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Adult Health 3 > Test 3 - Neuro > Flashcards

Test 3 - Neuro Flashcards

1
Q

What are the 3 main things inside the skull?

A

Brain, blood, and CSF

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2
Q

What is the Monro-Kellie Hypothesis?

A

An increase in any of the 3 main components can increase ICP because the skull is rigid

Brain herniation and death will result, if not resolved

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3
Q

C-Spine vs. Airway

A

C-Spine = airway priority (prevent worsening of injury)

Maintain C-Spine immobilization

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4
Q

Primary Brain Damage

A

Damage from physical force (open or closed injury)

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5
Q

Secondary Brain Damage

A

Neuro damage after the initial injury (high ICP, hematoma, etc.)

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6
Q

Open Injury

A

The skull is open or fractured

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7
Q

Closed Injury

A

The skull is intact

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8
Q

Linear Fracture

A

Single, clean break (common in kids)

Least likely to be fatal

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9
Q

Comminuted Fracture

A

Multiple fractures with potential bone depression into brain tissue

Requires emergency surgery

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10
Q

Basilar Skull Fracture: description

A

A fracture at the base of the skull, extends into anterior, middle, and posterior fossa

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11
Q

What can a Basilar Skull Fracture cause?

A

May cause a tear into the dura mater, resulting in a CSF leak

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12
Q

Basilar Skull Fracture: Clinical Manifestations

A
  • CSF leak
  • Facial Palsy
  • Nystagmus (eye twitch)
  • Facial numbness
  • Deafness
  • Battle’s Sign
  • Raccoon’s Eyes
  • Hemotympanum
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13
Q

What can a CSF leak cause?

A
  • Otorrhea

- Rhinorrhea

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14
Q

How do you confirm that fluid is CSF?

A
  • Halo Sign

- Test for glucose or chloride

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15
Q

What is Battle’s Sign?

A

Ecchymosis behind the ear (indicates basilar skull fx)

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16
Q

What is Raccoon’s Eyes?

A

Periorbital edem (indicates basilar skull fx)

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17
Q

What is hemotympanum?

A

Blood in the ear drum causing inflammation

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18
Q

What does Basilar Fracture increase the risk for?

A

Meningitis

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19
Q

What are signs of Meningitis?

A
  • Increased Temperature

- Nucchal rigidity

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20
Q

Basilar Skull Fracture: Nursing Care

A
  • Assess cranial nerves for vision, hearing, or smell
  • Avoid NG, nasal intubation, or use of foreign objects into nares/ears!
  • HOB 30 degrees
  • Avoid straining, coughing, blowing nose (increases meningitis risk)
  • Administer abx
  • Watch for meningitis s/s
  • Surgery if CSF leak >1 week
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21
Q

Closed Head Injury Types (3)

A
  • Concussion
  • Contusion
  • Diffuse axonal injury (DAI)
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22
Q

Concussion: description and cause

A
  • Brain strikes inside of skull, causing damge at the cellular level
  • Caused by blunt force to the head
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23
Q

Concussion: S/S

A
  • Dizziness
  • Headaches
  • Irritability
  • Memory loss
  • Brief LOC
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24
Q

What are s/s of post concussion syndrome?

A
  • Personality changes
  • Irritability
  • Headaches
  • Memory loss
  • Depression
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25
Q

Is Concussion damage visible on a CT scan?

A

No. It is at the cellular level

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26
Q

Contusion: description

A

Bruising of the brain at coup or contrecoup

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27
Q

What is “coup”?

A

Site of injury

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28
Q

What is “contrecoup”?

A

Opposite of the site of injury

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29
Q

What is Diffuse Axonal Injury (DAI)?

A

Direct injury to axons (twist and/or tear of axons)

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30
Q

What is the result of DAI?

A

Coma or severe intellectual damage

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31
Q

Can axons heal?

A

No. Once they have been twisted and torn, there is not going back.

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32
Q

Minor Head Injury Education

A
  • If sleeping, wake q3-4 hr for first 48hr
  • HA, Nausea, Dizziness = normal, at least 24 hrs
  • Notify HCP become severe or do not improve
  • No sedatives for at least 24 hrs
  • Frequent neuro checks
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33
Q

What is Chronic Traumatic Encephalopathy (CTE)?

