Neurological Flashcards
(245 cards)
1
Q
What encompasses the CNS?
A
Brain & Spinal chord
2
Q
What encompasses the PNS?
A
Cranial and Spinal nerves. Autonomic & Somatic sytems
3
Q
What are autonomic and somatic muscles?
A
Muscles that does not require thought to move i.e intestines, heart etc.
4
Q
What is the basic functional unit of the Neurologic system?
A
Neurons
5
Q
What do the neurons control?
A
All motor, sensory, autonomic, cognitive & behavioral activities.
6
Q
How do we do a neurologic assessment? (long answer)
A
- PAIN
- SEIZURES
- DIZZINESS (ABNORMAL SENSATION OF IMBALANCE OR MOVEMENT) AND VERTIGO (ILLUSION OF MOVEMENT, USUALLY ROTATION)
- VISUAL DISTURBANCES (for example when a patient have migraines and see spots, or if they’ve had a stroke they may struggle to see in the periphery)
- Weakness
- Abnormal sensations (feeling hot, burning, stabbing)
- PAST HEALTH, FAMILY, SOCIAL HISTORY
7
Q
Define altered level of conciousness.
A
- LEVEL OF RESPONSIVENESS AND CONSCIOUSNESS IS THE MOST IMPORTANT INDICATOR OF THE PATIENT’S CONDITION
- LOC IS A CONTINUUM FROM NORMAL ALERTNESS AND FULL COGNITION (CONSCIOUSNESS) TO COMA
8
Q
As altered LOC the actual disorder?
A
No, its a result of pathology. It is the most important indicator that there is something wrong neurologically.
9
Q
What are some things that can lead to altered LOC?
A
Head injury, Stroke, Trauma.
It could be caused by toxicity such as drug overdose or alcohol intoxication.
It could also be due to hepatic and renal conditions.
10
Q
Define Coma.
A
Unconsciousness, Unarousable, Unresponsiveness.
11
Q
What is Akinetic Mutism?
A
An unresponsiveness to the environment. The person makes no movements or sounds but may open their eyes .
Akinetic means no movement
Mutism means that they’re not speaking,
12
Q
What is persistent vegetative state?
A
Severe altered LOC.
Person is devoid of cognitive function but has sleep-wake cycles.
Patients in this state may have severe brain damage from trauma or bleed.
Patients are normally vented and intubated and we are often talking about end of life decisions.
13
Q
What is Locked-in syndrome?
A
The inability to move or respond except for eye movement due to a lesion affecting the pons.
Can be a result of interruption or dysfunction of the cells in the CNS.
14
Q
What do we assess when we do an assessment on patients w/ altered LOC.
A
- VERBAL RESPONSE
- ALERTNESS (Are patients alert, looking at you, following commands, posturing in bed)
- MOTOR RESPONSE (POSTURING: DECORTICATE VS. DECEREBRATE)
- RESPIRATORY STATUS (breathing normal, irregular etc)
- EYE SIGNS (are they tracking you?)
- REFLEXES
15
Q
What is the Glasgow Coma Scale?
A
The Glasgow Coma Scale (GCS) is a clinical tool used to assess a person’s level of consciousness after a brain injury or other medical event affecting the brain (like trauma, stroke, or overdose).
It measures three areas of function:
- Eye Opening (E)
- Verbal Response (V)
- Motor Response (M
16
Q
Explain Decorticate posturing assessment.
A
Decorticate posturing is an abnormal body posture that indicates severe damage to the brain, specifically above the brainstem (at the level of the cerebral hemispheres, internal capsule, or thalamus).
How it looks during assessment:
- Arms: Flexed (bent) tightly toward the chest
- Legs: Extended (straight) and internally rotated
- Fists: Clenched
- Feet: Plantar flexed (toes pointed downward)
17
Q
Explain Decerebrate posturing assessment.
A
Decerebrate posturing is an even more abnormal body posture than decorticate, indicating more severe brain damage — specifically involving the brainstem (at or below the level of the red nucleus, midbrain, or pons).
How it looks during assessment:
- Arms: Extended straight away from the body
- Legs: Extended and internally rotated
- Wrists and Fingers: Pronated (turned inward) and flexed
- Feet: Plantar flexed (toes pointed downward)
- Head and Neck: May be arched back
18
Q
If we see a patient is Decerebrate position, what do we do?
A
Call stroke, get physician at the bedside.
19
Q
Can you do a motor assessment if a patient is in a Decerebrate position or in a Decorticate postion?
A
No.
20
Q
When can motor response not be assessed in a patient ?
A
If the patient is under the influence of vecuronium, a paralytic or neuromuscular agent.
21
Q
What are the diagnostic testing that we do w suspicion of neurological issues? (Long Answer!)
A
- COMPUTED TOMOGRAPHY (CT)
- POSITRON EMISSION TOMOGRAPHY (PET)
- SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY (SPECT)
- MAGNETIC RESONANCE IMAGING (MRI)
- CEREBRAL ANGIOGRAPHY
- MYELOGRAPHY
- NONINVASIVE CAROTID FLOW STUDIES
- TRANSCRANIAL DOPPLER
- ELECTROENCEPHALOGRAPHY (EEG)
- ELECTROMYOGRAPHY (EMG)
- NERVE CONDUCTION STUDIES, EVOKED POTENTIAL STUDIES
- LUMBAR PUNCTURE, QUECKENSTEDT TEST, AND ANALYSIS OF
CEREBROSPINAL FLUID
22
Q
Which is the most common scan?
