Week 9 Perception and Cognition: Neuro

Question 1

Warning sign of ischemic stroke

Answer 1

TIA or reversible neurologic deficit (RIND)

Question 2

TIA time frame

Answer 2

a few minutes to 24 hours but sx usually resolve in 30-60 min

Question 3

RIND time frame

Answer 3

24 hours to 7 days

Question 4

Vision changes in TIA

Answer 4

blurred vision, diplopia, blindness in one eye and tunnel vision

Question 5

Dysarthria

Answer 5

slurred speech

Question 6

Onset of thrombotic stroke

Answer 6

slow over minutes to hours

Question 7

Onset of embolic stroke

Answer 7

sudden

Question 8

sx of cerebral aneurysm

Answer 8

SEVERE HA (#1)
N/V, photophobia, cranial neuropathy, stiff neck, change in mental status

Question 9

What is indicated by a change in LOC

Answer 9

increased ICP

Question 10

Functions of the right cerebral hemisphere

Answer 10

vision, spatial awareness and proprioception

Question 11

Function of the left cerebral hemisphere

Answer 11

language, math and analytical thinking

Question 12

Unilateral neglect syndrome

Answer 12

common in rt side stroke

Pt is unaware of L or paralyzed side

Question 13

BP needed to maintain cerebral perfusion after ischemic stroke

Answer 13

150/100

Higher BPs may cause another stroke

Question 14

Emotional lability

Answer 14

Pt laughs or cries unexpectedly

Occurs when frontal lobe is affected in stroke

Question 15

Tests for stroke

Answer 15

CT (no contrast), MRI, 12 lead and cardiac enzymes to r/o MI, elevated H&H indicate body compensation to low O2, coags used to determine baseline

Question 16

Priority problems for Pt with a stroke (7)

Answer 16

1. Inadequate perfusion to the brain
2. Impaired Swallowing
3. Impaired Physical Mobility and Self-Care Deficit
4. Aphasia or dysarthria
5. Urinary and/or Bowel Incontinence
6. Sensory changes
7. Unilateral body neglect syndrome

Question 17

Immediate assessment in ischemic stroke

Answer 17

monitor for increasing ICP

Question 18

Time window for rTPA

Answer 18

within 3 hours of time last seen normal

Question 19

Time window for fibrinolytic treatment

Answer 19

within 6 hours

Question 20

Key features of ICP

Answer 20

< LOC, restlessness, irritability, confusion, HA, N/V, speech changes, pupil changes, ataxia, seizures, HTN, bradycardia, wide pulse pressure

Question 21

Interventions to avoid increased ICP

Answer 21

HOB at 30 degrees, apply O2 for <92%, keep head midline, avoid hip/neck flexion, avoid clustering care, position on the side if hemiparesis is present

Question 22

What to monitor for in possible impaired swallowing

Answer 22

facial drooping, drooling, impaired voluntary cough, hoarseness, incomplete mouth closure, or cranial nerve palsies
Observe for fatigue

Question 23

Focus of managing sensory perception after Rt sided damage

Answer 23

visual-perceptual or spatial-perceptual tasks and routine ADLs

Question 24

Focus of managing sensory perception after L sided brain damage

Answer 24

Re-orient the patient d/t memory problems, establish a routine

Question 25

Apraxia

Answer 25

Inability to perform previously learned motor skills or commands Typically exhibits a slow and cautious behavior Seen in L sided brain damage

Question 26

Mild TBI rating

Answer 26

GCS of 13-15 and loss of consciousness for up to 15 min

Question 27

Moderate TBI rating

Answer 27

loss of consciousness up to 6 hours GSC of 9-12 Havvi difficulty with work, learning and role function

Question 28

Severe TBI rating

Answer 28

GCS of 3-8 and loss of consciousness of > 6 hours

Question 29

Post concussion syndrome

Answer 29

physical and cognitive problems remain despite mild initial sx and normal dx test findings