A

A progressive, degenerative brain disease caused by repetitive head traume (athletes, veterans, etc.)

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34
Q

What are S/E of CTE?

A
  • Problems with thinking and memory
  • Memory loss
  • Confusion
  • Impaired judgement
  • Early, progressive dementia
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35
Q

Brain Laceration Types (3)

A
  • Epidural Hematoma
  • Subdural Hematoma
  • Intracerebral Hemorrhage
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36
Q

Epidural Hematoma: description and s/s

A
  • Rapid, arterial bleed above the dura

- Lucid interval**

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37
Q

What is a Lucid Interval?

A

Brief period of lucidity before 2nd LOC

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38
Q

Subdural Hematoma

A
  • Slow, venous bleed between the dura and the brain

* Takes longer to see in geriatrics r/t brain atrophy with age

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39
Q

Intracerebral Hemorrhage

A

-A bleed inside the brain

Commonly a ruptured aneurysm

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40
Q

What does decorticate mean?

A

Abnormal stiffness

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41
Q

Glasgow Coma Scale: purpose

A

To evaluate neuro status in comatose patients

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42
Q

What are the categories assessed with the GCS?

A
  • Eye (4)
  • Verbal (5)
  • Motor (6)
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43
Q

GCS scores: 15, 7, 3

A

15- excellent

7- <8 = airway issues, needs intubation

3- completely comatose

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44
Q

Decorticate Positioning: Indicates

A

Lesion in the cortiocspinal pathway

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45
Q

Decerebrate Positioning: Indicates

A

Lesion in the brainstem

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46
Q

Normal ICP Value

A

5-15 mmHg

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47
Q

What ICP value indicateds intracranial HTN?

A

> 20 mmHg

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48
Q

Measurement of ICP

A
  • HOB at 20-30 degrees

- Level transducer with foramen of Monro/ “Tragus” (the ear)

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49
Q

What is the relationship between ICP and CPP?

A

Increased ICP = decreased CPP

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50
Q

What can too elevated CPP cause?

A

Rupture of brain blood vessels

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51
Q

Normal CPP Value

A

60 mmHg (max 80 mmHg)

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52
Q

How does BP (MAP) relate to CPP?

A

BP needs to be in a healthy range to maintain proper CPP

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53
Q

How do you calculate MAP?

A

[(2 x Diastolic BP) + Systolic BP]/3 = MAP

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54
Q

How do you calculate CPP?

A

MAP - ICP = CPP

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55
Q

What are clinical manifestations of increased ICP?

A

-#1 sign = LOC change
-Pupillary changes (ipsilateral/same side as injury)
Bilateral changes indicates worsening
-Papilledema
-Motor Changes
-Headache
-Projectile Vomiting
-Cushing’s Triad

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56
Q

What are the steps in worsening motor changes?

A

Decorticae, Decerebrate, Flaccid paralysis

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57
Q

What is Cushing’s Triad?

A
  • HTN with widdening pulse pressure
  • Bradycardia
  • Alternating respiratory patterns (Cheyne Stoke)
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58
Q

What are Cheyne Stoke Respirations?

A

Segments of tachypnea followed by apnea

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59
Q

Maximum Na Level

A

160

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60
Q

Medicinal Care to reduce Cerebral Edema

A

-Hypertonic saline (3% NaCl)
-Osmitrol (Mannitol)
Use a filter* (d/t crystallization)
Bolus for best results
-Dexamethasone (Decadron), Solumedrol = steroids per protocol
-Avoid hypotonic fluids (such as D5W or 1/2 NS) will worsen condition

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61
Q

Normal Osmolality Value

A

295 - 320

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62
Q

What type of medications do you use to treat Vasogenic Edema?

A

Diuretics

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63
Q

What type of medications do you use to treat Cytotoxic Edema?

A

Steroids

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64
Q

What is Vasogenic Edema?

A

Fluid accummulation outside of cells; damage occurs to BBB

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65
Q

What is Cytotoxic Edema?

A

Fluid accummulation inside of cells

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66
Q

What is the affect of Hypertonic Solutions?

