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Nursing 283 > Week 9 Perception and Cognition: Neuro > Flashcards

Week 9 Perception and Cognition: Neuro Flashcards

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1
Q

Warning sign of ischemic stroke

A

TIA or reversible neurologic deficit (RIND)

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2
Q

TIA time frame

A

a few minutes to 24 hours but sx usually resolve in 30-60 min

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3
Q

RIND time frame

A

24 hours to 7 days

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4
Q

Vision changes in TIA

A

blurred vision, diplopia, blindness in one eye and tunnel vision

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5
Q

Dysarthria

A

slurred speech

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6
Q

Onset of thrombotic stroke

A

slow over minutes to hours

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7
Q

Onset of embolic stroke

A

sudden

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8
Q

sx of cerebral aneurysm

A 
SEVERE HA (#1)
N/V, photophobia, cranial neuropathy, stiff neck, change in mental status
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9
Q

What is indicated by a change in LOC

A

increased ICP

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10
Q

Functions of the right cerebral hemisphere

A

vision, spatial awareness and proprioception

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11
Q

Function of the left cerebral hemisphere

A

language, math and analytical thinking

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12
Q

Unilateral neglect syndrome

A

common in rt side stroke

Pt is unaware of L or paralyzed side

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13
Q

BP needed to maintain cerebral perfusion after ischemic stroke

A

150/100

Higher BPs may cause another stroke

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14
Q

Emotional lability

A

Pt laughs or cries unexpectedly

Occurs when frontal lobe is affected in stroke

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15
Q

Tests for stroke

A

CT (no contrast), MRI, 12 lead and cardiac enzymes to r/o MI, elevated H&H indicate body compensation to low O2, coags used to determine baseline

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16
Q

Priority problems for Pt with a stroke (7)

A
  1. Inadequate perfusion to the brain
  2. Impaired Swallowing
  3. Impaired Physical Mobility and Self-Care Deficit
  4. Aphasia or dysarthria
  5. Urinary and/or Bowel Incontinence
  6. Sensory changes
  7. Unilateral body neglect syndrome
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17
Q

Immediate assessment in ischemic stroke

A

monitor for increasing ICP

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18
Q

Time window for rTPA

A

within 3 hours of time last seen normal

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19
Q

Time window for fibrinolytic treatment

A

within 6 hours

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20
Q

Key features of ICP

A

< LOC, restlessness, irritability, confusion, HA, N/V, speech changes, pupil changes, ataxia, seizures, HTN, bradycardia, wide pulse pressure

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21
Q

Interventions to avoid increased ICP

A

HOB at 30 degrees, apply O2 for <92%, keep head midline, avoid hip/neck flexion, avoid clustering care, position on the side if hemiparesis is present

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22
Q

What to monitor for in possible impaired swallowing

A

facial drooping, drooling, impaired voluntary cough, hoarseness, incomplete mouth closure, or cranial nerve palsies
Observe for fatigue

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23
Q

Focus of managing sensory perception after Rt sided damage

A

visual-perceptual or spatial-perceptual tasks and routine ADLs

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24
Q

Focus of managing sensory perception after L sided brain damage

A

Re-orient the patient d/t memory problems, establish a routine

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25
Q

Apraxia

A

Inability to perform previously learned motor skills or commands
Typically exhibits a slow and cautious behavior
Seen in L sided brain damage

26
Q

Mild TBI rating

A

GCS of 13-15 and loss of consciousness for up to 15 min

27
Q

Moderate TBI rating

A

loss of consciousness up to 6 hours
GSC of 9-12
Havvi difficulty with work, learning and role function

28
Q

Severe TBI rating

A

GCS of 3-8 and loss of consciousness of > 6 hours

29
Q

Post concussion syndrome

A

physical and cognitive problems remain despite mild initial sx and normal dx test findings

30
Q

Normal ICP

A

10-15 mmHg

31
Q

First response to increased intracranial volume

A

shunting or increased absorption of CSF

32
Q

Epidural hematoma sx

A

Pt goes from being awake and talking to unconscious

33
Q

Acute subdural hematoma

A

presents within 48 hours of injury

34
Q

Subacute subdural hematoma

A

presents from 48 hours to 2 weeks

35
Q

Chronic subdural hematoma

A

sx may not be present for 2 months

36
Q

Uncal herniation of the brain sx

A

Life threatening!

