Neurology (Week 9) Flashcards
What diagnosis is associated with the physical findings of racoon eyes and battle’s sign?
KNOW THIS!!!!
Basilar Skull Fracture
What are the 3 components (and scores) of the Glascow Coma Scale (GCS)?
1.) Eyes Open (4)
2.) Motor Response (6)
3.) Verbal Response (5)
What is the difference in decorticate & decerebrate posture?
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- Decorticate posture = hands / arms come into the CORE
- Decerebrate posture = extension of the arms
What is decorticate posture?
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Hands / arms come into the CORE
Decorticate = into the core
What is decerebrate posture?
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Extension of the arms
Decerebrate = extension
What is anisocoria?
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Unequal pupil size
pupils are different sizes
What is diplopia?
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Double vision
What are oculocephalic reflex (doll’s eyes) & oculovestibular reflex (cold caloric test) used as part of?
brain death criteria
What is normal intracranial pressure (ICP)?
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0 - 15
What are the signs & symptoms that are part of Cushing’s Triad?
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- Widening pulse pressure
- Bradycardia (↓ HR)
- Irregular respirations (Cheyne-Stokes)
What is ptosis?
Eye drooping
What is homonymous hemianopsia?
KNOW THIS!!!!! Exam Question!
Loss of vision of one half of one or both eyes
Left Homonymous hemianopsia = loss of vision on the left side of one or both eyes
What is tardive dyskinesia?
involuntary repetitive movements / facial ticks
- lip smacking
- tapping
- squirming
- marching
- grimacing
What type of medications / medication class often cause tardive dyskinesia?
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Antipsychotic medications
Nursing Goals / Roles of Seizures
- Observe for aura, progression, muscle movement, incontinence, post ictal phase, presence of status
- Record / time the event
- Protect the patient from harm
- Place the patient in a side-lying position
- Do NOT put anything in the patient’s mouth
What is a coma and how is it diagnosed?
Coma is a state of unconsciousness
* arousal & awareness are lacking
Assessments & Diagnosis
* Diagnosis is clinical, based on LOC
* Neuroloigcal Assessment
* Diagnostic Tests / Procedures: skull x-rays, CT, MRI, LP, lab studies
Coma Etiology - structural lesions
- Vascular lesions
- Trauma
- Brain tumors
- CNS infection (brain abscess, meningitis/encephalitis)
- Increased ICP (trauma)
- Non-traumatic hydrocephalus
Coma Etiology - metabolic & toxic conditions
- Hypoxia / CO2 retention
- Electrolyte abnormalities
- Low cardiac output / shock
- Hypoglycemia, DKA, HHNS
- Poisoning, drugs, & alcohol
- Enironmental (hypothermia or hyperthermia)
- Encephalopathy (metabolic, anoxic, hypertensive)
- Sepsis
- Renal failure
- Liver failure
- Deficiency state (Wernicke’s encephalopathy)
- Post-convulsion
What is the goal during medical management of a coma?
Identify & treat the underlying cause
Nursing Management of Comas
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- Monitor for neurological changes
- Eye care
- Nutrition / impaired swallow
- Orthostasis: skin / DVT / atelectasis / VAP
- Prevention of infection
- Maintenance of clear airway – prevention of VAP
- Family care: “waiting care”
- Initiate rehabilitation measures
What is a persistent vegitative state (PVS)?
Patients who have severe brain damage & are in a state of what physicians call “wakefulness without awareness”
List the modifiable risk factors for stroke.
KNOW THIS!!!!! Exam Question!
- Hypertension
- Smoking
- Transient Ischemic Attack (TIAs)
- Heart Disease
- Diabetes
- Hypercoagulopathy
- High RBC count & sickle cell anemia
- Carotid bruit
List the non-modifiable risk factors for stroke.
KNOW THIS!!!!! Exam Question!
- Gender
- Hx of stroke
- Heredity / Genetics
- Age
What is the difference in a hemorrhagic & ischemic stroke?
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Hemorrhagic: rupture of an artery / blood vessel
Ischemic: loss of blood flow / blood supply to a certain area of the brain
What is an ischemic stroke?
Loss of blood flow / blood supply to a certain area of the brain
What is a hemorrhagic stroke?
rupture / bursting of an artery or blood vessel
What is a transient ischemic attack (TIA)?
temporary neurologic deficit caused by a cerebrovascular disease taht leaves no clinical or imaging trace
What percentage of all strokes are ischemic?
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87%
Which of these is the greastest risk factor for an ischemic stroke?
a.) Carotid atherosclerotic disease
b.) Diabetes
c.) Hypertension
d.) Smoking
c.) Hypertension
What is the window for administration of Fibrinolytic Therapy (TPA) for a patient with an ischemic stroke?
KNOW THIS!!!!!! Exam Question!
3-4 hours
What is the door to CT time for a patient with a stroke who is a TPA candidtate?
KNOW THIS!!!!! Exam Question
25 minutes
What is the door to thrombolytic therapy time for a patient who is a candidate for TPA?
KNOW THIS!!!!! Exam Question
60 minutes
What is the door-to-CT time & the door-to-thrombolytic therapy for a stroke patient who is a candidate for TPA?