A
CT scan
23
Q
When comparing CT scan and MRI, which image will be clearer to interpret?
A
The MRI scan.
24
Q
What is an COMPUTED TOMOGRAPHY (CT) scan?
A
A Computed Tomography (CT) scan is a diagnostic imaging test that uses X-rays and computer processing to create detailed cross-sectional images (slices) of the body’s internal structures.
A CT scanner rotates around the patient, taking multiple X-ray images from different angles.
25
What is an POSITRON EMISSION TOMOGRAPHY (PET)
scan?
A PET scan is a nuclear medicine imaging test that shows how tissues and organs are functioning by using a radioactive tracer - usually a form of glucose.
26
What is an SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY (SPECT) scan?
a nuclear imaging test that uses a radioactive tracer and a gamma camera to produce 3D images of organs and tissues, focusing on blood flow and functional activity.
27
What is an MAGNETIC RESONANCE IMAGING (MRI) scan?
Magnetic Resonance Imaging (MRI) is a non-invasive medical imaging technique used to create detailed images of the internal structures of the body. It uses strong magnetic fields and radio waves to generate images, providing high-resolution pictures of soft tissues, such as the brain, muscles, heart, and organs, without the need for ionizing radiation (unlike X-rays or CT scans)
28
What is CEREBRAL ANGIOGRAPHY ?
a diagnostic imaging procedure used to visualize the blood vessels of the brain and neck using contrast dye and X-rays.
29
What is MYELOGRAPHY ?
Myelography is a diagnostic imaging procedure that involves the injection of contrast dye into the spinal canal (specifically into the subarachnoid space) to visualize the spinal cord, nerve roots, and meninges using X-ray or CT imaging.
30
What are NONINVASIVE CAROTID FLOW STUDIES ?
Noninvasive carotid flow studies are ultrasound-based tests used to evaluate blood flow through the carotid arteries, which supply blood to the brain. These studies help detect blockages, narrowing (stenosis), or plaque buildup that could lead to stroke
31
What is a TRANSCRANIAL DOPPLER study?
A Transcranial Doppler (TCD) is a noninvasive ultrasound test that measures blood flow velocity in the brain's major arteries, typically through the skull.
32
What is ELECTROENCEPHALOGRAPHY (EEG) ?
Electroencephalography (EEG) is a noninvasive test that measures and records the brain's electrical activity using small electrodes placed on the scalp.
33
What is ELECTROMYOGRAPHY (EMG) ?
Electromyography (EMG) is a diagnostic test used to evaluate the electrical activity of muscles and the nerves controlling them. It helps assess the health of muscles and the motor neurons (nerve cells that control muscle movement).
34
What are NERVE CONDUCTION STUDIES, EVOKED POTENTIAL STUDIES?
Both Nerve Conduction Studies (NCS) and Evoked Potential (EP) Studies are neurodiagnostic tests used to assess the function of the nervous system—specifically how well electrical signals travel through nerves.
Measures the speed and strength of electrical signals traveling through peripheral nerves (sensory and motor).
35
What are LUMBAR PUNCTURE, QUECKENSTEDT TEST, AND ANALYSIS OF CEREBROSPINAL FLUID ?
Common procedure in patients who may have a brain bleed or infection in the CNS. They test to see if there is an infection.
36
What lab studies may we do in patients with a suspicion of neurological disorder? (long answer)
BLOOD GLUCOSE
SERUM ELECTROLYTES
SERUM AMMONIA
LIVER FUNCTION TESTS
SERUM BUN
SERUM OSMOLALITY
CALCIUM LEVEL
PT/PTT
SERUM KETONES
ETOH/BAC
DRUG CONCENTRATIONS
ARTERIAL BLOOD GASES
37
Why would we assess blood glucose?
If glucose levels are low a person will have altered mentation. If BG is high then the patient may go into a coma.
38
Why would we look at serum electrolytes?
If sodium is low the person may have seizures.
39
Why would we look at serum ammonia?
If high then the patient may have hepatic encephalopathy.
40
Why would we look at serum BUN and serum Osmolality?
May help us determine if patient have diabetes insipidus or SIADH.
41
Why would we look at SERUM KETONES?
For DKA
42
What is Delirium?
"Acute Confusion State"
Begin w/ disorientation but may progress to changes in LOC, irreversible brain damage & death.
43
Delirium happens in ____ % of ICU patients.
80%
44
why does Delirium happen so frequently in ICU patients?
Due to a combination of critical illness, environmental factors, and medical interventions that disrupt normal brain function. It's a common but often underrecognized complication in intensive care settings.
45
What is a delirium protocol?
A delirium protocol is a structured set of evidence-based interventions used in hospitals—especially ICUs—to prevent, detect, and manage delirium in at-risk patients. These protocols aim to reduce the incidence, severity, and complications of delirium.
CAM-ICU (Confusion Assessment Method for ICU) is the most used tool.
46
Delirium is often mistaken for _________ .
Dementia. This may happen especially in the elderly population.
47
What is Delirium usually a result of?
Being intubated or having a trauma.
48
How do we assess for Delerium?
