Neuro

Question 1

What are key elements of a neuro assessment?

Answer 1

History
motor and reflexes
mental status
memory
language
sensory function
cranial nerves

Question 2

what 3 things are involved in GCS scale?

Answer 2

Eyes
Motor/movement
Verbal response

Question 3

What is the normal ICP?

Answer 3

5-10 mmHg

Question 4

What parameters indicate increased ICP?

Answer 4

if pressure is 20 mm Hg or greater

Question 5

What can ICP lead to?

Answer 5

Herniation

Question 6

What is herniation? When does it happen?

Answer 6

shifting of brain tissue from an area of high pressure to one of lower pressure
“brain tries to exit towards brain stem”
WHEN ICP IS SUSTAINED AT GREATER THAN 20 FOR 5 MINUTES OR LONGER

Question 7

what is the normal range for cerebral perfusion pressure?

Answer 7

60-100 mmHg

Question 8

How do you calculate cerebral perfusion pressure?

Answer 8

MAP - ICP

Question 9

How do you calculate MAP?

Answer 9

SBP + 2(DBP) / 3

Question 10

what are 3 causes of ICP?

Answer 10

Increased brain and blood volume
and cerebrospinal fluid

Question 11

What is increased brain volume?

Answer 11

cerebral edema, increase in water content in brain tissue

Question 12

What are the indications for ICP monitoring?

Answer 12

GCS of 3-8

Question 12

What is the purpose of ICP monitoring?

Answer 12

assess response to therapy
augment neurological assessment

Question 13

How to use the transducer system?

Answer 13

flush pressure tubing with sterile NS without preservatives
never use pressurized fluid

Question 14

What is a ventriculostomy?

Answer 14

ventricle catheter system that connects to a drainage bag to drain CSF or blood

Question 15

what is cerebral oxygenation monitoring?

Answer 15

fiberoptic catheter placed thru internal jugular vein to monitor oxygen saturation

Question 16

what is the normal range for cerebral oxygenation?

Answer 16

60%-70%

Question 17

What are the early signs of ICP?

Answer 17

Headache
N/V
Confusion (mental status change)
Visual changes (blurred/double vision)
Cheyne stokes respiration

Question 18

What are the late signs of ICP?

Answer 18

Cushing’s triad
pupils fixed and dilated
posturing (decorticate/decerebrate)
coma

Question 19

what does cushing’s triad mean and what are the signs?

Answer 19

PRIMARY signs that indicate increased ICP

widening pulse pressure
bradycardia
irregular breathing pattern

Question 20

Nursing management of ICP

Answer 20

ELEVATE HOB 30 degrees
prevent hyperextension, flexion, or rotation of head
limit suctioning to 10-15 seconds HYPEROXYGENATE
prevent stress and emotions
prevent Valsalva maneuver
prevent constipation
prevent sudden arousal from sleep
keep lights low
antiseizure meds
treat fevers

Question 21

What is the medical management of ICP?

Answer 21

oxygenation
CO2 management
diuretics
BP management
reduce metabolic demands
fluids (3% solution)

Question 22

How do you reduce metabolic demands?

Answer 22

control temperature
sedation
prevent seizures

Question 23

What medications are used to treat ICP?

Answer 23

Mannitol
diuretics
BP medications
seizure medications

Question 24

What does Mannitol do?

Answer 24

pulls water from brain interstitium

Question 25

What are the 3 types of hematomas?

Answer 25

epidural subdural intracerebral

Question 26

Mild symptoms of TBI

Answer 26

loss of consciousness for seconds headache confusion dizziness blurred vision ringing in ears N/V tiredness sensitivity to light or sound

Question 27

Moderate/severe symptoms of TBI

Answer 27

loss of consciousness for minutes to hours persistent headache seizures loss of vision difficulty understanding/communicating balance/coordination challenges

Question 28

Priorities for TBI

Answer 28

Airway patency Control any bleeding GCS monitoring ICP monitoring Level of consciousness

Question 29

What can cause a spinal cord injury?

Answer 29

hyperflexion hyperextension excessive rotation penetrating trauma

Question 30

Clinical manifestations of neurogenic shock

Answer 30

profound bradycardia with hypotension warm, dry and flushed skin hypothermia

Question 31

SCI involves the loss of...

Answer 31

Motor function sensory function Reflexes Control of elimination

Question 32

What is it called when there is an injury in cervical region of spine?

Answer 32

Quadriplegia

Question 33

What is it called when there is an injury in thoracic region of spine?

Answer 33

Paraplegia

Question 34

Nursing priorities for SCI

Answer 34

Ventilation/airway Tissue perfusion I&O Neuro status Mobility Sensation Bowl/bladder function GI function Skin integrity sexual function

Question 35

What is autonomic dysreflexia?

Answer 35

Life threatening condition where body overreacts to a noxious stimulus leading to dangerously high BP signal from brain can't get to site

Question 36

Causes of autonomic dysreflexia

Answer 36

bladder distension kinked catheter bowl impaction pressure injury

Question 37

Expected findings for autonomic dysreflexia

Answer 37

Severe HTN bradycardia flushing Sudden severe headache pallor blurred vision restlessness nausea goosebumps

Question 38

Nursing interventions for autonomic dysreflexia

Answer 38

Elevate HOB loosen tight clothing identify and remove trigger administer BP meds

Question 39

What is stuporous?

Answer 39

does not obey commands difficult to arouse

Question 40

Normal pupil size

Answer 40

1.5-6 mm

Question 41

What is autoregulation?

Answer 41

brains ability to maintain consistent cerebral blood flow despite changes in systemic blood pressure or ICP

Question 42

What is important to remember when a patient with suspected ICP is getting a CT?

Answer 42

do not use contrast

Question 43

What some ICP diagnostic tests?

Answer 43

Imaging ABGs Coagulation profile Urinalysis serum osmolality electrolytes EEG