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Hesi Study > Neurosensory and neurologic > Flashcards

Neurosensory and neurologic Flashcards

1
Q

Closed traumatic brain injury

A

Result of Blunt trauma

More serious than open due to chance of increased ICP in closed vault

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2
Q

The most important indicator of increased ICP

A

Changes in level of responsiveness

Even subtle changes such as restlessness, irritability, or confusion may indicate increased ICP

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3
Q

Symptoms of increased ICP

A

Changes in level of responsiveness
Changes in vital signs (bradypnea or resp irregularities, changes in pulse, rising BP, rising temperature)
Headache
Vomiting (usually projectile)
Pupillary changes
Seizures
Ataxia
Abnormal posturing (decerebrate or decorticate)
Cerebral spinal fluid leaking through nose or ear

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4
Q

Head injury patients should keep their head of bed elevated to

A

30- 45 degrees to aid in venous return from the neck and decrease cerebral volume

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5
Q

Head injury patients should have neurological vital signs taken every

A

1-2 hours

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6
Q

What should you do if client with head injury develops a fever

A

Immediately take action to reduce temperature through medication, or cooling blankets because increased temperature increases the cerebral blood flow drastically.

Avoid client shivering

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7
Q

When an intracranial monitoring system is being used to lower and maintain ICP pressure- at what level ICP should be reported immediately?

A

Elevations of ICP over 20 mm Hg should be reported stat

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8
Q

Why should nurses avoid narcotics in patients with head injuries?

A

They mask the level of responsiveness which is needed to assess early signs of increased ICP pressure

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9
Q

Post traumatic syndrome symptoms

A

Headache vertigo emotional instability, inability to concentrate, impaired memory

This is a possible after effect of a head injury

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10
Q

Most common sites for spinal cord injuries are

A

C5, C6, C7, T12, and L1

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11
Q

When can permanent impairment be determined in a spinal cord injury?

A

When the spinal cord edema has subsided- usually by 1 week

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12
Q

Hypotension and bradycardia will occur with any injury above (—) because sympathetic outflow is affected

A

T6

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13
Q

Spinal shock

A

A complete loss of all reflex, motor, sensory, and autonomic activity below the lesion

Medical emergency that occurs immediately after the injury

Characterized by hypotension and bradycardia. Complete paralysis and lack of sensation below lesion. Bladder and bowel distention

It is imperative to reverse spinal shock as quickly as possible bc permanent paralysis can occur is spinal cord is compressed for 12-24 hours

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14
Q

Autonomic dysreflexia

A

Exaggerated autonomic responses to stimuli that usually occurs in clients with lesions at or above T6.

Medical emergency that usually occurs after the period of spinal shock has finished and is usually triggered by a noxious stimulus such as bowel or bladder distention.

Characterized by elevated BP, pounding headache, sweating, nasal congestion, Goode bumps, bradycardia, bladder and bowel distention

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15
Q

Acute Paralytic ileus

A

Lack of gastric activity after spinal cord injury

Assess bowel sounds frequently and initiate gastric suction to reduce distention, and prevent aspiration and vomiting.

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16
Q

Spinal cord injury related to UTI

A

A common cause of death after a spinal cord injury is a UTI.

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17
Q

Brain tumors

A

Neoplasms occurring in the brain

Primary tumors can arise in any tissue of brain
Secondary tumors are result of metastasis from other areas (mostly lungs)

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18
Q

Multiple sclerosis

A

Demyelinating disease resulting in the destruction of CNS myelin and consequent disruption in the transmission of nerve impulses

Symptoms usually begin in upper extremities with weakness progressing to spastic paralysis.

More common in women

19
Q

Myasthenia gravis

A

Disorder affecting the neuromuscular transmission of impulses in the voluntary muscles of the body

Autoimmune disorder characterized by pretense of acetylcholine receptor antibodies

Usually affects women ages10-40 and men ages 50-70.

