Exam 2 neuro Flashcards
what is the goal of neuro problems?
prevent further injury
achieve goal by understanding foundations of neuro function so that disfunction is easily identified
what are the neuro problems?
- traumatic brain injury (TBI): inter-cranial pressure monitoring
- cerebrovascular accident (CVA/stroke): tissue plasminogen activator (TPA) and cerebral aneurysm
- seizures
- spinal cord injuries
- Guillain-barre
what is an open TBI?
Basilar skull fracture
(Visible on the external skull)
KEY FINDING
Clear or blood-tinged drainage from the eyes, ears, nose that is positive for glucose = Cerebrospinal Fluid (CSF)
what is a closed TBI?
Concussion
Clinical findings: brief loss of consciousness, headache, retrograde amnesia (memory loss of events immediately prior to injury)
Contusion
(more emergent)
Described as:
Coup- affecting one area of the brain due to impact
Contrecoup- affecting the area opposite of coup
Together- Coup-Contrecoup
Typically affecting the frontal and occipital lobes
what are the different areas of the brain?
frontal lobe
temporal lobe
brainstem
cerebellum
occipital lobe
pariental lobe
motor control (premotor cortex), problem solving (prefrontal area), and speech production (Broca’s area)
frontal lobe
auditory processing (hearing), language comprehension (Wernicke’s area), memory/info retrieval
temporal lobe
involuntary responses
brainstem
balance and coordination
cerebellum
sight (visual cortex) and visual reception and visual interpretation
occipital lobe
touch perception (somatosensory cortex) and body orientation and sensory discrimination.
pariental lobe
what are the 3 types of cerebral hematomas?
- Epidural hematoma- rapid accumulation of blood in the epidural space.
-Rapid increase in ICP leading to death
-Intermittent loss of consciousness and waking. - Subdural hematoma
-Often resolve but may need intervention depending on the lobe involved - intracerebral hematoma
what is the treatment for cerebral hematomas?
The treatment of brain hematomas depends on the severity of the bleed, the location of the bleed, and presentation of the patient condition.
What do you need to monitor for increased ICP?
early s/s:
agitation
restlessness/irritability
change in LOC
decreased mental status
sudden vomiting
without nausea
late s/s:
seizures
posturing (decorticate and decerebrate)
Cushing triad
what are the late deadly signs of increased ICP?
lungs: irreg. respirations and Cheyne strokes respirations
neck: nuchal rigidity (stiff neck)
brainstem affected:
-eyes: pupils (fixed and dilated, unequal) 8mm (normal = 2-6mm)
-foot: babinski reflex (toes fan out when stimulated = BAD)
seizures and coma
abnormal posturing: decorticate and decerebrate
focus on recognizing the _________ in ICP and _________ interventions.
changes
proper
what does ICPS stand for?
I- Immobilize C spine. Log roll patient
C- CO2 low: lower CO2 means lower ICP. CO2 dilates vessels and will increase ICP.
P- Positioning: 30-35 degrees (semi-fowlers), no flexing/bending, no coughing, sneezing, etc
S- Suctioning: 10 seconds or less, infrequent, hyperventilate patient
what are the interventions for hematomas?
Airway, breathing, circulation – vital signs w/ O2 sat
Stabilize cervical spine(Position client with HOB 30-45 degrees elevation)
Intubate (GCS <8) or if gag reflex impaired or absent
Control external bleeding
Maintain normothermia
what is important to know for prevention of 2nd injury, concussion and contusions, and skull fx in hematomas?
Prevent secondary injury:
by treating cerebral edema and increased ICP
Concussion and contusion:
monitor and manage ICP
Skull fractures:
If CSF leak, prophylactic antibiotics
Surgery –elevate depressed bones, remove fragments; craniectomy and cranioplasty
what needs to be managed with hematomas?
Manage intracranial pressure monitoring system and ICP: Manage nausea and vomiting Minimize environmental stimulation
Manage eye problems- prevent corneal damage
Manage hyperthermia (goal 36-37 deg C/96.8-98.6 F): Cooling blanket, etc
Manage CSF leak – rhinorrhea or otorrhea – notify HCP
Teach client not to sneeze or blow nose
No NGT or perform NT suctioning – if basilar skullfracture r/f meningitis
Implement seizure precautions and prophylaxis
Manage headache
Prevent VTE, skin breakdown
A nurses assesses the GCS of a patient who is resting with eyes closed. When the nurse speaks to the patient, they open their eyes. What eye opening score would you give this patient?
3
the pt opened eyes to speech
A nurses is assessing the GCS of a patient admitted with a TBI following a motor vehicle accident. When asked where they were, the patient responded his “dorm room” and stated that his dad, who was at the bedside was his roommate. What verbal response score would you give this patient?
4
the pt is speaking with intention, but appears confused
A nurses is assessing the GCS of a patient admitted with a TBI following a motor vehicle accident. When assessing the patient for motor response using the Babinski reflex, the nurse notes that the patient’s toes fan out. What does this indicate about the patient and what score would you give?
3
When the Babinski reflex is tested, the toes should extend or point down normally. A positive Babinski test indicates brain stem involvement
What is the scoring on the Glasgow coma scale (GCS)?
13-15 mild
9-12 moderate
3-8 severe
less than 8 = intubate
anosmotic diuretic, elevates blood plasma osmolality, resulting in enhanced flow of water from tissues, including the brain and cerebrospinal fluid, into interstitial fluid and plasma.
Mannitol
