Neuro

Question 1

Glasgow coma scale

Eye=
Motor=
Verbal=

Answer 1

4
6
5

Question 2

Glasgow eyes

SVPNR

Answer 2

Spontaneous-4
Verbal-3
Pain-2
No response-1

Question 3

Glasgow motor

VPWFENR

Answer 3

Verbal-6
Pain-5
Withdraws-4
Flexes abnormally-3
Extends abnormally-2
No response-1

Question 4

Glasgow verbal

ODWSNR

Answer 4

Oriented
Disoriented
Words are inapprpriate
Sounds are incomprehensible
No response

Question 5

We like a high number of ____ to ____ in glasgow coma scale.

Answer 5

13…15

Question 6

Babinski reflex is when

It is normal in infants up to_____ year and may be seen up to ______ years.

If toddler is walking already this means they should not have ______.

Answer 6

Toes fan out

1 year….2 years

Babinski reflex

Question 7

Curling of the toes when the bottom of the foot is stroked and is a normal reflex in adult or child >1 year is?

Answer 7

Plantar Reflex

Question 8

DTR scale

0=
1+ =
2+ =
3+ =
4+ =

Answer 8

No response
Hypoactive
Active/normal
Slightly hyperactive
Hyperactive with clonus

Question 9

Ankle clonus is

Answer 9

Abnormal reflex movements of the foot induced by dorsiflexion

Question 10

Lumbar puncture site

Purposes are:

Obtain cerebrospinal fluid to test for _______ infection and______ cells.

Measures______ ______ and reduce_____ pressure

Administer drug ______

Answer 10

Lumbar subarachnoid space

Blood…tumor

Pressure readings…..CSF

Intrathecally ( into the spinal canal )

Question 11

Positions during lumbar puncture

Answer 11

Propped up over bedside table with head down
Fetal Position( chin to chest and knees flexed)

Question 12

CSF should be inspected for ______

CSF should be ____ and _____

Answer 12

Infection

Clear … colorless

Question 13

Post lumbar procedure position should be _____ for _____ hours.

Answer 13

Prone or lie flat

4-8 hours

Question 14

What is the most common complication after lumbar puncture?

This pain _______ when client is sitting up or _____ and ________ when the client is laying down

Treatment for this complication?

Answer 14

Headache

Increases..standing…decreases

Bed rest,pain meds,increase fluids and BLOOD PATCH

Question 15

Earliest sign of increased ICP?

Speech may become _____ or ______

______ to respond to commands

______ with no apparent reason and ______

Answer 15

Change in LOC

Slurred … Slowed

Slow

Restlessness…. confusion

Question 16

Late signs of increased ICP

Marked change to LOC progressing to stupor, then _____

Cushings triad requires _______ intervention to prevent further brain ischemia and restore perfusion

Cushings triad are:

Answer 16

Coma

Immediate

Systolic HPN with widening pulse pressure
Slow,full and bounding pulse
Irregular respiration

Question 17

Another late sign for increased ICP are ______ and _______ posturing

This posturing flexes arms inward towards the body and legs extended

This posturing flexes all 4 extremities outward and considered to be the WORST.

Answer 17

Decorticate…decerebrate

Decorticate

Decerebrate

Question 18

National Dysphagia Diet consists of_____ stages

Answer 18

3

Question 19

Stage I aka _______. Consists of food that are uniform, _______ and _________ texture.
Examples are hot cereals,apple sauce and yogurt.

Stage II aka_______ Includes foods that are______ and ________. Examples are canned fruit(except pineapple),moist ground meat and well-cooked noodles.

Stage III aka_______ Includes ______ foods with exception of hard, sticky and crunchy foods.

Answer 19

Dysphagia Puree…..Pureed..Pudding-like

Dysphagia Mechanically Altered…..moist….soft-textured

Dysphagia Advanced…regular

Question 20

A _________ maneuver should be used instead of the _______,________ on a patient with spinal cord injury or trauma to the head or neck.

Why?

The patient should be stabilized and manipulation of the ______ should be ______

Answer 20

Jaw-thrust…head tilt chin lift

To avoid further damage to the spine.

Neck….avoided

Question 21

________ is a paralysis or weakness in the muscles involved in lifting the front part of foot.

Use hight top shoes or ______ to provide_______ when at rest.