Dilated/nonreactive pupils, ptosis (drooping eyelids), and a rapidly deteriorating LOC

37
Q

Central herniation of the brain sx

A

Cheyne-Stokes respirations, pinpoint and nonreactive pupils, and hemodynamic instability

38
Q

Cushing’s triad

A

late sign of ICP

HTN with a widened pulse pressure and bradycardia

39
Q

Pulse changes in increased ICP

A

thready, irregular and rapid

40
Q

early indicators of changes in LOC

A

behavior changes (e.g., restlessness, irritability) and disorientation

41
Q

sx of brainstem disfunction

A

pinpoint nonreactive pupils

42
Q

Goals of nursing care for a head injury

A

preventing or detecting increased ICP, promoting fluid and electrolyte balance, and monitoring the effects of treatments and drug therapy

43
Q

Use of glucocorticoids in increased ICP

A

have no benefit

44
Q

Use of osmotic diuretics in increased ICP

A

Mannitol is used
It pulls water out of the extracellular space of the edematous brain tissue
Best given in boulses
Administer through a filter

45
Q

Use of Lasix in increased ICP

A

Enhances Mannitol

Also reduces edema and blood volume, decreases Na+ uptake by the brain, and decreases the production of CSF

46
Q

Use of anti-seizure medication for increased ICP

A

Not reccomended if 1st seizure is 7+ days after injury but ok if < 7 days

47
Q

Barbituate coma

A

used for increased ICP that can not be controlled otherwise

48
Q

First sign of increased ICP

A

declining LOC

49
Q

Teach the patient to report which sx after a carotid endarterectomy

A

Severe headache
Change in brain function (e.g., drowsiness, decreased cognition)
Muscle weakness
Severe neck pain
Neck swelling
Hoarseness or difficulty swallowing (due to nerve damage)

50
Q

Sx of post concussion syndrome seen in a minor head injury

A
  • Personality changes
  • Irritability
  • Headaches
  • Dizziness
  • Restlessness
  • Nervousness
  • Insomnia
  • Memory loss
  • Depression
51
Q

Cranial nerve I

A

Olfactory

Give them something to smell

52
Q

Cranial nerve II

A

Optic: central and peripheral vision

Have Pt read, count fingers from 6” away, test ability to see fingers moving in the periphery

53
Q

Cranial nerve III

A

Occulomotor: pupil constriction

Test with a penlight

54
Q

Cranial nerve IV

A

Trochlear: eye movement down and in

Have Pt follow finger toward the tip of their nose

55
Q

Cranial nerve V

A

Trigeminal: Facial movement and sensation

Check sensation of sharp/dull, have Pt open jaw, check on scalp also

56
Q

Cranial nerve VI

A

Abducens: eye movement to the sides

Tell Pt to look at each ear, follow finger through visual fields, make an X in the air and watch for nystagmus

57
Q

Cranial nerve VII

A

Facial: movement and expression

Assess symmetry, wrinkle forehead, close eyes, smile, pucker

58
Q

Cranial nerve VIII

A

Acoustic: hearing

Rub fingers beside ear, whisper

59
Q

Cranial nerve IX

A

Glossopharyngeal: Tongue

Assess taste, ability to swallow, have Pt open mouth and say AHHH, uvula should be midline and palate should rise.

60
Q

Cranial nerve X

A

Vagus: Throat

Ability to swallow, have Pt open mouth and say AHHH, uvula should be midline and palate should rise.

61
Q

Cranial nerve XI

A

Spinal accessory: neck and shoulder movement

Ask to raise shoulders or turn head against hands

62
Q

Cranial nerve XII

A

Hypoglossal: innervates the tongue

Ask to stick out tongue and evaluate if it is midline, check problems eating, swallowing, speaking

Nursing 283 (10 decks)

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