KNOW THIS!!!! Exam Question
- Door-to-CT = 25 minutes
- Door-to-Thrombolytic Therapy = 60 minutes
What is involved in the management / general care of a patient with an acute stroke?
KNOW THIS!!!!!
- Maintain normovolemia (avoid D5W)
- Control hyperglycemia > 140 & hypoglycemia
- NPO status (until swallow study is performed)
- Management of hypertension
- Cardiac monitoring
Anti-hypertensive therapy for ischemic stroke
Want BP to be elevated to ensure blood flow to the brain (but not too high)
- treat elevated BP if a pt is a candidate for fibrinolytic therapy (BP must be < 185/110)
TPA (rtPA) administration
* What needs to be done before & during TPA administration?
- rtPA is administered in divided doses: 10% is given as a bolus over 1 minute & the remaining 90% is administered as a continuous infusion over the next 60 minutes
- Insert lines BEFORE administering tpa (IVs, Foley, endo tube, etc.)
Cautions after tPA administration
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NO anti-thrombotic or anti-platelet aggregating drugs (Aspirin, heparin, warfarin, etc.) for the first 24 hours!!!
- Avoid CVC, LP, or arterial lines for 24 hours unless absolutely necessary
- Avoid NG placement for 24 hours
- Avoid foley insertion for 30 minutes after tPA administration
Patient / Community Education regarding Strokes
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- Education of Stroke S&S
- Mild S & S un-noticed or ignored
- 1/2 of all stroke victimy are driven by family (important to transport via EMS)
What is FAST?
- F: facial weakness
- A: arm weakness
- S: speech problems
- T: time to call 911
B - balance
E - eyes
F - facial weakness
A - arm weakness
S - speech problems
T - terrible headache & time to call 911
Potential Etiology of Subarachnoid Hemorrhages (SAH)
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- Cerebral Aneurysm Rupture (75% of cases)
- AVM Bleed (< 10% of cases)
Signs & Symptoms of a Subarachnoid Hemorrhage (SAH)
KNOW THIS!!!! Exam Question!
Worst headache of their life!!!!
- Abrupt onset of headaches / nausea / vomiting / syncope / neurological deficit
- May cause LOC / coma or death
Nursing Management of Subarachnoid Hemorrhage (SAH)
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- Monitor for changes in neurological signs & symptoms
- Surveillance for complications (bleeding, vasospasm, impaired swallowing, & ineffective airway)
- Monitor BP
- Prevent orthostatic complications
- Educate patient & family
What is an epidural hematoma?
Arterial bleeding after trauma
What is a subdural hematoma?
Spontaneous or venous bleeding after trauma
What are the classifications of Subdural Hematomas?
KNOW THIS!!!! Exam Question!
Acute, Sub-acute, & Chronic
What is an uncal herniation?
KNOW THIS!!!!!
Medial part of the temporal lobe protrudes over the tentorial edge as a result of increased ICP
Can lead to cushing’s traid
What can an uncal herniation lead to?
KNOW THIS!!!!!
Cushing’s Triad
* widening pulse pressure
* bradycardia
* irregular respirations
What is a diffuse axonal injury?
KNOW THIS!!!!! Exam Question!
Rotational injury resulting in severe brain injury
* Shearing of fibers
- Can lead to coma
- Common in MVAs & diving accidents
What can a diffuse axonal injury lead to?
Coma
Normal range for intracranial pressure (ICP)
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0 - 15
Normal range for cerebral perfusion pressure
70 - 100
How do you calculate CPP?
KNOW THIS!!!! Exam Question!
CPP = MAP - ICP
MAP = ((2 x DBP) + SBP) / 3
What is autonomic dysreflexia? And what patient population does it occur in?
Abnormal over-reaction of the autonomic (involuntary) nervous system
- change in HR
- excessive sweating
- changes in BP
Occurs in spinal cord injury patients
Treatment of Autonomic Dysreflexia
- Sit the pt upright
- Evaluate possible cause
- Keep evaluating BP
A white female patient is admitted to an acute care facility with a diagnosis of cerebrovascular accident (CVA). Her history reveals bronchial asthma, exogenous obesity, & iron deficiency anemia. Which history finding is a risk factor for CVA?
a.) Caucasian race
b.) Female sex
c.) Obesity
d.) Bronchial asthma
c.) Obesity
A critical care medication has been ordered to be titrated at 15mcg/min. The solution is available at 25 mg in 250 mL of D5W. How should the nurse set the flow rate?
a.) 9 mL/hr
b.) 15 mL/hr
c.) 150 mL/hr
d.) 125 mL/hr
a.) 9 mL/hr
1.) 15 mcg = 0.015 mg
2.) (0.015 mg / min) x (250 mL / 25 mg) = (3.75 mL / 25 min)
3.) (3.75 mL / 25 min) x (60 min / hr) = 9 mL/hr
The physician prescribed 1500 mL of a solution to run over 7 hours. THe drop factor is 15. What will the drip rate be?
a.) 50 drops/min
b.) 54 drops/min
c.) 62 drops/min
d.) 66 drops/min
b.) 54 drops/min
1.) 7 hr x 60 min = 420 min
2.) (1500 mL / 420 min) x 15 = 53.57 –> 54 drops/min
