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Adults 2 Exam 3 > Neuro > Flashcards

Neuro Flashcards

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1
Q

What part of the brain has contralateral control

A

Forebrain
Responsible for motor, sensory, vision, visceral activities etc.

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1
Q

What part of the brain has ipsilateral control

A

Hindbrain
Responsible for balance and posture
Also responsible for autonomic activities

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2
Q

What part of the brain controls voluntary and involuntary visual motor movements, hearing, production of dopamine

A

Midbrain

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3
Q

What is a normal intercranial pressure

A

5-15mmHg, don’t start treating until above 20

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4
Q

How do you calculate cerebral perfusion pressure

A

mean arterial pressure (MAP) - intercranial pressure (ICP)

CCP=pressure needed to perfuse the brain should be above 60-80mmHg

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5
Q

How do you measure ICP

A

subarachnoid bolt

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6
Q

How do you remove CSF in a pt with high ICP

A

Intraventricular drain

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7
Q

What can cause cerebral edema

A

hyponatremia, TBI, ruptured aneurysm

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8
Q

How do you treat cerebral edema

A

hypertonic solutions (3% NS), osmotic diuretics (mannitol), corticosteroids

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9
Q

Describe stage 1-4 ICP scale

A

1: no sx
2: subtle confusion, lethargic, restless
3: small pupil, extreme lethargy, breathing changes, increased BP, decreased HR
4: Cushing’s triad, fixed and dilated pupils

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10
Q

What is cushings triad

A

low hr, change in respirations, widening pulse pressures

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11
Q

Two nursing interventions for pt’s with brain injuries

A

Seizure precautions
Low-stimulation environment

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12
Q

difference between tonic and clonic

A

Tonic-body stiffens
Clonic-body jerks

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13
Q

Describe the pathophysiology of a seizure

A

One indv neuron becomes excited and starts making nearby neurons go crazy so that they’re taking up way more resources than they should and releases abnormal amount of lactate which tells the body that they need increased blood flow to replace but increases icp and further exacerbates hypoxia

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14
Q

Lab values that may cause seizures

A

Severe hyper or hyponatremia
Hypoglycemia
Acidosis

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15
Q

precursor to status epilepticus

A

deep sleep in post-ictal phase

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16
Q

WHAT ARE THE 4 SEIZURE MANIFESTATION PHASES

A

Prodrome (days/weeks ahead of time)
Possible aura
Ictal phase (physical manifestation of seizure)
Postictal (Confusion)

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17
Q

Name some labs that could indicate the cause of a seizure

A

CBC increased WBC from infection (fever?)
Glucose hypo
Calcium hyper/hypo can cause neuro
BUN increased if pt w/ kidney disease
Creatinine increased if pt w/ kidney disease

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18
Q

What do you need to do before a Electroencephalogram (eeg) or video electroencephalogram (veeg)

A

take pt off all seizure meds

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19
Q

What medications PREVENT, DON’T STOP SEIZURES

A

Anti-seizure medications

Phenytoin (Dilantin)
Carbamazepine
Phenobarbital
Levetiracetam (Keppra)

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20
Q

What medications helps break seizure activity, GIVE WHEN IN SEIZURE

A

Benzodiazepines

Lorazepam
Diazepam

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21
Q

How do you treat REPEATED SEIZURES, NOT ONE OFF SEIZURE

A

Deep Brain Stimulation (senses abnormal electrical activity and zaps brain to reset)

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22
Q

How do you treat identified focal seizures

A

Possible surgical intervention

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23
Q

Diet for patients that experience seizures

A

Ketogenic diet
Reduces glutamate (which encourages seizure activity) and increases GABA (which suppresses seizure activity)

