Neuro 1 Flashcards
(64 cards)
1
Q
What is Akinetic Mutism?
A
Unresponsiveness to the environment, makes no movement, but sometimes opens eyes.
2
Q
What is a Persistent Vegetative State?
A
Devoid of cognitive function, but has sleep-wake cycles
Usually from severe brain damage, comes with end of life decisions
3
Q
What is Locked In Syndrome?
A
Inability to move or respond except eye movements due to a lesion affecting the pons
4
Q
What is meant by Altered Level of Consciousness?
A
When a patient is not oriented, doesn’t follow commands, or needs persistent stimuli to achieve a state of alertness
The patient with an altered LOC is at risk for alterations in every body system
5
Q
What is the Glasgow Coma Scale?
A
6
Q
What is Decorticate Posturing?
A
Posturing and flexion of the upper extremities, internal rotation of the lower extremities, and plantar flexion of the feet.
Results from neurologic injury
7
Q
What is Decerebrate Posturing?
A
Extension and outward rotation of upper extremities and plantar flexion of the feet
Results from neurologic injury
8
Q
What would inhibit an accurate motor response assessment?
A
If the patient was taking neuromuscular-blocking agents or paralytics
9
Q
What is the most common diagnostic testing for a suspected neurological injury?
A
Computed Tomography
CT
10
Q
Which labs may be diagnostic for neurological injury?
A
- Blood glucose
- Serum electrolytes
- Serum ammonia (hepatic encephalopathy)
- Serum BUN
- Serum Osmolality
- Calcium Levels
- PT/PTT
- Serum Ketones (DKA?)
- ETOH/BAC
- Drug concentrations
- Arterial Blood Gases
11
Q
What is Delirium?
A
ACUTE CONFUSION STATE
- Begins with disorientation, can progress to changes in LOC, irreversible brain damage, and death
- Happens to 80% of ICU patients
- Can be mistaken for dementia
- Need to assess closely with CAM (Confusion Assessment Method)
12
Q
What are the risk factors for Delirium?
A
- Use of benzodiazepines
- Blood transfusions
- Age
- Dementia
- Prior coma
- Recent emergency or trauma
- Older adults with polypharmacy
13
Q
What is Dementia?
A
GRADUAL PROGRESSIVE CONFUSION
- Progression can take months or years
- Cause: neurodegeneration
Some cases can be reversible IF the cause is a pathologic condition masquerading as dementia
14
Q
What is the most common type of Dementia?
A
Alzheimer’s Disease
Up to 75% of dementia cases
Other types: Vascular, Neoplastic, Demyelinating, infectious, inflammatory, toxic, metabolic, psychiatric
15
Q
What is a Seizure?
A
- Abnormal electrical discharges in the cerebral cortex
- Manifests as an alteration in sensation, behavior, movement, perception, or consciousness
16
Q
What is Epilepsy?
A
A group of syndromes characterized by more than one unprovoked seizure
17
Q
What is a Focal Onset Seizure?
A
- Electrical activity begins on one side or “focus” of your brain.
- Symptoms usually affect one side of your body and may or may not affect your awareness
- May or may not remember the seizure
18
Q
What is a Generalized Onset Seizure?
A
- Affect both hemispheres of your brain
- Symptoms affect both sides of your body
- Usually more severe
19
Q
What are some specific causes of seizures?
A
- Cerebrovascular Disease
- Hypoxemia
- Fever (in children)
- Head Injury
- Hypertension
- Central Nervous System Infections (e.g. meningitis)
- Metabolic and toxic conditions
- Brain tumor
- Drug and alcohol withdrawal
- Allergies
20
Q
What is Status Epilepticus?
A
Acute prolonged seizure activity
- Lasts 5 minutes or longer
- Serial seizures occurring without full recovery of consciousness between attacks
- Also describes a seizure without impairment of consciousness lasting 30 minutes or longer
- Produces cumulative effects
- Vigorous muscular involvement causes heavy metabolic demand
- Can lead to brain anoxia and respiratory arrest
- Medical emergency
21
Q
What can cause Status Epilepticus?
A
- Interruption in anticonvulsant therapy
- Fever
- Concurrent infection
- Illness
22
Q
What is a Stroke?
A
- Sudden loss of function resulting from a disruption of the blood supply to part of the brain
- Types: Ischemic and Hemorrhagic
The leading cause of long term disability in the US and 5th leading cause of death
23
Q
What is a Transient Ischemic Attack (TIA)?
A
- Temporary neurologic deficit resulting from a temporary impairment of blood flow
- A warning sign of an impending stroke!
