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MedSurg > Neuro Disorders > Flashcards

Neuro Disorders Flashcards

1
Q

Cerebral lobes

A
  • Frontal
  • Parietal
  • Temporal
  • Occipital
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2
Q

Frontal lobe function

A
  • Motor cortex, voluntary movement
  • Broca’s expressive speech center
  • Personality
  • Behaviors: social, sexual, judgement, problem solving
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3
Q

Parietal lobe function

A
  • Sensation interpretation & perception
  • Social relationships such as body position
  • Integration of sensory input, especially visual input
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4
Q

Temporal lobe function

A
  • Auditory sensation and perception
  • Long term memory
  • Wernicke’s receptive speech center
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5
Q

Occipital lobe function

A
  • Process visual information
  • Perception of color and shapes
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6
Q

CT or CTA

A
  • Assess for bleed, edema, masses

*Suspected ischemic stroke: CT rule out hemorrhagic stroke which would be contraindication to thrombolytic therapy

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7
Q

CT/CTA nursing implications

A
  • Pt education about procedure
  • Noninvasive and painless
  • Patient IV (if giving contrast)
  • Iodine allergies (shellfish or dye)
  • Monitor BUN/Cr
  • DM? Taking Metformin? If yes, Metformin held 48 hrs prior
  • IV/PO fluids post-procedure to enhance excretion of dye
  • Monitor for allergic rxn
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8
Q

Lumbar puncture

A
  • Obtain CSF for analysis
  • Measure ICP
  • Spinal anesthesia, intrathecal meds
  • Remove CSF to reduce pressure
  • Performed between L3 and L4 (below level of spinal cord)
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9
Q

LP nursing implications

A
  • Pt education about procedure
  • Hold antiplatelet/anticoag drugs prior (decreased risk of bleeding)
  • Check coagulation studies prior
  • Informed consent
  • Flat bedrest for 4-6 hrs to prevent CSF leakage
  • Leakage can cause severe HA
  • Encouraging fluids post LP
  • Blood patch can seal CSF leak
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10
Q

Secondary headache

A
  • Caused by underlying pathology
  • Typical presentation: sudden onset, severe pain (not alleviated w meds)
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11
Q

Secondary headache work-up

A
  • CBC and blood culture (infection)
  • CRP and ESR (inflamm)
  • CT and MRI (masses, cysts, vessel, osseous skull abnormalities)
  • EEG (electrical activity: seizures, tumors, inflamm, brain injury)
  • Sleep studies (fatigue, sleep apnea)
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12
Q

Primary brain tumor

A

Malignant:
- Glioma: from glial cells
- Oligodendroglioma: from oligodendrocyte

Benign:
- Meningioma: most common form
- Acoustic neuroma / schwannoma: from Schwann cell
- Pituitary tumor: hormone hypersecretion

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13
Q

Metastatic (secondary) brain tumor

A

Occurs at:
- Brain parenchyma
- Spinal cord
- Leptomeninges

Most common cancers resulting in CNS metastases:
- Lung, melanoma, renal, breast, CRC

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14
Q

Brain tumor medical management

A
  • Chemotherapy
  • Gliadal wafers: impregnanted w chemotherapy and put in surgical bed at time of surgical resection
  • Radiation therapy
  • Cyberknife: radiation directed to specific area of brain to spare normal tissue
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15
Q

Brain tumor surgical management

A
  • Craniotomy: section of skull (bone flap) removed
  • Debunk: removing as much of tumor as possible if not completely removable
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16
Q

Seizure nursing assess

A
  • Airway and breathing: maintain airway patency during sz & postictal state
  • VS: O2 sat & resp status, HR and BP may increase
  • Sz activity: careful observation and document
  • Presence of aura
17
Q

Seizure nursing intervention

A
  • O2 at bedside
  • Suction equipment at bedside
  • Safety measures: bed in low position, L side lying position during sz to prevent aspiration, do not restrain movements
  • Place IV per orders, administer meds if needed
18
Q

Seizure pt education

A
  • *Medication regimen: therapeutic level monitor, possible SE
  • *Understand triggers, aura
  • Medic alert bracelet
  • Driving restrictions
19
Q

