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NSCC 7520 > Neuro > Flashcards

Neuro Flashcards

(74 cards)

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1
Q

neuro assessment - why do we do it?

A
  • establish a baseline
  • gather data
  • get to know pt
  • monitor trends
  • notice potential or actual problems
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2
Q

neuro assessment: what are the components?

A
  • hx
  • GCS
  • cranial nerves
  • motor strength
  • vitals
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3
Q

what is the first sign of neurological deterioration?

A

any decrease in LOC

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4
Q

what does GCS assess?

A

LOC

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5
Q

what are the components of GCS?

A
  • best eye opening response
  • best verbal response
  • best motor response
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6
Q

eye opening response

A
  1. spontaneously
  2. to speech/sound
  3. to pain/pressure
  4. no response
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7
Q

verbal response

A
  1. oriented to time, person, place
  2. confused
  3. inappropriate words
  4. incomprehensible sounds
  5. no response
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8
Q

motor response

A
  1. obeys commands
  2. moves to localized pain
  3. flex to withdraw from pain (normal flexion)
  4. abnormal flexion
  5. abnormal extension
  6. no response
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9
Q

what does assessing motor response and strength tell us?

A

focus of injury

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10
Q

what do motor nerve tracts tell us?

A

they decussate (cross) in the medulla oblongata: strength changes are seen on the contralateral (opposite) side as the injury

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11
Q

where do pupil changes happen?

A

on the ipsilateral (same) side as the injury

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12
Q

CN II: which cranial nerve? sensory or motor? assessment?

A

optic; sensory; pupil reaction to light

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13
Q

CN III: which cranial nerve? sensory or motor? assessment?

A

oculomotor; motor; pupil reaction to light, tracking, open eyes

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14
Q

CN IV: which cranial nerve? sensory or motor? assessment?

A

trochlear; motor; tracking up and down

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15
Q

CN V: which cranial nerve? sensory or motor? assessment?

A

trigeminal; both; corneal reflex

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16
Q

CN VI: which cranial nerve? sensory or motor? assessment?

A

abducens; motor; tracking side to side

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17
Q

CN VII: which cranial nerve? sensory or motor? assessment?

A

facial; both; corneal reflex, raise eyebrows

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18
Q

CN IX: which cranial nerve? sensory or motor? assessment?

A

glossopharyngeal; both; gag reflex

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19
Q

CN X: which cranial nerve? sensory or motor? assessment?

A

vagus; both; gag reflex, cough reflex

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20
Q

pupillary response determines what, which nerves are involved, and what does it indicate?

A
  • determines focus of injury and cranial nerve function
  • CN II optic and CN III oculomotor
  • indicates damage on ipsilateral side
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21
Q

pupil tests

A
  • PERL
  • size
  • reaction to light (constrict)
  • consensual (other eye also constricts)
  • tracking? CN III, CN IV
  • any other abnormality
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22
Q

cranial nerve testing - corneal reflex

A

CN V - trigeminal
CN VII - facial

open the eye, touch cornea with gauze, eye drops - look for blink

if pt is spontaneously blinking, no need to check for reflex

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23
Q

cough and gag reflex and testing

A
  • CN IX (glossopharyngeal) and X (vagus)
  • Reflexes associated with these nerves provide airway protection
  • Use tongue depressor, suction the patient, do mouth care… look for
    tongue movement, swallowing, coughing, gagging
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24
Q