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24
What are the nursing interventions for a patient having a seizure
OBSERVE (HOW LONG, WHEN DID IT START, PATENT AIRWAY) AND ENSURE SAFETY (POSITIONING, PADDED ENVIRONMENT, GUIDE TO SAFE ENVIRONMENT) GET IV IN STAT TO ADMIN MEDS, PUT ON SEIZURE PRECAUTIONS
25
Dark red, bloody CSF indicates a
Hemorrhagic stroke
26
What can cause a hemorrhagic stroke
Hypertension (sustained 180 systolic) Tumors (very vascular Impaired coagulation Trauma Stimulant use (meth, cocaine)
27
What baseline labs should you expect to draw for a patient suspected of stroke
coag studies, electrolytes, renal labs
28
How do you know a stroke is happening in the hind brain
unbalance and abnormal posture Also responsible for autonomic activities (weird breathing, irregular heart rate) Symptoms on same side of brain injury
29
How do you know a stroke is happening in the Forebrain
Responsible for motor, sensory, vision, visceral activities Symptoms happening on the opposite side of injury to brain
30
Fibrinolytics Must be given within the first ____ _______ to be effective
4.5 hours
31
How do you treat a Subarachnoid hemorrhage
Nimodipine (decrease discharge of neurons) Ventriculostomy (drains excess cerebrospinal fluid (CSF) from the head. It is also used to measure the pressure in the head)
31
What is the difference between a focal and diffuse TBI
Focal: affects one area of the brain Diffuse: affects more than one area of the brain
31
What intervention can you expect when a patient is diagnosed with an Ischemic Stroke
Hypothermia protocol
32
What meds might you administer to a patient with seizures
spironolactone for cerebral edema blood thinners/amiodarone for afib 1.5-3% saline for hyponatremia phenytoin, levateracital) to prevent seizures SSRI to improve function (lopram, ertaline)
32
What types of nursing interventions do you expect to give a stroke patient
Monitor neurological status carefully-GCS Ensure DVT prophylaxis Assess for musculoskeletal issues, provide ROM Facilitate communication (write on whiteboard) Speech consult to assess swallowing ability
33
What is the difference between a primary and secondary TBI
Primary TBI: caused by direct force Focal: affects one area of the brain Diffuse: affects more than one area of the brain Secondary TBI: Indirect effects of the primary injury Systemic responses: edema, hemorrhage, increased ICP, infection Molecular cascades and inflammatory events can be involved
34
What is the difference between a coup and countercoup TBI injury
Coup injury: injury at the site of impact Contrecoup injury: injury from brain rebounding
35
What is the difference between a Epidural and Subdural hematoma
Epidural hematoma: arterial bleed, rapid loss of consciousness, regaining of consciousness and then progressive loss of consciousness Subdural hematoma: venous bleeds (elderly pt on anticoags) Slower build to altered LOC
36
What is a Intracerebral hematoma:
bleeding in the brain Often caused by penetrating trauma or shearing forces Presents with a slower LOC change as well
37
What is a Diffuse axonal injury (DAI)
damage to axons caused by shearing forces Does not immediately increase ICP Does affect function and can lead to long-term dementia/dysfunction
38
Is decerebrate or decorticate posturing worse
Decerebrate (brain stem compression) worse than decorticate
39
What are some manifestations of a serious TBI
Gross ataxia (poor muscle control), Battle’s sign, raccoon eyes, rhinorrhea (Halo sign)
40
How do you treat increased intracranial pressure
Osmotic diuretics if elevated ICP (mannitol) Possible hypertonic saline (1.5 % (Peripheral IV)or 3% (Central line)) Barbiturates for reducing ICP and cerebral edema
41
What are two prophylactic medications you should give your TBI pt
(Keppra, phenytoin)
42
T/F: Corticosteroids are the first line medication administered when a patient begins to show symptoms of a severe TBI
FALSE Corticosteroids not recommended for TBI
43
When would you intubate your TBI patient
if GCS < 8
44
When would you perform an emergency craniotomy on a patient
evacuate hematomas, give brain room to swell, freeze bone or keep it in the abdomen
45
What nursing interventions should you expect to provide for a TBI patient
Oxygen Maintain spinal precautions until cleared Reduce metabolic rate Monitor for CSF leaks (halo test) Low stimulation
46
What is Chronic traumatic encephalopathy (CTE)
(Can only be dx in a autopsy) compounded TBI that causes anger/aggression
47
What is Post Concussion syndrome
(lingering manifestations of TBI)
48
What is Neurogenic Fever
a non-infectious source of fever in a patient with brain injury, especially hypothalamic injury
49
What is the difference between a primary and secondary spinal cord injury
Primary: Initial trauma and tissue destruction affect the spinal cord Secondary: physiological response of inflammation, edema and ischemia results in destruction of tissue
50
Describe paraplegia
Paraplegia = thoracic spine level 🡪 impacts all or part of the trunk, pelvic region, & legs, but NOT the arms
51
What are the 4 types of vertebral injuries
Flexion Hyperextension Compression Rotational
52
What are you concerned about with someone with a ACUTE spinal cord injury
Ensure good oxygenation and patent airway Make sure MAP is 85 or higher and SBP is greater than 90 thermal regulation disruption Maintain spinal precautions until cleared Assess for possible ileus-NGT if appropriate Maintain catheter to ensure client does not develop neurogenic bladder
53
How do you maintain spinal perfusion if in a state of shock
Vasopressors (epi, dopamine, vasopressor)
54
How do you treat a spinal cord injury
Immobilization of injury Surgical repair of vertebral fracture Therapeutic hypothermia Hypothermia protocol
55
What are you concerned about with someone with a spinal cord injury AFTER THE ACUTE PHASE
Ensure clients are wearing braces/ortho devices properly (Nurses should log roll patient until cleared) Maintain skin integrity TEDs/SCDs Manage pain
56
What are the 3 immobilization devices used for spinal cord injuries
halo 🡪 severe, unstable upper cervical spine injury (neck frx, dislocations) C collar 🡪 stable c spine injury TLSO (thoracic-lumbar-sacral orthotic device, aka ‘turtle shell’ for the older hard plastic ones!) 🡪 Spinal precautions 🡪 ‘log roll’
57
What is Autonomic dysreflexia
(T6 or above): sympathetic stimulation reaches the brain, but parasympathetic compensation cannot travel below the level of injury Hypertension Bradycardia Pounding headache Blurred vision Flushed skin/sweating in the face Caused by ‘noxious stimuli’ below the level of injury. The majority of the time it’s d/t a urological problem: full bladder, clogged Foley, UTI Tx: sit ‘em upright, find & address noxious stimuli – empty bladder
58
What is Spinal shock
Occurs in immediate aftermath of damage Loss of motor, sensory, reflex and autonomic functions below area of damage due to spinal cord ischemia Flaccid paralysis below the level of injury Loss of bladder control Hypotension Hypothermia
59
What is Neurogenic shock
hypotension, often with bradycardia occurs at T6 or higher 🡪 can cause permanent damage IS A MEDICAL EMERGENCY = sympathetic nervous system (your ‘fight or flight’ = incr. HR, BP, RR, vasoconstriction, pupil dilation, slows down GI processes) goes haywire 🡪 parasympathetic cascade jumps in & takes over, does the opposite 🡪 hypotension, bradycardia, hypothermia 🡪 poor perfusion 🡪 blood shunted to vital organs 🡪 more severe hypotension 🡪 exacerbation of cascade 🡪 dead
60
How do you evaluate the INTERNAL STRUCTURE of the spinal cord, including nerve roots & discs
MRI = first line in the acute setting
61
Severity of injury 🡪 ‘graded’ via...
American Spinal Injury Scale (ASIA scale) D is good

Adults 2 Exam 3 (3 decks)

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