A

Pulls fluid out of cells, shrinking them

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67
Q

Non-Pharmalogical Care for increased ICP/Cerebral Edema

A

-HOB degrees to improve venous drainage from brain
-Keep Blood Glucose WNL
Monitor q4h

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68
Q

Normal BG Value

A

80-120 mg/dL

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69
Q

Significane of hyperglycemia in brain injury

A

Predictor of poor outcome - associated with UTI, pneumonia, etc.

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70
Q

BP control with increased ICP

A
  • When HTN is severe (>180/95 mmHg)

- Avoid hypotension = cerebral ischemia

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71
Q

What is a severe HTN value?

A

> 180/95 mmHg

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72
Q

Why do you need to avoid hyperventilation?

A

hyperventilation = low CO2 = vasoconstriction = ischemia

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73
Q

End tidal CO2 value

A

30-35 mmHg

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74
Q

PCO2 (ABG) Value for Brain Injury

A

35-38 mmHg

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75
Q

What can cause a seizure?

A

Too high temperature

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76
Q

Room Set up for Brain Injury

A

-Patient’s Temperature is kept ~97 F (36 C)
Need to slowly lower body temp to avoid shivering
-Bedside swallow studies PRN
-Decrease stimuli
-Avoid clustering of care

Measures to prevent ICP increases

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77
Q

What kind of sedatives are given for brain injury?

A

Non-Barbituates (Diprovan [Propofol])
Anticonvulsants (within 1 weeks of injury)
S/E: bradycardia, hypotension
“Keppra” (1000 mg)

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78
Q

What does OT do?

A

Helps people regain ability to do ADLs

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79
Q

Brain Death: description

A

Non-reversible brain injury that precedes cardiac arrest

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80
Q

Organ donation requirements

A

Donor must have intact heartbeat and circulation (MAP >60)

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81
Q

Organ Donor Eligibility

A

<65 years old with:
No hx of metastatic cancer
No active sepsis
No evidence of communicable diseases such as Hepatitis or HIV/AIDS

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82
Q

Brain Death Determination

A

Must be “warm and dead”

  • Normal temperature
  • No brain activity depressing drugs
  • SBP >100
  • Etiology of coma known
  • No brainstem reflexes (pupillary, ocular, corneal, gag, and cough)
  • Apnea test
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83
Q

What is an Apnea Test?

A

Don’t extubate, but disconnect from the ventilator and only give O2
Compare ABG b4/after for exponentially increased CO2

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84
Q

Additional Brain Death confirmatory tests

A
  • Cerebral angiogram
  • Electroencephalography (EEG)
  • Transcranial doppler
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85
Q

What is seen on a Cerebral Angiogram in brain death?

A

Decreased bloodflow (“Hollow skull”)

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86
Q

Nurse’s Role in Brain Death Care

A
  • Follow state/facility procedures
  • Don’t use misleading terms (i.e life support)
  • Don’t perform misleading actions (overly cheery, talking to patient as if conscious)
  • Document accurate Time of Death
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87
Q

What are things that cause increased Serum Osmolality?

A
  • Dehydration
  • Lasix
  • Diuretics: Mannitol
  • Hypertonic Fluids
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88
Q

What is the function of the Spinal Cord?

A

It is the highway between the CNS and the Brain

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89
Q

What do the Spincal Cord’s Upper Neurons do?

A

Send signals from the brain to the spinal cord

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90
Q

What do the Spinal Cord’s Lower Neurons do?

A
  • Sensory: send signals from spinal cord to the brain

- Motor: send signals from spinal cord to the body (reflexes, muscles, etc.)

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91
Q

How many of each Spinal Nerve?

A

Breakfast, Lunch, Dinner

Cervical - 8
Thoracic - 12
Lumbar/Sacral - 5 each

92
Q

SCI Mechanisms of Injury

A

Hyper Flexion
-head on collision

Hyper Extension
-rear end collision

Axial loading
-compression injury

Rotational
-head turned beyond normal range

Penetrating Injury
-bullet, stab, etc.

93
Q

What area of the spine are most commonly injured?

A
  • Cervical
  • Thoracolumbar

(Areas with the most mobility)

94
Q

What impacts SCI outcomes?

A

Severity and level of injury

Higher injury = Higher disability

Complete (permanent loss of function below LOI) or Incomplete

95
Q

What is Brown Sequard?

