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Adult Health > Exam 3 Saunders Neuro > Flashcards

Exam 3 Saunders Neuro Flashcards

1
Q

Syndrome characterized by paroxysmal hypertension, bradycardia, excessive sweating, facial flushing, nasal congestion, pilomotor responses, and HA. Occurs with spinal lesions above T6 after the period of spinal shock is complete. Triggers include visceral stimulation from a distended bladder or impacted rectum. This is a neurological emergency and must be treated immediately to prevent a hypertensive stroke.

A

autonomic dysreflexia aka autonomic hyerreflexia

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2
Q

dorsiflexion of the big toe with extension; elicited by firmly stroking the lateral aspect of the sole of the foot
is a pathological or abnormal reflex in anyone older than 2 years and represents the presence of CNS disease

A

babinski reflex

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3
Q

involuntary flexion of the hip and knee when the neck is passively flexed; indicates meningeal irritation

A

Brudzinski’s sign

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4
Q

stiff extension of one or both arms, and possibly the legs; indicates a brainstem lesion

A

decerebrate (extensive) posturing

memory trick: (cerebrate-cerebellum–>brainstem)

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5
Q

flexure of one or both arms on the chest and possibly stiff extension of the legs; indicates damaged cortex

A

decorticate (flexor) posturing

memory trick: (corticate-cortex damage)

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6
Q

loss of the ability of a supine client to straighten the leg completely when it is fully flexed at the knee and hip-indicates meningeal irritation

A

Kernig’s sign

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7
Q

occurs most commonly in clients with injuries above T6 and usually is experienced soon after the injury. Massive vasodilation occurs, leading to pooling of the blood in the blood vessels, tissue hypoperfusion, and impaired cerebellar metabolism

A

neurogenic shock

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8
Q

stiff neck, flexion of the neck onto the chest causes intense pain

A

nuchal rigidity

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9
Q

a complete but temporary loss of motor, sensory, reflex, and autonomic fxn that occurs immediately after injury as the cord’s response to the injury. Usually last less than 48 hours but can continue for several weeks

A

spinal shock

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10
Q

an inability to recognize a physical impairment on one side of the body. It occurs most commonly in clients who have had a right cerebral stroke.

A

unilateral neglect or neglect syndrome

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11
Q

Where is the respiratory center and breathing regulation?

A

Pons

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12
Q

CSF normal pressure and normal volume

A

50-175 mm H20 is normal pressure

125-150 mL is normal volume

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13
Q

Why is metformin withheld before a CT scan with contrast?

A

risk of metformin induced lactic acidosis

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14
Q

Why is MRI contraindicated for pregnant women?

A

increase in amniotic temperature that occurs during the procedure may be harmful to the fetus

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15
Q

When is lumbar puncture contraindicated?

A

Lumbar puncture is contraindicated in clients with increased ICP bc lumbar puncture will cause a rapid decrease in ICP and may lead to brain herniation

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16
Q

Why do we assess pupils?

A

unilateral pupil dilation suggests compression of the third cranial nerve
midposition fixed pupils indicates midbrain injury
pinpoint pupils indicate pontine damage

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17
Q

rhythmic, with periods of apnea

can indicate a metabolic dysfunction or dysfunction in the cerebral hemisphere or basal ganglia

A

cheyne-stokes

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18
Q

regular rapid and deep sustained respirations

indicates a dysfunction in the low midbrain and middle pons

A

neurogenic hyperventilation

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19
Q

irregular respirations, with pauses at the end of inspiration and expiration
idicates a dysfunction in the middle or caudal pons

A

apneustic

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20
Q

totally irregular in rhythm and depth

indicates a dysfunction of the medulla

A

ataxic

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21
Q

cluster of breaths with irregularly spaced pauses

indicates a dysfunction in the medulla and pons

A

cluster breathing

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22
Q

bilateral dilated, fixed pupils

A

ominous sign

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23
Q

increased pulse and BP
dilated pupils
decreased peristalsis
increased perspiration

A

SNS

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24
Q 
decreased pulse and BP
constricted pupils
increased salivation
increased peristalsis
dilated blood vessels
bladder contraction
A

PNS

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25
Q

Early indication of increased ICP?