Answer 21

Foot drop

Boots…..support

Question 22

Always _______ a patient with head injury that their ICP is going up if they complain of a ________.

Answer 22

Assume…Headache

Question 23

Projectile_______ can occur. Why?

Answer 23

Vomiting. Because the vomiting center in the brain is being stimulated.

Question 24

Complications of increased ICP.

Answer 24

Brain herniation
DI
Siadh

Question 25

Brain herniatian obstructs the _____ _______ to the brain leading to anoxia and then brain _______.

Answer 25

Blood flow....death

Question 26

``` Treatment for increased ICP: Goals: Reducing cerebral _______ Reducing the amount of _______ Reducing ______ ______ in the brain ```

Answer 26

Edema CSF Blood volume

Question 27

_____ oxygen levels and ____ CO2 levels causes cerebral vasodilation in the brain which increases ______. Increased ______ = increased _____ = increased_______

Answer 27

Decreased....High....ICP Volume...cardiac output.....brain perfusion

Question 28

If glasgow coma is below 8 think ______

Answer 28

Intubate

Question 29

``` Maintaining cerebral perfusion Oxygenation Hypotension/bradycardia -dobutamine/norepinephrine Keep temp below 100.4⁰f -hypothalamus -hypothermia Elevate and Midline Watch TURNING Avoid and Limit Spaced ```

Answer 29

Because decreased in oxygen and high carbon dioxide causes vasodilation which increases ICP We dont want hypotension/bradycardia because this decreases cerebral perfusion. - isotonic solutions or inotropic medications can be given for short term Increased temp increases cerebral demand and edema which increases ICP -hypothalamus may not be working properly so cooling blanket is needed -hypothermia may be used as treatment to decrease metabolic demand in the brain thus decreasing cerebral edema Elevate the HOB and keep the head in midline position to facilitate drainage In turning the client, you should monitor for increased ICP, if the ICP has not come down in 15 minutes this means the client is not tolerating that side very well Avoid restraints,valsalva,nose blowing,bladder distention and Limit suctioning and coughing Nursing interventions should be spaced

Question 30

ICP monitoring devices: Ventricular catheter monitor or subarachnoid screw Greatest risk? Loose connections Dressings should be dry

Answer 30

Infection Loose connections should be avoided to decrease bacterial invasion Bacteria loves wet or moist places

Question 31

Meningitis is Causes: bacterial or viral ``` S/S: Kernig Brudzinski Severe N/V Fever Disorientation Seizure ``` ``` Treatment: Corticosteroids Antibiotics Seizure precautions, give Droplet preacutions -immunizations Contact precautions -children and infants ```

Answer 31

Inflammation of the meninges which is the covering of the spinal cord Bacterial or viral whic mainly travels through the resporatory system S/S: Kernig is the severe stiffness of the hamstrings. Inability to straighten when hips is flexed 90⁰ Brudzinki is when severe neck stiffness which causes hips and knees to flex when neck is flexed Severe HEADACHE nausea and vomiting Chills and High Fever Disorientation that can lead to coma Corticosteroids decreases inflammation of the brain Antibiotics for bacterial Seizure precautions must give anticonvulsants Droplet precautions for bacterial meningitis because it is transferred by the respiratory system -immunizations is recommended for college students Contact precautions if viral, usually seen in children and infants and transmitted via feces

Question 32

Traumatic Brain Injury is Can either be Closed or Open Basilar skull fracture -bleeding in Battles Sign Raccoons Eyes Cerebrospinal Rhinorrhea How to tell if CSF leaking from nose? Depressed fractures requires 2 types of TBI: Contusions(whiplash) Hematoma -small or massive Remember: fast bleeding = increased ICP

Answer 32

Injury to the brain Closed TBI there is NO skull fracture and Dura is not Torn Open TBI there IS skull fracture and Dura is TORN Basilar is the most serious skull fracture -bleeding will happen in the EENT (EYES, EARS,NOSE,THROAT) Battles sign is bruising over the mastoid bone behind the ears Raccoons eyes is periorbital bruising Leaking spinal fluid from the nose Glucose and HALO TEST Surgery but non depressed dont Contusions are seen with blunt trauma or acceleration-deceleration injuries like a whiplash Small hematomas that develops rapidly may be fatal, massive hematomas that develops slowly can allow the patient to adapt