A

Ipsilateral (same as injury side): loss of motor function, sensation, vibration affected

Contralateral: loss of pain/temperature affected

96
Q

Brown Sequard: Affected Side

A

No motor function, full sensation

97
Q

Brown Sequard: Unaffected Side

A

No sensation, full motor function

98
Q

Spinal Shock: onset and duration

A

Immediate onset after injury

Temporary (lasts 4-6 weeks)

99
Q

Spinal Shock: S/S

A
  • Complete loss of motor function, including Bowel and Bladder (flaccid paralysis)
  • Gradual return of function
  • Positive anal wink (assesses S5 Nerve, which is lower than the nerves for toes)
  • Loss of sensory function
100
Q

Spinal Shock: Care

A
  • NPO = NGT need

- Foley Catheter needed

101
Q

Neurogenic Shock: onset

A

Immediately after injury

102
Q

Neurogenic Shock: S/S

A

Only shock with bradycarida and hypotension***

Temp SNS loss = PNS taking over

PNS activation = decreased HR and vasodilation

BP and heart rate drop

Flushed, warm, dry skin

103
Q

Neurogenic Shock: Interventions

A
  • Vasopressors
  • Dopamine
  • Volume Replacement
  • Ace Wrap
104
Q

Autonomic Dysreflexia: onset and cause

A

Delayed = a few weeks post-injury

Any nerve over stimulation (especially bowel and bladder)

105
Q

Autonomic Dysreflexia: S/S

A
  • HA, flushing, warmth
  • HTN (d/t vasoconstriction) = SBP 20-40+ baseline
  • Bradycardia
  • Anxiety
  • Cold skin below LOI
106
Q

What does a LOI above T6 cause?

A

Loss of SNS

107
Q

Autonomic Dysreflexia: Interventions

A
  • Elevate HOB
  • Remove stimulus
  • VS q2-5 minutes
  • If BP remains elevated, IV meds
108
Q

Autonomic Dysreflexia: Pathology

A

Nerves don’t communicate

SNS is triggered below LOI

PNS is triggered above LOI

109
Q

Autonomic Dysreflexia: above LOI

A

PNS triggered

  • HA
  • Flushed
  • Vasodilation
110
Q

Autonomic Dysreflexia: below LOI

A

SNS triggered

  • Cold
  • Clammy
  • HTN
111
Q

Where is T4?

A

Nipple line

112
Q

Where is T10?

A

Belly button

113
Q

Autonomic Dysreflexia: Goals and Teaching

A

Goal: prevent episodes from occurring

Teaching:

  • recognize triggers (Bowel and Bladder = top 2)
  • Remove stimulus quickly
  • Maintain effective bowel and bladder regimens
114
Q

Bladder Regimen

A 
-Straight Cath (sterile techiniqure) after voiding
          Use BR q2h after meals
-Bladder scans to check residuals
-DC regimen if residual urine <100 mL
-Increase fluids 2,000 to 2,500 mL/day
-S/S UTI
115
Q

UTI: S/S for sensory impaired

A

Urine odor and appearance

116
Q

Stimulating Bladder

A
  • Valsalva
  • Tighten abs
  • Straight cath
  • Stroke inner thigh
  • Pull pubs

DC if residuals <100 mL

117
Q

Bowel Regimen

A
  • Maintain routine
  • High fiber and fluid if allowed
  • Rectal stimulation
  • Mini Enema
  • Manual decompaction
118
Q

SCI reproductive effects

A

Men may have problems with erection, ejaculation, or both

Women can conceive and get pregnant

119
Q

Transient Ischemic Attack (TIA)

A

Transient focal neurologic dysfunction w/o acute infarction

Mini-stroke - “warning sign” of full stroke potential
1/3 of pt. within a year

S/S resolve in about 60 min

120
Q

Stroke: Risk Factors

A
  • > 60 yr
  • African America
  • Female
  • HTN
  • High cholesterol
  • Diabetes
  • Lifestyle factors
  • A. Fib d/t clotting at appendage of heart
121
Q

Stroke: Types

A

Ischemic (MOST COMMON)
-Clots, thrombus, or embolus

Hemorrhagic
-broken blood vessel

122
Q

Stroke: Assessment

A

GFAST

123
Q

G.F.A.S.T

A 
G- gaze
F- facial droop
A- arm weakness
S- speech difficulty
T- time to call for help
124
Q

What is the time limit for thrombolytic treatment of strokes?

