NEURO02 Flashcards
(131 cards)
1
Q
What is consciousness?
A
The person is aware of the self and environment and can respond appropriately to stimuli.
It requires normal arousal and full cognition.
2
Q
Define Full Consciousness.
A
Alert, oriented to time, place, and person; comprehends spoken and written words.
3
Q
What characterizes confusion?
A
Unable to think rapidly and clearly; easily bewildered, with poor memory and short attention span; misinterprets stimuli; judgment is impaired.
4
Q
What is disorientation?
A
Not aware or not oriented to time, place, or person.
5
Q
Describe obtundation.
A
Lethargic, somnolent; responsive to verbal or tactile stimulation but quickly drifts back to sleep.
6
Q
What is stupor?
A
Generally unresponsive; may be briefly aroused by vigorous, repeated, or painful stimuli.
7
Q
Define semi-comatose.
A
Does not move spontaneously, unresponsive to stimuli; may stir, moan, or withdraw from stimuli.
8
Q
What is a coma?
A
Unarousable; will not stir or moan in response to any stimuli.
9
Q
What is deep coma?
A
Completely unarousable and unresponsive to any kind of stimulus including pain.
10
Q
List major causes of altered level of consciousness.
A
- Lesions or injuries affecting cerebral hemispheres
- Metabolic disorders
11
Q
What is a Persistent Vegetative State?
A
A permanent condition of complete unawareness of self and the environment and loss of cognitive functions.
12
Q
What occurs in Locked-In Syndrome?
A
The client is alert and aware but unable to communicate due to blocked efferent pathways from the brain.
13
Q
Define brain death.
A
The cessation and irreversibility of all brain functions including the brainstem.
14
Q
List criteria for brain death.
A
- Unresponsive coma with absent motor and reflex movements
- No spontaneous respirations
- Pupils fixed and dilated
- Absent ocular responses to head-turning and caloric stimulation
- Flat electroencephalogram (EEG)
15
Q
What are Cheyne-Stokes respirations?
A
Alternating regular periods of deep, rapid breathing followed by periods of apnea.
16
Q
What is neurogenic hyperventilation?
A
Respiratory rate may exceed 40 per minute due to uninhibited stimulation of the respiratory centers.
17
Q
What characterizes apneustic respirations?
A
Sighing on mid-inspiration or prolonged inhalation and exhalation.
18
Q
Describe ataxic/apneic respirations.
A
Uncoordinated and irregular, likely due to loss of responsiveness to carbon dioxide.
19
Q
What do fixed and dilated pupils indicate?
A
Progression of functional impairment in neurologic function.
20
Q
What are Doll’s Eye Movements?
A
Reflexive movements of the eyes in the opposite direction of head rotation; indicator of brainstem function.
21
Q
What is caloric stimulation?
A
Performed by irrigating the ear with ice-cold water to test the oculovestibular reflex.
22
Q
What is the apnea test?
A
Ventilator is removed while maintaining oxygenation to check for spontaneous respiration.
23
Q
List diagnostic tests used for altered LOC.
A
- CT and MRI scanning
- Cerebral Angiography
- Transcranial Doppler Studies
- EEG
- Laboratory Tests
24
Q
What is the Monro-Kellie hypothesis?
A
An increase in any one of the cranial components causes a change in the volume of the others, leading to increased ICP.
25
Define cerebral edema.
An increase in the volume of brain tissue due to abnormal accumulation of fluid.
26
What are the two types of cerebral edema?
* Vasogenic edema
* Cytotoxic edema
27
What is hydrocephalus?
Progressive dilatation of the ventricular system due to excessive production of CSF.
28
Differentiate between non-communicating and communicating hydrocephalus.
* Non-communicating: Obstruction of CSF drainage
* Communicating: Ineffective reabsorption of CSF
29
What is brain herniation?
Displacement of brain tissue due to increased intracranial pressure.
30
What are the manifestations of uncal herniation?
