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High Acuity Exam 3 > Neuro > Flashcards

Neuro Flashcards

(103 cards)

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1
Q

lethargic

A

sleeps in between assessments, awakens easily to voice, spontaneous movement

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2
Q

obtunded

A

needs physical stimulus to wake, sluggish response, purposeful movement

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3
Q

stuporous

A

need painful stimuli to wake, no spontaneous movement

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4
Q

comatose

A

unresponsive to painful stimuli, no movement

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5
Q

GCS less than 8

A

intubate!

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6
Q

GCS of 3 is considered -

A

unresponsive

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7
Q

decorticate posturing

A

flexion into core, sign of increased ICP

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8
Q

decerebrate posturing

A

extension out, severe sign of increased ICP

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9
Q

central painful stimuli is testing…

A

the brain’s response to pain

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10
Q

peripheral painful stimuli is testing…

A

the spinal cord’s response to pain

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11
Q

is lack of central or peripheral pain reaction more severe?

A

central

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12
Q

examples of central painful stimuli

A

trap squeeze, sternal rub, supraorbital pressure

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13
Q

examples of peripheral painful stimuli

A

nail bed pressure

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14
Q

what does a positive babinski indicate?

A

brain damage

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15
Q

what can dampen reflexes?

A

hypermag

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16
Q

how do you perform the Romberg test?

A

stand with feet together & hold for 30s, then repeat with eyes closed - observe for balance

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17
Q

how do you test the cerebellum?

A

finger to nose, foot to shin, Romberg

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18
Q

meningeal s/s

A

headache, photophobia, nuchal rigidity, n/v, decreased LOC, positive kernig’s & brudzinski

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19
Q

Cushing’s triad

A

HTN w wide pulse pressure, bradycardia, irregular respirations

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20
Q

what is cushing’s triad a sign of?