A

4.5 hours maximum

125
Q

What is the time limit for mechanical removal of clots in strokes?

A

24 hrs

126
Q

What are the best diagnostic tests for stroke?

A
  • # 1 = urgent CT, no contrast
  • MRI
  • Fingerstick BG (to see if BG level is cause)
  • O2 saturation
  • 12 lead ECG
  • CBC
127
Q

Stroke: S/S

A

Based on:

  • Location
  • Size
  • Perfusion
  • Collateral blood flow
128
Q

Where are the most common strokes?

A

Middle Cerebral Artery

129
Q

Basilar Artery Syndrome: S/S

A

Affects the brainstem; 95% fatal

  • Dizziness
  • Ataxia
  • Tinnitus
  • Nausea/Vomiting
  • One sided weakness

Test function: touch nose, touch RN finger

130
Q

Right MCA

A

Largest cerebral artery; most affected by stroke

  • Left* sided weakness
  • Eyes turned toward* stroke (right)
  • Left side neglect
  • Disorientation, impulsive, poor judgement, constant smiling, lack of position sensing
131
Q

Left MCA

A
  • Right* sided weakness
  • Altered intellectuality, slow, cautious, anxious, depressed, dyslexia or alexia
  • No hearing deficit
  • Eyes turn towards stroke
132
Q

Left MCA: Aphasia

A

Expressive: ask “what is this object?”

Receptive: tell “give me a thumbs up”

133
Q

Left MCA: Dysarthia

A

Loss of speech

134
Q

Expressive Aphasia: area and lobe

A

Broca’s Area

Frontal lobe

-Difficulty in expressing thoughts (written or verbal)

135
Q

Receptive Aphasia: area and lobe

A

Wernicke’s Area

Temporarl lobe

  • Unable to understand (written or vebal)
  • Neologisms
136
Q

Global/Mixed Aphasia

A

Combination of Expressive and Receptive Aphasia

137
Q

Stroke: Motor changes

A
  • Hemiplegia/Hemiparesis (one side paralysis)

- Motor changes on opposite* side of stroke location

138
Q

Stroke: Sensory changes

A
  • Agnosia: can’t recognize familiar objects
  • Apraxia: inability to carry out skilled movements that were previously known
  • Visual Fields Deficit: hoomonymous hemianopsia “field cut”
139
Q

Major problem with Cranial Nerve deficits

A

Aspiration pneumonia

140
Q

Cranial Nerve Deficits

A

-Impaired swallowing
Test: give 1 tsp of water, fails if wet/gurgling voice
Fail = NPO, IV meds, suppository not PO meds

141
Q

Implications for clear oral test

A
  • Sitting straight up
  • Soft/semisoft foods
  • “Thick it”
  • Fodd supplements
  • Daily weight
  • I&O
142
Q

Impaired Communication: Care

A
  • Speech therapy
  • Facial muscle exercises
  • Face client when speaking
  • Anticipate needs
143
Q

Impaired Communication: Nursing Considerations

A
  • Speak slowly, not loudly
  • Divide tasks into smaller units
  • One step commands
  • Anticipate needs
  • Picture boards (Boca’s area)
  • Avoid yes/no questions
  • Use understandable vocabularies (Wernicke’s area)
144
Q

Stroke: Medical/Surgical Interventions

A

-CEA (if plaque >70&)
-Craniotomy to evacuate clot to prevent ICP increase
-BP
Hemorrhagic stroke (keep close to 140 SBP, but not over)
Ischemic stroke (Keep BP less than 185/110)
-Stent retreivers

145
Q

Stroke: Drug Therapy

A

-Fibrinolytic/Thrombolytic therapy
T-PA
Alteplaze (activase)

Max dose: 82 mg, flush at rate of admin

146
Q

Stroke: Drug Therapy - Criteria before T-PA administration

A

-No acute hemmorrhage
-Tx 4.5 hr or less from onset of S/S
-BP less than 185/110
Anti-HTN meds
-Neuro and VS assessment: before and after infusion (q15min)

147
Q

Stroke: Anti-HTN Meds

A

Labetalol: 10-20 mg IV over 1-2 minutes

Nicardipine: 5 mg/hr IV

148
Q

Fibrinolytics/Thrombolytics Exclusion Criteria

A
  • Significant head trauma, intraspinal surgery, or stroke in past 3 months
  • Active internal bleeds
  • Bleed predisposition (plt <100,000, INR >1.7, high PTT)
  • Severe uncontrolled HTN
149
Q

What meds can be taken with Fibrinolytics?

