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MedSurg 2 > Neuro > Flashcards

Neuro Flashcards

1
Q

2 Nervous System

A

Central and Peripheral Nervous System

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2
Q

CNS is about

A

Brain and Spinal Cord

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3
Q

2 Types of PNS

A

Somatic and Autonomic Nervous System

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4
Q

Voluntary Movements

A

Somatic Nervous System

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5
Q

2 Types of Autonomic Nervous System

A

Sympathetic
Parasympathetic

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6
Q

Basic functional unit of The Nervous System

A

NEURONS

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7
Q

Extension that carry the impulses toward the cell body.

A

Dendrite

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8
Q

Transmits impulses away from the cell body

A

Axon

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9
Q

Allows impulse to transmit

A

Myelin Sheath

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10
Q

Types of Neurons

A

Sensory Neurons (Affarent)
Motor Neurons (Efferent)
Interneurons

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11
Q

Transports impulse from receptors to the CNS

A

Sensory Neurons

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12
Q

Transports impulse from CNS to the receptors

A

Motor Neurons

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13
Q

Found entirely within the central nervous system
Specialized to transmit sensory / motor impulse

A

Interneurons

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14
Q

Communicate message from one neuron to another or from a neuron to a specific target tissue

A

Neurotransmitters

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15
Q

Excitatory
Control movements, motivation, and cognition
Regulates emotion response

A

DOPAMINE

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16
Q

Excitatory
Causes sympathetic stimulation
Causes changes in attention and learning

A

NOREPINEPHRINE

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17
Q

Excitatory
Control fight or flight response

A

EPINEPHRINE

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18
Q

Inhibitory
Controls emotion (happy and sad)

A

SEROTONIN

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19
Q

Inhibitory / Excitatory
Signals muscles to be alert
Controls wakefulness and sleep cycle

A

ACETYLCHOLINE

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20
Q

Inhibitory
Relaxation hormone

A

GABA

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21
Q

Excitatory
Responsible for relaying messages between MOTOR neurons

A

GLUTAMATE

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22
Q

CENTRAL NERVOUS SYSTEM

A

CEREBRUM
CEREBELLUM
BRAIN STEM
DIENCEPHALON

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23
Q

Cerebrum Lobes

A

Frontal
Parietal
Temporal
Occipital

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24
Q

Personality
Attention / Focus
Speech: Brocha’s Area (Expressive)
Thinking / Judgment

A

Frontal Lobe

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25
Q

Touch
Taste
Temperature

A

Parietal Lobe

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26
Q

Memory of sound
Hearing and Smelling
Speech: Wernicke’s Area (Receptive)

A

Temporal Lobe

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27
Q

Vision
Memory

A

Occipital Lobe

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28
Q

Balance and Coordination

A

Cerebellum

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29
Q

Brain Stem

A

Mid Brain
Pons
Medulla Oblongata

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30
Q

Auditory and Visual REFLEX

A

MId Brain

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31
Q

Pattern of Breathing

A

Pons

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32
Q

Controls heart and respiratory rate, coughing and vomiting

A

Medulla Oblongata

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33
Q

Diencephalon

A

Hypothalamus
Thalamus

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34
Q

Controls BP and Temperature
Hormone release

A

Hypothalamus

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35
Q

Pain threshold
Capable of suppressing minor sensation

A

Thalamus

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36
Q

Peripheral Nervous System

A

Cranial Nerves

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37
Q

CN
Sense of Smell
Sensory
Assessment: With eyes closed, patient is asked to identify familiar odors (Coffee, Cinnamon)
Abnormal: Anosmia – Loss of sense of smell

A

I - OLFACTORY

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38
Q

CN
Sense of Sight / Vision
Sensory
Assessment: Snellen’s Chart (Normal: 20/20)
Abnormal: Hemianopia, Blindness

A

II - OPTIC

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39
Q

CN
Pupillary constriction & dilation
Motor
Assessment: PERRLA
Abnormal: (-) PERRLA

A

III – OCULOMOTOR

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40
Q

CN
6 Cardinal Gaze movement
Motor
Assessment: Cardinal Field of Gaze Assessment
Abnormal: Nystagmus