By using the Confusion Assessment Method (CAM) in the ICU.
49
What are modifiable risk factors or developing delirium?
Use of Benzodiazepines (can put patients, esp. elderly into an acute state of delirium) & Blood Transfusions
50
What are non-modifiable risk factors or developing delirium?
Age
Dementia
Prior Coma
Recent Emergency or Trauma
51
Delirium may happen in older adults with ___________ .
Polypharmacy.
52
What is dementia?
* Not an acute state.
* Symptoms may be subtle w/ slow progression over months to years.
53
What is the cause of dementia?
Neurodegeneration.
54
What is the most common type of dementia?
Alzheimer's Disease
55
Alzheimer's disease account for up to _____ % of older adult w/ demetia.
75%
56
Apart from Alzheimer's, what are other types of Dementia?
Vascular, Neoplastic, Demyelinating, Infections, Inflammatory, Toxic, Metabolic & Psychiatric.
57
Can dementia be reversable?
Yes, if it occur with pathologic conditions such as infection that masquerade as dementia.
58
What are seizures?
Episodes of abnormal motor, sensory, autonomic or psychic activity caused by a sudden excessive discharge from cerebral neurons.
It can be local or involve the entire brain.
'Glitching in activity'
Usually short term.
59
What is Epilepsy?
Defined as "more than one unprovoked seizure"
60
What are the 3 types of Epilepsy?
* Focal onset - Localized area of brain
* Generalized onset - Bilateral distributed networks
* Unknown onset. - Provoked or unknown etiology.
61
What are specific causes of Seizure disorders? (long answer)
CEREBROVASCULAR DISEASE
HYPOXEMIA - Deprived of oxygen for a long time.
FEVER (CHILDHOOD) - tend to happen to children under 2 y.o due to quick spike in temperature.
HEAD INJURY - shift in fluid within the brain that causes pressure.
HYPERTENSION - if severe (i.e preeclampsia in pregnancy)
CENTRAL NERVOUS SYSTEM INFECTIONS - i.e meningitis.
METABOLIC AND TOXIC CONDITIONS
BRAIN TUMOR
DRUG AND ALCOHOL WITHDRAWAL
ALLERGIES
62
What is Status Epilepticus?
An acute prolonged seizure.
* Last >5 min
* Series of seizures that occur without recovery in-between the rapid attacks.
* Can happen without impairment of consciousness.
* Medical emergency.
63
What effect may Status Epilepticus have?
May have cumulative effects.
The vigorous muscular involvement causes a heavy metabolic demand.
May lead to brain anoxia and resp. arrest due to brain damage.
64
What may cause Status Epilepticus?
Interruption in anticonvulsant therapy (patients not taking their medications) , fever concurrent infection or other illness.
65
What are Cerebrovascular disorders?
Functional abnormality of the CNS that occur when the blood supply to the brain is disrupted this is a TIA or a Stroke.
66
What is the primary cerebrovascular disorder?
Stroke.
It is also the 5th leading cause of death in the U.S & leading cause of serious long-term disability
67
What is Transient Ischemic Attack (TIA) ?
A temporary neurologic deficit resulting from a temporary impairment/blockage of blood flow.
It is a warning of an impending stroke
Diagnostic workup required to treat & prevent irreversible deficits.
68
What are the non-modifiable risk factors in Stroke/ TIA?
* Age
* Gender
* Ethnicity
69
What are the modifiable risk factors in Stroke/ TIA?
* Controlling HTN (Primary factor)
* Cardiovascular disease (Diet, exercise)
* Elevated cholesterol or elevated hematocrit
* Obesity
* Control diabetes
* Oral contraceptive use due to risk of clotting
* Smoking & Drugs and Alcohol abuse.
70
What is a stroke?
" Brain attack"
* Sudden loss of function resulting from a disruption of the blood supply to part of the brain.
71
What are the 2 types of stroke?
* Ischemic
* Hemorrhagic
72
What is an Ischemic stroke?
Disruption of blood supply caused by an obstruction (thrombus or embolism) that causes infarction of brain tissue (tissue to die)
73
What types of obstructions may cause an Ischemic stroke?
* Large Artery thrombus
* Small penetrating artery thrombus
* Cardiogenic embolism (a-fib)
* Cryptogenic
74
How has COVID-19 been linked to Ischemic Strokes?
COVID-19 caused abnormal clotting in some patients, which resulted in ischemic strokes.
75
What are the signs of a stroke, what should we look out for?
Remember the acronym 'BEFAST' (Be quick)
Balance - loss of balance
Eyes - Loss of vision or focus
Face - drooping
Arm - weakness
Speech - speech difficulty
Time - When did the symptoms start. time to call an ambulance.
76
How does an Ischemic stroke manifest itself?
* Symptoms depending on location of the brain.
* Numbness/ Weakness of face, arm or leg (esp. one
side)
* Trouble speaking or understanding (blank stare)
* Trouble walking, dizziness, loss of balance and
coordination (usually biggest sign)
* Sudden HA
* Perceptual disturbances.
77
How is a Hemorrhagic stroke caused?
Bleeding into the brain tissue, the ventricles or subarachnoid space,
78
What may a Hemorrhagic stroke be caused by?
* Spontaneous rupture of small vessels primarily r/t to HTN.
