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Med Surg II -- EXAM 2 > Neurology (Week 9) > Flashcards

Neurology (Week 9) Flashcards

1
Q

What diagnosis is associated with the physical findings of racoon eyes and battle’s sign?

KNOW THIS!!!!

A

Basilar Skull Fracture

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2
Q

What are the 3 components (and scores) of the Glascow Coma Scale (GCS)?

A

1.) Eyes Open (4)
2.) Motor Response (6)
3.) Verbal Response (5)

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3
Q

What is the difference in decorticate & decerebrate posture?

KNOW THIS!!!

A
  • Decorticate posture = hands / arms come into the CORE
  • Decerebrate posture = extension of the arms
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4
Q

What is decorticate posture?

KNOW THIS!!!

A

Hands / arms come into the CORE

Decorticate = into the core

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5
Q

What is decerebrate posture?

KNOW THIS!!!!

A

Extension of the arms

Decerebrate = extension

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6
Q

What is anisocoria?

KNOW THIS!!!

A

Unequal pupil size

pupils are different sizes

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7
Q

What is diplopia?

KNOW THIS!!!!!

A

Double vision

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8
Q

What are oculocephalic reflex (doll’s eyes) & oculovestibular reflex (cold caloric test) used as part of?

A

brain death criteria

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9
Q

What is normal intracranial pressure (ICP)?

KNOW THIS!!!!!

A

0 - 15

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10
Q

What are the signs & symptoms that are part of Cushing’s Triad?

KNOW THIS!!!!!

A
  • Widening pulse pressure
  • Bradycardia (↓ HR)
  • Irregular respirations (Cheyne-Stokes)
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11
Q

What is ptosis?

A

Eye drooping

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12
Q

What is homonymous hemianopsia?

KNOW THIS!!!!! Exam Question!

A

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

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13
Q

What is tardive dyskinesia?

A

involuntary repetitive movements / facial ticks

  • lip smacking
  • tapping
  • squirming
  • marching
  • grimacing
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14
Q

What type of medications / medication class often cause tardive dyskinesia?

KNOW THIS!!!!

A

Antipsychotic medications

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15
Q

Nursing Goals / Roles of Seizures

A
  • 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
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16
Q

What is a coma and how is it diagnosed?

A

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

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17
Q

Coma Etiology - structural lesions

A
  • Vascular lesions
  • Trauma
  • Brain tumors
  • CNS infection (brain abscess, meningitis/encephalitis)
  • Increased ICP (trauma)
  • Non-traumatic hydrocephalus
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18
Q

Coma Etiology - metabolic & toxic conditions

A
  • 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
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19
Q

What is the goal during medical management of a coma?

A

Identify & treat the underlying cause

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20
Q

Nursing Management of Comas

KNOW THIS!!!

A
  • 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
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21
Q

What is a persistent vegitative state (PVS)?

A

Patients who have severe brain damage & are in a state of what physicians call “wakefulness without awareness”

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22
Q

List the modifiable risk factors for stroke.

KNOW THIS!!!!! Exam Question!

A
  • Hypertension
  • Smoking
  • Transient Ischemic Attack (TIAs)
  • Heart Disease
  • Diabetes
  • Hypercoagulopathy
  • High RBC count & sickle cell anemia
  • Carotid bruit
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23
Q

List the non-modifiable risk factors for stroke.

KNOW THIS!!!!! Exam Question!

A
  • Gender
  • Hx of stroke
  • Heredity / Genetics
  • Age
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24
Q

What is the difference in a hemorrhagic & ischemic stroke?

KNOW THIS!!!!!

A

Hemorrhagic: rupture of an artery / blood vessel

Ischemic: loss of blood flow / blood supply to a certain area of the brain

25
Q

What is an ischemic stroke?

A

Loss of blood flow / blood supply to a certain area of the brain

26
Q

What is a hemorrhagic stroke?

A

rupture / bursting of an artery or blood vessel

27
Q

What is a transient ischemic attack (TIA)?

A

temporary neurologic deficit caused by a cerebrovascular disease taht leaves no clinical or imaging trace

28
Q

What percentage of all strokes are ischemic?

KNOW THIS!!!!!

A

87%

29
Q

Which of these is the greastest risk factor for an ischemic stroke?

a.) Carotid atherosclerotic disease
b.) Diabetes
c.) Hypertension
d.) Smoking

A

c.) Hypertension

30
Q

What is the window for administration of Fibrinolytic Therapy (TPA) for a patient with an ischemic stroke?

