neuro 1

  1. the spinal cord extends from the first cervical vertebra (C1) and terminates at which vertebra
    second lumbar vertebra (L2)
  2. where does cerebral spinal fluid found (CSF) circulate
    in the subarachnoid space in the meninges; between the arachnoid mater and pia mater
  3. CSF
    • shock abosrber for the brain
    • made of water, glucose, sodium, chloride and protein
    • exchanges nutrients and wastes between the blood and CNS neurons
  4. cranial nerves
    • olfactory
    • optic
    • oculomotor
    • trochlear
    • trigeminal
    • abucens
    • facial
    • vestibulocochlear
    • glossopharyngeal
    • vagus
    • accessory
    • hypoglossal
  5. sympathetic nervous system
    • triggered by stress
    • secretes epinepherine and norepinephrine
    • increases heart rate, constricts peripheral blood vessels, increase BP
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  6. what is the most accurate and reliable indicator of neuro status
    level of consciousness
  7. which scale uses eye opening, verbal response and motor response to deterimine the level of the pt conciousness
    Image Upload 2
  8. term for involuntary movement of the eyes
  9. what is PERRLA
    • part of pupillary evaluation
    • pupils, equal, round, reactive to light, reactive to accomodation
  10. what are late indicators of neurological deteriorationvi
    vital signs
  11. what is a recommended after a pt has a lumbar puncture
    • pt lies flat for 6 - 8 hrs with the head of the bed flat
    • increase oral intake of fluids
  12. How is a spinal headache caused by a lumbar puncture treated
    a blood patch; small amount of pt blood injected into puncture site which clots and prevents leakage
  13. inflammation of the brain and spinal cord that may be caused by either bacterial or viral infection
  14. which form of meningitis can be spread by direct contact with discharge from the respiratory tract of an infected person
  15. pathophysiology of meningitis
    • infection/inflammation of brain and spinal cord
    • purulent exudate
    • increased intracranial pressure
    • cranial nerves may be affected
  16. of all the symptoms associated with meningitis which one is a tell tale sign
    nuchal rigidity (pain and stiffness when the neck is moved)
  17. signs and symptoms of meningitis
    • severe headache
    • fever
    • photophobia
    • petechial rash
    • nuchal rigidity
    • positve kernigs and brudzinski's signs
    • nausea and vomiting
    • encephalopathy
  18. kernig's sign
    flex the pt hip to a 90 degree angle and then extend the knee.  pain in the hamstring indicates meningeal infection
  19. brudzinski's sign
    flexion of both hips when pts neck is flexed indicates meningeal infection
  20. nursing care for a pt with meningitis
    • monitor respiratory status, gag and swallow reflexes
    • instruct pt to avoid couging and not hold breath during turning
    • monitor for signs of increasing ICP
    • measures to lower body temp to reduce the metabolic rate
    • elevate HOB as ordered
    • risk for seizure and fall precautions
  21. encephalitis
    • inflammation of brain tissue
    • nerve damage, edema, necrosis
    • increased intracranial pressure
  22. signs and symptoms of encephalitis
    • directly related to area brain involved
    • fever, nuchal rigidty, headache, nausea, vomiting, tremors, photophobia, confusion, delirium, agitation and restlesness
    • comatose or exhibit aphasia, hemiparesis, facial weakness
  23. what are the complications associated with encephalitis
    • cognitive disabilities
    • personality changes
    • ongoing seizures
    • motor deficits
    • blindness
  24. what causes intracranial pressure to increase
    increase in brain, blood or CSF usually caused by brain tumor, brain trauma or intracranial hemorrhage
  25. what is the monroe-kellie hypothesis
    if the volume of brain, blood or CSF increases the other 2 must decrease to maintain normal ICP (0 - 15 mmhg)
  26. initial signs of increased ICP
    restlessness, irritability and decreased level of consciousness
  27. classic late sign of increased ICP; characterized by bradycardia, htn and widening pulse pressure
    cushings triad
  28. as ICP increases pupil becomes dilated and fixed; no longer responds to light. this is a late sign of increased ICP.
    blown pupil
  29. How is ICP measured
    • place a catheter into the ventricle of the brain, cerebral parenchyma, subdural space or subarachnoid space
    • patients under ICP monitoring are usually pharmacologically paralyzed and sedated
  30. signs and symptoms of increased intracranial pressure
    • vomiting
    • headache
    • dilated pupil on affected side
    • hemiparesis or hemiplegia
    • decorticate then decerebrate posturing
    • decreased LOC
    • increasing systolic blood pressure
    • increasing then decreasing pulse rate
    • rising temperature
  31. Will elevating the head of the bed to 30 degress help prevent increased ICP and possibly decrease pain?
  32. Will placing a pt with a head injury in a low stimulus environment (ex. dim lights and low noise) help relieve pain?
    yes. alternative comfort measures are known to aid in pt comfort and may help reduce headache
  33. pts with infections, brain or systemic, require their temperature to be monitored. How often should a pts temperature be assessed?
