1. Home
  2. Flashcards
  3. Preview

Exam 2 - Neuro

  1. In assessment of a patient with neuro events what are focused things we need to know?
    • Events before onset
    • How did they progress: Gradual or sudden progression?
    • injury?
    • Anticoags?
    • Allergies
    • Meds
    • Recreational drugs
  2. A quick onset of neuro symptoms indicates?
    Embolic stroke
  3. A slower progression, step progression of onset of neuro symptoms indicates?
    Thrombotic stroke
  4. Alert, attentive and follows commands?
    full consciousness
  5. Drowsy but awakens to stimulation, follows commands but slowly, may need reminding?
    lethargy
  6. Difficult to arouse and needs constant stimulation to follow commands- falls back to sleep without stimulation?
    obtundation
  7. Responds to vigorous and continuous stimulation- does not follow commands?
    stupor
  8. Does not respond to continuous or painful stimulation, reflexive movement only, does not make any verbal sounds?
    coma
  9. Glascow coma classifications?
    • 8 or < = severe head injury
    • 9-12 = moderate head injury
    • 13-15 = mild head injury

    GCS of 8 = intubate
  10. What is the progression, typically, in changes of mentation?
    • AOX4
    • First LOSE DATE
    • THEN LOCATION
    • THEN NAME
  11. Name the types of memory?
    • long term
    • recent (short term)
    • immediate
  12. What is the norm of pupil sizes?
    • 2-5mm
    • <2 = pinpoint
    • >5 = dilated
  13. A change in pupils is indicative of?
    a late sign and indicates brain herniation (outward displacement of tissue)
  14. How is motor functions scored?
    • scale of 0-5
    • 5 full ROM, full strength
    • 4 full ROM, less than normal strength
    • 3 Can raise extremity but not against resistance
    • 2 Can move extremity but not lift it
    • 1 slight movement
    • 0 no movement
  15. What is the test that assesses proprioceptive or vestibular dysfunction?
    Romberg - do they sway or break stance?

    • stands with feet together arms at sides eyes open then closes eyes
    • nose to finger
    • heel slide
  16. What is the most acceptable way is central stimulation?
    sternal rub
  17. A noninvasive imaging technique used to measure magnetic fields produced by electrical activity in the brain via extremely sensitive devices such as super conducting quantum interference devices (SQUIDS). Assists neurosurgeons in localizing pathology or defining sites of origin for epileptic seizures.
    MEG - magnetoencephalography
  18. This test involves the insertion of a spinal needle into the subarachnoid space between the third and fourth lumbar vertebrae
    Lumbar puncture
  19. This test is an accurate, quick, easy, noninvasive, painless and the least expensive-method of diagnosing neurologic problems. Using ionizing radiation, pictures are taken at many horizontal levels, or slices of the brain or spinal cord
    Computed tomography (CT)
  20. This test records the electrical activity of the cerebral hemispheres. Each graphic recording represents electrical impulses within the brain. The frequency, amplitude, and characteristics of the brain waves are included.
    Electroencephalography (EEG)
  21. This test is done to visualize the cerebral circulation to detect blockages in the arteries or veins in the brain, head, or neck. It remains the gold standard for the diagnosis of intracranial vascular disease and is required for any transcatheter therapy or for surgical intervention
    Cerebral angiography
  22. This is a non-invasive procedure that generates high-resolution clinical images to detect abnormalities in the brain's biochemical processes. It has been used to detect chemical abnormalities that occur with epilepsy, Alzheimer's disease, and stroke
    (MRS) magnetic resonance angiography
  23. This test requires the physician or nuclear med tech to inject IV deoxyglucose, which is tagged to an isotope. The isotope emits activity in the form of positrons, which are scanned and converted into a color image by computer. The more active a given part of the brain, the greater the glucose uptake. Used to evaluate drug metabolism and detect areas of metabolic alteration that occur in dementia, epilepsy, psych and degenerative disorders, neoplasms, and Alzheimer's disease
    CT-PET - computed tomography positron emmision tomography
  24. This test is used to determine bony fractures, curvatures, bone erosion, dislocation, and calcification which can damage the nervous system. Radiation exposure is minimal and the patient must be able to lay still
    Xray
  25. This test is used to identify nerve and muscle disorders as well as spinal cord disease. This test and nerve conduction velocity studies are commonly used together
    EMG - electromyography
  26. This test uses a radiopharmaceutical agent that enables isotopes to cross the blood-brain barrier. The patient is injected with the material an hour before the actual scan, is positioned in a dark room with several gamma scans at their head. This test is useful in studying cerebral blood flow, amnesia, neoplasms, head trauma, or persistent vegetative state.
    SPECHT - single-photon emission computed tomography
  27. This nerve is located in the nose and controls the sense of smell
    CN I - olfactory nerve
  28. This nerve is located in and behind the eyes and controls central and peripheral vision.
    CN II - Optic nerve
  29. This nerve is located in and behind the eyes and controls pupillary constriction
    CN III - oculomotor nerve
  30. This nerve acts as a pulley to move the eyes down - toward the tip of the nose
    CN IV - Trochlear nerve
  31. This nerve covers most of the face
    CN V - Trigeminal nerve
  32. This nerve controls eye movement to the sides
    CN VI - Abducens nerve
  33. This nerve controls facial movements and expression
    CN VII - facial nerve
  34. These nerves innervate the tongue and throat (pharynx and larynx)
    • CN IX - glossopharyngeal nerve
    • CN X - vagus nerve
  35. This nerve controls neck and shoulder movement
    CN XI - spinal accessory nerve
  36. This nerve innervates the tongue
    CN XII - hypoglossal nerve
  37. This nerve is located in the ears and control hearing.
    CN VIII - Acoustic nerve
  38. This side of the brain is used for visual, situational, and spatial awareness
    Right side
  39. This side of the brain is used for language, math, and analytical functioning?
    Left side
  40. What are S/S of aspiration?
    • coughing
    • Drooling
    • Hx of pneumonia - right middle/upper
    • Weight loss
  41. What is the process of the water swallow screening test?
    • Sit patient up
    • Put fingers over thyroid cartilage.
    • Give pt. 60 ml of cool water in cup.
    • Instruct pt. to first take small sip.