A 
altered consciousness
(then comes the HA, abnormal respirations, rise in BP with widening pulse pressure, slowing of pulse, elevated temp, vomiting, pupil changes)
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26
Q

Late signs of ICP

A

increased systolic BP, widened pulse pressure, and slowed heart rate, weakness to hemiplegia, a positive babinski reflex, docorticate or decerebrate posturing, seizures

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27
Q

What do you do if some one has ICP?

A

maintain mechanical ventilation with PaCo2 at 30-35 mm Hg, which will result in vasocontriction of the cerebral blood vessels, decreased blood flow, and therefore, decreased ICP.

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28
Q

What do high CO2 levels in blood do?

A

increases ICP

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29
Q

Why give anticonvulsants in increased ICP

A

seizures increase metabolic requirements and cerebral blood flow and volume,thus increasing ICP. Anticonvulsants may be given prophylactically to prevent seizures

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30
Q

why give antipyretics and muscle relaxants to clients with increased ICP?

A

temperature reduction decreases metabolism, cerebral blood flow, and thus intracranial pressure. Muscle relaxants prevent shivering

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31
Q

Why give BP meds to someone with increased ICP?

A

blood pressure medication may be required to maintain cerebral perfusion at a normal level. Notify HCP if systolic bp is 150.

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32
Q

Why give corticosteriods to pt with increased ICP?

A

corticosteriods stabilize the cell membrane and reduce leakiness of the BBB and also reduce cerebral edema

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33
Q

Why give IV fluids to a pt with increased ICP?

A

a hyperosmotic agent increases intravascular pressure by drawing fluid from the interstitial spaces and from teh brain cells. Monitor renal fxn and expect diuresis

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34
Q

How often do you measure drainage from the hemovac or jackson-pratt drain?

A

q8hours and record the amount and color-notify HCP if >30-50mL per shift

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35
Q

what is fluid restriction post-craniotomy?

A

1500mL/day

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36
Q

How often do you perform ROM exercises post craniotomy?

A

q8h

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37
Q

Loss of motor fxn and vibration, position and deep touch sensation on same side as the cord damage and loss of pain, temp and light touch on the opposite side

A

Brown-Sequard syndrome

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38
Q

central cord syndrome

A

loss of motor fxn is more pronounced in the upper extremities

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39
Q

anterior cord syndrome

A

motor fxn, pain, and temp sensation are lost below the level of the injury. the sensations of position, vibration, and touch remain intact.

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40
Q

posterior cord syndrome

A

motor fxn remains intact, but vibration, crude touch, and position sensation are lost

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41
Q

conus medullaris syndrome

A

follows damage to the lumbar nerve roots and conus medullaris in the spinal cord. Bowel and bladder areflexia and flaccid LE. if damage is limited to the upper sacral segments of the spinal cord, bulbospongiosus penile (erection) and micturition reflexes remain intact

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42
Q

cauda equina syndrome

A

injury to the lumbosacral nerve roots below the conus medullaris. Areflexia of the bowel, bladder, and LE

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43
Q

usually fatal

A

injury C2-C3

44
Q

Where is the major innervation to the diaphragm by the phrenic nerve?

A

C4

45
Q

S2 and S3 center on micturition

A

therefore below this level the bladder will contract but not empty (neurogenic bladder)

46
Q

Injury above ______ allow males to have an erection, but they are unable to ejaculate bc of Sympathetic nerve damage

A

S2

47
Q

CNV

A

diff chewing

48
Q

CN VII

A

Facial paralysis

49
Q

CN IX and X

A

dysphagia

50
Q

CN XI

A

absent gag reflex

51
Q

CN XII

A

impaired tongue mvmt

52
Q

the inability to recognize familiar objects or persons

A

agnosia

53
Q

characterized by loss of ability to execute or carry out skilled movements or gestures, despite having the desire and physical ability to perform them

A

apraxia

54
Q

What breathing pattern is common in a stroke

A

cheyne stokes

55
Q

expressive aphasia

A

damage to Broca’s area of the frontal brain. The client understands what is being said, but is unable to communicate verbally

56
Q

receptive aphasia

A

injury involves Wernicke’s area in the temporoparietal area. Client is unable to understand the spoken and often the written work.