A

IV - TROCHLEAR

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41
Q

CN
TriCHEWminal – For chewing
Facial SENSATION
Both
Assessment: Wisp of cotton
Abnormal: Absent of sensation and jaw weakness

A

V - TRIGEMINAL

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42
Q

CN
Eye movement side-to-side (AbduSIDE-TO-SIDE)
Motor
Assessment: Test for bilateral eye movement
Abnormal: Double Vision

A

VI – ABDUCENS

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43
Q

CN
Facial MOVEMENT
Anterior 2/3 of tongue sensation
Both
Assessment: Ask patient to smile and wrinkle forehead
Abnormal: Facial weakness

A

VII - FACIAL

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44
Q

Sense of hearing, balance, and coordination
Sensory
Assessment: Weber’s / Rinne Test and Romberg Test
Abnormal: Deafness and Impaired balance

A

VIII - VESTIBULOCOCHLEAR

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45
Q

CN
Swallowing
Posterior 1/3 of the tongue sensation
Both
Assessment: Food tasting
Problem: Augeusia / Dysphagia

A

IX – GLOSSOPHARYNGEAL

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46
Q

CN
Movement of Uvula / Gag Reflex
Parasympathetic sensation
Both
Assessment: Tongue Depressor
Abnormal: Absent Gag Reflex

A

X - VAGUS

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47
Q

CN
Neck movement
Motor
Assessment: Ask the patient to turn head and shrug shoulders
Problem: Weak / Absent Shoulder Shrug

A

XI - ACCESSORY

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48
Q

CN
Tongue movement
Motor
Assessment: Ask patient to move tongue side to side
Problem: Dysphagia / Slurred Speecj

A

XII - HYPOGLOSSAL

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49
Q

31 PAIRS SPINAL NERVES

A

CERVICAL – C1 – C8

THORACIC – T1 – T12

LUMBAR – L1 – L5

SACRAL – S1 – S5

COCYX - 1

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50
Q

DACALGG

A

C1 – C4 – Diaphragm
C5 – T1 – Arms
T2 – T6 – Chest
T7 – T12 – Abdomen
L1 – L5 – Legs
S1 – S3 – GI & GU
S4 – S5 – Genitals

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51
Q

Fight or Flight Response
Increase Everything; Decrease GI & GU

A

SYMPATHETIC NERVOUS SYSTEM

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52
Q

Dominates during relaxed situations
Decrease Everything; Increase GI & GU

A

PARASYMPATHETIC NERVOUS SYSTEM

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53
Q

Neuro Assessment

A

CEREBRAL FUNCTION
Assess degree of wakefulness / alertness
Note the intensity of stimulus to cause a response
Apply a painful stimulus over the nailbed with a blunt instrument
Ask questions to assess orientation to person, place, and time

GLASGOW COMA SCALE
3 Areas:
Eye Opening
Verbal Response
Motor Response
Scores Interpretation:
15 = highest score; patient is fully oriented and alert
<7 = comatose patient
3 = Deep coma

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54
Q

DIAGNOSTIC TEST

A

SKULL AND SPINAL X-RAY
Identifies fracture, dislocation, compression, and spinal cord problem
Nursing Care:
1. Provide support for the confuse of combative client
2. Remove metal items
3. Maintain immobilization

CT - SCAN
Used for diagnosing neurological disorder of the brain or the spine
Can detect:
1. Hemorrhage
2. Tumors
3. Abscess
Nursing Care:
1. Assess for iodine allergy
2. Instruct to lie still on a movable table
3. Inform the patient of possible discomforts
4. Remove any metallic object

MAGNETIC RESONANCE IMAGING
Used for diagnosis of degenerative diseases, intracranial and spinal abnormalities
Not useful when looking bony abnormalities

ELECTROENCEPHALOGRAPHY (EEG)
Graphic recording of electrical activity of the brain by placing electrodes to the scalp

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55
Q

Unilateral inflammation of CN 7 (Facial)

Cause:
Infection
Autoimmune
Viral Infection (Herpes simplex)