cranial vault

A
  • boney outside that protects the brain
  • Fixed, inflexible box
    comprised of blood, brain and CSF
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25
monroe-kellie hypothesis
the sum volume of brain, blood, CSF are constant. an increase in one component should cause a reciprocal decrease in either one or both of the remaining two components *time is brain
26
CSF compensation
- CSF shunted down spinal cord - decreased CSF production - insertion of drain to remove CSF
27
blood compensation
- Vasoconstricting blood flow - Increase venous blood drainage
28
brain compensation
- Surgery to remove the “brain” (i.e., blood clot or tumor) - Hypertonic solutions to reduce swelling
29
ICP
- pressure exerted by the cranium on the brain tissue, CSF, and circulating blood volume in the brain - product of the volume within the intracranial cavity - constantly fluctuates in response to changes (i.e., coughing, straining, exercise, etc.)
30
normal ICP
0-15mmHg
31
CPP
- cerebral perfusion pressure (BP of brain) - BP gradient available to perfuse - reflected as the difference between the incoming MAP & ICP on the arteries - ICP is pressure inside the head that MAP must overcome to provide cerebral perfusion - MAP is the driving pressure for the arterial system
32
normal CPP
60-100mmHg
33
CPP equation
CPP = MAP - ICP
34
cushing's triad
1) bradycardia 2) inc sBP with widening pulse pressure 3) irregular resps
35
what do hematomas refer to?
brain volume not blood volume
36
autoregulation
the maintenance of CBF despite constant changes in arterial pressure; is impaired in TBI pts
37
normally without autoregulation...
CHEMICAL THEORY - Stretch receptors respond to levels of O2, CO2, H+ trigger dilation or constriction of the cerebral blood vessels BIOPHYSICAL THEORY - Vessels constrict when systemic BP high (MAP>80) - Vessels dilate when systemic BP low (MAP<60)
38
optimal condition for autoregulation
" zone of autoregulation" CPP >60 ICP <30 MAP 60-150
39
why is autoregulation important?
to prevent secondary injury
40
primary injury
the initial damage that occurs at the moment of trauma or injury. is immediate and often irreversible. it can include: - Contusions or lacerations - Skull fractures or penetrating injuries - Hemorrhage - Diffuse axonal injury
41
secondary injury
- evolves over hours to days following the initial injury and is caused by the physiological responses to the primary injury - responses result due to: hypoxia, ischemia, cerebral edema, hypercapnia, meningitis, seizures
42
primary injury: what's important? what helps us to understand if ____injuries are present?
- mechanism of injury is important - index of suspicion helps to understand if occult injuries are present
43
diffuse axonal injury diagnostics and symptoms
- usually unable to see on CT, need to go for MRI symptoms: - decreased LOC >6hrs post-injury - widespread neuro dysfunction (cognition, memory, speech, motor function and personality) - Looks like a ‘coma’ - Increased ICP, ↑HR, nausea, temp
44
basal skull fracture
TBI involving a break in at least one of the bones at the base of the skull (frontal/sphenoid/temporal/occipital bones)
45
symptoms of basal skull fracture
- raccoon eyes - halo sign - partial/total loss of vision, smell, hearing - Battle's sign (bruising behind ears)
46
factors that can increase cerebral metabolic demand
- fever - physical activity - stress (physiological, psychological)
47
increase in metabolic demand exacerbates ____
secondary injury
48
how do we monitor cerebral O2 supply and demand?
- SjVO2 = jug bulb venous saturation - CERO2 = cerebral extraction ratio - PbO2 = brain saturation
49
SjVO2
- taken from jugular bulb - normal = 55-75% - reflects cerebral extraction (how much O2 is left in the blood returning from cerebral circulation)
50
CERO2
- normal = 25-35% - amount of O2 being used by the brain SaO2 - SjVO2/SaO2 x100
51
prevention
1) decrease O2 demand - Core temp 35-36 - Intravenous sedation & narcotics - Neuromuscular paralysis - Seizure detection/therapy 2) increase O2 delivery - Increase MAP /SBP - Hgb >90 - Pa02 >100mmHg - PaC02 35-40mmHg
52
what is goal for PbO2?
>15mmHg
53
hyperventilation
- CO2 potent vasodilator - Can limit CBF if level decreases - NOT recommended within first 24 hrs - TEMPORARY measure - Only to be used if despite other measures patient continues to deteriorate
54
hypertonic sodium
- typically slightly higher Na goals 140-145 for TBI pts - monitor serum Na levels - central line preferred
55
mannitol
- osmotic diuretic → decreases overall water content, so monitor urine output - weight based 1-1.5g/kg over 10-20 mins - use 0.2 micron filter - can give centrally or peripherally IV - contraindications: anuric with severe kidney injury
56
when should you be suspicious of potential spinal injury?
unwitnessed fall, unconscious, TBI, trauma, or any pt with altered movement and sensation
57
what does the ASIA (American Spinal Injury Association) impairment scale look at?
- standardized neurological exam of motor and sensory system function - classifications from A (complete injury) → E (no impairment, normal movement and sensation) - gives injury grade and level to aide in rehab prognosis and treatment interventions
58
level of injury
where on the spinal column
59
complete vs incomplete injury
complete = severed spinal cord. loss of motor and sensory below injury level incomplete = some nerve signals will still be relayed. movement or sensation may be present below level of injury
60
ligamentous injury
- Stretched muscles - Can clear via MRI - Collar 6 weeks
61
treatment for spinal cord injury
- (+/- surgery) - need to be transported to a trauma hospital - Non-surgical treatment: - Increasing the BP and MAP to allow for greater spinal cord perfusion. MAP > 85 for 7 days to facilitate spinal cord perfusion and function
62
diagnostic for spinal cord injury
gold standard is MRI
63
protection and alignment with spinal cord injury
- aspen collar - neutral alignment, use a spinal wedge, no pillows - sandbags on either side of head - 3-4 person turns - sheep skin *no pillow - reverse trendelenburg - no air beds/no slings (at this point)
64
SCI nursing considerations
pain control, frequent repositioning, monitor for neurogenic shock, relational nursing practice
65
neurogenic shock
- Hemodynamic phenomenon - Consequence of SCI at level T6 or higher
66
when does neurogenic shock start?
Starts within 30 min of injury, lasts up to 6 weeks (not permanent)
67
what happens to your PNS and SNS in neurogenic shock?
- Lose/ decrease sympathetic stimulation (Epi/NE), but parasympathetic stimulation is preserved. Remember, PNS and SNS work in opposition to balance each other! - No opposing force to the PNS, so “rest and digest” system takes control - increase of PNS functions (bradycardia, hypotension, temp dysregulation core -hypothermia)
68
how does neurogenic shock affect O2 S+D?
- Reduced vascular tone causes massive peripheral vasodilation - Decreased afterload = blood pooling in venous system - Reduced venous return = decreased preload - Overall reduced SV - Reduced HR - Reduced CO
69
symptoms of reduced O2 supply and demand in neurogenic shock
- Decreased 02 delivery - Decreased urine output - Bradycardia - Hypotension - Warm skin
70
treatment for neurogenic shock
- epi and norepi - IV fluids - atropine
71
DAI
- significant brain injury that has irreversible damage - stretching & tearing of nerve fiber tracts - damages the axons and their ability to transmit signals
72
what factors can increase brain volume?
tumors, hematomas, cerebral edema, abscesses
73
what factors can block CSF production?
spina bifida, tumors, pus/abscesses; SAH blocks CSF reabsorption; overproduction of CSF is rare
74
what factors can increase blood volume?
elevated PaCO2/acidosis, hypoxia, MAP/loss of autoregulation, vasodilators, venous outflow obstruction

NSCC 7520 (5 decks)

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