Complex Exam 3 - acute intracranial disorders

Question 1

Does loss of consciousness occur with a concussion?

Answer 1

briefly

Question 2

What are s/sx of a concussion?

Answer 2

• retrograde amnesia
• confusion
• memory loss

Question 3

What is a contusion?

Answer 3

bruising of the brain

Question 4

Does loss of consciousness occur with a contusion?

Answer 4

YES

Question 5

What posturing can occur from a contusion?

Answer 5

decorticate and decerebrate

Question 6

What can a diffuse axonal injury lead to?

Answer 6

coma

Question 7

What does intracerebral hemorrhage lead to?

Answer 7

hemorrhagic stroke

Question 8

What are s/sx of intracranial hemorrhages?

Answer 8

• decreased LOC
• ipsilateral pupillary dilation (on the side of injury)
• weakness

Question 9

What type of intracranial hemorrhage causes ICP to decrease fast?

Answer 9

epidural

Question 10

When should you monitor for a CSF leak from the nose or ears? What does it indicate?

Answer 10

• skull fractures
• basilar skull fracture

Question 11

What is the “halo sign”?

Answer 11

a yellow stain surrounded by blood that will test positive for glucose

Question 12

Battle’s sign can happen with skull fractures. What is this?

Answer 12

bruising over the mastoid process

Question 13

What is it called when a patient with a skull fracture has periorbital edema and ecchymoses?

Answer 13

raccoon eyes

Question 14

When should a lumbar puncture be avoided?

Answer 14

with increased ICP

Question 15

How can increased ICP be ruled out?

Answer 15

CT

Question 16

What is the patient at risk for after a craniotomy?

Answer 16

• permanent neuro deficits
• seizure disorder
• infection
• death

Question 17

How should the patient be positioned if their head injury was infratentorial?

Answer 17

flat on either side

Question 18

How should the patient be positioned if their head injury was supratentorial?

Answer 18

head midline with HOB @ 30 degrees

Question 19

What SCI results in quadriplegia?

Answer 19

injury to the cervical region

Question 20

What SCI results in paraplegia?

Answer 20

injuries below T1

Question 21

What SCI causes the inability to protect the airway?

Answer 21

C4 and above

Question 22

What is the function of the phrenic nerve?

Answer 22

stimulates spontaneous breathing

Question 23

What happens to the bladder of a patient with a SCI?

Answer 23

spastic and flaccid neurogenic bladder

Question 24

What SCI causes hypertonia?

Answer 24

above L1/L2

Question 25

What SCI causes hypotonia?

Answer 25

below L1/L2

Question 26

What happens to BP and RR with a SCI?

Answer 26

hypotension and shallow respirations

Question 27

If a patient with a SCI experiences loss of thermoregulation what is it a sign of?

Answer 27

neurogenic shock

Question 28

Should the HOB be raised with a SCI?

Answer 28

NO

Question 29

What is important to monitor with a SCI?

Answer 29

- neuro status - muscle strength - mobility - sensation - skin breakdown

Question 30

How should a patient with a SCI be moved?

Answer 30

logroll

Question 31

What type of SCI causes autonomic dysreflexia?

Answer 31

injury around T6 and above

Question 32

What are the s/sx of autonomic dysreflexia?

Answer 32

- extreme HTN - severe headache - diaphoresis - increased temp - anxiety/restlessness - goosebumps

Question 33

What does autonomic dysreflexia increase the risk of?

Answer 33

stroke, seizure, death

Question 34

What are the 3 B's that cause autonomic dysreflexia?

Answer 34

- bladder: distended - bowel: fecal impaction - breakdown of skin: tight clothing

Question 35

What is important to teach with autonomic dysreflexia?

Answer 35

bladder/bowel training

Question 36

When does neurogenic shock usually occur?

Answer 36

within 24 hours of a spinal cord injury

Question 37

What happens to BP and HR with neurogenic shock?

Answer 37

hypotension and bradycardia

Question 38

How can postural hypotension occur with neurogenic shock?

Answer 38

keeping the pt in an upright position

Question 39

How can postural HTN be avoided with neurogenic shock?

Answer 39

transfer the patient in stages by first raining the HOB and then transferring the patient into a reclining wheelchair

Question 40

If a patient experiences dizziness with neurogenic shock what should be done?

Answer 40

- lower HOB - lock and lean wheelchair to fully reclining position

Question 41

What medication should be given for bradycardia with neurogenic shock?

Answer 41

atropine

Question 42

What are vasopressors used for with neurogenic shock?

