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Med Surg II -- EXAM 2 > Neurology (Week 9) > Flashcards

Neurology (Week 9) Flashcards

(58 cards)

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1
Q

What diagnosis is associated with the physical findings of racoon eyes and battle’s sign?

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A

Basilar Skull Fracture

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2
Q

What are the 3 components (and scores) of the Glascow Coma Scale (GCS)?

A

1.) Eyes Open (4)
2.) Motor Response (6)
3.) Verbal Response (5)

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3
Q

What is the difference in decorticate & decerebrate posture?

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A
  • Decorticate posture = hands / arms come into the CORE
  • Decerebrate posture = extension of the arms
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4
Q

What is decorticate posture?

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A

Hands / arms come into the CORE

Decorticate = into the core

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5
Q

What is decerebrate posture?

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A

Extension of the arms

Decerebrate = extension

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6
Q

What is anisocoria?

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A

Unequal pupil size

pupils are different sizes

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7
Q

What is diplopia?

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A

Double vision

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8
Q

What are oculocephalic reflex (doll’s eyes) & oculovestibular reflex (cold caloric test) used as part of?

A

brain death criteria

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9
Q

What is normal intracranial pressure (ICP)?

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A

0 - 15

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10
Q

What are the signs & symptoms that are part of Cushing’s Triad?

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A
  • Widening pulse pressure
  • Bradycardia (↓ HR)
  • Irregular respirations (Cheyne-Stokes)
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11
Q

What is ptosis?

A

Eye drooping

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12
Q

What is homonymous hemianopsia?

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A

Loss of vision of one half of one or both eyes

Left Homonymous hemianopsia = loss of vision on the left side of one or both eyes

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13
Q

What is tardive dyskinesia?

A

involuntary repetitive movements / facial ticks

  • lip smacking
  • tapping
  • squirming
  • marching
  • grimacing
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14
Q

What type of medications / medication class often cause tardive dyskinesia?

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A

Antipsychotic medications

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15
Q

Nursing Goals / Roles of Seizures

A
  • Observe for aura, progression, muscle movement, incontinence, post ictal phase, presence of status
  • Record / time the event
  • Protect the patient from harm
  • Place the patient in a side-lying position
  • Do NOT put anything in the patient’s mouth
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16
Q

What is a coma and how is it diagnosed?

A

Coma is a state of unconsciousness
* arousal & awareness are lacking

Assessments & Diagnosis
* Diagnosis is clinical, based on LOC
* Neuroloigcal Assessment
* Diagnostic Tests / Procedures: skull x-rays, CT, MRI, LP, lab studies

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17
Q

Coma Etiology - structural lesions

A
  • Vascular lesions
  • Trauma
  • Brain tumors
  • CNS infection (brain abscess, meningitis/encephalitis)
  • Increased ICP (trauma)
  • Non-traumatic hydrocephalus
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18
Q

Coma Etiology - metabolic & toxic conditions

A
  • Hypoxia / CO2 retention
  • Electrolyte abnormalities
  • Low cardiac output / shock
  • Hypoglycemia, DKA, HHNS
  • Poisoning, drugs, & alcohol
  • Enironmental (hypothermia or hyperthermia)
  • Encephalopathy (metabolic, anoxic, hypertensive)
  • Sepsis
  • Renal failure
  • Liver failure
  • Deficiency state (Wernicke’s encephalopathy)
  • Post-convulsion
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19
Q

What is the goal during medical management of a coma?

A

Identify & treat the underlying cause

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20
Q

Nursing Management of Comas

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A
  • Monitor for neurological changes
  • Eye care
  • Nutrition / impaired swallow
  • Orthostasis: skin / DVT / atelectasis / VAP
  • Prevention of infection
  • Maintenance of clear airway – prevention of VAP
  • Family care: “waiting care”
  • Initiate rehabilitation measures
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21
Q

What is a persistent vegitative state (PVS)?

A

Patients who have severe brain damage & are in a state of what physicians call “wakefulness without awareness”

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22
Q

List the modifiable risk factors for stroke.

