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Flashcards in neuro Deck (50):
1

glasgow coma scale

eye opening
motor response
verbal response

ideal: 13 - 15

2

normal pupil size

2 - 6 mm

3

babinski reflex

normal up to age 1 / walking = no babinski

should have plantar reflex (toe curl) when foot stroked

toe splay = severe problem in central nervous sytem

4

CT scan

can be with dye
pics in slices, no talking

5

MRI

picks up on pathology earlier than CT
magnet, thumping sound, tube, can talk

6

cerebral angiography

x ray of cerebral circulation, through femoral artery

consent needed

neuro assessment before (baseline)

7

iodine based dye nursing considerations

monitor: BUN/creat, uop
hold metformin
hydrate to excrete
iodine/shellfish allergies!

8

EEG

records electrical activity of brain
- diagnose seizure disorders, sleep disorders, cerebral infarct, brain tumor, abscess
- eval: seizure types, LOC, dementia
- coma screening, indicates brain death

hold sedatives before! (decrease activity)

9

lumbar puncture

site: lumbar subarachnoid space
obtain spinal fluid to analyze for blood, infection, tumor cells;
pressure readings with manometer;
administer drugs intrathecally (brain, spinal cord)

10

post-lumbar puncture

lie flat OR prone (preferable, seal forms) - 2 to 3 hours
- increase fluids (replace)
- common: headache with pain increasing if sitting up

11

lumbar puncture positioning

1) propped over bedside table, head down
2) side lying fetal - arch back max

12

contraindication for lumbar puncture

ICP - brain herniation can result

13

early s/s ICP

earliest: change in LOC
- drowsy, randomly restless, confusion
speech: slurred, slowed
response: delayed

14

late s/s ICP

marked change in LOC (stupor to coma progression)
cushing's triad
posturing

15

cushing's triad

1) systolic htn (widening pulse pressure)
2) slow, full, bounding pulse
3) irregular respirations

16

posturing

response to painful/noxious stumuli, indicates motor response centers of brain are compromised; rigid, tight, burning calories
- decorticate
- decerebrate

17

decorticate posturing

arms flexed inward, bent in toward body and legs extended

18

decerebrate posturing

all four extremities in rigid extension
WORST

19

CSF circulates in which space

subarachnoid

20

lumbar puncture goes into

subarachnoid space

21

ICP tx

- O2
- adequate cerebral perfusion
- T under 100.4/38 (metabolic demand)
- elevate HOB
- head midline (jugulars drain)
- limit suction/cough
- space interventions
- barbiturate induced coma (phenobarb)
- osmotic diuretics (mannitol)
- steroids (dexamethasone) decrease cerebral edema

22

GCS: 8

intubate!

23

meningitis

inflammation of spinal cord or brain
(meninges lining of brain/spinal cord)

causes viral (fecal trans) or bacterial (resp trans)

24

bacterial meningitis: nursing considerations

very contagious, medical emergency; high mortality

droplet precautions (respiratory transmission)

25

viral meningitis: nursing considerations

transmitted by feces, common infants kids

contact precautions

26

seizures

symptom of underlying disorder rather than disease
- not considered epilepsy if resolves with disease ending

27

partial seizure

aka focal; limited to specific local area of brain
- aura may be only manifestation
- s/s: simple to complex

28

partial seizure simple s/s

without loss of consciousness, numbness, tingling, prickling, pain

29

partial seizure complex s/s

impaired consciousness, confused, unable to respond

30

generalized seizure

aka non-focal; involves entire brain
- loss of consciousness initial manifestation

31

tonic clonic seizures

formerly grand mal
- entire brain, convulsive

32

myoclonic seizures

sudden, brief contractures of muscle or group of muscles

33

absence seizures

formerly petit mall
- brief loss of consciousness
- behavior change very little, maybe short memory loss

34

status epilepticus

continuous seizure without returning to consciousness between seizures

35

rapid acting anticonvulsants

lorazepam, diazepam

36

long acting anticonvulsants

phenytoin, phenobarbital

37

anticonvulsants nursing considerations

monitor for toxicity
use smallest dose necessary
abrupt withdrawal can cause seizure

38

how do you tell CSF from other drainage

glucose +
halo test (blood spot with ring around)

39

neurological hematoma nota bene

small that develops rapidly may be fatal, massive that develops slowly may allow client to adapt

40

epidural hematoma

rupture of the middle meningeal ARTERY - fast bleed under high pressure

injury -> LOC -> recovery -> can't compensate (ICP max) -> neuro changes

agitation, restlessness, pupil changes, seizures, posturing

EMERGENCY

41

subdural hematoma

usually VENOUS
acute (fast), subacute (med), chronic (slow; s/s drunk, stroke-like)

42

myasthenia gravis

acquired autoimmune disease of neuromuscular junction

- fatigue, weakness primarily in muscles innervated by the cranial nerves (eye, swallow), also skeletal and respiratory muscles, gu

- progressive loss of muscle strength

- cause unclear, thymus and hyperthyroid associations

43

myasthenic crisis

sudden exacerbation, sometimes post-infection
- oropharngeal weakness: upper airway obstruction, loss of gag, dysphagia + aspiration
- respiratory failure (muscle weakness)
- VS increase, dec uop, incontinence, hypoxia

HOLD cholinesterase inhibitors temporarily

44

cholinergic crisis

too much cholinesterase inhibitor (anticholinergic): SLUDGE BAM
hard to distinguish from myasthenia gravis
rare

45

differentiate myasthenic vs cholinergic crisis

tensilon test (increases ACh by inhibiting breakdown)
myasthenic: temp improvement
cholinergic: gets worse

46

parkinson's

progressive, neurodegenerative

t remor
r igidity (cogwheel, plastic, lead pipe)
a kinesia
p ill rolling

give dopamine (agonist)

47

guillain barre

acute autoimmune disorder assoc w pns demyelination; hypothesis - response to virus
- varying degrees of motor weakness, paralysis, sensory abnormalities
- ascending (most common), pure motor, descending

- give immunoglobulin, plasmapheresis

48

multiple sclerosis

chronic autoimmune disease affecting myelin sheath, conduction pathway of cns,

remission and exacerbation (ex more freq as severity, duration progresses)

FATIGUE!

49

amyotrophic lateral sclerosis

aka lou gehrig’s; adult-onset upper/lower motor neuron disease
- progressive weakness, muscle wasting, spasticity - eventually leads to paralysis

50

myelogram

insertion of contrast medium into subarachnoid space of spine via lumbar puncture

pre: fluids, allergies; anti-psych/dep/coag can be held for several days; valium ok to give

post: supine with head elevated, several hours