    If problem detected   STOP WSST.

    • If no problem detected:
    • Have pt. drink remaining water “as quickly, but as comfortable as possible.”
    • Allow 5 seconds to consume water.
    • Have pt. count aloud one to ten.
  42. Name the risk factors of cerebral infarction (stroke)?
    • Age
    • HTN
    • DM
    • Hyperlipidemia
    • FHX
    • Cocaine/meth
    • Smoking
  43. Name the 5 warning signs of cerebral infarction (stroke)?
    • Sudden onset of weakness/numbness on one side
    • Sudden speech difficulty or confusion
    • Sudden visual difficulty (one or both eyes)
    • Sudden onset of dizziness, trouble walking or loss of balance
    • Sudden, severe headache with no known cause
  44. What does the acronym FAST mean?
    • FACE - Smile
    • ARMS - Drift
    • SPEECH - Slurred
    • TIME – last known normal is crucial – time cutoff is 6 hours
  45. Which signs and symptoms are consistent with a left hemisphere stroke? (Select all that apply.)

    A.aphasia (language)

    B.Inability to discriminate words/letters

    C.Quick anger and frustration

    D.Loss of ability to hear tonal variations

    E.Depression or catatonic response to illness.
    • A
    • B
    • C
    • E
  46. A nurse is caring for a client who has experienced a right-hemispheric stroke. Which of the following are expected findings? (select all that apply)

    A.Impulse control difficulty

    B.Left hemiplegia

    C.Loss of depth perception

    D.Aphasia

    E.Lack of situational awareness.
    • A
    • B
    • C
    • E
  47. This type of stroke is caused by the blood supply being cut off from a clot formation.
    ISCHEMIC THROMBOSIS
  48. This type of stroke is caused by a emboli that has traveled to the brain.
    Ischemia embolism
  49. This type of stroke causes small arteries (blood vessel in the brain) to hemorrhage
    intracerebral hemorrhage
  50. This type of stroke causes an artery in or near the brain to burst, causes a sudden severe headache. (releases blood directly into CSF and is Quick)
    Subarachnoid hemorrhage
  51. What are the initial goals of management for a patient displaying stroke symptoms?
    • Determine onset
    • Monitor V/S
    • Medical stability - quickly reverse anything contributing (ie - BP)
    • Checking BS for hypoglycemia
    • DETERMINE IF CANDIDATE FOR TPA
    • CHECK NEUROLOGIC SYMPTOMS
  52. What is the GWTG timeframe for completing the NIHSS?
    less than 15 minutes
  53. What are the stroke patient guidelines upon arrival?
    • Door to physician ≤ 10 min
    • Door to stroke team ≤ 15 min
    • Door to CT initiation ≤ 25 min
    • Door to CT interpretation ≤ 45 min
    • Door to drug ≤ 60 min
    • Door to stroke unit ≤ 3 hours
  54. In a suspected stroke patient when do we give oxygen?
    sat <94%
  55. When is it not safe to give TpA (fibrinolytics)?
    BP MUST BE LESS THAN SBP <185 / DBP <110


