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Fundamentals SEM3 > WEEK 5 (Neuro part 2) > Flashcards

WEEK 5 (Neuro part 2) Flashcards

Cerebral edema, aneurysms, Parkinson's disease, and peripheral neuropathy (med-surg adult)

1
Q

what is the most common type of CE

A

vasogenic

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2
Q

what is vasogenic CE

seen in patients who had a?
what moves into extravascular space?

A

interruption of the blood-brain barrier

It can be seen in clients who have experienced a stroke, have a brain tumor, or in cases of high-altitude illness

proteins and ions move into the extravascular spaces, fluids are drawn into the interstitium of the brain via osmosis

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3
Q

what is cellular/cytotoxic CE

A

influx of sodium and water accompanied by the brain cell’s hemostatic mechanism

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4
Q

what is interstitial CE

A

outflow of CSF from the intraventricular space to the interstitial space

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5
Q

what can interstitial CE be a result from

A

hydrocephalus or meningitis

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6
Q

what is osmotic CE

A

It occurs when the brain cells draw water from the circulating plasma, leading to CE

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7
Q

what can osmotic CE be associated with?

A

metabolic pathologies like DKA and hyponatremia

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8
Q

Risk Factors for CE

A

Uncontrolled blood pressure
Smoking
Uncontrolled diabetes mellitus (diabetic ketoacidosis)
Activities or behaviors that put the client at risk for falls
Traveling to high altitudes without allowing time for acclimation
Not wearing seat belts in vehicles
Engaging in contact sports without head protection

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9
Q

most common symptom of having CE

A

headache

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10
Q

clinical manifestations of CE

A

Headache (most common)
Neck rigidity or pain
Nausea/vomiting
Dizziness
Changes to respiratory pattern
Deviations to vision
Cognitive variations including mood changes
Ataxia
Aphasia
Seizure activity
Loss of consciousness

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11
Q

key factors to assess with some with CE

A

responsiveness
signs of visual disturbances
indications of increasing ICP

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12
Q

labs and dx for CE

A

ct
mri
possible insertion of device to monitor ICP

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13
Q

safety precautions for CE

A

head of bed 30/45 degrees
side rails padded for seizure precautions
restraints avoided as applicable
place suction at bedside (in case of a seizure)

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14
Q

(CE) Correction of the underlying cause can include

A

controlling hypertension, surgical removal of intracranial tumors/lesions, correcting metabolic abnormalities, or insertion of a shunt to remove the accumulation of fluid

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15
Q

define head injuries

A

broad term that refers to any damage to the head because of a traumatic event.

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16
Q

does a head injury always result in a brain injury

A

no, a simple scalp laceration can be considered a head injury

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17
Q

what are the two TBIs talked about in ATI to study?

A

concussion and subdural hematoma

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18
Q

subdural definition

A

The area beneath the dura covering the brain and spinal cord.

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19
Q

monro-kellie doctrine for head injuries

A

equal parts of…

blood
csf
and brain tissue

if one increases and and at least one of the two decrease, there will be an increase in ICP

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20
Q

how can TBIs be classified as

A

mild
moderate
severe

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21
Q

what are TBI classifications based on

A

GCS

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22
Q

GCS for mild head injury

aka a what?

A

13-15 (sometimes referred to as a concussion)