24
Q
What are the modifiable risk factors for Stroke & TIA?
A
- Hypertension (primary risk factor)
- Cardiovascular disease
- Elevated cholesterol
- Elevated hematocrit
- Obesity
- Diabetes
- Oral Contraceptive use
- Smoking, drug, alcohol abuse
25
What is an **Ischemic Stroke**?
Disruption of blood supply caused by an obstruction, usually a thrombus or an embolism, causing an infarction of brain tissue
26
What does BE FAST stand for in Stroke Awareness?
* Balance
* Eyes
* Face
* Arm
* Speech
* Time
27
What are the clinical manifestations of an **Ischemic Stroke**?
**Depends on location and size of affected area**
* Numbness or weakness of face, arm, or leg - especially one sided
* Confusion or change in mental status
* Trouble speaking or understanding speech
* Difficulty in walking, dizziness, or loss of balance or coordination
* Sudden onset of severe headache
* Perceptual disturbances
* Agnosia - unable to recognize people or objects
28
What is a **Hemorrhagic Stroke**?
* **Caused by bleeding into brain tissue, the ventricles, or subarachnoid space**
* Brain metabolism is disrupted by exposure to blood
* ICP increases caused by blood in the subarachnoid space
* Compression or secondary ischemia from reduced perfusion and vasoconstriction causes injury to brain tissue
29
What can cause a **Hemorrhagic Stroke**?
* Spontaneous rupture of small vessels primarily related to HTN
* Subarachnoid hemorrhage (SAH), caused by a ruptured aneurysm
* Intracerebral hemorrhage related to amyloid angiopathy
* Arterial venous malformations
* Intracranial aneurysms
* Medications such as anticoagulants
30
What are the clinical manifestations of a **Hemorrhagic Stroke**?
* **Severe Headache *(Often sudden onset)***
* Similar to ischemic stroke
* Loss of consciousness for a variable amount of time
* Early and **sudden** changes in LOC
* Vomiting *(often projectile)*
* Bleeding *(e.g. nose bleeds)*
31
What are some complications of a **Hemorrhagic Stroke**?
* **Vasospasm** *(7-8 days AFTER hemorrhage)*
* **Seizure** *(caused from disruption in blood flow, vasospasms, or shifting)*
* **Hydrocephalus** *(blood in subarachnoid space impedes circulation of CSF)*
* **Rebleeding** *(recurrence in 1-5% after initial hemorrhage)*
* **Hyponatremia** *(found in 30% of SAH pts., associated w/onset of vasospasms, could lead to SIADH or cerebral salt wasting syndrome)*
32
What are some complications that come with having an Altered Level of Consciousness?
* Respiratory Distress or Failure *(inability to maintain a patent airway)*
* Pneumonia *(ineffective breathing)*
* Aspiration
* Pressure Injuries
* DVTs
* Contractures
32
What are Nursing Interventions to **Maintain the Airway** of a patient with **Altered LOC**?
* Frequent monitoring of Respiratory status, Lung sounds
* Positioning to promote accumulation of secretions and prevent obstruction of upper airway
* Head of Bed **elevated to at least 30 degrees**
* Lateral or Semi-Prone Positioning
* Suctioning
* Oral Hygiene
* Chest Physiotherapy
33
What are Nursing Interventions to **Maintain Tissue Integrity** of a patient with **Altered LOC**?
* Assess skin frequently, especially bony prominences
* Frequent turning
* Careful positioning in correct body alignment
* Use splints, foam boots, trochanter rolls, and specialty beds as needed
* Passive ROM exercises
* Clean eyes with Cotton Balls moistened with saline
* Use artificial tears as ordered
* Protect the eyes
* Frequent, scrupulous oral care
34
What are Nursing Interventions to **Maintain Fluid Status** of a patient with **Altered LOC**?
* Assess fluid status by examining turgor, mucosa, lab. test data, and I&Os
* Administer IVFs, Tube Feedings, fluids via Feeding Tube as required
* Monitor ordered rate of fluids carefully
35
What are Nursing Interventions to **Maintain Body Temperature** of a patient with **Altered LOC**?
* Adjust environment and cover patient appropriately
* If temp is elevated, use minimum amt of bedding
* Administer acetaminophen
* Use Hyperthermia blanket
* Give a cooling sponge bath
* Allow for fan to blow over patient to increase cooling
* Monitor temp frequently
* Use measures to prevent shivering
36
What are Nursing Interventions to **Promote Bowel and Bladder Function** of a patient with **Altered LOC**?