    Give meds to bring down then TpA (labetalol)
  56. What is the stroke protocol for a patient with sudden onset of 1 or more of the stroke warning signs?
    • Prepare for head CT
    • Obtain vital signs and O2 saturation
    • Correct hypotension/hypovolemia
    • Correct hypertension: SBP <185 mmHg & DBP <110
    • Apply oxygen if O2 sat < 94%
    • Correct hyperthermia
    • Obtain fingerstick glucose
    • Treat blood glucose <60 mg/dL (Maintain 140-180 mg/dL)
    • Place 2 IVs (can't stick once given TpA and obtain labs (CBC/plt, PT & aPTT, CMP, cardiac enzymes)
    • 1st IV to run NS at 50ml/h and second IV saline locked
    • Obtain 12 lead ECG & CXR
  57. When considering aspiration, which cranial nerves may be involved?
    9, 10, 12 MOSTLY
  58. How is alteplase (Activase) given?
    (0.9 mg/kg over 60 minutes with initial 10% of dose given as a bolus over 1 minute)

    2 nurse verification
  59. When administering fibrinolytic therapy, what is the priority intervention?

    A.Have suction equipment available for use

    B.Monitor VS q 1-2 hours

    C.Place the client on a cardiac monitor to detect arrhythmias.

    D.Carefully observe for signs of intracerebral hemorrhage
    D.Carefully observe for signs of intracerebral hemorrhage
  60. If the patient receiving alteplase c/o severe headache, acute hypotension, N&V, or worsening neurological exam what does the nurse do?
    discontinue infusion and obtain CT scan
  61. What are stroke GWTG
    • Document- time last known normal & when stroke code called
    • IV Alteplase: Door to drug 60 minutes from arrival
    • ASA administration within 24- 48 hours after onset - Hold for 24 hours after IV Alteplase administration
    • VTE prophylaxis: ASA (after 24 hours if IV Alteplase) & SCDs
    • Swallow screening at bedside before giving food or meds
    • Cholesterol screening
    • Use of NIHSS
    • Carotid duplex within 24 hours of admission
    • Discharged on:
    • Aspirin
    • Anticoagulation for A Fib/A Flutter
    • Statins for hyperlipidemia
    • Smoking cessation information
  62. What do the NIHSS scores mean?
    • >25 Very severe neurological impairment
    • 15-24 Severe impairment
    • 5-14 Moderately severe impairment
    • <5 Mild impairment
  63. What is important to watch for in a patient with meningitis?
    ICP

    • Never do LP if suspect ICP
    • Bacterial meningitis is worse than viral
  64. What is included in a FOCUSED neuro assessment?
    • LOC (AO)
    • Movement (facial, limbs)
    • Pupils
  65. Name some risk factors for stroke?
    • AGE
    • HTN
    • A-FIB
    • SMOKING
    • CHOLESTEROL
    • DM
    • OVERWEIGHT
    • SLEEP APNEA
    • ORAL CONTRACEPTIVES
    • ETOH (HEMORRHAGIC MORE)
    • ANTIHISTAMINES
  66. This type of skull fracture is a simple clean break
    Linear fx
  67. This type of skull fracture is when the skull pressed inward whole thickness
    depressed
  68. This type of skull fracture is open to the brain
    open
  69. This type of skull fracture is fragmented bone depresses the brain
    comminuted
  70. This type of skull fracture is at the base of the skull – could be at the nose or eyes…
    basilar fx
  71. Name some signs of a basilar fracture of the skull
    • racoon eyes(battle signs)
    • bruising of the mastoid process (behind the ears)
    • otorrhea
    • rhinorrhea
  72. What cranial nerve involvement can happen with a basilar fracture?
    1, 2, 7, 8
  73. Why is a closed fracture of the skull worse than an open?
    pressure can build and cause secondary injury
  74. What are the different types of traumatic brain injuries (TBI)?
    • Closed:
    • Contusion - bruising
    • Concussion
    • Diffuse axonal injury