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23
Q

GCS for moderate head injury

A

9-12

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24
Q

GCS of a severe head injury

A

less than 8

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25
aside from mild/mod/severe, how else can TBIs be classified as?
primary or secondary
26
primary head injury
curs at the moment of the initial injury because of contact with the head or brain by a blunt or penetrating force
27
secondary head injury
hours or even days after the initial head trauma
28
secondary head trauma results from?
inflammation vasospasm ischemia
29
manifestations of a concussion
headache confusion difficulty concentrating nausea vomiting dizziness blurred vision fatigue amnsia
30
how can manifestations develop with a concussion
immediately following the injury or appear days later
31
define a subdural hematoma (SDH)
collection of blood between the brain and the dura
32
acute SDH
occurs within minutes of injury The client may be asymptomatic or exhibit manifestations, such as a change in consciousness
33
A client who has a severe acute SDH can exhibit
hypertension, bradycardia, bradypnea and can become comatose.
34
chronic SDH
manifest weeks to months after initial injury
35
what is a chronic SDH usually misdiagnosed as?
another disorder like a stroke
36
Leading causes of head injuries
mother vechicles accidents falls physical assults
37
most common mechanism for head injury
blunt force trauma
38
second most common mechanism for head injuries
penetrating injuries
39
post concussive syndrome
manifestations of a concussion (mild TBI) persist for more than 3 months
40
in an older adult, what can mask a dx of a TBI?
dementia
41
clinical manifestations of a TBI: domains
affective/emotional cognitive physical/somatic sleep
42
clinical manifestations of a TBI: affective/emotional domain
Emotional lability Changes in mood Irritability
43
clinical manifestations of a TBI: cognitive domain
Difficulty concentrating Amnesia Confusion Brain fog
44
clinical manifestations of a TBI: physical/somatic domain
Visual disturbances Headaches Dizziness
45
clinical manifestations of a TBI: sleep domain
Trouble falling asleep Drowsiness Sleeping more or less than usual
46
Moderate to severe head injuries can initially cause a loss of
consciousness that lasts from a few minutes to a few hours
47
manifestations of a moderate to severe head injury
Pupillary dilation, persistent headache, and difficulty waking may occur. Long-term findings can include agnosia, memory loss, aphasia, ataxia, agraphia, alexia, anosmia, loss of balance, weakness of the limbs, and personality changes
48
agnosia
Failure to recognize familiar objects even though the sensory mechanism is intact.
49
agraphia
The inability to express thoughts in writing.
50
alexia
The inability to read.
51
anosmia
A loss of smell.
52
Manifestations of SDH include
persistent headache, confusion, nausea and vomiting, slurred speech, unilateral weakness, and disorientation.
53
Diagnostic studies used to evaluate head injury include
ct mri x-rays
54
A client who is exhibiting manifestations of neurologic injury or has a suspected moderate to severe TBI will have a
ct scan
55
A CT scan allows for evaluation of the
brain, skull, and tissues to identify bruising, edema, fractures, or hemorrhage
56
MRI allows for more detailed images and can identify
subtle alterations in the brain, tissues, and vasculature that are not able to be visualized on a CT scan
57
A skull x-ray may be obtained for a client who has a
penetrating head injury or a suspected fracture
58
An x-ray can identify a
break in the skull bone or foreign bodies in the cranial vault, such as a bullet, shrapnel, or knife blade
59
Routine laboratory testing performed in the ED for clients who have a known or suspected TBI usually include a
CBC or CMP PT/INR and PTT
60
Some common preventive strategies are the following for a brain injury
Wear a seat belt. Wear helmets and other protective gear when participating in sporting activities (football, boxing, biking, soccer, hockey, rugby). Avoid driving if taking medications that cause drowsiness or dizziness. Ensure there is adequate lighting in and around the home. Limit use of alcohol and other substances. Do not drive after consuming alcohol or other substances. Seek assistance from others if feeling angry or frustrated when caring for an infant or young child.
61
mild TBI or concussion
home care usually if neuro status is fine rest, pain meds
62
tx for a small SDH
rest and continued observation
63
tx for large SDH
emergency tx! surgical intervention to remove the hematoma
64
define a cerebral aneurysm
weakening in the wall of a cerebral artery and is typically asymptomatic
65
Cerebral arteries, like other arteries within the body, are comprised of
tunica intima, tunica media, and adventitia.
66
Blood and oxygen are supplied to the brain via the
carotid and vertebral arteries
67
circle of Willis
connects the blood vessels from the front of the brain to the rear of the brain, which allows for blood and oxygen circulation
68
modifiable risk factors often seen in patients with aneurysms
htn and smoking
69
nonmodifiable risk factors for aneurysms
genetics (ADPKD) sex hormones like estrogen
70
stages of CAs
unruptured ruptured leaking
71
unruptured CA manifestations
usually no symptoms
72
ruptured CA manifestations
sudden severe headache
73
leaking CA manifestations
sudden extreme painful headache
74
Clients who experience a CA can display manifestations that are similar to