57
Q

global or mixed aphasia

A

language dysfunction occurs in expression and reception

58
Q

Stroke interventions

A

airway
VS
usually a bp of 150/100 is maintained to ensure cerebral perfusion
client is more at risk for ICP first 72 hours post stroke
position client on his side with HOB 15-30 degrees

59
Q

How long can the client be positioned on the affected side following a stroke (with regard to the turning schedule)?

A

2 hours on unaffected side, then 20 minutes on affected side. position client prone for 30 mins 3 times/day

60
Q

a chronic, progressive, noncontagious , degenerative disease of the CNS characterized by demyelination of the neurons

A

Multiple Sclerosis

61
Q

caused by insufficient secretion of acetylcholine, excessive secretion of cholinesterase, and unresponsiveness of the muscle fibers to acetylcholine

A

myasthenia gravis

62
Q

weakness and fatigue, diff chewing and swallowing, dysphagia, ptosis, diplopia, weak, hoarse voice, diff breathing, diminished breath sounds, respiratory paralysis and failure

A

myasthenia gravis

63
Q

bradykinesia, abnormal slowness of mvmt, and sluggishness of physical and mental responses, akinesia, monotonous speech, handwriting that becomes progressively smaller, tremors in hands and fingers at rest (pill rolling), tremors increasing when fatigued and decreasing with purposeful activity or sleep, rigidity with jerky mvmts, restlessness and pacing, blank facial expression; masklike faces, drooling, diff swallowing and speaking, loss of coordination and balance, shuffling steps, stooped position, and propulsives gait

A

Parkinson’s Disease

64
Q

flaccid facial muscles, inability to raise the eyebrows, frown, smile, close the eyelids, or puff out the cheeks

upward mvmt of the eye when attempting to close the eyelid
loss of taste

A

bells palsy

65
Q

what is the major concern in Guillain-Barre syndrome?

A

difficulty breathing-monitor respiratory status closely

66
Q

eventually, the respiratory muscles become affected, leading to respiratory compromise, pneumonia, and death

A

Amyotrophic Lateral Sclerosis (ALS)

67
Q

presence of cold sores, lesions, or ulcerations of the oral cavity, history of insect bits and swimming in fresh water, exposure to infectious disease, travel to areas where the disease is prevalent, n/v, fever, nuchal rigidity, changes in LOC, signs of increased ICP, motor dysfunction and focal neurological deficits

A

Encephalitis

68
Q

assess for Kernigs and Brudzinski’s signs

A

Encephalitis

69
Q

CSF is analysized to determine the diagnosis and type. CSF is cloudy, with increased protein, increased WBC and decreased glucose

A

Meningitis (transmitted by direct contact, including droplet)

70
Q

mild lethargy, photophobia, deterioration in the LOC, nuchal rigidity, Kernig’s sign, Brudzinski’s sign, red, macular rash or abdominal and chest pain

A

meningitis
red, macular rash with meningococcal meningitis
abdominal and chest pain with viral meningitis

71
Q

What do you do with a patient with pneumococcal meningitis?

A

maintain respiratory isolation

72
Q

how do you assess cerebral response to pain?

A

sternal rub, placing upward pressure on the orbital rim, or squeezing the clavicle or sternocleidomastoid muscle

73
Q

abdominal cramps, n/v/d, pupillary miosis, hypotension and dizziness, increased bronchial secretions, increased tearing and salivation, increased perspiration, bronchospasm, wheezing, and bradycardia

A

cholinergic crisis-give atropine sulfate

74
Q

Sinemet, Levodopa, Mirapex, Cogentin

A

Anti Parkinsons meds

75
Q

which anti parkinson med is dangerous if taken with an MAOI?