* Assess for urinary retention or incontinence *(risk of bladder rupture)*
* May require catheterization
* Bladder Retraining Program *(timed voiding, etc)*
* Assess for abd. distention, constipation, bowel incontinence
* Monitor BMs
* Promote elimination with stool softeners, glycerin suppositories, or enemas
* Diarrhea may result from infections, medications, or hyperosmolar fluids
37
What are Nursing Interventions to address **Sensory Stimulation and Communication** of a patient with **Altered LOC**?
* Talk to and touch the patient and encourage family to do the same
* Maintain normal day-night pattern
* Orient patient frequently
* When arousing from coma, minimize stimulation to decrease agitation
* Follow programs for sensory stimulation
* Allow family to vent, provide support
* Reinforce and provide consistent information to family
* Refer to support groups and services for family
38
What is used to diagnose seizures?
* EEG *(Electroencephalogram)*
* MRI
* SPECT *(Single-photon emission computed tomography)*
39
What is important to document **during/after** a **seizure**?
**Observe and document sequence of events:**
* What were the circumstances before?
* Was there an aura *(warning sign)*?
* First thing the patient does during a seizure
* Type of movements
* Part of body involved
* Size of both pupils
* Eyes open or closed?
* Is there involuntary motor activity?
* Incontinence?
* Duration of each phase of the seizure?
* Loss of consciousness?
* Paralysis or weakness after seizure?
* Ability to speak after seizure?
* Movements at end of seizure?
* Does the patient sleep afterwards?
* Cognitive status after seizure?
40
**Nursing Care DURING a Seizure?**
* Provide privacy
* Ease patient to floor
* Protect the head with a pad
* Loosen constrictive clothing, remove eyeglasses
* Push aside any furniture that may injure patient
* If in bed, **remove pillows, raise side rails**
* Do not attempt to pry open jaws that are clenched
* Do not attempt to restrain patient
* Place **patient on one side with head flexed forward**
41
**Nursing Care AFTER a seizure?**
* Keep **patient on side** to prevent aspiration
* Ensure **patent airway**
* **Reorient** patient to environment
* Guide patIent gently to bed or chair if they are wandering
* If patient is agitated after seizure, stay a distance away, but close enough to prevent injury until patient is fully aware
42
How are **Seizures** Medically Managed?
* Goal is to achieve minimal side effects with best therapeutic action
* Almost every medication causes dizziness/drowsiness
**Common medications**
*(Anticonvulsants)*
* Carbamazepine
* Clonazepam *(Klonopin)*
* Lorazepam *(Ativan)*
* Phenobarbital
* Phenytoin
* Topiramate
* Levetiracetam *(Keppra)*
* Gabapentin
* Lamotrigine
43
What is **Primary Prevention** for **Stroke**?
**Healthy Lifestyle Choices:**
* No smoking
* Physical activity, at least 40 min/day, 3-4 days/week
* Maintain healthy weight
* Specific diets: DASH, Mediterranean
44
What is **Secondary Prevention** for **Stroke**?
* Carotid Endarterectomy for Carotid Stenosis *(plaque removal)*
* Anticoagulant Therapy for Atrial Fibrillation
* Antiplatelet Therapy: Low Dose Aspirin, Clopidogrel *(Plavix)*, Dipyridamole *(Aggrenox)*
* Statins
* Antihypertensive Medications
45
What is the medical management in the **Acute Phase of an Ischemic Stroke**?
**Prompt diagnosis** *(Use the NIHSS Assessment tool)*
**Thrombolytic Therapy**
* Given within 45 minutes of arrival
* Max 4.5 hrs after onset of symptoms
* Monitor patient closely
* Side effects: Bleeding
**Elevate HOB**
**Maintain airway and ventilation**
**Continuous Hemodynamic Monitoring and Neurologic Assessment**
46
What are the eligibility criteria for Tissue Plasminogen Activator Administration?
* Age: at least **18 years old**
* Clinical diagnosis of **Ischemic Stroke**
* Systolic BP: **185 or less**
* Diastolic BP: **110 or less**
* No minor strokes
* Prothrombin time: **15 seconds** or less
* INR: **1.7** or less
* Platelet count: **100,000** or higher
* No low molecular weight heparin in the past 24 hours
* **No active bleeding** anywhere
* No prior intracranial hemorrhage
* No subarachnoid hemorrhage
* No stroke, serious head trauma, or intracranial surgery in the last 3 months
* No GI bleeding in the past 21 days
47
What are the Nursing Interventions for an **Acute Ischemic Stroke**?