Signs and Symptoms:
Drooping of the eyelid (Ptosis)
Inability to close eye completely
Unilateral facial weakness (temporary)

A

BELL’S PALSY

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56
Q

Management:
1. Facial Massage (Moist Heat Massage)
2. Artificial tears
3. Antibiotics / Antiviral Drugs
4. Corticosteroids
5. Eye patch on affected side / sun glasses
6. Soft diet - Chew on the unaffected side
7. Avoid hot fluids / food
8. Facial Exercise (grimacing, wrinkling, puffing of cheeks, blowing of air

A

Bell’s Palsy

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57
Q

Other name: Tic Douloureux

Problem in CN 5 (Trigeminal)

Cause:
Chronic compression and irritation of CN 5
Degenerative changes in the Gasserian Ganglion
Pressure from surrounding tissue

Risk factors:
Patient with multiple sclerosis (Damage to myelin sheath around trigeminal nerve
Men with MS > Women with MS

Signs and Symptoms:
Sudden severe unilateral facial pain
Sensitive to extreme changes in temperature
Difficulty chewing

A

TRIGEMINAL NEURALGIA

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58
Q

other name of TRIGEMINAL NEURALGIA

A

Tic Douloureux

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59
Q

Medical Management:
1. Pharmacologic Therapy
Anti-seizure (Carbamazepine) – To manage pain by decreasing electrical impulse on trigeminal nerve
Alcohol / Phenol injection of the Gasserian Ganglion – To make the nerve numb
2. Surgical Treatment
Microvascular Decompression of the Trigeminal Nerve
Percutaneous Balloon Micro-Compression
3. Radiofrequency Thermal Coagulation

Nursing Management:
1. void extreme changes in temperature
2. No facial massage / teaching
3. Pat dry to cleanse face
4. Chew on unaffected side
5. Soft diet
6. Post op care:
Instruct not to rub the eye
Assess the eyes for redness
Artificial tears

A

TRIGEMINAL NEURALGIA

60
Q

Autoimmune diseases that damages the myelin sheath and would lead into delayed impulse transmission

A

Demyelination Disorders

61
Q

Demyelination of CNS nerves

Has remission and exacerbation

Common cause:
Autoimmune
Post Viral Infection

Common in: 20-40 years old (female)

A

MULTIPLE SCLEROSIS

62
Q

Signs and Symptoms:
-Visual Disturbances:
Scotoma -white patches in vision (EARLIEST SIGN)
Diplopia
Blurred Vision
-Respiratory Depression
-Cerebellum/Basal Ganglia Involvement:
Tremors
Muscle Weakness (descending) MS (Mataas Simula)
Ataxia
-Sensory Nerve Disturbances:
Paresthesia
Pain
-Cognitive Disturbances:
Memory Loss
Decrease Concentration
Dementia
-Bowel and Bladder Dysfunction
-Lhermitte’s Sign

A

Multiple Sclerosis

63
Q

Is an electric shock sensation that radiated from the back of your neck down your spine.

A

Lhermitte’s Sign

64
Q

MS
Due to impaired cerebellar function
Intentional Tremors
Scanning Speech
Nystagmus

A

CHARCOAT’S TRIAD

65
Q

Medical Management:
1. Corticosteroid (Methylprednisolone)
2. Baclofen – Muscle relaxant
3. Oxygen and Mech Vent - If (+) respi involvement

Nursing Management:
1. Warm pack application – To minimize spasm
2. Avoid hot baths – Due to head intolerance
3. Moderate exercise (swimming, stationary biking)
4. Unilateral eye patch
5. Promote regular elimination:
- Increase fluid and fiber intake
- Stool softener
6. Priority: SAFETY due to impaired muscle control
7. WOF: UHTHOFF’S SIGN
- Transient worsening of symptoms after exposure to hot environment

A

Multiple Sclerosis

66
Q

Demyelination of PNS nerves

Cause: Autoimmune
History of GI or Respi Infxn (Campylobacter Jejuni)

Signs and Symptoms:
Dyskinesia (Leg weakness / Clumsiness ) – Early Sign
Paralysis of Diaphragm
Dec. GIT and GUT function
Numbness & Spasticity
Ataxia

