Neuro

Question 1

Kernigs Sign is?

And is a postive sign when found in ________ or _________

Answer 1

The Inability to extend a patients legs past 135^o with out pain. This is done with a patient supine

Positive sign Of meningittis, or subarachnoid Hemorrhage.

Question 2

Brudizinski reflex is ?

Answer 2

When you bend a patients head at the neck toward the chest and this causes the same flexation at the hips.

Question 3

What are the three major catagories of Meningitis

Answer 3

Viral

Fungal

Bacterial

Question 4

What are the S/S ofViral meningitis

Answer 4

Generally follows another major viral illness, such as measles, mumps, herpes simplex, herpes zoster

Increased Temps, Head Ache, Neucol Ridgitity(Stiff Neck), Nausea, Vomiting

Essentially presents as flu like symptoms

Flu = Virus

Question 5

What is the Most commonly encountered Meningitis and how is it treated

Answer 5

Viral meningitis, is the most common, it is treated by monitoring for Seziures and treating Symptoms, the general course takes 1-2 weeks

Question 6

What type of patient is fungal meningitis generally found in.

What are the general s/s

how is it treated

Answer 6

immunosupressive patients.

S/S were dependent on the type of immunosupression

treatment is generally IV antifungals, and symptomatic

Question 7

what is the worst type of meningitis?

Answer 7

Bacterial Meningitis is the worst type of meningitis

It is a medical emergency

Question 8

What are the S/S of Bacterial Meningitis

Answer 8

Very Rapid Progression and action

High Fever Nuchal rigidity

Question 9

What nursing interventions are needed for Bacterial Meningitis

Answer 9

Rapid thourogh assessment

Blood Draw immediately

Prep for L/P

Adminster Broad Spectrum antibiotics

Question 10

What is the Name of the Vaccine for Meningitis

Answer 10

Menomune

Question 11

What are two test you can do during assessment that would lead you to suspect meningitis

Answer 11

Brudizinski reflex and Kernigs Sign

Brudinski’s- neck bends feet body draws to core

kernigs- Painful extension of the legs

Question 12

what are some lab/ Diagnostics for Meningitis

Answer 12

Culture and sensitivity

Cbc with Differential

L/P

CT/ MRI

Question 13

What are the primary nursing care items for a person with Meningitis

Answer 13

Monitor Neruo with special attention cranial nerves

observe for s/s of ICP

seziure Precations

Monitor for septic shock

Assessment will show Fever, hard to arouse, decreased appetite, decreased mental status

Question 14

Who are at the greatest risk for Meningitis?

Why?

Answer 14

Antivaxers, Imnunocompromised)

people who live in grouped settings (dorm, prisons, etc)

This is spread by respiratory so close quarters breeds illness

Question 15

Important Patient care considerations for People with Meningitis

Answer 15

Vital signs at least q2-4 hours

Frequent Neuro Checks

Pain management-balance with ability to arouse

I+0

Decrease environmental stimuli

Bed Rest HOB always 30⁰

Isolation precautions

Question 16

What are some Prevetions complications for a nurse treating a patient with Meningitis

Answer 16

Intercrainial presssure ICP

Vascualar Dysfunction

F+E imbalances

Seziures

Shock

Question 17

What is a CVA Stroke

Answer 17

Cerbreal vascular attack, is an interuption of blood flow to the brain similar to a heart attack, that is caused either by a blockage or bleed

Question 18

What are the types of CVA

Answer 18

• Ischeimic- Occlusive

1. Thrombolytic
2. embolitic

• Hemorrhagic

Question 19

What is an Ischemic Stroke

Answer 19

It is a interuption of blood flow to the brain by some form of thrombus or embolus

Thrombus come from larger venus stasis

Embolus tend to come from a cardiac event such as A-fib

Question 20

Diagnosis of ischemic stroke is done by?