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A
  • Hypertension
  • Smoking
  • Transient Ischemic Attack (TIAs)
  • Heart Disease
  • Diabetes
  • Hypercoagulopathy
  • High RBC count & sickle cell anemia
  • Carotid bruit
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23
Q

List the non-modifiable risk factors for stroke.

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A
  • Gender
  • Hx of stroke
  • Heredity / Genetics
  • Age
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24
Q

What is the difference in a hemorrhagic & ischemic stroke?

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A

Hemorrhagic: rupture of an artery / blood vessel

Ischemic: loss of blood flow / blood supply to a certain area of the brain

25
**What is an ischemic stroke?**
**Loss of blood flow / blood supply to a certain area of the brain**
26
**What is a hemorrhagic stroke?**
**rupture / bursting of an artery or blood vessel**
27
**What is a transient ischemic attack (TIA)?**
temporary neurologic deficit caused by a cerebrovascular disease taht leaves no clinical or imaging trace
28
**What percentage of all strokes are ischemic?** | **KNOW THIS!!!!!**
**87%**
29
**Which of these is the greastest risk factor for an ischemic stroke?** **a.)** Carotid atherosclerotic disease **b.)** Diabetes **c.)** Hypertension **d.)** Smoking
**c.) Hypertension**
30
**What is the window for administration of Fibrinolytic Therapy (TPA) for a patient with an ischemic stroke?** | **KNOW THIS!!!!!! Exam Question!**
**3-4 hours**
31
**What is the door to CT time for a patient with a stroke who is a TPA candidtate?** | **KNOW THIS!!!!! Exam Question**
**25 minutes**
32
**What is the door to thrombolytic therapy time for a patient who is a candidate for TPA?** | **KNOW THIS!!!!! Exam Question**
**60 minutes**
33
**What is the door-to-CT time & the door-to-thrombolytic therapy for a stroke patient who is a candidate for TPA?** | **KNOW THIS!!!! Exam Question**
* **Door-to-CT = 25 minutes** * **Door-to-Thrombolytic Therapy = 60 minutes**
34
**What is involved in the management / general care of a patient with an acute stroke?** | **KNOW THIS!!!!!**
* **Maintain normovolemia** (avoid D5W) * **Control hyperglycemia > 140 & hypoglycemia** * **NPO status** (until swallow study is performed) * **Management of hypertension** * **Cardiac monitoring**
35
**Anti-hypertensive therapy for ischemic stroke**
**Want BP to be elevated to ensure blood flow to the brain** (but not too high) * treat elevated BP if a pt is a candidate for fibrinolytic therapy (BP must be < 185/110)
36
**TPA (rtPA) administration** * What needs to be done before & during TPA administration?
* rtPA is administered in divided doses: 10% is given as a bolus over 1 minute & the remaining 90% is administered as a continuous infusion over the next 60 minutes * **Insert lines BEFORE administering tpa** (IVs, Foley, endo tube, etc.)
37
**Cautions after tPA administration** | **KNOW THIS!!!!!**
**NO anti-thrombotic or anti-platelet aggregating drugs (Aspirin, heparin, warfarin, etc.) for the first 24 hours!!!** ## Footnote * Avoid CVC, LP, or arterial lines for 24 hours unless absolutely necessary * Avoid NG placement for 24 hours * Avoid foley insertion for 30 minutes after tPA administration
38
**Patient / Community Education regarding Strokes** | **KNOW THIS!!!!!**
* Education of Stroke S&S * Mild S & S un-noticed or ignored * 1/2 of all stroke victimy are driven by family **(important to transport via EMS)**
39