A

GUILLAIN – BARRE SYNDROME

67
Q

Complications:
Respiratory failure
Cardiac dysrhythmias
Orthostatic hypertension

Medical Management:
1. Plasmapheresis
2. Corticosteroids
3. Dantrolene Sodium – Muscle relaxant
Nursing Management:
1. Maintain adequate ventilation
2. Perform range-of-motion exercises
3. Assess gag reflex prior to feeding
4. Assistive devices
5. No to hot baths
6. Priority: SAFETY
7. Promote regular elimination:
- Increase fluids and fiber intake

A

GUILLAIN – BARRE SYNDROME

68
Q

Nurse Marty is monitoring a client for adverse reactions to Dantrolene Sodium. Which adverse reaction is most common?

Excessive tearing
Urine retention
Muscle weakness
Slurred speech

A

Muscle weakness

69
Q

Nurse Kim is assessing a 37 year old client diagnosed with multiple sclerosis. Which of the following symptoms would the nurse expect to find?

Vision changes
Absent deep tendon reflex
Tremors at rest
Flaccid muscles

A

Vision changes

70
Q

The nurse is teaching a female client with multiple sclerosis. When teaching the client how to reduce fatigue, the nurse should tell the client to:

Take a hot bath
Rest in an air-conditioned room
Increase the dose of muscle relaxants
Avoid naps during the day

A

Rest in an air-conditioned room

71
Q

A male client with Bell’s Palsy asks the nurse what caused this problem. The nurse’s response is based on an understanding that the cause is:

Unknown, but possibly includes ischemia, viral infection, or an autoimmune problem
Unknown, but possibly includes long term tissue malnutrition and cellular hypoxia
Primary genetic in origin, triggered by exposure to meningitis
Primary genetic in origin, triggered by exposure to neurotoxins

A

Unknown, but possibly includes ischemia, viral infection, or an autoimmune problem

72
Q

Although an adverse reaction to Tensilon is considered rare, which medication should be readily available to give as an antidote in case a patient should experience complications?

Protamine Sulfate
Narcotic Analgesic
Atropine Sulfate
Regitine

A

Atropine Sulfate

73
Q

Cranial Nerve Disorders

A

Bell’s Palsy
Trigeminal Neuralgia

74
Q

Demyelination Disorders

A

Multiple Sclerosis
Guillain-Barre Syndrome

75
Q

Neurotransmitter Disorders

A

Myasthenia Gravis
Parkinson’s Disease
Amyotropic Lateral Sclerosis
Huntington’s Disease

76
Q

Defect in transmission of nerve impulse at myoneural/neuromuscular junction
Cause: Autoimmune that will attack acetylcholine receptors

Antibody will bind to acetylcholine receptors

Acetylcholine can’t bind anymore

Acetylcholine accumulates in the synapse

Cholinesterase will kill acetylcholine in the synapse

POOR MUSCLE MOVEMENT

A

Myasthenia Gravis

77
Q

Diagnostics:
TENSILON TEST (Confirmatory)
- Cholinesterase inhibitor (Endrophonium) is injected
- (+) MG = Temporary (5 mins) improve in muscle movement
- Prepare Atropine Sulfate (Symphatomemitics) for possible side effects.

Signs and Symptoms:
Descending Paralysis (Mataas Galing)
Diplopia & ptosis – Early Sign !
Muscle weakness in the afternoon
Dysphonia (voice impairment)

A

Myasthenia Gravis

78
Q

Management:
1. Priority: Airway
2. NGT feeding
3. Plasmapheresis to remove excess antibody
4. Mechanical Ventilator Stand-by
5. Tracheostomy Set at Bed Side
6. Medications: (anticholinesterase/Cholinergics)
Neostigmine (Prestigmine)
Pyrastigmine (Mestonin)
Steroids

A

Myasthenia Gravis

79
Q

MYASTHENIA GRAVIS Complications (CHOLINERGIC CRISIS VS. MYASTHENIC CRISIS)

A

CHOLINERGIC CRISIS
Overmedication
Tensilon Test: Muscle weakness
Parasympathetic effects
Prepare: Atropine Sulfate

