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Neuro Flashcards

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1
Q

GCS

A

Eye Opening
Motor Response
Verbal Response

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2
Q

Normal pupil size

A

2-6mm

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3
Q

Babinski Reflex is normal when?

A

Child up to 1 year

If they’re walking, it shouldn’t be present

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4
Q

Positive Babinski Reflex

A

Fanning of the toes when you stroke the bottom of the foot. This means there is a severe problem in the CNS. (Tumor or lesion on the brain or spinal cord, multiple sclerosis, lou gehrig’s dz)

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5
Q

Negative Babinski Reflex

A

Good thing, should have a plantar reflex/curling of the toes

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6
Q

Ankle clonus

A

Series of abnormal reflex movements of the foot, induced by sudden dorsiflexion

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7
Q

CT scan

A

With/without contrast dye
Takes pics in layers
Keep head still, no talking

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8
Q

Do you need to sign a consent for a CT w/ dye?

A

Yes

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9
Q

Why are MRIs better than CTs

A

They pick up on the patho earlier

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10
Q

What is used in an MRI

A

A magnet
No radiation
Sometimes dye, not usually

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11
Q

Do teeth fillings matter for MRIs?

A

No, they aren’t metal

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12
Q

Old veterans for MRIs

A

They should get an x-ray first to see if any scrap metal is in their skin

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13
Q

Cerebral angiography

A

Consent is needed bc dye is used
X-ray of cerebral circulation
Goes through the femoral artery, similar to heart cath

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14
Q

Pre-procedure cerebral angiography

A

Well hydrated/void/peripheral pulses/groin prepped
Watch BUN and creatinine, output
Explain they will have a warmth in face and metallic taste
Check for allergies to iodine or shellfish

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15
Q

What med do you hold before a cerebral angiography?

A

Metformin

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16
Q

Why does the client receiving a scan with dye need to be well hydrated?

A

Dye is excreted through the kidneys

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17
Q

Post procedure cerebral angiography

A

Bed rest for 4-6 hours
Watch for bleeding at femoral artery site
Embolus can go to arm, heart, lung, kidney
If it goes to the brain, the client will have a change in LOC, one-sided weakness, and paralysis, motor/sensory deficits.

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18
Q

EEG

A

Records electrical activity of the brain
Helps diagnose a seizure disorder
Evaluates loss of consciousness and dementia
Indicator of brain death
Diagnoses sleep disorders like narcolepsy, cerebral infarct, brain tumors or abscesses

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19
Q

Pre procedure EEG

A

Hold sedatives bc they decrease the electricity of brain
No caffeine-increases electricity
Not NPO be drops BS

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20
Q

During EEG procedure

A

Get a baseline first with client lying quietly
May be asked to hyperventilate for 2-3 minutes to assess brain circulation, assess photo stimulation for seizures, or sedate for sleep study
If you have someone who is completely unconscious, a pain response or noxious stimuli may be introduced to stimulate a brain wave. This can be anything from a strong smell like ammonia to a bright light

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21
Q

Lumbar Puncture site

A

Lumbar subarachnoid space

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22
Q

Purpose of lumbar puncture

A

To obtain spinal fluid to analyze for blood, infection, and tumor cells
To measure pressure readings with a manometer
To administer drugs intrathecally (brain, spinal cord)

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23
Q

How is the client positioned for lumbar puncture?

A

Propped up over the bedside table to arch back for space to form between the vertebrae and needle will go in easily, or side lying fetal position

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24
Q

Care during lumbar puncture

A

Inspect surrounding skin at puncture site for any infection

CSF should be clear and colorless (looks like water)

