Neurology Flashcards
(156 cards)
1
Q
What headache comes from stress or lack of sleep?
A
Tension headache
2
Q
What 2 headaches are due to vasodilation?
A
Migraine and cluster
3
Q
Which headache is unilateral?
A
Migraine
4
Q
What’s the first sign of ICP?
A
Decreased level of consciousness
5
Q
Assessments for neuro system?
A
Glasgow coma scale, mini cog test, mini mental status exam.
6
Q
What is a migraine?
A
Recurring headache, causes throbbing pain on one side of head (unilateral)
7
Q
What may migraines cause?
A
Aura, can be visual hallucinations of bright lights, vision changes or tingling in face, or nausea and vomiting.
8
Q
What do we do for migraines?
A
Sumatriptin,Excedrin, Tylenol, ibuprofen, aspirin, propanolol, metoclopramide
9
Q
Cluster headaches?
A
Localized around eye, more common in men, triggers: same as migraine plus high altitudes, heat and exertion. Sumatriptan and prednisone given to Tx.
10
Q
Nerve pain s/s
A
Causes burning and tingling at site of pain.
11
Q
Nerve pain interventions?
A
Pain meds, anticonvulsants (gabapentin, carbamazepine), acetaminophen, ibuprofen, OPIOIDS NOT HELPFUL, antidepressants.
Promote rest, avoid straining w/ bowel movement, promote mobility.
12
Q
Increased intracrainial pressure can be a result from?
A
Brain injury, brain tumor, hemorrhage in brain, hydrocephalus.
13
Q
What happens if ICP is not tx promptly?
A
Leads to death
14
Q
First sign of ICP
A
Confusion, DO NOT ignore confusion in a non confused patient.
15
Q
What happens to eyes of patient with ICP?
A
Eyes will dilate due to nerve compression in the eye, causing eye to be unable to constrict.
16
Q
Symptoms of ICP
A
Are opposite of shock
17
Q
Symptoms pt may report with ICP
A
Diplopia, changes in personality, difficulty thinking, headache, change in LOC, Hiccups, vomiting w/o nausea
18
Q
Signs you may find in pt with ICP?
A
Altered LOC, bradycardia, Cheyne-stokes respirations, widened pulse pressure, pupillary changes, hemiplegia, babinski reflex, decorticate or decerebrate posturing
19
Q
Herniation of brain occurs?
A
When increased ICP occurs, and the brain has nowhere else to go. (MEDICAL EMERGENCY)
20
Q
What do we watch for with herniation of brain?
A
Widening pulse pressure, elevation in systolic BP, bradycardia, cheyne stokes breathing, respiratory paralysis.
21
Q
How would we diagnose increased ICP?
A
Check for glucose in nasal fluid, check for halo sign, check CT and MRI, DO NOT DO lumbar puncture may cause herniation, EEG, ICP monitoring device?
22
Q
ICP should be?
A
Between 7-15
23
Q
Medications for Increased ICP
A
Mannitol, furosemide, bumetanide, dexamethasone, anti seizure meds to prevent seizures
24
Q
Side effects of diuretics?
A
Electrolyte imbalance, low blood pressure, increased pulse rate
25
Nursing interventions for increased ICP
Low fowlers position (30-45 degrees), keep neck in neutral position, no extreme hip flexion, RESTRICT FLUID INTAKE, give stool softener, no valsalva maneuver, avoid suctioning, administer oxygen, keep pt at cool temp.
26
Management of pt with increased ICP
Find and treat underlying cause of the increased ICP, remove tumor, suture a hemorrhage in the brain, hyper oxygenate pt, my need intubation, mechanical decompression; craniotomy, craniectomy, drainage of hematoma
27
Most common cause of head trauma?
Falls, followed by motor vehicle accidents and self inflicted head injuries
28
True or false?
Younger pts will have a harder time recovering from concussion than older pts
TRUE!!!!
