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Flashcards in Neuro Deck (89):
1

Three layers surrounding brain

Meninges
Arachnoid
Pia mater

2

Anatomical part often implicated in stroke

Circle of willis at base of brain

3

What three things would alter the blood-brain barrier?

- Head trauma
- Cerebral edema
- Cerebral hypoxia

4

How long is the spinal cord?

18"

5

Where does the spinal cord end?

L1

6

Where are epidurals / spinal anesthesias placed?

L3

7

When would you use an MRI / MRA to look at neuro stuff?

Non-acute situations (can take 30-90 minutes, looks at circulation)

8

When would you use a cat scan to look at neuro stuff?

For emergencies -- dx stroke, type of stroke

9

When is an EEG used with neuro stuff? (3)

- Diagnose seizures
- Screen for coma
- Helps determine brain death

10

When is a spinal tap indicated?

When Cerebral Spinal fluid needs to be assessed for contents or pressure

11

Pressure reading of CSF (normal

1-15 cmH20
70-200 mmHg

12

3 minor complications of a lumbar puncture

- Headache
- Voiding problems
- Backache

13

3 Major complications of a lumbar puncture

- Herniation of cerebral contents
- Infection
- Hematoma

14

Indication for a blood patch

CSF leakage

15

Structural causes of neurologic dysfuncction (5)

- Head injury
- Intracranial hemorrhage
- Encephalitis
- Brain abcess
- Stroke

16

Metabolic causes of neurologic dysfunction (9 - don't memorize)

- Sepsis
- Hypovolemia
- MI
- Respiratory arrest
- Hypoglycemia
- Electrolyte imbalance
- Drug and / or alcohol abuse
- DKA
- Hepatic encephalopathy

17

Goals for a patient with neurologic dysfunction

QUALITY OF LIFE for patient and family

18

Intracranial pressure is a reflection of 3 relatively fixed volumes:

- The brain
- CSF
- Blood

19

Closed Box Theory (Munro-Kellie Hypothesis)

Any increase in ICP within an intact skull results in a compression or decrease in one of the other compartments (Brain, Blood, CSF)

20

3 possible causes of increased brain volume:

- Tumor
- Bleed
- Abcess

21

3 possible causes of increased blood volume:

- Hypertension
- Increase in blood flow
- Decrease in venous return from the head

22

2 possible causes of increased CSF

Hydrocephalis
Obstruction of outflow of CSF

23

Define Hydrocephalis

Increased production of CSF

24

Blood levels that contribute to increased intracranial pressure (2)

• Hypercapnia: PaCO2 > 45
• Hypoxemia: PaO2 < 50

25

7 factors contributing to increased increased intracranial pressure (7 - not blood levels)

• Valsalva maneuver:
• Positioning
• Isometric muscle contractions:
• Coughing, sneezing
• Emotional upset
• Noxious stimuli (suctioning, starting IVs, any painful procedure)
• Excessive sensory stimuli

26

Risk with ICP

Brain stem herneating: Can lead to irreversible anoxia, death

27

Characteristics of a patient with increased ICP (5)

- Lethargy
- Confusion
- Obtundation
- Stuporous
- Comatose

28

Six early warnings of increased intracranial pressure - 6 sixs

(which is earliest?)

1) Change in LOC or behavior **Earliest sign! Extremely sensitive to decrease in oxygenation
2) Pupils react sluggishly
3) Motor function
4) Constant headache – not a reliable sign
5) VS
6) Visual disturbances

29

What vital signs would be off in a patient experiencing early intracranial pressure?

- Tachycardia
- Hypertensive swings

30

5 sxs of a late picture of ICP

1) LOC becomes stuporous or comatose
2) Loss of rain stem reflexes (corneal, pupillary)
3) Characteristic motor response
4) Vital signs off
5) Projectile vomiting

31

When is death inevitable with ICP?

When pupils are fixed and dilated

32

Three characteristic motor responses of ICP

- Decorticate
- Decerebrate
- Total flaccidity

33

What does a decorticate position look like?

Arms up "toward the core"
Feet are flexed and pointed

34

What does a decerebrate position look like

Arms at side, hands flexed and pronated
Feet are flexed and pointed

35

What does a decorticate position indicate?

Hemisphere damage

36

What does a decerebrate position indicate?

Mid brain damage

37

What does total flaccidity indicate?

Lower brain damage (worst prognosis)

38

What vital signs would be off with a late-picture ICP patient?

Cheyne stokes respirations (intermittent apnea and irregular)

39

What tool is used to monitor ICP

Intraventricular catheter in lateral ventricle

40

Nursing interventions with ICP

1) Monitor ICP
2) Decrease cerebral edema
3) Maintain cerebral perfusion
4) Reduce CSF and blood volume
5) Control fever
6) Reduce metabolic demands
7) Maintain a patent airway
8) Improve cerebral tissue perfusion
9) Monitor fluid balance
10) Prevent infection
11) Monitor for complications

41

To maintain cerebral perfusion, what would you do if pressure is low? (2)

- Administer fluid
- Positive inotropic agents

42

To maintain cerebral perfusion, what would you do if pressure is high?