Question 33

Epidural hematoma is Patho Treatment: Burr holes Ask questions like: Did they pass out , wake up and pass out again? Epidural hematoma is a

Answer 33

Rupture or laceration of the middle meningeal artery which is a fast bleeder under high pressure Injury ➡️ loss of consciousness ➡️ recovery period ➡️ bleeding into their head ➡️ cant compensate anymore➡️ neuro changes Burr holes to remove clot, stop bleeding and control ICP Medical emergency

Question 34

Subdural hematoma Usually a Venous bleed which is -May be acute, subacute, or chronic Treatment Acute or chronic is

Answer 34

Collection of blood between the dura and the brain Which is much slower than arterial Immediate craniotomy to remove clot and control ICP

Question 35

Concussion is Bring patient to ED if these signs appear: ☆☆Difficulty awakening/speaking, confusion, severe headache,one sided weakness

Answer 35

Temporary loss of neurologic function with complete recovery These are signs that ICP is going up

Question 36

Spinal cord injury: Autonomic dysreflexia is - T6 - exaggerated ☆☆Causes: (DCS) Distended bladder Constipation Sttimulation to skin like: ``` S/S: Sweating Severe Bradycardia Blurred vision Nausea and anxiety ``` ``` ☆☆treatment First is to sit -if bed bound Treat the cause like -distended bladder -impaction -skin stimuli ```

Answer 36

Life threatening emergency that can occur with an upper spinal cord injury above the T6. Aka hyper-reflexia Exaggerated response to stimuli that are harmless to someone without spinal injury Pressure, pain or temperature Sweating especially on the forehead Hypertension Decreased pulse ``` Sit the client up to lower BP -if bedbound put them in semi-fowlers Treat the cause like Distended bladder insert catheter Remove impaction with local anesthetic Remove the skin stimuli causing pain, pressure or cold temp ```

Question 37

CT scan ``` With or without Takes pictures Check for allergy to Velcostrap on Claustrophobic ```

Answer 37

Computerized tomography of the brain Dye In slices Shellfish or iodine Forehead to immobilize client and keep head still May become claustrophobic so make sure to tell client they can talk and hear others

Question 38

MRI ``` Picks up on Enclosed and no jewelry Tattoos Veterans could have Claustrophobic Thumping sound ```

Answer 38

Magnetic resonance Imaging Pathology earlier than CT scan Client will be enclosed in a tube and remove jewelry Find out if client has tattoos that contains lead Veterans could have shrapnels Client may become claustrophobic so talk to them Teach client that a thumping sound may be heard to relieve their anxiety

Question 39

PET Nuclear image test Useful in diagnosing During procedure must inhale or injected with - may have dizziness,lighthead,headache After procedure no contact with

Answer 39

Positron emission tomography Test to view parts of the brain or any part of the body as its working Alzheimer's disease, brain tumors, CVA(stroke), parkinsons, aspects associated with mental illness Radioactive Gas or radioactive substance and may experience dizziness or lightheadedness or headache upon inhalation of gas NO contact with infants, children or pregnant women for 24 hours because they are radioactive

Question 40

Cerebralangiography ``` Femoral or brachial artery Check for allergy to Protect kidneys -hold metformin -hydration -BUN/Crea Facial flushing and metallic taste Peripheral pulse is 4-6 hours on Complications: Bleeding and Embolus ```

Answer 40

Series of timed x-rays of the cerebral corculation using dye Injected through the femoral or brachial artery like a heart cath Iodine and shellfish Dye is excreted through the kidneys so we must make sure kidneys are functioning properly. We need to HOLD metformin for 24 hours prior to administering and 48 hours more before resuming Hydration is maintained pre and post procedure BUN/CREA is monitored pre and post procedure Upon injection of dye, facial flushing and metallic taste will happen Peripheral pulses are Monitored pre and post Bed rest for 4-6 hours same as heart cath clients Bleeding and embolus can happen so monitor these closely

Question 41

Electroencephalography records ``` Diagnostic for Screens for Indicator for Hold caffeine Blood sugar ```

Answer 41

Records electrical brain activity Seizure disorders Coma Brain death Hold stimulants like coffee it increases electrical brain activity Not npo because we dont want blood sugar to drop because it could affect brain electricity