(Because in younger pts the nerves are still forming and now will be focused on forming and healing, while in older pts the nerves are formed thus it is only focused on healing.)
29
Things to watch for in head injuries
Halo sign or glucose sign from the ears or the nose secretions, watch for loss of consciousness, abnormal sensations
30
What sign do we see if there has been a fracture to the skull?
Battle sign, raccoon eyes and periorbital edema, monitor pupils for abnormalities (may be sign of increased ICP)
31
Spinal cord injury can cause?
Loss of motor function, sensation, reflex, activity as well as bowl and bladder control, in certain areas of injury, it can also cause lack of ability to breathe on their own.
32
As soon as you notice that a patient has had injury to spinal cord you would?
Immobilize the patient on a spinal backboard. Keep the neck in neutral position and keep the neck still.
33
Autonomic dysreflexia
A disorder which occurs with pts later, after spinal shock has slowed down. It happens especially in pts with quadriplegia or paraplegia.disorder where pt has “confused” nerves especially when a pt has distended bladder or when the rectum is full. Can be due to tight pressure on lower abdomen like with belt or sitting too long.
34
What will autonomic dysreflexia cause?
Sudden onset sever throbbing headaches, hypertension and flushing above the level of the injury, as well as hypotension and pale extremities below the injury.
35
Autonomic dysreflexia is considered?
A neurological emergency and needs to be treated immediately to prevent pt from having stroke.
36
If you notice signs of autonomic dysreflexia you will?
Immediately raise the head of the bed, notify the HCP, loosen tight clothing like belts or pants, check for noxious stimuli, administer antihypertensive
37
What are the two types of strokes?
Ischemic and hemorrhagic stroke
38
What is a stroke?
Also known as CVA is anoxia to the brain
39
True or false?
Even depriving the brain of oxygen for 10 min can cause irreversible damage.
TRUE (for this reason any suspicion of stroke needs to be treated very seriously)
40
How can we prevent strokes?
Keep your BP low, manage diabetes, lower cholesterol, drink in moderation, eat healthy, stop smoking, exercise regularly, avoid stress, maintain healthy weight, treat sleep apnea
41
What is F.A.S.T?
Face drooping, arm weakness, speech difficulty, time is critical
42
Signs of stroke?
Facial drooping, slurred speech, arm weakness, visual changes, headache (worst headache of life), paralysis.
43
Right Sided stroke will have effect on what side of the body?
The left side
44
Hemorrhagic stroke are?
Frequently caused by brain injury or elevated BP. Can cause subdural hematoma. There is decreased perfusion to the brain. Increased in ICP due to bleeding into brain.
45
Symptoms of increased ICP?
Confusion, cushings triad (high BP, low Pulse, low RR), vomiting without nausea, headache
46
What is an ischemic stroke?
Disrupted blood supply to portion of brain due to clot, fat or cancerous material making its way to the brain. It can be embolic or thrombotic.
47
What is a TIA?
A mini stroke, usually a warning that the pt has a stroke coming on in the future. Clot obscures perfusion and then stops, usually lasts 15minutes to 24 hours
48
What do we do if we suspect someone has a TIA?
Since this is still an emergency! We have to treat it like pt is having stroke until we are certain that they are not. Must follow up with doctor
49
Pt that has a TIA will have a stroke in?
2-5 years (should be given anticoagulant and should be taught to reduce their personal risk factors for stroke)
50
Someone with right sided stroke would have?
(Think they are always right)
Impaired judgment, impaired concept of time, they are impulsive; have safety problems, left sided neglect, short attention span.
51
Someone with left sided stroke would have?
(Ask themselves what is left)
Impaired language, impaired right side, slow caution performance
52
What do we do for ischemic stroke?
We give alteplase (tPA) therapy for up to 4.5 hours after the initial onset, pts who get it within 3 hours have better outcome. Mechanical thrombectomy may be done if the clot is too large for alteplase
53
What do we do for hemorrhagic stroke?
