neuro Flashcards
(65 cards)
1
Q
what are the most common neurological problems?
(5)
A
- TBI
- CVA (stroke)
- seizures
- spinal cord injuries
- Guillain-Barre
2
Q
what causes an open TBI?
A
basilar skull fracture
3
Q
what are the causes for a closed TBI?
(2)
A
- concussion
- contusion
4
Q
what are the manifestations of a closed TBI caused by concussion?
A
- loss of consciousness
- HA
- retrograde amnesia
5
Q
what are the types of injuries of a closed TBI caused by contusion?
brain matter bumps against skull
A
- coup
- contrecoup
- coup-contrecoup
6
Q
definition
coup
A
affecting one area of the brain due to impact
7
Q
definition
contra-coup
A
affecting the area opposite of coup
8
Q
definition
coup-contrecoup
A
effects to the frontal & occipital lobes
9
Q
control
frontal lobe
A
- motor control
- problem solving
- speech
10
Q
control
temporal lobe
A
- auditory processing
- language comprehension
- memory retrieval
11
Q
control
parietal lobe
A
- touch perception
- body orientation
12
Q
control
occipital lobe
A
- sight
- visual reception
- visual interpretation
13
Q
control
cerebellum
A
- balance
- coordination
14
Q
control
brainstem
A
involuntary responses
15
Q
which cause of closed TBI is more emergent?
A
contusion
16
Q
what are the types of cerebral hematoma?
(3)
A
- epidural hematoma
- subdural hematoma
- intracerebral hematoma
17
Q
definition
epidural hematoma
A
- rapid accumulation of blood in epidural space
- rapid increase of ICP
- intermittent loss of consciousness & waking
18
Q
a patient who suffered a TBI is in the ICU presents the following s/s
- agitation
- restlessness
- change in LOC
- decreased mental status
- sudden emesis (no nausea)
what is the pt currently experiencing?
A
early signs of increased ICP
19
Q
signs of impending emergency for a patient with late manifestations of ICP
PNBCDC
A
- fixed, dilated, & unequal pupils
- Nuchal rigidity
- positive Babinsky reflex
- Cheyne-Stokes respirations
- decorticate/ decerebrate
- Cushing’s triad
20
Q
what is Cushing’s triad?
A
- high SBP, low DBP (wide pulse pressure)
- slow RR
- low HR
21
Q
what are called the key findings of an open TBI?
A
clear drainage from the eyes, nose, & ears
22
Q
how is the clear drainage from an open TBI tested?
A
glucose strips
23
Q
what is a series of concussions called?
A
chronic traumatic encephalopathy
24
Q
what are the types of hematoma?
A
- subdural
- epidural
- intracerebral
25
which of the hematomas is the most serious?
epidural hematoma
26
how does a surgeon treat *intracerebral hematoma*?
coil embolization
27
how is ICP monitored?
with an *intraparenchymal fiberoptic catheter* inserted through a burr hole in the cranium
28
what does the nursing intervention "ICPS" mean?
* immobilize *(log roll)*
* CO2 *(needs to be lowered)*
* positioning *(30 degrees HOB)*
* suctioning *(< 10 seconds)*
29
what measure does the nurse need to take first before suctioning a patient with ICP?
hyperventilate the patient
30
what is the goal when caring for a patient with ICP?
* asepsis
* frequent GCS assessment
* prevent corneal damage
* seizure precautions
31
what are components of the *GCS*?
* eye opening
* verbal response
* motor response
32
how can a nurse prevent *corneal damage* due to involuntary eye opening?
use clear tape on the eyes of the patient
33
what are the types of *stroke*?
* ischemic
* hemorrhagic
34
what is the MOA of *mannitol*?
elevates blood plasma osmolality–**enhances flow of water** away from tissues & CSF **into the interstitial space**
35
what are the side effects of *mannitol*?
* edema
* HF
| HF needs to be PREVENTED
36
how is *mannitol* administered?
IV
37
what is the primary risk factor of *stroke*?
HTN *(over 140 systolic mmHg)*
38
BEFAST
| stroke symptoms & interventions
B(alance)
E (sudden vision loss)
F(acial asymmetry)
A(rm weakness)
S(peech difficulty)
T(ime to call 911)
39
s/s of stroke that affects the *left brain*
* **expressive aphasia**
* reading/ writing problems
* right hemiparesis
* right side neglect
40
s/s of stroke that affects the *right brain*
* lack of **impulse control**
* behavioral changes
* left hemiparesis
* left side neglect
41
what kind of diagnostic test is used to determine the type of *stroke* a pt suffered?
CT scan
42
the patient comes in to the ED with signs of stroke, why does the nurse ask when was the patient's last "normal time"?
to determine their eligibility for tPA treatment
43
what is the treatment for an *ischemic stroke*?
tPA
44
through which route is tPA administered if the patient started having an *ischemic stroke* less than 3 hours ago?
IV
45
what are the most important to monitor for a *stroke* patient?
* **neuro assessment** q1-2h
* NIH stroke scale
* VS *(including ICP & CPP)* q1-2h
* **respiratory status**
46
what other factors does the nurse need to manage for a *stroke patient*?
* I&O
* ECG
* cardiac enzymes
* sodium levels
* bladder & bowel function
* ability to communicate
47
The patient was given tPA through an arterial line. How long have they been suffering from the *ischemic stroke*?
3-5 hours
48
a patient with their last known "normal time" 5 hours ago cannot be given tPA
true
49
what are the bedside interventions for a *stroke patient*?
| (6)
* swallow screening
* HOB 30 degrees
* mobility
* ROM exercises
* bleeding precautions
* monitor unilateral neglect *(strengthen affected side)*
50
what are the manifestations of *cervical injury*?
* impaired breathing
* quadriplegia
51
what are the manifestations of *thoracic injury*?
paraplegia *(including GU)*
52
what are the manifestations of *lumbar injury*?
legs & bladder paralysis
53
what are the causes of *neurogenic shock*?
* spinal cord injury *(to above T5)*
* spinal anesthesia
* vasomotor center depression
54
s/s of *neurogenic shock*
* low SVR
* excessive PNS activity
* bradycardia
* hypotension
* low cardiac output
55
what are the treatments for *neurogenic shock*?
* IV fluids
* vasopressors *(Epi/ Norepi)*
* steroids
* muscle relaxers *(for muscle spasms)*
| increase BP
56
***neurogenic shock*** is specific to injuries above *T5*
true
57
the nurse assesses a patient and determines the GCS score to be 8, what is the priority action?
intubation stat
58
# definition
Guillain-Barré
an idiopathic inflammatory ***demyelinating*** polyneuropathy that leads to ascending paralysis & paresthesia
59
what is the treatment for *Guillain-Barré*?
* plasmaphoresis
* immunoglobulin therapy
60
what is ***autonomic dysreflexia***?
a *SCI* complication that only occurs with injuries ***T5 and above*** resulting in vasoconstriction ***below the injury*** & HTN *(SNS response)* in response to simple stimuli *(such as tight clothing or full bladder)*
61
what is the body's response to ***autonomic dysreflexia*** in the area *above* the injury?
vasodilation of vessels to counteract vasoconstriction ocurring *below* the level of injury *(T5 or T6)*
62
what is the *first symptom* of ***autonomic dysreflexia***?
throbbing HA
63
what is the *patient presentation* of ***autonomic dysreflexia***?
* flushed face
* diaphoretic
* bradycardia
64
what causes **spinal shock**?
the spinal cord is compressed and causes an *increase* of **swelling**
65
what are the *manifestations* of **spinal shock**?
* weakness
* loss of sensation