* Help with positioning/ambulation to improve mobility
* Prevent shoulder pain
* Enhance self care, encourage use of assistive devices
* Assist with nutrition
* Swallow evaluation within 24 hours, keep NPO until then
* Speech therapy referral
* Bladder/Bowel training, high fiber diet
* Address patient, avoid finishing sentences, speak slowly
* Prevent skin breakdown
* Educate family about psuedobulbar effect, encourage family participation, plan for rehab
* Monitor for complications
48
What is the medical management in the **Acute Phase of a Hemorrhagic Stroke**?
* Primarily Supportive
* Bed rest with sedation
* Oxygen Therapy
* Treatment of vasospasm, increased ICP, hypertension, potential seizures, and prevention of further bleeding
49
What are the Nursing Interventions for an **Acute Hemorrhagic Stroke**?
**Ongoing, frequent monitoring of all systems**
* LOC
* Vitals
* Motor symptoms
* Speech
* Pupil changes *(Is one larger than the other)*
* I&O
* Bleeding
* Oxygen Saturation
* Blood pressure management
50
**A nurse is caring for a patient that suddenly starts having a tonic-clonic seizure. What is the nurse's priority action?**
**a.** Place a padded tongue blade in the client's mouth to prevent injury.
**b.** Restrain the client's arms and legs to prevent injury
**c.** Turn the client to their side to protect their head
**d.** Run to get help from other staff members immediately
**c. Turn the client to their side and protect their head**
**Rationale:**
During a seizure, turning the client to their side helps prevent aspiration and keeps the airway open. Protecting the head reduces the risk of injury.
Placing objects in the mouth or restraining the client can cause additional harm and is contraindicated.
51
**After a CT scan confirms an ischemic stroke, what medication should be considered next?**
**a.** Warfarin
**b.** Clopidogrel
**c.** Labetalol
**d.** Atorvastatin
**e.** Recombinant tissue-plasminogen activator *(rt-PA)*
**f.** Low molecular weight-based heparin
**e. Recombinant tissue-plasminogen activator (rt-PA)**
52
**A patient comes into the ER with signs of stroke. What is the priority nursing intervention for this patient?**
**a.** Administer aspirin 325 mg. orally
**b.** Start an IV line and administer fluids
**c.** Obtain a stat CT of their head
**d.** Monitor blood glucose levels
**c. Obtain a stat CT of their head**
53
**A patient with an ischemic stroke is showing signs of increased intracranial pressure. What is the most appropriate nursing intervention?**
**a.** Administer IV mannitol
**b.** Perform a lumbar puncture
**c.** Apply ice packs to the head
**d.** Elevate the head of the bed to 30 degrees
**d. Elevate the head of the bed to 30 degrees**
54
**What is the patient with an ischemic stroke that is experiencing increased ICP most likely experiencing?**
**a.** Recurrent ischemic stroke
**b.** Seizure activity
**c.** Hemorrhagic transformation
**d.** Hypoglycemia
**c. Hemorrhagic transformation**
55
**When a patient experiences an ischemic stroke that has transformed into a hemorrhagic stroke, what is the next step?**
**a.** Increase IV fluid rate
**b.** Prepare for possible surgical intervention
**c.** Adminster additional dose of rt-PA
**d.** Initiate seizure precautions
**b. Prepare for possible surgical intervention**
56
**What follow-up care is essential to prevent recurrence of stroke?**
**a.** Regular blood pressure monitoring
**b.** Daily IV hydration
**c.** Weekly blood transfusions
**d.** Monthly MRI scans
**a. Regular blood pressure monitoring**
57
What is homonymous hemianopsia?
Homonymous hemianopsia is a visual field loss on the same side of both eyes, caused by brain injury or damage
58
What is apraxia?
Inability to perform previously learned purposeful motor acts on a voluntary basis
When a patient makes verbal substitutions for desired syllables or words
59
What is agnosia?
The loss of the ability to recognize objects through a particular sensory system; it may be visual, auditory, or tactile
60
What is Diplopia?
Double vision
61
What is ataxia?
* Staggering, unsteady gait
* Unable to keep feet together; needs a broad base to stand
62
What are signs of a **Left Hemispheric Stroke**?
* Paralysis or weakness on the right side of the body
* Right visual field deficit
* Aphasia (receptive, expressive, or global *(both)*)
* Altered intellectual ability
* Slow, cautious behavior
63
What are signs of a **Right Hemispheric Stroke**?
* Paralysis or weakness on the left side of the body
* Left visual field deficit
* Spatial-perceptual deficits
* Increased distractibility
* Impulsive behavior and poor judgment
* Lack of awareness