Surgical decompression
54
What do we do for subdural hematoma?
Burr holes
55
S/S of increased ICP
CONFUSION, CUSHINGS TRIAD (high BP, low Pulse, low RR), pupils dilated or anisocoria, vomiting without nausea, hiccups, headache, seizures
56
What do we do for someone with increased ICP?
Semi fowlers position (30-45 degrees), restrict fluid intake, no suction unless necessary, give eyes is basin, give stool softener, keep neck in a neutral position, medications: mannitol, docusate, phenytoin.
57
What are the S/S for head trauma?
Symptoms of increased ICP, check for LOC- alert and oriented, did the pt pass out?, monitor CSF Fluid, battle sign- bruising at the back of the head, raccoon eyes
58
What do we do for a head trauma?
Prep for CT scan and MRI, quiet dark room, monitor for sedation or lethargy, monitor for breathing, monitor for increased ICP
59
What is a migraine?
A unilateral headache, may experience aura (abnormal smells, lights, etc.)
60
What is a tension headache?
Pain feels like a band around the head.
61
What is a cluster headache?
Unilateral usually occurring on one of the eyes
62
Would we do a CT scan and MRI to rule out underlying problems for migraines, tension and cluster headaches?
YES
63
What medication can be given for both migraines and cluster headaches?
Sumatriptan, metoclopramide, ondansetron
64
What are S/S of spinal cord injury?
Paralysis, loss of motor movements, absence of reflexes, absence of bladder or bowel control, no active range of motion, loss of sensation
65
What can we give for tension headaches?
Acetaminophen, propranolol, ibuprofen, aspirin
66
What can we do for spinal cord injury?
Monitor for autonomic dysreflexia, monitor for neurogenic and spinal shock, stabilize the head, CT scan or MRI or X-ray to check if spine is severed partially or totally, halo traction, spine immobilizer.
67
Signs of neurogenic shock?
Bradycardia, hypotension, vasodilation
68
Signs of spinal shock
Loss of ability to move the body
69
About autonomic dysreflexia
Only occurs in pt with spinal cord injury T6 or higher
Causes: full bladder or bowels
Symptoms: throbbing headache, hypertension and flushing in the upper body, low BP and cool skin into the lower body, pale extremities
70
What can we do for autonomic dysreflexia?
Raise head of the bed, put legs down, loosen the clothing or belt, allow pt to empty bowels or bladder, check catheter for kinks, give antihypertensive
71
What should I know about stroke?
FAST acronym, facial drooping, arm weakness, speech difficulty
72
What diagnostic test do we do for stroke?
CT scan, MRI for all strokes
73
Hemorrhagic stroke S/S
Swelling in the head, increased ICP- cushing’s triad, confusion, high BP, or low BP, “worst headache of life”
74
What do we do for a patient with hemorrhagic stroke?
Prep pt for surgical decompression or Burr holes
75
Ischemic stroke S/S
High BP, headache moderate
76
What do we do for an Ischemic stroke?
Alteplase tPA less than 3 hours for best outcome, mechanical thrombectomy
77
What are signs of right sided stroke?
Patients states they’re always right, left sided weakness, behavioral issues, don’t understand their deficits well
78
Signs of left sided stroke?
Difficulty with speech, depression, comprehending speech
79
Signs of TIA
Stroke symptoms, stoke symptoms will go away
80
TIA diagnostic tests
Unless proven otherwise, it is considered a stroke
81
We make close note of what with seizures?
When the seizure started, what kind of movements the body had, monitor for urinary or bladder incontinence.
82
What do we do when a patient is having a seizure?
Turn them to the side. Do not put anything in their mouth. Keep bed at the lowest position if the pt is expected to have seizures then we can pad side rails
83
What are the different types of seizures?
Tonic clonic (grand mal), absence, myoclonic, atonic (drop attack), simple partial or complex partial.