Answer 20

CT MRI

EKG ECG

ABG

CMP CKP

Question 21

Treatment for an ischemic stroke is

Answer 21

TPA(clot busters)

Must be adminstered within 3 hours of onset of stroke to be successful

Question 22

TPA dosing is based on

Answer 22

Dosing is based on weight, with max dose being 90mg

Question 23

What is the Norm for INR

Answer 23

2-3

the higher the number the thiner the blood

Question 24

What is a TIA

Answer 24

Trans Ischemic attack

Generally Preceeds stroke is a warning sign

It allows for Reversable neruo Deficits or RIND

Damage can be seen by MRI or CT

Multiple TIAs ^ risk for Stroke

Question 25

Number one cause of Stroke IS?

Answer 25

HTN Prevention is key so controlled BP is paramont

Question 26

Blood Thiners and Antiplatets are used to prevent what type of stroke

Answer 26

Ischemic

Question 27

Can you use TPA for all strokes"

Answer 27

NO TPA is only for ISCHEMIC Strokes In hemmoragic you want the blood to clot

Question 28

Hemoragic Stroke is

Answer 28

A bleed in the brain caused by a rupture of a vessle, Aneurysm, or rupture of an AV fistula malformation

Question 29

Hemorrhagic stroke risk factors include

Answer 29

Smoking Coccaine use obesity sedintary lifestyle ^stress levels, ^ HTN ^Cholesterol Previous CVA/TIA Sudden discontiuance of HTN meds

Question 30

Treatment for Hemmoragic stroke includes

Answer 30

Clipping, or spiraling artery, montioring for ICP Regular Neruo assessments monitor basic Asssesment HOB 30⁰

Question 31

Management of Pts with Stroke

Answer 31

Prevention is key: maintain blood pressure pharmacology surgical interventions if needed prevent complications Assess FAST

Question 32

The assessment acryonmm FAST stands for

Answer 32

**F-** Face Drooping, numbness **A**- Arm Weakness, Raising **S**- Slurred Speach **T- Time to ED ASAP**

Question 33

Remember TREATMENT FOR ALL STROKES IS IN WHAT PRIORITY

Answer 33

**A B C** **Oxygenate**

Question 34

What are some Degenerative Neurological Conditions

Answer 34

MS ALS( amytrophic lateral sclerosis) parkinsons myasthenia Gravis Guillain-Barre Syndrome Huntingtons

Question 35

What are some commonalities between all Degenerative Neuro Disorders

Answer 35

* Altered Motor activity * Altered coordination * Altered Sensory Function * altered urinary/Bowel functions * Altered role/Self preception * altered speech/Swallowing * impaired Physical Mobility * risk for Injury * Nutrition Less than body req. * Risk for aspiration

Question 36

MS is characterized by periods of remission and exacerbation but what is it

Answer 36

it is an inflamatory response that is autoimmune where the body attacks its own mylean sheaths on the nerve cells

Question 37

MS is more common in women then men and more prevailant in northern climates, when does the onset generally begin

Answer 37

typically occurs between 20-40 y/o, believed to be related to childberaring and new stressors, and there is thought to be a link to family there is no cure

Question 38

there are two focus types of ms they are

Answer 38

Relapse/Remit vs Chronic R/R is treatable and less debilitating, Chronic is progressive and leads to a rapid decrease in function and need for total care

Question 39

MS Trigger Factors Include

Answer 39

* Virus or infectious agent * living in a cold climate * physical injury * emotional stress * pregnancy * fatigue * overexertion * temperature extremes * hot bath/shower

Question 40

MS is diagnosed how

Answer 40

History, and symptoms, there is no test to confirm

Question 41

What are the primary Symptoms of MS

Answer 41

Fatigue weakness numbness Difficulty with coordination, loss of balance visual disturbances * blurring * dilopia(double vison) * patchy or total blindness * change in peripheral vision * nystagmus(repetative uncontroled movements)

Question 42

More Primary symptoms of MS include

Answer 42

Speech defecits (stutter) Dysarthria Dysphagia spastic weakness, ataxia, tremors, dysmeteria Emontial labilit, depression, euphoria bladder and bowl dysfunction-loss of sensation Tinitus, vertigo, decrease hearing Cognative changes

Question 43

MS Secondary Symptoms - Problems related to primary symptoms

Answer 43

* Repeated utis * loss of muscle tona and disuse weakness * poor posture and torso control * decreased body density * shallow ineffcient breathing * pressure ulcers from immobility *

Question 44

MS drug of Choice is ? What are some other common drugs used

Answer 44

Avonex(inteferon beta 1) given subq once a week also used are prednisone, baclofen(spacitiy) Keppra

Question 45

Parkinsons is a disease that affects?