Answer 42

to treat hypotension

Question 43

How many people should be used to transfer a patient in neurogenic shock?

Answer 43

3

Question 44

Is viral meningitis contagious?

Answer 44

not very

Question 45

Is bacterial meningitis contagious?

Answer 45

very

Question 46

What type of meningitis has a vaccine?

Answer 46

bacterial

Question 47

Meningitis causes a positive kernig's sign. What does this mean?

Answer 47

there is pain and resistance when attempting to straighten the knee, the head flexes up

Question 48

Meningitis causes a positive brudzinski's sign. What does this mean?

Answer 48

the knees and hips flex when the patient's neck is flexed

Question 49

What happens to DTR's with a SCI?

Answer 49

they are absent

Question 50

What happens to DTR's with meningitis?

Answer 50

they are hyperactive

Question 51

What happens to the neck of a patient with meningitis?

Answer 51

stiff, rigid

Question 52

Can meningitis cause seizures?

Answer 52

YES

Question 53

What will the CSF of a patient with bacterial meningitis look like?

Answer 53

- cloudy - decreased glucose - positive gram stain - increased WBC's and protein

Question 54

What will CSF of a patient with viral meningitis look like?

Answer 54

- clear - negative gram stain - increased WBC's and protein

Question 55

What isolation precautions should be used for meningitis?

Answer 55

droplet

Question 56

How long does a patient with bacterial meningitis have to be isolated?

Answer 56

at least 24 hours

Question 57

Is meningitis a reportable disease?

Answer 57

yes

Question 58

What type of meningitis needs antibiotics?

Answer 58

bacterial

Question 59

What vaccines should be given for meningitis?

Answer 59

- Hib - pneumonia (PPSV 13 or 23) - meningococcal (MCV 4)

Question 60

Which side of the brain causes aphasia, agnosia, alexia, agraphia, apraxia, dysarthria, and dysphagia?

Answer 60

left

Question 61

Which side of the body is weak/paralyzed after a left-sided stroke?

Answer 61

right

Question 62

Which side of the brain causes unilateral neglect?

Answer 62

right

Question 63

Which side of the brain causes depression, anger/frustration?

Answer 63

left

Question 64

Which side of the brain causes overestimation of abilities, loss of depth perception, and poor impulse control/judgment?

Answer 64

right

Question 65

Which side of the body is weak/paralyzed after a right-sided stroke?

Answer 65

left

Question 66

What are important to know about a patient with hemorrhagic stroke?

Answer 66

- a-fib - blood thinner use - time the s/sx started

Question 67

How should you communicate with someone after a stroke?

Answer 67

- short phrases - gestures/pointing - no distraction - patience - repetition - one question at a time - communication board

Question 68

What diet should someone be on after a stroke until their speech path is clear?

Answer 68

NPO

Question 69

What infant reflex returns if there is a brain tumor?

Answer 69

babinski

Question 70

What is papilledema and when does it happen?

Answer 70

optic nerve swelling that occurs with brain tumors

Question 71

Brain tumors can cause the inability to discriminate sounds, loss of gag reflex, and loss of blink response. What are these examples of?

Answer 71

cranial nerve dysfunction

Question 72

What are s/sx of brain tumors?

Answer 72

- HA - dysarthria - dysphagia - vertigo - hemiparesis - papilledema

Question 73

What should be stopped before surgery for brain tumors?

Answer 73

- 72 hours before: aspirin - 5 days before: alcohol, tobacco, anticoagulants, NSAIDS

Question 74

What does a CT tell you about a brain tumor?

Answer 74

- size - location - extent

Question 75

What labs should be monitored with brain tumors?

Answer 75

- electrolytes - renal function - endocrine function

Question 76

What causes SIADH?

Answer 76

overproduction of ADH due to damaged hypothalamus

Question 77

What does the overproduction of ADH cause?

Answer 77

fluid retention

Question 78

What medication can be given for SIADH?

Answer 78

conivaptan (vasopressin antagonist)

Question 79

What happens of SIADH goes untreated?

Answer 79

seizures, coma

Question 80

What can cause diabetes insipidus?

Answer 80

- supratentorial surgery, craniotomy - ADH deficiency

Question 81

What does ADH deficiency cause?

Answer 81

increased urine excretion

Question 82

How is diabetes insipidus treated?

Answer 82

- fluid replacement - electrolyte replacement

Question 83

What intracranial disorder can have photophobia?

Answer 83

meningitis