    every 4 hrs and prn
  34. Measures to prevent increased ICP
    • keep head of bed eleveated at 30 degrees
    • avoid flexing the neck; keep head and neck in midline position
    • give anitemetics and antitussives a necessary to prevent vomiting and cough
    • adminsiter stool softeners
    • minimize suctioning
    • avoid hip flexion
    • prevent unnecessary noise and startling the pt
    • space care activities to provide rest between each disturbance
  35. decorticate posturing
    • abnormal flexion of upper extremities with extension of lower extremities
    • pressure exerted in the cerebral tissue above the midbrain
  36. decerebrate posturing
    • abnormal extension of upper extremities with extension of lower extremities
    • increasing pressure exerted on the midbrain or upper pons
  37. tension headache
    • can be caused by persistent contraction of the scalp and facial, cervical and upper thoracic muscles
    • associated with PMS or psychosocial stressors such as anxiety, emotional distress, or depression
    • pain described as pressure, aching, steady and tight
  38. migraine
    • believed to be caused by cerebral vasoconstriction followed by vasodilation
    • may or may not begin with an aura
    • often hereditary
    • pain described as throbbing, boring, vise-like, and pounding
  39. what are some common triggers for a migraine
    specific foods, noise, bright light, alcohol and stress
  40. prodromal phase of a classic migraine
    • preheadache phase
    • pt may experience visual disturbances, difficulty with speaking and/or numbness or tingling
    • common migraines do not have a prodromal phase
  41. medicinal treatments for migraines
    • prophylactic: nifedipine (calcium channel blocker), propranolol (beta blocker); both lower blood pressure and may help prevent the vasoconstriction and vasodilation
    • amitriptyline (tricyclic antidepressant)
    • acute: NSAIDs, ergot, triptans and opiods
  42. does controlled hyperventilation help decrease ICP
    • yes
    • elimination of carbon dioxide causes blood vessels to constrict  and ICP to fall
  43. cluster headaches
    • caused by vascular disturbance, stress, anxiety, and emotional distress
    • occur in clusters spanning from several days to weeks
    • NSAIDs and tricyclics may be prescribed
    • pain described as throbbing and excruciating
  44. epilepsy
    • idiopathic epilepsies occur before age 20
    • new seizures after 20 are caused by an underlying disorder
  45. partial seizure
    • repetitive, purposeless behaviors (automatisms) are classic symptoms
    • pt appears to be in a dream like state while picking at his or her clothing, chewing or smacking his or her lips
  46. absence seizure
    • aka petit mal seizure
    • occur most often in kids
    • staring that last for several seconds
  47. tonic-clonic seizures
    • tonic phase: lasts 30 to 60 seconds and is characterized by muscular rigidity
    • clonic phase: contraction and relaxation of all muscles in a jerky, rhythmic fashion
  48. postictal period
    • recovery period following a seizure
    • pt is exhausted  and may sleep deeply for 30 minutes to several hours
  49. mannitol
    • hyperosmolar diuretic used to decrease ICP
    • draws fluid from tissue into blood stream
    • urination is increased since it is a diuretic
  50. what do corticosteroids do for a person with ICP or cerebral edema
    dexamethasone helps decrease ICP and cerebral edema
  51. status epilepticus
    • 30 minutes of repetitive seizure activity without a return to consciousness
    • usually caused by abrupt cessation of anticonvulsant therapy
    • valium and ativan given to stop seizures
  52. seizure precautions the nurse can implement
    • pad side rails of bed
    • keep call light within reach
    • assist pt with ambulation
    • keep suction and oral airway at bedside
  53. nursing care during a seizure
    • stay with pt
    • do not restrain pt
    • protect from injury
    • loosen tight clothing
    • turn on side to prevent occlusion of airway or aspiration
    • suction if needed
    • monitor vitals when able
    • document progression of symptoms
  54. what is documented when a pt has a seizure
    • behavior before seizure
    • length of seizure
    • associated behaviors
    • incontinence
    • lingering effects
    • time before recovery
  55. concussion
    • mild brain injury
    • characterized by headache, dizziness, nausea and vomiting
    • may have amnesia of events before or after trauma
    • loss of consciousness for 5 minutes or less
  56. contusion
    • bruising of brain tissue
    • brainstem contusions affect level of consciousness
  57. subdural hematoma
    • acute: develops within 24 hrs of injury
    • subacute: more than 24 hrs and less than 1 week
    • chronic: occurs within weeks or month of injury; associated with low impact injuries that cause slow bleeding
  58. who are particularly prone to chronic subdural hematomas
    • older adults
    • alcoholics
  59. epidural hematoma
    • results from arterial bleeding
    • pt loses conciousness right after injury
    • regains consciousness and is briefly coherent
    • rapidly deteriorates
    • airway management and control of ICP must be initiated immediately
  60. autonomic dysreflexia
    • occurs at or above T6
    • normally caused by distended bladder
    • noxious stimuli below the spinal cord injury causes activation of the sympathetic nervous system
    • b/p goes up to 300 systolic
    • vasodilation, flushing and diaphoresis above the lesion and bradycardia as low as 30 bpm
    • cool, pale skin , gooseflesh and vasocontstriction below the spinal lesion
    • pounding headache and nasal congestion secondary to dilated blood vessels
  61. what is likely if a pt has an injury at or above C5?
    respiratory impairment
  62. what is the purpose of crutchfield and gardener-wells tongs
    keeps the head and neck immobile while fusion and healing take place
  63. common causes of autonomic dysreflexia
    • bladder distention (most common)
    • UTI
    • ingrown toenails
    • pressure ulcers
    • pain 
    • labor in a pregnant woman
    • bowel impaction
  64. if a pt is at risk for or you suspect that a pt has autonomic dysreflexia what can you do?
    • take the pt blood pressure and continue to monitor it every 5 minutes
    • place pt in high fowlers; utilizes the effect of orthostasis to control blood pressure
    • remove elastic stocking or any other garment that could prevent blood from pooling the periphery; allowing blood to pool can help reduce blood pressure
    • monitor blood pressure when catheterizing
  65. signs of autonomic dysreflexia
    • sudden high blood pressure
    • bradycardia
    • headache
    • pale skin below the injury
    • gooseflesh
  66. spinal shock
    • immediately after injury the sympathetic nervous system function is disrupted
    • symptoms: vasodilation, hypotension and bradycardia
    • hypothermia is caused by vasodilation
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neuro 1
neuro 1