20
Q

Nursing assessment of myasthenia gravis

A

Diplopia (double vision)
Ptosis (eyelid drooping)
Mask like effects (sleepy appearance due to facial muscle involvement)
Weakness improved by rest- worsened by activity
Keep tracheostomy kit available at bedside incase of myasthenic crisis

Be alert for changes in resp status- most severe involvement may result in resp failure

21
Q

Edrophonium (tension) test can indicate what for myasthenia gravis patients?

A

A positive Tensilon test indicates myasthenic crisis

A negative test indicates cholonergic crisis

22
Q

Parkinson’s disease

A

Chronic progressive debilitating neurological disease of the basal ganglia and substantia nigra, affecting motor ability and characterized by tremor at rest, pill rolling movement, increased muscle tone (rigidity), slowness in initiating movement (bradykineshia), and postural instability

23
Q

Medication for Parkinson’s diseases

A

Levodopa

24
Q

Guillain-Barré syndrome

A

Clinical syndrome of unknown Orgin involving peripheral and cranial nerves
Usually preceded by a viral resp or GI infection 1-4 weeks prior to the onset of neurological deficits
Constant monitoring is needed for these pts to prevent the life threatening problem of acute resp failure

Full recovery usually occurs within several months to a year after the onset of symptoms

25
Q

Nursing assessment of Guillain-Barré syndrome

A

Parasthesia (tingling and numbness)
Muscle weakness in legs progressing to the upper extremities, trunk, and face
Paralysis of the ocular, facial, and oropharyngeal muscles causing marked difficulty in talking chewing and swallowing

26
Q

Major things to assess for in patients with Guillan-Barre syndrome

A

Breathlessness while talking
Shallow and irregular breathing
Use of accessory muscles when breathing
Paradoxical inward movement of the upper abdominal wall while in a supine position because this could indicate weakness and impending paralysis of the diaphragm

May need to be mechanically ventilated

27
Q

Stroke CVA

A

Thrombotic or hemorrhagic resulting in loss of blood supply to brain

Hemorrhagic- caused by slow or fast hemorrhage into brain tissue often related to HTN
Embolic- caused by a clot that broken away from a vessel and has lodged in one of the arteries of brain, blocking blood supply. Often related to atherosclerosis so it may occur again

28
Q

The quicker movement is recovered in stroke patients….

A

The better prognosis is for full or improved recovery

29
Q

Left hemi strokes

A 
Right sided weakness 
Asphagia
Reading problems
Unable to discriminate words and letters 
Deficits in right visual field
Depression
30
Q

Right hemi strokes…

A 
Left sided weakness 
Visual/spaci deficits 
Neglect of left visual field
Loss of depth perception
IMPULSIVE IMPULSIVE IMPULSIVE
unaware of neurological deficits
POOR JUDGEMENT
OVERESTIMATES ABILITIES

SAFTEY CONCERNS for risk of injury

31
Q

Apraxia

A

Inability to perform purposeful movements in the absence of motor problems

32
Q

Dysarthria

A

Difficulty articulating

33
Q

Dysphasia

A

Impairment of speech and verbal comprehension

34
Q

Aphasia

A

Loss of Ability to speak

35
Q

Agraphia

A

Loss of ability to write

36
Q

Alexia

A

Loss of ability to read

37
Q

Dysphasia

A

Difficulty swallowing

38
Q

Why are steroids administered after a stroke

A

To decrease cerebral edema and retard permanent disability.

39
Q

Conductive hearing loss

A

Transmission of sound to inner ear is blocked

40
Q

Sensorineural hearing loss

A

Damage to eighth cranial nerve

41
Q

How should the head of the bed be positioned for post craniotomy clients with infratentorial lesions?

A

Flat

42
Q

How should the head of the bed be positioned for post craniotomy clients with supratentorial lesions?

A

Elevated

43
Q

Open traumatic brain injury

A

When there is a fracture of the skull or penetration of the skull by a foreign object

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