Parkinson’s clinical manifesations

A
  1. Resting tremors
  2. Muscle rigidity
  3. Bradykinesia
  4. Postural instability
  • Unilateral weakness, upper extremity tremors
  • Slow shuffling gate, postural instability, stooped posture, rigidity, generalized tumor, masklike face
20
Q

Parkinson’s diagnosis

A

2 or more observable sympts w asymmetry on presentation:
1. Bradykinesia
2. Resting tremor
3. Rigidity
4. Postural instability

21
Q

Herniated disc

A

Vertebral disk rupture or tearing that causes leaking into vertebral area resulting in back pain

22
Q

Parkinson’s

A

Decreased level of dopamine in brain –> slow, tremor, etc.

23
Q

Herniated disc conservative medical treatment

A

Most pt improve in 1-2 mos
- Pain management: NSAIDs, gabapentin, tramadol, pregabalin
- Physical therapy to increase strength, improve function, and prevent future injury

24
Q

Herniated disc nursing assess

A
  • *VS: pain, infection
  • *Level of function/ability
  • *Muscle tone/ strength
  • *Surgical incision: signs of infection
  • *Urine output: postoperative urinary retention d/t anesthesia
  • Bowel elimination: constipation secondary to opioids
25
Q

Herniated disc nursing intervention

A
  • Pain meds
  • *Corticosteroids as prescribed for inflamm
  • *Comfort w positioning: HOB 30-45 degrees w legs bent
  • ROM exercises
  • Increase fluids/fiber: constipation
26
Q

Herniated disc pt teaching

A
  • Exercise and mobility
  • Good posture
  • Avoid bending at waist and lifting
  • Review dz process & prognosis
27
Q

Amyotrophic Lateral Sclerosis

A

Gradual degen and death of upper (brain) and lower (spinal cord) motor neurons

28
Q

ALS complications

A
  • Aspiration
  • Resp failure, pneumonia
  • Pressure injuries
  • DVT and PE
29
Q

ALS nursing assess

A
  • *Airway and O2 sat
  • Motor strength
  • *Ability to swallow
  • Skin
  • Coping skills
30
Q

ALS nursing interventions

A
  • *Elevate HOB while eating, drinking or brushing teeth
  • *Turn, cough, and deep breath to promote gas exchange
  • *Reposition and turn every 2 hrs to prevent skin breakdown
  • *Emotional support
  • ROM to prevent contractures and strengthen affected muscles
  • Administer meds to manage sympts
31
Q

ALS pt teaching

A
  • Report increased difficulty swallowing or breathing
  • *Dz prognosis and process; ventilation support
  • *Communication strategies
32
Q

Spinal cord injuries

A

Direct injury to spinal cord or indirect injury to surrounding bones, tissues, vessels resulting in loss of function

33
Q

Spinal cord injury clinical manifestations

A

Lvl of injury predicts what part of body is affected
Cervical injuries:
- Quadriplegia
- C4 and above –> inability to breathe, phrenic nerve innervates diaphragm at this level

Thoracic injuries:
- Paraplegia, poor trunk control

Lumbar & sacral:
- Leg control, bowel and bladder function, sexual function

Other effects:
- Hypotension
- Chronic pain
- Decreased temp control

34
Q

Spinal cord medical management

A

No way to reverse spinal cord damage. Acute stages of injury focuses on:
- *Maintaining airway patency
- *Adeq breathing and oxygenation
- Prevent and monitor spinal shock
- Restore and maintain BP
- Prevent further cord damage
- *Spinal immobilization
- Avoid possible complications

35
Q

Spinal cord injury nursing assess

A
  • Resp function: hypoventilation (intercostal muscle paralysis), C4 and higher (no diphragmatic innervation)
  • VS: loss of sympathetic input, spinal shock, neurogenic shock, respirator or cardiac arrest, autonomic dysreflexia, can’t regul temp
  • Increased pain above injury level
  • I&O
  • Surgical sites: infection, bleeding, CSF leak
  • GI: decreased blood flow, peristalsis and paralytic ileus

MedSurg (15 decks)

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