- Decrease fluids
- Administer vasodilators

43

What would you do to control fever in an increased ICP patient?

- Acetaminophen
- Cooling blanket - no shivering

44

What drug would decrease shivering

Thorazine

45

What paralyzing agent would decrease metabolic demands with ICP?

Norcuron

46

When would you give a patient Norcuron

Only if they are in the ICU and on a ventilator - it paralyzes their breathing!

47

PEEP with ICP? and - why?

DO NOT USE PEEP because it increases thoracic pressure and can decrease venous return from the head!

48

Patient position to improve cerebral tissue perfusion

- Keep head midline (no tilting forward)
- Elevate the head of the bed 30 degrees

49

What could Cheyne-Stokes respirations indicate?

Brain lesion

50

What could hyperventilation indicate?

Brain or metabolic injury

51

Head injury: Patient is PERRLA. What could this indicate?

Injury is toxic or metabolic

52

Head injury: Pupils are unequal. What could this indicate?

Pupils are localizing.

53

Head injury: Pupils are dilating. What could this indicate?

ICP or brain injury

54

If blink reflex is unilateral, what type of brain injury is this?

Local

55

Stiff neck could indicate

Subarachnoid heme meningitis

56

3 measurements of the glascow coma scale

- Eye opening
- Motor response
- Verbal response

57

Most common type of complication with head injuries

RESPIRATORY

58

Three respiratory complications with head injury

- Pneumonia
- Aspiration
- Respiratory infection

59

Transient cerebral ischemia timing

Within 24 hours (new research = 3-6 hourse)

60

How often does TIA lead to stroke?

20% (within a few years)

61

Most common risk factors for CVD (6)

• Cardiovascular Disease
• HTN
• DM
• Smoking
• Family history of CVA
• Sedentary lifestyle

62

o Temporary episode of neurological dysfunction manifested by a sudden loss of motor, sensory or visual function

TRANSIENT ISCHEMIC ATTACK (TIA)

63

What do you use to assess a TIA (3)?

• Auscultate carotid arteries
• Carotid Doppler study
• Carotid angiogram

64

Stroke risk: Racial disparities

2x more likely in blacks

65

Acronym to recognize a stroke

Face
Arms
Speech
Time

66

Two general causes of CVA

- Ischemia
- Hemorrhagic

67

Risk factors for Ischemic CVA (3)

- AFib (#1)
- Ateriosclerosis
- Heart valve disease

68

Risk factors for hemorrhagic CVA (4)

- Uncontrolled HTN
- Arteriovenous malformation
- Intracranial aneurisms
- Anticoags

69

What % of CVAs are hemorrhagic?

10-20%

70

Define Hemianopsia

Partial loss of visual field

71

CVA: 3 visual field manifestations

Hemianopsia
Loss of peripheral vision
Diplopia

72

CVA: 5 motor manifestations

Hemiparesis
Hemiplegia
Ataxia
Dysarthia
Dyspagia

73

CVA: 2 sensory manifestations

Paresthesias
Problems with proprioception

74

CVA: 3 forms of aphagia

Expressive: Can’t express language
Receptive: Can’t understand language
Global: Both receptive and expressive

75

CVA: 4 cognitive manifestations

Memory loss
Decreased attention span
Can’t concentrate
Poor reasoning, altered judgment

76

CVA: 5 emotional manifestations

- Loss of self-control
- Emotional lability
- Decreased tolerance to stress
- Depression, withdrawal, feeling of isolation
- Fear, hostility, anger

77

3 characteristics unique to left hemisphere CVA

Aphasia (right handed people)
Altered intellectual ability
Slow, cautious behavior

78

3 characteristics unique to right hemisphere CVA

Spacial, perceptual deficits, very distractible
Impulsive behavior and poor judgment
Lack of awareness of deficits

79

Two characteristics common of either hemisphere CVAs

- Same-sided paralysis or paresthesias
- Deficit in same-sided visual field

80

Medical management for ischemic stroke (2)

- Thrombolitic therapy
- Anticoagulants

81

Medical management for hemorrhagic stroke

- Manage ICP
- Surgery

82

3 common CVA complications

• Cerebral hypoxia

• Decreased cerebral blood flow

• Extension of the area of injury

83

What would cause extension of the area of injury (CVA)

hyper or hypo tension

84

Craniotomy: Indications (4)

• Remove clot
• Relieve intracranial edema
• Remove tumor
• Control hemorrhage

85

Craniotomy: C&DB Patient teaching

o Deep breathing good
o Coughing not good

86

Craniotomy: Anticonvulsant meds (2)
How long administered?

o Often continued for 6 months to a year (discontinue if no seizures at that point)
o Dilantin, phenobarbitol

87

Drugs to reduce cerebral edema - craniotomy (2)

steroids
diuretics

88

Craniotomy: Complications to assess for and avoid (6)

o Increased ICP
o Bleeding at operative site
o Fluid and electrolyte embalances
o Infection
o Seizures

89

Decreased mental status: Craniotomy

o Common: Decreased mental status 2nd day 2/2 swelling.