MYASTHENIC CRISIS
Undermedication
Tensilon Test: Temp. Relief
Sympathetic effects
Prepare: Cholinergics

80
Q

Slowly progressing neurologic movement disorder caused by Decrease Dopamine Level

Causes:
Idiopathic
Degenerative
Viral infection
Head trauma
Use of antipsychotic medications

Pathophysiology:
Damage to Substantia Negra

Decrease dopamine production

Abnormal muscle movement

A

Parkinson’s Disease

81
Q

Signs and Symptoms:
Cog-wheel rigidity
Pill-rolling tremors
Resting tremors – Early sign!
Stooped posture – Osteoporosis like
Bradykinesia – Dec. Muscle Movement
Shuffling gait – Dragging 1 foot when moving
Mask – Like appearance
Dysphagia
Decrease GIT and GUT function
Respiratory depression

A

Parkinson’s Disease

82
Q

Medical Management:
1. Pharmacologic treatment:
Antiparkinsonian Drug
- Levodopa
- Carbidopa
Antiviral drugs
- Amantadine
Dopamine Agonist
- Bromocriptine
- Pergolide
Antihistamines
- Benadryl
Anticholinergic Agents
- Cogentin
- Artane
- Akineton

A

Parkinson’s Disease

83
Q

NursingManagement:
1. Activity: Anything that involves fingers
2. Priority: Safety
3. Mobility: Marching walk ; if they freeze, move to opposite side
4. Diet: Puree diet because of dysphagia
5. Aspiration precaution

A

Parkinson’s Disease

84
Q

Other name of Amyotropic Lateral Sclerosis

A

Lou Gehrig’s Disease

85
Q

AKA: Lou Gehrig’s Disease

Progressive, degenerative condition that affects MOTOR NEURONS

Causes:
Unknown
5-10% Genetically transmitted
Increase GLUTAMATE in the brain

Pathophysiology:
Increase Glutamate in the brain

Voluntary muscle problem

FINE MOTOR
Fasciculation
- Twitching of muscle
- Earliest Sign
Tremors
Dysphagia
GROSS MOTOR
Respiratory Depression
- Common cause of death (2 years)

A

AMYOTROPIC LATERAL SCLEROSIS

86
Q

AMYOTROPIC LATERAL SCLEROSISMedical Management:
1. Riluzole (Rilutek)
– To decrease glutamate in the brain
- Can delay symptoms for as long as 3 months
2. Mechanical ventilator stand-by

A

AMYOTROPIC LATERAL SCLEROSIS

87
Q

Nursing Management:
1. Maximize functional abilities:
- Prevent complications of immobility
- Promote self care
- Maximize effective communication
- Promote use of assistive devices
2. Ensure adequate nutrition
3. Prevent respiratory complications:
- Promote measures to maintain adequate airway

A

AMYOTROPIC LATERAL SCLEROSIS

88
Q

Progressive atrophy of basal ganglia and some parts of cerebral cortex

Basal Ganglia – Helps to control muscle movements
- Produces GABA

Pathophysiology: Decrease GABA

Impaired muscle relaxation

Overactivity of muscle

Cause: Autosomal Dominant
- Only takes 1 parent to pass the gene
- 50% transmission to child

A

HUNTINGTON’S DISEASE

89
Q

Neurotransmitter abnormalities:
Decrease GABA
- Increased voluntary movements
- Chorea – Sudden muscle jerking
- Impaired chewing and swallowing
Increase Dopamine
- Psychosis
- Personality changes
Abnormal Serotonin
- Depression / Manic

A

HUNTINGTON’S DISEASE

90
Q

Nursing Management:
1. Foster independence in ADL
2. Reinforce use of assistive devices
3. Aspiration precaution
4. Provide safe environment
5. Genetic counseling

A

Huntington’s Disease

91
Q

NEURO - INFECTIOUS DISORDERS

A

Meningitis

92
Q

Inflammation of meninges in the brain and spinal cord

Causes: Bacterial, Viral, or Protozoan Infection

Signs and Symptoms:
Increase ICP
Hearing loss
Photophobia
Projectile vomiting

Nuchal Rigidity - Neck Stiffness
Kernig’s Sign - Knee
Brudzinki’s Sign - Batok

A

Meningitis

93
Q

Management:
1. Droplet precaution
2. Antibiotics within 24 hours para dili na contagious
3. Isolate the patient
4. Place in private, non-stimulating room to prevent seizure
5. WOF: Aspiration

A

Meningitits

94
Q

SEIZURE – RELATED DISORDERS

A

Seizure

95
Q

Abnormal transmission of impulse at motor complex of the brain.