Question 30

Normal ICP

Answer 30

10-15 mmHg

Question 31

First response to increased intracranial volume

Answer 31

shunting or increased absorption of CSF

Question 32

Epidural hematoma sx

Answer 32

Pt goes from being awake and talking to unconscious

Question 33

Acute subdural hematoma

Answer 33

presents within 48 hours of injury

Question 34

Subacute subdural hematoma

Answer 34

presents from 48 hours to 2 weeks

Question 35

Chronic subdural hematoma

Answer 35

sx may not be present for 2 months

Question 36

Uncal herniation of the brain sx

Answer 36

Life threatening! | Dilated/nonreactive pupils, ptosis (drooping eyelids), and a rapidly deteriorating LOC

Question 37

Central herniation of the brain sx

Answer 37

Cheyne-Stokes respirations, pinpoint and nonreactive pupils, and hemodynamic instability

Question 38

Cushing's triad

Answer 38

late sign of ICP | HTN with a widened pulse pressure and bradycardia

Question 39

Pulse changes in increased ICP

Answer 39

thready, irregular and rapid

Question 40

early indicators of changes in LOC

Answer 40

behavior changes (e.g., restlessness, irritability) and disorientation

Question 41

sx of brainstem disfunction

Answer 41

pinpoint nonreactive pupils

Question 42

Goals of nursing care for a head injury

Answer 42

preventing or detecting increased ICP, promoting fluid and electrolyte balance, and monitoring the effects of treatments and drug therapy

Question 43

Use of glucocorticoids in increased ICP

Answer 43

have no benefit

Question 44

Use of osmotic diuretics in increased ICP

Answer 44

Mannitol is used It pulls water out of the extracellular space of the edematous brain tissue Best given in boulses Administer through a filter

Question 45

Use of Lasix in increased ICP

Answer 45

Enhances Mannitol | Also reduces edema and blood volume, decreases Na+ uptake by the brain, and decreases the production of CSF

Question 46

Use of anti-seizure medication for increased ICP

Answer 46

Not reccomended if 1st seizure is 7+ days after injury but ok if < 7 days

Question 47

Barbituate coma

Answer 47

used for increased ICP that can not be controlled otherwise

Question 48

First sign of increased ICP

Answer 48

declining LOC

Question 49

Teach the patient to report which sx after a carotid endarterectomy

Answer 49

Severe headache Change in brain function (e.g., drowsiness, decreased cognition) Muscle weakness Severe neck pain Neck swelling Hoarseness or difficulty swallowing (due to nerve damage)

Question 50

Sx of post concussion syndrome seen in a minor head injury

Answer 50

* Personality changes * Irritability * Headaches * Dizziness * Restlessness * Nervousness * Insomnia * Memory loss * Depression

Question 51

Cranial nerve I

Answer 51

Olfactory | Give them something to smell

Question 52

Cranial nerve II

Answer 52

Optic: central and peripheral vision | Have Pt read, count fingers from 6" away, test ability to see fingers moving in the periphery

Question 53

Cranial nerve III

Answer 53

Occulomotor: pupil constriction | Test with a penlight

Question 54

Cranial nerve IV

Answer 54

Trochlear: eye movement down and in | Have Pt follow finger toward the tip of their nose

Question 55

Cranial nerve V

Answer 55

Trigeminal: Facial movement and sensation | Check sensation of sharp/dull, have Pt open jaw, check on scalp also

Question 56

Cranial nerve VI

Answer 56

Abducens: eye movement to the sides | Tell Pt to look at each ear, follow finger through visual fields, make an X in the air and watch for nystagmus

Question 57

Cranial nerve VII

Answer 57

Facial: movement and expression | Assess symmetry, wrinkle forehead, close eyes, smile, pucker

Question 58

Cranial nerve VIII

Answer 58

Acoustic: hearing | Rub fingers beside ear, whisper

Question 59

Cranial nerve IX

Answer 59

Glossopharyngeal: Tongue | Assess taste, ability to swallow, have Pt open mouth and say AHHH, uvula should be midline and palate should rise.

Question 60

Cranial nerve X

Answer 60

Vagus: Throat | Ability to swallow, have Pt open mouth and say AHHH, uvula should be midline and palate should rise.

Question 61

Cranial nerve XI

Answer 61

Spinal accessory: neck and shoulder movement | Ask to raise shoulders or turn head against hands

Question 62

Cranial nerve XII

Answer 62

Hypoglossal: innervates the tongue | Ask to stick out tongue and evaluate if it is midline, check problems eating, swallowing, speaking