* Subarachnoid hemorrhage (SAH) caused by a ruptured aneurism.
* Intracerebral hemorrhage r/t amyloid angiopathy
* Arterial venous malformations
* Intracranial aneurysms
* Medications such as anticoagulants.
79
What happens when a patient is having a Hemorrhagic stroke?
* Brain metabolism is disrupted by exposure to blood
* ICP (intracranial pressure) caused by blood in
subarachnoid space
* Compressed or secondary ischemia from reduced perfusion and vasoconstriction causes injury to brain tissue,
80
Intracranial pressure plays a huge part in :
Mentation, Altered level of consciousness and brain function.
81
How does a Hemorrhagic stroke manifest itself?
* Similar to ischemic stroke
* Severe HA (often sudden)
* Loss of consciousness for variable amount of time.
* Sudden changes in LOC
* Vomiting (often projectile)
* Bleeding within the brain and nosebleed esp if patient is on blood thinners.
82
When distinguishing the difference between an Ischemic stroke and a Hemorrhagic stroke, what are one of the first tell tale signs?
Loss of consciousness happens more suddenly in Hemorrhagic stroke, and happens later in an Ischemic stroke and happens more gradually.
Vomiting also happens mainly in hemorrhagic stroke.
83
What are other potential problems that can arise when a patient is having a Hemorrhagic stroke? (long answer)
* VASOSPASM-FREQUENTLY OCCURS 7-8 DAYS AFTER INITIAL HEMORRHAGE, need to be watched in the ICU closely due to possible recurrent bleeding.
* SEIZURE-CAUSED FROM DISRUPTION IN BLOOD FLOW, VASOSPASMS, OR SHIFTING.
* HYDROCEPHALUS-BLOOD IN SUBARACHNOID SPACE IMPEDES CIRCULATION OF CSF
* REBLEEDING-RECURRENCE 1%-5% AFTER INITIAL HEMORRHAGE
* HYPONATREMIA-FOUND IN 30%-50% OF SUBARACHNOID HEMORRHAGE PATIENTS, ASSOCIATED W/ONSET OF VASOSPASMS. COULD LEAD TO SIADH OR CEREBRAL SALT WASTING SYNDROME
84
What is the most important indicator that there may be something wrong with the patient neurologically?
Altered level of consciousness.
85
In Locked-in syndrome, what area of the brain is affected?
The pons.
The pons contains important motor pathways (like the corticospinal and corticobulbar tracts) that control voluntary movement.
Damage to the ventral pons results in quadriplegia and anarthria (inability to speak), but consciousness and cognitive function remain intact.
Patients can often communicate using eye movements (since the vertical gaze and blinking are usually preserved).
86
What 3 functions do the Glasgow Coma Scale assess?
* Eye Opening (E)
* Verbal Response (V)
* Motor Response (M
87
What Glasgow coma score would indicate that the patient is in a deep coma?
3
88
What Glasgow coma score would indicate that the patient has a normal level of consciousness?
15
89
* Arms: Flexed (bent) tightly toward the chest
* Legs: Extended (straight) and internally rotated
* Fists: Clenched
* Feet: Plantar flexed (toes pointed downward)
Which posture?
Decorticate
90
* Arms: Extended straight away from the body
* Legs: Extended and internally rotated
* Wrists and Fingers: Pronated (turned inward) and flexed
* Feet: Plantar flexed (toes pointed downward)
* Head and Neck: May be arched back
Which posture?
Decerebrate
91
Elderly patients are at an increased risk of delirium if they have been given ____________ .
Benzodiazepines
92
What is myelography?
X-ray or CT with contrast injected into the spinal canal to visualize the spinal cord.
93
What are modifiable stroke risk factors?
Hypertension, cardiovascular disease, diabetes, smoking, obesity, and drug/alcohol abuse.
94
What can cause a hemorrhagic stroke?
HTN, ruptured aneurysm, AVMs, anticoagulant use, or trauma.
95
What is a TIA?
A transient ischemic attack; temporary neurologic deficit due to temporary blood flow impairment.
96
What is vasospasm and when does it occur?
Narrowing of blood vessels, typically 7-8 days after a hemorrhagic stroke.
97
What can status epilepticus lead to if not treated?
Brain anoxia and respiratory arrest.
98
What does decerebrate posturing indicate?
Damage to the brainstem, characterized by extension of arms and legs, arching of neck, and downward pointing of toes.
99
What is the most common type of dementia?
Alzheimer’s disease.
100
What is hyponatremia's significance in SAH patients?
It occurs in 30-50% and is linked to vasospasms; can be due to SIADH or cerebral salt wasting.
101
What is the Glasgow Coma Scale used for?
To assess a patient's level of consciousness based on verbal, motor, and eye responses.
102
What does decorticate posturing indicate?
Damage to the cerebral hemispheres, characterized by flexion of arms, clenched fists, and extended legs.
103
What is a persistent vegetative state?
Condition where a patient is awake but not aware, with no cognitive function.
104
What is a lumbar puncture used to analyze?
Cerebrospinal fluid (CSF).
105
What is the primary risk factor for stroke?
Hypertension.
106
What condition can mimic dementia in the ICU?
Delirium.
107
What is akinetic mutism?
Unresponsiveness to the environment; patient may open eyes but does not move or speak.
108
What is status epilepticus?