Answer 45

The neuro transmission of impulses causeing tremors, ridgitity slow movement(Bradykinesia) poor posture, depression/psych, dementia, autonomic symptoms, sleep distrubances

Question 46

Cause of Parkisons is unknown but it affects what

Answer 46

Affects Gross motor Function, Degeneration of the nerves that control voluntary movment Occurs in the brain affects response to dopamines causes death of cells that create dopamine

Question 47

MOST SEEN Symptoms IN PARKINSONS

Answer 47

Temors Rigidity Poor Posture Bradykinesia(Slow Movement)

Question 48

What is the most used and gold standard treatment for Parkinsons meds

Answer 48

Levodopa and Carbidopa- may take up to 6 months to reach theraputic effect

Question 49

what are some adverse affects of Levodopa-Carbidopa

Answer 49

Involuntary movements ataxia(loss of full control of body movements) Increased Tremors anorexia

Question 50

Symmetrel is

Answer 50

An antiviral antiparkonsionian med that is thought to increase dopamine release. it is used to treat Bradykinesia, tremor, and ridgity, but is commonly avoided due to adverse effects: Dizziness, insomnia, confusion, orthostatic hypo-tension, which can all lead to increased risk for falls

Question 51

Major Complications from parkinsons include

Answer 51

Aspiration Pnemonia from aphasia Altered cognition/ Dementia

Question 52

Other than medication what is another theraputic option for parkinsons treatment

Answer 52

Deep brain stimulation- This is like a pacemaker to the heart but is place in the brain to help regulate

Question 53

Not every case of parkinsons is believed to be from brain issues, what are some other thoughts of what may contribute to parkinsons

Answer 53

Medications(esp Psych) Heavy metal poisoning, pestasides mid-brain injuries and High levels of CO poisoning

Question 54

True or False Parkinsons is a slowly progressing neurological dissorder that eventually leads to disablity

Answer 54

TRUE

Question 55

Assessment and Care of parkinsons patients

Answer 55

Focus on degree of disabiltiy TEACHING AND SAFETY ARE KEY

Question 56

Goals of treatment for Parkinsons Include

Answer 56

Improved functional ability, maintaining indepence with adls achieveing adequate bowel elimination maintiaining appropiate nutritional status, copiing skills, and communicatoin

Question 57

Ways to focus on improving mobility for a parkinsons patient are

Answer 57

Daily excersise program, ROM Postural excersises PT EVAL and TX Techniques to ensure saftey and balance while walking Frequent rest, proper footwear Use of assistive devices PRN

Question 58

What is ALS Amyotrophic Lateral Sclerosis

Answer 58

Loss of motor neurons in the anterior horn of the spinal cord and the motor nuclei of the brainstem: Leads to progressive weakness of extremities and trunk then, Muscle Atrophy, and weakness of the bulbar muscles which impairs swallowing and speech. Respiratory function is also imparied Due to Difficulty clearing secretions leading to drowning in own fluids

Question 59

How is ALS Diagnosed

Answer 59

There is no diagnostice test but some test are used to attempt to rule it out. Some diagnostic proceedures Include: * CK- will be increased Muscle damage * EMG(electromyography) muscle Fasciculations-muscle twitching * Muscle Biopsy- testing atrophy * Serial muscle Testing- loss of stregnth * Pulmonary Function Testing- VIP to do at DX to establish a baseline for monitoring of progression *

Question 60

ALS is a traditional assessment, with focus on speech and airway function, Primarily AIRWAY. What are some interventions.