* Ipsilateral papillary dilation
* Alteration in LOC
* Motor deficits
31
List early clinical manifestations of decreased LOC.
* Confusion
* Restlessness
* Lethargy
* Disorientation
32
What vital signs changes occur with increased ICP?
* Altered respiratory pattern
* Increased Mean Arterial Pressure (MAP)
33
What does a MAP indicate?
The average pressure in a patient's arteries during one cardiac cycle, indicating perfusion to vital organs.
34
What is a common headache associated with increased ICP?
Uncommon but may occur with slow increases in ICP; worse in the morning and with position changes.
35
What does the CT scan procedure require?
Patient on NPO except for medications ordered as part of the test.
36
What does MAP stand for in medical terms?
Mean Arterial Pressure
## Footnote
It is considered a better indicator of perfusion to vital organs.
37
How is Mean Arterial Pressure (MAP) calculated?
MAP = [(2 x diastolic) + systolic] divided by 3
38
What are some uncommon manifestations of increased intracranial pressure (ICP)?
* Headache
* Projectile vomiting without nausea
* Papilledema
39
What is the normal range for serum osmolality?
280-300 mOsm/kg H2O
40
What is a significant nursing consideration when administering Mannitol?
Monitor BP for hypotension
41
What is the drug of choice for loop diuretics?
Lasix (Furosemide)
42
What are some nursing interventions to prevent increased ICP?
* Maintain a quiet & comfortable environment
* Avoid use of restraints
* Instruct patient to avoid Valsalva maneuver
* Limit fluid intake to 1,200 – 1,500 ml/day
43
What is a common cause of headache in the older population?
Cranial Arteritis
44
What characterizes a migraine headache?
A recurring vascular headache lasting from 4 to 72 hours, often initiated by a triggering event
45
What is the most common type of migraine headache?
Common Migraine
46
What characterizes a classic migraine?
Aura stage, characterized by sensory manifestations such as visual disturbances
47
What is a cluster headache?
An extremely severe, unilateral, burning pain located behind or around the eyes
48
What is the characteristic pain of a tension headache?
Bilateral pain with a sensation of tightness or pressure around the head
49
What diagnostic tests are used for headaches?
* CT scan
* MRI
* X-ray studies
* EEG
* Lumbar puncture for CSF if inflammation is suspected
50
What is the definition of epilepsy?
A chronic disorder of abnormal recurring, excessive, and self-terminating electrical discharge from neurons
51
What are the two classifications of seizures?
* Partial seizures
* Generalized seizures
52
What is a simple partial seizure?
Involves the motor portion of the cortex causing recurrent muscle contractions of the face or contralateral body part
53
What is a complex partial seizure characterized by?
Impaired consciousness and repetitive nonpurposeful activity
54
What is the hallmark of generalized seizures?
Involvement of the entire cerebral cortex
55
What is an absence seizure?
Characterized by abrupt and brief lapses of consciousness, lasting 5-10 seconds
56
What are myoclonic seizures?
Sudden uncontrollable jerking movements of one or more muscle groups
57
What is a tonic-clonic seizure?
Affects all age groups, characterized by tonic and clonic phases lasting 2-5 minutes
58
What is status epilepticus?
A life-threatening condition where seizure activity becomes continuous
59
What is the priority in managing status epilepticus?
Establish and maintain the airway
60
What medications are used for abortive therapy in headaches?
* Methysergide Maleate
* Propranolol hydrochloride
* Antimigraine Agents (Triptans)
61
What are some potential triggers for tension headaches?
* Stress
* Anxiety
* Prolonged computer use
62
What nursing care is recommended during a migraine attack?
Comfort measures such as a quiet, dark environment, and elevation of the head of the bed
63
What is the first step in seizure management?
Establish and maintain the airway.
64
What should be administered IV to stop a seizure?
50% dextrose IV. Repeat in 10 minutes if necessary.
65
Which medication is used for long-term seizure control?
Dilantin IV.
66
What is a key part of the diagnostic tests for seizures?
Complete History & Physical Examination.