Cause:
Information overload
Infection
Trauma (Brain)
Autoimmune
Heredity
Vegan diet – Vitamin B12 deficiency

A

Seizure

96
Q

Types of Seizure

A

Epilepsy
Status Epilepticus
Petit Mal
Grand Mal
Myoclonic
Akinetic
Symptomatic
Simple Partial / Focal Awareness
Complex Partial / Focal Impaired Awareness

97
Q

Chronic, recurrent episodes of seizure that is unprovoked

A

Epilepsy

98
Q
  • A continuous seizure that last 5-30 minutes
    - Risk for hypoxia:
    3-5 mins – Normal tolerance
    6-8 mins – Cerebral damage
    >8 mins – Brain stem damage
A

Status Epilepticus

99
Q
  • Absence seizure
    - Blank facial expression
    - “Blank Stare”
    - Common in pedia
A

Petit Mal

100
Q
  • Tonic – Clonic Seizure (Preceeded with Aura)
  • Tonic – Stiffening
  • Clonic – Involuntary muscle jerking
  • Generalized seizure
A

Grand Mal

101
Q
  • Brief, involuntary muscle jerking of the body
  • 1– 2 seconds
A

Myoclonic

102
Q
  • Drop attack seizure
  • Sudden loss of postural tone & consciousness
A

Akinetic

103
Q
  • Benign seizure
  • Temporary until the cause will be addressed
  • ex: Febrile (convulsion)
A

Symptomatic

104
Q
  • Conscious seizure
  • Purposeless behavior
A

Simple Partial / Focal awareness

105
Q
  • Preceded with Aura
  • Impaired consciousness
  • Cannot remember what happened
A

Complex Partial / Focal Impaired awareness

106
Q

Pre - Ictal Phase
- Aura:
Flashing lights
Smells burning wire
Metallic taste
Dizziness
- Loss of consciousness:
1. Protect the head and neck then lay down
2. Turn to sides
3. Loosen constrictive clothing
4. Clear the area
- Priority: SAFETY ! ! !

A

Seizure

107
Q

What phase:
- Aura:
Flashing lights
Smells burning wire
Metallic taste
Dizziness
- Loss of consciousness:
1. Protect the head and neck then lay down
2. Turn to sides
3. Loosen constrictive clothing
4. Clear the area
- Priority: SAFETY ! ! !

A

Pre-Ictal Phase

108
Q

Management:
1. Turn patient to side (Left lateral side lying)
2. Remove objects that may harm the patient
3. Loosen restrictive clothing
4. Raise 2-3 side rails
5. Do not put anything inside the patient’s mouth
6. Remove pillow if seizure on bed; Put pillow if happens on the floor
7. Suction machine at bedside
8. Medications: Anticonvulsants

A

Seizure

109
Q

Seizure: Anticonvulsants

PhenyCarDiLaToDe

A

PHENYtoin
CARbamazepine
DIazepam
LAmotrigene
TOpamax
DEpakene

110
Q

SEIZURE anticonvulsant:

First line in the hospital; given via IV
Fast acting
Sedative / Relaxant: Can induce sleep
HIGHLY ADDICTIVE
Antidote: Flumazenil

A

Diazepam (valium)

111
Q

SEIZURE anticonvulsant:

For maintenance due to its least toxic effect
Side effect:
GINGIVAL HYPERPLASIA
- Have a good oral hygiene
- Massage gums
- Use soft bristle toothbrush dip in warm water
Adverse effct: AGRANULOCYSTOSIS – Dec. WBC
Don’t discontinue abruptly because it may lead to Status Epilepticus
Therapeutic level: 10 – 20 mg/dL (DilanTEN – PhenyTOINte)