A
  • Aspirin

- Plavix

150
Q

How is treatment window determined if pt. wakes up with S/S of stroke?

A

Based on “last known well”

151
Q

Post Activase/Altepase: Nursing Care

A
  • Coag studies
  • Neurochecks (often)
  • Bed rest
  • IV access maintained from before tx
  • No ASA, etc. for 24 hr
152
Q

Ant-Coags for CVA

A 
Heparin
     PTT 1.5-2.5x baseline (baseline = 20-30 sec)
Warfarin (Coumadin)
     PT/INR
          INR: 2-3
          If cardiac origin, INR 3-4
     Antidote: Aquamephyton (Vitmain K)
Kcentra (for URGENT Coumadin reversal)
153
Q

Newer Drugs for CVA

A

“-xaban”

Lovenox (Enoxaparin)
Antiplatelets
-ASA (325 mg)
-Plavix (Clopidogrel)

154
Q

Cerebral Aneurysm: Definition

A

An out-pouching or dilation of a cerebral artery

155
Q

Cerebral Aneurysm: Most Common Site

A

Bifurcation of blood vessels in the Circle of Willis

156
Q

Cerebral Aneurysm: Etiology

A
  • HTN
  • Atherosclerotic plaque build up
  • Infectious aneurysm
  • Congenital defect
    e. g. Arteriocenous malformation (AVM)
157
Q

Cerebral Aneurysm: Types

A
  • Berry: most common
  • Fusiform (saccular): dilated vessel wall, out-pouching
  • Mycotic: rare
158
Q

Cerebral Aneurysm: S/S

A

Before rupture- asymptomatic

After rupture:

  • Thunderclap headache (worst headache of life)
  • Pain above and behind the eye
  • Dilated pupil
  • Photophobia*
  • Seizure, motor deficit
  • Nucchal rigidity*, irritability, blurred vision, positive Kernig’s and Brudzinki’s Signs
  • Unconscious

If not treated successfully -> death

159
Q

Brudzinki’s Sign

A

As the neck is flexed, pain causes the knees to flex in order to reduce the pain

160
Q

Kernig’s Sign

A

Hips and knees flexed and straigtened = pain in hamstring

161
Q

Cerebral Aneurysm: Diagnosing

A
  • CT
  • Arteriogram
  • MRI

If results, unclear -> lumbar puncture (look for blood)

162
Q

Cerebral Aneurysm: interventions/precautions

A
  • Bed rest
  • BP kept within parameters
  • Dark/Quiet environment
  • Limit external stimuli (to present ICP increase)
  • Avoid vagal stimulation
  • Monitor/manage pain and stress
  • TEDs or SCDs
  • Surgery
163
Q

Aneurysm Surgical Interventions

A

Clip placement, Vessel wrapping, or Coils

164
Q

AVM Interventions

A

Embolization or Radiosurgery

-To decrease the number of feeding arteries to aneurysm

165
Q

Aneurysm Responsibilities: Post-op

A

-Monitor neuro status
-Maintain BP and CPP
-Monitor for re-bleed
Peak incidence: 24-48 hrs
-Monitor for hyponatremia (can cause cerebral edema)
-Monitor for hydrocephalus (due to CSF clogging)

166
Q

Vasospasm: Nursing Responsibilities

A

-Monitor for S/S (altered LOC -> assess with GCS)
Occurs between day 4-14 post op
-Diagnostic: transcranial doppler**
-Hemodynamic augmentation
Vasopressors (dopamine and Nor-Epi***)

167
Q

Vasospasm: preventative med

A

Nimodipine (s/e Hypotension)