84
Tonic clonic (grand mal)
The classic stiffening (tonic) and jerking of extremities (clonic), can be preceded with an aura similar to migraines, the pt later goes into postictal phase where they are very drowsy while recovering.
85
Absence seizure
May appear as if a pt is daydreaming, brief seizure that lasts seconds. Pt might not even notice that they were “gone”
86
Myoclonic seizure
Brief generalized jerking or stiffening in parts of the body, shorter than tonic clonic, pt stays conscious.
87
Atonic seizure
“Drop attack”, brief loss of muscle tone
88
Simple partial or complex partial seizure
Similar to absence but the pt is awake for it, frequently preceded by aura, can last up to 2 min.
89
True or false?
Every Time the patient has a seizure it means the patient has epilepsy.
False!!!
90
What is epilepsy?
Epilepsy is a series of disorders which cause seizures. Chronic seizures activity.
91
What is status epilepticus and what can that result in?
Where patient has rapid seizure activity without stopping, which results in brain damage.
92
What do we do for a patient who has a seizure?
Maintain patent airway, do not force the jaws open or place anything in mouth, place the pt lying on the floor so that secretions do not cause the pt to choke, note the time and duration, administer oxygen, suction secretions if needed, do not restrain the patient.
93
Medications for seizures
Phenytoin, benzodiazepines, leviciterazam, carbamazepine
94
Nursing interventions for pt with seizures?
Pts can not drive unless cleared by HCP, an EEG may be done to monitor and evaluate seizure, make sure pt understands the importance of taking their medications even if seizure have stopped, do not mix alcohol and medication,
95
What diet can help with seizures?
The ketogenic diet might be prescribed to treat seizures for a patient with epilepsy.
(High fat, low carbohydrate)
96
Parkinson’s disease is?
Chronic progressive disorder that causes movement problems
97
S/S of Parkinson’s
Stooped posture, bradykinesia (slow movement), shaking, tremors, shuffling gait, dysphagia
98
Is Parkinson’s curable?
NO
99
What does Parkinson’s cause in the body?
Decreased dopamine and increased acetylcholine.
100
What is the Parkinson’s triad?
tremors, rigidity, bradykinesia
101
Tremors in pt with Parkinson’s
Pill rolling tremor, eventually the pt is unable to use hands appropriately
102
Rigidity in pt with Parkinson’s
It takes more effort to move a part of the body, movement takes on jerky style, cogwheel rigidity
103
Bradykinesia in Parkinson’s pt
Lack of spontaneous activity, the body is stiff, the pt has to think about every movement.
104
Meds for Parkinson’s
Carbidopa-levadopa which can cause orthostatic hypotension, amantadine (antiviral drug that increases dopamine)
105
Nursing interventions for Parkinson’s
Help pt maintain activity, encourage ambulation, perform active and passive range of motion exercises, work on the pts posture by using pillows in bed, keep the back straight, give easy to swallow and chew foods, monitor and help pt with drooling, increase fruit and veggie to help constipation, monitor airway as pt may have trouble chewing and swallowing
106
Alzheimer’s disease
A type of chronic progressive and degenerative brain disease that results in memory loss and impaired intellectual functioning. Brain changes can be seen in MRI or postmortem
107
Pt with Alzheimer’s in third phase can develop?
Apraxia (inability to carry out tasks), delusions, hallucinations, visual agnosia (inability to recognize objects), dysgraphia (inability to communicate via writing), total incontinence
108
Medications for Alzheimer’s
Lorazepam or haloperidol (can decrease agitation and anxiety), SSRIs (for depression and behavioral disturbances), trazodone, cholinesterase inhibitors such as donepezil, rivastigmine and galantamine (may slow down cognitive decline), memetanine (slows disease symptom progression but does not slow cognitive decline)
109
Nursing interventions for Alzheimer’s
Maintain adequate nutrition, give finger food, allow patient to eat while walking if they wander, frequent meals with high calories, encourage fluids, maintain pt safety, redirect pt and reminisce with them
110
Multiple sclerosis is?