Answer 60

* Excercise and mobility are used * Managment of Swallowing * Maitain Respiratory function * includes L/S assessments * prn suctioning * Cough and DB * Meds for Issues Rilusole, Quinine, Baclofen, Dantrolene, Diazepam * Pt Family Teaching

Question 61

Meds used treatment of ALS include Rilusole, Quinine, Levsin, Baclofen, Dantrolene, Diazepam, what is each used for

Answer 61

Rilusole- Used to prolong Survival time of the Trachea Levsin-Dry Secretion Quinine - Muscle Cramps BACLOFEN, dantrolene Diazepam- Antispasmodics

Question 62

When is Rilusole given

Answer 62

Generally toward the end of the disease process, and is used and good for 12 weeks

Question 63

What is Diplopia

Answer 63

Double Vision

Question 64

Myasthenia Gravis is

Answer 64

A progressive autoimmune disease, that leads to severe muscle weakness that affects women 15-35 or men over 40

Question 65

Myastheia Gravis presents as

Answer 65

Extreme muscle weakness, Fatigue diplopia and ptosis are early signs Sleepy mask like expression dysphonia problems with chewing and swallowing leading to aspiration progressive weakness of Diaphram leading to Resp. Distress

Question 66

Diagnosed with

Answer 66

* Pt Hist & Phys * Tensiloon Testing- * 10 cc's IV, 2cc's pushed to monitor for reaction then remaining 8cc's Tensilon test reverse the effects of MG within 30 secs * ENSURE ATROPINE IS AT THE BEDSIDE, in case of adverse effects

Question 67

Theraputic Treatments of Myasthenia Gravis include

Answer 67

Plasmapheresis- which removes antibodies that are believed to be the cause of the condition

Question 68

Medications given for M Gravis

Answer 68

* Anticholinesterase meds- * pyridostigmine(Mestinon)- give with food due to gi upset, and must be taken sametime each day to ensure theraputic levels * ambenonium (mytelase) * Both may cause Cholinergic Crisis * Chorticosteroids and Immunosupressents to tx inflamation

Question 69

What are two potential complications with medication of MGravis

Answer 69

1. Myasthenic crisis- Under medication 2. cholinergic crisis- over medication

Question 70

What are the S/s Of Myasthenic crisis(undermedication)

Answer 70

* Resp Muscle weakness \> need Mechanical Ventilation * Myasthenic Symptoms \> Weakness incotinece fatigue, hypertension, * temporary relief of symptoms with tensilon * PT's Cant breath from stopping medications

Question 71

12 Cranial nerves Ooo, ooo, ooo, to touch and feel a girls vagina ah heaven

Answer 71

Most typically, humans are considered to have twelve pairs of cranial nerves (I–XII). They are: olfactory nerve (I), optic nerve (II), oculomotor nerve (III), trochlear nerve (IV), trigeminal nerve (V), abducens nerve (VI), facial nerve (VII), vestibulocochlear nerve (VIII), glossopharyngeal nerve (IX) vagus nerve (X), accessory nerve (XI), and hypoglossal nerve (XII)

Question 72

Cholinergic Crisis Presentations Include

Answer 72

* Muscle twitching that results in muscle weakness and causes need for mechanical ventilation * Leads to hypersecretions, hypermotility * Hypotension * Tensolin has no positive effect on symptoms * Symptoms will improve with Anti cholinergic meds due to med overdose.

Question 73

What is GBS, Guilian Barre Syndrome

Answer 73

It is an acute inflammatroy disease usually preceeded by a viral infection(URI or GI) 1-4 weeks Degeneration of the mylein sheath of the peripheral nerves, which is diagnosis by H&Pyshical and CSF

Question 74

Guillian Barre Syndome Presents

Answer 74

Ascending paralysis that starts at the feet ascending up the body until It decides to stops which can take up to 3 weeks to progress, and may take up to 6 months to a year to go away

Question 75

Interventions For GBS

Answer 75

Monitor Cerebral vascular status Monitor Respitory treat accordingly, Vent, HOB ^, Chest PT Trach Nutritional interventions PRN, NG, TPN, Bowel sounds, Ensure communication, Lip reading, pic cards, eye blinks Pyschological support, prevention of deformities as ROM, Skin care prevention of Breakdown, Consider Steroids if needed **Plasmaphoresis- attempt to remove antibobies believed to be a possible cause**