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Flashcards in neuro Deck (48):
1

define glasgow coma scale

a scale that measures the degree or level on consciousness.

used to assess the level of consciousness or has the potential of altered consciousness.

2

three responses of the glasgow coma scale

1. eye opening
2. motor response
3. verbal response

3

we like to have a number ranging from ___ for the glasgow coma scale.

13-15. 15 is the best score

never will be 0. at least 3

4

what is included in a neuro assessment?

glasgow coma scale
pupillary changes (normal pupil size 2-6) PERRLA
hand grips/lift legs/ pushing strenght of feet
reflex assessment (babinski reflex)

5

___ is always the #1 with neuro assessment.

LOC

6

babinski reflex

normal in a child up to 1 yr.
abnormal in an adult!
the adult or child greater then one year should have a planter reflex or curling or the toes when the bottom of the foot is stroked.

7

what does it mean if the adult has a present babinski reflex or faning on the toes when you stroke the bottom on the foot?

a severe problem in the central nervous system. (tumor or lesion on the brain or spinal cord, MS, lou gehrig's disease)

8

a normal reflex response would be documented as ___.

2+/4+

9

will you need the client to sign a consent form prior to the test when using dye? (CT scan)

YES

CT takes pictures in slices(layers), head still, no talking.

10

MRI:
is dye used?

mri is better than ct. mri picks up on a problem earlier.

NO DYE. no radiation. a magnet is used.

11

cerebral angiography:
will a consent form be needed? why?

xray of cerebral circulation through the femoral artery.
yes signed consent because they are using dye

12

when cerebral angiography , what should you tell the patients?

they will have a warmth in the face and a metallic taste.

13

post procedure for cerebral angiography?

bed rest 4-6 hrs.
watch for bleeding at the femoral artery
embolus (embolus will go to brain bc of this... changes in loc, one sided weakness, paralysis, motor/sensory deficits)

***baseline neuro assessment before they go for procedure.

14

EEG helps to diagnose...

seizure disorders and evaluate the types of seizures occuring.

evaluates loss of consciousness and dementia

screening procedure for coma

indicator of brain death

used to diagnose sleep disorders

15

whats the one test we dont want client to be NPO

EEG

16

pre procedure of eeg

hold sedatives (decrease electricity in brain), no caffeine, not NPO (drops blood sugar)

17

how should a client be positioned with lumbar puncture?

back arched up!!
leaning on table or side lying fetal position

18

post procedure for lumbar puncture?

lie flat or prone for 2-3 hours
increase fluid to replace lost spinal fluid
HA most common complication

19

life threatening complication of lumbar punction?

brain herniation (with known increased ICP, a lumbar puncture is contraindicated)

meningitis

20

normal lab value for icp

0-15mmHG

21

early sign of increased icp

earliest sign? change in loc
speech slurred and slow
delayed in response to verbal
increasing drowsiness
restless with no apparent reason
cofusion

22

late signs of increased icp

marked changes in loc progressing to stupor, then coma!!
vital signs changes (cushing traid)
posturing

23

cushing's traid

1. systolic hypertenson with a widening pulse pressure
2. slow, full, and bounding pulse
3. irregular respirations

24

decorticate posturing

arms flexed inward and bent in towards the body and the legs are extended

25

decerebrate posturing

all 4 extremities in rigid extension; WORST

26

complications of increased ICP

brain herniation :this herniation obstructs the blood flow to the brain leading to anoxia and then brain death

DI and SIADH: can either so you must assess for both

27

with increased icp, you should keep the temperature below ___.

they should be getting ___ saline and ____agents

100.4

isotonic and inotropic (to prevent hypotension)

28

if the glasgow come scale is below 8, think ___

intubate

29

meningitis

inflammation of the spinal cord or brain

can be either viral or bacterial. bacterial is transmitted throught the respiratory system

30

s/s of meningitis

-chills and fever
-severe HA
-N/V
-nuchal rigidity (stiff neck)
-photophobia

31

tx meningitis

steriod
antibiotics if bacterial
analgescis
drop precautions for BACTERIAL meningitis

32

bacterial meningitis is very contagious, medical emergency. it has a high mortality and _____ is recommended for college-aged students.

viral meningitis is transmitted by feces and requires ___ precautions . most commonly seen in infants and children.

immunizations

DROPLET PRECATIONS


contact precautions!

33

partial seizure

is limited to a specific local area of the brain

an aura may be the only manifestation

called focal seizure

symptoms can range from simple to complex

34

aura

things before seizure, bright light etc.

35

simple symptoms

means without loss of consciousness; will see numbness, tingling, prickling or pain

36

complex symptoms

means that they have impaired consciousness and may be confused and unable to respond

37

generalized seizures

involves the entire brain

called non-focal seizure

loss of consciousness is the initial manifestations

38

____ formerly known as grand mal
___sudden, brief contractions of a muscle or group of muscles
____ formerly called petit mal and characterized by a brief loss of consciousness.

tonic -clonic
myoclonic
absence

39

a continuous seizure without returning to consciousness between seizures

status epilepticus

40

anticonvulsants: can be long or short term therapy.

rapid acting are_____.
long acting are _____.

lorazepam and diazepam

phenytoin and phenobarbital

41

battle's sign

bruising over mastoid

42

with basal skull fracture, where do you see bleeding

EENT

43

how do we tell CSF from other drainage?

positive for glucose and the halo test (bloody spot on pillow then it will form a halo)

44

non-depressed skull fractures usually ______; depressed fracture ___ surgery.

do not require surgery

do require

45

what should you be watching for with a client with a concussion?

concussion is a temporary loss of neurologic function with complete recovery!

watch for increased ICP!

46

epidural hematoma


is this an emergency?

rupture of the middle meningeal artery. fast bleeder under high pressure

injury---loss of consciousness--recovery period---cant compensate any longer---neuro changes

tx-burr holes and remove the clot; control the icp

YES THIS IS AN EMERGENCY

47

subdural hematoma

usually a venous bleed.
can be acute (fast), subacute (medium), chronic (slow)

tx- chronic imitates other conditions. bleeding and compensating. neuro changes= maxed out (cant compensate anymore!!)

acute or chronic- immediate craniotomy and remove clot and control ICP

48

autonomic dysreflexia

with upper spinal cord injury (above t6)!

sudden onset. medical emergency. hypertensive stroke could occur.

distended bladder, constipation, and painful stimuli can cause this