neuro

Question 1

glasgow coma scale

Answer 1

eye opening
motor response
verbal response

ideal: 13 - 15

Question 2

normal pupil size

Answer 2

2 - 6 mm

Question 3

babinski reflex

Answer 3

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

Question 4

CT scan

Answer 4

can be with dye

pics in slices, no talking

Question 5

MRI

Answer 5

picks up on pathology earlier than CT

magnet, thumping sound, tube, can talk

Question 6

cerebral angiography

Answer 6

x ray of cerebral circulation, through femoral artery

consent needed

neuro assessment before (baseline)

Question 7

iodine based dye nursing considerations

Answer 7

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

Question 8

EEG

Answer 8

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)

Question 9

lumbar puncture

Answer 9

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

Question 10

post-lumbar puncture

Answer 10

lie flat OR prone (preferable, seal forms) - 2 to 3 hours

• increase fluids (replace)
• common: headache with pain increasing if sitting up

Question 11

lumbar puncture positioning

Answer 11

1) propped over bedside table, head down

2) side lying fetal - arch back max

Question 12

contraindication for lumbar puncture

Answer 12

ICP - brain herniation can result

Question 13

early s/s ICP

Answer 13

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

Question 14

late s/s ICP

Answer 14

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

Question 15

cushing’s triad

Answer 15

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

Question 16

posturing

Answer 16

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

• decorticate
• decerebrate

Question 17

decorticate posturing

Answer 17

arms flexed inward, bent in toward body and legs extended

Question 18

decerebrate posturing

Answer 18

all four extremities in rigid extension

WORST

Question 19

CSF circulates in which space

Answer 19

subarachnoid

Question 20

lumbar puncture goes into

Answer 20

subarachnoid space

Question 21

ICP tx

Answer 21

• 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

Question 22

GCS: 8

Answer 22

intubate!

Question 23

meningitis

Answer 23

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

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

Question 24

bacterial meningitis: nursing considerations

Answer 24

very contagious, medical emergency; high mortality

droplet precautions (respiratory transmission)

Question 25

viral meningitis: nursing considerations

Answer 25

transmitted by feces, common infants kids contact precautions

Question 26

seizures

Answer 26

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

Question 27

partial seizure

Answer 27

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

Question 28

partial seizure simple s/s

Answer 28

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

Question 29

partial seizure complex s/s

Answer 29

impaired consciousness, confused, unable to respond

Question 30

generalized seizure

Answer 30

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

Question 31

tonic clonic seizures

Answer 31

formerly grand mal | - entire brain, convulsive

Question 32

myoclonic seizures

Answer 32

sudden, brief contractures of muscle or group of muscles

Question 33

absence seizures

Answer 33

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

Question 34

status epilepticus

Answer 34

continuous seizure without returning to consciousness between seizures

Question 35

rapid acting anticonvulsants

Answer 35

lorazepam, diazepam

Question 36

long acting anticonvulsants

Answer 36

phenytoin, phenobarbital

Question 37

anticonvulsants nursing considerations

Answer 37

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

Question 38

how do you tell CSF from other drainage

Answer 38

``` glucose + halo test (blood spot with ring around) ```

Question 39

neurological hematoma nota bene

Answer 39

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

Question 40

epidural hematoma

Answer 40

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

Question 41

subdural hematoma

Answer 41

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

Question 42

myasthenia gravis

Answer 42

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

Question 43

myasthenic crisis

Answer 43

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

Question 44

cholinergic crisis

Answer 44

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

Question 45

differentiate myasthenic vs cholinergic crisis

Answer 45

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

Question 46

parkinson's

Answer 46

progressive, neurodegenerative t remor r igidity (cogwheel, plastic, lead pipe) a kinesia p ill rolling give dopamine (agonist)

Question 47

guillain barre

Answer 47

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

Question 48

multiple sclerosis

Answer 48

chronic autoimmune disease affecting myelin sheath, conduction pathway of cns, remission and exacerbation (ex more freq as severity, duration progresses) FATIGUE!

Question 49

amyotrophic lateral sclerosis

Answer 49

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

Question 50

myelogram

Answer 50

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