a stroke
75
Manifestations of a Ruptured CA
Sudden, severe headache Nausea Vomiting Visual disturbances Sensitivity to light Stiff neck Drooping eyelid Confusion Seizure Loss of consciousness Cardiac arrest Death
76
most valid testing for a CA
cerebral angiogram
77
how does a cerebral angiogram work
catheter into blood vessel in upper leg and guided up to the brain (using contrast dye)
78
what test is usually done for a ruptured CA
a CSF test or lumbar puncture to see if there are RBCs in the CSF
79
client education with an unruptured aneurysm
main BP stop smoking do not use cocaine or other stimulant drigs
80
take action for a CA
prepare for surg seizure precautions
81
what meds to admin with an aneurysm
administer calcium channel blockers administer anticonvulsant
82
how do calcium channel blockers help with aneurysms
reduce vasospasms and reduce risk of stroke
83
how do anticonvulsants help with aneurysms
to prevent seizures
84
Endovascular Therapy
The surgeon places a ball of small wires in the blood vessel where the aneurysm is located. Alternately, the surgeon can place a stent or balloon instead of the ball. This ball is a mesh barrier on which a blood clot forms. This blood clot blocks blood flow to the aneurysm
85
define Parkinson's disease (PD)
degenerative, progressive condition primarily caused by the gradual loss of cells in the substantia nigra of the brain
86
what are the three things you lose with Parkinson's
loss of substantia nigra loss of dopamine loss of norephinephrine
87
what can present due to no dopamine in PD?
tremors, slow movement, stiffness, and problems with balance
88
what can present due to no norepinephrine in PD?
fatigue, irregularities in blood pressure, and slowed movement of the gastrointestinal tract.
89
memory trick for no dopamine in PD
no DOPE at the Park
90
what is high in PD
high acetylcholine high acetylCCCholine think-we get high seCCCretions with lots of drooling
91
causes of PD
unknown
92
risk factors for PD: environmental
exposure to heavy metals, pesticides, and chemical toxins (trichloroethylene [TCE], polychlorinated biphenyls [PCBs]), and occupational risk factors linked to certain work environments, including agriculture, education, and the health care field living in a rural area, consuming dairy products, traumatic head injury, metastatic skin cancer, such as melanoma, and type 2 diabetes mellitus.
93
genetic risk factors with PD
a-synuclein and Parkin
94
protective factors to PD
nicotine, caffeine, as well as antioxidants found in tea.
95
how many stages to Parkinson's disease
5 stages
96
manifestations through the stages of PD: stage 1
mild tremors on one side facial/walking changes
97
manifestations through the stages of PD: stage 2
tremors of both sides interference with ADLs balance bad difficulty walking
98
manifestations through the stages of PD: stage 3
mid-stage loss of balance slow movements motor is worse
99
manifestations through the stages of PD: stage 4
severely disabling severe tremors and stiffness cane/walker
100
manifestations through the stages of PD: stage 5
most debilitating wheelchair or bedbound maximum assistance with self-care activities
101
in a question with PD, what is a word that is associated with PD?
"shuffling" gait
102
One of the main causes of death in clients who have PD is
pneumonia
103
eating: patient with PD
sit up straight for 30 mins after eating thickened liquids soft foods and easy to chew small bites increase fluid and fiber due to constipation issues seen in PD
104
medication to help with PD?
Levodopa/Carbidopa synthetic DOPamine to help with walking and
105
how does levodopa/carbidopa help with PD?
leaves more dopamine and decrease acetylcholine
106
define peripheral neuropathy (PN)
condition that is caused by damage to the peripheral nervous system, resulting from an underlying pathological condition
107
nerves involved in peripheral neuropathy (PN)
cranial nerves spinal nerve roots nerve trunks ANS nerves ganglia
108
what will a blood vessel look like with PN?
disappearing, causing nerves to shrivel up
109
what is one of the most common causes of PN
diabetes mellitus
110
what are some risk factors for PN
AI disorders nutritional deficiencies tumors chemo
111
co-morbidities with PN
Sjogren’s syndrome, lupus, rheumatoid arthritis, Guillian-Barre syndrome, diabetes mellitus, Lyme disease, shingles, Epstein-Barr virus, both malignant and benign tumors, myeloma, lymphoma, kidney disease, liver disease, and hypothyroidism
112
A nurse is assessing a client who has peripheral neuropathy. Which of the following should the nurse identify as a potential risk factor for peripheral neuropathy?
shingles
113
how can PN impact a patient's overall life
sleep disturbances emotional-well being missed work
114
clinical presentation of peripheral neuropathy
walking issues talking issues balance issues coordination issues foot drop numbness/tingling irregularities with BP heat intolerance
115
safety: ensure water heater is at what?
110 degrees or below
116
A nurse is planning education for a client who has peripheral neuropathy. When planning the teaching, the nurse should include safety considerations for which of the following sensory impairments?
temperature
117
tx for peripheral neuropathy
lidocaine creams/patches gabapentin, carbamazepine, etc
118
med used for diabetic neurpathy
tapentadol opioid agonist
119
non-pharm tool helpful for diabetic neuropathy
TENS

Fundamentals SEM3 (6 decks)

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