A

PHENYTOIN (DILANTIN)

112
Q

Monro – Kellie Hypothesis:
“Skull is incompressible”
Brain – 80%
CSF - 10%
Blood - 10%

Normal: 0-15 mmHg

Causes:
Brain abscess
Brain Hemorrhage
Brain edema
Hydrocephalus

Initial Sign: Altered Level of Consciousness (Cerebrum will be the first affected)
- Restlessness
- Confusion
- Disorientation
- GCS alteration

Late Sign: - Decrease Level of Consciousness (Lethargy)
- Seizure
- Projectile Vomiting - Indicates medulla oblongata damage

  • Cheyne – Stoke Respiration – Indicates pons damage
  • Decerebrate Posture
  • High - pitched cry (newborn)
  • Bulging fontanels (newborn)
  • Cushing’s Triad – Indicates brain stem damage
A

Increased Intracranial Pressure

113
Q
  1. Medications:
    IV mannitol - For cerebral edema
    - Check BP before administration
    - Check urine output during therapy
    Dexamethasone - Steroids for cerebral inflammation
  2. DON’TS:
    Valsalva Maneuver
    Routine suctions
    Lumbar puncture
    Coughing / Sneezing
A

Increased Intracranial Pressure

114
Q

Disruption of blood supply to the brain

Causes:
Thrombus Formation
Hypertension
Atherosclerosis
Diabetes Mellitus
Aneurysm

Risk Factors:
Age: 45 years old and above
Obesity
Estrogen Therapy – Increases clotting ability
Hereditary
Sedentary lifestyle
Smoking
Alcoholism

A

CEREBROVASCULAR ACCIDENT

115
Q

2 types of CEREBROVASCULAR ACCIDENT

A

Ischemic
Hemorrhagic

116
Q

2 Areas affected:
Left Hemispheric Stroke
- Paralysis to the right side of the body
- Right visual field deficit
- Aphasia
- Altered intellectual ability
- Slow, cautious behavior
Right Hemispheric Stroke
- Paralysis to the left side of the body
- Left visual field deficit
- Increase distractibility
- Lack of awareness of deficits

What to assess:
Facial drooping
Arm defect
Slurred speech
Time – To measure the severity of brain damage and for the drug administration

A

CEREBROVASCULAR ACCIDENT

117
Q

Signs and Symptoms:
Aphasia:
- BROCHA’S APHASIA – Unable to speak fluently
- WERNICKE’S APHASIA – Unable to comprehend
- GLOBAL APHASIA – Combined
- Management:
1. Short, one at a time task
2. Independence promotion
3. Make simple direction
4. Alternative communication style
5. Provide time to verbalize concerns
-Paralysis (Hemiparesis)
Weakness of 1 side of the body
Management:
1. Quad cane on the AFFECTED SIDE
2. Slipping Tub Bath
3. Electric wheel chair
4. Avoid - Roller Walker
Foot drop (Plantar Flexion)
- Management:
1. High topped sneakers
2. Foot board

Neglect Syndrome (Unilateral Neglect)
- Inability to identify for weak side
- Management:
1. Instruct the patient to touch the weak side
2. Offer a mirror
Homonymous Hemianopia (Half Vision)
-Management:
1. Scan the environment
2. Move side-to-side
3. Initially; Approach from unaffected side
4. Latter; Approach from affected side
Drug Management:
-Striptokinase
-Thrombolytics (for ischemic stroke)
-Ideally given within 4-8 hours
-NOt given in Hemorrhagic stroke
-Antihypertensives

A

Cerebrovascular Accident

118
Q

Intracranial Hemorrhage Types:

A

Epidural
Subdural
Subarachnoid
Intracerebral

119
Q

Type of Intracranial Hemorrhage:

Location: Between skull and dura mater
Blood Vessel Affected: Middle Meningieal Artery
Hallmark: Lucid Interval

A

Epidural

120
Q

Type of Intracranial Hemorrhage:

Location: Between Dura and Arachnoid
Blood vessel affected: Cortical vein
Hallmark: Gradual Deterioration