-Not all CA Channel Blockers*

168
Q

Brain Tumors: Primary

A

Originate in the CNS and rarely metastisize

169
Q

Brain Tumors: Secondary

A

Results from metastasis from elsewhere

170
Q

Brain Tumor: Classifications

A

Histology: Malignant or Benign

Location: Supra- or Infra-tentorial

171
Q

Brain Tumor: Types

A

Malignant:

  • Glioblastoma (worst)
  • Astrocytoma
Benign:
-Meningiomas
-Pituitary tumors
-Acoustic neuromas
     S/S: tinnitus, hearing loss, dizziness, and vertigo
172
Q

Brain Tumor effects (regardless of location)

A
  • Cerebral edema
  • Brain dysfunction
  • Increased ICP
173
Q

Brain Tumor: Manifestations

A
  • Headache (worse in am)
  • Vomiting (d/t vomit center stimulation)
  • Personality changes
  • Aphasia
  • Ataxia
174
Q

Brain Tumor: Complications

A

-Increased ICP
-Bleeding
-Cerebral edema
Vasogenic: BBB disrupted
-Seizures
-Venous thromboembolism

175
Q

Brain Tumor: Diagnosis

A
  • CT scan or MRI
  • Cerebral angiography
  • Chest X Ray
  • Tissue Biopsy
176
Q

Brain Tumor: Post op Care

A

-Monitor neuro deficit
-Avoid activities that increase ICP
No bending, lifting, straining, and Valsalva maneuver
-Monitor s/s infection, wound care, drainage care
-NPO for 24hrs to avoid potential aspiration pneumonia
-Monitor CBC, e-lytes, and osmolarity
-Emotional support

177
Q

Brain Tumor: Post op Positioning

A

Supratentorial

  • HOB 30 degrees
  • Head, neck neutral position
  • May turn to side
  • Avoid placing on op side if large tumor

Infratentorial

  • Flat
  • Side lying
178
Q

Brain Tumor: Post op Care

A
  • Pituitary tumor removal
  • Monitor DI or SIADH
  • I&O
  • DI -> increase serum osmo, UOP, hypernatremia*
  • SIADH -> hyponatremia*
179
Q

Brain Tumor: Post op Care - DI

A
  • Administer synthetic ADH
  • Daily weight
  • Oral intake to balance output
180
Q

Brain Tumor: Post op Care - SIADH

A
  • Fluid restriction

- 3% NaCl solution for severe hyponatremia

181
Q

Seizures

A

Abnormal electrical activities

182
Q

Seizures: S/S

A

Changes in:

  • consciousness
  • Motor
  • Sensory
  • Behavior
183
Q

Seizures: Patho

A

Primary: idiopathic

Secondary (non-epileptic): trauma, surgery, tumor, stroke, infection, substance abuse, low O2

184
Q

Epilepsy:

A

2 or more unprovoked seizures, 24 hrs apart

Low GABA

185
Q

What is the function of GABA?

A

GABA is an inhibitory neurotransmitter

186
Q

Absence of Seizures

A
  • Brief LOC
  • Blank stare, daydreaming
  • Unresponsive
  • Minimal to no muscle alt.
  • Hand movement, lip smacking, swallowing

Aura in advance of seizure

187
Q

Lamotrigine (Lamictal) - Risk

A

Stevens-Johnson Syndrome (life threatening rash)

188
Q

Carbamazepine (Tegretol) - Risks

A

SIADH

Stevens-Johnson Syndrome (Asian HLA-B carriers)

189
Q

Valproex (Depakote) - Risk

A

Teratogenic

Teach patients and check HCG levels

190
Q

Benzodiazepines: Timing and Names

A

Within 6 minutes to prevent status epilepticus

Diazepam (Valium)
Clonazepam (Klonopin)
Phenobarbital (Luminal)

191
Q

Levetiracetam (Keppra) vs. Phenytoin (Dilantin)

A

Keppra is safer

192
Q

Phenytoin (Dilantin): Risk

A

Hepatoxicity risk:

  • Increased ALT
  • Increased AST
  • Jaundice
193
Q

Dilantin Blood Levels

A

Normal: 10-20

Toxic: >30

S/E: GI, anemia, gingival hyperplasia

194
Q

Status Epilepticus

A
  • Seizures lasting longer than 5 minutes
  • Two or more seizures without full recovery of consciousness between