A seizure lasting more than 5 minutes or multiple seizures without regaining consciousness.
109
What are non-modifiable risk factors for delirium?
Age, dementia, prior coma, emergency/trauma admissions.
110
What is hydrocephalus in the context of hemorrhagic stroke?
Impaired circulation of CSF due to blood in the subarachnoid space.
111
What is a hemorrhagic stroke?
Stroke caused by bleeding into brain tissue or spaces surrounding the brain.
112
What is an ischemic stroke?
Stroke caused by obstruction of blood flow to the brain, leading to infarction.
113
What is Locked-in Syndrome?
A condition where the patient cannot move or speak but is conscious and can communicate via eye movements due to a lesion in the pons.
114
What is the most important indicator of a neurologic patient's condition?
Level of consciousness (LOC).
115
What are modifiable risk factors for delirium?
Use of benzodiazepines and blood transfusions.
116
What is EEG used for?
Measuring electrical activity in the brain, often for seizure evaluation.
117
What is the difference between delirium and dementia?
Delirium is acute and reversible; dementia is chronic and progressive.
118
What are the three main types of seizure onset?
Focal onset, generalized onset, unknown onset.
119
What defines epilepsy?
More than one unprovoked seizure.
120
What symptom is more common in hemorrhagic stroke than ischemic?
Projectile vomiting and sudden severe headache.
121
What is a cerebral angiography used for?
Imaging the blood vessels in the brain.
122
The nurse is caring for a patient who suddenly begins having a tonic clonic seizure. What is the nurse's priority action?
A) Place a padded tongue blade in the client's mouth to prevent injury
B) Restrain the client's arms and legs to prevent injury
C) Turn the client to their side and protect their head
D) Run to get help from other staff members immediately.
C) Turn the client to their side and protect their head
Helps prevent aspiration and keep airways open.
123
What is meningitis?
And inflammation of the meninges whihc cover the & protect the brain and spinal chord.
124
what two bacteria can cause Meningitis?
Streptococcus pneumoniae & Neisseria meningitidis.
125
Can Meningitis be viral?
Yes
126
How is aseptic (non-viral) meningitis caused?
Viral infection secondary to cancer or weak immune system.
127
How is Neisseria meningitidis transmitted?
By secretions or aerosol contamination.
128
What type of community groups are at risk for meningitis?
Denese community groups such as college campuses.
129
how does Meningitis manifest itself?
HA
Fever
Changes in LOC
Behavioral changes
Nuchal Rigidity (stiff neck)
Positive Kernig sign
Positive Brudzinski sign
Photophobia
130
What type of isolation does people with meningitis need to be on?
Droplet Respiratory Isolation
131
How do we check for Kernig sign?
Position the patient: Lay the patient supine (flat on their back).
Flex the hip and knee: Bring one leg up so the hip and knee are both at 90 degrees.
Extend the knee: Slowly straighten the knee while keeping the hip flexed.
132
What is a positive Kernig sign?
The patient experiences pain in the lower back, neck, or resistance in the hamstrings during knee extension.
The leg cannot fully straighten without pain or resistance.
This response is due to stretching of inflamed meninges or spinal nerve roots.
133
How do we assess for Assess for Brudzinski sign?
Lay the patient supine (on their back).
Gently place one hand under the patient’s neck and the other on their chest to prevent movement.
Flex the neck by lifting the patient’s head toward their chest.
134
What is a positive Brudzinski sign?
The patient involuntarily flexes their hips and knees in response to neck flexion.
This is due to meningeal inflammation, which causes pain or discomfort when the meninges are stretched, so the body reflexively bends the legs to reduce that tension.
135
What is a brain abscess?
A collection of infectious material within brain tissue.
136
How does brain abscesses most often occur?
By untreated Otitis media or Rhinosinusitis or by trauma to the skull that allow for bacteria to enter.
137
How doe Brain Abscess manifest itself?
HA - usually worse in the morning
Fever
Vomiting
Neurologic deficits
S&S of ICP
138
How do we diagnose brain abscess?
MRI & CT
139
How do we identify the causative agent of brain abscess?
WIth CT-guided aspiration
140
What is Encephalitis?
Infection/ inflammation in the brain
141
What are the causes of Encephalitis?
Viral : Herpes (Herpes Simplex (HSV), Vector borne viral infections (West nile, St. Louis)
Fungal infections
142
How does Encephalitis manifest itself?
HA
Fever
Confusion
Hallucinations
If caused by vector born virus : Rash, Flaccid paralysis, Parkinson like movements.
143
How do we treat Encephalitis caused by HSV infection?
With Acyclovir
144
How do we treat Encephalitis caused by fungal infection?
Amphotericin
145
What are nursing management tasks associated with encephalitis?
* Frequent and ongoing assessment
* Supportive care
146
What are the 3 autoimmune nervous system disorders that we need to know?
Multiple Sclerosis
Myasthenia Gravis
Guillain- Barre Syndrome
147
What is MS?
A progressive immune-related demyelination disease of the CNS.
148
How does MS manifest itself clinically?
Varies and have different patterns.
Frequently manifest itself in exacerbations and recurrences of symptoms such as : fatigue, weakness, numbness, difficulty in coordination, loss of balance, pain and visual disturbances.
149
what disease modifying therapies can patients take?
