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Med Surg III Nrsg 116 > Unit 5: Brain/Spinal Cord Injuries & Neuro CAs > Flashcards

Unit 5: Brain/Spinal Cord Injuries & Neuro CAs Flashcards

1
Q

What is a “brain attack?”

A

Cerebrovascular accident (CVA). Disruption of blood flow to the brain by ischemia, hemorrhage, or embolism

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2
Q

Which type of CVA is most common?

A

Ischemia

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3
Q

What is brain ischemia? Are there different types?

A

Disruption of blood supply to the brain by thrombus or embolism. Yes.

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4
Q

Name the 13 risk factors for a brain attack.

A

Smoking, cocaine, oral contraceptives, previous CVA, A-Fib, hypercoaguability, hyperlipidemia, atherosclerosis, hypertension, obesity, DM, AVM, cerebral aneurysm

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5
Q

What is an AV?

A

Arteriovenous malformation. A vein and an artery are inappropriately linked

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6
Q

What does bleeding into brain tissue, subarachnoid space, or ventricles cause?

A

Hemorrhagic stroke

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7
Q

What are some causes of hemorrhagic stroke?

A

HTN, aneurysm, amyloid angiopathy (amyloid is a protein), AVM’s, meds (anticoagulants)

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8
Q

What causes brain damage in a hemorrhagic stroke?

A

Compression, or ischemia from reduced perfusion or vasoconstriction

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9
Q

What is a TIA?

A

Transient Ischemic Attack. Temporary impairment of blood flow to the brain. A warning of impending stroke. More TIA’s means greater risk for stroke

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10
Q

What are some left hemisphere stroke symptoms?

A

Aphasia, agnosia, alexia, agraphia, right side weakness, slow/cautious behavior, depression, frustration, anger, loss of vision in one or both eyes, one-sided neglect syndrome (forget it exists)

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11
Q

What are some right hemisphere stroke symptoms?

A

Altered perception of deficits, one-sided neglect syndrome (more common in right side), loss of depth perception, poor impulse control and impaired judgement, short attention span, hemianopsia

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12
Q

Do you have to be certified to do a NIHSS?

A

No. You must be certified to do a full neuro assessment, but not to do a partial

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13
Q

What does the NIHSS assess?

A

Degree of disability from a stroke. Max score of 42 = most disability

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14
Q

When is the NIHSS assessment done?

A

Baseline ASAP, then at 2 hr, 24 hr, 7-10 days

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15
Q

What is the scale on the NIHSS?

A

0 = no stroke. 1-4 = minor stroke. 5-15 = moderate/severe stroke. 21-42 = severe stroke

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16
Q

At what score on the NIHSS do you treat the patient?

A

5 and up

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17
Q

What Glasgow coma scale level is considered severe? When is organ procurement notified?

A

Less than or equal to 8.5 or less

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18
Q

What tests are done for a stroke? What is an MRA?

A

MRI, MRA, CT, lumbar puncture. Angiography (looks at vessels of brain)

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19
Q

What is Activase (Altiplase)? How is it given? Criteria for tPA?

A

tPA (clotbuster). Bolus then IV. 18 or over, BP < 185/110, > 3 hrs since onset, PT < 15 sec, INR < 1.7, platelets >100,000, no surgery within 14 days, no stroke/head injury/brain surgery in 3 months, no GI/Urinary bleeding within 21 days

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20
Q

What is the dosage for tPA?

A

0.9 mg/kg with a max of 90 mg

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21
Q

When do you do a neuro assessment for a patient receiving tPA?

A

Every 15 mins for 2 hrs. Every 30 mins for 2 hrs. Every hr for 24 hrs

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22
Q

What are some additional meds given post CVA?

A

Thinners = Aspirin, Heparin, Lovenox (enoxaparin), Coumadin (warfarin). Antiplatelets = Ticlopidine (Ticlid), Clopidrogel (Plavix). Antiepileptics = Phenytoin (Dilantin), Gabapentin (Neurontin)

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23
Q

What are some other interventions for patients with a CVA?

A

Turn every 2 hrs, splints, ROM 4-5 times a day, position hands/fingers (washcloth splint), prevent shoulder abduction (don’t grab by flaccid shoulder).

24
Q

How can you assist with communication in a CVA patient?

A

Picture board, simple commands, closed ended questions (but you have to determine accuracy of answers first)

25
Q

What is a carotid endarterectomy?

A

Open up carotid artery and clean out the plaque

26
Q

What can increase ICP?

