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Which neurological disorder does not affect cognitive function or LOC?
Guillain- Barre Syndrome
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Which disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia?
Huntingtons disease
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Myasthenia Gravis occurs when antibodies attack which receptor sites?
Acetylcholine
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What is the term for rapid, jerky, involuntary, and purposeless movement of the extremities or facial muscles?
Chorea
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______ is impaired ability to execute voluntary movements
Dyskinesia
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What is the most common clinical manifestation in patients with multiple sclerosis?
Fatigue
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Which disease is there a loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brian stem?
Amyotrophic lateral sclerosis (ALS)
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Which anticholinergic agent control tremors and rigidity in parkinson's disease?
Cogentin
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Which disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brian?
Parkinson's disease
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Which disease is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurence of small patches of demyelination in the brain and spinal cord?
Multiple sclerosis
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What disease is a progressive degenerative neurological disease resulting in decreased motor function in the upper motor neurons in the medulla oblongata and lower motor neurons in the spinal cord?
Amyotrophic lateral sclerosis (ALS)
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Which disorder is characterized by the body unable to transmit nerve impulses which results in muscle weakness?
Myasthenia Gravis
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Progressive demyelinating disease of motor and sensory neurons that has periods of remission and exacerbation:
Multiple Sclerosis
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A chemical imbalance in the brain leads to movement and coordination problems:
Parkinson's disease
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Dysfunction in the lower motor neuron pathways results in:
Flaccidity
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Hyperventilation is recommended if there is any indication of increased ICP. This intervention decreases ICP by:
Lowering Co2, which results in vasoconstriction
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The earliest sign of incresing ICP is a change in:
level of consciousness
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What are the signs of Cushing's Triad?
Bradycardia, hypertension, bradypnea
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You are caring for a patient with a brainstem injury. Your priority assessment should be:
Respiratory rate and rhythm
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What is cranial nerve 4?
Trochlear- Eye movement (down and inward)
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What is cranial nerve 5?
Trigeminal (facial sensation)
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What is cranial nerve 8?
Acoustic (hearing accuracy/ balance)
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What is cranial nereve 6?
Abducens (lateral eye movement)
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What are the first 3 cranial nerves?
- olfactory
- optic (normal vision)
- oculomotor (PERRLA)
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Before a cerebral angiography, what lab value needs to be assessed?
Creatine levels (0.5-1.2 mg/dl)
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How should the patient be positioned after a lumbar puncture?
Lying flat for several hours
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______: stimulate to wake up, will fall back asleep on you, but when you wake them up again, they remember what happen before
Lethargic
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______: every time you go in room, you have to wake patient up. Disoriented, will not remember that you woke them up an hour ago.
Somnolent
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______: cognitively intact but cannot express what they want to say
Expressive
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______: can speak but cannot use right words/grammar
Receptive
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______: difficult due to impairment of muscles usde to produce speech
Dysarthria
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_______: extension of legs, internal rotation and adduction of arms with flexion of elbows, wrists and fingers
Decorticate
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______: back arched, rigid extension of all extremities, hyperpronation of arms and plantar flexion of feet. Away from core of the body.
Decerbrate
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______: regular, rhythmic breathing, alternates between hyperventilation and apnea
Cheyne- stokes
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What type of solution are you most likely going to hang in a patient with brain trauma?
HYPERTONIC (prevents cerebral edema because keeps fluid from shifting into that tissue)
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What are the four earliest signs seen with increased ICP?
- LOC changes
- Pupil changes
- Weakness
- Headaches
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What is your highest priority in a brainstem injury?
Respiratory rate and rhythm
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What is normal creatine level?
0.5 to 1.2
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What can be given to patients with high levels of creatine (0.5-1.2) if they need to have a cerebral angiography done?
Mucomyst and sodium bicarb
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what does normal spinal fluid look like?
Clear, looks just like water
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What is used to take away ammonia?
Lactulose
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If there is a positive babinski's reflex in an adult, think _____.
CNS
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With decorticate posturing (extension of legs, internal rotation and adduction of arms with flexion of elbows, wrists and fingers) there is most likely damage to where?
Corticospinal tracts, cerebral hemisphere
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With decerbrate posturing (back arched, rigid extension of all extremities, hyperpronation of arms and plantar flexion of feet) there is most likely damage to where?
Upper brain stem, midbrain or pons
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With cheyne-stokes respirations (regular, rhythmic, alternates btw hyperventilation and apnea) there is most likely a ______ injury or ______.
cerbral injury or blood sugar issue
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Central neurogenic hyperventilation (sustained, rapid, regular respiration of 25 or more per minute) indicates _______.
Brainstem- ominous sign that they are nearing death (brain bleeding)
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How do you want to position a patient with altered LOC?
Lateral or semi prone (recovery position- get off backside)
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What should you give the patient if they are shivering?
Thorazine
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What is considered a high ICP?
15 mmHG
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What are the three symptoms associated with Cushing's syndrome?
- Hypertension
- Bradycardia
- Bradypnea
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Decreased cerebral flow causes ______
vasodilation
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What hyperosmotic agent would you give to dehydrate the brain and reduce cerebral edema?
- Mannitol (osmitrol)
- - Short term use only
- - Never give to client with cerebral hemorrhage
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What analgesic medication needs to be avoided?
- Opiates
- They effect respiratory patterns and effects pupils, which will alter our neurologic status checks
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What needs to be checked when administering Decadron?
Blood sugars!!! (complication is high BS)
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What is the therapeutic drug level of phenytoin?
10-20 mcg/ml
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Barbituates (such as phenobarbital) are beneficial how?
Reduce metabolic demand so brain does not need as much oxygen
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Where is ICP measured?
lateral ventricle
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______ is caused by decreased ADH and is a complication of ICP
Diabetes Insipidus
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_______ is caused by increased ADH and is a complication of ICP
SIADH
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What is diabetes insipidus going to be treated with?
- IVF
- Electrolytes
- Vasopressin
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What is SIADH treated with?
Fluid restriction (<800 ml daily)
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Post-op nursing for a client who had supratentorial surgery is what?
- 30-45 degree HOB, neck neutral
- Back or unaffected side every 2 hours
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Post-op nursing for a client who had infratentorial surgery is what?
- Flate or elevate HOB 20-30 degrees (small pillow)
- No neck flexion
- Turn side to side as unit (with sheet)
- Monitor for respiratory distress
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What is the first choice inotrope for a patient with low cardiac output that does not improve with fluid resuscitation?
Dobutamine (dobutrex)
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If you see a halo sign and use a dextrostix to check for glucose reaction and get a positive result, what does it suggest?
CSF leak
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_______ post op includes no vigorous coughing, no sucking on a straw or sneezing.
Transphenoidal
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______ seizures occur in one area of the brain, begin focally
partial
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________ seizures- your consciousness is still intact
Simple partial
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_________ seizures- consciousness impaired, automatisms
Complex partial
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________- muscle contraction and > tone and contraction with relaxation
Tonic clonic (general seizure)
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_________- loss of awareness, motor activity stops
Absence seizures (general seizure)
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What are automatisms?
Lip smacking or swallowing
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What is the complication associated with Dilantin?
Gingival hyperplasia
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What is defined by no recovery, 3 episodes of seizures that lasts >30 mins
Status epilepticus
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Which headache is characterized by steady, constant feeling of pressure that usually begins in the forehead, temple, or back of teh neck. It is often bandlike or may be described as "weight on top of my head"
Tension headache
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What medications are given for migraine headaches?
Triptans- serotonin receptor antagonists (Zomig, Maxalt, Imitrex)
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What medications are given for cranial arteritis?
Corticosteroids
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