Interferon B-1A and B-1B
Glatiramer Acetate
IV Methylprednisolone
150
Why would we potentially give muscle relaxants to patients with MS?
To try to relieve muscle spasms.
151
What assessments do we make with people with MS?
*Assess Neurologic deficits (i.e. visual disturbances)
*Secondary complications (decreased activity level?)
*Impact of disease on physical, social and emotional function & lifestyle.
*Patient and family coping.
152
What is Myasthenia Gravis?
An autoimmune disorder that affects the Myoneural Junction.
Antibodies directed at acetylcholine at the myoneural junction impair transmission of impulses.
153
What are the initial symptoms of Myasthenia Gravis?
Involve ocular muscles
Diplopia
Ptosis - drooping of upper eyelid
154
What are some other symptoms of Myasthenia Gravis?
Weakness of facial muscles, swallowing and voice impairment, Generalized weakness.
155
What is a Myasthenic Crisis?
Result of disease exacerbation of Myasthenia Gravis OR Precipitating event, most commonly a resp. infection.
156
How does a Myasthenic crisis manifest itself?
Patients will have severe generalized muscle weakness w/ respiratory & bulbar weakness.
Patient may develop resp. compromise or failure.
157
What is a Cholinergic Crisis?
A crisis that occur from the treatment Myasthenia gravis. Caused by overmedication with cholinesterase inhibitors.
158
How does a Cholinergic Crisis manifest itself?
Patients will have severe generalized muscle weakness w/ respiratory & bulbar weakness.
Patient may develop resp. compromise or failure.
159
What is Guillain-Barre Syndrome?
Autoimmune disorder w/acute attack of peripheral nerve myelin.
160
What may happen if Guillain-Barre develop quickly?
Rapid demyelination may result in respiratory failure and autonomic nervous system dysfunction with cardiovascular instability.
161
What triggers Guillain-Barre syndrom?
Viral infection by epstein-barr virus
162
How does Guillain-Barre manifest itself?
Weakness
Paralysis
Paresthesia
Pain
Diminished or absent reflexes starting @ lower extremities & progressing upward.
Bulbar weakness
Cranial Nerve Symptoms
Tachy or Bradycardia
Hyper or Hypotension
163
What is Bulbar Weakness?
Bulbar weakness refers to weakness of the muscles controlled by the cranial nerves originating in the medulla oblongata.
164
How do we assess patients w/ Guillain - Barre syndrome?
* Ongoing neurological testing to detect how far up it is progressing.
* Early detection is key to prevent complications such as respiratory failure, cardiac dysrhythmias and DVT from not being able to move lower extremities.
* Monitor for changes of vital capacity in the lungs (ability to breathe)
* Assess vital signs frequently 7 continuous monitoring of ECG
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What is Bell's Palsy?
Facial paralysis caused by unilateral inflammation of the 7th cranial nerve
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How does Bell's Palsy manifest itself?
unilateral face muscle weakness or Paralysis
Increased lacrimation
Painful sensation to face
May have difficulty speaking & eating
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True/ False
most Bell's Palsy patients recover completely in 3-5 weeks
True.
The disorder is also very rare.
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How do we differentiate Bell's Palsy to a Stroke?
Bell's Palsy normally does not include any other weakness other than in one side of the face whereas a stroke can come with weakness elsewhere as well.
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What is Bell's palsy normally proceeded by?
A viral infection.
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Which nerve is affected in Bell's Palsy?
The Facial nerve
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What are the primary types of Brain Tumors?
* Gliomas
* Meningiomas
* Acoustic Neuromas
* Pituitary Adenomas
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What are Angiomas?
Masses of abnormal blood vessels in the brain
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Do all brain tumors manifest the same way?
No, it is determined on the location of the tumor in the brain.
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How does a brain tumor manifest itself generically?
Localized or Generalized Neurologic Symptoms
Symptoms of Increased ICP
HA
Vomiting
Visual Disturbances
Seizures
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What type of brain tumor causes hormonal effects?
Pituitary adenoma
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What type of brain tumor causes loss of hearing, tinnitus & vertigo?
Acoustic neuroma
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How do we diagnose Brain Tumors?
* Neurologic examination
* CT scan
* MRI
* PET scan
* EEG
* Cytologic Study of Cerebrospinal fluid
* Biopsy
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Patients with a brain tumor will often be put on ____________ medication.
Antiseizure
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How do we assess a patient w primary or metastases brain tumor? (long answer)
* Baseline neuro exam w focus on : Functioning, adapting to weakness, paralysis, loss of vision & speech & dealing w seizures.
* Pain, respiratory symptoms, bowel & bladder function, sleep, skin integrity, fluid balance and temp. regulation (hypothalamus).
* Nutritional status and dietary history
* Family coping
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What is Parkinson's Disease?
Slow. progressive degenerative neurological movement disorder associated w/ decreased levels of dopamine.
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How does Parkinson's manifest itself?
* Cardinal : Tremor, Rigidity, Bradykinesia/Akinesia, Postural instability.
* Autonomic : Sweating, drooling, flushing, orthostatic hypotension, gastric & urinary retention
* Dysphagia (aspiration pneumonia risk)
* Psychiatric changes : depression, anxiety, dementia, delirium, hallucinations.
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How do we assess patients w/ Parkinson's Disease?