67
What blood tests are performed during seizure diagnostics?
To identify systemic diseases and related disorders like infection, poisoning, electrolyte imbalance.
68
What imaging tests are used to determine structural brain issues?
CT SCAN or MRI.
69
What does an EEG help confirm in seizure diagnosis?
Seizure diagnosis and localizes any lesion.
70
What is the purpose of a lumbar puncture in seizure diagnostics?
To determine the presence of infection (Meningitis) or elevated protein levels in the CSF.
71
What are antiepileptic drugs (AEDs) used for?
To reduce or control most seizure activity.
72
What is the action of antiepileptic drugs?
By raising the threshold or by limiting the spread of abnormal activity within the brain.
73
What medication is given for partial seizures?
Tigabine (Lobitri).
74
What is the recommended action if a patient is seizure-free for 3 years on Tigabine?
Withdraw the medication.
75
What is the therapeutic plasma level for Phenytoin (Dilantin)?
10 – 20 ug/dL.
76
What are some side effects of Phenytoin?
* drowsiness * ataxia * nystagmus * blurred vision * hirsutism * lethargy * GI upset * gingival hypertrophy.
77
What should be included in nursing considerations for Phenytoin?
* Give oral meds with at least ½ glass of water or with meals * Inform about discoloration of sweat and urine * Have resuscitation equipment for IV administration.
78
What does Carbamazepine (Tegretol) inhibit?
Nerve impulses by limiting the influx of Na ions across neuronal membranes.
79
What are the side effects of Carbamazepine?
* dizziness * drowsiness * ataxia * diplopia * rash.
80
What is the action of Phenobarbital (Luminal)?
Reduces responsiveness of normal neurons to impulses arising in focal areas.
81
What are the side effects of Phenobarbital?
* drowsiness * rash * GI upset.
82
What nursing considerations are important for Phenobarbital?
* Monitor V/S * resuscitation equipment should be available if given IV.
83
What is Clonazepam (Clonopin) used for?
Decreases frequency, duration, and spread of discharges in minor motor seizures.
84
What are the side effects of Diazepam (Valium)?
* drowsiness * ataxia * hypotension * tachycardia * respiratory depression.
85
What is the agent of choice in many seizure disorders of young children?
Valproic acid (Depakote).
86
What are the nursing considerations for Valproic acid?
* Do not take with carbonated beverages * Take with food * Monitor platelets, bleeding time, and liver function tests.
87
What is the percentage of epilepsy candidates that may require surgery?
5%.
88
What are the indications for surgical intervention in epilepsy?
* Unresponsive to medical management * With unilateral focus * Impaired quality of life from seizures.
89
What should be done during a seizure?
* Maintain airway * Provide privacy * Protect the patient from injury * Loosen constrictive clothing.
90
What should be done after a seizure?
* Keep the patient on one side * Ensure the airway is patent * Administer oxygen if prescribed.
91
What is the importance of patient education regarding seizure medication?
Emphasize the importance of regularity of taking meds and avoidance of sudden withdrawal.
92
What is the definition of traumatic brain injury (TBI)?
Any injury of the scalp, skull, or brain capable of causing physical, intellectual, emotional, social, and vocational changes.
93
What are the classifications of TBI?
* Penetrating (OPEN) Trauma * Blunt (CLOSED) Trauma.
94
What are common causes of TBI?
* Falls * Vehicular accidents * Gunshot wounds * Sports injuries * Occupational injuries.
95
What is a skull fracture?
A break in the continuity of the skull caused by forceful trauma.
96
What is a linear skull fracture?
Most common, comprising 80% of all skull fractures, simple, clean break.
97
What are the signs of a CSF leak?
* Rhinorrhea * Otorrhea * Hemotympanum * Battle’s sign * Raccoon eyes.
98
What imaging tests are used for assessment of cranial injuries?
* X-rays * CT scan * MRI * Cerebral Angiography.
99
What is the management for a linear skull fracture?
Bed rest and observation for underlying injury.