**What is FAST?**
* **F:** facial weakness * **A:** arm weakness * **S:** speech problems * **T:** time to call 911 ## Footnote **B -** balance **E -** eyes **F -** facial weakness **A -** arm weakness **S -** speech problems **T -** terrible headache & time to call 911
40
**Potential Etiology of Subarachnoid Hemorrhages (SAH)** | **KNOW THIS!!!!**
* **Cerebral Aneurysm Rupture** (75% of cases) * **AVM Bleed** (< 10% of cases)
41
**Signs & Symptoms of a Subarachnoid Hemorrhage (SAH)** | **KNOW THIS!!!! Exam Question!**
**Worst headache of their life!!!!** * Abrupt onset of headaches / nausea / vomiting / syncope / neurological deficit * May cause LOC / coma or death
42
**Nursing Management of Subarachnoid Hemorrhage (SAH)** | **KNOW THIS!!!**
* **Monitor for changes in neurological signs & symptoms** * **Surveillance for complications** (bleeding, vasospasm, impaired swallowing, & ineffective airway) * **Monitor BP** * **Prevent orthostatic complications** * **Educate patient & family**
43
**What is an epidural hematoma?**
**Arterial** bleeding after trauma
44
**What is a subdural hematoma?**
**Spontaneous or venous** bleeding after trauma
45
**What are the classifications of Subdural Hematomas?** | **KNOW THIS!!!! Exam Question!**
**Acute, Sub-acute, & Chronic**
46
**What is an uncal herniation?** | **KNOW THIS!!!!!**
**Medial part of the temporal lobe protrudes over the tentorial edge as a result of increased ICP** ## Footnote Can lead to cushing's traid
47
47
**What can an uncal herniation lead to?** | **KNOW THIS!!!!!**
**Cushing's Triad** * widening pulse pressure * bradycardia * irregular respirations
48
**What is a diffuse axonal injury?** | **KNOW THIS!!!!! Exam Question!**
**Rotational injury resulting in severe brain injury** * Shearing of fibers ## Footnote * Can lead to coma * Common in MVAs & diving accidents
49
**What can a diffuse axonal injury lead to?**
Coma
50
**Normal range for intracranial pressure (ICP)** | **KNOW THIS!!!!!!!!**
**0 - 15**
51
**Normal range for cerebral perfusion pressure**
70 - 100
52
**How do you calculate CPP?** | **KNOW THIS!!!! Exam Question!**
**CPP = MAP - ICP** ## Footnote **MAP =** ((2 x DBP) + SBP) / 3
53
**What is autonomic dysreflexia? And what patient population does it occur in?**
**Abnormal over-reaction of the autonomic (involuntary) nervous system** * change in HR * excessive sweating * changes in BP **Occurs in spinal cord injury patients**
54
**Treatment of Autonomic Dysreflexia**
* Sit the pt upright * Evaluate possible cause * Keep evaluating BP
55
**A white female patient is admitted to an acute care facility with a diagnosis of cerebrovascular accident (CVA). Her history reveals bronchial asthma, exogenous obesity, & iron deficiency anemia. Which history finding is a risk factor for CVA?** **a.)** Caucasian race **b.)** Female sex **c.)** Obesity **d.)** Bronchial asthma
**c.) Obesity**
56
**A critical care medication has been ordered to be titrated at 15mcg/min. The solution is available at 25 mg in 250 mL of D5W. How should the nurse set the flow rate?** **a.)** 9 mL/hr **b.)** 15 mL/hr **c.)** 150 mL/hr **d.)** 125 mL/hr
**a.) 9 mL/hr** ## Footnote **1.)** 15 mcg = 0.015 mg **2.)** (0.015 mg / min) x (250 mL / 25 mg) **=** (3.75 mL / 25 min) **3.)** (3.75 mL / 25 min) x (60 min / hr) **= 9 mL/hr**
57
**The physician prescribed 1500 mL of a solution to run over 7 hours. THe drop factor is 15. What will the drip rate be?** **a.)** 50 drops/min **b.)** 54 drops/min **c.)** 62 drops/min **d.)** 66 drops/min
**b.) 54 drops/min** ## Footnote **1.)** 7 hr x 60 min = 420 min **2.)** (1500 mL / 420 min) x 15 **=** 53.57 --> **54 drops/min**

Med Surg II -- EXAM 2 (10 decks)

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