* Focus on disability and functional changes that occur i.e response to medication
* Quality of speech, loss of facial expression, swallowing deficits (drooling, poor head control, coughing), tremors, slowness of movement, weakness, forward posture, rigidity, evidence of mental slowness & confusion.
* Fall risk assessment.
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What is huntington disease?
Chronic progressive hereditary disease that results in choreiform movement & dementia.
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What are choreiform movements?
Choreiform movements are involuntary, irregular, unpredictable, brief, and jerky movements that flow randomly from one part of the body to another. They resemble dancelike or fidgety motions.
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How is Huntington Disease transmitted?
It is an hereditary autosomal dominant trait.
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What is the pathology of Huntington disease?
Premature death of cells in the striatum of the basal ganglia (control movement) & the cortex (control thinking memory, perception & judgement)
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What is Amyotrophic Lateral Sclerosis (ALS)?
"Lou Gehrig Disease'
Loss of motor neurons in the anterior horn of the spinal cord and loss of motor nuclei of lower brainstem.
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How does ALS manifest itself?
* Progressive weakness and atrophy of muscle cramps, twitching & lack of coordination
* Spasticity, deep tendon reflex brisk & overactive
* Difficulty speaking, swallowing, breathing
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What tools would we use to diagnose ALS?
CT, MRI where we can visualize loss of motor neurons.
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What are muscular dystrophies?
Incurable disorders characterized by progressive weakening & wasting of skeletal & voluntary muscles.
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How do people get muscular dystrophies?
Most are inherited disorders.
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What is the most common muscular dystrophy and how is it inherited ?
Duchenne.
Inherited as a sex linked trait.
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What are the common characteristics of muscular dystrophies?
* Varying degrees of muscle wasting & weakness
* Abnormal elevation in serum levels of muscle enzymes.
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How are muscular dystrophies normally discovered in patients?
Normally discovered in children that don't gain function or are able to progress as well as other children.
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Most back problems are related to _______ _________.
Disc Disease.
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What is one of the most common contributors to opioid abuse?
Back pain
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As we age, what tend to happen to the discs of our spine?
They tend to shrink and lose their elasticity.
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What is Radiculopathy?
Radiculopathy is a condition caused by compression, inflammation, or injury of a spinal nerve root.
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The most common herniation of lumbar discs occur in the ____________ Lumbar spine
L5-S1
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If patient have a herniated disk in L5-S1, what will be their most common complaitns?
Low back pain, muscle spasms, sciatica.
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what is herniation of lumbar discs usually aggravated by?
Repeated bending over motion and not using proper body mechanics, because this can cause interstitial spinal fluid pressure to build up.
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What is a positive Kernig sign?
A) Extreme sensitivity to light
B) Any attempt at flexion of the head are difficult because of spasms in the muscles of the neck.
C) When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended.
D) When the patient's neck is flexed, flexion of the knees and hips is produced, when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity.
C) When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended.
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What can we give to prevent meningitis?
Vaccine to youth 11 - 12 y.o
Booster at 16. F1st yr college students and members of military.
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How do we treat meningitis?
Early administration of high dose of appropriate IV antibiotic - for bacterial meningitis
Dexamethasone
Treatment for dehydration, shock and seizures (bacterial)
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True/False
Viral meningitis is "worse" than bacterial meningitis.
False.
Bacterial meningitis is worse. There are worse symptoms and the patient may go into shock. Abx is needed for treatment.
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Why are we giving Dexamethasone for Meningitis?
Reduce inflammation in the subarachnoid space and help decrease the risk of neurologic complications, such as hearing loss, seizures, or increased intracranial pressure.
It works by suppressing inflammation and immune responses.
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What are the nursing managements r/t Meningitis? (long answer)
* Frequent neuro assessment (LOC) and VS
* Pain & Fever management
* Protect from injury r/t seizures
* Monitor daily weight, serum electrolytes, urine
volume, specific gravity and osmolality.
* Prevent complications ass. w/ immobility
* Infection precautions
* Supportive care
* Coping. Client & family.
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In terms of meningitis, when do the patient normally seek medical attention?
When they have constant HA and Nuchal rigidity .
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With meningitis patients, why would we need to check urine volume, specific gravity and osmolality daily?
To monitor for SIADH.
ICP can put a strain on the pituitary gland and lead to hormone imbalances.
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How does a patient acquire a brain abscess?
Ear and Nose.
Otitis Media, Rhinosinusitis
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how do we manage a brain abscess medically ?
Control ICP
Drain Abscess
Admin. appropriate abx
Corticosteroids may be used to treat cerebral edema.
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What are the nursing managements associated w/ brain abscess?
* Frequent Neuro assess.
* Admin medications
* Assess response to treatment
* Supportive care
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What is the biggest symptom of increased ICP?
HA & decreased/ altered LOC
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What are the major treatment goals for managing a patient w/ MS? (long answer)
* Promotion of physical mobility
* Avoid injuries
* Achievement of bladder & bowel incontinence
* Promote speech & swallow mechanisms
* Improve cognitive functioning.
* Develop coping strengths
* Home maintenance
* Adaption of sexual function (patients are often younger)
* Memory aid - daily routine.
* Interventions to minimize stress
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What should patients w/ MS avoid?
Very strenuous activity & extreme fatigue.