100
What is the nursing diagnosis related to skull fracture?
Risk for infection related to access to cranial contents.
101
What is a concussion?
A temporary loss of neurologic function after a head injury with no apparent structural damage.
102
What are the signs of epidural hematoma?
* Loss of consciousness * Lucid period * Rapid decline of LOC * Headache * Vomiting.
103
What is an acute subdural hematoma?
Develops within 48 hours of the initial head injury.
104
What are the symptoms of chronic subdural hematoma?
* Slowed thinking * Confusion * Drowsiness * Lethargy * Headache * Seizures.
105
What is the initial management for concussion?
Observe client for 1 to 2 hours at the ER.
106
What is the purpose of administering hypertonic solution in acute TBI?
Reduces intracranial hypertension.
107
What does ABCs stand for in medical terms?
Airway, Breathing, and Circulation
108
What is the purpose of administering a hypertonic solution?
Reduces intracranial hypertension
109
What is the purpose of inserting an ICP monitor probe?
To assess ICP and monitor therapy to reduce cerebral edema and maintain perfusion
110
What is osmotic diuresis and give an example?
A method to reduce cerebral edema; example: Mannitol
111
What therapy is used to maintain cerebral metabolism?
Oxygen therapy
112
What equipment is typically initiated for a client admitted to the ICU?
* Central Venous Pressure (CVP) catheter
* Arterial line
* Pulmonary catheter
* ICP monitor
* Endotracheal tube
* Mechanical ventilator
* Cardiac monitor
* Pulse oximetry
113
What is the treatment of choice for epidural hematoma and large acute subdural hematoma?
Surgical evacuation of the clot through burr holes and ligation of bleeders
114
What is necessary for treating chronic subdural hematoma?
Craniotomy to evacuate it
115
Why is surgery less successful for intracerebral hematoma?
Due to widespread damage
116
What is a common nursing diagnosis related to increased ICP?
Decreased intracranial adaptive capacity
117
What are signs and symptoms of increased ICP to monitor for?
* Mental state changes
* Vital signs changes
* Vomiting
* Headache
* Lethargy
* Restlessness
* Purposeless movements
* Changes in mentation
118
What is Kernig’s Sign?
Positive if pain is present when extending the legs after flexing the knees towards the abdomen
119
What indicates a positive Brudzinski’s Sign?
Flexion of hips and knees in response to neck flexion
120
What is the primary cause of bacterial meningitis?
Infections from organisms like Neisseria meningitis, Streptococcus pneumoniae, and others
121
What are common clinical manifestations of meningitis?
* Fever and chills
* Headache
* Vomiting
* Sore throat
* Cough
* General malaise
122
What is the key diagnostic test for meningitis?
Lumbar puncture to aspirate CSF
123
What is the nursing management for a patient with meningitis?
* Monitor vital signs
* Maintain fluid and electrolyte balance
* Administer antibiotics
* Provide safety measures due to possible seizures
124
What is encephalitis?
Acute inflammation of the parenchyma of the brain or spinal cord
125
What are common causes of viral encephalitis?
Herpes simplex virus, arboviruses, and others
126
What are the clinical manifestations of viral encephalitis?
* Fever
* Headache
* Seizures
* Stiff neck
* Altered level of consciousness
127
What is the primary management for brain abscess?
* Controlling IICP
* Draining the abscess
* Providing antimicrobial therapy
128
What are common pathogens associated with brain abscess?
* Streptococci
* Staphylococci
* Yeast
* Fungi
129
What diagnostic tests are used for a brain abscess?
* Gram stain and culture of CSF
* CT scan
* Lumbar puncture
130
What is the purpose of administering corticosteroids in brain abscess management?
To reduce inflammatory cerebral edema
131
What is the Clean Program for mosquito control?
* C – Chemically Treated Mosquito Net
* L – Lavivorous fishes
* E – Environmental Sanitation
* A – Anti-mosquito Soap
* N – Neem Trees or Eucalyptus Tree