KNOW THIS!!!!!! Exam Question!

A

3-4 hours

31
Q

What is the door to CT time for a patient with a stroke who is a TPA candidtate?

KNOW THIS!!!!! Exam Question

A

25 minutes

32
Q

What is the door to thrombolytic therapy time for a patient who is a candidate for TPA?

KNOW THIS!!!!! Exam Question

A

60 minutes

33
Q

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

A
  • Door-to-CT = 25 minutes
  • Door-to-Thrombolytic Therapy = 60 minutes
34
Q

What is involved in the management / general care of a patient with an acute stroke?

KNOW THIS!!!!!

A
  • Maintain normovolemia (avoid D5W)
  • Control hyperglycemia > 140 & hypoglycemia
  • NPO status (until swallow study is performed)
  • Management of hypertension
  • Cardiac monitoring
35
Q

Anti-hypertensive therapy for ischemic stroke

A

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)
36
Q

TPA (rtPA) administration
* What needs to be done before & during TPA administration?

A
  • 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.)
37
Q

Cautions after tPA administration

KNOW THIS!!!!!

A

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
38
Q

Patient / Community Education regarding Strokes

KNOW THIS!!!!!

A
  • 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)
39
Q

What is FAST?

A
  • 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

40
Q

Potential Etiology of Subarachnoid Hemorrhages (SAH)

KNOW THIS!!!!

A
  • Cerebral Aneurysm Rupture (75% of cases)
  • AVM Bleed (< 10% of cases)
41
Q

Signs & Symptoms of a Subarachnoid Hemorrhage (SAH)

KNOW THIS!!!! Exam Question!

A

Worst headache of their life!!!!

  • Abrupt onset of headaches / nausea / vomiting / syncope / neurological deficit
  • May cause LOC / coma or death
42
Q

Nursing Management of Subarachnoid Hemorrhage (SAH)

KNOW THIS!!!

A
  • Monitor for changes in neurological signs & symptoms
  • Surveillance for complications (bleeding, vasospasm, impaired swallowing, & ineffective airway)
  • Monitor BP
  • Prevent orthostatic complications
  • Educate patient & family
43
Q

What is an epidural hematoma?

A

Arterial bleeding after trauma

44
Q

What is a subdural hematoma?

A

Spontaneous or venous bleeding after trauma

45
Q

What are the classifications of Subdural Hematomas?

KNOW THIS!!!! Exam Question!

A

Acute, Sub-acute, & Chronic

46
Q

What is an uncal herniation?

KNOW THIS!!!!!

A

Medial part of the temporal lobe protrudes over the tentorial edge as a result of increased ICP

Can lead to cushing’s traid

47
Q
A
47
Q

What can an uncal herniation lead to?

KNOW THIS!!!!!

A

Cushing’s Triad
* widening pulse pressure
* bradycardia
* irregular respirations

48
Q

What is a diffuse axonal injury?

KNOW THIS!!!!! Exam Question!

A

Rotational injury resulting in severe brain injury
* Shearing of fibers

  • Can lead to coma
  • Common in MVAs & diving accidents
49
Q

What can a diffuse axonal injury lead to?

A

Coma

50
Q

Normal range for intracranial pressure (ICP)

KNOW THIS!!!!!!!!

A

0 - 15

51
Q

Normal range for cerebral perfusion pressure

A

70 - 100

52
Q

How do you calculate CPP?

KNOW THIS!!!! Exam Question!

A

CPP = MAP - ICP

MAP = ((2 x DBP) + SBP) / 3

53
Q

What is autonomic dysreflexia? And what patient population does it occur in?

A

Abnormal over-reaction of the autonomic (involuntary) nervous system

  • change in HR
  • excessive sweating
  • changes in BP

Occurs in spinal cord injury patients

54
Q

Treatment of Autonomic Dysreflexia

A
  • Sit the pt upright
  • Evaluate possible cause
  • Keep evaluating BP
55
Q

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

A

c.) Obesity

56
Q

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

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

57
Q

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

A

b.) 54 drops/min

1.) 7 hr x 60 min = 420 min

2.) (1500 mL / 420 min) x 15 = 53.57 –> 54 drops/min

Med Surg II -- EXAM 2 (10 decks)

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