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25
Post procedure lumbar puncture
Lie flat or prone for 2-3 hours | Increase fluids to replace lost spinal fluid
26
What is the most common complication of a lumbar puncture?
HA, increases in when they sit up, decreases when they lie down
27
How is the HA from lumbar puncture treated?
Bed rest, fluids, pain med, blood patch
28
Life threatening complications of lumbar puncture
Brain herniation: with known increased ICP, lumbar puncture is contraindicated (tell doc immediately if you suspect increased ICP) Meningitis- bacteria can get into the puncture site and into spinal fluid
29
Early signs of increased ICP
Change in LOC Slurred or slowed speech Restless with no apparent reason
30
Late signs of increased ICP
Marked change in LOC progression to stupor, then coma Cushing's Triad-requires immediate intervention to prevent brain ischemia Posturing-response to painful or noxious stimuli
31
Cushing's Triad
Systolic HTN with widening pulse pressure Slow, full, bounding pulse Irregular respirations-look for change in pattern (cheyne stokes or ataxic respirations)
32
Posturing indicates what?
That the motor response centers of the brain are compromised. The client will be rigid and tight and burning
33
Decorticate posturing
Arms flexed inward and bent in toward the body and the legs are extended. Think towards "core"
34
Decerebrate posturing
All 4 extremities in rigid extension. Think away from body
35
Is decorticate or decerebrate worse?
Decerebrate
36
What does the posturing client need?
Calories, doc will start feedings ASAP
37
Miscellaneous signs of increased ICP
HA Changes in pupils and pupil response (fixed, dilated) Projectile vomiting
38
Complication of increased ICP
Brain herniation-obstructs blood flow to the brain leading to anoxia and then brain death DI and SIADH-assess for both
39
Tx of increased ICP
Maintain oxygenation Maintain adequate cerebral perfusion-don't want hypotension or bradycardia bc that decreases brain perfusion Keep temp below 100.4-increased temp increases cerebral metabolism which increases ICP, hypothalamus may not be working and a cooling blanket may be used, hypothermia is used as tx to decrease cerebral edema by decreasing the metabolic demands of the brain Elevate HOB Keep head in midline so jugular veins can drain Watch ICP monitor with turning-it should come back down within 15 min, if not then try another position Avoid restrains/bowel/bladder distention, hip flexions, valsalva, isometrics. No sneezing/blowing Limit suctioning and coughing Spaced nursing interventions Barbiturate induced come to decrease cerebral metabolism: phenobarbital Osmotic diuretics like mannitol to pull fluid from brain cells and filter it out through kidneys Steroids like dexamethasone to decrease cerebral edema
40
Decreased O2 levels and increased CO2 causes what?
Cerebral vasodilation which increases ICP
41
How can you prevent hypotension?
Isotonic saline and inotropic agents like dobutamine and norepi to cause vasoconstriction
42
GCS less than 8, think what?
Intubate
43
ICP monitoring devices
Ventricular cath monitor or subarachnoid screw Greatest risk is infection No loose connections Keep dressings dry (Bacterial travel faster through something wet)
44
Meningitis
Inflammation of spinal cord or brain
45
Causes of meningitis
Either viral or bacterial. Bacterial is transmitted through the respiratory system
46
S/S of meningitis
``` Chills and fever Severe HA N/V Nuchal rigidity (stiff neck) Photophobia ```
47
Treatment of meningitis
Corticosteroids ABX if bacterial Analgesics
48
What precautions for bacterial meningitis?
Droplet. It is very contagious, medical emergency. Has high mortality and vaccine is recommended for college aged students
49
Viral meningitis precautions
Transmitted through feces so contact. Commonly seen in infants and children
50
Partial seizure
Limited to a specific local area of brain | Aura may be only sign
51
What is also called a focal seizure?
Partial
52
Simple partial seizure
Without loss of consciousness, will see numbness, tingling, prickling, or pain
53
Complex partial seizure
Means they have impaired consciousness and may be confused and unable to respond
54
Generalized seizure
Involves entire brain | Loss of consciousness is the initial manifestation
55
What is also called a non-focal seizure?
Generalized
56
Tonic clonic seizure is formally known as what?
Grand mal
57
Myoclonic seizure
Sudden, brief contractions of a muscle or group of muscles
58
Absence seizure
Formally called petit mal and characterized by a brief loss of consciousness
59
Status epilepticus
Continuous seizure without returning to consciousness between seizures
60
Tx for seizure
``` Anticonvulsants: long or short term Rapid acting: lorazepam and diazepam Long acting: phenytoin or phenobarbital *Toxic SE, use smallest dose *Abrupt withdrawal can cause seizures ```
61
Can you bag a seizing pt if they're turning blue?
Yes, don't stick anything in their mouth
62
Open skull fx
Torn dura
63
Closed skull fx
Durn not torn
64
With basal skull fx, you see bleeding where?
Eyes, ears, nose, throat
65
Battle's sign
Seen with skull injury | Bruising over mastoid
66
Raccoon eyes
Seen with skull injury | Peri-orbital bruising
67
Cerebrospinal rhinorrhea with skull injury
Leaking spinal fluid from nose-don't blow or absorb, let it flow out freely
68
How do you tell CSF from other drainage?
Positive for glucose and the halo test
69
Non-depressed skull fx
Usually don't require sx, depressed fx do
70
Concussion
Temporary loss of neurologic function with complete recovery | Will have short (maybe seconds) period of unconsciousness or may just get dizzy or see spots
71
When will a concussion pt have to come back to hospital?
Difficulty awakening/speaking, confusion, severe HA, vomiting, pulse changes, unequal pupils, one-sided weakness (all signs of increased ICP)
72
Small hematoma that develops rapidly
May be fatal
73
Large hematoma that develops slowly
May allow client to adapt
74
Epidural hematoma
Rupture of the middle meningeal artery (faster bleeding under high pressure) Injury then loss of consciousness then recovery period then they can't compensate any longer and have neuro changes EMERGENCY!
75
Tx of epidural hematoma
Burr Hoes and remove clot, control ICP
76
What questions do you ask to identify the type of injury and tx needed with epidural hematoma?
Did they pass out and stay out? Did they pass out and walk up and pass out again? Did they just see stars?
77
Subdural hematoma
Usually a venous bleed | Can be an acute (fast) bleed, subacute (medium) or chronic (slow)
78
Tx of subdural hematoma
Chronic: imitates other conditions, bleeding and compensation, neuro changes are maxed out Acute or chronic: immediate craniotomy and remove clot, control ICP
79
Autonomic dysreflexia
With an upper spinal cord injury (above T6), major complication to look for is autonomic dysreflexia or hyperreflexia.
80
S/S of autonomic dysreflexia
Severe HTN and HA, bradycardia, nasal stuffiness, flushing, sweating, lured vison, anxiety Sudden onset, near emergency is not treated promptly.
81
What can occur with autonomic dysreflexia if not treated promptly?
HTN stroke
82
Causes of autonomic dysreflexia
Distended bladder, constipation, painful stimuli
83
Tx of autonomic dysreflexia
First: sit the client up to lower BP Put in catheter, removed impaction with topical anesthetic, look for skin pressure, painful stimuli, or cold draft breeze in the room

NCLEX (14 decks)

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