A

levodopa

76
Q

signs of blood dyscrasia

A

sore throat, bruising, nose bleeds (anticonvulsants)

77
Q

Who cant get Romazicon?

A

increased ICP or status epilepticus bc Romazicon will reverse benzodiazepines

78
Q

elevate HOB, avoid Trendelenburg position, and prevent flexion of the neck and hips

A

nursing management of IICP

79
Q

what is normal ICP?

A

5-15 mm Hg

80
Q

Autoregulation to maintain constant blood flow to the brain becomes ineffective when the MAP is below ___

A

50mm HG which causes the brain to become ischemic

81
Q

Autoregulation becomes ineffective when MAP is above _____ because the vessels are maximally _____.

A

150 mm Hg, constricted

82
Q

What is CPP?

A

the pressure needed to ensure blood flow to the brain. Normal is 60-100mm Hg.

83
Q

What level of CPP is incompatible with life?

A

a CPP less than 30 mm Hg is incompatible with life.

84
Q

Cushings Triad

A

increased SBP, widening pulse pressure, bradycardia with a full, boudning pulse, and irregular RR

85
Q

cingulate herniation

A

displacement of brain tissue to the opposite hemisphere beneath the falx cerebri

86
Q

What is the priority intervention during intraventricular catheterization?

A

aeseptic technique to prevent infection

87
Q

during ICP monitoring, the patient may be at risk for development of increased ICP when the height of the P2 wave is ______ than the p1 wave.

A

higher

88
Q

Where should hte transducer of the ICP monitor be?

A

level with the tragus of the ear

89
Q

What consideration is necessary when measuring ICP using a CSF drainage device?

A

device must be closed at least 6 mins prior to reading in order to get an accurate reading

90
Q

what is a complication of removal of CSF during ICP monitoring?

A

ventricular collapse

91
Q

What measures brain oxygenation and temperature?

A

Licox brain tissue oxygenation catheter

92
Q

What is the normal range for the pressure of oxygen in brain tissue? (PbtO2)

A

20-40 mmHG

93
Q

What do barbs do to manage IICP?

A

Barbituates decrease cerebral metabolism

94
Q

What happens to the brain if malnourished?

A

cerebral edema

95
Q

What three criteria does the Glascow Coma Scale measure?

A

Eye openning, vest verbal response, best motor response

96
Q

Testing the pupillary response to light is testing function of which cranial nerve?

A

CNIII

97
Q

Testing the corneal reflex is testing the function of which cranial nerves?

A

CN V and CNVII

98
Q

Testing for oculocephalic (doll’s eyes) reflex is testing for fxn of which CN?

A

All CN’s involved w eye mvmt

99
Q

If a patient is unconscious at the time of a head injury with a brief period of consciousness followed by a decreased in LOC what do you suspect?

A

arterial epidural hematoma which is the most acute neurological emergency

100
Q

If a patient is exhibiting nonspecific, nonlocalizing progression of alteration in LOC occurring over weeks or months, what do you suspect?

A

chronic subdural hemotoma

101
Q

If a patient is exhibiting a rapid deterioration of neurologic function within 24-48 hours following a head injury, what do you suspect?

A

acute subdural hematoma

102
Q

When a patient is admitted to the ED following a head injury, the nurse’s first priority in management of the patient once the airway is confirmed is

A

maintaining cervical spine precautions; always assume a patient with a head injury has a cervical spine injury until cleared

103
Q

symptoms of visual disturbances and seizures may indicate a tumor where?

A

occipital lobe

104
Q

what is the most common malignant brain tumor?

A

a glioblastoma multiforme

105
Q

what are the highest risk factors for thrombotic stroke?

A

hypertension and diabetes

106
Q

dysarthria

A

Dysarthria is a condition in which you have difficulty controlling or coordinating the muscles you use when you speak, or weakness of those muscles.

107
Q

What would hyperventilation of a stroke patient do?

A

Hyperventilation of a stroke patient would vasodilate and thus increase risk for hemorrhage

Adult Health (18 decks)

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