    • Three major types of hemorrhage:
    • Epidural hematoma
    • Subdural hematoma
    • Intracerebral hemorrhage
  75. What is a contusion?
    bruise to the brain
  76. What does Coup/contre-coup mean?
    Contusions that occur at two sites in the brain
  77. Why is a diffuse axonal injury (DAI) bad?
    • AXONS ARE DAMAGED AND CANNOT TRANSMIT
    • PT WILL NEED LONG TERM CARE
  78. What is chronic traumatic encephalopathy (CTE)?
    • Progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma
    • PET scan show the build-up of an abnormal protein called tau.
  79. What are the effects of  chronic traumatic encephalopathy (CTE)?
    • memory loss
    • confusion
    • impaired judgment
    • impulse control problems
    • aggression
    • depression
    • progressive dementia
  80. A blood clot that forms between the skull and the dura. This blood clot can cause fast changes in the pressure inside the brain. Emergency surgery may be needed
    Epidural hematoma
  81. What is a subdural hematoma?
    • A blood clot that forms between the dura and the brain tissue
    • Venous bleed higher mortality rate
    • Often goes unrecognized
  82. What is an intracerebral hemorrhage?
    • A blood clot deep in the middle of the brain
    • Hard to remove
    • Pressure from this clot may cause damage to the brain
  83. Name some secondary brain injuries:
    • hypoxia
    • fevers
    • Hyperglycemia
    • Hypotension
    • Seizures
  84. What is the normal ICP?
    15 mmHg
  85. What is the sweet spot for MAP for TBI's?
    60-150
  86. What is the Cerebral Perfusion Pressure (CPP)?
    MAP – ICP (must have ventriculostomy in place to measure ICP
  87. What is the target CPP?
    60-70
  88. What are things that affect the CPP?
    • BP
    • Oxygenation
    • cerebral edema
    • ICP
  89. What are the Indications for ICP Monitoring?
    • GCS 8 or less
    • Abnormal head T, age >40, posturing, systolic BP<90
    • Neurologic injury with clinical exam (ex. systemic trauma, going to the OR and under general anesthesia)
  90. What are the causes of increased intracranial pressure?
    • Severe head injury
    • Subdural hematoma
    • Hydrocephalus
    • Brain tumor
    • Hypertensive brain hemorrhage
    • Intraventricular hemorrhage
    • Meningitis
    • Encephalitis
    • Aneurysm rupture and subarachnoid hemorrhage
    • Status epilepticus
    • Stroke
  91. What are S/S of increased intracranial pressure?
    • CHANGE IN LOC
    • DILATION AND NON REACTIVE PUPILS (PRESSURE ON 3RD CRANIAL NERVE)
    • VOMITING
    • HA
    • DECORTICATE AND DECEREBRATE POSTURING

    LATE:CUSHINGS TRIAD
  92. What is the gold standard for ICP monitors?
    • INTRAVENTRICULAR (External ventricular device)
    • VENTRICULOSTOMY ALLOWS FOR DRAINAGE
    • LOCATED IN LATERAL VENTRICLE
    • MUST BE LEVELED when patient is repositioned
  93. What is a major concern for a patient with an intraventricular ICP monitor?
    INFECTION
  94. What is the desired level of ICP for a TBI?
    • 5-15
    • more than that, the nurse will drain off 1-2 ml in 2-3 min then wait
  95. What are the components of Cushings Triad?
    • bradycardia
    • Widening pulse pressure
    • Irregular respirations
  96. What is the difference between Decorticate and Decerebrate posturing?
    Decorticate – going to the core

    Decerebrate rigidity – out is worse, pressing on the medulla
  97. What are S/S of Uncle herniation?
    • DILATED NON REACTIVE pupils
    • ptosis
    • deteriorating loc
  98. What are S/S of central herniation?
    • CHEYNE-STOKES breathing
    • PIN POINT NON REACTIVE PUPILS
    • HEMODYNAMIC INSTABILITY
  99. For VTE what is done?
    • NO HEPARIN
    • SCD'S
  100. Name some nursing interventions for TBI patients
    • CPP 60-70
    • PACO2 = VASODILATION INCLUDING IN THE HEAD
    • KEEP THE PATIENT POSITIONED NEUTRALLY
    • NO HIP FLEXION
    • DON’T WANT PT COUGHING OR VALSALVAING
    • DECREASE STIMULATION, QUIET ENV, LIGHTS DOWN
    • FLUID, ELECTROLYTES
    • DECREASED BP AND/OR INCREASE BP-BOTH CAUSE INCREASED ICP
  101. What signs/symptoms of a TBI patient do you report to the MD?
    • no pupillary response, non-reactive pupils, pinpoint pupils
    • Any posturing
    • Loss of gag reflexes
  102. Name some diagnostic tests used to diagnose meningitis?
    • Kernig’s (lift knee causes back pain)
    • Brudzinski’s (lift neck causes legs to draw upward)
    • LP
  103. When is Cushing's Triad detected?
    Late sign of increased ICP.
Author
cbennett
ID
342343
Card Set
Exam 2 - Neuro
Description
Exam 2 - Neuro
Updated

  1. Home
  2. Flashcards
  3. Preview