A chronic progressive degeneration of the myelin sheath in the nerves. A destruction of myelin sheaths called demyelination occurs, which reduce the nerve pathways. The body does its best to heal this and then the degeneration happens again.
111
Multiple sclerosis is more common in who?
Woman than in men
112
Symptoms of MS
Incontinence or urinary retention, visual problems, fatigue is huge with pt with MS, weakness, poor coordination, swallowing difficulties, ataxia (impaired ability to coordinate movement), nystagmus (weird eye video)
113
Diagnosis of MS
Clinical Hx and presence of ms lesions on nerves as seen by MRI
114
Tx for MS
No specific treatment we give adrenocorticotrophic hormone, corticosteroids, muscle relaxants, prophylactic antibiotic for UTI’s from urinary incontinence or retention, bethanechol to decrease urinary retention
115
Myasthenia Gravis is?
An autoimmune issue of the neuromuscular junction. It causes fluctuating weakness. It most commonly occurs to woman under 40 years of age.
116
How do we diagnose Myasthenia Gravis?
With a tensilon test aka edrophonium test
117
Myasthenia Gravis usually affects?
It can affect different muscle groups but usually affects face and trunk
118
Can myasthenia Gravis cause aspiration?
Yes in pts where it affects the throat, they are at high risk for aspiration.
119
What kind of disease is MG?
Myasthenia Gravis is a progressive disease and eventually will cause problems moving the rest of the body. At worst progression pt may need help breathing via mechanical intubation.
120
What should we watch for with someone with Myasthenia Gravis?
Myasthenic crisis!!! This is often a medical emergency! Pt will have several muscle weakness in the respiratory tract. May need a bag valve or mechanical ventilation until the crisis passes.
*anticholinergic meds can increase the risk for MG.
121
What would we give pt with Myathenia Gravis?
Neostigmine and/ or pyridostigmine (mestinon)
The meds increase nerve impulse strength and allow the pt to have increased muscle control. Long term we may also give meds that suppress the immune system as it is an autoimmune disorder, corticosteroids or immunosuppressants are appropriate.
122
What do we do if the problem is cholinergic crisis in pt with MG?
We will give atropine
123
Nursing interventions for myasthenia Gravis
Help pt with swallowing, teach chin tuck technique or double swallow, monitor for aspiration, suction as needed, make sure the pt has adequate nutrition, if they are unable to eat due to swallowing issues, a feeding tube may be administered, take meds 30 min before eating, ROM exercise may be helpful
124
Between MG and MS which disorder affects the whole body?
Multiple sclerosis
125
What part of the body does MG affect?
Face and trunk- esophagus and respiratory tract.
126
How can we diagnose MS
MRI
127
What is the main thing MS causes?
Fatigue and weakness
128
What can we avoid if pt has Multiple sclerosis?
Extreme temperatures
129
How do we diagnose Myasthenia Gravis?
EMG, edrophonium test (tensilin test)
130
What are we most worried about with myasthenia Gravis?
Respiratory problems, airway, and aspiration
131
What can be seen in both MS and MG?
Muscle weakness, nerve damage, auto immune
132
What is ALS (amyotrophic lateral sclerosis)
A progressive and degenerative disease which causes degeneration between the brain and spinal cord. Electricity cannot be transferred from one place to the next.
133
What happens to the body in pt with ALS?
Results in muscle wasting, weakness and some twitching. Pt will maintain full cognitive function while their body wastes away. Prognosis usually 3-5 years after diagnosis.
134
What do we treat ALS with?
Some medications can delay the progression of the disease, but it will continue to progress. We give riluzole and edaravone.
135
Nursing interventions for ALS
Make sure the patient is getting physical therapy, speech therapy and respiratory therapy, consult pt with nutritionist, encourage exercise to increase endurance for the trunk and limbs, support emotions for pt, watch for respiratory failure (most common cause of death for a pt with ALS)
136
What is Huntington’s disease?
