase

Answer 46

• Maintain the head of the bed at 30 degreed to facilitate jugular venous drainage and help reduce intracranial pressure
• Maintain systolic BP within parameters to reduce the potential for further bleeding or ischaemic changes
• Continuous neurological obs to help identify deterioration to initiate timely intervention and treatment
• Ensure correct positioning of paralysed limbs to prevent contractures and maximise function for rehabilitation
• Ensure patient is kept NBM until swallow is assessed by speech and language therapist to prevent the aspiration of oral liquid and food
• Administer prescribed aspirin orally or enterally to impede clotting and prevent further ischaemia
• Turn the patient regularly to maintain skin integrity and prevent pressure injurys if the patient cannot move themselves.

Question 47

What are the different types of TBI’s?

Answer 47

Closed (blunt) brain injury
Open brain injury
Concussion
Contusion
Diffuse axonal injury
Focal injury

Question 48

What are basilar skull fractures?

Answer 48

This is the most serious type of skull fracture, and involves a break in the bone at the base of the skull. Patients with this type of fracture frequently have bruises around their eyes and a bruise behind their ear. They allow CSF to leak from nose and ears.

Question 49

Hypoxic brain injurys are caused by what?

Answer 49

Smoke inhalation
carbon monoxide poisoning
Cardiac arrest
Strangulation
Drowning
Drug overdose
Traumatic birth
Stroke
Electrocution

Question 50

What are the key symptoms of damage to the brainstem?

Answer 50

Loss of consciousness
Interruption of normal breathing
Interruption of cardiac functioning
Fixed and dilated pupils (big)

Question 51

What is parkinsons disease?

Answer 51

A chronic progressive neurological condition that affects the pigmented dopaminergic neurons of the substantia nigra and locus ceruteus of the basal ganglia. Causing the degeneration of neurons in the brain leading to impaired motor function.

Question 52

What are the side effects of parkinsons disease?

Answer 52

Tremor, rigidity, bradykinesia, and postural instability.

Question 53

Side effects of parkinsons disease are directly caused by what?

Answer 53

Impairment of extrapyramidal tracts in the brain which control complex body movement

Question 54

What are some symptoms of raised ICP?

Answer 54

The main 3 symptoms are (cushings triad)
- Decreased HR
- Irregular respiration
- Widended pulse pressure (inc difference between systolic and diastolic)

As well as: weakness, blurred vision, headaches, vomiting, lethargy, and changes in behaviour.

Question 55

What is the treatment for raised intracranial pressure?

Answer 55

Elevation of the head, medications (mannitol intravenous), draining of fluid, and sometimes craniotomy

Question 56

What is meningitis?

Answer 56

Meningitis is an inflammation (swelling) of the protective membranes (meninges) covering your brain and spinal cord. The swelling from meningitis typically triggers symptoms such as headache, fever and a stiff neck.

Question 57

Aeitiology of meningitis

Answer 57

There are many causes of meningitis, the most common being viral or bacterial infection.

Bacterial meningitis can develop very rapidly over a few hours and can cause serious complications or even death.

Those most at risk are babies and young children under 5 years, teenagers and young adults, older adults, those with weakened immune systems or those living in shared accommodation.

Question 58

What is epilepsy?

Answer 58

Epilepsy (mate hukihuki) is a type of brain disorder where a person has recurrent seizures (sometimes called fits or convulsions)

Question 59

What is a seizure?

Answer 59

A seizure is a sudden burst of uncontrolled electrical and chemical activity in your brain. This disturbs its normal pattern of activity, causing strange sensations, emotions and behaviour or sometimes jerking or twitching of the body or limbs, muscle spasms and loss of consciousness.

Question 60

Aeitiology of epilepsy

Answer 60

Genetics
Injury to brain cells (TBI, growth/tumour, stroke, previous infection such as meningitis)

Question 61

What are generalised seizures?

Answer 61

Generalised seizures result from abnormal brain activity on both sides of your brain at once.

These seizures may cause momentary stares, loss of consciousness, falls or repetitive muscle jerks

Question 62

What are focal seizures?

Answer 62

Focal seizures start in one part of your brain. The sensations or feelings you experience during a focal seizure depend on which part of your brain is affected.