A

Brain tumor, CVA, and head injuries

27
Q

What is the Monroe-Kellie hypothesis?

A

An increase of volume of any skull component will cause a change in the volume of the others (tissue, blood, CSF)

28
Q

What is normal ICP?

A

10-20 mm HG

29
Q

What is the earliest sign of increasing ICP?

A

LOC changes

30
Q

What do you HAVE to know to see increased ICP in a patient?

A

Baseline assessments

31
Q

What are some early s/s of increased ICP?

A

Increased restlessness, confusion, drowsiness, respiratory effort, movements, pupillary changes/impaired movements, weakness in a side or extremity, HA

32
Q

What are some late s/s of increased ICP?

A

Respiratory and vasomotor changes, increase in systolic or pulse pressure, slowing HR, increase temperature, tachy/bradycardia, Cushing’s triad (bradycardia, bradypnea, HTN), projectile vomiting, Cheyne-Stokes, loss of reflexes (pupil, cornea, gag, swallowing)

33
Q

How do you determine if pupil reflexes are gone?

A

Touch with cotton and they should blink

34
Q

What posturing is involved in later symptoms of increased ICP?

A

Decorticate (hands towards body) and decerebrate (arms outstretched at sides). High mortality rate

35
Q

What position do we put the bed for a patient with increased ICP?

A

30 degrees

36
Q

What do we discourage with increased ICP?

A

Coughing or blowing nose forcefully

37
Q

What do we minimize with increased ICP?

A

Oral and endotracheal suctioning

38
Q

When do you call the doctor with increased ICP?

A

Clear fluid is coming out of the nose or ears

39
Q

What environment is best for a patient with increased ICP?

A

Calm/restful. Limit visitors. Minimize noise

40
Q

What body position is best for a patient with increased ICP?

A

Midline neutral. In other words, keep them straight and don’t let them move much!

41
Q

What was another precaution mentioned for patients with increased ICP?

A

Seizure precautions

42
Q

What medications do patients with increased ICP need?

A

Dexamethasone (Decadron), methylprednisolone (Solu-Medrol), Mannitol (Osmitrol)(osmotic draws fluid out of cerebral space into the vascular space), pentobarbital (Nembutol), Phenytoin (Dilantin), Morphine or Fentanyl

43
Q

What procedure is used to remove non-viable brain tissue?

A

Craniotomy

44
Q

If there is a brain drain in place, how do you know how much to drain at one time?

A

Doctor prescribes how much per hour to drain

45
Q

What must be done before moving the brain drain?

A

Clamp it off

46
Q

What type of brain tumor has a high mortality rate?

A

Metatastic

47
Q

What are some risk factors for brain tumors?

A

Electromagnetic fields, genetics, environmental crap, ionizing agents, previous head injury

48
Q

What is transspendoidal surgery? Brachytherapy? Stereotactic therapy?

A

Through the nose. Radioactive seeds. Well aimed radiation

49
Q

What happens with a cervical spine injury? Thoracic?

A

Cervical = quadriplegic, or worse. Thoracic = paraplegic

50
Q

What is the most important intervention for spinal cases?

A

Maintain respiratory function (O2/suction, vent)

51
Q

What is some other interventions for spinal cases?

A

Monitor for muscle changes and do active/passive ROM, position every 2 hrs in bed/every 1 hr in chair

52
Q

What is done for spastic neurogenic bladder? Flaccid neurogenic bladder?

A

Foley catheter. In/out catheter

53
Q

What GI assessments are done for spinal cases?

A

Monitor for bowel sounds. Stool softeners/bulk laxatives is recommended

54
Q

What medications are given for spinal cases?

A

Dexamethasone (Decadron), Vasopressors (Norepinephrine/dopamine), Iron (Dextran)(plasma extender), muscle relaxants (Dantrolene/Baclofen), Heparin, analgesics (opioids, NSAIDs, non-opioids)

55
Q

What is autonomic dysreflexia? S/S? When does it NOT occur?

A

Overstimulation of autonomic system (involuntary). Throbbing HA, profuse sweating, nasal stuffiness, flushing skin above lesion, bradycardia, anxiety. Injury below T6

56
Q

What are the 2 classifications of spinal tumors?

A

Intramedullary (within the cord) and extramedullary (outside dural membrane)

57
Q

What are the s/s of spinal tumors?

A

Loss of motor function/sensation/reflexes, pain weakness

Med Surg III Nrsg 116 (3 decks)

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