Cerebral Dysfunction

Question 1

cranial nerves

Answer 1

1. Olfactory
2. Optic
3. Oculomotor
4. Trochlear
5. Trigeminal
6. Abducens
7. Facial
8. Vestibulocochlear
9. Glossopharyngeal
10. Vagus
11. Accessory
12. Hypoglossal

Question 2

cranial nerve 1

Answer 2

olfactory
close eyes and inhale, do each nostril

Question 3

cranial nerve 2

Answer 3

optic
central and peripheral vision

Question 4

cranial nerve 3

Answer 4

oculomotor
pupillary constriction

Question 5

cranial nerve 4

Answer 5

trochlear
follow my finger as i move down towards tip of pts nose

Question 6

cranial nerve 5

Answer 6

trigeminal
assess jaw strength

Question 7

cranial nerve 6

Answer 7

abducens
eye movement to sides, assess six cardinal directions

Question 8

cranial never 7

Answer 8

facial
facial expressions

Question 9

cranial nerve 8

Answer 9

vestibulocochlear
rub fingers together by each ear

Question 10

cranial nerve 9

Answer 10

glossopharyngeal
say ahhh, gag reflex

Question 11

cranial nerve 10

Answer 11

vagus
swallow and speak

Question 12

cranial nerve 11

Answer 12

accessory
neck and shoulder

Question 13

cranial nerve 12

Answer 13

hypoglossal
stick out tongue and move side to side

Question 14

normal PERRLA

Answer 14

pupils…
equal
round (2-3mm)
reactive to light (brisk)
movements are parallel

Question 15

abnormal PERRLA

Answer 15

pupils…
sluggish (slow constriction)
pinpoint (overdose)
sudden fixed and dilated (neuro emergency)

Question 16

levels of consciousness

Answer 16

full consciousness
confusion
disorientation
lethargy
obtunded (arousable only to stimulation)
stupor (arousable only to vigorous stimulation/sternal rub/pinch fingernail bed)
coma
persistent vegetative state

Question 17

red flag LOC

Answer 17

lack of response to painful stimuli

Question 18

can start assessing extremity strength at…

Answer 18

toddler / preschool age

Question 19

decorticate posturing

Answer 19

cerebral cortex damage
flexion
arms held tightly to body
feet plantar

Question 20

decerebrate posturing

Answer 20

brainstem damage
extension
hands pronated
back is arched

Question 21

pediatric glasgow coma scale

Answer 21

eyes (1-5)
verbal response (1-5)
motor response (1-5)
15= unaltered
less than 8= coma
less than 3= extreme

Question 22

normal ICP for children

Answer 22

1-10 mmHg

Question 23

early signs of increased ICP for infants

Answer 23

tense and bulging fontanels!!
irritability
poor feeding
distended scalp veins
separated cranial sutures

Question 24

early signs of increased ICP for children

Answer 24

diplopia (double vision)
HA
nausea w or w/out vomit

Question 25

late signs of increased ICP

Answer 25

bradycardia decreased LOC alterations in pupil size cheyne stokes respirations

Question 26

RN interventions for increased ICP

Answer 26

HOB 30+ avoid activities that may increase ICP eliminate noise no suctioning mannitol be careful of overhydration with IVF

Question 27

posturing with increased ICP

Answer 27

increased ICP-- pressure on medulla oblongota (controls pulse and RR, apart of brainstem)--- extension posturing

Question 28

epidural hematoma

Answer 28

between dura and skull

Question 29

subdural hematoma

Answer 29

between dura and arachnoid deeper

Question 30

concussion

Answer 30

caused by blunt trauma to head CM: amnesia, confusion, HA, lack of coordination, N/V, dizziness, ringing in ear, sleepiness complication: hematoma, increased ICP concerning when sleepiness for more than 24hrs or disorientation for a few hours

Question 31

meningitis

Answer 31

bacterial or viral CM: nuchal rigidity, photophobia, HA, vomiting, fever and chills, symptoms of increased ICP dx: lumbar puncture (CSF will be cloudy, increased protein, decreased glucose, contain RBCs), Brudzinski sign, kerning sign manage: isolation, abx, antipyretics, restrict hydration, reduce ICP

Question 32

brudzinski sign

Answer 32

lay supine, lift pt neck + if knees flex with neck flexion

Question 33

kerning sign

Answer 33

lay supine, lift one leg with knee flexed at 90 then slowly straighten leg out + if pain or cannot extend

Question 34

vaccines to prevent meningitits

Answer 34

Hib and pneumococcal

Question 35

reye syndrome

Answer 35

swelling of liver and brain, acute form of encephalopathy dx: liver biopsy CM: fever, profuse vomiting, neuro impairment, disordered hepatic function treat: steroids

Question 36

tonic clonic seizure

Answer 36

generalized onset without warning tonic (10-20sec) clonic (30-50sec/up to 30 min) postictal (30 min)

Question 37

absence seizure

Answer 37

generalized LOC 5-10 sec blank stare, daydreaming

Question 38

myoclonic seizure

Answer 38

generalized contractions

Question 39

atonic seizure

Answer 39

generalized "drop attacks" lost muscle tone causing a fall, period of confusion follows

Question 40

febrile seizures

Answer 40

partial (local/focal) sudden spike in temp (38.9-40C) (102-104) 10-15 sec