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What is a symptom MS patients may exhibit of they are having issues w/ swallowing?
Coughing due to aspiration.
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What usually causes Guillain-Barre Syndrome?
Viral infection
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What is Guillain-Barre Syndrome classifies as?
An neurological autoimmune disorder.
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Where int he body does Guillain-Barre syndrome start?
From the toes and the progress upward. Ascending inflammation disorder of the nerve fibers.
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What does Guillain-Barre syndrome do to the nerve fibers?
Makes then non or or only partly functioning depending on severity of the disease.
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Can patients recover from Guillain-Barre Syndrome?
Yes, with treatment.
Will take at least 2-4 weeks to recover, sometimes longer.
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What is the most severe effect of Guillain-Barre Syndrome?
Respiratory failure.
Ensure that we have a ventilator and suction in the room of the patient,
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What are other severe complication of Guillain-Barre Syndrome?
DVT - lack of movement
PE - lack of movement
Urinary retention - If severe enough.
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What are the major goals when it comes to treating patients w/ Guillain-Barre Syndrome?
* Improve resp function
* Increase mobility
* Improve nutritional status
* Effective communication
* Decrease fear and anxiety
* Effective coping
* Absence of complications
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What are some nursing management tasks that we should be doing with patients with Guillain-Barre Syndrome to prevent DVT caused by lack of mobility?
* Enhance physical mobility
- Passive ROM TID
- Position changes Q2H
- Elastic compression hose or Sequential Compression
Boots
- Adequate hydration
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In patients w/ Guillain-Barre syndrome, we should carefully assess ___________ & ________ reflexes to prevent aspiration.
Swallowing & Gag
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What are contractures?
Permanent tightening or shortening of muscles, tendons, or ligaments, leading to limited joint movement, stiffness, and deformity.
They often occur due to immobility, neurological damage, burns, or lack of range-of-motion exercises.
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Why are Contractures are a concern with Guillain-Barré syndrome?
The condition causes muscle weakness and paralysis, which can lead to prolonged immobility. Without regular movement or physical therapy, the muscles and connective tissues can tighten and shorten, resulting in permanent loss of joint mobility and function.
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What causes Bell's Palsy?
Viral infection. Epstein Barr virus.
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How do we manage Bell's Palsy Medically?
Corticosteroid therapy may be used to reduce inflammation and diminish severity of the disorder.
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What nursing managements should we be doing for patients with Bell's Palsy?
* Reassure patient that stroke has not occurred.
* Protect eye from injury - Cover eye with shield at night, instruct patient to close eyelid, use eye ointment & sunglasses.
* Facial exercises and massage to maintain muscle tone.
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What is a common type of brain tumor of the brainstem?
A) Astrocytoma
B) Neuroma
C) Pineocytoma
D) Pineoblastoma
A) Astrocytoma
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How do we manage Parkinson's Medically?
Levodopa-Carbidopa most effective medical treatment.
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How does Levodopa-Carbidopa work to treat Parkinson's disease?
LEVODOPA CONVERTS TO DOPAMINE IN BASAL GANGLIA=SYMPTOM RELIEF
CARBIDOPA GIVEN TO AVOID METABOLISM OF LEVODOPA BEFORE IT REACHES BRAIN
THERAPEUTIC MOSTLY IN FIRST 1-2 YEARS, AFTER THE BENEFITS WANE
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Within 5-10 yrs, most patients with Parkinson's develop ___________ .
Dyskinesia
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What is Dyskinesia?
Facial grimacing, Rhythmic jerking movement of hands, head bobbing, chewing and lip smacking movements and involuntary movements of the trunk and extremities.
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what are the major goals in Parkinson's disease treatment?
* Improving functional mobility
* Maintaining independence in ADLS
* Achieve adequate bowel elimination.
* Attain acceptable nutrition status
* Achieve effective communication
* Develop positive coping skills.
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How do we improve mobility in patients with PArkinson's disease?
* Progressive daily program
* Strength and ROM exercises
* Postural exercises
* Consult w/ PT
* Walking technique for safety & balance
* Frequent rest periods
* Proper shoes
* Use of assistive devices
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What is an anticholinergic medication used to treat Parkinson's disease?
A) Benztropine Mesylate
B) Diphenhydramine Hydrochloride
C) Orphenadrine Citrate
D) Phenindamine Hydrochloride
A) Benztropine Mesylate
Used to control tremors, rigidity and counteract action of Ach in patients with PArkinson's
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What pain relief is given for Lumbar Disc Disease?
Muscle relaxants
NSAIDs
Systemic Corticosteroids - for inflammation
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In patients with Lumbar Disc Disease, what are some ways that we can help increase their functional ability?
* Weight reduction if needed
* PT / Exercise
* Biofeedback - TENS units (electrical conductivity that
relaxes muscles)
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how can we surgically treat Lumbar Disc Disease?
With Lumbar Laminectomy/Discectomy
Or Microdiscectomy (take of pieces of broken disc)
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What is Myelographyy?
A treatment for Lumbar Disc Disease where they stimulate damage nerves due to disc compression.
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For chronic Lumbar Disc Disease, what type of pain management medication may the patient be on?
* Opioids (although we try to avoid this)
* Antidepressants due to the nerve pathway.
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After a back surgery, how long should a patient avoid heavy work?
2-3 months post-op.