A genetically transmitted disorder which causes movement problems, as well as cognitive and psychiatric problems it is caused by an over activity of the dopamine pathways, increased dopamine, which is the opposite of Parkinson’s disease
137
When is huntingtons usually diagnosed?
Most people experience symptoms after they have already had children. Usually around 30-50 years of age
138
S/S of huntingtons disease?
Abnormal and excessive involuntary movements, abnormal facial movements, poor chewing and swallowing, gait deterioration, intellectual decline, psychotic behavior
139
How do we treat Huntingtons disease?
Treatment is palliative there is no cure. Antipsychotic medications and antidepressants are given for psychotic symptoms. We would increase calories to 4,000-5,000 per day and maintain physical safety, makes sure pt doesnt aspirate
140
What is Trigeminal neuralgia?
Disorder that causes excruciating knife like pain in the lips, cheeks and side of the nose and forehead. Pain is usually brief lasting anywhere between seconds and minutes.
141
What are some triggers for Trigeminal neuralgia?
Touching trigger points on face, brushing teeth, chewing, blast of air on face, hot food, washing the face, or talking
142
How do we treat Trigeminal neuralgia?
Avoid triggers, lidocaine injection, anti seizure meds, NSAIDs and acetaminophen, acupuncture, biofeedback, gabapentin
143
Comfort measures for pt with Trigeminal neuralgia
Keep moderate temp, avoid touching face, do not force pt to perform hygiene activities, perform hygiene tasks while the pt has been anesthetized, avoid hot and cold foods
144
What is Bell’s palsy?
Disorder that can frequently be confused for stroke due to asymmetrical appearance of the face. Usually caused by viruses such as herpes and Epstein Barr
145
How do we treat Bell’s palsy?
No specific treatment, corticosteroids are usually used to reduce inflammation as well as antivirals to treat underlying infections.
146
How long does Bell’s palsy last
Most people recover in about 3-6 months it can take up to a year. Taste is usually the first sense to come back permanently paralysis can occur but is rare
147
What is Gillian barre syndrome
Antibodies attack the Schwann cells causing demyelination, exact reason why people get this is unknown.
148
S/S of guillain barre syndrome?
Causes muscle weakness, tingling and numbness. Symptoms begin in the legs and move up, if it moves to thoracic area pt will have respiratory paralysis and failure. Pt may also have fluctuating BP, pt must be hospitalized.
149
How can we diagnose guillain barre syndrome?
Diagnosed by exclusion as well as nerve conduction studies
150
Nursing interventions for Guillain barre syndrome
Monitor pts respiratory status, provide emotional support, feed pt through TPN or NG tube, continuous care for preventing contractures, initiate physical therapy ASAP, give gabapentin or tricyclic antidepressants to reduce nerve pain.
151
What is meningitis
Infection of the meninges. Pus builds up in the pia mater and arachnoid space
Can be caused by bacteria, virus, or parasites
152
Common signs of meningitis
Kernig’s sign, brudzinski’s sign, stiff neck (nuchal rigidity), high fever, headache, problems with looking at bright lights, increased ICP
153
Once a patient has meningitis we should?
Act fast, CT scan will be ordered to check the level of ICP, if ICP not increased we can do a lumbar puncture to check the CSF for presence of virus, bacteria, parasites
154
What is the treatment for meningitis
Multiple IV antibiotics, corticosteroids (decrease ICP), anticonvulsants (reduce risk of seizure), antipyretics, IV fluids to hydrate the pt
155
Nursing interventions for meningitis
The pt needs to be in droplet precautions, decrease bright lights, keep noise to minimum, manage fever (it can increase seizures), place pt on seizure precautions, prevent by getting vaccine.
156
What is Encephalitis
Symptoms are similar to meningitis but with a more gradual rather than rapid onset and more neurological deficits