A

Subdural

121
Q

Type of Intracranial Hemorrhage:

Location: Between Pia Mater and Arachnoid
Blood Vessel Affected: Berry Aneurysm
Hallmark: Thunder drop headache (worst headache of his/her life)

A

Subarachnoid

122
Q

Type of Intracranial Hemorrhage:

Location: Brain parenchyma
Blood vessel affected: Hemorrhagic stroke
Hallmark: Sudden onset

A

Intracerebral

123
Q

Management:
1. Craniotomy
-Supratentorial - superior to tentorium cerebelli
- Post op position: Semi-Fowlers
-Infratentorial - Inferior to tentorium cerebelli
- Post op position: Flat

A

INTRACRANIAL HEMORRHAGE

124
Q

2 types of Traumatic Brain Injury

A

Closed
Open (Skull Fracture)

125
Q

Types of CLOSED traumatic brain injury

A

Concussion
Contusion

126
Q

Jarring of the brain

A

Concussion

127
Q

Bruising of the brain

A

Contusion

128
Q

Types of Contusion

A

Coup
Counter-Coup
Coup-Counter-Coup

129
Q

Same side of the site of injury

A

Coup

130
Q

Opposite side to the site of injury

A

Counter-coup

131
Q

Bouncing Back traumatic brain injury

A

Coup-Counter-Coup

132
Q

Types of OPEN (Skull fracture) traumatic brain injury

A

Linear
Depressed
Comminuted
Basal-Skull

133
Q

Fine line on the skull
most common

A

Linear

134
Q

Skull is driven inward

A

Depressed

135
Q

skull is fragmented

A

comminuted

136
Q

Signs and symptoms:
Raccoon’s eye - Periorbital Edema
Battle sign - Ecchymosis of Mastoid Bone
CSF leakage

A

Open skull fracture

137
Q

Injury to the spinal cord which characterized by a decrease or loss of sensory and motor functions below the level of injury
, Causes:
. Motor vehicle accidents
• Gunshot injuries
• Falls
• Sports injuries
• Whiplash injury - Neck
•
Transection - Due to sharp objects
• Hyper rotation

Risk factors:
Young age
Alcohol and drug base
Male

A

Spinal Cord Injury

138
Q

types of spinal cord injury

A

Cervical SCI
Thoracolumbar SCI

139
Q

Paralysis: Quadriphlagia
Priority: Respiratiory

A

Cervical SCI

140
Q

Paralysis: Paraphlagia (Lower body)
Priority: Elimination

A

Thoracolumbar SCI

141
Q

Management
1. Stabilize the airway (Jaw Thrust Maneuver)
2. Immobilization (Flat, firm surface)
3. Cervical collar
4. Transport client as a unit
5. Do not attempt to realign body parts
6. Suctioning may be indicated, but with caution
7. Position change q 2 hours
8. Intermittent catheterization for bladder distention
9. Anticoagulants
10. Anti-embolic stockings

A

Spinal Cord Injury

142
Q

Complication of Spinal Cord Injury

A

Autonomic Dysreflexia

143
Q

Complication: AUTONOMIC DYSREFLEXIA
- Life threatening condition that occurs in patients with SCI above T6 level.
- Impairs the normal equilibrium between sympathetic and parasympathetic divisions
• Causes:
Bladder distention (Most common)
•
Bowel impaction
.
UTI
.
Pressure ulcers

A

Spinal Cord Injury

144
Q

Manifestations:
• Hypertension
• Throbbing / Pounding headache
• Diaphoresis
• Piloerection
• Bradycardia
• Blurring of vision
• Warm and flushed - Above the level of injury
• Cold and Pale - Below the level of injury

A

Spinal Cord Injury

145
Q

Management:
1. Position the patient in sitting position to decrease BP
2. Catheterization
3. Check for fecal impaction
4. Monitor blood pressure
5. Antihypertensive medication: HYDRALAZINE

A

Spinal Cord Injury

146
Q

Antihypertensive medication in spinal cord injury

A

HYDRAZALINE

MedSurg 2 (2 decks)

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