Seizures >30 = neuro complications

195
Q

Status Epilepticus: etiology

A

Trauma, drug/alcohol withdrawal

196
Q

Status Epilepticus: actions

A

-ABC
-Safety (bed low, rails x4, etc.)
-Call a rapid response
-IV Benzos ( Ativan, Valium, Versed)
-Keppra
-NPO
-Post Ictal (seizure) Care
ABC, safety, prevent aspiration

197
Q

Seizure Precautions

A
  • O2 and suction equipment nearby
  • Saline locked IV access
  • Side rails up x4 (no padding)
  • Bed low
  • No tongue blade
198
Q

Seizure/Epilepsy: Education

A

-Anti Epileptic drugs can’t be stopped, even if seizures stop

Driving? - most states = clear of seizures for 6 months

199
Q

Meningitis: definition

A

Infection of the meninges that surround the brain and spinal cord

200
Q

Meningitis: cause

A

Primary: Viral/Aseptic, fungal, or bacterial
Secondary: following surgery or trauma

201
Q

Where do Meningitis outbreaks happen?

A

Areas of high population density

202
Q

Who is most likely to get Meningitis?

A

Young (<5), old, or immunocompromised

203
Q

Bacterial vs. Viral Meningitis: severity

A

Bacterial is much more lethal

Viral is self-limiting

204
Q

Meningitis: S/S

A
  • Meningismus (Meningeal irritation)
  • Divergent degrees of neuro changes
  • HA
  • N/V, fever, chills, generalized aches and pains
  • Tachycardia

-Red macular skin rash

205
Q

Meningismus: S/S

A
  • Photophobia
  • Nuchal rigidity
  • Positive Brudzinski’s or Kernig’s signs (some pts. don’t have these)
206
Q

What other condition has similar S/S of meningitis?

A

Aneurysm

207
Q

Meningitis: Diagnostics

A
  • CT (check for aneurysm)
  • CBC, CMP

-Lumbar puncture and CSF analysis to confirm

208
Q

Kernig’s Sign

A

Move legs, bending knees = hamstring pain

209
Q

Brudzinski’s Sign

A

Tilt head to chest = knees raise to reduce pain

210
Q

CSF Analysis: Bacterial vs. Viral Meningitis

A

Bacterial: cloudy CSF, decreased Glucose

Viral: clear CSF, normal glucose

211
Q

Meningococcal meningitis: precautions

A

Droplet and standard:

  • Mask when <3 feet of pt
  • Gloves to touch body fluids
  • Door can be open

-Pt. mask if outside room

212
Q

PPE: donning order

A
  • Gown
  • Mask
  • Goggles/face shield
  • Gloves
213
Q

PPE: doffing order

A
  • Gloves
  • Goggles/face shield
  • Gown
  • Mask
214
Q

Bacterial Meningitis: Prevention

A
  • Vaccination

- Prophylactic abx within 7 days of exposure

215
Q

What is the only stroke med?

A

T-PA

216
Q

Transient Ischemic Attack (TIA): teaching

A
  • Diet
  • Exercise
  • ASA: 325 mg dose
  • Plavix (clopidogrel)
217
Q

Penumbra

A

The area that remains viable after stroke w/ rapid intervention

218
Q

Anti-platelet use: before/after T-PA admin

A

Before: not a problem

After: not for 24 hrs

219
Q

Hemorrhagic Stroke: BP goal

A

140 SBP

220
Q

Ischemic Stroke: BP goal

A

185/110

221
Q

T-PA contraindicated meds

A

“-xaban” within 24 hrs

222
Q

ABG values for TBI

A

pH: 7.35 - 7.45
CO2: 35 - 38
HCO3: 22 - 26

223
Q

Meds to decrease ICP

A

Mannitol
3% NaCl (hypertonic fluid)
Steroids (Increases BG and GI bleed risk)

224
Q

ICP: value

A

5 - 15

225
Q

CPP: value

A

> 60

226
Q

TIA aspirin dose

A

325 mg

227
Q

What needs to be looked out for 4-14 days post-op?

A

Vasospasms d/t increased risk

Adult Health 3 (12 decks)

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