A

dangerously high ICP, imminent brain herniation

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21
Q

anosmia

A

loss of sense of smell

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22
Q

what do pinpoint pupils indicate

A

opioid OD

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23
Q

anisocoria

A

uneven pupils

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24
Q

what kind of pupils are present in brain death

A

blown, unreactive, fixed

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25
ptosis
drooping eyelid
26
nystagmus
involuntary rhythmic eye movement
27
LP positioning
on side, prone if intubated
28
s/s of CSF leak
headache, n/v, photophobia
29
CSF leak prevention
lay flat, drink caffeine, avoid increasing intrathoracic pressure - coughing, straining, suction, lifting
30
spinal headache treatment
caffeine, blood patch
31
what is delirium
acute, transient confusion w/ rapid onset
32
encephalopathy
disease causing global brain dysfunction
33
s/s of encephalopathy
confusion, aggression, changes in LOC, inability to speak/understand, twitching
34
how does the body compensate for high ICP
decrease CSF production, increase reabsorption, or vasoconstriction
35
what can high ICP eventually cause?
brain can herniate into brain stem -- brain death, hemorrhage
36
how do you calculate CPP
MAP - ICP
37
goal CPP
greater than 70
38
what can low CPP cause
inadequate brain perfusion, anoxic/ischemic injury
39
how can u increase ICP?
fluids/pressors to raise MAP, decrease ICP
40
causes of high ICP
cerebral edema, stroke, head trauma, intracranial hematomas
41
epidural hematoma location
between skull & dura
42
subdural hematoma location
between dura & arachnoid
43
which type of intracranial hematoma is most severe?
epidural
44
epidural hematoma s/s
pt rapidly deteriorates
45
subdural hematoma s/s
gradual onset
46
epidural hematoma treatment
surgical evacuation
47
subdural hematoma treatment
varies, most reabsorb over time
48
s/s of high ICP
early - changes in LOC; headache, vomiting, blurred/double vision, late - cushing's, blown pupils
49
external ventriculostomy device
monitors ICP & drains CSF
50
where should an EVD be leveled to?
tragus
51
pt position to decrease ICP
HOB 30, neutral head position, avoid sharp hip flexion or neck compression
52
why should PEEP be limited with high ICP
increases intrathoracic pressure
53
dexamethasone
can decrease ICP, only if pt has brain tumor
54
how does mannitol work?
pulls cerebral edema intravascularly, osmotic diuretic
55
side effects of mannitol
massive diuresis, dehydration, hypotension, hypoK, hyperNa, renal damage
56
how does 3% saline work?
pulls cerebral edema intravascularly
57
side effects of 3%
renal failure, dehydration, hyperNa
58
how do you give 3%
slowly though central line, can be PIV if emergent
59
what analgesic/sedation is preferred to manage ICP, why
fent & prop - quick onset, short half life
60
what sedative should be avoided in a pt with high ICP
benzos - last longer, obscure neuro assessment
61
what are barbiturates used for
coma induction for refractory high ICP
62
why are vasopressors used to manage high ICP?
increase MAP to maintain CPP
63
decompressive craniotomy
bone flap of skull removed
64
decompressive crani mgmt
protect exposed brain, must wear helmet if OOB
65
lobectomy
removal of part of brain, last resort for refractory high ICP
66
expressive aphasia
pt understands u, but cannot talk
67
receptive aphasia
pt cannot understand u, can talk
68
global aphasia
pt cant understand u or talk
69
what info should u have on a pt experiencing a stroke?
LKW, activity at onset, neuro baseline, seizure/fall at onset/before, sudden or slow symptom progression
70
embolic stroke
sudden symptom onset, from emboli lodged in brain
71
thrombotic stroke
from atherosclerosis - gradual symptom onset
72
lacunar stroke
small deep brain arteries, often caused by HTN - good prognosis
73
transient ischemic attack
mini stroke, resolves within 24h, warning sign of real stroke soon
74
mgmt of TIA
admit for obs & work up, help make lifestyle changes to reduce future risk
75
ischemic stroke treatment
thrombectomy, permissive HTN, fibrinolytics
76
penumbra
area surrounding ischemic core, can recover if perfused early
77
permissive HTN
allowing BP up to 220/110 to perfuse penumbra
78
when is permissive HTN used
when pt is not a candidate for tPA
79
tPA admin window
4.5h since LKW
80
tPA admin & dose
0.9mg/kg, 10% bolused, 90% over 1h
81
absolute tPA contraindications
more than 4.5h since LKW, hypoglycemia, BP > 185/110, low plt, prolonged PT/PTT, recent/active surgery, trauma, bleeding
82
subarachnoid hemorrhage location
bleeding between brain & skull
83
SAH s/s
worst headache ever with sudden onset
84
SAH tx
coiling if from aneurysm, microembolize if from AVM
85
SAH complications
vasospasm, hydrocephalus
86
when is the risk of vasospasm the highest?
days 3-14
87
vasospasm s/s
neuro changes - causes ischemia
88
vasospasm tx
nimodipine, ICP monitoring, pain f+e & glucose control
89
hydrocephalus
accumulation of CSF in ventricles
90
hydrocephalus s/s
LOC changes, headache, n/v, incontinence
91
hydrocephalus tx
drain excess CSF, EVD, proper positioning
92
cause of intracerebral hemorrhage
HTN
93
intracerebral hemorrhage s/s
seizure, headache, LOC change, loss of airway
94
intracerebral hemorrhage mgmt
keep BP in safe range, SBP<140 using labetalol, nicardipine, hydral
95
R sided MCA stroke symptoms
L sided deficits, head & eye deviation to R, impulsive, mood disorder, unaware of deficits
96
L sided MCA stroke symptoms
R sided deficits, head & eye deviation to L, aphasic, impaired math & reasoning, cautious
97
cerebellar stroke s/s
impaired balance, lethargy, dysphagia, dysarthria
98
brainstem stroke s/s
LOC, hemodynamic instability, irregular RR, absent protectives & pupil, posturing, loss of thermoregulation, flaccidity
99
quadriplegia
all 4 limbs paralyzed
100
paraplegia
just arms or legs paralyzed
101
autonomic dysreflexia triggers
bowel/bladder distension, pressure injuries, skin stimulation - tight clothing
102
autonomic dysreflexia s/s
flushing, headache, sweating, severe HTN, n/v, blurred vision
103
mgmt of autonomic dysreflexia
BP control, avoiding triggers - elevate HOB, check foley, no tight clothing

High Acuity Exam 3 (3 decks)

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