week 1: neuro/ TBI

Question 1

what are prodromes

Answer 1

aura; experiences that are precursor of a symptom; early symptom

Question 2

what are the diet triggers of migraines

Answer 2

chocolate, aged cheese and meat, wine and beer, and citrus fruits

other triggers: lack of sleep, noise, light

Question 3

what class of medications do not work for migraines

Answer 3

opiates

Question 4

what are preventative medications for migraines

Answer 4

beta blockers**, CCB, antidepressants, anticonvulsants

Question 5

drug of choice due to rapid onset of action and long duration of action

Answer 5

lorazepam (Ativan)

Question 5

what is the main class of medication used for treatment of status epilepticus

Answer 5

benzodiazepine (-azepam)*

Question 6

The earlier the seizure terminates the…

Answer 6

better!
why: benzodiazepines will be fast acting

Question 7

what are anti-epileptic drugs

Answer 7

Keppra (levetiracetam), Dilantin (phenytoin), Valium (diazepam) for status epilepticus*

tegretol neurotin (partial seizure), lamictal

Question 8

what do we do to avoid toxicity and under-dosing for anti-epileptics?

Answer 8

monitor therapeutic lab levels for medication

Question 9

tertiary prevention for seizures

Answer 9

patent airway
- turn head to side, loosen collar
protect from injury
- remove objects, lower to floor, block from from furniture, nothing in mouth, watch for bony prominences
ensure adequate oxygenation
- O2, suctioning
remain calm and reassuring, stay with patient

Question 10

seizure precautions

6 with stars

Answer 10

• suction - always make sure set is working in pt room
• side rails up and padded
• loosen restrictive clothing
• time the seizure
• do no force anything in mouth
• do not hold pt down or restrain

stay w pt, O2, IV access, bed low, turn pt to side, neuro check

Question 11

what is secondary injury

related to pathophysiology of TBI

Answer 11

delayed injury from hypoxia, ischemia, and release of neurtoxins

cause cerebral swelling and neuronal death, increased ICP cause hypoxia

Question 12

When do we not use CT on head with TBI?

Answer 12

• age: greater than 55 or less than 2
• witnessed LOC
• coagulopathy: blood is thinned by meds or disease

GCS<15, intoxicated, amnesia, vomit, basilar skull frac, penetrating HI

Question 13

first sign for high ICP

Answer 13

change in LOC

Question 14

what medication should a patient post-concussion not use

Answer 14

• ibuprofen
• naproxen
• ASA

Question 15

ICP management

4 with stars

Answer 15

• HOB 30
• drugs for sedation (propofol, ketamine, precedex)
• maintain normothehrmia (fever increase ICP, acetaminophen PR)
• seizure control

monitor ICP, drain CSF from ventricle or lumbar drain, pace activities

Question 16

signs of epidural hematoma

Answer 16

brief unconciousness, lucid interval awake, alert, then rapid decline of LOC

Question 17

main nursing intervention with TBI

Answer 17

seizure prophylaxis

Question 18

what are the three volumes inside the skull

Answer 18

brain, blood, CSF

Question 19

if volume of any fluid increase, pressure will …, unless…..

Answer 19

if volume of any fluid increase, pressure will increase, unless volume of otehrs go down

Question 20

what is the normal ICP

Answer 20

5-15 HHmg

Question 21

most common caused of elevated ICP

Answer 21

*** TBI **
* cerebral edema
* mass, lesion, tumor
* hydrocepalus
* brain inflammation
* CVA
* ventricular shunt malfunctions

Question 22

progressive symptoms of high ICP

Answer 22

beware of vomiting (projectile!) *
* motor deficit
* pupil changes, abnormal PERRLA
* headache

Question 23

what are three main evidence based medical guidelines for TBI nursing management

Answer 23

• neuro exam
• antiseizure PPX
• analgesic/ sedatives

Question 24

avoid too frequent of suctioning as it will …

Answer 24

increase ICP

only prn and still not often

Question 25

drugs to control ICP

movement will increase ICP

Answer 25

pentobarbital/ propofol/ versed for burst suppression

Question 26

what is somthing to consider during evaluation

Answer 26

TBI and depression

Question 27

not starred

tension type headache

Answer 27

• 1. most common type of HA
• patho myofacial (tension by the jaw)

characteristics
* bilateral, pressing, bandlike pressure
* can occur intermittently over wks, mos, yrs
* no prodrone, no n/v
* common at the end of the day

treatment
* nonopioid analgesics
* sedatives, muscle relaxants

Question 28

not starred

cluster headaches

Answer 28

• rare and severe
• primary neurovascular pathophhysiology
• seasonal, same time of day
• ~1hr severe stabbing, sharp unilateral pain around the eye, temple, forehead, cheeks, nose, gums

treatment
* 100%O2 for 15-20
* sumatriptan
* B-blocker for prophylactic

Question 29

not starred

migraines

Answer 29

• patho: vasoconstrict -> dilate

Question 30

not starred

what are some auras of migraines

Answer 30

• scotoma
• fortification
• sxintilla
• unilateral paresthesia
• hallucination
• hemianopsia